Measurement by intracoronary ultrasound of in vivo arterial distensibility within atherosclerotic lesions

doi:10.1016/0002-9149(93)90289-O

The American Journal of Cardiology

Volume 72, Issue 17, 1 December 1993, Pages 1232-1237

https://doi.org/10.1016/0002-9149(93)90289-O Get rights and content

Abstract

Arterial distensibility is diminished by atherosclerosis. This process has not been well studied in the coronary arteries. The purpose of this study was to assess changes in coronary arterial distensibiltty in 4 groups of patients. Group I (n = 20) consisted of patients with normal vessels, group II (n = 40) with diseased undilated vessels, group III (n = 15) after successful percutaneous transluminal coronary angioplasty (PTCA), and Group IV (n = 20) after successful directional coronary atherectomy CDCA). Intracoronary ultrasound imaging was used to assess distensibiltty, plaque morphology and atherosclerotic burden (expressed as the percentage of total vessel cross-sectional area occupied by plaque: percent plaque area). Distensibility was defined as percent change in lumen area in a cardiac cycle. Group I (normal vessels) had a distensibility = 14 ± 5%, which was significantly greater than that seen in group II (distensibiltty = 4 ± 2%, p < 0.001). In undilated vessels, distensibiltty was related to the degree of atherosclerotic burden (r = 0.75). This relation was curvilinear with a marked decrease in distensibility when percent plaque area exceeded 30%. Distensibility in group III (after PTCA) was higher than in group II (10 ± 3 vs 4 ± 2%, p < 0.001) despite a larger plaque burden (percent plaque area of 56 ± 12 vs 46 ± 11%, p < 0.005). The distensibility in group IV (after DCA) was also higher than in group II (8 ± 4 vs 4 ± 2%, p < 0.001) despite a similar residual percent plaque area (49 ± 13 vs 46 ± 11%, p = NS). After PTCA, hard lesions had greater distensibility than soft lesions (distensibility = 11 ± 3 vs 8 ± 2%, p = 0.04), whereas after DCA hard lesions had less distensibility than soft lesions (distensibility = 6 ± 4 vs 10 ± 4%, p = 0.04). In conclusion, arterial distensibility is decreased by atherosclerosis wtth a marked reduction in even minimally diseased vessels. PTCA and DCA result in an increase in arterial distensibility at the site of the treated lesion. Hard lesions have greater distensibility after PTCA, suggesting greater plaque disruption in these lesions than in soft lesions. Hard lesions have less distensibiltty after DCA, consistent wtth less effective plaque cutting and removal in these lesions than in soft lesions. It is concluded that the study of arterial distensibiltty by intracoronary ultrasound provides insights into the mechanisms of interventional therapy and may be useful for the assessment of early atherosclerosis.

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Cited by (25)

