Implications of the local haemodynamic forces on the phenotype of coronary plaques.

Bourantas, Christos V; Zanchin, Thomas; Sakellarios, Antonis; Karagiannis, Alexios; Ramasamy, Anantharaman; Yamaji, Kyohei; Taniwaki, Masanori; Heg, Dik; Moschovitis, Aris; Fotiadis, Dimitrios; Mihalis, Lampros; Baumbach, Andreas; Torii, Ryo; Serruys, Patrick; Garcia-Garcia, Hector M; Windecker, Stephan; Räber, Lorenz (2019). Implications of the local haemodynamic forces on the phenotype of coronary plaques. Heart (British Cardiac Society), 105(14), pp. 1078-1086. BMJ Publishing Group 10.1136/heartjnl-2018-314086

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To examine the effect of endothelial shear stress (ESS) on the dynamic changes in plaque phenotype.


Patients with myocardial infarction that had intravascular ultrasound-virtual histology (IVUS-VH) and optical coherence tomography (OCT) at baseline and 13-month follow-up were studied. The IVUS-VH data were used to reconstruct the nonculprit vessels, and in the obtained models the ESS was estimated in 3 mm segments. Plaque morphology was derived in each segment from IVUS-VH and OCT. Disease progression was defined as the presence of ≥2 out of the following criteria: reduction in lumen area, increase in plaque burden and change of plaque morphology to a more vulnerable phenotype. Linear mixed effects models were used to assess the effect of ESS in different phenotypes.


Sixty-eight vessels were included in the analysis. Low ESS was associated with plaque progression in all phenotypes. The effect of ESS on plaque burden (p for interaction=0.467) and phenotype (p for interaction=0.188) was similar in all plaque types, whereas the effect of ESS on the changes in lumen dimensions was more prominent in disease-free (β=0.70, p<0.001) than fibrotic/fibrocalcific (β=0.28, p<0.001) or lipid-rich plaques (β=0.15, p=0.015). Standalone IVUS-VH misclassified plaque morphology in one-third of the cases leading to erroneous estimations about the effect of ESS on plaque evolution in different phenotypes.


The effect of ESS on plaque progression is similar in all phenotypes and cannot be accurately assessed by standalone IVUS-VH which often misclassifies plaque morphology. Therefore, multimodality imaging should be considered to examine the implications of ESS on plaque evolution.


NCT00962416; Post-results.

Item Type:

Journal Article (Original Article)


04 Faculty of Medicine > Department of Cardiovascular Disorders (DHGE) > Clinic of Cardiology
04 Faculty of Medicine > Pre-clinic Human Medicine > CTU Bern
04 Faculty of Medicine > Pre-clinic Human Medicine > Institute of Social and Preventive Medicine (ISPM)

UniBE Contributor:

Zanchin, Thomas, Karagiannis Voules, Alexios, Yamaji, Kyohei, Heg, Dierik Hans, Moschovitis, Aris, Windecker, Stephan, Räber, Lorenz


600 Technology > 610 Medicine & health
300 Social sciences, sociology & anthropology > 360 Social problems & social services




BMJ Publishing Group


[4] Swiss National Science Foundation




Doris Kopp Heim

Date Deposited:

21 Mar 2019 09:38

Last Modified:

05 Dec 2022 15:27

Publisher DOI:


PubMed ID:


Additional Information:

Bourantas and Zanchin contributed equally to this work.

Uncontrolled Keywords:

coronary artery disease




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