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European Heart Journal Advance Access published online on May 22, 2006
European Heart Journal, doi:10.1093/eurheartj/ehl034
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European Heart Journal © The European Society of Cardiology 2006; all rights reserved
Received March 2, 2006
Revised March 27, 2006
Accepted April 27, 2006

Clinical research

Relation between baseline plaque burden and subsequent remodelling of atherosclerotic left main coronary arteries: a serial intravascular ultrasound study with long-term (≥12 months) follow-up

Marc Hartmann 1, Clemens von Birgelen 1 *, Gary S. Mintz 2, Patrick M.J. Verhorst 1, and Raimund Erbel 3

1 Department of Cardiology, Medisch Spectrum Twente, Thoraxcentrum Twente, Haaksbergerstraat 55, 7513 ER Enschede, The Netherlands
2 Cardiovascular Research Foundation, New York, NY, USA
3 Department of Cardiology, Essen University, Essen, Germany

* To whom correspondence should be addressed.
Clemens von Birgelen, E-mail: von.birgelen{at}12move.nl


  Abstract

Aims Glagov's histopathological observation and non-serial intravascular ultrasound studies (IVUS) concluded that compensatory coronary remodelling diminishes as 40% atherosclerotic plaque burden is reached. We tested this hypothesis with serial IVUS.

Methods and results Serial IVUS examinations of 46 atherosclerotic non-stenotic left main stems (18 ± 8 months apart) were analysed to assess the relation between baseline plaque burden (=plaque+media area/vessel area) vs. serial remodelling (=vessel area at baseline-at follow-up). There were 25 plaques with baseline plaque burden <40% (30.1 ± 6.6%, group A) and 21 plaques with baseline plaque burden ≥40% (46.1 ± 5.8%, group B). There was no relation between baseline plaque burden vs. subsequent changes in vessel area overall (r=0.07, P=0.7), for group A (r=0.03, P=0.6), and group B (r=0.01, P=0.8). The frequency of positive serial remodelling (vessel area increase) vs. negative or intermediate serial remodelling (no change or decrease) were similar in group A [17 (68%) vs. 8 (32%)] and group B lesions [18 (86%) vs. 3 (14%)] (P=0.2).

Conclusion IVUS demonstrates that serial coronary remodelling is not related to baseline plaque burden. Lesions with baseline plaque burden <40% may subsequently show a lack of compensation or frank arterial shrinkage, whereas lesions with baseline plaque burden >40% may continue to develop compensatory enlargement.

Keywords: Coronary artery disease; Intravascular ultrasound; Remodelling.
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