Accuracy of Stent Measurements Using ECG-Gated Greyscale Intravascular Ultrasound Images: A Validation Study
2009, Ultrasound in Medicine and Biology
Citation Excerpt :
IVUS has shown that epicardial coronary lumen areas increase during systole, despite the fact that the majority of coronary blood flow occurs during diastole (Weissman et al. 1995). This finding is consistent with animal model data and is thought to be due to the increase in intracoronary pressure (Reddy et al. 1993; Vatner et al. 1980). Standard greyscale IVUS acquires images throughout diastole and systole, whereas R-wave ECG-gated greyscale IVUS only acquires images during systole.
Greyscale intravascular ultrasound (IVUS) is an accurate tool for measuring stent dimensions and residual disease at the stent edge. Electrocardiographically (ECG)-gated IVUS is used in evolving second-generation IVUS systems, but this modality provides fewer greyscale cross-sectional images, and its accuracy to measure stent dimensions has not been assessed. This study was designed to validate the use of ECG-gated greyscale IVUS in measuring minimum stent area (MSA), stent length and reference dimensions compared to standard greyscale IVUS data. IVUS imaging was performed after drug-eluting stent implantation in 53 target lesions in 48 patients with acute coronary syndrome. The IVUS catheter was mechanically withdrawn at 0.5 mm/s, standard greyscale images were collected at 10 frames/s, and ECG-gated greyscale images were constructed from R-wave gated images. The MSA measured 6.20 ± 1.75 mm²vs. 5.98 ± 1.55 mm² on standard greyscale and ECG-gated greyscale IVUS, respectively (R² = 0.91, p = 0.005). The MSA position (R² = 0.66, p = 0.179) and stent length (R² = 0.99, p = 0.435) measurements were similar between modalities. Proximal reference vessel area was larger by ECG-gated IVUS, but proximal reference lumen and distal reference measurements were similar. Bland-Altman plots demonstrated good agreement between modalities. In conclusion, ECG-gated greyscale IVUS provides accurate and reliable measurements of stent length, area and reference segment plaque burden after stent implantation and is not inferior to standard greyscale IVUS. (E-mail: [email protected] or [email protected]).
Determinants of coronary artery compliance in subjects with and without angiographic coronary artery disease
2002, Journal of the American College of Cardiology
Citation Excerpt :
In addition, we observed coronary C to be greater in subjects early after T. Previous studies using IVUS have established a systolic expansion in the cross-sectional area of major coronary arteries (8,9,14,15). There are a number of possible determinants of coronary expansion.
The goal of this study was to determine factors contributing to the biomechanical properties of coronary arteries in people with and without angiographic coronary artery disease (CAD).
The stiffness of the aorta is known to increase with increasing age and in the presence of CAD. However, little is known about the mechanics of coronary arteries, which may have important clinical consequences.
Intravascular ultrasound was used to determine the mechanical properties of coronary arteries and plaque behavior in subjects with CAD (n = 38), those with chest pain but angiographically normal coronary arteries (N) (n = 9) and those early (<2 weeks) after cardiac transplant (T) (n = 14).
Coronary arteries dilated during systole in all groups, but cross-sectional compliance and distensibility were lowest in the proximal left anterior descending artery (LAD) in the subjects with CAD compared with the N and T groups (compliance: 1.2 ± 0.2 vs. 1.7 ± 0.5 and 2.7 ± 0.6 × 10⁻²mm²mm Hg⁻¹[mean ± SEM] respectively, p < 0.02 CAD vs. T; distensibility: 0.8 ± 0.2 vs. 1.7 ± 0.5 and 1.7 ± 0.3 × 10⁻³mm Hg⁻¹, p < 0.05 CAD vs. T). There was extensive plaque in the CAD group, and plaque was also present in the N group, but minimal atheroma was present in the T group. Plaque cross-sectional area diminished significantly during systole in both the LAD and circumflex arteries. Absolute changes were: 0.50 ± 0.30, 0.33 ± 0.11 and 0.68 ± 0.13 mm²in the proximal LAD, distal LAD and proximal circumflex arteries, respectively. In subjects with atheroma, there was a significant correlation between cross-sectional compliance and plaque compression at all sites, and plaque compression was a significant determinant of cross-sectional compliance at both proximal sites in multiple regression analyses with age, mean arterial pressure and extent of plaque as the other independent variables.
A major determinant of the systolic increase in coronary luminal area in patients with atheroma is a reduction in plaque cross-sectional area during systole.
Mechanical strain stimulates a mitogenic response in coronary vascular smooth muscle cells via release of basic fibroblast growth factor
2001, American Journal of Hypertension
Mechanical strain has been shown to induce mitogenesis in a rat neonatal vascular smooth muscle (VSM) cell line in a response mediated predominantly by transcription, expression, and release of platelet-derived growth factor (PDGF). We examined the effect of cyclic mechanical strain and growth factor production on mitogenic response in ovine coronary artery smooth muscle cells. Vascular smooth muscle cells were cultured from explants of left anterior descending (LAD) coronary arteries from young sheep. Cells for experiments were grown on wells with silicone-elastomer bottoms, and subjected to strain (60 cycles/min) using a vacuum actuated strain device. Tritiated thymidine incorporation was used as a measure of DNA synthesis. Cell membrane damage was assessed with differentially permeable nuclear staining dyes. We observed an increase in tritiated thymidine incorporation in response to strain with a temporal response identical to that observed in response to exogenous growth factors (PDGF-BB and basic fibroblast growth factor [bFGF]). Supernatant medium obtained from stretched cells induced a twofold increase in DNA synthesis in unstretched cells. The mitogenic response was abolished by monoclonal antibodies to bFGF, but not by antibodies to PDGF-AB. Studies of fluorescent dye exclusion indicated the stretching protocol caused no cell membrane damage. Thus, mechanical strain is an important stimulus for growth factor release in coronary VSM cells. The mitogenic response is mediated by release of bFGF.
Coronary artery distensibility in diabetic patients with simultaneous measurements of luminal area and intracoronary pressure: Evidence of impaired reactivity to nitroglycerin
