The American Journal of Cardiology

1999

DOI: 10.1016/s0002-9149(99)00222-2

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Remodeling of atherosclerotic coronary arteries varies in relation to location and composition of plaque

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Pim J. de Feyter

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Quantitative Coronary Angiography and Intravascular Ultrasou1

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Cited by 63 publications

(30 citation statements)

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“…2 In a study using postmortem histology specimens, IB-IVUS demonstrated high diagnostic accuracy for tissue characterization of coronary plaques and better diagnostic potential for identification of fibrous lesions and lipid pools compared with conventional IVUS. 12 Previous analysis of coronary plaques using IB-IVUS showed that vulnerable plaques causing ACS contain more lipids and are associated with higher plaque burden, rate of eccentricity, and remodeling index, 3 similar to the findings from our study. It has been also reported that patients with metabolic syndrome have a significant increase in the percentage lipid area and percentage lipid volume in mild to moderate coronary lesions compared with those without metabolic syndrome.…”

Section: Discussionsupporting

confidence: 91%

“…9,10 Coronary artery lesions with positive remodeling tend to be more echolucent, softer, and have less calcified plaque than those with negative remodeling. 11, 12 Soft plaques considered to have higher lipid content are found more commonly in patients with ACS than in those with stable AP. 9, 13 However, objective analysis of plaque composition and quantification of each tissue component, such as lipids, calcification and fibrosis, are not feasible with conventional IVUS.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Effect of Vessel Size on Lipid Content of Coronary Plaques Assessed by Integrated Backscatter Intravascular Ultrasound

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et al. 2010

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Circulation Journal Official Journal of the Japanese Circulation Society http://www. j-circ.or.jp ntravascular ultrasound (IVUS) is a useful imaging modality for assessing the morphology of atherosclerotic plaque and the vessel wall. 1 However, objective plaque characterization and quantification of each tissue component are not feasible with conventional IVUS. Recently, Kawasaki et al developed integrated backscatter (IB)-IVUS to assess plaque composition by spectral analysis of the radiofrequency ultrasound backscatter signals, which enables identification of tissue components, such as calcification, lipids, and fibrosis, based on the IB values, as well as visualization of each component in different colors. 2 The relative content of each tissue component of the coronary plaque on a vessel cross-section is automatically quantified. Higher lipid content of coronary plaque assessed by IB-IVUS has been reported to be associated with the presence of acute coronary syndrome (ACS) and metabolic syndrome. 3,4 Analysis of IB ultrasound signals has also shown that the use of statins or pioglitazone can reduce the lipid component in coronary as well as carotid plaques. 5,6 However, there are few data on the direct relationship between coronary artery remodeling, plaque eccentricity, and plaque burden at the percutaneous coronary intervention (PCI) target lesion with plaque composition assessed by IB-IVUS. Recent studies using virtual histology (VH, Volcano Therapeutics, Rancho Cordova, CA, USA) for tissue characterization by analyzing backscattered ultrasound signals showed conflicting results on this issue. 7 Therefore, in the present study, we analyzed the tissue composition of coronary plaques with IB-IVUS and investigated the correlations with various clinical and conventional IVUS parameters. Background: Tissue characterization of coronary plaques is feasible using integrated backscatter intravascular ultrasound (IB-IVUS), and higher lipid content has been found in the target lesions of acute coronary syndrome (ACS). The present study was performed to identify clinical and IVUS parameters that correlate with plaque composition assessed by IB-IVUS. Methods Study Patients

“…2 In a study using postmortem histology specimens, IB-IVUS demonstrated high diagnostic accuracy for tissue characterization of coronary plaques and better diagnostic potential for identification of fibrous lesions and lipid pools compared with conventional IVUS. 12 Previous analysis of coronary plaques using IB-IVUS showed that vulnerable plaques causing ACS contain more lipids and are associated with higher plaque burden, rate of eccentricity, and remodeling index, 3 similar to the findings from our study. It has been also reported that patients with metabolic syndrome have a significant increase in the percentage lipid area and percentage lipid volume in mild to moderate coronary lesions compared with those without metabolic syndrome.…”

Section: Discussionsupporting

confidence: 91%

“…9,10 Coronary artery lesions with positive remodeling tend to be more echolucent, softer, and have less calcified plaque than those with negative remodeling. 11, 12 Soft plaques considered to have higher lipid content are found more commonly in patients with ACS than in those with stable AP. 9, 13 However, objective analysis of plaque composition and quantification of each tissue component, such as lipids, calcification and fibrosis, are not feasible with conventional IVUS.…”

