title: Vessel shrinkage as a sign of atherosclerosis progression in type 2 diabetes: a serial intravascular ultrasound analysis.
abstract: OBJECTIVE
  The aim of this study was to determine the natural history of vascular remodeling of atherosclerotic plaques in patients with type 2 diabetes and the predictors of vessel shrinkage.
  
  
  METHODS
  In this serial intracoronary ultrasound (IVUS) study, 237 coronary segments from 45 patients enrolled in the DIABETES I, II, and III trials were included. Quantitative volumetric IVUS analyses (motorized pullbacks at 0.5 mm/s) were performed in the same coronary segment after the index procedure and at the 9-month follow-up. Nontreated mild lesions (angiographic stenosis <25%) with > or =0.5 mm plaque thickening and length of > or =5 mm assessed by IVUS were included. Vessel shrinkage was defined as a Deltaexternal elastic membrane area/Deltaplaque area < 0. Statistical adjustment by multiple segments and multiple lesions per patient was performed.
  
  
  RESULTS
  Vessel shrinkage was identified in 37.1% of segments and was associated with a significant decrease in lumen area at 9 months (vessel shrinkage, 10 +/- 4 mm(2) vs. non-vessel shrinkage, 11 +/- 4 mm(2); P = 0.04). Independent predictors of vessel shrinkage were insulin requirements (odds ratio 4.6 [95% CI 1.40-15.10]; P = 0.01), glycated hemoglobin (1.5 [1.05-2.10]; P = 0.02), apolipoprotein B (0.96 [0.94-0.98]; P < 0.001), hypertension (3.7 [1.40-10.30]; P = 0.009), number of diseased vessels (5.6 [2.50-12.50]; P < 0.001), and prior revascularization (17.5 [6.50-46.90]; P < 0.001).
  
  
  CONCLUSIONS
  This serial IVUS study suggests that progression of coronary artery disease in patients with type 2 diabetes may be mainly attributed to vessel shrinkage. Besides, vessel shrinkage is influenced by insulin requirements and metabolic control and is associated with more advanced coronary atherosclerosis.
authors.affiliation: Cardiovascular Institute, San Carlos University Hospital, Madrid, Spain.
authors.forename: Pilar
authors.initials: P
authors.lastname: Jiménez-Quevedo
authors.forename: Nobuaki
authors.initials: N
authors.lastname: Suzuki
authors.forename: Cecilia
authors.initials: C
authors.lastname: Corros
authors.forename: Cruz
authors.initials: C
authors.lastname: Ferrer
authors.forename: Dominick J
authors.initials: DJ
authors.lastname: Angiolillo
authors.forename: Fernando
authors.initials: F
authors.lastname: Alfonso
authors.forename: Rosana
authors.initials: R
authors.lastname: Hernández-Antolín
authors.forename: Camino
authors.initials: C
authors.lastname: Bañuelos
authors.forename: Javier
authors.initials: J
authors.lastname: Escaned
authors.forename: Cristina
authors.initials: C
authors.lastname: Fernández
authors.forename: Marco
authors.initials: M
authors.lastname: Costa
authors.forename: Carlos
authors.initials: C
authors.lastname: Macaya
authors.forename: Theodore
authors.initials: T
authors.lastname: Bass
authors.forename: Manel
authors.initials: M
authors.lastname: Sabaté
mesh_terms: D050197:Atherosclerosis / Q000209:etiology / Q000473:pathology*; D003331:Coronary Vessels / Q000000981:diagnostic imaging / Q000473:pathology*; D003924:Diabetes Mellitus, Type 2 / Q000150:complications*; D018450:Disease Progression; D006801:Humans; D018084:Ultrasonography, Interventional