1999, Journal of the American College of Cardiology
OBJECTIVES
This study investigated whether noninsulin dependent diabetes mellitus (NIDDM) adversely affects the elastic properties of the coronary arteries in patients with coronary artery disease (CAD) and NIDDM.
BACKGROUND
Attenuated vascular smooth muscle dilation to exogenous donors of nitric oxide, such as nitroglycerin, has been observed with forearm blood flow studies in patients with NIDDM.
METHODS
Twenty patients with CAD and NIDDM (diabetics), and 20 patients with only CAD (nondiabetics) were evaluated. Intracoronary ultrasound (ICUS) imaging with simultaneous intracoronary pressure (P₂) recordings were performed at the imaging site with 0.014 in fiber-optic high fidelity pressure monitoring wire. The same wire was used as guide wire for the ICUS catheter. Sites with less than 50% luminal stenosis by ICUS were studied. Recordings were done before and after 300 μg of intracoronary nitroglycerin (IC-NTG). Electrocardiographic tracings recorded simultaneously with ICUS images were used for timing. Systolic and diastolic cross-sectional lumen area (CSLA) and coronary artery distensibility (C-DIST) were measured, C-DIST = {(systolic CSLA-diastolic CSLA)/[(intracoronary pulse pressure) × (diastolic CSLA)]} × 1,000.
RESULTS
Diabetics had smaller CSLA (diabetics = 8.6 ± 0.6 mm², nondiabetics = 11.5 ± 0.5 mm², p < 0.01). Although C-DIST was similar before IC-NTG in the two groups, it became significantly lower in diabetics after IC-NTG (diabetics C-DIST = 3.02 ± 0.14 mm Hg⁻¹, nondiabetics C-DIST = 4.21 ± 0.15 mm Hg⁻¹, p < 0.01). Degrees of circumference involved, total plaque burden and composition were similar in both groups.
CONCLUSIONS
Noninsulin dependent diabetes mellitus reduces C-DIST after IC-NTG administration.
2-D and 3-D endoluminal ultrasound: Vascular and nonvascular applications
1999, Ultrasound in Medicine and Biology
Endoluminal ultrasound using catheter-based transducers has been used for the evaluation of a wide range of abnormalities. To date, one of the most promising areas of clinical application is its use intravascularly for quantitating the degree of arterial stenosis and for monitoring the therapeutic effects of angioplasty in peripheral and coronary arteries. Uses in the gastrointestinal tract include quantification of the size and wall thickness of esophageal varices, distinguishing between various submucosal lesions and measuring the degree of fibrosis in scleroderma. In the genitourinary system, endoluminal ultrasound provides a unique intraoperative tool allowing the addition of a third dimension (depth) to endourological procedures. The indications for, and the use of, endoluminal ultrasound within the upper urinary tract can be expected to increase with more experience, and the procedure has become an important technique that yields information not available through other modalities. In the bronchotracheal tree, endoluminal ultrasound allows imaging and subsequent biopsy of lymph nodes and tumors that cannot be visualized at routine bronchoscopy. Three-dimensional (3-D) reconstruction of two-dimensional (2-D) ultrasound imaging is a new method in the evolution of intraluminal imaging. It provides information about spatial relationships of anatomic structures that cannot be evaluated using conventional 2-D imaging. Although still in its infancy, 3-D endoluminal ultrasound has the potential to become a dynamic tool in both the research and clinical areas.
Dynamic expansion of the coronary arteries: Implications for intravascular ultrasound measurements
1995, American Heart Journal
The majority of coronary artery blood flow occurs in diastole; however, systolic epicardial coronary artery expansion has been described. With the advent of intravascular ultrasound, precise measurements of arterial structures with excellent spacial and temporal resolution are now readily available. However, the effect of dynamic expansion of the coronary arteries on routine intravascular ultrasound measurements has not been assessed. The purpose of this study was to determine in vivo the presence, timing, and extent of dynamic changes in the coronary arteries and saphenous vein grafts and to assess their implications for intravascular ultrasound measurements. Intravascular ultrasound images were obtained with simultaneous electrocardiographic monitoring in 202 coronary artery and 50 saphenous vein graft sites in 32 patients with varying plaque burden and morphologic features. Arterial, luminal, and plaque area were measured at end-diastole and early, mid-, and end-systole. Coronary luminal diameter increased 2.1%; luminal area increased 8.1%; arterial area increased 3.7%; and plaque area decreased 4.9% during mid and late systole (p < 0.01). There was no detectable cyclic change in saphenous vein graft dimensions. In coronary arteries there was significant systolic expansion of the artery and lumen and systolic thinning of the plaque. The magnitude of dynamic luminal area change was greater than the variability in measurement and thus warrants gating to the cardiac cycle. The lack of dynamic change in saphenous vein grafts and the relatively small dynamic change in luminal diameter and arterial and plaque areas suggest nominal utility in gating these measurements to the cardiac cycle.

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¹: Dr. Reddy was a Research Fellow of the American Heart Association, Northeast Ohio Affiliate, Inc., Cleveland.

²: Dr. Suneja was supported by an educational grant from Advanced Cardiovascular Systems, Inc., Santa Clara, California.

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Measurement by intracoronary ultrasound of in vivo arterial distensibility within atherosclerotic lesions

Abstract

Int J Cardiol

J Am Coll Cardiol

J Am Coll Cardiol

J Am Coll Cardiol

J Am Coll Cardiol

Am J Cardiol

J Am Coll Cardiol

Stiffness of systemic arteries in patients with myocardial infarction: a noninvasive method to predict severity of coronary atherosclerosis

Circulation

Regional compliance of brachial artery and saline infusion in patient with arteriosclerosis obliterans

Arteriosclerosis

In vivo measurement of the elasticity and diameter of the femoral artery

Acta Radiol

Percutaneous intravascular ultrasound imaging: validation of a real time synthetic aperture array catheter

Am J Card Imaging

Application of a new phased-array ultrasound imaging catheter in the assessment of vascular dimensions. In vivo comparison to cineangiography

Circulation