Case examples highlighting the prognostic value of the local hemodynamic forces in predicting events. Panel (A) illustrates the angiographic image of a lesion located in the mid left circumflex that caused an event at 13-month follow-up (D). VH-IVUS imaging showed a moderate lesion with a minimum lumen area of 2.94 mm2 (indicated with a white circle on angiography, the corresponding VH-IVUS cross-section is shown in the white inset), a plaque burden of 70.5% and a TCFA phenotype. Blood flow simulation analysis demonstrated high wall shear stress (WSS) at the throat of the lesion with the maximum predominant WSS estimated at 6.94 Pa (B), while plaque structural stress (PSS) analysis also showed increased plaque stress (C) estimated at 123 kPa (maximum PSS location on coronary angiography is indicated with a light blue circle, the corresponding VH-IVUS cross-section is shown in the light blue inset). Panel (E) portrays the angiographic image of a moderate lesion located in the right coronary artery that remained quiescent at 13-month follow-up (H). VH-IVUS imaging showed a plaque with a TCFA phenotype, minimum lumen area of 3.75 mm2 (its location in coronary angiography is shown with a white circle and the VH-IVUS image in the white inset) and similar plaque burden (78.6%) compared to the previous lesion. However, in this occasion, the maximum predominant WSS was normal (3.73 Pa, F), while PSS (the location in angiography is shown with a light blue circle and the corresponding VH-IVUS frame in the light blue inset) was lower (71 kPa, G) suggesting an athero-protective hemodynamic environment that inhibited atherosclerotic disease progression.
