Mintz G S, Pichard A D, Kent K M, Satler L F, Popma J J, Leon M B
Intravascular Ultrasound Imaging Laboratory, Washington Hospital Center, DC, USA.
Am J Cardiol. 1998 Feb 15;81(4):387-91. doi: 10.1016/s0002-9149(97)00924-7.
Intravascular ultrasound (IVUS) detects target lesion calcium twice as often as does coronary angiography. Target lesions in smaller vessels are thought to be more calcified than target lesions in large vessels. This study determined whether the presence and magnitude of target lesion calcium is related to angiographic reference lumen size. Preintervention IVUS imaging and coronary angiography were performed to study 1,454 non-aortoostial native vessel lesions in 1,342 patients. Target lesions and reference segments were evaluated according to previously published methods and are presented as mean +/- 1 SD. By angiography, 37% of lesions contained calcium, and 68% of calcium-containing lesions were classified as moderately calcified, and 32% as severely calcified. There was no relation between angiographic reference lumen size and angiographic calcium detection (p = 0.7066) or classification (none/mild vs moderate vs severe, p = 0.8135). By IVUS, 73% of lesions contained calcium. There was a consistent relation between decreasing angiographic reference lumen size and increasing IVUS lesion-associated calcium: the presence of any calcium (p = 0.0122), arc of calcium (p = 0.002), percent of lesions with an arc of calcium > 180 degrees (p = 0.0018), length of calcium (p < 0.0001), presence of any superficial calcium (p < 0.0001), arc of superficial calcium (p < 0.0001), percent of lesions with an arc of superficial calcium > 180 degrees (p = 0.0021), and length of superficial calcium (p < 0.0001). This was especially true for arteries with an angiographic reference lumen dimension < 2.00 mm. There is a distinct relation between decreasing angiographic reference lumen size and increasing lesion calcium, most striking in vessels < 2.00 mm. This increased target lesion calcium in small vessels is not seen angiographically.
血管内超声（IVUS）检测目标病变钙化的频率是冠状动脉造影的两倍。人们认为，较小血管中的目标病变比大血管中的目标病变钙化更严重。本研究旨在确定目标病变钙化的存在及程度是否与血管造影参考管腔大小相关。对1342例患者的1454处非开口处的天然血管病变进行了干预前IVUS成像和冠状动脉造影。根据先前公布的方法对目标病变和参考节段进行评估，并以平均值±1标准差表示。血管造影显示，37%的病变含有钙化，68%的含钙化病变被分类为中度钙化，32%为重度钙化。血管造影参考管腔大小与血管造影钙化检测（p = 0.7066）或分类（无/轻度与中度与重度，p = 0.8135）之间无相关性。通过IVUS检查，73%的病变含有钙化。血管造影参考管腔大小减小与IVUS病变相关钙化增加之间存在一致的关系：任何钙化的存在（p = 0.0122）、钙化弧度（p = 0.002）、钙化弧度>180度的病变百分比（p = 0.0018）、钙化长度（p < 0.0001）、任何浅表钙化的存在（p < 0.0001）、浅表钙化弧度（p < 0.0001）、浅表钙化弧度>180度的病变百分比（p = 0.0021）以及浅表钙化长度（p < 0.0001）。对于血管造影参考管腔直径<2.00 mm的动脉尤其如此。血管造影参考管腔大小减小与病变钙化增加之间存在明显关系，在直径<2.00 mm的血管中最为明显。血管造影未显示小血管中这种增加的目标病变钙化情况。
