Remodeling Index Compared to Actual Vascular Remodeling in Atherosclerotic Left Main Coronary Arteries as Assessed With Long-Term (≥12 Months) Serial Intravascular Ultrasound

Remodeling Index Compared to Actual Vascular Remodeling in Atherosclerotic Left Main Coronary Arteries as Assessed With Long-Term (≥12 Months) Serial Intravascular Ultrasound Clemens von Birgelen, Marc Hartmann, Gary S. Mintz, Dirk Böse, Holger Eggebrecht, Till Neumann, Mario Gössl, Heinrich Wieneke...

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Published in:Journal of the American College of Cardiology 2006-04, Vol.47 (7), p.1363-1368
Main Authors: von Birgelen, Clemens, Hartmann, Marc, Mintz, Gary S., Böse, Dirk, Eggebrecht, Holger, Neumann, Till, Gössl, Mario, Wieneke, Heinrich, Schmermund, Axel, Stoel, Martin G., Verhorst, Patrick M.J., Erbel, Raimund
Format: Article
Language:English
Subjects:
Aged
Cardiology
Cardiovascular disease
Cholesterol
Coronary Artery Disease - diagnostic imaging
Coronary Artery Disease - physiopathology
Coronary vessels
Coronary Vessels - diagnostic imaging
Coronary Vessels - physiopathology
Demographics
Family medical history
Female
Follow-Up Studies
Heart attacks
Humans
Intervention
Lipids
Lipoproteins
Male
Middle Aged
Studies
Triglycerides
Ultrasonography, Interventional - methods
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Summary:Remodeling Index Compared to Actual Vascular Remodeling in Atherosclerotic Left Main Coronary Arteries as Assessed With Long-Term (≥12 Months) Serial Intravascular Ultrasound Clemens von Birgelen, Marc Hartmann, Gary S. Mintz, Dirk Böse, Holger Eggebrecht, Till Neumann, Mario Gössl, Heinrich Wieneke, Axel Schmermund, Martin G. Stoel, Patrick M. J. Verhorst, Raimund Erbel We performed serial intravascular ultrasound studies of 46 non-stenotic left main stems 18 ± 8 months apart. The vast majority of atherosclerotic lesions with a remodeling index (lesion divided by reference external elastic membrane area) >1 had evidence of a previous increase in lesion external elastic membrane dimensions. We present the remodeling index (RI) versus serial intravascular ultrasound (IVUS) data. The RI, derived by comparing lesion external elastic membrane (EEM) cross-sectional area versus the reference at one time point, is used in various IVUS studies as a substitute of true remodeling (change in EEM over time), assuming that it represents true remodeling. We studied 46 non-stenotic left main arteries using serial IVUS (follow-up 18 ± 8 months). Plaques were divided into subgroups according to the follow-up RI: follow-up RI >1 (n = 27) versus follow-up RI ≤1 (n = 19). Lesions with a follow-up RI >1 had an increase in lumen despite an increase in plaque because of an increase in EEM. Conversely, lesions with a follow-up RI ≤1 had a reduction in lumen as a result of both a plaque increase and EEM decrease. Overall, the follow-up RI correlated directly with changes in lesionsite EEM (baseline-to-follow-up). Although there was no correlation between the follow-up RI and changes in referenceEEM area, changes in reference EEM area did correlate directly with changes in lesion EEM area. In nearly 90% of lesions with a follow-up RI >1, there was a previously documented increase in EEM area. Using multivariate linear regression analysis, the follow-up RI was dependent on the baseline RI, the increase in lesion EEM area, and the decrease in reference EEM area. The follow-up RI was not dependent on changes in lesion plaque area. The vast majority of left main lesions with a remodeling index >1 had evidence of a previous increase in lesion-site EEM area.
ISSN:0735-1097
1558-3597
DOI:10.1016/j.jacc.2005.11.055