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European Heart Journal Advance Access published online on March 8, 2006
European Heart Journal, doi:10.1093/eurheartj/ehi796
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European Heart Journal © The European Society of Cardiology 2006; all rights reserved
Received October 8, 2005
Revised December 17, 2005
Accepted January 26, 2006

Clinical research

Compensatory enlargement of human coronary arteries during progression of atherosclerosis is unrelated to atheroma burden: serial intravascular ultrasound observations from the REVERSAL trial

Ilke Sipahi 1, E. Murat Tuzcu 1 *, Paul Schoenhagen 2, Stephen J. Nicholls 1, Volkan Ozduran 1, Samir Kapadia 1, and Steven E. Nissen 1

1 Department of Cardiovascular Medicine, The Cleveland Clinic Foundation, 9500 Euclid Avenue, Desk F25, Cleveland, OH 44195, USA
2 Department of Cardiovascular Medicine, The Cleveland Clinic Foundation, 9500 Euclid Avenue, Desk F25, Cleveland, OH 44195, USA; Department of Diagnostic Radiology, The Cleveland Clinic Foundation, Cleveland, OH, USA

* To whom correspondence should be addressed.
E. Murat Tuzcu, E-mail: tuzcue{at}ccf.org


  Abstract

Aims On the basis of the evidence from autopsy studies, it is accepted that compensatory enlargement (remodelling) of coronary arteries during progression of atherosclerosis diminishes once atheroma burden (cross-sectional area stenosis) reaches ~40%. Our aim was to evaluate whether atheroma burden is a limiting factor for coronary arterial remodelling using in vivo serial intravascular ultrasound (IVUS).

Methods and results From the cohort of the Reversal of Atherosclerosis with Aggressive Lipid Lowering (REVERSAL) trial, we identified 210 focal coronary lesions at baseline IVUS. Of these, 128 lesions that had an increase in atheroma area at the 18-month follow-up IVUS were included in the analysis. Lesions were matched at baseline and follow-up. The increase in external elastic membrane (EEM) area for each mm2 increase in atheroma area was not significantly different in lesions with <40 and ≥40% atheroma burden at baseline (1.62 vs. 1.28 mm2, P = 0.30). There were no correlations between atheroma burden at baseline and change in EEM (r = 0.02, P = 0.86) or change in lumen (r = 0.04, P = 0.64) areas.

Conclusion Assessment of coronary arterial remodelling by serial IVUS revealed that compensatory remodelling is not limited by atheroma burden. Atheroma burden is not a determinant of arterial enlargement during the progression of atherosclerosis.

Keywords: Coronary artery disease; Remodelling; Intravascular ultrasound; Imaging.
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