(Circulation. 2000;101:598.)
© 2000 American Heart Association, Inc.
Clinical Investigation and Reports |
Extent and Direction of Arterial Remodeling in Stable Versus Unstable Coronary Syndromes
An Intravascular Ultrasound Study
From The Cleveland Clinic Foundation, Cleveland, Ohio.
Correspondence to E.M. Tuzcu, MD, The Cleveland Clinic Foundation, F 25, 9500 Euclid Ave, Cleveland, OH 44195. E-mail tuzcue{at}cesmtp.ccf.org
Background—The morphological characteristics of coronary plaques in patients with stable versus unstable coronary syndromes have been described in vivo with intravascular ultrasound, but the relationship between arterial remodeling and clinical presentation is not well known.
Methods and Results—We studied 85 patients with unstable and 46 patients with stable coronary syndromes using intravascular ultrasound before coronary intervention. The lesion site and a proximal reference site were analyzed. The remodeling ratio (RR) was defined as the ratio of the external elastic membrane (EEM) area at the lesion to that at the proximal reference site. Positive remodeling was defined as an RR >1.05 and negative remodeling as an RR <0.95. Plaque area (13.9±5.5 versus 11.1±4.8 mm2; P=0.005), EEM area (16.1±6.2 versus 13.0±4.8 mm2; P=0.004), and the RR (1.06±0.2 versus 0.94±0.2; P=0.008) were significantly greater at target lesions in patients with unstable syndromes than in patients with stable syndromes. Positive remodeling was more frequent in unstable than in stable lesions (51.8% versus 19.6%), whereas negative remodeling was more frequent in stable lesions (56.5% versus 31.8%) (P=0.001).
Conclusions—Positive remodeling and larger plaque areas were associated with unstable clinical presentation, whereas negative remodeling was more common in patients with stable clinical presentation. This association between the extent of remodeling and clinical presentation may reflect a greater tendency of plaques with positive remodeling to cause unstable coronary syndromes.
Key Words: coronary disease • remodeling • ultrasonics • imaging
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S. M. Lessner, D. E. Martinson, and Z. S. Galis Compensatory Vascular Remodeling During Atherosclerotic Lesion Growth Depends on Matrix Metalloproteinase-9 Activity Arterioscler Thromb Vasc Biol, November 1, 2004; 24(11): 2123 - 2129. [Abstract] [Full Text] [PDF]
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Y Shimada, M Yoshiyama, Y Kobayashi, H Tanaka, S Jissho, H Iida, Y Nakamura, S Ehara, K Shimada, K Takeuchi, et al. Positive correlation between coronary arterial remodelling and prodromal angina in acute myocardial infarction Heart, April 1, 2004; 90(4): 444 - 445. [Full Text] [PDF]
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S. Achenbach, D. Ropers, U. Hoffmann, B. MacNeill, U. Baum, K. Pohle, T. J. Brady, E. Pomerantsev, J. Ludwig, F. A. Flachskampf, et al. assessment of coronary remodeling in stenotic and nonstenotic coronary atherosclerotic lesions by multidetector spiral computed tomography J. Am. Coll. Cardiol., March 3, 2004; 43(5): 842 - 847. [Abstract] [Full Text] [PDF]
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M. Sahara, H. Kirigaya, Y. Oikawa, J. Yajima, K. Ogasawara, H. Satoh, K. Nagashima, H. Hara, Y. Nakatsu, and T. Aizawa Arterial remodeling patterns before intervention predict diffuse in-stent restenosis: An intravascular ultrasound study J. Am. Coll. Cardiol., November 19, 2003; 42(10): 1731 - 1738. [Abstract] [Full Text] [PDF]
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P. Schoenhagen, G. W. Stone, S. E. Nissen, C. L. Grines, J. Griffin, B. S. Clemson, D. G. Vince, K. Ziada, T. Crowe, C. Apperson-Hanson, et al. Coronary Plaque Morphology and Frequency of Ulceration Distant From Culprit Lesions in Patients With Unstable and Stable Presentation Arterioscler Thromb Vasc Biol, October 1, 2003; 23(10): 1895 - 1900. [Abstract] [Full Text] [PDF]
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M. Kato, K. Dote, S. Habara, H. Takemoto, K. Goto, and K. Nakaoka Clinical implications of carotid artery remodeling in acute coronary syndrome: Ultrasonographic assessment of positive remodeling J. Am. Coll. Cardiol., September 17, 2003; 42(6): 1026 - 1032. [Abstract] [Full Text] [PDF]
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E. M. Tuzcu and P. Schoenhagen Acute coronary syndromes, plaque vulnerability,and carotid artery disease: The changing role ofatherosclerosis imaging J. Am. Coll. Cardiol., September 17, 2003; 42(6): 1033 - 1036. [Full Text] [PDF]
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M.-K. Hong, G. S. Mintz, C. W. Lee, Y.-H. Kim, J.-W. Lee, J.-M. Song, K.-H. Han, D.-H. Kang, J.-K. Song, J.-J. Kim, et al. Intravascular ultrasound assessment of patterns of arterial remodeling in the absence of significant reference segment plaque burden in patients with coronary artery disease J. Am. Coll. Cardiol., September 3, 2003; 42(5): 806 - 810. [Abstract] [Full Text] [PDF]
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N. J. Weissman Vascular remodeling: do we really need yet another study? J. Am. Coll. Cardiol., September 3, 2003; 42(5): 811 - 813. [Full Text] [PDF]
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B. D. MacNeill, H. C. Lowe, M. Takano, V. Fuster, and I.-K. Jang Intravascular Modalities for Detection of Vulnerable Plaque: Current Status Arterioscler Thromb Vasc Biol, August 1, 2003; 23(8): 1333 - 1342. [Abstract] [Full Text] [PDF]
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J.-i. Kotani, G. S. Mintz, M. T. Castagna, E. Pinnow, C. O. Berzingi, A. B. Bui, A. D. Pichard, L. F. Satler, W. O. Suddath, R. Waksman, et al. Intravascular Ultrasound Analysis of Infarct-Related and Non-Infarct-Related Arteries in Patients Who Presented With an Acute Myocardial Infarction Circulation, June 17, 2003; 107(23): 2889 - 2893. [Abstract] [Full Text] [PDF]
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F. Prati, T. Pawlowski, R. Gil, A. Labellarte, A. Gziut, E. Caradonna, A. Manzoli, A. Pappalardo, F. Burzotta, and A. Boccanelli Stenting of Culprit Lesions in Unstable Angina Leads to a Marked Reduction in Plaque Burden: A Major Role of Plaque Embolization?: A Serial Intravascular Ultrasound Study Circulation, May 13, 2003; 107(18): 2320 - 2325. [Abstract] [Full Text] [PDF]
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P. K. Shah Mechanisms of plaque vulnerability and rupture J. Am. Coll. Cardiol., February 19, 2003; 41(4_Suppl_S): 15S - 22S. [Abstract] [Full Text] [PDF]
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