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dc.contributor.authorCostopoulos, Charis
dc.contributor.authorMaehara, Akiko
dc.contributor.authorHuang, Yuan
dc.contributor.authorBrown, Adam J
dc.contributor.authorGillard, Jonathan H
dc.contributor.authorTeng, Zhongzhao
dc.contributor.authorStone, Gregg W
dc.contributor.authorBennett, Martin
dc.date.accessioned2019-05-20T23:30:33Z
dc.date.available2019-05-20T23:30:33Z
dc.date.issued2020-05
dc.identifier.issn1936-878X
dc.identifier.urihttps://www.repository.cam.ac.uk/handle/1810/293002
dc.description.abstractOBJECTIVES: This study sought to determine if plaque structural stress (PSS) and other plaque stress parameters are increased in plaques that cause future major adverse cardiovascular event(s) (MACE) and if incorporating these parameters improves predictive capability of intravascular ultrasonography (IVUS). BACKGROUND: Less than 10% of coronary plaques identified as high-risk by intravascular imaging result in subsequent MACE. Thus, more specific measurements of plaque vulnerability are required for effective risk stratification. METHODS: Propensity score matching in the PROSPECT (Providing Regional Observations to Study Predictors of Events in the Coronary Tree) study plaque cohort resulted in 35 nonculprit lesions (NCL) associated with future MACE and 66 matched NCL that remained clinically silent. PSS was calculated by finite element analysis as the mechanical loading within the plaque structure in the periluminal region. RESULTS: PSS was increased in the minimal luminal area (MLA) regions of NCL MACE versus no MACE plaques for all plaques (PSS: 112.1 ± 5.5 kPa vs. 90.4 ± 3.3 kPa, respectively; p = 0.001) and virtual histology thin-cap fibroatheromas (VH-TCFAs) (PSS: 119.2 ± 6.6 kPa vs. 95.8 ± 5.0 kPa, respectively; p = 0.005). However, PSS was heterogeneous over short segments, and PSS heterogeneity index (HI) was markedly greater in NCL MACE than in no-MACE VH-TCFAs (HI: 0.43 ± 0.05 vs. 0.29 ± 0.03, respectively; p = 0.01). Inclusion of PSS in plaque assessment improved the identification of NCLs that led to MACE, including in VH-TCFAs (p = 0.03) and plaques with MLA ≤4 mm2 (p = 0.03). Incorporation of an HI further improved the ability of PSS to identify MACE NCLs in a variety of plaque subtypes including VH-TCFA (p = 0.001) and plaques with MLA ≤4 mm2 (p = 0.002). CONCLUSIONS: PSS and variations in PSS are increased in the peri-MLA regions of plaques that lead to MACE. Moreover, longitudinal heterogeneity in PSS is markedly increased in MACE plaques, especially VH-TCFAs, potentially predisposing to plaque rupture. Incorporation of PSS and heterogeneity in PSS may improve the ability of IVUS to predict MACE.
dc.description.sponsorshipBHF
dc.format.mediumPrint-Electronic
dc.languageeng
dc.publisherElsevier BV
dc.rightsAttribution 4.0 International
dc.rights.urihttps://creativecommons.org/licenses/by/4.0/
dc.subjectCoronary Vessels
dc.subjectHumans
dc.subjectRupture, Spontaneous
dc.subjectUltrasonography, Interventional
dc.subjectPrognosis
dc.subjectRisk Assessment
dc.subjectRetrospective Studies
dc.subjectPredictive Value of Tests
dc.subjectStress, Mechanical
dc.subjectUnited States
dc.subjectEurope
dc.subjectCoronary Artery Disease
dc.subjectPlaque, Atherosclerotic
dc.subjectPercutaneous Coronary Intervention
dc.subjectHeart Disease Risk Factors
dc.titleHeterogeneity of Plaque Structural Stress Is Increased in Plaques Leading to MACE: Insights From the PROSPECT Study.
dc.typeArticle
prism.endingPage1218
prism.issueIdentifier5
prism.publicationDate2020
prism.publicationNameJACC Cardiovasc Imaging
prism.startingPage1206
prism.volume13
dc.identifier.doi10.17863/CAM.40153
dcterms.dateAccepted2019-05-03
rioxxterms.versionofrecord10.1016/j.jcmg.2019.05.024
rioxxterms.versionVoR
rioxxterms.licenseref.urihttp://www.rioxx.net/licenses/all-rights-reserved
rioxxterms.licenseref.startdate2020-05
dc.contributor.orcidTeng, Zhongzhao [0000-0003-3973-6157]
dc.contributor.orcidBennett, Martin [0000-0002-2565-1825]
dc.identifier.eissn1876-7591
rioxxterms.typeJournal Article/Review
pubs.funder-project-idCambridge University Hospitals NHS Foundation Trust (CUH) (RG51001 CARDIOVASCULAR)
pubs.funder-project-idHeart Research UK (RG2638/14/16)
pubs.funder-project-idBritish Heart Foundation (FS/15/26/31441)
pubs.funder-project-idBritish Heart Foundation (CH/2000003/12800)
pubs.funder-project-idBritish Heart Foundation (PG/18/14/33562)
pubs.funder-project-idEngineering and Physical Sciences Research Council (EP/N014588/1)
pubs.funder-project-idBritish Heart Foundation (None)
cam.orpheus.successThu Jan 30 10:44:58 GMT 2020 - Embargo updated
rioxxterms.freetoread.startdate2100-01-01


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Attribution 4.0 International
Except where otherwise noted, this item's licence is described as Attribution 4.0 International