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Peverelli M, Maughan RT, Gopalan D, Dweck MR, Dey D, Buch MH, Rudd JHF, Tarkin JM. Use of coronarycomputed tomography for cardiovascular risk assessment in immune-mediated inflammatory diseases. Heart 2024; 110:545-551. [PMID: 38238078 DOI: 10.1136/heartjnl-2022-321403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Accepted: 12/05/2023] [Indexed: 02/15/2024] Open
Abstract
Immune-mediated inflammatory diseases (IMIDs) are recognised risk factors for accelerated atherosclerotic cardiovascular disease (CVD), particularly in younger individuals and women who lack traditional CVD risk factors. Reflective of the critical role that inflammation plays in the formation, progression and rupture of atherosclerotic plaques, research into immune mechanisms of CVD has led to the identification of a range of therapeutic targets that are the subject of ongoing clinical trials. Several key inflammatory pathways implicated in the pathogenesis of atherosclerosis are targeted in people with IMIDs. However, cardiovascular risk continues to be systematically underestimated by conventional risk assessment tools in the IMID population, resulting in considerable excess CVD burden and mortality. Hence, there is a pressing need to improve methods for CVD risk-stratification among patients with IMIDs, to better guide the use of statins and other prognostic interventions. CT coronary angiography (CTCA) is the current first-line investigation for diagnosing and assessing the severity of coronary atherosclerosis in many individuals with suspected angina. Whether CTCA is also useful in the general population for reclassifying asymptomatic individuals and improving long-term prognosis remains unknown. However, in the context of IMIDs, it is conceivable that the information provided by CTCA, including state-of-the-art assessments of coronary plaque, could be an important clinical adjunct in this high-risk patient population. This narrative review discusses the current literature about the use of coronary CT for CVD risk-stratification in three of the most common IMIDs including rheumatoid arthritis, psoriasis and systemic lupus erythematosus.
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Affiliation(s)
- Marta Peverelli
- Section of Cardiorespiratory Medicine, University of Cambridge, Cambridge, UK
| | | | - Deepa Gopalan
- Department of Radiology, Imperial College Healthcare NHS Trust, London, UK
- Department of Radiology, Cambridge University Hospitals NHS Trust, UK
| | - Marc R Dweck
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
| | - Damini Dey
- Departments of Biomedical Sciences and Medicine, Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Maya H Buch
- Centre for Musculoskeletal Research, University of Manchester, Manchester, UK
| | - James H F Rudd
- Section of Cardiorespiratory Medicine, University of Cambridge, Cambridge, UK
| | - Jason M Tarkin
- Section of Cardiorespiratory Medicine, University of Cambridge, Cambridge, UK
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2
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Wu M, Mirkin S, Nagy S, McPhail MN, Demory Beckler M, Kesselman MM. Computed Tomography (CT) Calcium Scoring in Primary Prevention of Acute Coronary Syndrome and Future Cardiac Events in Patients With Systemic Lupus Erythematosus. Cureus 2023; 15:e47157. [PMID: 38022274 PMCID: PMC10653626 DOI: 10.7759/cureus.47157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Accepted: 10/16/2023] [Indexed: 12/01/2023] Open
Abstract
Systemic lupus erythematosus (SLE) is a complex and chronic autoimmune disease that impacts multiple organ systems and presents with varying symptomatology that makes targeting treatment extremely difficult. The cardiovascular system and more specifically the coronary arteries are heavily affected by SLE causing increased atherosclerosis and subsequently increased acute coronary syndrome (ACS) and increased future cardiac events. ACS is a common occurrence in patients with SLE due to the premature development of atherosclerosis due to the dysregulation of pro-inflammatory cytokines. Calcium scoring has been effectively utilized to identify plaque burden in patients with coronary artery calcification (CAC). Calcium scoring is a score obtained from a computed tomography (CT) image using non-contrast imaging, which provides quantitative information regarding CAC and aids in assessing cardiovascular risk. A calcium score of zero Hounsfeild units can be obtained using CT calcium scoring which indicates no calcium is identified in the coronary arteries and is a strong negative risk predictor for coronary artery disease. Early screening of SLE patients with CT calcium scoring could aid in early detection and treatment subsequently leading to delay of premature coronary atherosclerosis and future cardiac events in this patient population. Multiple studies have used calcium scoring as a method to measure arterial calcification in SLE patients. The Society of Cardiovascular Imaging has now endorsed the idea of obtaining a baseline calcium artery score with a repeat progression scan in 3-5 years. Calcium scoring has also been identified as an effective initial tool for stratification and identification of possible ACS. The various advantages of early calcium scoring signify the further research needed to fully understand and implement the advantages calcium scoring has to offer patients with SLE.
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Affiliation(s)
- Michael Wu
- Osteopathic Medicine, Nova Southeastern University Dr. Kiran C. Patel College of Osteopathic Medicine, Fort Lauderdale, USA
| | - Sophia Mirkin
- Osteopathic Medicine, Nova Southeastern University Dr. Kiran C. Patel College of Osteopathic Medicine, Fort Lauderdale, USA
| | - Stephanie Nagy
- Rheumatology, Nova Southeastern University Dr. Kiran C. Patel College of Osteopathic Medicine, Fort Lauderdale, USA
| | - Marissa N McPhail
- Osteopathic Medicine, Nova Southeastern University Dr. Kiran C. Patel College of Osteopathic Medicine, Fort Lauderdale, USA
| | - Michelle Demory Beckler
- Microbiology and Immunology, Nova Southeastern University Dr. Kiran C. Patel College of Allopathic Medicine, Fort Lauderdale, USA
| | - Marc M Kesselman
- Rheumatology, Nova Southeastern University Dr. Kiran C. Patel College of Osteopathic Medicine, Fort Lauderdale, USA
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3
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Nafakhi H, Elwali HQ, Al-Sharea KMK, Al-Mosawi AA. Relationship of cardiovascular risk factors, pericardial fat, and carotid thickness with coronary plaque type in patients with diabetes mellitus. J Diabetes Metab Disord 2023; 22:713-719. [PMID: 37255796 PMCID: PMC10225442 DOI: 10.1007/s40200-023-01190-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 01/20/2023] [Accepted: 01/23/2023] [Indexed: 06/01/2023]
Abstract
Background There is paucity of data on the potential predictors of coronary plaque types among patients with diabetes mellitus(DM). Aims To assess the association of cardiovascular risk factors, pericardial fat volume (PFV) assessed by multi-detector CT(MDCT)angiography, and internal carotid intima media thickness with coronary atherosclerotic plaque types in patients with type 2 DM. Patients and methods Patients with suspected coronary artery disease who underwent 64-slice MDCT angiography were enrolled in this retrospective study. Results A total of 784 patients were enrolled in this study, 198 of whom had DM and 586 of whom did not. The prevalence of calcified and mixed plaques was significantly higher in the DM group than without DM group, while no significant difference was found in the distribution of non-calcified plaque between groups. There was significant association between smoking [OR(CI) = 4(2-10),P = 0.001] and increased age[OR(CI) = 1.1(1-1.3),P = 0.023] and calcified plaque presence. Regarding mixed and non-calcified plaque, increased PFV[OR(CI) = 1.1(1-1.3),P = 0.001] and positive family history[OR(CI) = 4(2-12),P = 0.049] showed a significant association with coronary mixed plaque presence while no significant association was observed between cardiovascular risk factors, PFV, and internal carotid intima media thickness and non-calcified plaque presence in patients with DM. Conclusion Increased PFV showed significant and independent association with mixed coronary plaques development, which suggests that PFV may be used as an imaging marker for early detection of increased risk for future coronary events in patients with DM.
