Coronary Artery Calcification: Its Relationship to Coronary Artery Stenosis and Myocardial Infarction

Image intensification allows the radiologist readily to detect calcifications within the heart on routine fluoroscopic chest examination. Even small calcifications in the coronary arteries can be seen when the appropriate fluoroscopic position is used. Once the location and extent of coronary artery calcification is established, the clinical question naturally arises, “What is the pathologic significance or prognostic import of this arterial calcification?” Many investigators (1–3) have studied coronary artery calcification clinically and on autopsy specimens. Prior to image intensification, however, the demonstration of calcium in coronary arteries was a rare event (4, 9). Reports on image intensification, such as those of Jorgens (5, 6) and Tampas and Soule (10), indicate that coronary artery calcification can be detected frequently in the living patient and appears to augur early arteriosclerotic heart disease. The current study of autopsied hearts shows the relationship of coronary calcification to coronary stenosis and myocardial disease. Methods and Materials The present material consists of 80 essentially consecutive autopsied cases selected at random in a five-month period — January 1967 to June 1967. The causes of death were various. The series was restricted to persons thirty years of age or older at death. Because of the particular way the heart was cut for this study, cases of congenital heart disease and recent intracardiac surgery were excluded. The heart was removed from the body with the pulmonary veins cut flush with the left atrium, the superior and inferior vena cava flush with the right atrium, the pulmonary artery at the bifurcation, and the aorta approximately 1 cm above the sinuses of Valsalva. The dissection and injection of coronary arteries and gross and microscopic examination of the myocardium was performed by the authors and constituted the autopsy examination of the heart. The heart was opened by a modification of the Schlesinger method first described in 1938 (8). A small central portion of the ventricular septum was removed. Cuts were made through the aortic and pulmonic valves and along the right ventricular side of the ventricular septum, thus separating the right ventricle anteriorly from the left ventricle. The heart was then “unrolled” and laid fiat so that the coronary arteries and their branches lay in one “spread-out” plane and did not overlap each other when radiographed. The heart was then radiographed in a flat position, endocardial surface down. A target-film distance of 38 in. was used with filter removed. Factors were 40 kV, 100 m A, and 0.3 seconds. The heart was next immersed in cold water, and each coronary artery was injected under water with approximately 15 cc of a thick barium water suspension (3 cups barium to 8 oz. water) through a specially adapted syringe which fit snugly in the coronary ostia.