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CLINICAL RESEARCH: CARDIAC IMAGING

Positive Remodeling of the Coronary Arteries Detected by Magnetic Resonance Imaging in an Asymptomatic Population

MESA (Multi-Ethnic Study of Atherosclerosis)

Cuilian Miao, MD^_*, Shaoguang Chen, MS, Robson Macedo, MD^_*, Shenghan Lai, MD, Kiang Liu, MD, Debiao Li, PhD^||, Bruce A. Wasserman, MD^_*, Jens Vogel-Clausen, MD^_*, João A.C. Lima, MD^_*, and David A. Bluemke, MD, PhD^¶,_*

^_* Department of Radiology and Radiological Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland
Department of Medicine, Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, Maryland
Department of Preventive Medicine, Northwestern University Medical School, Chicago, Illinois
^|| Department of Radiology, Northwestern University Medical School, Chicago, Illinois
^¶ Radiology and Imaging Sciences, National Institutes of Health, Bethesda, Maryland

Manuscript received October 26, 2008; revised manuscript received December 11, 2008, accepted December 22, 2008.

^_* Reprint requests and correspondence: Dr. David A. Bluemke, MRI Room 143 (Nelson Basement), The Johns Hopkins Hospital, 600 North Wolfe Street, Baltimore, Maryland 21287 (Email: dbluemke{at}jhmi.edu).

Objectives: The purpose of this study was to assess coronary arterial remodeling as a marker of subclinical atherosclerosis using coronary wall magnetic resonance imaging (MRI) in an asymptomatic population-based cohort.

Background: In early atherosclerosis, compensatory enlargement of both the outer wall of the vessel as well as the lumen, termed compensatory enlargement or positive remodeling, occurs before luminal narrowing.

Methods: One hundred seventy-nine participants in the MESA (Multi-Ethnic Study of Atherosclerosis) trial were evaluated using black-blood coronary wall MRI. Coronary cross-sectional area (vessel size), lumen area, and mean wall thickness of the proximal coronary arteries were measured.

Results: Men had a greater vessel size, lumen area, and mean wall thickness than women (38.3 ± 11.3 mm² vs. 32.6 ± 9.4 mm², 6.7 ± 3.2 mm² vs. 5.3 ± 2.4 mm², and 2.0 ± 0.3 mm vs. 1.9 ± 0.3 mm, respectively, p < 0.05). No significant coronary artery narrowing was present by magnetic resonance angiography. Overall, coronary vessel size increased 25.9 mm² per millimeter increase in coronary wall thickness, whereas lumen area increased only slightly at 3.1 mm² for every millimeter increase in wall thickness (difference in slopes, p < 0.0001). Adjusting for age and sex, participants with an Agatston score >0 were more likely to have wall thickness >2.0 mm (odds ratio: 2.0, 95% confidence interval: 1.01 to 3.84).

Conclusions: Coronary wall MRI detected positive arterial remodeling in asymptomatic men and women with subclinical atherosclerosis.

Key Words: subclinical atherosclerosis • magnetic resonance imaging • coronary artery disease • plaque

Abbreviations and Acronyms   3D = 3-dimensional   CAC = coronary artery calcium   CAD = coronary artery disease   CT = computed tomography   IMT = intima-media thickness   LAD = left anterior descending coronary artery   LM = left main coronary artery   LV = left ventricle/ventricular   MDCT = multidetector computed tomography   MRA = magnetic resonance angiogram   MRI = magnetic resonance image/imaging   RCA = right coronary artery

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