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. 2000 Sep;84(3):314–319. doi: 10.1136/heart.84.3.314

Coronary artery compliance and adaptive vessel remodelling in patients with stable and unstable coronary artery disease

A Jeremias 1, C Spies 1, N Herity 1, E Pomerantsev 1, P Yock 1, P Fitzgerald 1, A Yeung 1
PMCID: PMC1760936  PMID: 10956298

Abstract

OBJECTIVE—To test the hypothesis that patients with unstable coronary syndromes show accentuated compensatory vessel enlargement compared with patients with stable angina, and that this may in part be related to increased coronary artery distensibility.
DESIGN AND PATIENTS—In 23 patients with unstable coronary syndromes (10 with non-Q wave myocardial infarction and 13 with unstable angina), the culprit lesion was investigated by intravascular ultrasound before intervention. The vessel cross sectional area (VA), lumen area (LA), and plaque area (VA minus LA) were measured at end diastole and end systole at the lesion site and at the proximal and distal reference segments. Similar measurements were made in 23 patients with stable angina admitted during the same period and matched for age, sex, and target vessel. Calculations were made of remodelling index (VA at lesion site ÷ VA at reference site), distensibility index ([(ΔA/A)/ΔP] × 103, where ΔA is the luminal area change in systole and diastole and ΔP the difference in systolic and diastolic blood pressure measured at the tip of the guiding catheter during a cardiac cycle), and stiffness index β ([ln(Psys/Pdias)]/(ΔD/D), where Psys is systolic pressure, Pdias is diastolic pressure, and ΔD is the difference between systolic and diastolic lumen diameters). Positive remodelling was defined as when the VA at the lesion was > 1.05 times larger than at the proximal reference site, and negative remodelling when the VA at the lesion was < 0.95 of the reference site.
RESULTS—Mean (SD) LA at the lesion site was similar in both groups (4.03 (1.8) v 4.01 (1.93) mm2), while plaque area was larger in the unstable group (13.29 (4.04) v 8.34 (3.6) mm2, p < 0.001). Remodelling index was greater in the unstable group (1.14 (0.18) v 0.83 (0.15), p < 0.001). Positive remodelling was observed in 15 patients in the unstable group (65%) but in only two (9%) in the stable group (p < 0.001). Negative remodelling occurred only in two patients with unstable symptoms (9%) but in 17 (74%) with stable symptoms. At the proximal reference segment, the difference in LA between systole and diastole was 0.99 (0.66) mm2 in the unstable group and 0.39 (0.3) mm2 in the stable group (p < 0.001), and the calculated coronary artery distensibility was 3.09 (2.69) and 0.94 (0.83) per mm Hg in unstable and stable patients, respectively (p < 0.001). The stiffness index β was lower in patients with unstable angina (1.95 (0.94) v 3.1 (0.96), p < 0.001).
CONCLUSIONS—Compensatory vessel enlargement occurs to a greater degree in patients with unstable than with stable coronary syndromes, and is associated with increased coronary artery distensibility.


Keywords: coronary artery disease; remodelling; compliance; angina pectoris

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Figure 1  .

Figure 1  

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Comparison of the pulsatile variation of the cross sectional lumen area of a 77 year old male patient with an unstable lesion in his proximal left anterior descending artery (A) and of an age and target vessel matched patient with stable angina (B). The cyclic variation is graphically illustrated in the left panels, with the corresponding intravascular ultrasound images on the right. The change in luminal area over the cardiac cycle is more pronounced in the unstable patient. Empty circles indicate points of measurements. D, diastole; S, systole.

Figure 2  .

Figure 2  

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Cross sectional lumen area (LA), plaque area (PA), and vessel area (VA) are shown for each patient group at the lesion site. Remodelling index (RI) is calculated as VA at the lesion site divided by VA at the proximal reference segment. *p < 0.001. 

Figure 3  .

Figure 3  

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Difference in lumen area (ΔLA, mm2), vessel distensibility (per mm Hg), and β stiffness index (B) at the proximal reference site for each patient group. *p < 0.001. 

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