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Vessel shrinkage as a sign of atherosclerosis progression in type 2 diabetes: a serial intravascular ultrasound analysis.

Jiménez-Quevedo P, Suzuki N, Corros C, Ferrer C, Angiolillo DJ, Alfonso F, Hernández-Antolín R, Bañuelos C, Escaned J, Fernández C, Costa M, Macaya C, Bass T, Sabaté M - Diabetes (2008)

Bottom Line: Vessel shrinkage was defined as a Deltaexternal elastic membrane area/Deltaplaque area < 0.Vessel shrinkage was identified in 37.1% of segments and was associated with a significant decrease in lumen area at 9 months (vessel shrinkage, 10 +/- 4 mm(2) vs. non-vessel shrinkage, 11 +/- 4 mm(2); P = 0.04).Besides, vessel shrinkage is influenced by insulin requirements and metabolic control and is associated with more advanced coronary atherosclerosis.

View Article: PubMed Central - PubMed

Affiliation: Cardiovascular Institute, San Carlos University Hospital, Madrid, Spain.

ABSTRACT

Objective: The aim of this study was to determine the natural history of vascular remodeling of atherosclerotic plaques in patients with type 2 diabetes and the predictors of vessel shrinkage.

Research design and methods: In this serial intracoronary ultrasound (IVUS) study, 237 coronary segments from 45 patients enrolled in the DIABETES I, II, and III trials were included. Quantitative volumetric IVUS analyses (motorized pullbacks at 0.5 mm/s) were performed in the same coronary segment after the index procedure and at the 9-month follow-up. Nontreated mild lesions (angiographic stenosis <25%) with > or =0.5 mm plaque thickening and length of > or =5 mm assessed by IVUS were included. Vessel shrinkage was defined as a Deltaexternal elastic membrane area/Deltaplaque area < 0. Statistical adjustment by multiple segments and multiple lesions per patient was performed.

Results: Vessel shrinkage was identified in 37.1% of segments and was associated with a significant decrease in lumen area at 9 months (vessel shrinkage, 10 +/- 4 mm(2) vs. non-vessel shrinkage, 11 +/- 4 mm(2); P = 0.04). Independent predictors of vessel shrinkage were insulin requirements (odds ratio 4.6 [95% CI 1.40-15.10]; P = 0.01), glycated hemoglobin (1.5 [1.05-2.10]; P = 0.02), apolipoprotein B (0.96 [0.94-0.98]; P < 0.001), hypertension (3.7 [1.40-10.30]; P = 0.009), number of diseased vessels (5.6 [2.50-12.50]; P < 0.001), and prior revascularization (17.5 [6.50-46.90]; P < 0.001).

Conclusions: This serial IVUS study suggests that progression of coronary artery disease in patients with type 2 diabetes may be mainly attributed to vessel shrinkage. Besides, vessel shrinkage is influenced by insulin requirements and metabolic control and is associated with more advanced coronary atherosclerosis.

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Independent predictors of vessel shrinkage. Data in the y-axis are presented on a logarithmic scale. *All statistics were calculated with the GEE method stratifying by patients, vessel, and segment.
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f4: Independent predictors of vessel shrinkage. Data in the y-axis are presented on a logarithmic scale. *All statistics were calculated with the GEE method stratifying by patients, vessel, and segment.

Mentions: Vessel shrinkage was identified in 88 segments (37.1%), whereas some degree of vessel enlargement was observed in the remaining segments. At follow-up, vessel shrinkage was associated with a significant decrease in lumen area at 9 months (vessel shrinkage, 10 ± 4 mm2, vs. non–vessel shrinkage, 11 ± 4 mm2; P = 0.04). These two differential patterns of vascular remodeling are depicted in Fig. 3. Segments that, on average, shrank during follow-up presented a significant decrease in mean lumen dimension as a result of mean EEM reduction. In this scenario, mean plaque area was also reduced during follow-up. Conversely, segments that, on average, enlarged presented an increase in the mean lumen area secondary to an enlargement in both mean EEM and plaque areas. Factors associated with vessel shrinkage at the univariable analysis are depicted in Table 2. There were not significant differences between the type of plaque and the development of vessel shrinkage (Table 3). By multivariate analysis, independent predictors of vessel shrinkage were insulin-dependent diabetes, glycated hemoglobin, apoB level, hypertension, number of diseased vessels, and prior revascularization (Fig. 4). Results of this multivariate analysis remained basically unchanged after excluding those patients with prior revascularization. In addition, a significant inverse correlation between mean lumen area at follow-up and glycated hemoglobin levels were observed: lumen area (mm2) = 13.83–0.39 (glycated hemoglobin, %) + 3.8 intrastate variable.