Section: Discussionmentioning

confidence: 99%

Effect of Vessel Size on Lipid Content of Coronary Plaques Assessed by Integrated Backscatter Intravascular Ultrasound

¹

,

²

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et al. 2010

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Circulation Journal Official Journal of the Japanese Circulation Society http://www. j-circ.or.jp ntravascular ultrasound (IVUS) is a useful imaging modality for assessing the morphology of atherosclerotic plaque and the vessel wall. 1 However, objective plaque characterization and quantification of each tissue component are not feasible with conventional IVUS. Recently, Kawasaki et al developed integrated backscatter (IB)-IVUS to assess plaque composition by spectral analysis of the radiofrequency ultrasound backscatter signals, which enables identification of tissue components, such as calcification, lipids, and fibrosis, based on the IB values, as well as visualization of each component in different colors. 2 The relative content of each tissue component of the coronary plaque on a vessel cross-section is automatically quantified. Higher lipid content of coronary plaque assessed by IB-IVUS has been reported to be associated with the presence of acute coronary syndrome (ACS) and metabolic syndrome. 3,4 Analysis of IB ultrasound signals has also shown that the use of statins or pioglitazone can reduce the lipid component in coronary as well as carotid plaques. 5,6 However, there are few data on the direct relationship between coronary artery remodeling, plaque eccentricity, and plaque burden at the percutaneous coronary intervention (PCI) target lesion with plaque composition assessed by IB-IVUS. Recent studies using virtual histology (VH, Volcano Therapeutics, Rancho Cordova, CA, USA) for tissue characterization by analyzing backscattered ultrasound signals showed conflicting results on this issue. 7 Therefore, in the present study, we analyzed the tissue composition of coronary plaques with IB-IVUS and investigated the correlations with various clinical and conventional IVUS parameters. Background: Tissue characterization of coronary plaques is feasible using integrated backscatter intravascular ultrasound (IB-IVUS), and higher lipid content has been found in the target lesions of acute coronary syndrome (ACS). The present study was performed to identify clinical and IVUS parameters that correlate with plaque composition assessed by IB-IVUS. Methods Study Patients

“…This concept was initially described by Glagov et al (1) in a postmortem, histopathological study and confirmed by in vivo studies using intracoronary ultrasound (IVUS) analysis (2)(3)(4)(5)(6)(7). Two different patterns of coronary remodeling have been described: a compensatory enlargement of the vessel in response to an increase of atherosclerotic plaque (positive remodeling) and a failure to enlarge or even vessel shrinkage (negative remodeling).…”

mentioning

confidence: 92%

Vessel Shrinkage as a Sign of Atherosclerosis Progression in Type 2 Diabetes

Jiménez‐Quevedo

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et al. 2009

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OBJECTIVE-The aim of this study was to determine the natural history of vascular remodeling of atherosclerotic plaques in patients with type 2 diabetes and the predictors of vessel shrinkage.RESEARCH DESIGN AND METHODS-In this serial intracoronary ultrasound (IVUS) study, 237 coronary segments from 45 patients enrolled in the DIABETES I, II, and III trials were included. Quantitative volumetric IVUS analyses (motorized pullbacks at 0.5 mm/s) were performed in the same coronary segment after the index procedure and at the 9-month follow-up. Nontreated mild lesions (angiographic stenosis Ͻ25%) with Ն0.5 mm plaque thickening and length of Ն5 mm assessed by IVUS were included. Vessel shrinkage was defined as a ⌬external elastic membrane area/⌬plaque area Ͻ 0. Statistical adjustment by multiple segments and multiple lesions per patient was performed.RESULTS-Vessel shrinkage was identified in 37.1% of segments and was associated with a significant decrease in lumen area at 9 months (vessel shrinkage, 10 Ϯ 4 mm 2 vs. non-vessel shrinkage, 11 Ϯ 4 mm 2 ; P ϭ 0.04). Independent predictors of vessel shrinkage were insulin requirements (odds ratio 4.6 [95% CI 1.40 -15.10]; P ϭ 0.01), glycated hemoglobin (1.5 [1.05-2.10]; P ϭ 0.02), apolipoprotein B (0.96 [0.94 -0.98]; P Ͻ 0.001), hypertension (3.7 [1.40 -10.30]; P ϭ 0.009), number of diseased vessels (5.6 [2.50 -12.50]; P Ͻ 0.001), and prior revascularization (17.5 [6.50 -46.90]; P Ͻ 0.001).CONCLUSIONS-This serial IVUS study suggests that progression of coronary artery disease in patients with type 2 diabetes may be mainly attributed to vessel shrinkage. Besides, vessel shrinkage is influenced by insulin requirements and metabolic control and is associated with more advanced coronary atherosclerosis. Diabetes 58:209-214, 2009 C oronary artery remodeling is a phenomenon by which vessel dimension changes in response to atherosclerotic plaque accumulation. This concept was initially described by Glagov et al. (1) in a postmortem, histopathological study and confirmed by in vivo studies using intracoronary ultrasound (IVUS) analysis (2-7). Two different patterns of coronary remodeling have been described: a compensatory enlargement of the vessel in response to an increase of atherosclerotic plaque (positive remodeling) and a failure to enlarge or even vessel shrinkage (negative remodeling). The latter is a common finding in coronary stenosis of diabetic patients (8,9). In cross-sectional studies, negative remodeling has been associated with coronary risk factors, such as hypertension (5) and smoking (4), with the type of plaque (2,7) (calcified, hard plaques), and with metabolic control in diabetic patients (10 -12). In most studies, remodeling has been evaluated only at a single time point. Therefore, the natural history of this process has not been properly addressed. In addition, remodeling index has been assessed by comparing vessel dimension at target site and that at the most normal-looking cross-section within 10 mm from the lesion taken as reference segment (2-7). Howev...

