Korean Circ J.  2012 Nov;42(11):747-752. 10.4070/kcj.2012.42.11.747.

Positive Vascular Remodeling in Culprit Coronary Lesion is Associated With Plaque Composition: An Intravascular Ultrasound-Virtual Histology Study

• Lee CS
• Seo YH
• Yang DJ
• Kim KH
• Park HW
• Yuk HB
• Lee MS
• Kim WH
• Kwon TG
• Bae JH

• KMID: 2224974
• DOI: http://doi.org/10.4070/kcj.2012.42.11.747

Abstract

BACKGROUND AND OBJECTIVES
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.
SUBJECTS AND 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 mm3/mm vs. 3.04+/-1.79 mm3/mm, p=0.003) and necrotic core volume/lesion length (1.26+/-0.89 mm3/mm vs. 0.90+/-0.66 mm3/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 mm2 vs. 3.61+/-2.30 mm2, p<0.001), dense calcified area (0.73+/-0.69 mm2 vs. 0.46+/-0.43 mm2, p=0.001), and necrotic core area (1.93+/-1.33 mm2 vs. 1.06+/-0.91 mm2, 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.
CONCLUSION
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.

Keyword

Atherosclerosis; Coronary artery; Intravascular ultrasonography

MeSH Terms

Atherosclerosis
Coronary Artery Disease
Coronary Vessels
Humans
Membranes
Multivariate Analysis
Phenobarbital
Ultrasonography, Interventional
Phenobarbital

Figure

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  Fig. 1 Cross-sectional images of virtual histology (VH) intravascular ultrasound (IVUS) from distal to proximal within a same lesion in A (patient with NR) and B (patient with PR). VH-IVUS images in patient with PR (B) shows large amount of necrotic core area throughout the entire lesion length. EEM: external elastic membrane, CSA: cross sectional area.

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  Fig. 2 Volumetric analyses over the entire lesion segment. Fibrous plaque was larger in lesions with positive remodeling (PR) than in lesions negative remodeling (NR) (A). Necrotic core plaque was larger in lesions with PR than in lesions NR (B).

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  Fig. 3 Correlations of remodeling index and (A) fibrous volume, (B) necrotic core volume.

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  Fig. 4 Correlations of remodeling index and (A) fibrous area, (B) fibrofatty area, (C) dense calcium area, (D) necrotic core area at the minimal luminal area site.

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