Yin Da, Maehara Akiko, Shimshak Thomas M, Ricotta Joseph J, Ramaiah Venkatesh, Foster Malcolm T, Davis Thomas P, Matsumura Mitsuaki, Mintz Gary S, Gray William A
1 Cardiovascular Research Foundation, New York, NY, USA.
2 The First Affiliated Hospital of Dalian Medical University, Dalian, China.
J Endovasc Ther. 2017 Aug;24(4):478-487. doi: 10.1177/1526602817708796. Epub 2017 May 15.
To validate 3 angiographic scoring systems for peripheral artery calcification using intravascular ultrasound (IVUS) as the gold standard.
The study employed preprocedure angiography and IVUS data from 47 patients (median age 72 years; 34 men) in the 55-patient JetStream G3 Calcium Study ( ClinicalTrials.gov identifier NCT01273623) to validate the 3 angiographic scoring systems [Peripheral Academic Research Consortium (PARC), Peripheral Arterial Calcium Scoring System (PACSS), and the DEFINITIVE Ca trial]. Preprocedure angiograms were analyzed using conventional quantitative vessel analysis software in 2 orthogonal views. Calcium length was evaluated by markers placed beside the artery during the procedure; calcium deposit(s) were assessed as being on one or both sides of the vessel wall. The 3 calcium scoring systems used these 2 basic angiographic elements to evaluate calcium severity. Based on these criteria, calcium severity varied from none to focal, mild, moderate, or severe in PARC; grade 0 to 4 in PACSS; and none, moderate, or severe in the DEFINITIVE Ca system. Calcium location on IVUS was classified as superficial, deep, or mixed. Lesion length was the segment between the most normal looking proximal and distal reference sites. Superficial, deep, and calcium length were based on motorized IVUS pullback.
IVUS detected calcium in 44/47 (93.6%) lesions, and angiography detected calcium in 26/47 (55.3%) lesions (p<0.001). The sensitivity, specificity, positive predictive value, and negative predictive value of angiography relative to IVUS were 59%, 100%, 100%, and 14%, respectively. With increasing severity of angiographic calcium, there was a stepwise increase in the prevalence of IVUS superficial calcium and the maximum arc and length of superficial calcium. Using PARC criteria, with increasing severity of calcification, IVUS maximum calcium arc increased from 120° for none to 305° for severe (p<0.001); the length of calcium increased from 7 to 68 mm (p<0.001). Though a similar trend was seen in IVUS superficial calcium, it was not observed in IVUS deep calcium. Similar observations were seen when using the PACSS and DEFINITIVE Ca scoring systems.
IVUS confirmed that the PARC, PACSS, and DEFINITIVE Ca calcium scoring systems can be used to classify the degree of calcium in peripheral artery disease, especially superficial calcium.
以血管内超声（IVUS）作为金标准，验证3种用于外周动脉钙化的血管造影评分系统。
该研究采用了来自55例患者的JetStream G3钙研究（ClinicalTrials.gov标识符NCT01273623）中47例患者（中位年龄72岁；34例男性）的术前血管造影和IVUS数据，以验证3种血管造影评分系统[外周学术研究联盟（PARC）、外周动脉钙化评分系统（PACSS）和DEFINITE Ca试验]。术前血管造影使用传统定量血管分析软件在2个正交视图中进行分析。术中通过放置在动脉旁的标记评估钙化长度；钙化沉积物评估为位于血管壁的一侧或两侧。这3种钙化评分系统使用这2个基本血管造影要素来评估钙化严重程度。基于这些标准，PARC中钙化严重程度从无到局灶性、轻度、中度或重度不等；PACSS中为0至4级；DEFINITE Ca系统中为无、中度或重度。IVUS上的钙化位置分为浅表、深部或混合性。病变长度是最正常的近端和远端参考部位之间的节段。浅表、深部和钙化长度基于电动IVUS回撤。
IVUS在44/47（93.6%）的病变中检测到钙化，血管造影在26/47（55.3%）的病变中检测到钙化（p<0.001）。血管造影相对于IVUS的敏感性、特异性、阳性预测值和阴性预测值分别为59%、100%、100%和14%。随着血管造影钙化严重程度的增加，IVUS浅表钙化的患病率、浅表钙化的最大弧度和长度呈逐步增加。使用PARC标准，随着钙化严重程度的增加，IVUS最大钙化弧度从无钙化时的120°增加到重度钙化时的305°（p<0.001）；钙化长度从7毫米增加到68毫米（p<0.001）。虽然IVUS浅表钙化也观察到类似趋势，但IVUS深部钙化未观察到。使用PACSS和DEFINITE Ca评分系统时也有类似观察结果。
IVUS证实PARC、PACSS和DEFINITE Ca钙化评分系统可用于对外周动脉疾病中的钙化程度进行分类，尤其是浅表钙化。
