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Does the extent and direction of arterial remodeling predict subsequent progression of coronary atherosclerosis? A serial intravascular ultrasound study
  1. Ilke Sipahi (sipahii{at}ccf.org)
  1. Cleveland Clinic Foundation, United States
    1. E Murat Tuzcu (tuzcue{at}ccf.org)
    1. Cleveland Clinic Foundation, United States
      1. Keon-Woong Moon
      1. Cleveland Clinic Foundation, United States
        1. Stephen Nicholls
        1. Cleveland Clinic Foundation, United States
          1. Paul Schoenhagen
          1. Cleveland Clinic Foundation, United States
            1. Jay Zhitnik
            1. Cleveland Clinic Foundation, United States
              1. Timothy Crowe
              1. Cleveland Clinic Foundation, United States
                1. Samir Kapadia
                1. Cleveland Clinic Foundation, United States
                  1. Steven Nissen (nissens{at}ccf.org)
                  1. Cleveland Clinic Foundation, United States

                    Abstract

                    Objective Despite the link between positive coronary remodelling and acute ischemic events, no data exist about the impact of arterial remodelling on subsequent progression of coronary atherosclerosis. The objective of this study was to examine whether extent and direction of arterial remodelling are predictors of progression of coronary atherosclerosis.

                    Design, setting & patients From the Reversal of Atherosclerosis with Aggressive Lipid Lowering (REVERSAL) trial, we identified 210 focal coronary lesions (single lesion per patient) with ?50% angiographic diameter stenosis at baseline intravascular ultrasound (IVUS). Remodelling was categorized using the remodeling index.

                    Main outcome measures Lesion sites were matched to the 18 months follow-up IVUS examination and change in atheroma area was calculated. Additionally, change in atheroma volume of the whole imaged artery was calculated.

                    Results There were no relationships between baseline remodelling index and change in atheroma area at the lesion site (r=0.004, p=0.96) or change in atheroma volume in the whole artery (r=0.06, p=0.37). Change in atheroma area was not significantly different in lesions with positive, negative or no remodelling at baseline (0.4±2.1 vs. 0.7±1.7 vs. 0.6±1.8 mm2, p=0.76). Similarly, change in atheroma volume in the whole artery was not significantly different among the three remodelling categories (2.2±25.0 vs. 1.4±31.2 vs. 2.4±27.1 mm3, p=0.98).

                    Conclusions Extent and direction of arterial remodelling do not predict subsequent progression of coronary atherosclerosis. Although positively remodeled lesions are associated with unstable clinical presentation, they are not associated with accelerated progression of atherosclerosis during lipid lowering therapy.

                    • atherosclerosis
                    • coronary artery disease
                    • remodelling
                    • ultrasound

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