title: Positive Vascular Remodeling in Culprit Coronary Lesion is Associated With Plaque Composition: An Intravascular Ultrasound-Virtual Histology Study.
abstract: OBJECTIVE
  The relationship between the positive remodeling (PR) of a coronary artery and plaque composition has been studied only in a relatively small number of study population or non-culprit lesion. We evaluated the association between coronary plaque composition and coronary artery remodeling in a relatively large number of culprit lesions.
  
  
  METHODS
  The study population consisted of 325 consecutive patients with coronary artery disease that underwent intravascular ultrasound-virtual histology examination in a culprit lesion. The remodeling index (RI) was calculated as the lesion external elastic membrane (EEM) area divided by the average reference EEM area.
  
  
  RESULTS
  The lesions with PR (RI>1.05, n=97, mean RI=1.19±0.12) had a higher fibrous volume/lesion length (3.85±2.12 mm(3)/mm vs. 3.04±1.79 mm(3)/mm, p=0.003) and necrotic core volume/lesion length (1.26±0.89 mm(3)/mm vs. 0.90±0.66 mm(3)/mm, p=0.001) than those with negative remodeling (NR) (RI<0.95, n=132, mean RI=0.82±0.09). At the minimal luminal area site, the lesions with PR had a higher fibrous area (5.81±3.17 mm(2) vs. 3.61±2.30 mm(2), p<0.001), dense calcified area (0.73±0.69 mm(2) vs. 0.46±0.43 mm(2), p=0.001), and necrotic core area (1.93±1.33 mm(2) vs. 1.06±0.91 mm(2), p<0.001) than those with NR. RI showed significant positive correlation with fibrous volume/lesion length (r=0.173, p=0.002), necrotic core volume/lesion length (r=0.188, p=0.001), fibrous area (r=0.347, p<0.001), fibrofatty area (r=0.111, p=0.036), dense calcified area (r=0.239, p<0.001), and necrotic core area (r=0.334, p<0.001). Multivariate analysis showed that the independent factor for PR was the necrotic core volume/lesion length (beta=0.130, 95% confidence interval; 0.002-0.056, p=0.037) over the entire lesion.
  
  
  CONCLUSIONS
  This study suggests that PR in a culprit lesion is associated with the necrotic core volume in the entire lesion, which is a characteristic of vulnerable plaque.
authors.affiliation: Department of Cardiology, Konyang University College of Medicine, Daejeon, Korea.
authors.forename: Chung Seop
authors.initials: CS
authors.lastname: Lee
authors.forename: Young Hoon
authors.initials: YH
authors.lastname: Seo
authors.forename: Dong Ju
authors.initials: DJ
authors.lastname: Yang
authors.forename: Ki Hong
authors.initials: KH
authors.lastname: Kim
authors.forename: Hyun Woong
authors.initials: HW
authors.lastname: Park
authors.forename: Hyung Bin
authors.initials: HB
authors.lastname: Yuk
authors.forename: Moo-Sik
authors.initials: MS
authors.lastname: Lee
authors.forename: Wan-Ho
authors.initials: WH
authors.lastname: Kim
authors.forename: Taek-Geun
authors.initials: TG
authors.lastname: Kwon
authors.forename: Jang-Ho
authors.initials: JH
authors.lastname: Bae