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Affiliation(s)
- Hussein Nafakhi
- Internal medicine department, Medicine College, University of Kufa, P.O. 21, Kufa, Najaf, Iraq
| | | | - Kareem M Khalaf Al-Sharea
- Diabetes and endocrine center, Al-Sader teaching medical city, Najaf health directorate, Najaf, Iraq
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Moore J, Lakshmanan S, Manubolu VS, Kinninger A, Stojan G, Goldman DW, Petri M, Budoff M, Karpouzas GA. Coronary plaque progression is greater in systemic lupus erythematosus than rheumatoid arthritis. Coron Artery Dis 2023; 34:52-58. [PMID: 36421035 DOI: 10.1097/mca.0000000000001205] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Systemic lupus erythematosus (SLE) and rheumatoid arthritis (RA) are associated with a high incidence of cardiovascular disease. Coronary atherosclerosis, particularly total plaque and noncalcified plaque on coronary computed tomography angiography (CCTA) has been correlated with cardiovascular events. We compared baseline coronary plaque burden and progression by serial CCTA in SLE and RA patients. METHODS We prospectively evaluated 44 patients who underwent serial CCTA examinations to quantify coronary plaque progression, 22 SLE patients, and 22 age- and sex-matched RA patients. Semiautomated plaque software was used for quantitative plaque assessment. Linear regression examined the effect of SLE diagnosis (versus RA) on annualized change in natural log-transformed total normalized atheroma volume (ln-TAV norm ) for low-attenuation, fibrofatty, fibrous, total noncalcified, densely calcified, and total plaque. RESULTS No quantitative differences for any plaque types were observed at baseline between SLE and RA patients ( P = 0.330-0.990). After adjustment for baseline plaque and cardiovascular risk factors, the increase in ln-TAV norm was higher in SLE than RA patients for fibrous [Exp-β: 0.202 (0.398), P = 0.0003], total noncalcified [Exp-β: 0.179 (0.393), P = 0.0001], and total plaque volume [Exp-β: 0.154 (0.501), P = 0.0007], but not for low-attenuation, fibrofatty, or densely calcified plaque ( P = 0.103-0.489). Patients with SLE had 80% more fibrous, 82% more noncalcified, and 85% more total plaque increase than those with RA. CONCLUSION Coronary plaque volume was similar in RA and SLE at baseline. Progression was greater in SLE, which may explain the greater cardiovascular risk in this disease. Further research to evaluate screening and management strategies for cardiovascular disease in these high-risk patients is warranted.
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Affiliation(s)
- Jeff Moore
- Chronic Disease Clinical Research Center, The Lundquist Institute for Biomedical Innovation at the Harbor University of California Los Angeles Medical Center, Torrance
- School of Exercise and Nutritional Sciences, San Diego State University, San Diego, California
| | - Suvasini Lakshmanan
- Chronic Disease Clinical Research Center, The Lundquist Institute for Biomedical Innovation at the Harbor University of California Los Angeles Medical Center, Torrance
| | - Venkat Sanjay Manubolu
- Chronic Disease Clinical Research Center, The Lundquist Institute for Biomedical Innovation at the Harbor University of California Los Angeles Medical Center, Torrance
| | - April Kinninger
- Chronic Disease Clinical Research Center, The Lundquist Institute for Biomedical Innovation at the Harbor University of California Los Angeles Medical Center, Torrance
| | - George Stojan
- Division of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Daniel W Goldman
- Division of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Michelle Petri
- Division of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Matthew Budoff
- Chronic Disease Clinical Research Center, The Lundquist Institute for Biomedical Innovation at the Harbor University of California Los Angeles Medical Center, Torrance
| | - George A Karpouzas
- Chronic Disease Clinical Research Center, The Lundquist Institute for Biomedical Innovation at the Harbor University of California Los Angeles Medical Center, Torrance
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A Meta-Analysis on the Global Prevalence, Risk factors and Screening of Coronary Heart Disease in Nonalcoholic Fatty Liver Disease. Clin Gastroenterol Hepatol 2022; 20:2462-2473.e10. [PMID: 34560278 DOI: 10.1016/j.cgh.2021.09.021] [Citation(s) in RCA: 44] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 09/04/2021] [Accepted: 09/10/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Cardiovascular disease remains the leading cause of death in patients with nonalcoholic fatty liver disease (NAFLD). Studies examining the association of coronary heart disease (CHD) and NAFLD are cofounded by various cardiometabolic factors, particularly diabetes and body mass index. Hence, we seek to explore such association by investigating the global prevalence, independent risk factors, and influence of steatosis grade on manifestation of CHD among patients with NAFLD. METHODS Two databases, Embase and Medline, were utilized to search for articles relating to NAFLD and CHD. Data including, but not limited to, continent, diagnostic methods, baseline characteristics, prevalence of CHD, CHD severity, NAFLD severity, and risk factors were extracted. RESULTS Of the 38 articles included, 14 reported prevalence of clinical coronary artery disease (CAD) and 24 subclinical CAD. The pooled prevalence of CHD was 44.6% (95% confidence interval [CI], 36.0%-53.6%) among 67,070 patients with NAFLD with an odds ratio of 1.33 (95% CI, 1.21%-1.45%; P < .0001). The prevalence of CHD was higher in patients with moderate to severe steatosis (37.5%; 95% CI, 15.0%-67.2%) than those with mild steatosis (29.6%; 95% CI, 13.1%-54.0%). The pooled prevalence of subclinical and clinical CAD was 38.7% (95% CI, 29.8%-48.5%) and 55.4% (95% CI, 39.6%-70.1%), respectively. CONCLUSION Steatosis was found to be related with CHD involvement, with moderate to severe steatosis related to clinical CAD. Early screening and prompt intervention for CHD in NAFLD are warranted for holistic care in NAFLD.
