Pathologic validation of a new method to quantify coronary calcific deposits in vivo using intravascular ultrasound


      Current methods of calcium quantification by intravascular ultrasound (IVUS) measure the arc of calcium using the cross-sectional image at the lesion and at the reference site while neglecting calcium elsewhere. Calcium at these sites may not adequately represent the extent of total epicardial coronary calcium. We devised a new method to quantify calcium as a percentage of the coronary luminal surface. This study examines whether this new method accurately reflects coronary calcium determined by histology. Seventeen postmortem coronary arteries were pressure-fixed and imaged by IVUS using a motorized pullback device. Total plaque-luminal circumferential length and calcified plaque-luminal circumferential length were measured from serial cross-sectional IVUS images every 1 mm. With use of Simpson’s method, the total plaque and calcified plaque surface area was then calculated. Histologic sections were stained with hematoxylin-eosin and Movat pentachrome at 3-mm intervals. Calcium was independently quantified by planimetry under light microscopy. Histologic analysis (n = 253 sections) revealed a wide range of calcium (0 to 47 mm2; mean 12 ± 16 mm3). The IVUS-derived calcified plaque surface area was 17 ± 23 mm2), which represented 3.1 ± 4.1% (range 0% to 13.9%) of the total plaque surface area. The histologic and IVUS quantification of calcium by this method was strongly related (r = 0.84, p <0.0001), which was an improvement over current 2-dimensional measures of calcium arc (r = 0.41, p = 0.18). Calculation of calcified plaque surface area from sequential IVUS images appears to accurately reflect the degree of total coronary calcification.
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        • Tuzcu E.M.
        • Berkalp B.
        • De Franco A.C.
        • Ellis S.G.
        • Goormastic M.
        • Whitlow P.L.
        • Franco I.
        • Raymond R.E.
        • Nissen S.E.
        The dilemma of diagnosing coronary calcification.
        J Am Coll Cardiol. 1996; 27: 832-838
        • Fitzgerald P.J.
        • Ports T.A.
        • Yock P.G.
        Contribution of localized calcium deposits to dissection after angioplasty. An observational study using intravascular ultrasound.
        Circulation. 1992; 86: 64-70
        • Weissman N.J.
        • Palacios I.F.
        • Nidorf S.M.
        • Dinsmore R.E.
        • Weyman A.E.
        Three-dimensional intravascular ultrasound assessment of plaque volume after successful atherectomy.
        Am Heart J. 1995; 130: 413-419
        • Roelandt J.R.
        • di Mario C.
        • Pandian N.G.
        • Wenguang L.
        • Keane D.
        • Slager C.J.
        • de Feyter P.J.
        • Serruys P.W.
        Three-dimensional reconstruction of intracoronary ultrasound images. Rationale, approaches, problems, and directions.
        Circulation. 1994; 90: 1044-1055
        • Mintz G.S.
        • Douek P.
        • Pichard A.D.
        • Kent K.M.
        • Satler L.F.
        • Popma J.J.
        • Leon M.B.
        Target lesion calcification in coronary artery disease.
        J Am Coll Cardiol. 1992; 20: 1149-1155
        • Honye J.
        • Mahon D.J.
        • Jain A.
        • White C.J.
        • Ramee S.R.
        • Wallis J.B.
        • al-Zarka A.
        • Tobis J.M.
        Morphological effects of coronary balloon angioplasty in vivo assessed by intravascular ultrasound imaging.
        Circulation. 1992; 85: 1012-1025
        • Ellis S.G.
        • Roubin G.S.
        • King III, S.B.
        • Douglas Jr, J.S.
        • Cox W.R.
        Importance of stenosis morphology in the estimation of restenosis risk after elective percutaneous transluminal coronary angioplasty.
        Am J Cardiol. 1989; 63: 30-34
        • Mintz G.S.
        • Popma J.J.
        • Pichard A.D.
        • Kent K.M.
        • Salter L.F.
        • Chuang Y.C.
        • Griffin J.
        • Leon M.B.
        Intravascular ultrasound predictors of restenosis after percutaneous transcatheter coronary revascularization.
        J Am Coll Cardiol. 1996; 27: 1678-1687
        • Tuzcu E.M.
        • Simpfendorfer C.
        • Badhwar K.
        • Chambers J.
        • Dorosti K.
        • Franco I.
        • Hollman J.
        • Whitlow P.
        Determinants of primary success in elective percutaneous transluminal coronary angioplasty for significant narrowing of a single major coronary artery.
        Am J Cardiol. 1988; 62: 873-875
        • Dussaillant G.R.
        • Mintz G.S.
        • Pichard A.D.
        • Kent K.M.
        • Satler L.F.
        • Popma J.J.
        • Bucher T.A.
        • Griffin J.
        • Leon M.B.
        Mechanisms and immediate and long-term results of adjunct directional coronary atherectomy after rotational atherectomy.
        J Am Coll Cardiol. 1996; 27: 1390-1397
        • Kovach J.A.
        • Mintz G.S.
        • Pichard A.D.
        • Kent K.M.
        • Popma J.J.
        • Satler L.F.
        • Leon M.B.
        Sequential intravascular ultrasound characterization of the mechanisms of rotational atherectomy and adjunct balloon angioplasty.
        J Am Coll Cardiol. 1993; 22: 1024-1032