Intravascular ultrasound assessment of patterns of arterial remodeling in the absence of significant reference segment plaque burden in patients with coronary artery disease.
OBJECTIVE
We evaluated the impact of reference vessel segment plaque burden on lesion remodeling. Intravascular ultrasound (IVUS) assessment of lesion remodeling compares lesions to reference segments. However, reference segments are rarely disease-free and, therefore, have also undergone remodeling changes.


METHODS
Pre-intervention IVUS was obtained in 274 patients with right coronary artery lesions selected because the right coronary artery has less tapering and fewer side branches than the left anterior descending or left circumflex artery. Standard IVUS definitions were used. Patients were divided according to reference vessel segment plaque burden: group A (minimal reference disease, n = 91), both proximal and distal reference plaque burden <20%; group B (n = 91), either proximal or distal reference plaque burden 20% to 40% but both < or =40%; and group C (n = 92), either proximal or distal reference plaque burden >40%.


RESULTS
The remodeling index measured 0.98 +/- 0.16 in group A (range, 0.68 to 1.47), 1.04 +/- 0.18 in group B (range, 0.67 to 1.91), and 1.04 +/- 0.15 in group C (range, 0.74 to 1.70), analysis of variance p = 0.0208 (p = 0.0234 group A vs. group B and p = 0.0012 group A vs. group C, but p = 0.8 group B vs. group C). Positive, intermediate, and negative remodeling were observed in 24 (26%), 24 (26%), and 43 lesions (48%) in group A; 36 (40%), 28 (30%), and 27 lesions (30%) in group B; and 34 (37%), 39 (42%), and 19 lesions (21%) in group C, respectively (p = 0.0022).


CONCLUSIONS
Negative remodeling occurs commonly in coronary lesions with minimal reference segment disease. Negative remodeling is not just an "artifact" introduced by comparing lesions to diseased reference segments.
Hong
Myeong-Ki
MK
Department of Medicine, University of Ulsan College of Medicine, Asan Medical Center, 388-1 Poongnap2-dong, Songpa-gu, Seoul 138-736, South Korea.
Mintz
Gary S
GS
Lee
Cheol Whan
CW
Kim
Young-Hak
YH
Lee
Jae-Whan
JW
Song
Jong-Min
JM
Han
Ki-Hoon
KH
Kang
Duk-Hyun
DH
Song
Jae-Kwan
JK
Kim
Jae-Joong
JJ
Park
Seong-Wook
SW
Park
Seung-Jung
SJ
D000368:Aged; D000704:Analysis of Variance; D001158:Arteries / Q000000981:diagnostic imaging / Q000473:pathology*; D016477:Artifacts; D016009:Chi-Square Distribution; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000145:classification / Q000000981:diagnostic imaging* / Q000209:etiology / Q000473:pathology*; D003331:Coronary Vessels / Q000000981:diagnostic imaging / Q000473:pathology*; D048909:Diabetes Complications; D018450:Disease Progression; D005260:Female; D006801:Humans; D006949:Hyperlipidemias / Q000150:complications; D006973:Hypertension / Q000150:complications; D007723:Korea; D016014:Linear Models; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D012189:Retrospective Studies; D012720:Severity of Illness Index; D012907:Smoking / Q000009:adverse effects; D018084:Ultrasonography, Interventional / Q000379:methods*