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Mendoza-Pinto C, Munguía-Realpzo P, García-Carrasco M, Godinez-Bolaños K, Rojas-Villarraga A, Morales-Etchegaray I, Ayón-Aguilar J, Méndez-Martínez S, Cervera R. Asymptomatic coronary artery disease assessed by coronary computed tomography in patients with systemic lupus erythematosus: A systematic review and meta-analysis. Eur J Intern Med 2022; 100:102-109. [PMID: 35410814 DOI: 10.1016/j.ejim.2022.04.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 03/22/2022] [Accepted: 04/01/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND Coronary artery disease (CAD) assessed by coronary computed tomography (CT) in patients with systemic lupus erythematosus (SLE) has been investigated in several studies, but with conflicting results. The aim of this systematic review and meta-analysis of the literature was synthesize the evidence on this topic. METHODS The relevant literature was identified and evaluated from inception until January 2021 in PubMed, Embase, Web of Science and Cochrane library. Studies reporting coronary artery calcification (CAC), and its prevalence and extent using the coronary calcium score (CCS) were included. Data extracted from eligible studies were used to calculate effect estimates (ESs) and 95% confidence intervals (95%CI) and weighted mean differences (WMD) with 95%CI. RESULTS Twenty-four studies were eligible for inclusion. For the CAC prevalence, 11 studies were included (918 SLE patients and 3952 controls) and the pooled prevalence for the random effect was 29.8% (95%CI 25.7-32.9%) for SLE patients and 11.8% (95%CI 16.2-20.4%) in controls (RR 2.22, 95%CI 1.42 to 3.48; p= 0.0005) and no significant increase in the WMD for CCS (MD= 0.32, 95%CI -5.55 to 6.20, p= 0.91) compared with controls in seven studies. Greater organ damage and glucocorticoid use has been associated with a higher CCS. According to two studies, the coronary CT angiography calcified and non-calcified plaque burden were increased in SLE patients compared with controls. CONCLUSIONS In SLE, asymptomatic CAD by CAC is more prevalent and there is more multivessel disease compared with controls without lupus. However, the extent of CAC was not increased in SLE patients. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42021228710.
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Affiliation(s)
- Claudia Mendoza-Pinto
- Department of Rheumatology, Medicine School, Meritorious Autonomous University of Puebla, Puebla, Mexico; Systemic Autoimmune Diseases Research Unit, Specialties Hospital UMAE, Mexican Social Security Institute, Puebla, México.
| | - Pamela Munguía-Realpzo
- Department of Rheumatology, Medicine School, Meritorious Autonomous University of Puebla, Puebla, Mexico.
| | - Mario García-Carrasco
- Department of Rheumatology, Medicine School, Meritorious Autonomous University of Puebla, Puebla, Mexico.
| | - Karla Godinez-Bolaños
- Department of Rheumatology, Medicine School, Meritorious Autonomous University of Puebla, Puebla, Mexico.
| | | | - Ivet Morales-Etchegaray
- Department of Rheumatology, Medicine School, Meritorious Autonomous University of Puebla, Puebla, Mexico.
| | - Jorge Ayón-Aguilar
- Research in Health Coordination, Mexican Social Security Institute, Puebla, México.
| | | | - Ricard Cervera
- Department of Autoimmune Diseases, Hospital Clínic, Barcelona, Spain.
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7
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Mak A, Chan JKY. Endothelial function and endothelial progenitor cells in systemic lupus erythematosus. Nat Rev Rheumatol 2022; 18:286-300. [PMID: 35393604 DOI: 10.1038/s41584-022-00770-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/04/2022] [Indexed: 12/13/2022]
Abstract
The observations that traditional cardiovascular disease (CVD) risk factors fail to fully account for the excessive cardiovascular mortality in patients with systemic lupus erythematosus (SLE) compared with the general population have prompted in-depth investigations of non-traditional, SLE-related risk factors that contribute to cardiovascular complications in patients with SLE. Of the various perturbations of vascular physiology, endothelial dysfunction, which is believed to occur in the earliest step of atherosclerosis, has been extensively investigated for its contribution to CVD risk in SLE. Endothelial progenitor cells (EPCs), which play a crucial part in vascular repair, neovascularization and maintenance of endothelial function, are quantitatively and functionally reduced in patients with SLE. Yet, the lack of a unified definition of EPCs, standardization of the quantity and functional assessment of EPCs as well as endothelial function measurement pose challenges to the translation of endothelial function measurements and EPC levels into prognostic markers for CVD in patients with SLE. This Review discusses factors that contribute to CVD in SLE, with particular focus on how endothelial function and EPCs are evaluated currently, and how EPCs are quantitatively and functionally altered in patients with SLE. Potential strategies for the use of endothelial function measurements and EPC quantification as prognostic markers of CVD in patients with SLE, and the limitations of their prognostication potential, are also discussed.
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Affiliation(s)
- Anselm Mak
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore. .,Division of Rheumatology, University Medicine Cluster, National University Health System, Singapore, Singapore.
