The Association Between Time-Varying Wall Shear Stress and the Development of Plaque Ulcerations in Carotid Arteries From the Plaque at Risk Study

Background and Purpose: Shear stress (WSS) is involved in the pathophysiology of atherosclerotic disease and might affect plaque ulceration. In this case-control study, we compared carotid plaques that developed a new ulcer during follow-up and plaques that remained silent for their exposure to time...

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Autores principales:	Kristine Dilba, Dianne H. K. van Dam-Nolen, Suze-Anne Korteland, Anja G. van der Kolk, Mohamed Kassem, Daniel Bos, Peter J. Koudstaal, Paul J. Nederkoorn, Jeroen Hendrikse, M. Eline Kooi, Frank J. H. Gijsen, Anton F. W. van der Steen, Aad van der Lugt, Jolanda J. Wentzel
Formato:	article
Lenguaje:	EN
Publicado:	Frontiers Media S.A. 2021
Materias:	shear stress (fluid) carotid ulceration risk atherosclerotic cardiovascular disease MRI Diseases of the circulatory (Cardiovascular) system RC666-701
Acceso en línea:	https://doaj.org/article/c4d56fc2ae344b27a240369d6c98c31f
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spelling	oai:doaj.org-article:c4d56fc2ae344b27a240369d6c98c31f2021-11-18T05:45:03ZThe Association Between Time-Varying Wall Shear Stress and the Development of Plaque Ulcerations in Carotid Arteries From the Plaque at Risk Study2297-055X10.3389/fcvm.2021.732646https://doaj.org/article/c4d56fc2ae344b27a240369d6c98c31f2021-11-01T00:00:00Zhttps://www.frontiersin.org/articles/10.3389/fcvm.2021.732646/fullhttps://doaj.org/toc/2297-055XBackground and Purpose: Shear stress (WSS) is involved in the pathophysiology of atherosclerotic disease and might affect plaque ulceration. In this case-control study, we compared carotid plaques that developed a new ulcer during follow-up and plaques that remained silent for their exposure to time-dependent oscillatory shear stress parameters at baseline.Materials and Methods: Eighteen patients who underwent CTA and MRI of their carotid arteries at baseline and 2 years follow-up were included. These 18 patients consisted of six patients who demonstrated a new ulcer and 12 control patients selected from a larger cohort with similar MRI-based plaque characteristics as the ulcer group. (Oscillatory) WSS parameters [time average WSS, oscillatory shear index (OSI), and relative residence time (RRT)] were calculated using computational fluid dynamics applying the MRI-based geometry of the carotid arteries and compared among plaques (wall thickness>2 mm) with and without ulceration (Mann–Whitney U test) and ulcer-site vs. non-ulcer-site within the plaque (Wilcoxon signed rank test). More detailed analysis on ulcer cases was performed and the predictive value of oscillatory WSS parameters was calculated using linear and logistic mixed-effect regression models.Results: The ulcer group demonstrated no difference in maximum WSS [9.9 (6.6–18.5) vs. 13.6 (9.7–17.7) Pa, p = 0.349], a lower maximum OSI [0.04 (0.01–0.10) vs. 0.12 (0.06–0.20) p = 0.019] and lower maximum RRT [1.25 (0.78–2.03) Pa−1 vs. 2.93 (2.03–5.28) Pa−1, p = 0.011] compared to controls. The location of the ulcer (ulcer-site) within the plaque was not always at the maximal WSS, but demonstrated higher average WSS, lower average RRT and OSI at the ulcer-site compared to the non-ulcer-sites. High WSS (WSS>4.3 Pa) and low RRT (RRT < 0.25 Pa) were associated with ulceration with an odds ratio of 3.6 [CI 2.1–6.3] and 2.6 [CI 1.54–4.44] respectively, which remained significant after adjustment for wall thickness.Conclusion: In this explorative study, ulcers were not exclusively located at plaque regions exposed to the highest WSS, OSI, or RRT, but high WSS and low RRT regions had a significantly higher odds to present ulceration within the plaque even after adjustment for wall thickness.Kristine DilbaKristine DilbaDianne H. K. van Dam-NolenSuze-Anne KortelandAnja G. van der KolkMohamed KassemDaniel BosDaniel BosPeter J. KoudstaalPaul J. NederkoornJeroen HendrikseM. Eline KooiFrank J. H. GijsenAnton F. W. van der SteenAad van der LugtJolanda J. WentzelFrontiers Media S.A.articleshear stress (fluid)carotidulcerationriskatherosclerotic cardiovascular diseaseMRIDiseases of the circulatory (Cardiovascular) systemRC666-701ENFrontiers in Cardiovascular Medicine, Vol 8 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	shear stress (fluid) carotid ulceration risk atherosclerotic cardiovascular disease MRI Diseases of the circulatory (Cardiovascular) system RC666-701
