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  • Title: Remodeling index compared to actual vascular remodeling in atherosclerotic left main coronary arteries as assessed with long-term (> or =12 months) serial intravascular ultrasound.
    Author: von Birgelen C, Hartmann M, Mintz GS, Böse D, Eggebrecht H, Neumann T, Gössl M, Wieneke H, Schmermund A, Stoel MG, Verhorst PM, Erbel R.
    Journal: J Am Coll Cardiol; 2006 Apr 04; 47(7):1363-8. PubMed ID: 16580523.
    Abstract:
    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 < or =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 < or =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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