This Article Figures Only Full Text Full Text (PDF) All Versions of this Article: j.jacc.2005.11.040v1 47/5/992    most recent Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Nicholls, S. J. Articles by Nissen, S. E. Search for Related Content PubMed PubMed Citation Articles by Nicholls, S. J. Articles by Nissen, S. E.

CLINICAL RESEARCH: ATHEROSCLEROSIS

Relationship Between Atheroma Regression and Change in Lumen Size After Infusion of Apolipoprotein A-I Milano

Department of Cardiovascular Medicine, The Cleveland Clinic Foundation, Cleveland, Ohio

Manuscript received August 1, 2005; revised manuscript received September 19, 2005, accepted September 26, 2005.

^_* Reprint requests and correspondence: Dr. Steven E. Nissen, Department of Cardiovascular Medicine/F15, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, Ohio 44195 (Email: nissens{at}ccf.org).

OBJECTIVES: The aim of this study was to determine the relationship between atheroma regression and arterial wall remodeling.

BACKGROUND: Infusion of reconstituted high-density lipoprotein (rHDL) containing recombinant apolipoprotein A-I Milano (AIM) has been reported to promote rapid regression of coronary atherosclerosis. The current study analyzed intravascular ultrasound (IVUS) to define the changes that take place in the arterial wall that accompanied atheroma regression in this study.

METHODS: Forty-seven patients, ages 30 to 75 years, after an acute coronary syndrome were randomized to receive five weekly infusions of placebo or rHDL containing either low- or high-dose AIM. External elastic membrane (EEM) and lumen volumes were compared between coronary IVUS studies at baseline and follow-up.

RESULTS: In comparison with baseline, infusion of rHDL was associated with a 4.6% reduction in EEM volume. Lumen volume did not change. In 10-mm arterial subsegments with the greatest plaque burden at baseline, atheroma volume regressed by 10.9% with a similar reduction in EEM volume but with no change in lumen size. In contrast, EEM and atheroma volume did not change in the 10-mm segments containing the least plaque burden. The reduction in EEM in the most diseased segments was only apparent in subjects who underwent plaque regression. Reduction in EEM volume correlated with the decreased atheroma volume (r = 0.62), but there was no correlation between change in lumen size and change in plaque volume.

CONCLUSIONS: Remodeling of the arterial wall is a focal and heterogeneous process. After infusion of rHDL containing AIM, regression of coronary atherosclerosis is accompanied by reverse remodeling of the EEM, resulting in no change in luminal dimensions.

This article has been cited by other articles:

				B. S. Sutton, R. S. Blumenthal, and N. K. Kapur Letter by Sutton et al Regarding Article, "Effect of Rosuvastatin Therapy on Coronary Artery Stenoses Assessed by Quantitative Coronary Angiography: A Study to Evaluate the Effect of Rosuvastatin on Intravascular Ultrasound-Derived Coronary Atheroma Burden" Circulation, November 25, 2008; 118(22): e707 - e707. [Full Text] [PDF]

				A. A. Sethi, J. A. Stonik, F. Thomas, S. J. Demosky, M. Amar, E. Neufeld, H. B. Brewer, W. S. Davidson, W. D'Souza, D. Sviridov, et al. Asymmetry in the Lipid Affinity of Bihelical Amphipathic Peptides: A STRUCTURAL DETERMINANT FOR THE SPECIFICITY OF ABCA1-DEPENDENT CHOLESTEROL EFFLUX BY PEPTIDES J. Biol. Chem., November 21, 2008; 283(47): 32273 - 32282. [Abstract] [Full Text] [PDF]

				G. L. Weibel, E. T. Alexander, M. R. Joshi, D. J. Rader, S. Lund-Katz, M. C. Phillips, and G. H. Rothblat Wild-Type ApoA-I and the Milano Variant Have Similar Abilities to Stimulate Cellular Lipid Mobilization and Efflux Arterioscler Thromb Vasc Biol, September 1, 2007; 27(9): 2022 - 2029. [Abstract] [Full Text] [PDF]

				N. V. Deshpande, H. M. Mardikar, and D. Deo A Call for Development of Comprehensive Therapy for Dyslipidemia J. Am. Coll. Cardiol., April 3, 2007; 49(13): 1502 - 1502. [Full Text] [PDF]

				B. G. Brown and X.-Q. Zhao Is Intravascular Ultrasound the Gold Standard Surrogate for Clinically Relevant Atherosclerosis Progression? J. Am. Coll. Cardiol., March 6, 2007; 49(9): 933 - 938. [Abstract] [Full Text] [PDF]

				P. K. Shah Inhibition of CETP as a novel therapeutic strategy for reducing the risk of atherosclerotic disease Eur. Heart J., January 1, 2007; 28(1): 5 - 12. [Abstract] [Full Text] [PDF]