In vitro analysis of coronary atheromatous lesions by intravascular ultrasound - reproducibility and histological correlation of lesion morphology
In vitro analysis of coronary atheromatous lesions by intravascular ultrasound - reproducibility and histological correlation of lesion morphology
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DOI：
10.1053/euhj.1999.1627
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发表时间：
1999-12-01
影响因子：
39.3
通讯作者：
Fox, KAA
中科院分区：
文献类型：
--
作者：
Palmer, ND;Northridge, D;Fox, KAA
目的利用欧洲心脏病学会最近提出的斑块组成分类，在接近临床环境的条件下，确定冠状动脉粥样硬化定性血管内超声成像的可重复性和组织学相关性。方法在模拟冠状动脉血流的脉动血流系统中，使用血管内超声对30例死后冠状动脉粥样硬化病变（n = 21）进行成像。50个位点（21个最小流明区域和29个远端参考位点）由两名观察员从连续录像中独立选择。动脉粥样斑块被每个观察者分类为回声密集、回声透明、异质或钙化，在不同的场合由一个观察者分类。动脉标本在这些部位进行组织学切片，并由第三位对血管内超声外观视而不见的观察者进行类似的分析。结果斑块类型（Kappa分别为0.87[0.80-0.94]和0.89[0.85-0.93]）和局灶性钙化（0.78[0.74-0.82]和0.88[0.84-0.92]）的整体观察者间和观察者内重现性较高。位点选择的差异显著影响了再现性，特别是在参考位点。89%的血管内超声和组织学对总体斑块类型的判断一致（Kappa 0.73[0.69-0.77]）。单个斑块类型的特异性和阳性预测值大于90%。结论在接近临床环境的体外系统中使用现代血管内超声技术，提出的血管内超声斑块组成ESC分类具有可重复性，且与组织学有良好的相关性。因此，在诊断血管内超声检查和经皮冠状动脉介入治疗的指导下，它应该可靠地进行pet成像。(C) 1999欧洲心脏病学会。
Aim To determine the reproducibility rind histological correlation of qualitative intravascular ultrasound imaging of atheromatous coronary arteries using the recently proposed European Society of Cardiology classification of plaque composition in conditions approximating the clinical setting.Methods Atheromatous lesions (n = 21), identified from 30 post-mortem human coronary arteries, were imaged using intravascular ultrasound in a pulsatile flow system which simulates coronary flow. Fifty sites (21 x minimum lumen area and 29 x distal reference sites) were selected independently by two observers from continuous video recordings. Atheromatous plaque was classified as echodense, echolucent, heterogenous or calcified by each observer and by one observer on separate occasions. Arterial specimens were histologically sectioned at these sites and similarly analysed by a third observer blinded to the intravascular ultrasound appearances.Results Overall inter- and intra-observer reproducibility for plaque-type (Kappa 0.87[0.80-0.94] and 0.89[0.85-0.93 respectively]) and focal calcification (0.78[0.74-0.82] and 0.88[0.84-0.92]) was high. Differences in site selection significantly influenced reproducibility particularly at reference sites. Agreement for overall plaque type between intravascular ultrasound and histology occurred in 89% of sites (Kappa 0.73[0.69-0.77]). Specificity and positive predictive values for individual plaque types were greater than 90%.Conclusion Using modern intravascular ultrasound technology in an in vitro system which approximates the clinical setting the proposed ESC classification of plaque composition by intravascular ultrasound is reproducible and correlates well with histology. It should therefore pet-form reliably in diagnostic intravascular ultrasound examinations and in the guidance of percutaneous coronary interventions. (C) 1999 The European Society of Cardiology.