Vessel shrinkage as a sign of atherosclerosis progression in type 2 diabetes: a serial intravascular ultrasound analysis.

Jiménez-Quevedo P, Suzuki N, Corros C, Ferrer C, Angiolillo DJ, Alfonso F, Hernández-Antolín R, Bañuelos C, Escaned J, Fernández C, Costa M, Macaya C, Bass T, Sabaté M - Diabetes (2008)

Independent predictors of vessel shrinkage. Data in the y-axis are presented on a logarithmic scale. *All statistics were calculated with the GEE method stratifying by patients, vessel, and segment.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2606874&req=5

f4: Independent predictors of vessel shrinkage. Data in the y-axis are presented on a logarithmic scale. *All statistics were calculated with the GEE method stratifying by patients, vessel, and segment.
Mentions: Vessel shrinkage was identified in 88 segments (37.1%), whereas some degree of vessel enlargement was observed in the remaining segments. At follow-up, vessel shrinkage was associated with a significant decrease in lumen area at 9 months (vessel shrinkage, 10 ± 4 mm2, vs. non–vessel shrinkage, 11 ± 4 mm2; P = 0.04). These two differential patterns of vascular remodeling are depicted in Fig. 3. Segments that, on average, shrank during follow-up presented a significant decrease in mean lumen dimension as a result of mean EEM reduction. In this scenario, mean plaque area was also reduced during follow-up. Conversely, segments that, on average, enlarged presented an increase in the mean lumen area secondary to an enlargement in both mean EEM and plaque areas. Factors associated with vessel shrinkage at the univariable analysis are depicted in Table 2. There were not significant differences between the type of plaque and the development of vessel shrinkage (Table 3). By multivariate analysis, independent predictors of vessel shrinkage were insulin-dependent diabetes, glycated hemoglobin, apoB level, hypertension, number of diseased vessels, and prior revascularization (Fig. 4). Results of this multivariate analysis remained basically unchanged after excluding those patients with prior revascularization. In addition, a significant inverse correlation between mean lumen area at follow-up and glycated hemoglobin levels were observed: lumen area (mm2) = 13.83–0.39 (glycated hemoglobin, %) + 3.8 intrastate variable.

Bottom Line: Vessel shrinkage was defined as a Deltaexternal elastic membrane area/Deltaplaque area < 0.Vessel shrinkage was identified in 37.1% of segments and was associated with a significant decrease in lumen area at 9 months (vessel shrinkage, 10 +/- 4 mm(2) vs. non-vessel shrinkage, 11 +/- 4 mm(2); P = 0.04).Besides, vessel shrinkage is influenced by insulin requirements and metabolic control and is associated with more advanced coronary atherosclerosis.

View Article: PubMed Central - PubMed

Affiliation: Cardiovascular Institute, San Carlos University Hospital, Madrid, Spain.

ABSTRACT

Objective: The aim of this study was to determine the natural history of vascular remodeling of atherosclerotic plaques in patients with type 2 diabetes and the predictors of vessel shrinkage.

Research design and methods: In this serial intracoronary ultrasound (IVUS) study, 237 coronary segments from 45 patients enrolled in the DIABETES I, II, and III trials were included. Quantitative volumetric IVUS analyses (motorized pullbacks at 0.5 mm/s) were performed in the same coronary segment after the index procedure and at the 9-month follow-up. Nontreated mild lesions (angiographic stenosis <25%) with > or =0.5 mm plaque thickening and length of > or =5 mm assessed by IVUS were included. Vessel shrinkage was defined as a Deltaexternal elastic membrane area/Deltaplaque area < 0. Statistical adjustment by multiple segments and multiple lesions per patient was performed.

Results: Vessel shrinkage was identified in 37.1% of segments and was associated with a significant decrease in lumen area at 9 months (vessel shrinkage, 10 +/- 4 mm(2) vs. non-vessel shrinkage, 11 +/- 4 mm(2); P = 0.04). Independent predictors of vessel shrinkage were insulin requirements (odds ratio 4.6 [95% CI 1.40-15.10]; P = 0.01), glycated hemoglobin (1.5 [1.05-2.10]; P = 0.02), apolipoprotein B (0.96 [0.94-0.98]; P < 0.001), hypertension (3.7 [1.40-10.30]; P = 0.009), number of diseased vessels (5.6 [2.50-12.50]; P < 0.001), and prior revascularization (17.5 [6.50-46.90]; P < 0.001).

Conclusions: This serial IVUS study suggests that progression of coronary artery disease in patients with type 2 diabetes may be mainly attributed to vessel shrinkage. Besides, vessel shrinkage is influenced by insulin requirements and metabolic control and is associated with more advanced coronary atherosclerosis.

Show MeSH
Related in: MedlinePlus