{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,29]],"date-time":"2026-08-29T16:52:28Z","timestamp":1788022348635,"version":"build-2784847793"},"reference-count":34,"publisher":"eLife Sciences Publications, Ltd","license":[{"start":{"date-parts":[[2021,5,11]],"date-time":"2021-05-11T00:00:00Z","timestamp":1620691200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2021,5,11]],"date-time":"2021-05-11T00:00:00Z","timestamp":1620691200000},"content-version":"am","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2021,5,11]],"date-time":"2021-05-11T00:00:00Z","timestamp":1620691200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100005156","name":"Alexander von Humboldt-Stiftung","doi-asserted-by":"publisher","award":["Postdoctoral Research Fellowship"],"award-info":[{"award-number":["Postdoctoral Research Fellowship"]}],"id":[{"id":"10.13039\/100005156","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["elifesciences.org"],"crossmark-restriction":false},"short-container-title":[],"abstract":"<jats:p>Plaque rupture occurs if stress within coronary lesions exceeds the protection exerted by the fibrous cap overlying the necrotic lipid core. However, very little is known about the biomechanical stress exerting this disrupting force. Employing optical coherence tomography (OCT), we generated plaque models and performed finite-element analysis to simulate stress distributions within the vessel wall in 10 ruptured and 10 non-ruptured lesions. In ruptured lesions, maximal stress within fibrous cap (peak cap stress [PCS]: 174 \u00b1 67 vs. 52 \u00b1 42 kPa, p&lt;0.001) and vessel wall (maximal plaque stress [MPS]: 399 \u00b1 233 vs. 90 \u00b1 95 kPa, p=0.001) were significantly higher compared to non-ruptured plaques. Ruptures arose in the immediate proximity of maximal stress concentrations (angular distances: 21.8 \u00b1 30.3\u00b0 for PCS vs. 20.7 \u00b1 23.7\u00b0 for MPS); stress concentrations excellently predicted plaque rupture (area under the curve: 0.940 for PCS, 0.950 for MPS). This prediction of plaque rupture was superior to established vulnerability features such as fibrous cap thickness or macrophage infiltration. In conclusion, OCT-based finite-element analysis effectively assesses plaque biomechanics, which in turn predicts plaque rupture in patients. This highlights the importance of morpho-mechanic analysis assessing the disrupting effects of plaque stress.<\/jats:p>","DOI":"10.7554\/elife.64020","type":"journal-article","created":{"date-parts":[[2021,5,10]],"date-time":"2021-05-10T20:07:28Z","timestamp":1620677248000},"update-policy":"https:\/\/doi.org\/10.7554\/elife.64020","source":"Crossref","is-referenced-by-count":37,"title":["Coronary plaque composition influences biomechanical stress and predicts plaque rupture in a morpho-mechanic OCT analysis"],"prefix":"10.7554","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7580-8029","authenticated-orcid":true,"given":"Andrea","family":"Milzi","sequence":"first","affiliation":[{"name":"Department of Cardiology, University Hospital of the RWTH Aachen, Aachen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Enrico Domenico","family":"Lemma","sequence":"additional","affiliation":[{"name":"Zoological Institute, Department of Cell- and Neurobiology, Karlsruhe Institute of Technology (KIT), Karlsruhe, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rosalia","family":"Dettori","sequence":"additional","affiliation":[{"name":"Department of Cardiology, University Hospital of the RWTH Aachen, Aachen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kathrin","family":"Burgmaier","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, University Hospital of Cologne, Cologne, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nikolaus","family":"Marx","sequence":"additional","affiliation":[{"name":"Department of Cardiology, University Hospital of the RWTH Aachen, Aachen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sebastian","family":"Reith","sequence":"additional","affiliation":[{"name":"Department of Cardiology, University Hospital of the RWTH Aachen, Aachen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mathias","family":"Burgmaier","sequence":"additional","affiliation":[{"name":"Department of Cardiology, University Hospital of the RWTH Aachen, Aachen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"4374","published-online":{"date-parts":[[2021,5,11]]},"reference":[{"key":"bib1","doi-asserted-by":"publisher","first-page":"723","DOI":"10.1016\/j.ultras.2003.11.017","article-title":"Finite element modeling and intravascular ultrasound elastography of vulnerable plaques: parameter variation","volume":"42","author":"Baldewsing","year":"2004","journal-title":"Ultrasonics"},{"key":"bib2","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1016\/j.jbiomech.2019.03.005","article-title":"Calcifications in atherosclerotic plaques and impact on plaque biomechanics","volume":"87","author":"Barrett","year":"2019","journal-title":"Journal of Biomechanics"},{"key":"bib3","doi-asserted-by":"publisher","first-page":"2206","DOI":"10.1016\/j.jcmg.2020.02.028","article-title":"Shear stress estimated by quantitative coronary angiography predicts plaques prone to progress and cause events","volume":"13","author":"Bourantas","year":"2020","journal-title":"JACC: Cardiovascular Imaging"},{"key":"bib4","doi-asserted-by":"publisher","DOI":"10.1186\/s12933-014-0117-8","article-title":"A score to quantify coronary plaque vulnerability in high-risk patients with type 2 diabetes: an optical coherence tomography study","volume":"13","author":"Burgmaier","year":"2014","journal-title":"Cardiovascular Diabetology"},{"key":"bib5","doi-asserted-by":"publisher","first-page":"1276","DOI":"10.1056\/NEJM199705013361802","article-title":"Coronary risk factors and plaque morphology in men with coronary disease who died suddenly","volume":"336","author":"Burke","year":"1997","journal-title":"New England Journal of Medicine"},{"key":"bib6","doi-asserted-by":"publisher","first-page":"228","DOI":"10.1016\/j.actbio.2018.09.010","article-title":"Relating the mechanical properties of atherosclerotic calcification to radiographic density: a nanoindentation approach","volume":"80","author":"Cahalane","year":"2018","journal-title":"Acta Biomaterialia"},{"key":"bib7","doi-asserted-by":"publisher","first-page":"870","DOI":"10.1016\/j.jbiomech.2014.01.010","article-title":"Effect of tissue properties, shape and orientation of microcalcifications on vulnerable cap stability using different hyperelastic constitutive models","volume":"47","author":"Cardoso","year":"2014","journal-title":"Journal of Biomechanics"},{"key":"bib8","volume-title":"Deaths, Percent of Total Deaths, and Death Rates for the 15 Leading Causes of Death in 10-Year Age Groups, by Race and Sex","author":"Center for Disease Control","year":"2013","unstructured":"Center for Disease Control. 2013. 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