Histological evaluation disqualifies IMT and calcification scores as surrogates for grading coronary and aortic atherosclerosis. (1st December 2016)

• Record Type: Journal Article
• Authors: Meershoek, Armelle; van Dijk, Rogier A.; Verhage, Sander; Hamming, Jaap F.; van den Bogaerdt, Antoon J.; Bogers, Ad J.J.C.; Schaapherder, Alexander F.; Lindeman, Jan H.
• Is Part Of: International journal of cardiology. Volume 224(2016)
• Page Start: 328
• Page End: 334
• Publication Date: 2016-12-01
• Subjects: IMT intimal media thickness -- CCS coronary calcium scores -- AHA American Heart Association -- H&E hematoxylin and eosin stain -- AIT Adaptive Intimal Thickening -- IX Intimal Xanthoma -- PIT Pathological Intimal Thickening -- EFA early fibroatheroma -- LFA late fibroatheroma -- TCFA thin cap fibroatheroma -- PR plaque rupture -- HR healed rupture -- FCP fibrous calcified plaque; Intima media thickness -- Coronary calcium -- Atherosclerosis -- Classification -- Histology; Cardiology -- Periodicals; Electronic journals; 616.12
• DOI: 10.1016/j.ijcard.2016.09.043
• Languages: English
• ISSNs: 0167-5273

Abstract

Abstract: Background/objectives: Carotid intimal media thickness (IMT) and coronary calcium scores (CCS) are thought to reflect atherosclerotic burden. The validity of this assumption for IMT is challenged by recent meta-analyses; for CCS by absence of a relationship between negative scores, and freedom of future events. As such, we considered evaluation of the relationship between tissue IMT and CCS, and extend of atherosclerotic disease relevant. Methods: Analyses were performed on donor aortas obtained during renal graft procurement, and on coronary arteries collected during heart valve procurement for tissue donation. Movat pentachrome and Hematoxylin staining was performed, and the degree of atherosclerosis histologically graded. IMT and presence of calcium deposits were quantified on graded tissue sections. Results: 304 aortas and 185 coronary arteries covering the full atherosclerotic spectrum were evaluated. Aortas and coronaries showed similar relationships between tissue IMT and degree of atherosclerosis, with gradual increase in tissue IMT during earlier phases of atherosclerosis (r = 0.68 and r = 0.30, P < 0.00001 for aorta and coronaries respectively), followed by plateauing of the curve in intermediate and advanced stages. Results for tissue IMT reveal high variability, resulting in wide confidence intervals. Results for CCS are similar for aorta and coronaries, with calcium depositions limited to advanced lesions. Conclusions: Histological IMT measurements for the aorta and coronaries show large variations around the trend and plateauing of, and possibly reductions in IMT in late stage atherosclerotic disease. These observations for the aorta and coronaries may (partly) explain the limited benefit of including carotid IMT in risk prediction algorithms.