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Coronary artery fixation at iso-arterial pressure: impacts on histologic evaluation and clinical management
Philippe Laflamme1, Jonathan Vaucher1, Justine Turmel-Roy1
1Department of Pathology, Quebec Heart and Lung Institute, 2725 Chemin Sainte-FoyG1V 4G5 ,Quebec, Canada.
Insights
Histologic evaluation of coronary artery stenosis differs significantly based on fixation method. Active fixation, mimicking physiologic pressure, provides more accurate assessments than passive fixation, resolving discrepancies with coronary angiography.
Area of Science:
- Cardiovascular Pathology
- Medical Imaging
- Histopathology Techniques
Background:
- Coronary angiography is standard for assessing coronary artery disease severity.
- Existing literature highlights discordance between angiography and post-mortem histologic evaluation of coronary stenosis.
- Passive fixation methods for histology introduce significant biases in stenosis assessment.
Purpose of the Study:
- To compare stenosis severity estimates using passive versus active fixation methods in post-mortem coronary artery samples.
- To evaluate the impact of iso-physiologic mechanical perfusion (active fixation) on coronary stenosis measurements.
- To identify discrepancies in coronary artery stenosis assessment between different histological fixation techniques.
Main Methods:
- Comparison of stenosis severity in passively fixed coronary arteries versus actively (perfused) fixed coronary arteries from patients with chronic coronary artery disease.
- Quantitative histopathology analysis of major coronary vessels (Cx, LAD, LM, RC).
- Statistical analysis to determine mean differences and significance (P-values) between fixation methods and coronary angiography.
Main Results:
- Significant discrepancies were observed between passively fixed coronary arteries and coronary angiography (P=.002 combined; P=.045 Cx; P=.026 CD).
- No significant mean difference in stenosis was found when comparing actively fixed (perfused) samples with coronary angiography.
- Active fixation yielded significantly reduced stenosis means compared to passive fixation (P=.0001 combined; P=.003 Cx; P=.025 LAD; P=.056 LM; P=.007 RC).
Conclusions:
- Passive fixation in post-mortem histopathology leads to biased overestimation of coronary artery stenosis.
- Active (iso-physiologic) fixation provides more accurate coronary stenosis assessments, aligning with coronary angiography.
- This study underscores the importance of fixation methodology in accurate histopathological evaluation of coronary artery disease.
Abstract:
Coronary angiography is the standard imaging method for determining the site, extent, and severity of coronary artery disease. Several publications have reported discordance between the degree of coronary artery stenosis determined from post-mortem histologic evaluation and coronary angiography. While the 2-dimensional limitations of coronary angiography are well established, the determination of coronary stenosis based on histologic evaluation of passively fixed samples is also associated with significant biases. In this study, we used patients with chronic coronary artery disease to compare the stenosis severity estimates that were determined using the passive fixation method with those determined using the active fixation method. Our results showed a significant discrepancy between the stenosis in passively fixed coronary arteries when compared with coronary angiography in all major coronary vessels combined (P=.002), and in Cx (P=.045) and CD (P=.026). However, there was no mean difference when compared with perfused (actively fixed) samples when all vessels were combined or examined individually. Iso-physiologic mechanical perfusion (active) fixation yielded significantly reduced coronary artery stenosis means when compared to the passive fixation method in post-mortem evaluations during autopsies. This was evident when all vessels were combined (P=.0001) and assessed individually (Cx (P=.003), LAD (P=.025), LM (P=.056) and RC (P=.007)). Autopsies including cardiac explant patients also showed differences in estimates for all vessels combined (P=.0001) and in Cx (P=.016) and RC (P=.006). In summary, our quantitative histopathology analyses using perfused coronary artery stenosis at physiologic pressure showed significant discrepancies when compared with passive histopathology.
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