| | - Jerry Kok Yen Chan
- Department of Reproductive Medicine, KK Women's and Children's Hospital, Singapore, Singapore.,Academic Clinical Programme in Obstetrics and Gynaecology, Duke-NUS Medical School, Singapore, Singapore.,Department of Obstetrics and Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
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8
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Jin X, Li Y, Yan F, Liu Y, Zhang X, Li T, Yang L, Chen H. Automatic coronary plaque detection, classification, and stenosis grading using deep learning and radiomics on computed tomography angiography images: a multi-center multi-vendor study. Eur Radiol 2022; 32:5276-5286. [PMID: 35290509 DOI: 10.1007/s00330-022-08664-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 12/12/2021] [Accepted: 01/13/2022] [Indexed: 11/28/2022]
Abstract
OBJECTIVES An automatic system utilizing both the advantages of the neural network and the radiomics was proposed for coronary plaque detection, classification, and stenosis grading. METHODS This study retrospectively included 505 patients with 127,763 computed tomography angiography (CTA) images from 5 medical center. A convolutional neural network (CNN) model was used to segment the coronary artery, detect the plaque candidate, and extract the image patch with high computation efficiency. The manually designed radiomics feature extractor was utilized to collect plaque patterns, followed by the different classifiers to perform the plaque classification and stenosis grading. RESULTS The CNN model achieved 100% of sensitivity and the highest positive predictive value (83.9%) than U-Net and baseline model in plaque candidate detection. Twenty-six representative radiomics features were selected to construct the classifiers. Among different models, the gradient-boosting decision tree (GBDT) achieved the best performance in plaque classification (accuracy: 87.0%, sensitivity: 83.2%, specificity: 91.4%) and stenosis grading (accuracy: 90.9%, sensitivity: 84.1%, specificity: 95.7%). GBDT also achieved the highest AUC of 0.873 in plaque classification and 0.910 in stenosis grading. The computation time of processing one patient was 56.2 ± 5.7 s which was significantly less than radiologist manual analysis (285.6 ± 134.5 s, p = 0.0001). CONCLUSIONS In this study, an automatic workflow was proposed to detect and analyze coronary plaques with high accuracy and efficiency, showing the potential in clinical application. KEY POINTS • The proposed automatic system integrated deep learning and radiomics to perform the coronary plaque analysis. • The proposed automatic system achieved high accuracy in both plaque classification and stenosis grading. • The proposed automatic system was five times more efficient than radiologist manual analysis.
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Affiliation(s)
- Xin Jin
- Radiology Department, Chinese PLA General Hospital, 28th Fuxing Road, Haidian District, Beijing, 100853, China
| | - Yuze Li
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, School of Medicine, Tsinghua University, Room 109, Haidian District, Beijing, 100084, China
| | - Fei Yan
- Radiology Department, Chinese PLA General Hospital, 28th Fuxing Road, Haidian District, Beijing, 100853, China
| | - Ye Liu
- Radiology Department, Chinese PLA General Hospital, 28th Fuxing Road, Haidian District, Beijing, 100853, China
| | - Xinghua Zhang
- Radiology Department, Chinese PLA General Hospital, 28th Fuxing Road, Haidian District, Beijing, 100853, China
| | - Tao Li
- Radiology Department, Chinese PLA General Hospital, 28th Fuxing Road, Haidian District, Beijing, 100853, China
| | - Li Yang
- Radiology Department, Chinese PLA General Hospital, 28th Fuxing Road, Haidian District, Beijing, 100853, China.
| | - Huijun Chen
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, School of Medicine, Tsinghua University, Room 109, Haidian District, Beijing, 100084, China.
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Parel PM, Berg AR, Hong CG, Florida EM, O'Hagan R, Sorokin AV, Mehta NN. Updates in the Impact of Chronic Systemic Inflammation on Vascular Inflammation by Positron Emission Tomography (PET). Curr Cardiol Rep 2022; 24:317-326. [PMID: 35171444 DOI: 10.1007/s11886-022-01651-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/17/2021] [Indexed: 12/13/2022]
Abstract
PURPOSE OF REVIEW In this review, we focus on the clinical and epidemiological studies pertaining to systemic and vascular inflammation by positron emission tomography (PET) in patients with chronic inflammatory conditions such as rheumatoid arthritis (RA), systemic lupus erythematosus (SLE), human immunodeficiency virus (HIV), and psoriasis to highlight the importance of chronic systemic inflammation on vascular inflammation by PET in these disease states. RECENT FINDINGS Recent clinical and translation advancements have demonstrated the durable relationship between chronic systemic inflammation and cardiovascular disease (CVD). In chronic inflammatory states, this relationship is robustly evident in the form of increased vascular inflammation, yet traditional risk estimates often underestimate the subclinical cardiovascular risk conferred by chronic inflammation. PET has emerged as a novel, non-invasive imaging modality capable of both quantifying the degree of systemic and vascular inflammation and detecting residual inflammation prior to cardiovascular events. We begin by demonstrating the role of inflammation in the pathogenesis of atherosclerosis, discussing how PET has been utilized to measure systemic and vascular inflammation and their effect on subclinical atherosclerosis, and finally reviewing recent applications of PET in constructing improved risk stratification for patients at high risk for stroke and CVD.
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Affiliation(s)
- Philip M Parel
- Inflammation and Cardiometabolic Diseases, Clinical Research Center, National Heart, Lung, and Blood Institute, National Institutes of Health, 10 Center Drive, Bethesda, MD, USA
| | - Alexander R Berg
- Inflammation and Cardiometabolic Diseases, Clinical Research Center, National Heart, Lung, and Blood Institute, National Institutes of Health, 10 Center Drive, Bethesda, MD, USA
| | - Christin G Hong
- Inflammation and Cardiometabolic Diseases, Clinical Research Center, National Heart, Lung, and Blood Institute, National Institutes of Health, 10 Center Drive, Bethesda, MD, USA
| | - Elizabeth M Florida
- Inflammation and Cardiometabolic Diseases, Clinical Research Center, National Heart, Lung, and Blood Institute, National Institutes of Health, 10 Center Drive, Bethesda, MD, USA
| | - Ross O'Hagan
- Inflammation and Cardiometabolic Diseases, Clinical Research Center, National Heart, Lung, and Blood Institute, National Institutes of Health, 10 Center Drive, Bethesda, MD, USA
| | - Alexander V Sorokin
- Inflammation and Cardiometabolic Diseases, Clinical Research Center, National Heart, Lung, and Blood Institute, National Institutes of Health, 10 Center Drive, Bethesda, MD, USA
| | - Nehal N Mehta
- Inflammation and Cardiometabolic Diseases, Clinical Research Center, National Heart, Lung, and Blood Institute, National Institutes of Health, 10 Center Drive, Bethesda, MD, USA.
