title: Compensatory enlargement of the left main coronary artery: insights from the PROSPECT study.
abstract: OBJECTIVE
  Glagov proposed that remodeling delayed development of significant coronary artery stenoses until plaque occupied, on average, 40% of arterial area (40% plaque burden). The aim of the current study was to confirm the previously proposed concept of coronary remodeling as first described by Glagov who studied postmortem left main coronary arteries (LMCAs).
  
  
  METHODS
  Using the in-vivo intravascular ultrasound data from the Providing Regional Observations to Study Predictors of Events in the Coronary Tree (PROSPECT) study, we evaluated 552 LMCAs in 552 patients.
  
  
  RESULTS
  External elastic membrane cross-sectional areas (CSAs) increased in proportion to the increase in plaque and media CSAs (r=0.61, P<0.0001), especially when the plaque burden was 20% or lower (r=0.88, P<0.0001). For more advanced atherosclerosis (>40% plaque burden), there was an inverse relationship between lumen CSA and plaque burden (r=-0.57, P<0.0001), whereas this relationship was weak in the presence of less than 40% plaque burden. The frequency of virtual histology derived thin-cap fibroatheroma increased with increasing plaque burden. In contrast, the frequency of pathological intimal thickening decreased.
  
  
  CONCLUSIONS
  The previously proposed remodeling concept of Glagov was validated in vivo in the PROSPECT study patients. In addition, the present study suggested that plaque phenotype worsened with increasing LMCA plaque growth.
authors.affiliation: aCardiovascular Research Foundation bColumbia University Medical Center cIcahn School of Medicine at Mount Sinai, New York, New York dSt. Luke's Hospital, Kansas City, Missouri, USA eCardiovascular Center Aalst, OLV Hospital, Aalst, Belgium fErasmus University Medical Center, Rotterdam, The Netherlands.
authors.forename: Shinji
authors.initials: S
authors.lastname: Inaba
authors.forename: Gary S
authors.initials: GS
authors.lastname: Mintz
authors.forename: Takehisa
authors.initials: T
authors.lastname: Shimizu
authors.forename: Giora
authors.initials: G
authors.lastname: Weisz
authors.forename: Roxana
authors.initials: R
authors.lastname: Mehran
authors.forename: Steven P
authors.initials: SP
authors.lastname: Marso
authors.forename: Ke
authors.initials: K
authors.lastname: Xu
authors.forename: Bernard
authors.initials: B
authors.lastname: de Bruyne
authors.forename: Patrick W
authors.initials: PW
authors.lastname: Serruys
authors.forename: Gregg W
authors.initials: GW
authors.lastname: Stone
authors.forename: Akiko
authors.initials: A
authors.lastname: Maehara
mesh_terms: D000368:Aged; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging* / Q000628:therapy; D003331:Coronary Vessels / Q000000981:diagnostic imaging*; D018450:Disease Progression; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D062645:Percutaneous Coronary Intervention; D010641:Phenotype; D058226:Plaque, Atherosclerotic; D011237:Predictive Value of Tests; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional