Journal
JACC-CARDIOVASCULAR INTERVENTIONS
Volume 10, Issue 24, Pages 2539-2547Publisher
ELSEVIER SCIENCE INC
DOI: 10.1016/j.jcin.2017.08.059
Keywords
acute coronary syndromes(s); coronary physiology; endothelial shear stress; mechanisms of atherosclerosis; plaque vulnerability
Categories
Funding
- British Heart Foundation [RE-13-5-30177]
- MRC [MR/N003403/1] Funding Source: UKRI
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In this review, the authors explore the evolving evidence linking physiological assessment of coronary artery disease with plaque progression and vulnerability. Reducing adverse clinical events remains the ultimate goal for diagnostic tests, and this review highlights evidence supporting the prognostic value of physiological metrics in predicting outcomes. Historical and contemporary studies support synergy among lesion severity, ischemia, plaque vulnerability, and patient prognosis. Ischemia contributes to clinical events through association with plaque burden, but this review addresses the emerging concept that it associates with atherothrombosis via disturbed lesion hemodynamics. Biomechanical pathophysiological forces including endothelial shear stress-the frictional force generated by blood flow on the vessel wall-are increasingly linked with atherogenesis, vulnerable plaque morphology, and platelet and leukocyte activation. The authors conclude by transitioning from the model of the vulnerable plaque to the concept of the vulnerable patient, looking more broadly at physiological contributors to Virchow's triad underpinning acute coronary syndrome. (C) 2017 the American College of Cardiology Foundation. Published by Elsevier. All rights reserved.
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