Association of atherosclerotic cardiovascular disease risk stratification with carotid wall shear stress as measured by vector flow mapping: a study of a Chinese population.

BACKGROUND

Wall shear stress (WSS) is affected by a variety of hemodynamic factors and plays a role in the pathogenesis of many diseases, such as abnormal WSS is associated with local endothelial dysfunction and atherosclerosis (AS). Vector flow mapping (VFM) is a new tool developed to calculate WSS according to the mass conservation equation. The aim of this study was to evaluate the association between carotid WSS measured by the VFM technique and atherosclerotic cardiovascular disease (ASCVD) risk stratification.

METHODS

A retrospective analysis was conducted on 155 individuals who were recruited from the Department of Cardiology at Qilu Hospital of Shandong University. Carotid WSS was measured via the VFM technique. The correlations between carotid intima-media thickness (CIMT) or ASCVD risk stratification and carotid WSS were assessed via Spearman analysis. Multiple linear regression was used to examine the correlation between traditional risk factors or biochemical indicators and carotid WSS. Receiver operating characteristic (ROC) analysis was performed to analyze the association between carotid WSS and ASCVD risk stratification.

RESULTS

The mean age of all participants was 53.06±15.07 years, and 68.4% (n=106) of them were male. The mean carotid WSS of a cardiac cycle (WSSmean) for low, moderate, high, very high, and ultrahigh risk of ASCVD was 0.93±0.21, 0.76±0.20, 0.67±0.10, 0.63±0.18, and 0.52±0.18 Pa, respectively. Carotid WSS was negatively associated with CIMT and ASCVD risk stratification (all P values <0.001). Multiple linear regression analysis confirmed that the maximum WSS of a cardiac cycle (WSSmax) was correlated with age, body mass index (BMI), and heart rate (HR) (R2=0.460; P<0.001). The minimum WSS of a cardiac cycle (WSSmin) was correlated with age, BMI, systolic blood pressure (SBP), HR, high-density lipoprotein cholesterol (HDL-C), and low-density lipoprotein cholesterol (LDL-C) (R2=0.472; P<0.001). WSSmean was correlated with age, BMI, HR, and LDL-C (R2=0.454; P<0.001). The difference between the WSSmax and WSSmin (WSS△) was correlated with age, BMI, and SBP (R2=0.316; P<0.001). The area under the curve (AUC) of WSSmax, WSSmin, and WSSmean for predicting very high or ultrahigh risk of ASCVD was larger than of CIMT (all P values <0.05).

CONCLUSIONS

Carotid WSS measured with the VFM technique was significantly correlated with CIMT and ASCVD risk stratification and could be used for screening and monitoring individuals with potential ASCVD risk.