Postmortem studies suggest that coronary angiography does not always accurately delineate the extent of coronary-artery disease. We examined this problem in living human hearts by performing high-frequency epicardial echocardiography at the time of cardiac surgery. The ratio of the diameter of the lumen of the coronary artery to the thickness of its wall was used to quantify the severity of coronary lesions. In 11 patients with no angiographic evidence of coronary disease anywhere in the coronary tree, the mean (+/- SEM) ratio was 5.9 +/- 0.3. In 21 patients with angiographic disease at the site evaluated by echocardiography, the mean ratio was lower (2.3 +/- 0.2, P less than 0.05), reflecting encroachment into the arterial lumen by atherosclerotic plaque. In 15 patients with arterial segments that were angiographically normal but with arterial stenoses elsewhere in the coronary tree, the mean ratio was 4.1 +/- 0.3, with marked overlap with the values in the patients who had angiographic disease at the site of the echocardiographic evaluation. These results demonstrate, in living human hearts, that diffuse coronary atherosclerosis is often present when coronary angiography reveals only discrete stenoses. This finding suggests that coronary angiography may underestimate the severity and extent of coronary disease.
This article has been cited by other articles:
Philipp, S., Bose, D., Wijns, W., Marso, S. P., Schwartz, R. S., Konig, A., Lerman, A., Garcia-Garcia, H. M., Serruys, P. W., Erbel, R.
(2009). Do systemic risk factors impact invasive findings from virtual histology? Insights from the international virtual histology registry. Eur Heart J
0: ehp428v1-ehp428
[Abstract][Full Text]
D'Ancona, G., Hartman, J. M., Bartolozzi, F., van Deel, E., Duncker, D. J.G.M., Bogers, A. J.J.C., Pilato, M., Kappetein, A. P.
(2008). Epicardial coronary artery Doppler: validation in the animal model. ICVTS
7: 634-637
[Abstract][Full Text]
Crouse, J. R. III
(2006). Thematic review series: Patient-Oriented Research. Imaging atherosclerosis: state of the art. J. Lipid Res.
47: 1677-1699
[Abstract][Full Text]
Budde, R. P.J., Bakker, P. F. A., Meijer, R., Borst, C., Grundeman, P. F.
(2006). Ultrasound Mini-Transducer with Malleable Handle for Coronary Artery Surgery. Ann. Thorac. Surg.
81: 322-326
[Abstract][Full Text]
McPherson, D. D., Holland, C. K.
(2003). Seizing the science of ultrasound: Beyond imaging and into physiology and therapeutics. J Am Coll Cardiol
41: 1628-1630
[Full Text]
Eikelaar, J. H. R., Meijer, R., van Boven, W. J., Klein, P., Grundeman, P. F., Borst, C.
(2002). Epicardial 10-MHz ultrasound in off-pump coronary bypass surgery: A clinical feasibility study using a minitransducer. J. Thorac. Cardiovasc. Surg.
124: 785-789
[Abstract][Full Text]
De Bruyne, B., Hersbach, F., Pijls, N. H.J., Bartunek, J., Bech, J.-W., Heyndrickx, G. R., Gould, K. L., Wijns, W.
(2001). Abnormal Epicardial Coronary Resistance in Patients With Diffuse Atherosclerosis but "Normal" Coronary Angiography. Circulation
104: 2401-2406
[Abstract][Full Text]
Gradus-Pizlo, I., Sawada, S. G., Wright, D., Segar, D. S., Feigenbaum, H.
(2001). Detection of subclinical coronary atherosclerosis using two-dimensional, high-resolution transthoracic echocardiography. J Am Coll Cardiol
37: 1422-1429
[Abstract][Full Text]
Fayad, Z. A., Fuster, V., Fallon, J. T., Jayasundera, T., Worthley, S. G., Helft, G., Aguinaldo, J. G., Badimon, J. J., Sharma, S. K.
(2000). Noninvasive In Vivo Human Coronary Artery Lumen and Wall Imaging Using Black-Blood Magnetic Resonance Imaging. Circulation
102: 506-510
[Abstract][Full Text]
Demos, S. M., Alkan-Onyuksel, H., Kane, B. J., Ramani, K., Nagaraj, A., Greene, R., Klegerman, M., McPherson, D. D.
(1999). In vivo targeting of acoustically reflective liposomes for intravascular and transvascular ultrasonic enhancement. J Am Coll Cardiol
33: 867-875
[Abstract][Full Text]
Labinaz, M., Pels, K., Hoffert, C., Aggarwal, S., O'Brien, E. R
(1999). Time course and importance of neoadventitial formation in arterial remodeling following balloon angioplasty of porcine coronary arteries. Cardiovasc Res
41: 255-266
[Abstract][Full Text]
Frielingsdorf, J., Seiler, C., Kaufmann, P., Vassalli, G., Suter, T., Hess, O. M.
(1996). Normalization of Abnormal Coronary Vasomotion by Calcium Antagonists in Patients With Hypertension. Circulation
93: 1380-1387
[Abstract][Full Text]
Crouse, J. R., Goldbourt, U., Evans, G., Pinsky, J., Sharrett, A. R., Sorlie, P., Riley, W., Heiss, G.
(1996). Risk Factors and Segment-Specific Carotid Arterial Enlargement in the Atherosclerosis Risk in Communities (ARIC) Cohort. Stroke
27: 69-75
[Abstract][Full Text]
El-Tamimi, H., Mansour, M., Pepine, C. J., Wargovich, T. J., Chen, H.
(1995). Circadian Variation in Coronary Tone in Patients With Stable Angina : Protective Role of the Endothelium. Circulation
92: 3201-3205
[Abstract][Full Text]
Adams, M. R., Nakagomi, A., Keech, A., Robinson, J., McCredie, R., Bailey, B. P., Freedman, S. B., Celermajer, D. S.
(1995). Carotid Intima-Media Thickness Is Only Weakly Correlated With the Extent and Severity of Coronary Artery Disease. Circulation
92: 2127-2134
[Abstract][Full Text]
Syvanne, M., Kahri, J., Virtanen, K. S., Taskinen, M.-R.
(1995). HDLs Containing Apolipoproteins A-I and A-II (LpA-I:A-II) as Markers of Coronary Artery Disease in Men With Non–Insulin- Dependent Diabetes Mellitus. Circulation
92: 364-370
[Abstract][Full Text]
Minor, R. L. Jr., Scott, B. D., Brown, D. D., Winniford, M. D.
(1991). Cocaine-induced Myocardial Infarction in Patients with Normal Coronary Arteries. ANN INTERN MED
115: 797-806
[Abstract]
Popma, J. J., Dehmer, G. J.
(1989). Care of the Patient after Coronary Angioplasty. ANN INTERN MED
110: 547-559
[Abstract]
Fitzgerald, P. J., Yock, P. G., Ring, E. J.
(1989). Catheter-Tipped Ultrasonic Intravascular Imaging. PERSPECT VASC SURG ENDOVASC THER
2: 113-125
Previous
