Arterial calcification and not lumen stenosis is highly correlated with atherosclerotic plaque burden in humans: a histologic study of 723 coronary artery segments using nondecalcifying methodology

Division of Cardiovascular Diseases, Mayo Clinic and Mayo Foundation, Rochester, Minnesota 55905, USA.

OBJECTIVES: This study was designed to evaluate whether calcium deposition in the coronary arteries is related to atherosclerotic plaque burden and narrowing of the arterial lumen. BACKGROUND: Many studies have recently documented the feasibility of electron beam computed tomography to detect and quantify coronary artery calcification in patients. Although these studies suggest a general relation between calcification and severity of coronary artery disease, the value of coronary calcium in defining atherosclerotic plaque and coronary lumen narrowing is unclear. Previous pathologic comparisons have failed to detail such a relation in identical histologic sections. This finding may be due to atherosclerotic remodeling. METHODS: A total of 37 nondecalcified coronary arteries were processed, sectioned at 3-mm intervals (723 sections) and evaluated by computer planimetry and densitometry. RESULTS: A significant relation between calcium area and plaque area was found on a per-heart basis (n = 13, r = 0.87, p < 0.0001), per-artery basis (left anterior descending coronary artery [LAD]: n = 13, r = 0.89, p < 0.0001; left circumflex coronary artery [LCx]: n = 11, r = 0.7, p < 0.001; right coronary artery [RCA]: n = 13, r = 0.89, p < 0.0001) and per-segment basis (n = 723, r = 0.52, p < 0.0001). In contrast, a poor relation existed between residual histologic lumen area and calcium area for individual hearts (r = 0.48, p = NS), individual coronary arteries (LAD: r = 0.59, p = NS; LCx: r = 0.10, p = NS; RCA: r = 0.59, p = NS) and coronary segments (r = 0.07, p = NS). Longitudinal changes in external elastic lamina areas were highly correlated with changes in plaque area values (r = 0.60, p < 0.0001), whereas lumen area did not correlate with plaque size change (r = 0.01, p = NS). CONCLUSIONS: Coronary calcium quantification is an excellent method of assessing atherosclerotic plaque presence at individual artery sites. Moreover, the amount of calcium correlates with the overall magnitude of atherosclerotic plaque burden. This study suggests that the remodeling phenomenon is the likely explanation for the lack of a good predictive value between lumen narrowing and quantification of mural calcification.

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				M. A. Allison, M. H. Criqui, and C. M. Wright Patterns and Risk Factors for Systemic Calcified Atherosclerosis Arterioscler Thromb Vasc Biol, February 1, 2004; 24(2): 331 - 336. [Abstract] [Full Text]

				T. M. Doherty, L. A. Fitzpatrick, A. Shaheen, T. B. Rajavashisth, and R. C. Detrano Genetic Determinants of Arterial Calcification Associated With Atherosclerosis Mayo Clin. Proc., February 1, 2004; 79(2): 197 - 210. [Abstract] [PDF]

				Y. Asanuma, A. Oeser, A. K. Shintani, E. Turner, N. Olsen, S. Fazio, M. F. Linton, P. Raggi, and C. M. Stein Premature Coronary-Artery Atherosclerosis in Systemic Lupus Erythematosus N. Engl. J. Med., December 18, 2003; 349(25): 2407 - 2415. [Abstract] [Full Text] [PDF]

				L. A. Fitzpatrick Hormones and the Heart: Controversies and Conundrums J. Clin. Endocrinol. Metab., December 1, 2003; 88(12): 5609 - 5610. [Full Text] [PDF]

				F. Akhrass, A. T. Evans, Y. Wang, S. Rich, C. R. Kannan, L. Fogelfeld, and T. Mazzone Hormone Replacement Therapy Is Associated with Less Coronary Atherosclerosis in Postmenopausal Women J. Clin. Endocrinol. Metab., December 1, 2003; 88(12): 5611 - 5614. [Abstract] [Full Text] [PDF]

				U. Hoffmann, D. C. Kwait, J. Handwerker, R. Chan, G. Lamuraglia, and T. J. Brady Vascular Calcification in ex Vivo Carotid Specimens: Precision and Accuracy of Measurements with Multi-Detector Row CT Radiology, November 1, 2003; 229(2): 375 - 381. [Abstract] [Full Text] [PDF]

				T. M. Doherty, K. Asotra, L. A. Fitzpatrick, J.-H. Qiao, D. J. Wilkin, R. C. Detrano, C. R. Dunstan, P. K. Shah, and T. B. Rajavashisth Calcification in atherosclerosis: Bone biology and chronic inflammation at the arterial crossroads PNAS, September 30, 2003; 100(20): 11201 - 11206. [Abstract] [Full Text] [PDF]

				C. M. Giachelli Vascular Calcification: In Vitro Evidence for the Role of Inorganic Phosphate J. Am. Soc. Nephrol., September 1, 2003; 14(90004): S300 - 304. [Abstract] [Full Text]

				R. F. Redberg, R. A. Vogel, M. H. Criqui, D. M. Herrington, J. A. C. Lima, and M. J. Roman Task force #3--what is the spectrum of current and emerging techniques for the noninvasive measurement of atherosclerosis? J. Am. Coll. Cardiol., June 4, 2003; 41(11): 1886 - 1898. [Full Text] [PDF]

				R. C. Christian, D. A. Dumesic, T. Behrenbeck, A. L. Oberg, P. F. Sheedy II, and L. A. Fitzpatrick Prevalence and Predictors of Coronary Artery Calcification in Women with Polycystic Ovary Syndrome J. Clin. Endocrinol. Metab., June 1, 2003; 88(6): 2562 - 2568. [Abstract] [Full Text] [PDF]

				L. A. Fitzpatrick, R. T. Turner, and E. R. Ritman Endochondral Bone Formation in the Heart: A Possible Mechanism of Coronary Calcification Endocrinology, June 1, 2003; 144(6): 2214 - 2219. [Abstract] [Full Text] [PDF]