BACKGROUND: Coronary atherosclerosis is a dynamic process, which progresses differently in coronary segments containing noncalcified or calcified plaques. This may have implications for the study of the effects of therapy on progression/regression. OBJECTIVE: To test this hypothesis, we performed a post-hoc analysis on data of a randomized trial in which perindopril treatment was compared with placebo on progression/regression of atherosclerosis with regard to the degree of calcification. METHODS AND RESULTS: The intracoronary ultrasound data of 118 patients, who were enrolled in the multicentre, double-blinded randomized trial (PERSPECTIVE), were analysed. Vessel, lumen and plaque areas were measured in 711 5-mm-long matched coronary segments (perindopril 360, placebo 351). Each individual intracoronary ultrasound cross-section was binary labelled for the presence of calcium (yes/no), and the degree of calcium was assessed as a percentage of length. The segments were classified into three groups: 0-25, 25-50 and 50-100% (percentage of length) calcification. Coronary plaques with no or little calcium (0-25%) regressed on perindopril and did not change on placebo (-0.33±1.74 vs. -0.03±1.66, respectively; P=0.04). Plaques containing moderate calcium (group 25-50%) did not change and plaques with severe amounts of calcification (group 50-100%) equally progressed. CONCLUSION: Noncalcified plaques may be amenable to regression with ACE inhibitor treatment. The method, which considers the amount of calcium content in a plaque, may lead to new insights for quantitative analysis of the effects of therapy in progression/regression studies of atherosclerosis.

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Keywords Coronary artery disease, Image processing, Intracoronary ultrasound
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Bruining, N, de Winter, S, Roelandt, J.R.T.C, Rodriguez-Granillo, G.A, Heller, I, van Domburg, R.T, … de Feijter, P.J. (2009). Coronary calcium significantly affects quantitative analysis of coronary ultrasound: Importance for atherosclerosis progression/regression studies. Coronary Artery Disease, 20(6), 409–414. doi:10.1097/MCA.0b013e32832fa9b8