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CLINICAL RESEARCH: ATHEROSCLEROSIS

Remodeling Index Compared to Actual Vascular Remodeling in Atherosclerotic Left Main Coronary Arteries as Assessed With Long-Term (12 Months) Serial Intravascular Ultrasound

Clemens von Birgelen, MD, PhD^_*,_*, Marc Hartmann, MD^_*, Gary S. Mintz, MD, FACC, Dirk Böse, MD, Holger Eggebrecht, MD, Till Neumann, MD, Mario Gössl, MD, Heinrich Wieneke, MD, Axel Schmermund, MD, Martin G. Stoel, MD^_*, Patrick M.J. Verhorst, MD, PhD^_* and Raimund Erbel, MD, FACC

^_* Medisch Spectrum Twente, Department of Cardiology, Enschede, the Netherlands
Essen University, Department of Cardiology, Essen, Germany
Cardiovascular Research Foundation, New York, New York.

Manuscript received July 28, 2005; revised manuscript received October 26, 2005, accepted November 8, 2005.

^_* Reprint requests and correspondence: Dr. Clemens von Birgelen, Medisch Spectrum Twente, Thoraxcenter Twente, Cardiology Department, Haaksbergerstraat 55, 7513 ER Enschede, the Netherlands. (Email: von.birgelen{at}12move.nl).

OBJECTIVES: We present the remodeling index (RI) versus serial intravascular ultrasound (IVUS) data.

BACKGROUND: The RI, derived by comparing lesion external elastic membrane (EEM) cross-sectional area versus the reference at one time point, is used in various IVUS studies as a substitute of true remodeling (change in EEM over time), assuming that it represents true remodeling.

METHODS: We studied 46 non-stenotic left main arteries using serial IVUS (follow-up 18 ± 8 months). Plaques were divided into subgroups according to the follow-up RI: follow-up RI >1 (n = 27) versus follow-up RI 1 (n = 19).

RESULTS: Lesions with a follow-up RI >1 had an increase in lumen despite an increase in plaque because of an increase in EEM. Conversely, lesions with a follow-up RI 1 had a reduction in lumen as a result of both a plaque increase and EEM decrease. Overall, the follow-up RI correlated directly with changes in lesion site EEM (baseline-to-follow-up). Although there was no correlation between the follow-up RI and changes in reference EEM area, changes in reference EEM area did correlate directly with changes in lesion EEM area. In nearly 90% of lesions with a follow-up RI >1, there was a previously documented increase in EEM area. Using multivariate linear regression analysis, the follow-up RI was dependent on the baseline RI, the increase in lesion EEM area, and the decrease in reference EEM area. The follow-up RI was not dependent on changes in lesion plaque area.

CONCLUSIONS: The vast majority of left main lesions with a remodeling index >1 had evidence of a previous increase in lesion-site EEM area.

Abbreviations and Acronyms   CSA = cross-sectional area   EEM = external elastic membrane   IVUS = intravascular ultrasound   P&M = plaque and media   RI = remodeling index

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