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10
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Dong T, Bevan G, Zidar DA, Achirica MC, Nasir K, Rashid I, Rajagopalan S, Al-Kindi S. Soluble Tumor Necrosis Factor Receptor 1 is Associated With Cardiovascular Risk in Persons With Coronary Artery Calcium Score of Zero. Pathog Immun 2022; 6:135-148. [PMID: 34988343 PMCID: PMC8714175 DOI: 10.20411/pai.v6i2.477] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 09/27/2021] [Indexed: 01/02/2023] Open
Abstract
Background: A coronary artery calcium (CAC) score of zero confers a low but nonzero risk of atherosclerotic cardiovascular events (CVD) in asymptomatic patient populations, and additional risk stratification is needed to guide preventive interventions. Soluble tumor necrosis factor receptors (sTNFR-1 and sTNFR-2) are shed in the context of TNF-alpha signaling and systemic inflammation, which play a role in atherosclerosis and plaque instability. We hypothesized that serum sTNFR-1 concentrations may aid in cardiovascular risk stratification among asymptomatic patients with a CAC score of zero. Methods: We included all participants with CAC=0 and baseline sTNFR-1 measurements from the prospective cohort Multi-Ethnic Study of Atherosclerosis (MESA). The primary outcome was a composite CVD event (myocardial infarction, stroke, coronary revascularization, cardiovascular death). Results: The study included 1471 participants (mean age 57.6 years, 64% female), with measured baseline sTNFR-1 ranging from 603 pg/mL to 5544 pg/mL (mean 1294 pg/mL ±378.8 pg/mL). Over a median follow-up of 8.5 years, 37 participants (2.5%) experienced a CVD event. In multivariable analyses adjusted for Framingham Score, doubling of sTNFR-1 was associated with a 3-fold increase in the hazards of CVD (HR 3.0, 95% CI: 1.48-6.09, P = 0.002), which remained significant after adjusting for traditional CVD risk factors individually (HR 2.29; 95% CI: 1.04-5.06, P=0.04). Doubling of sTNFR-1 was also associated with progression of CAC >100, adjusted for age (OR 2.84, 95% CI: 1.33-6.03, P=0.007). Conclusions: sTNFR-1 concentrations are associated with more CVD events in participants with a CAC score of zero. Utilizing sTNFR-1 measurements may improve cardiovascular risk stratification and guide primary prevention in otherwise low-risk individuals.
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Affiliation(s)
- Tony Dong
- Department of Medicine, University Hospitals, Cleveland, Ohio
| | - Graham Bevan
- Department of Medicine, University Hospitals, Cleveland, Ohio
| | - David A Zidar
- Department of Medicine, University Hospitals, Cleveland, Ohio.,Louis Stokes Cleveland Veterans Affairs Hospital, Cleveland, Ohio.,School of Medicine, Case Western Reserve University, Cleveland, Ohio.,Harrington Heart and Vascular Institute, University Hospitals, Cleveland, Ohio
| | | | | | - Imran Rashid
- Department of Medicine, University Hospitals, Cleveland, Ohio.,Louis Stokes Cleveland Veterans Affairs Hospital, Cleveland, Ohio.,Harrington Heart and Vascular Institute, University Hospitals, Cleveland, Ohio
| | - Sanjay Rajagopalan
- Department of Medicine, University Hospitals, Cleveland, Ohio.,Louis Stokes Cleveland Veterans Affairs Hospital, Cleveland, Ohio.,Harrington Heart and Vascular Institute, University Hospitals, Cleveland, Ohio
| | - Sadeer Al-Kindi
- Department of Medicine, University Hospitals, Cleveland, Ohio.,Louis Stokes Cleveland Veterans Affairs Hospital, Cleveland, Ohio.,Harrington Heart and Vascular Institute, University Hospitals, Cleveland, Ohio
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11
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Zeb I, Jorgensen NW, Blumenthal RS, Burke GL, Lloyd-Jones D, Blaha MJ, Wong ND, Nasir K, Budoff MJ. Association of inflammatory markers and lipoprotein particle subclasses with progression of coronary artery calcium: The multi-ethnic study of atherosclerosis. Atherosclerosis 2021; 339:27-34. [PMID: 34826751 DOI: 10.1016/j.atherosclerosis.2021.11.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2020] [Revised: 08/15/2021] [Accepted: 11/03/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND AND AIMS Atherosclerosis is a complex phenomenon manifesting several features typical of chronic inflammation and disorders of lipid metabolism. We assessed association of nuclear magnetic resonance (NMR) lipid variables and inflammatory markers with incident coronary artery calcium (CAC) and CAC progression among participants with baseline CAC ≥0. METHODS MESA is a longitudinal cohort study of 6,814 participants (aged 45-85). 3,115 had CAC = 0 and 2,896 had CAC>0 at baseline. Repeat CAC measurements were obtained (mean duration of follow up, 6.5 years). RESULTS IL-6 (log pg/mL) and fibrinogen (50 mg/dL) were associated with a higher relative risk (RR) of incident CAC (HU) (RR = 1.09, p=0.010 & RR 1.05, p=0.004, respectively). Small LDL (100 nmol/L) (RR = 1.03, p<0.001) and log large VLDL (log nmol/L) (RR = 1.06, p=0.001) were associated with higher risks, whereas large HDL (μmol/L) was associated with an inverse risk of incident CAC (RR = 0.97, p< 0.001) in a model adjusted for follow up time, age, gender and race. Among participants with baseline CAC>0, progression of CAC was positively associated with hsCRP (log mg/L) (β = 1.99), IL-6 (log pg/mL) (β = 2.9), fibrinogen (50 mg/dL) (β = 1.0), large VLDL (log nmol/L) (β = 2.2), and small LDL (100 nmol/L) (β = 0.36) (all p values < 0.05) in a model adjusted for scanner type, age, gender and race. Relationships with inflammatory markers and NMR lipoprotein particles lost significance after adjustment for traditional risk factors and statin use. Traditional risk factors were strongly associated with both CAC incidence and progression with the exception of cholesterol parameters not associated with CAC progression in adjusted model. CONCLUSIONS Inflammatory markers and lipoprotein particles were associated with CAC incidence and progression in minimally adjusted models, but not after adjustment for traditional risk factors.
