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Pasterkamp2

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Pasterkamp2

  1. 1. Definitions of arterial remodeling in post mortem and Intravascular ultrasound research G. Pasterkamp Experimental Cardiology, UMC and Interuniversity cardiology Institute of the Netherlands, Utrecht, The Netherlands
  2. 2. Arterial remodeling Gradual Luminal narrowing Expansive remodeling Constrictive remodeling Glagov et al. New Engl J Med 1987;316:1371-1375 Pasterkamp et al. Circulation 1995;91:1444-1449
  3. 3. Background In international literature, the modes of arterial geometrical remodeling are differentially defined resulting in different prevalence numbers. The current presentation will show and discuss the most widely used definitions
  4. 4. L = Lesion R1 = most proximal site R2 = proximal reference with normal lumen and least amount of plaque R3 = distal reference with normal lumen and least amount of plaque lumen plaque LR2 R3R1
  5. 5. Definition 1 Remodeling Index (RI)= VA L / ( (VA R2 + VA R3)/2) lumen plaque LR2 R3R1 Expansive remodeling when RI >1.05 Intermediate remodeling when RI >0.95 or < 1.05 Constrictive remodeling when RI <0.95 Smits et al. Heart 1999;82:461-464 von Birgelen et al. J Am Coll Cardiol 2001;37:1864-1870. Schoenhagen et al. Circulation 1999;101:598-603
  6. 6. Definition 2 RI= VA L / ( (VA R2 + VA R3)/2) lumen plaque LR2 R3R1 Expansive remodeling when RI >1.0 Constrictive remodeling when RI <1.0 Dangas et al. Circulation 1999;99:3149-3154. Nakamura et al. J Am Coll Cardiol. 2001 Jan;37(1):63-9 Okura et al. J Am Coll Cardiol 2001;37:1031-1035.
  7. 7. Definition 3 lumen plaque LR2 R3R1 Expansive remodeling when VA L > VA R2 and VA L > VA R3 Constrictive remodeling when VA L < VA R2 and VA L < VA R3 Other values: intermediate remodeling Nishioka et al. J Am Coll Cardiol 1996;27:1571-1576 Wexberg et al. J Am Coll Cardiol 2000;36:1860-1869.
  8. 8. Definition 4 lumen plaque Expansive/no remodeling when VA L / VA R2 > 0.78 Constrictive remodeling when VA L / VA R2 < 0. 78 Mintz et al Circulation 1997;95:1791-1798. Upper limit of normal tapering over 10 mm never exceeds 21% of vessel area reference limit at 0.78 LR2 R3R1
  9. 9. Definition 5 RI= VA L / ( VA R1) lumen plaque LR2 R3R1 Expansive remodeling when RI >1.0 Constrictive remodeling when RI <1.0 Taylor et al. J Am Coll Cardiol 1999 Sep;34(3):760-7
  10. 10. Definition 6 RI = VA L / VA R2 (site with least amount of plaque lumen plaque LR2 R3R1 Expansive remodeling when RI > 1.05 Constrictive remodeling when RI < 0.95 Other values: intermediate remodeling Pasterkamp et al. J Am Coll Cardiol 1995;26:422-428. (Only applied peripheral arteries)
  11. 11. Remodeling definitions lead to large variations in prevalence numbers. expansive remodeling intermediate remodeling constrictive remodeling definition remodeling Mintz et al 512 (85%) 91 (15%) 4 Nishioka et al 19 (53%) 7 (20%) 9 (27%) 3 Smits et al 24 (35%) 16 (23%) 29 (42%) 1 Wexberg et al 70 (29%) 110 (45%) 64 (26%) 3 Dangas et al. 269 (42%) 377 (58%) 2 Nakamura et al. 68 (54%) 57 (46%) 2 Okura et al. 59 (55%) 49 (45%) 2 Von Birgelen et al. 38 (48%) 22 (28%) 19 (24%) 1 Pasterkamp et al. 226 (37%) 383 (63%) 2 Schoenhagen et al. 70 (53%) 26 (20%) 35 (27%) 1
  12. 12. Which definition is best? All studies are cross-sectional The reference is not free of atherosclerotic disease The reference may have been remodeled in either direction We do not know which definition gives us the best estimate of the prevalence of the different remodeling modes.
  13. 13. Which definitions make sense? • Definitions 1-4 share the same receipt, only the tresholds differ. • Definition 5 may be used in casuistic studies, but in larger studies on prevalence this definition should not be used (it will, by definition, approximate the 50% for each remodeling mode) • Definition 6 can only be used in non tapering vessels.
  14. 14. Conclusion • The prevalence of constrictive and expansive remodeling differs widely in literature due to the application of different definitions. • Without serial studies, there is no gold standard for the reference site. • The definition of the remodeling modes merit careful consideration when prevalences are mentioned.

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