Implications of imaging modalities on coronary vessel reconstruction and computation of the local hemodynamic forces
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Ramasamy,Anantharaman;Sivananthan,Akash;Mohammed,Amear;Kumaran S M,Thamil;Yong,Enhui;Tanboga,Ibrahim Halil;He,Xingwei;Bajaj,Retesh;Kitslaar,Pieter;Ozkor,Mick;Dijkstra,Jouke;Mathur,Anthony;Serruys,Patrick;Garcia-Garcia,Hector M.;Baumbach,Andreas;Pugliese,Francesca;Torii,Ryo;Bourantas,Christos V.
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Issue Date
2025
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Article
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Abstract
BACKGROUND: Endothelial shear stress (ESS) is an instigator of vulnerable plaque formation and destabilization. Traditionally, their computation is performed in models reconstructed from the fusion of intravascular imaging and angiography. Three-dimensional quantitative coronary angiography (3D-QCA) and computed tomography coronary angiography (CCTA) have emerged as alternative approaches to assess flow patterns, however, there is limited evidence about their performance. METHODS: We analysed data from 27 patients (38 vessels) that underwent coronary angiography, CCTA and near-infrared spectroscopy intravascular ultrasound (NIRS-IVUS) imaging. In each vessel, four reconstruction models were generated: 3D-QCA, CCTA and two fusion models - NIRS-IVUS with 3D-QCA (Angio-NIRS-IVUS) and CCTA (CCTA-NIRS-IVUS). In these models, the minimum and maximum predominant ESS were computed in 3 mm segments and the detected lesions, and their estimations were compared using the CCTA-NIRS-IVUS as the reference standard. RESULTS: In the 3 mm analysis, the Angio-NIRS-IVUS and CCTA estimations had a higher correlation with CCTA-NIRS-IVUS than 3D-QCA for the minimum (intraclass correlation coefficient, ICC: 0.822 vs 0.704 vs 0.581, p < 0.001) and maximum ESS (ICC: 0.852 vs 0.758 vs 0.634, p < 0.001). In lesion-level analysis, only the CCTA-NIRS-IVUS and Angio-NIRS-IVUS (ICC: 0.606, p < 0.001) estimations for the minimum ESS were correlated, while for the maximum ESS, there was a stronger correlation between CCTA-NIRS-IVUS and Angio-NIRS-IVUS and CCTA compared to the 3D QCA (ICC: 0.898 vs 0.836 vs 0.742, p < 0.001). CONCLUSIONS: A strong association was noted for the ESS estimated in the hybrid NIRS-IVUS-based reconstructions with CCTA appearing as the 2nd best modality for assessing the local hemodynamic milieu.
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Journal
Atherosclerosis
Volume
408