Mann J M, Davies M J
British Heart Foundation Cardiovascular Research Unit, St George's Hospital Medical School, London.
Br Heart J. 1995 Nov;74(5):528-30. doi: 10.1136/hrt.74.5.528.
To compare the assessment of severity of coronary artery stenosis by the conventional pathology methods with a method designed to resemble quantitative angiography.
31 human hearts harvested at necropsy were fixed by perfusion of the aortic root with 10% formol saline at 120 mm Hg for 24 hours. The right coronary and left anterior descending coronary arteries were transversely sliced every 2 mm and the absolute lumen dimensions plotted against the distance from the coronary ostium. Stenosis figures were calculated by comparing the lumen diameter with the lumen diameters in adjacent normal arterial segments in a manner identical to that used in angiographic measurement. The coronary artery segments were then processed histologically. Stenosis was then remeasured by comparing the lumen diameter with the diameter of the vessel within the internal elastic lamina identified by elastic van Gieson staining.
Compared with the method that was analogous to angiography, the pathology method used on histological slides overestimated the degree of stenosis by 25-30%. The lack of concordance between the methods was not a function of the severity of the stenosis.
When they read necropsy reports in which the severity of coronary artery stenosis is assessed cardiologists should be aware of the discrepancy between clinical and pathological methods.
比较通过传统病理学方法与一种旨在类似定量血管造影的方法对冠状动脉狭窄严重程度的评估。
31例尸检获取的人类心脏通过在120毫米汞柱压力下用10%甲醛生理盐水经主动脉根部灌注固定24小时。右冠状动脉和左前降支冠状动脉每2毫米横向切片，并绘制绝对管腔尺寸与距冠状动脉口距离的关系图。通过以与血管造影测量相同的方式将管腔直径与相邻正常动脉段的管腔直径进行比较来计算狭窄数值。然后对冠状动脉段进行组织学处理。然后通过将管腔直径与经弹性凡吉森染色确定的内弹性膜内血管直径进行比较来重新测量狭窄程度。
与类似血管造影的方法相比，组织学切片上使用的病理学方法高估狭窄程度25% - 30%。方法之间缺乏一致性并非狭窄严重程度的函数。
心脏病学家在阅读评估冠状动脉狭窄严重程度的尸检报告时，应意识到临床和病理方法之间的差异。
