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(Circulation. 1998;97:1424-1425.)
© 1998 American Heart Association, Inc.

Correspondence

How Should We Define Inadequate Coronary Arterial Remodeling?

Toshihiko Nishioka, MD

Division of Cardiology, Self-Defense Forces Central Hospital, Tokyo, Japan

Hans Berglund, MD; Huai Luo, MD; Tomoo Nagai, MD; ; Robert J. Siegel, MD

Division of Cardiology, Cedars-Sinai Medical Center, Los Angeles, Calif

To the Editor:

After our report¹ showing the contribution of "inadequate compensatory enlargement" to the development of coronary narrowing, Mintz et al² in their recently published report confirmed this concept in a larger study population by using a different definition of "inadequate arterial remodeling." However, the assessment of the relative importance of "inadequate arterial remodeling" is highly dependent on the definition used.

As pointed out by Mintz et al, the assessment of the true effect of vessel remodeling on the progression of coronary narrowing would require serial or longitudinal intravascular ultrasound studies (IVUS) over a long time period. However, such longitudinal, serial studies are time consuming and impractical. Consequently, we compared the size of the external elastic lamina (EEL) area (the area within the outer border of the sonolucent zone considered to represent EEL) at the lesion site with those at the reference sites. The proximal and distal reference sites were defined as the sites with minimal narrowing by angiography and the largest lumen area and <50% area stenosis as determined by IVUS. In our study,¹ the EEL area of all arteries was larger at the proximal reference sites than at the distal reference sites, and "inadequate compensatory enlargement" was defined when there was a smaller EEL area at the lesion site than at the distal reference site. This definition is based on two factors: (¹ ) nonatherosclerotic coronary arteries taper from the proximal to the distal portion of the coronary artery and (² ) "adequate arterial remodeling" at the . . . [Full Text of this Article]

Gary S. Mintz, MD; ; Martin B. Leon, MD

Intravascular Ultrasound Imaging and Cardiac Catheterization Laboratories, Washington Hospital Center, Washington, DC