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.
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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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