ABSTRACT
@#Objective To initially evaluate the coronary arterial remodeling of the patients with coronary artery disease by use of intravascular unltrasound(IVUS).Methods 28 consecutive patients with coronary artery disease were randomly divided into the acute coronary syndrome(ACS)group(n=18)and stable angina group(n=10).The area of plaques,the area of extra-elasticity membrane(EEM)of vascellum and plaque burden as well as remodeling index(RI)of coronary arteries were measured by IVUS in two groups.The plasma levels of high sensitivity C-reactive protein(hs-CRP),matrix metalloproteinase(MMP,including MMP-2 and MMP-9),CD40 ligand(CD40L)and pregnancy associated plasma protein-A(PAPP-A)were measured by ELISA.Results The area of plaques(P=0.000),the area of EEM(P=0.003)and plaque burden of "criminal" lesions(P=0.037)in the patients of the ACS group increased more significantly than that of the control group.The incidence of high-risk plaques(P=0.028)and RI(P=0.015)in the ACS group increased more significantly than that of the control group.The positive remodeling was more common in the ACS group(P=0.040),while negative remodeling in the control group(P=0.039).The plasma levels of MMP-2(P=0.011),MMP-9(P=0.001)Pand CD40L(P=0.034)in the high-risk plaques group were significantly higher than those in the non-high-risk plaques group.There were no significant differences of the plasma levels of hs-CRP(P=0.190),MMP-2(P=0.255),MMP-9(P=0.574),CD40L(P=0.342),PPAP-A(P=0.403)and the incidence of high-risk plaques(P=0.566)in the positive and negative as well as none remodeling groups.Regression analysis showed that only the regression coefficient of ACS and stable angina by RI were significant(P<0.05),the Pregression equation was RI=0.179-0.131 group(group stands for ACS group and stable angina group).Conclusion The clinical types of coronary artery disease may be an independent predictor of the coronary arterial remodeling measured by IVUS.
ABSTRACT
Objective To invastigate the presence of coronary artery remodeling in acute myocardial infarction(AMI)patients by intracoronary ultrasound(ICUS). Methods Before percutaneous coronary intervention(PCI),sixty five AMI patients were divided into two groups according to two types of arterial remodeling by ICUS.Emergency PCI group had 28 patients and delayed PCI group had 37 patients.Positive remodeling(PR) or negative remodeling(NR)was considered present when the vessel cross sectional area at the lesion site was larger than the proximal cross sectional area or smaller than the distal cross sectional area, respectively. Results Twenty nine patients( 44.6 %) showed PR and 36( 55.4 %)showed NR. Incidence of essential hypertension was higher in NR patients than that in PR ones among risk factors of coronary artery disease.Soft plaques( 83.1 %)(Va+Vb stage lesion in paticular) were main lesions in two type of remodelings and eccentric plaque more common in PR patients( 93.1 % vs 63.8 %,P
ABSTRACT
BACKGROUND: Adaptive remodeling of the wall of diseased arterial segments occurs to compensate for the accumulation of atherosclerotic plaque. Histopathologic studies and intraoperative high-frequency epicardial coronary ultrasound imaging as well as intracoronary ultrasound imaging have shown that human coronary arteries enlarge in parallel with the formation of atherosclerotic plaque. Therefore, the lumen area is preserved until the progressive accumulation of plaque exceeds the compensatory mechanisms of the vessel. In 1995, however, Pastercamp et al. reported that arterial wall constriction (shrinkage) or inadequate enlargement may be a different mechanism associated with the development of severe arterial lumen narrowing in addition to plaque proliferation. The aim of this study is to examine what extent of de novo native coronary arterial stenosis is accompanied by compensatory enlargement and to find the predictors of inadequate remodeling with intravascualr ultrasound. METHODS: Fifty eight patients were enrolled from February 1997 through October 1997. Patients who had the lesion of more than 50% stenosis of minimal luminal diameter in coronary angiography were indicated. The lesion which was located in the ostium or was very tortuous or angulated was excluded. The lesion which had the history of balloon angioplasty or stent insertion was also excluded. We used 20 MHz endosonic intravascular ultrasound catheter. We measured EEM area (External Elastic Membrane area), lumen area and plaque plus media area and analysed plaque characteristics. RESULTS: 1) Fifty-eight consecutive patients (43 men, 15 women; mean age 55.4 years, range 33 to 78) who had not undergone previous catheter intervention were studied with a single intravascular ultrasound system. 2) Among 58 patients, 20 patients (35%) had acute myocardial infarction, 30 patients (52%) unstable angina, 6 patients (10%) stable angina and 2 patients (3%) old myocardial infarction. Lesions were located at the left anterior descending arteries in 29 patients (50%), right coronary arteries in 21 patients (36%) and left circumflex coronary artery in 8 patients (14%). 3) Compensatory enlargement was observed in 19 (32%) of 58 lesions and inadequate compensatory enlargement in 39 (68%). 4) EEM and plaque areas at lesion site of compensatory enlargement group were significantly larger than those of inadequate enlargement group (p240 mg/dl), smokings and plaque characteristics were not statistically related with inadequate enlargement. Although there was no statistical significance, there was a tendency of inadequate enlargement in patients with diabetes mellitus and calcified plaque. 6) The only predictor of inadequate remodeling was the postmenopausal female (p<0.05). CONCLUSION: Adaptive compensatory coronary arterial remodeling was occured less frequently in patients with acute coronary syndromes than in patients with stable angina. The only statistically significant predictor of adaptive compensatory coronary arterial remodeling was postmenopausal women. Inadequate compensatory coronary arterial remodeling was occured more frequently in patients with diabetes mellitus or calcified plaque but without statistical significance.