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Intravascular ultrasound evaluation of coronary plaque regression by low density lipoprotein-apheresis in familial hypercholesterolemia

The Low Density Lipoprotein-Apheresis Coronary Morphology and Reserve Trial (LACMART)

Masunori Matsuzaki, MD, PhD, FACC^*,*, Katsuhiko Hiramori, MD, PhD, Tsutomu Imaizumi, MD, PhD, FACC, Akira Kitabatake, MD, PhD, FACC, Hitoshi Hishida, MD, PhD^¶, Masanori Nomura, MD, PhD^||, Takashi Fujii, MD, PhD^*, Ichiro Sakuma, MD, PhD, Kenichi Fukami, MD, PhD, Takashi Honda, MD, PhD^¶, Hiroshi Ogawa, MD^# and Masakazu Yamagishi, MD, PhD, FACC^**

^* Division of Cardiovascular Medicine, Department of Medical Bioregulation, Yamaguchi University School of Medicine, Yamaguchi, Japan
Second Department of Internal Medicine, Iwate Medical University School of Medicine, Iwate, Japan
Department of Internal Medicine III, Kurume University School of Medicine, Fukuoka, Japan
Department of Cardiovascular Medicine, Hokkaido University Graduate School of Medicine, Hokkaido, Japan
^|| Department of Internal Medicine, Fujita Health University School of Medicine, Nagoya, Japan
^¶ Cardiovascular Center, Saiseikai Kumamoto Hospital, Kumamoto, Japan
^# Cardiovascular Medicine, Tokuyama Chuo Hospital, Yamaguchi, Japan
^** Cardiology Division of Medicine, National Cardiovascular Center, Osaka, Japan

View larger version (30K): [in a new window]   Figure 1 Net change in coronary angiogram and intravascular ultrasound parameters. The open columns show the medication (med) group and the solid columns the low density lipoprotein-apheresis (LDL-A) group. Net changes of minimal lumen diameter (MLD) (0.12 ± 0.43 mm in the LDL-A vs. –0.08 ± 0.45 mm in the medication group, p = 0.004) during one-year follow-up showed significant differences in both the LDL-A group and the medication group. The average net change of MLD was positive in the LDL-A group, whereas it was negative in the medication group (A). Net changes of plaque area (–0.69 ± 2.08 mm2 in the LDL-A vs. 0.88 ± 1.75 mm2 in the medication group, p = 0.008) were also significantly different between the LDL-A group and the medication group. The average net change of plaque area was negative in LDL-A subjects, while it was positive in medication subjects (B). No significant differences were seen in net change of lumen area (C, p = 0.13) and vessel area (D, p = 0.26) between the two groups.

View larger version (112K): [in a new window]   Figure 2 Representative examples of coronary angiograms and intravascular ultrasound (IVUS) images are shown in a patient treated with combined low density lipoprotein-apheresis and cholesterol-lowering drugs for one year. In coronary angiograms (A and B in baseline and follow-up, respectively), the minimal lumen diameter (MLD) at the left anterior descending coronary artery (LAD) increased from 1.5 to 2.2 mm. Panels C and D show the same portion using IVUS imaging. The plaque area was decreased from 7.8 to 7.0 mm2, which was associated with an increase in the lumen area from 3.3 to 5.3 mm2. The vessel area also changed, from 11.1 to 12.3 mm2. The image in D2 is the second diagonal branch as the reference vessel.