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Affiliation(s)
- Irfan Zeb
- West Virginia University Heart & Vascular Institute, Morgantown, WV, USA.
| | | | - Roger S Blumenthal
- John Hopkins Ciccarone Center for the Prevention of Heart Disease Baltimore, MD, USA
| | | | | | - Michael J Blaha
- John Hopkins Ciccarone Center for the Prevention of Heart Disease Baltimore, MD, USA
| | | | - Khurram Nasir
- John Hopkins Ciccarone Center for the Prevention of Heart Disease Baltimore, MD, USA; Baptist Health Medical Center, Miami, FL, USA; Houston Methodist Debakey Heart and Vascular Institute, TX, USA
| | - Matthew J Budoff
- Lundquist Institute at Harbor-UCLA Medical Center, Torrance, CA, USA
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12
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The impact of antimalarial agents on traditional and non-traditional subclinical atherosclerosis biomarkers in systemic lupus erythematosus: A systematic review and meta-analysis. Autoimmun Rev 2021; 20:102887. [PMID: 34237422 DOI: 10.1016/j.autrev.2021.102887] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 04/19/2021] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Cardiovascular (CV) morbidity is a well-established problem in systemic lupus erythematosus (SLE). Antimalarial (AM) therapy has been seen as a potential atheroprotective agent. The aim was to assess the impact of AM therapy on traditional and novel atherosclerosis (AT) biomarkers in patients with SLE. METHODS A search of MEDLINE, EMbase, and Cochrane library for studies evaluating the impact of AM on AT biomarkers in SLE was conducted. Data extraction included serum, functional and structural traditional and novel biomarkers. A narrative synthesis of the findings and a meta-analysis with random effects was conducted estimating mean differences (MD), OR, HR and 95% CIs. RESULTS The search strategy produced 148 articles, of which 64 were extracted for analysis. The MD in VLDL-cholesterol (-10.29, 95% CI -15.35, 5.24), triglycerides (-15.68, 95% CI -27.51, -3.86), and diastolic BP (-3.42, 95% CI -5.62, -1.23) differed significantly in patients on AM therapy compared with those without AM therapy. Patients on AM had a lower prevalence and incidence of diabetes mellitus than patients not on AM (HR: 0.39, 95% CI 0.17, 0.88). HCQ use was associated with lower blood pressure (BP) variability. Structural markers like carotid intima-media thickness (IMT), carotid plaque (CP) and coronary artery calcification (CAC) were not influenced by AM. For functional markers like endothelial and arterial stiffness the benefit was unclear. The GRADE approach showed a very low-to-low quality of evidence (QoE) per outcome. CONCLUSIONS There is some evidence on the associations between AM therapy and some AT markers. However, the data on which this conclusion was based was of low to very low evidence.
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13
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Chronic inflammatory diseases and coronary heart disease: Insights from cardiovascular CT. J Cardiovasc Comput Tomogr 2021; 16:7-18. [PMID: 34226164 DOI: 10.1016/j.jcct.2021.06.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Revised: 06/07/2021] [Accepted: 06/11/2021] [Indexed: 01/17/2023]
Abstract
Epidemiological and clinical studies have demonstrated a consistent relationship between increased systemic inflammation and increased risk of cardiovascular events. In chronic inflammatory states, traditional risk factors only partially account for the development of coronary artery disease (CAD) but underestimate total cardiovascular risk likely due to the residual risk of inflammation. Computed coronary tomography angiography (CCTA) may aid in risk stratification by noninvasively capturing early CAD, identifying high risk plaque morphology and quantifying plaque at baseline and in response to treatment. In this review, we focus on reviewing studies on subclinical atherosclerosis by CCTA in individuals with chronic inflammatory conditions including rheumatoid arthritis (RA), systemic lupus erythematous (SLE), human immunodeficiency virus (HIV) infection and psoriasis. We start with a brief review on the role of inflammation in atherosclerosis, highlight the utility of using CCTA to delineate vessel wall and plaque characteristics and discuss combining CCTA with laboratory studies and emerging technologies to complement traditional risk stratification in chronic inflammatory states.
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14
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Malik M, Gor R, Siddiqui NA, Gor D, Ahmed KI. Elucidating the Intriguing Association Between Systemic Lupus Erythematosus and Cardiovascular Disease. Cureus 2021; 13:e15538. [PMID: 34268056 PMCID: PMC8267499 DOI: 10.7759/cureus.15538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Accepted: 06/09/2021] [Indexed: 11/05/2022] Open
Abstract
Systemic lupus erythematosus (SLE) patients have demonstrated a higher risk of developing cardiovascular disease (CVD), resulting in it being one of the leading causes of death in SLE patients. SLE itself acts as a sole risk factor influencing the prevalence and progression of CVD. However, conventional risk factors, such as age, hypertension, smoking, and obesity, play a crucial role as well. Therefore, this systematic review attempts to unravel the association of CVD in SLE patients while evaluating the role of conventional risk factors. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed to search the PubMed database starting from March 2021 systematically. Original studies that evaluated the prevalence and progression of CVD in SLE patients were extracted by two reviewers independently. Quality in Prognostic Studies (QUIPS) tool was used to assess the risk of bias. Most studies have a moderate to low risk of bias. Among 3,653 studies identified by our search, 10 studies were included in the review. Strong epidemiologic evidence of SLE patients having an increased relative risk of CVD compared to controls was found. Traditional CVD risk factors, such as age, hypertension, obesity, and smoking, influence the prevalence of CVD among SLE patients. Several SLE-specific factors such disease activity, duration, and certain medications also acted as influencing factors. However, the relative risk of CVD was still higher in SLE patients after adjustment of certain risk factors. One study found that the odds of having a Coronary Artery Calcification (CAC) score greater than zero in women with SLE aged less than or equal to 45 years was 12.6 times higher than women in the Coronary Artery Risk Development in Young Adults (CARDIA) cohort (95% CI 5.2 to 30.7) (participants of CARDIA cohort acted as control). This finding was made after age, hypertension, total cholesterol levels, and aspirin use were adjusted, and the study was restricted to women. Although conventional risk factors increase CVD prevalence, SLE itself also dramatically increases the prevalence of CVD. Therefore, we recommend that SLE should be treated as a "CVD risk equivalent." SLE patients should be managed more extensively with greater emphasis given to cardiac health for better clinical outcomes.
