Abnormal shear stress and residence time are associated with proximal coronary atheroma in the presence of myocardial bridging

Andy S. C. Yong, Vedant S. Pargaonkar, Christopher C. Y. Wong, Ashkan Javadzdegan, Ryotaro Yamada, Shigemitsu Tanaka, Takumi Kimura, Ian S. Rogers, Itsu Sen, Leonard Kritharides, Ingela Schnittger, Jennifer A. Tremmel*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

Abstract

Background: Atheromatous plaques tend to form in the coronary segments proximal to a myocardial bridge (MB), but the mechanism of this occurrence remains unclear. This study evaluates the relationship between blood flow perturbations and plaque formation in patients with an MB. Methods and results: A total of 92 patients with an MB in the mid left anterior descending artery (LAD) and 20 patients without an MB were included. Coronary angiography, intravascular ultrasound, and coronary physiology measurements were performed. A moving-boundary computational fluid dynamics algorithm was used to derive wall shear stress (WSS) and peak residence time (PRT). Patients with an MB had lower WSS (0.46 ± 0.21 vs. 0.96 ± 0.33 Pa, p < 0.001) and higher maximal plaque burden (33.6 ± 15.0 vs. 14.2 ± 5.8%, p < 0.001) within the proximal LAD compared to those without. Plaque burden in the proximal LAD correlated significantly with proximal WSS (r = −0.51, p < 0.001) and PRT (r = 0.60, p < 0.001). In patients with an MB, the site of maximal plaque burden occurred 23.4 ± 13.3 mm proximal to the entrance of the MB, corresponding to the site of PRT. Conclusions: Regions of low WSS and high PRT occur in arterial segments proximal to an MB, and this is associated with the degree and location of coronary atheroma formation.

Original languageEnglish
Pages (from-to)7-13
Number of pages7
JournalInternational Journal of Cardiology
Volume340
Early online date8 Aug 2021
DOIs
Publication statusE-pub ahead of print - 8 Aug 2021

Keywords

  • Intravascular ultrasound
  • Myocardial bridge
  • Stable angina

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