“…11 Previous studies using necropsy specimens or gray-scale IVUS have consistently found a large lipid burden in positive remodeling lesions, [12][13][14] but the role of calcium deposition in coronary artery remodeling is still controversial. 4,[13][14][15][16] In the present study, we used spectral analysis of IVUS RF data to evaluate the relationship between coronary artery remodeling and culprit plaque composition in patients undergoing percutaneous coronary intervention (PCI) in order to confirm the findings of previous studies on lipid burden and to elucidate the role of calcium deposition.…”

mentioning

confidence: 93%

Relationship Between Coronary Artery Remodeling and Plaque Composition in Culprit Lesions An Intravascular Ultrasound Radiofrequency Analysis

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et al. 2007

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any clinical studies have shown that coronary arteries respond to plaque growth by either outward expansion of the vessel wall (positive remodeling) 1-3 or vessel shrinkage (negative remodeling). 4,5 The difference in plaque morphology between positive and negative remodeling lesions in vivo has been investigated in several clinical studies using intravascular ultrasound (IVUS), but it is difficult to evaluate the detailed plaque composition with gray-scale IVUS.Recently, spectral analysis of IVUS radiofrequency (RF) data was shown to provide detailed quantitative and qualitative information on coronary plaque composition in vivo. [6][7][8][9] A preliminary in vitro study showed that 4 components (eg, fibrous, fibrofatty, dense calcium components, and necrotic core) correlated with a specific spectrum of the RF signal. 10 Nasu et al used a color-coded mapping method by Virtual Histology (VH) that was able to identify atherosclerotic plaque composition of human coronary arteries in vivo. 11 Previous studies using necropsy specimens or gray-scale IVUS have consistently found a large lipid burden in positive remodeling lesions, 12-14 but the role of calcium deposition in coronary artery remodeling is still controversial. 4,[13][14][15][16] In the present study, we used spectral analysis of IVUS RF data to evaluate the relationship between coronary artery remodeling and culprit plaque composition in patients undergoing percutaneous coronary intervention (PCI) in order to confirm the findings of previous studies on lipid burden and to elucidate the role of calcium deposition. Methods Patients and LesionsBetween June 2005 and January 2006, a pre-interventional IVUS examination was performed prospectively in 93 consecutive de novo culprit lesions of 81 patients undergoing PCI; 18 lesions were excluded from analyses because we could not cross the lesion completely with the IVUS transducer; the images of 6 lesions could not be analyzed because of poor image quality; and for 13 lesions, no proximal reference site could be defined because the lesion involved the ostium (n=3) or a bifurcation (n=10). Finally, IVUS RF analyses were performed for 56 culprit lesions of 52 patients.Informed, written consent was given by all the patients. DefinitionsHyperlipidemia was defined as total cholesterol level ≥220 mg/dl, high-density lipoprotein cholesterol level <40 mg/dl, triglyceride level ≥150 mg/dl, low-density lipoprotein (LDL) level ≥140 mg/dl, or/and lipid-lowering medication use. Hypertension was defined as systolic blood pressure ≥140 mmHg, diastolic blood pressure ≥90 mmHg, or/and use of an antihypertensive drug. Diabetes mellitus was defined by a previous physician's diagnosis and treatment with diet, oral hypoglycemic agents, or insulin.Circ J 2007; 71: 654 -660 (Received September 13, 2006; revised manuscript received January 15, 2007; accepted February 9, 2007

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