Synergistic effect of local endothelial shear stress and systemic hypercholesterolemia on coronary atherosclerotic plaque progression and composition in pigs
Background Systemic risk factors and local hemodynamic factors both contribute to coronary atherosclerosis, but their possibly synergistic inter-relationship remains unknown. The purpose of this natural history study was to investigate the combined in-vivo effect of varying levels of systemic hyper...
| Main Authors: | , , , , , , , , , |
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| Format: | Article |
| Language: | en_US |
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Elsevier
2016
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| Online Access: | http://hdl.handle.net/1721.1/102306 https://orcid.org/0000-0002-7832-7156 https://orcid.org/0000-0002-5646-0378 |
| _version_ | 1811098391336189952 |
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| author | Koskinas, Konstantinos C. Chatzizisis, Yiannis S. Coskun, Ahmet U. Baker, Aaron B. Jarolim, Petr Antoniadis, Antonios Edelman, Elazer R. Stone, Peter H. Feldman, Charles L. Papafaklis, Michail |
| author2 | Institute for Medical Engineering and Science |
| author_facet | Institute for Medical Engineering and Science Koskinas, Konstantinos C. Chatzizisis, Yiannis S. Coskun, Ahmet U. Baker, Aaron B. Jarolim, Petr Antoniadis, Antonios Edelman, Elazer R. Stone, Peter H. Feldman, Charles L. Papafaklis, Michail |
| author_sort | Koskinas, Konstantinos C. |
| collection | MIT |
| description | Background
Systemic risk factors and local hemodynamic factors both contribute to coronary atherosclerosis, but their possibly synergistic inter-relationship remains unknown. The purpose of this natural history study was to investigate the combined in-vivo effect of varying levels of systemic hypercholesterolemia and local endothelial shear stress (ESS) on subsequent plaque progression and histological composition.
Methods
Diabetic, hyperlipidemic swine with higher systemic total cholesterol (TC) (n = 4) and relatively lower TC levels (n = 5) underwent three-vessel intravascular ultrasound (IVUS) at 3–5 consecutive time-points in-vivo. ESS was calculated serially using computational fluid dynamics. 3-D reconstructed coronary arteries were divided into 3 mm-long segments (n = 595), which were stratified according to higher vs. relatively lower TC and low (< 1.2 Pa) vs. higher local ESS (≥ 1.2 Pa). Arteries were harvested at 9 months, and a subset of segments (n = 114) underwent histopathologic analyses.
Results
Change of plaque volume (ΔPV) by IVUS over time was most pronounced in low-ESS segments from higher-TC animals. Notably, higher-ESS segments from higher-TC animals had greater ΔPV compared to low-ESS segments from lower-TC animals (p < 0.001). The time-averaged ESS in segments that resulted in significant plaque increased with increasing TC levels (slope: 0.24 Pa/100 mg/dl; r = 0.80; p < 0.01). At follow-up, low-ESS segments from higher-TC animals had the highest mRNA levels of lipoprotein receptors and inflammatory mediators and, consequently, the greatest lipid accumulation and inflammation.
Conclusions
This study redefines the principle concept that “low” ESS promotes coronary plaque growth and vulnerability by demonstrating that: (i.) the pro-atherogenic threshold of low ESS is not uniform, but cholesterol-dependent; and (ii.) the atherogenic effects of local low ESS are amplified, and the athero-protective effects of higher ESS may be outweighed, by increasing cholesterol levels. Intense hypercholesterolemia and very low ESS are synergistic in favoring rapid atheroma progression and high-risk composition. |
| first_indexed | 2024-09-23T17:14:20Z |
| format | Article |
| id | mit-1721.1/102306 |
| institution | Massachusetts Institute of Technology |
| language | en_US |
| last_indexed | 2024-09-23T17:14:20Z |
| publishDate | 2016 |
| publisher | Elsevier |
| record_format | dspace |
| spelling | mit-1721.1/1023062022-09-30T00:39:42Z Synergistic effect of local endothelial shear stress and systemic hypercholesterolemia on coronary atherosclerotic plaque progression and composition in pigs Koskinas, Konstantinos C. Chatzizisis, Yiannis S. Coskun, Ahmet U. Baker, Aaron B. Jarolim, Petr Antoniadis, Antonios Edelman, Elazer R. Stone, Peter H. Feldman, Charles L. Papafaklis, Michail Institute for Medical Engineering and Science Harvard University--MIT Division of Health Sciences and Technology Koskinas, Konstantinos C. Chatzizisis, Yiannis S. Papafaklis, Michail Baker, Aaron B. Edelman, Elazer R. Background Systemic risk factors and local hemodynamic factors both contribute to coronary atherosclerosis, but their possibly synergistic inter-relationship remains unknown. The purpose of this natural history study was to investigate the combined in-vivo effect of varying levels of systemic hypercholesterolemia and local endothelial shear stress (ESS) on subsequent plaque progression and histological composition. Methods Diabetic, hyperlipidemic swine with higher systemic total cholesterol (TC) (n = 4) and relatively lower TC levels (n = 5) underwent three-vessel intravascular ultrasound (IVUS) at 3–5 consecutive time-points in-vivo. ESS was calculated serially using computational fluid dynamics. 