Mintz G S, Pichard A D, Popma J J, Kent K M, Satler L F, Bucher T A, Leon M B
Intravascular Ultrasound Imaging Laboratory, Washington Hospital Center, Washington, D.C. 20010, USA.
J Am Coll Cardiol. 1997 Feb;29(2):268-74. doi: 10.1016/s0735-1097(96)00479-2.
This report used intravascular ultrasound and quantitative coronary angiography to explore the relation between lesion-associated calcium and risk factors, clinical presentation and angiographic severity of coronary artery stenoses.
Coronary artery calcium is a marker for significant coronary atherosclerosis. Noninvasive procedures are being proposed as screening tests for coronary artery disease. Intravascular ultrasound identification of tissue calcium has been validated in vitro.
Independent chart review, preintervention intravascular ultrasound imaging and coronary angiography were used to study primary native vessel lesions in 1,442 patients. Target lesions and reference segments were evaluated according to previously published quantitative and qualitative methods. Results are presented as mean value +/- SD.
Overall, 1,043 lesions contained target lesion calcium (72%); the arc of target lesion calcium was 110 +/- 109 degrees. Lesions with an ultrasound plaque burden > 0.75 or an angiographic diameter stenosis > 0.25 had a prevalence of calcium of at least 65%, with a mean arc > 100 degrees. Intermediate lesions had as much target lesion calcium as did angiographically severe lesions. Using multivariate linear regression analysis, patient age, stable (vs. unstable) angina and the intravascular ultrasound lesion site and reference segment plaque burden (but not the angiographic diameter stenosis) were the independent predictors of the arc of target lesion calcium (all p < 0.0001).
Intravascular ultrasound analysis shows that coronary calcification correlates with plaque burden but not with degree of lumen compromise. Thus, the noninvasive detection of coronary calcium is predictive of future cardiac events, presumably because coronary calcification is a marker for overall atherosclerotic plaque burden. Coronary calcium increases with increasing patient age and is less common in unstable lesion subsets.
本报告采用血管内超声和定量冠状动脉造影术，探讨病变相关钙与危险因素、临床表现以及冠状动脉狭窄的血管造影严重程度之间的关系。
冠状动脉钙化是严重冠状动脉粥样硬化的一个标志物。无创检查正被提议作为冠状动脉疾病的筛查试验。血管内超声对组织钙的识别已在体外得到验证。
采用独立病历审查、干预前血管内超声成像和冠状动脉造影术，对1442例患者的原发性天然血管病变进行研究。根据先前发表的定量和定性方法对靶病变和参考节段进行评估。结果以平均值±标准差表示。
总体而言，1043处病变含有靶病变钙（72%）；靶病变钙的弧度为110±109度。超声斑块负荷>0.75或血管造影直径狭窄>0.25的病变，其钙的患病率至少为65%，平均弧度>100度。中度病变的靶病变钙含量与血管造影严重病变的一样多。使用多变量线性回归分析，患者年龄、稳定（与不稳定）型心绞痛以及血管内超声病变部位和参考节段斑块负荷（而非血管造影直径狭窄）是靶病变钙弧度的独立预测因素（所有p<0.0001）。
血管内超声分析显示，冠状动脉钙化与斑块负荷相关，但与管腔狭窄程度无关。因此，冠状动脉钙的无创检测可预测未来心脏事件，推测是因为冠状动脉钙化是整体动脉粥样硬化斑块负荷的一个标志物。冠状动脉钙随患者年龄增加而增加，在不稳定病变亚组中较少见。
