{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,22]],"date-time":"2026-10-22T09:43:57Z","timestamp":1792662237950,"version":"4.5.0"},"reference-count":35,"publisher":"Oxford University Press (OUP)","issue":"6","license":[{"start":{"date-parts":[[2019,8,23]],"date-time":"2019-08-23T00:00:00Z","timestamp":1566518400000},"content-version":"vor","delay-in-days":1,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/100010663","name":"European Research Council","doi-asserted-by":"publisher","award":["310457"],"award-info":[{"award-number":["310457"]}],"id":[{"id":"10.13039\/100010663","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2020,5,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Aims<\/jats:title>\n                    <jats:p>Atherosclerotic plaque development has been associated with wall shear stress (WSS). However, the multidirectionality of blood flow, and thus of WSS, is rarely taken into account. The purpose of this study was to comprehensively compare five metrics that describe (multidirectional) WSS behaviour and assess how WSS multidirectionality affects coronary plaque initiation and progression.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and results<\/jats:title>\n                    <jats:p>Adult familial hypercholesterolaemic pigs (n\u2009=\u200910) that were fed a high-fat diet, underwent imaging of the three main coronary arteries at three-time points [3 (T1), 9 (T2), and 10\u201312 (T3) months]. Three-dimensional geometry of the arterial lumen, in combination with local flow velocity measurements, was used to calculate WSS at T1 and T2. For analysis, arteries were divided into 3\u2009mm\/45\u00b0 sectors (n\u2009=\u20093648). Changes in wall thickness and final plaque composition were assessed with near-infrared spectroscopy\u2013intravascular ultrasound, optical coherence tomography imaging, and histology. Both in pigs with advanced and mild disease, the highest plaque progression rate was exclusively found at low time-averaged WSS (TAWSS) or high multidirectional WSS regions at both T1 and T2. However, the eventually largest plaque growth was located in regions with initial low TAWSS or high multidirectional WSS that, over time, became exposed to high TAWSS or low multidirectional WSS at T2. Besides plaque size, also the presence of vulnerable plaque components at the last time point was related to low and multidirectional WSS. Almost all WSS metrics had good predictive values for the development of plaque (47\u201350%) and advanced fibrous cap atheroma (FCA) development (59\u201361%).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>This study demonstrates that low and multidirectional WSS promote both initiation and progression of coronary atherosclerotic plaques. The high-predictive values of the multidirectional WSS metrics for FCA development indicate their potential as an additional clinical marker for the vulnerable disease.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/cvr\/cvz212","type":"journal-article","created":{"date-parts":[[2019,8,20]],"date-time":"2019-08-20T15:16:40Z","timestamp":1566314200000},"page":"1136-1146","source":"Crossref","is-referenced-by-count":114,"title":["Multidirectional wall shear stress promotes advanced coronary plaque development: comparing five shear stress metrics"],"prefix":"10.1093","volume":"116","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3381-8779","authenticated-orcid":false,"given":"Ayla","family":"Hoogendoorn","sequence":"first","affiliation":[{"name":"Department of Cardiology, Biomedical Engineering, Erasmus MC, Dr. Molewaterplein 40, 3015 GD Rotterdam, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Annette M","family":"Kok","sequence":"first","affiliation":[{"name":"Department of Cardiology, Biomedical Engineering, Erasmus MC, Dr. Molewaterplein 40, 3015 GD Rotterdam, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eline M J","family":"Hartman","sequence":"first","affiliation":[{"name":"Department of Cardiology, Biomedical Engineering, Erasmus MC, Dr. Molewaterplein 40, 3015 GD Rotterdam, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1711-3047","authenticated-orcid":false,"given":"Giuseppe","family":"de Nisco","sequence":"first","affiliation":[{"name":"PoliToBIOMed Lab, Department of Mechanical and Aerospace Engineering, Politecnico di Torino, Turin, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2854-9615","authenticated-orcid":false,"given":"Lorena","family":"Casadonte","sequence":"first","affiliation":[{"name":"Department of Biomedical Engineering and Physics, Amsterdam UMC, Amsterdam, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2070-6142","authenticated-orcid":false,"given":"Claudio","family":"Chiastra","sequence":"first","affiliation":[{"name":"PoliToBIOMed Lab, Department of Mechanical and Aerospace Engineering, Politecnico di Torino, Turin, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adriaan","family":"Coenen","sequence":"first","affiliation":[{"name":"Department of Cardiology, Biomedical Engineering, Erasmus MC, Dr. Molewaterplein 40, 3015 GD Rotterdam, The Netherlands"},{"name":"Department of Radiology, Erasmus MC, Rotterdam, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2195-4033","authenticated-orcid":false,"given":"Suze-Anne","family":"Korteland","sequence":"first","affiliation":[{"name":"Department of Cardiology, Biomedical Engineering, Erasmus MC, Dr. Molewaterplein 40, 3015 GD Rotterdam, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6537-5992","authenticated-orcid":false,"given":"Kim","family":"Van der Heiden","sequence":"first","affiliation":[{"name":"Department of Cardiology, Biomedical Engineering, Erasmus MC, Dr. Molewaterplein 40, 3015 GD Rotterdam, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Frank J H","family":"Gijsen","sequence":"first","affiliation":[{"name":"Department of Cardiology, Biomedical Engineering, Erasmus MC, Dr. Molewaterplein 40, 3015 GD Rotterdam, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2836-2241","authenticated-orcid":false,"given":"Dirk J","family":"Duncker","sequence":"first","affiliation":[{"name":"Department of Cardiology, Experimental Cardiology, Erasmus MC, Rotterdam, The 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