Author + information
- Received April 30, 2018
- Revision received July 2, 2018
- Accepted July 3, 2018
- Published online October 15, 2018.
- Arnav Kumar, MDa,
- Olivia Y. Hung, MD, PhDa,
- Marina Piccinelli, PhDb,
- Parham Eshtehardi, MDa,
- Michel T. Corban, MDc,
- David Sternheim, MDa,
- Boyi Yang, PhDd,
- Adrien Lefieux, PhDa,d,
- David S. Molony, PhDa,
- Elizabeth W. Thompson, BSa,
- Wenjie Zeng, MD, MPHa,
- Yasir Bouchi, BSa,
- Sonu Gupta, MDa,
- Hossein Hosseini, MDa,
- Mohamad Raad, MDa,
- Yi-An Ko, PhDe,
- Chang Liu, MPHa,
- Michael C. McDaniel, MDa,
- Bill D. Gogas, MD, PhDa,
- John S. Douglas, MDa,
- Arshed A. Quyyumi, MDa,
- Don P. Giddens, PhDf,
- Alessandro Veneziani, PhDd and
- Habib Samady, MDa,∗ ()
- aAndreas Gruentzig Cardiovascular Center, Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
- bDepartment of Radiology, Emory University School of Medicine, Atlanta, Georgia
- cDepartment of Cardiovascular Diseases, Mayo Clinic College of Medicine and Science, Rochester, Minnesota
- dDepartment of Mathematics and Computer Science, Emory University, Atlanta, Georgia
- eDepartment of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, Georgia
- fWallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, Georgia
- ↵∗Address for correspondence:
Dr. Habib Samady, Andreas Gruentzig Cardiovascular Center, Division of Cardiology, Department of Medicine, Emory University School of Medicine, 1364 Clifton Road, Suite F606, Atlanta, Georgia 30322.
Objectives This study investigated the relationship between low wall shear stress (WSS) and severe endothelial dysfunction (EDFx).
Background Local hemodynamic forces such as WSS play an important role in atherogenesis through their effect on endothelial cells. The study hypothesized that low WSS independently predicts severe EDFx in patients with coronary artery disease (CAD).
Methods Forty-four patients with CAD underwent coronary angiography, fractional flow reserve, and endothelial function testing. Segments with >10% vasoconstriction after acetylcholine (Ach) infusion were defined as having severe EDFx. WSS, calculated using 3-dimensional angiography, velocity measurements, and computational fluid dynamics, was defined as low (<1 Pa), intermediate (1 to 2.5 Pa), or high (>2.5 Pa).
Results Median age was 52 years, 73% were women. Mean fractional flow reserve was 0.94 ± 0.06. In 4,510 coronary segments, median WSS was 3.67 Pa. A total of 24% had severe EDFx. A higher proportion of segments with low WSS had severe EDFx (71%) compared with intermediate WSS (22%) or high WSS (23%) (p < 0.001). Segments with low WSS demonstrated greater vasoconstriction in response to Ach than did intermediate or high WSS segments (−10.7% vs. −2.5% vs. +1.3%, respectively; p < 0.001). In a multivariable logistic regression analysis, female sex (odds ratio [OR]: 2.44; p = 0.04), diabetes (OR: 5.01; p = 0.007), and low WSS (OR: 9.14; p < 0.001) were independent predictors of severe EDFx.
Conclusions In patients with nonobstructive CAD, segments with low WSS demonstrated more vasoconstriction in response to Ach than did intermediate or high WSS segments. Low WSS was independently associated with severe EDFx.
- computational fluid dynamics
- coronary wall shear stress
- endothelial dysfunction
- nonobstructive coronary artery disease
This study was funded by the Wallace H. Coulter Translational/Clinical Research Seed Grant Program of Georgia Institute of Technology, Emory University, and Volcano Corporation; and supported in part by Public Health Service Grant No. UL1 RR025008 from the Clinical and Translational Science Award program, National Institutes of Health, National Center for Research Resources. Drs. Hung and Eshtehardi were supported by a Ruth L. Kirschstein National Research Service Awards training grant (no. 5T32HL007745). Dr. Samady has received research grants from Abbott Vascular, Medtronic, National Institutes of Health, St. Jude Medical, and Gilead; and owns stock in Covanos and Sidney Investment Group. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received April 30, 2018.
- Revision received July 2, 2018.
- Accepted July 3, 2018.
- 2018 American College of Cardiology Foundation