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Affiliation(s)
- Mushrin Malik
- Research, California Institute of Behavioral Neurosciences & Psychology, Los Angeles, USA
| | - Rajvi Gor
- Research, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Nabeel A Siddiqui
- Research, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Dhairya Gor
- Internal Medicine, Jersey Shore University Medical Center, Neptune, USA
| | - Kazi I Ahmed
- Internal Medicine, University of Dhaka, Dhaka, BGD
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15
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Chessa E, Piga M, Floris A, Devilliers H, Cauli A, Arnaud L. Use of Physician Global Assessment in systemic lupus erythematosus: a systematic review of its psychometric properties. Rheumatology (Oxford) 2021; 59:3622-3632. [PMID: 32789462 DOI: 10.1093/rheumatology/keaa383] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 05/19/2020] [Accepted: 05/21/2020] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVE The Physician Global Assessment (PGA) is a visual analogue score that reflects the clinician's judgement of overall SLE disease activity. The aim of this systematic literature review is to describe and analyse the psychometric properties of the PGA. METHODS This systematic literature review was conducted by two independent reviewers in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. All articles published through 1 July 2019 in PubMed were screened, with no limitation on year of publication, language or patients' age. Psychometric properties data were analysed according to the OMERACT Filter methodology version 2.1. RESULTS The literature search identified 91 studies. Face validity was reported in all the articles retrieved in which the PGA was used alone or as part of composite indices (Systemic Responder Index, Safety of Estrogen in Lupus Erythematosus National Assessment Flare Index, Lupus Low Disease Activity State, Definitions of Remission in Systemic Lupus Erythematosus criteria). Content validity was reported in 89 studies. Construct validity was demonstrated by a good correlation (r ≥ 0.50) between the PGA with the SLEDAI (12 studies), SLAM (4 studies), LAI, BILAG and ECLAM (2 studies each). Criterion validity was assessed exploring the PGA correlation with quality of life measurements, biomarker levels and treatment changes in 28 studies, while no study has evaluated correlation with damage. A good responsiveness for PGA was shown in eight studies. A high variability in scales was found, causing a wide range of reliability (intraclass correlation coefficient 0.67-0.98). CONCLUSION PGA is a valid, responsive and feasible instrument, though its reliability was impacted by the scale adopted, suggesting the major need for standardization of its scoring.
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Affiliation(s)
| | - Matteo Piga
- Rheumatology Unit, AOU University Clinic and University of Cagliari, Department of Medical Sciences and Public Health, Cagliari, Italy
| | - Alberto Floris
- Rheumatology Unit, AOU University Clinic and University of Cagliari, Department of Medical Sciences and Public Health, Cagliari, Italy
| | - Hervé Devilliers
- Centre Hospitalier Universitaire de Dijon, Hôpital François-Mitterrand, service de médecine interne et maladies systémiques (médecine interne, 2) et Centre d'Investigation Clinique, Inserm CIC-EC 1432, Dijon, France
| | - Alberto Cauli
- Rheumatology Unit, AOU University Clinic and University of Cagliari, Department of Medical Sciences and Public Health, Cagliari, Italy
| | - Laurent Arnaud
- Service de rhumatologie, Hôpitaux Universitaires de Strasbourg, Université de Strasbourg, Strasbourg, France.,Centre National de Référence des Maladies Systémiques et Autoimmunes Rares Est Sud-Ouest (RESO), Strasbourg, France
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16
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Hamal S, Cherukuri L, Shaikh K, Kinninger A, Doshi J, Birudaraju D, Budoff MJ. Effect of semaglutide on coronary atherosclerosis progression in patients with type II diabetes: rationale and design of the semaglutide treatment on coronary progression trial. Coron Artery Dis 2020; 31:306-314. [PMID: 32271261 DOI: 10.1097/mca.0000000000000830] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
BACKGROUND Cardiovascular morbidity and mortality are a major burden in patients with type 2 diabetic mellitus. In a landmark study, semaglutide (an injectable glucagon like peptide-1 receptor agonist) has been shown to significantly reduce cardiovascular events, however, the mechanism of benefit is still unknown. The primary hypothesis of our current study is to assess the effect of semaglutide to reduce progression of noncalcified coronary atherosclerotic plaque volume as measured by serial coronary CTA as compared to placebo in persons with diabetes over 1 year. METHODS One hundred forty patients will be enrolled after signing informed consent and followed up for 12 months and with a phone call 30 days after medical discontinuation. All the participants will undergo coronary artery calcium scoring and coronary computed tomography angiography at our center at baseline and 12 months. Eligible participants will be randomly assigned to semaglutide 2 mg/1.5 ml (1.34 mg/ml) prefilled pen for subcutaneous (SC) injection or placebo 1.5 ml, pen-injector for SC injection in a 1:1 fashion as add-on to their standard of care. RESULTS As of July 2019, the study was approximately 30% enrolled with an estimated enrollment completion by first quarter of 2020 and end of study by first quarter 2021. Thirty patients were enrolled as of 23 July 2019. Preliminary data of demographics and clinical characteristics were summarized. CONCLUSION Our current study will provide important imaging-derived data that may add relevance to the clinically derived outcomes from liraglutide effect and action in diabetes: evaluation of cardiovascular outcome results and semaglutide and cardiovascular outcomes in patients with type 2 diabetic mellitus 6 trials.
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Affiliation(s)
- Sajad Hamal
- Department of Cardiology, Lundquist Institute for Biomedical Innovation at Harbor UCLA Medical Center, Torrance, California, USA
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17
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Choi H, Uceda DE, Dey AK, Mehta NN. Application of Non-invasive Imaging in Inflammatory Disease Conditions to Evaluate Subclinical Coronary Artery Disease. Curr Rheumatol Rep 2019; 22:1. [PMID: 31832865 DOI: 10.1007/s11926-019-0875-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
PURPOSE OF REVIEW Traditional risk models, such as the Framingham risk score, fail to capture the increased cardiovascular disease risk seen in patients with chronic inflammatory diseases. This review will cover imaging modalities and their emerging applications in assessing subclinical cardiovascular disease for both research and clinical care in patients with chronic inflammatory diseases. RECENT FINDINGS Multiple imaging modalities have been studied to assess for subclinical cardiovascular disease via functional/physiologic, inflammatory, and anatomic assessment in patients with chronic inflammatory diseases. The use of imaging to evaluate subclinical cardiovascular disease in patients with chronic inflammatory diseases has the potential to capture early sub-clinical atherosclerosis, to improve risk stratification of future cardiovascular events, and to guide effective disease management.
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Affiliation(s)
- Harry Choi
- National Heart, Lung, Blood Institute, National Institutes of Health, Bethesda, MD, 20892, USA
| | - Domingo E Uceda
- National Heart, Lung, Blood Institute, National Institutes of Health, Bethesda, MD, 20892, USA
| | - Amit K Dey
- National Heart, Lung, Blood Institute, National Institutes of Health, Bethesda, MD, 20892, USA
| | - Nehal N Mehta
- National Heart, Lung, Blood Institute, National Institutes of Health, Bethesda, MD, 20892, USA.
