Circulation, Vol 86, 756-763, Copyright © 1992 by American Heart Association
FG St. Goar, FJ Pinto, EL Alderman, PJ Fitzgerald, EB Stinson, ME Billingham and RL Popp
BACKGROUND. Coronary atherosclerosis has been demonstrated in young adults
by postmortem pathology. Angiographic evaluation of coronary disease in
young adults is limited by ethical issues and the insensitivity of
angiography for detecting early pathology. Catheter- based intracoronary
ultrasound has proven useful both in detecting and quantitating coronary
disease, but the ultrasound appearance of young, angiographically normal,
coronary arteries has not been well defined. METHODS AND RESULTS.
Twenty-five subjects were examined with intracoronary ultrasound within 1
month of cardiac transplantation. Mean age of the donor hearts was 28 years
(range, 14-43 years). Measurements of an index of intimal thickening were
obtained at four left anterior descending coronary artery sites in each
patient. All study patients had angiographically normal coronary arteries.
Ultrasound in 14 subjects demonstrated a three-layered appearance of the
coronary vessel wall with a mean intimal index of 0.16 +/- 0.07. The other
10 subjects, including all donors under the age of 25 years, had coronary
vessel wall layers too thin to be imaged separately at the 30-MHz sound
frequency. Five subjects had ultrasound evidence of focal intimal
thickening greater than 500 microns. The donors of these hearts each had
risk factors for coronary artery disease. Two subjects died within 5 weeks
of their ultrasound study. Histological measurements of the vessel wall
layers were similar to the corresponding ultrasound values. CONCLUSIONS.
This study provides a reference for the intravascular ultrasound appearance
of young adult coronary arteries and confirms pathology findings that young
subjects with angiographically normal vessels have a range of coronary
intimal thickening, which includes occasional evidence of focal, early
atheromatous lesions.
ARTICLES
Detection of coronary atherosclerosis in young adult hearts using intravascular ultrasound
Division of Cardiovascular Medicine, Stanford University School of Medicine, CA 94305.
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