spellingShingle	shear stress (fluid) carotid ulceration risk atherosclerotic cardiovascular disease MRI Diseases of the circulatory (Cardiovascular) system RC666-701 Kristine Dilba Kristine Dilba Dianne H. K. van Dam-Nolen Suze-Anne Korteland Anja G. van der Kolk Mohamed Kassem Daniel Bos Daniel Bos Peter J. Koudstaal Paul J. Nederkoorn Jeroen Hendrikse M. Eline Kooi Frank J. H. Gijsen Anton F. W. van der Steen Aad van der Lugt Jolanda J. Wentzel The Association Between Time-Varying Wall Shear Stress and the Development of Plaque Ulcerations in Carotid Arteries From the Plaque at Risk Study
description	Background and Purpose: Shear stress (WSS) is involved in the pathophysiology of atherosclerotic disease and might affect plaque ulceration. In this case-control study, we compared carotid plaques that developed a new ulcer during follow-up and plaques that remained silent for their exposure to time-dependent oscillatory shear stress parameters at baseline.Materials and Methods: Eighteen patients who underwent CTA and MRI of their carotid arteries at baseline and 2 years follow-up were included. These 18 patients consisted of six patients who demonstrated a new ulcer and 12 control patients selected from a larger cohort with similar MRI-based plaque characteristics as the ulcer group. (Oscillatory) WSS parameters [time average WSS, oscillatory shear index (OSI), and relative residence time (RRT)] were calculated using computational fluid dynamics applying the MRI-based geometry of the carotid arteries and compared among plaques (wall thickness>2 mm) with and without ulceration (Mann–Whitney U test) and ulcer-site vs. non-ulcer-site within the plaque (Wilcoxon signed rank test). More detailed analysis on ulcer cases was performed and the predictive value of oscillatory WSS parameters was calculated using linear and logistic mixed-effect regression models.Results: The ulcer group demonstrated no difference in maximum WSS [9.9 (6.6–18.5) vs. 13.6 (9.7–17.7) Pa, p = 0.349], a lower maximum OSI [0.04 (0.01–0.10) vs. 0.12 (0.06–0.20) p = 0.019] and lower maximum RRT [1.25 (0.78–2.03) Pa−1 vs. 2.93 (2.03–5.28) Pa−1, p = 0.011] compared to controls. The location of the ulcer (ulcer-site) within the plaque was not always at the maximal WSS, but demonstrated higher average WSS, lower average RRT and OSI at the ulcer-site compared to the non-ulcer-sites. High WSS (WSS>4.3 Pa) and low RRT (RRT < 0.25 Pa) were associated with ulceration with an odds ratio of 3.6 [CI 2.1–6.3] and 2.6 [CI 1.54–4.44] respectively, which remained significant after adjustment for wall thickness.Conclusion: In this explorative study, ulcers were not exclusively located at plaque regions exposed to the highest WSS, OSI, or RRT, but high WSS and low RRT regions had a significantly higher odds to present ulceration within the plaque even after adjustment for wall thickness.
format	article
author	Kristine Dilba Kristine Dilba Dianne H. K. van Dam-Nolen Suze-Anne Korteland Anja G. van der Kolk Mohamed Kassem Daniel Bos Daniel Bos Peter J. Koudstaal Paul J. Nederkoorn Jeroen Hendrikse M. Eline Kooi Frank J. H. Gijsen Anton F. W. van der Steen Aad van der Lugt Jolanda J. Wentzel
author_facet	Kristine Dilba Kristine Dilba Dianne H. K. van Dam-Nolen Suze-Anne Korteland Anja G. van der Kolk Mohamed Kassem Daniel Bos Daniel Bos Peter J. Koudstaal Paul J. Nederkoorn Jeroen Hendrikse M. Eline Kooi Frank J. H. Gijsen Anton F. W. van der Steen Aad van der Lugt Jolanda J. Wentzel
author_sort	Kristine Dilba
title	The Association Between Time-Varying Wall Shear Stress and the Development of Plaque Ulcerations in Carotid Arteries From the Plaque at Risk Study
title_short	The Association Between Time-Varying Wall Shear Stress and the Development of Plaque Ulcerations in Carotid Arteries From the Plaque at Risk Study
title_full	The Association Between Time-Varying Wall Shear Stress and the Development of Plaque Ulcerations in Carotid Arteries From the Plaque at Risk Study
title_fullStr	The Association Between Time-Varying Wall Shear Stress and the Development of Plaque Ulcerations in Carotid Arteries From the Plaque at Risk Study
title_full_unstemmed	The Association Between Time-Varying Wall Shear Stress and the Development of Plaque Ulcerations in Carotid Arteries From the Plaque at Risk Study
title_sort	association between time-varying wall shear stress and the development of plaque ulcerations in carotid arteries from the plaque at risk study
publisher	Frontiers Media S.A.
publishDate	2021
url	https://doaj.org/article/c4d56fc2ae344b27a240369d6c98c31f
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The Association Between Time-Varying Wall Shear Stress and the Development of Plaque Ulcerations in Carotid Arteries From the Plaque at Risk Study

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