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18
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Rajendra Acharya U, Meiburger KM, Wei Koh JE, Vicnesh J, Ciaccio EJ, Shu Lih O, Tan SK, Aman RRAR, Molinari F, Ng KH. Automated plaque classification using computed tomography angiography and Gabor transformations. Artif Intell Med 2019; 100:101724. [PMID: 31607348 DOI: 10.1016/j.artmed.2019.101724] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Revised: 08/23/2019] [Accepted: 09/06/2019] [Indexed: 12/18/2022]
Abstract
Cardiovascular diseases are the primary cause of death globally. These are often associated with atherosclerosis. This inflammation process triggers important variations in the coronary arteries (CA) and can lead to coronary artery disease (CAD). The presence of CA calcification (CAC) has recently been shown to be a strong predictor of CAD. In this clinical setting, computed tomography angiography (CTA) has begun to play a crucial role as a non-intrusive imaging method to characterize and study CA plaques. Herein, we describe an automated algorithm to classify plaque as either normal, calcified, or non-calcified using 2646 CTA images acquired from 73 patients. The automated technique is based on various features that are extracted from the Gabor transform of the acquired CTA images. Specifically, seven features are extracted from the Gabor coefficients : energy, and Kapur, Max, Rényi, Shannon, Vajda, and Yager entropies. The features were then ordered based on the F-value and input to numerous classification methods to achieve the best classification accuracy with the least number of features. Moreover, two well-known feature reduction techniques were employed, and the features acquired were also ranked according to F-value and input to several classifiers. The best classification results were obtained using all computed features without the employment of feature reduction, using a probabilistic neural network. An accuracy, positive predictive value, sensitivity, and specificity of 89.09%, 91.70%, 91.83% and 83.70% was obtained, respectively. Based on these results, it is evident that the technique can be helpful in the automated classification of plaques present in CTA images, and may become an important tool to reduce procedural costs and patient radiation dose. This could also aid clinicians in plaque diagnostics.
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Affiliation(s)
- U Rajendra Acharya
- Department of Electronics and Computer Engineering, Ngee Ann Polytechnic, Singapore; Department of Biomedical Engineering, School of Science and Technology, Singapore University of Social Sciences, Singapore; International Research Organization for Advanced Science and Technology (IROAST), Kumamoto University, Kumamoto, Japan
| | - Kristen M Meiburger
- Department of Electronics and Telecommunications, Politecnico di Torino, Italy
| | - Joel En Wei Koh
- Department of Electronics and Computer Engineering, Ngee Ann Polytechnic, Singapore
| | - Jahmunah Vicnesh
- Department of Electronics and Computer Engineering, Ngee Ann Polytechnic, Singapore.
| | - Edward J Ciaccio
- Department of Medicine - Division of Cardiology, Columbia University, New York, USA
| | - Oh Shu Lih
- Department of Electronics and Computer Engineering, Ngee Ann Polytechnic, Singapore
| | - Sock Keow Tan
- Department of Biomedical Imaging, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia; University of Malaya Research Imaging Centre (UMRIC), Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia
| | - Raja Rizal Azman Raja Aman
- Department of Biomedical Imaging, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia; University of Malaya Research Imaging Centre (UMRIC), Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia
| | - Filippo Molinari
- Department of Electronics and Telecommunications, Politecnico di Torino, Italy
| | - Kwan Hoong Ng
- Department of Biomedical Imaging, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia; University of Malaya Research Imaging Centre (UMRIC), Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia
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19
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Roldan PC, Greene ER, Qualls CR, Sibbitt WL, Roldan CA. Progression of atherosclerosis versus arterial stiffness with age within and between arteries in systemic lupus erythematosus. Rheumatol Int 2019; 39:1027-1036. [PMID: 30877372 DOI: 10.1007/s00296-019-04267-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2019] [Accepted: 02/26/2019] [Indexed: 12/31/2022]
Abstract
The progression of atherosclerosis versus arterial stiffness with age within and between arteries has not been defined. Systemic lupus erythematosus (SLE) is a human model of accelerated arterial disease that may permit this determination. 76 SLE patients (69 women, age 37 ± 12 years) and 26 age-and-sex-matched controls (22 women, age 34 ± 11 years) underwent transesophageal echocardiography and carotid ultrasonography for assessment of atherosclerosis [plaques and intima-media thickening (IMT)] and arterial stiffness [increased pressure-strain elastic modulus (PSEM)] of the descending thoracic aorta and carotid arteries. Since IMT is highly associated with plaques, IMT was used as a marker of atherosclerosis to assess its progression in relation with age and PSEM. Aortic and carotid plaques, IMT, and PSEM were greater in patients than in controls (all p ≤ 0.05). Within the aorta and within the carotid arteries, the average percent increases per decade of age for IMT versus PSEM were similar in patients (8.55% versus 9.33% and 3.39% versus 2.46%, respectively) and controls (5.53% versus 6.60% and 4.75% versus 3.49%, respectively) (all p ≥ 0.58). However, in SLE patients, the average percent increases per decade of age for IMT and PSEM were higher in the aorta than in the carotid arteries (8.55% and 9.33% versus 3.39% and 2.46%, respectively, both p ≤ 0.03). In patients with SLE, atherosclerosis and arterial stiffness progress with age parallel to each other within arteries, but divergently between arteries with different anatomy and hemodynamics.
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Affiliation(s)
- Paola C Roldan
- Divisions of Cardiology and Rheumatology, Department of Medicine, University of New Mexico School of Medicine, Cardiology 5-ACC, MSC 10-5550, University of New Mexico, Albuquerque, NM, 87131-0001, USA
| | - Ernest R Greene
- Divisions of Cardiology and Rheumatology, Department of Medicine, University of New Mexico School of Medicine, Cardiology 5-ACC, MSC 10-5550, University of New Mexico, Albuquerque, NM, 87131-0001, USA
| | - Clifford R Qualls
- Divisions of Cardiology and Rheumatology, Department of Medicine, University of New Mexico School of Medicine, Cardiology 5-ACC, MSC 10-5550, University of New Mexico, Albuquerque, NM, 87131-0001, USA
| | - Wilmer L Sibbitt
- Divisions of Cardiology and Rheumatology, Department of Medicine, University of New Mexico School of Medicine, Cardiology 5-ACC, MSC 10-5550, University of New Mexico, Albuquerque, NM, 87131-0001, USA
| | - Carlos A Roldan
- Divisions of Cardiology and Rheumatology, Department of Medicine, University of New Mexico School of Medicine, Cardiology 5-ACC, MSC 10-5550, University of New Mexico, Albuquerque, NM, 87131-0001, USA.
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