Circulation, Vol 86, 154-158, Copyright © 1992 by American Heart Association
PJ Fitzgerald, FG St. Goar, AJ Connolly, FJ Pinto, ME Billingham, RL Popp and PG Yock
BACKGROUND. The purpose of this study was to evaluate the significance of
the three-layered appearance of coronary arteries in adolescence and adults
from intravascular ultrasound scans and to correlate these observations
with histopathology. METHODS AND RESULTS. Sixteen intact hearts were
excised at autopsy from patients with no clinical history of coronary
artery disease. The patients' ages ranged from 13 to 55 years. A 30-MHz
ultrasound imaging catheter was used to obtain images throughout the
epicardial coronary vasculature. A total of 72 image cross sections was
marked by epivascular sutures, and the corresponding histological sections
were examined. Ultrasound images were classified into two groups: images
exhibiting three-layered appearance and images without distinct layering.
Histological analysis revealed a significantly greater degree of intimal
thickening in segments with three layers (243 +/- 105 microns) than in
nonlayered segments (112 +/- 55 microns). Discriminant analysis of these
data predicted the threshold between the two groups to be 178 microns.
Measurements of medial thickness were not different between these two
groups (235 +/- 61 versus 210 +/- 76 microns). In the nonlayered group, the
average patient age was 27.1 +/- 8.5 years, whereas in the three-layered
groups, the average age was 42.8 +/- 9.8 years. CONCLUSIONS. The
intracoronary ultrasound image appearance of young, morphologically normal
coronary artery walls is homogeneous without layering. A three- layered
appearance suggests the presence of at least 178 microns of intimal
thickening and is seen more frequently with advancing age.
ARTICLES
Intravascular ultrasound imaging of coronary arteries. Is three layers the norm?
Cardiovascular Research Institute, University of California, San Francisco 94143.
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