Disease progression in nonintervened saphenous vein graft segments a serial intravascular ultrasound analysis.
OBJECTIVE
We used serial intravascular ultrasound (IVUS) to assess disease progression in nonintervened saphenous vein graft (SVG) segments to determine the natural rate of disease progression in SVG.


BACKGROUND
There are no serial IVUS studies of disease progression or luminal compromise in SVGs.


METHODS
We assessed serial (baseline and follow-up at 16.2 +/- 7.4 months) IVUS findings in 50 nonintervened SVG segments in 44 patients. The SVG age was 13.5 +/- 3.6 years.


RESULTS
Overall, from baseline to follow-up, plaque area increased (Delta = +0.58 +/- 1.25 mm(2), p = 0.003), and SVG and minimum lumen area (MLA) decreased (Delta = -0.50 +/- 1.14 mm(2), p = 0.002, and Delta = -1.08 +/- 1.28 mm(2), p < 0.001, respectively). The MLA decreased in 34 lesions (Delta = -1.67 +/- 1.08 mm(2)), and MLA increased in 16 lesions (Delta = +0.19 +/- 0.47 mm(2)). Compared with lesions with an increase in MLA, lesions with a decrease in MLA were associated with: 1) larger baseline SVG and plaque areas and plaque burden (15.57 +/- 3.90 mm(2) vs. 11.55 +/- 2.30 mm(2), p < 0.001; 7.97 +/- 3.77 mm(2) vs. 4.27 +/- 1.92 mm(2), p < 0.001; and 48.7 +/- 14.2% vs. 36.0 +/- 13.4%, p = 0.004, respectively); and 2) a greater decrease in SVG area (Delta = -0.96 +/- 1.05 mm(2) vs. +0.48 +/- 0.58 mm(2), p < 0.001) and greater increase in plaque area (Delta = +0.71 +/- 1.47 mm(2) vs. +0.29 +/- 0.45 mm(2), p < 0.001). The DeltaMLA correlated with both Deltaplaque area (r = -0.589, p < 0.001) and DeltaSVG area (r = 0.470, p = 0.001), and Deltaplaque area correlated with DeltaSVG area (r = 0.436, p = 0.002). There were linear relations between both the Deltaplaque area (r = 0.519, p < 0.001) and Deltalumen area (r = -0.500, p < 0.001) versus follow-up low-density lipoprotein (LDL) cholesterol; a follow-up LDL cholesterol of 100 mg/dl predicted no plaque increase.


CONCLUSIONS
Lumen loss in nonintervened SVG segments correlated with an increase in plaque area and a decrease in SVG area (plaque growth and negative remodeling) with a linear relationship between plaque growth versus follow-up LDL cholesterol leading to long-term lumen loss.
Hong
Young Joon
YJ
Cardiovascular Research Institute/Medstar Research Institute, Washington Hospital Center, DC 20010, USA.
Mintz
Gary S
GS
Kim
Sang Wook
SW
Lee
Sung Yun
SY
Kim
Seok Yeon
SY
Okabe
Teruo
T
Pichard
Augusto D
AD
Satler
Lowell F
LF
Waksman
Ron
R
Kent
Kenneth M
KM
Suddath
William O
WO
Weissman
Neil J
NJ
D000368:Aged; D019412:Anatomy, Cross-Sectional; D008078:Cholesterol, LDL / Q000097:blood; D001026:Coronary Artery Bypass; D003324:Coronary Artery Disease / Q000097:blood / Q000601:surgery*; D018450:Disease Progression; D005260:Female; D006083:Graft Occlusion, Vascular / Q000000981:diagnostic imaging*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012501:Saphenous Vein / Q000000981:diagnostic imaging* / Q000637:transplantation; D018084:Ultrasonography, Interventional
D008078:Cholesterol, LDL