3-D reconstructed coronary arteries were divided into 3 mm-long segments (n = 595), which were stratified according to higher vs. relatively lower TC and low (< 1.2 Pa) vs. higher local ESS (≥ 1.2 Pa). Arteries were harvested at 9 months, and a subset of segments (n = 114) underwent histopathologic analyses. Results Change of plaque volume (ΔPV) by IVUS over time was most pronounced in low-ESS segments from higher-TC animals. Notably, higher-ESS segments from higher-TC animals had greater ΔPV compared to low-ESS segments from lower-TC animals (p < 0.001). The time-averaged ESS in segments that resulted in significant plaque increased with increasing TC levels (slope: 0.24 Pa/100 mg/dl; r = 0.80; p < 0.01). At follow-up, low-ESS segments from higher-TC animals had the highest mRNA levels of lipoprotein receptors and inflammatory mediators and, consequently, the greatest lipid accumulation and inflammation. Conclusions This study redefines the principle concept that “low” ESS promotes coronary plaque growth and vulnerability by demonstrating that: (i.) the pro-atherogenic threshold of low ESS is not uniform, but cholesterol-dependent; and (ii.) the atherogenic effects of local low ESS are amplified, and the athero-protective effects of higher ESS may be outweighed, by increasing cholesterol levels. Intense hypercholesterolemia and very low ESS are synergistic in favoring rapid atheroma progression and high-risk composition. Novartis (Firm) Boston Scientific Corporation George D. Behrakis Cardiovascular Research Fellowship Hellenic Heart Foundation Hellenic Atherosclerosis Society National Institutes of Health (U.S.) (RO1 GM49039) 2016-04-28T12:51:11Z 2016-04-28T12:51:11Z 2013-10 2013-08 Article http://purl.org/eprint/type/JournalArticle 01675273 http://hdl.handle.net/1721.1/102306 Koskinas, Konstantinos C., Yiannis S. Chatzizisis, Michail I. Papafaklis, Ahmet U. Coskun, Aaron B. Baker, Petr Jarolim, Antonios Antoniadis, Elazer R. Edelman, Peter H. Stone, and Charles L. Feldman. “Synergistic Effect of Local Endothelial Shear Stress and Systemic Hypercholesterolemia on Coronary Atherosclerotic Plaque Progression and Composition in Pigs.” International Journal of Cardiology 169, no. 6 (November 2013): 394–401. https://orcid.org/0000-0002-7832-7156 https://orcid.org/0000-0002-5646-0378 en_US http://dx.doi.org/10.1016/j.ijcard.2013.10.021 International Journal of Cardiology Creative Commons Attribution-Noncommercial-NoDerivatives http://creativecommons.org/licenses/by-nc-nd/4.0/ application/pdf Elsevier PMC |
| spellingShingle | Koskinas, Konstantinos C. Chatzizisis, Yiannis S. Coskun, Ahmet U. Baker, Aaron B. Jarolim, Petr Antoniadis, Antonios Edelman, Elazer R. Stone, Peter H. Feldman, Charles L. Papafaklis, Michail Synergistic effect of local endothelial shear stress and systemic hypercholesterolemia on coronary atherosclerotic plaque progression and composition in pigs |
| title | Synergistic effect of local endothelial shear stress and systemic hypercholesterolemia on coronary atherosclerotic plaque progression and composition in pigs |
| title_full | Synergistic effect of local endothelial shear stress and systemic hypercholesterolemia on coronary atherosclerotic plaque progression and composition in pigs |
| title_fullStr | Synergistic effect of local endothelial shear stress and systemic hypercholesterolemia on coronary atherosclerotic plaque progression and composition in pigs |
| title_full_unstemmed | Synergistic effect of local endothelial shear stress and systemic hypercholesterolemia on coronary atherosclerotic plaque progression and composition in pigs |
| title_short | Synergistic effect of local endothelial shear stress and systemic hypercholesterolemia on coronary atherosclerotic plaque progression and composition in pigs |
| title_sort | synergistic effect of local endothelial shear stress and systemic hypercholesterolemia on coronary atherosclerotic plaque progression and composition in pigs |
| url | http://hdl.handle.net/1721.1/102306 https://orcid.org/0000-0002-7832-7156 https://orcid.org/0000-0002-5646-0378 |
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