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Heart 2001;86:207-211; doi:10.1136/heart.86.2.207
Copyright © 2001 BMJ Publishing Group Ltd & British Cardiovascular Society
Heart 2001;86:207-211 ( August )

Basic research

Relation between coronary artery remodelling (compensatory dilatation) and stenosis in human native coronary arteries A M Varnava, M J Davies

British Heart Foundation Department of Cardiovascular Pathology, St George's Hospital Medical School, Cranmer Terrace, London SW17 ORE, UK

Correspondence to: Dr Varnava avarnava{at}sghms.ac.uk

Accepted 4 April 2001

OBJECTIVES---To investigate the contribution of plaque size and vessel remodelling to coronary artery stenosis and to assess the role of vessel shrinkage (negative remodelling) across a wide range of lesions.
DESIGN---Postmortem study of coronary remodelling in perfusion fixed hearts.
SUBJECTS---24 men and 24 women who died suddenly with coronary artery disease.
MAIN OUTCOME MEASURES---Percentage stenosis, percentage plaque burden, percentage remodelling, and arc of normal vessel were measured and related to age, sex, smoking status, and history of hypertension.
RESULTS---There was a positive relation between percentage stenosis and percentage plaque burden (r = 0.6, p < 0.0001) and an inverse relation between percentage stenosis and percentage remodelling (r = -0.4, p < 0.0001). Multilinear regression modelling showed that luminal stenosis = 1.0 (plaque burden) - 0.4 (vessel remodelling). Remodelling was greater in lesions that would not have been significant at angiography (=< 25% stenosis) than in the remaining lesions (25.9 (26)% v 10.0 (21.1)%, p < 0.0001, respectively) and was reduced in segments with circumferential plaques (12.7 (24.5)% v 20.7 (24.3)% in eccentric plaques, p = 0.001). Remodelling did not correlate with age, sex, or smoking. Negative remodelling was present in 62 lesions with a stenosis > 25% versus 10 lesions with =< 25% stenosis (p < 0.0001). Lesions with negative remodelling had greater plaque burden and luminal stenosis and a reduced arc of normal segment.
CONCLUSION---Outward arterial remodelling negates the stenosing effect of increasing plaque size. Significant coronary stenoses arise from a failure of this outward remodelling in the face of a large plaque burden. Coronary arterial remodelling is unrelated to sex or smoking and is plaque specific.


Keywords: coronary artery disease; vessel remodelling; pathology

© 2001 by Heart
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