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Herten VRLM, Hampe N, Takx RAP, Franssen KJ, Wang Y, Sucha D, Henriques JP, Leiner T, Planken RN, Isgum I. Automatic Coronary Artery Plaque Quantification and CAD-RADS Prediction Using Mesh Priors. IEEE TRANSACTIONS ON MEDICAL IMAGING 2024; 43:1272-1283. [PMID: 37862273 DOI: 10.1109/tmi.2023.3326243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2023]
Abstract
Coronary artery disease (CAD) remains the leading cause of death worldwide. Patients with suspected CAD undergo coronary CT angiography (CCTA) to evaluate the risk of cardiovascular events and determine the treatment. Clinical analysis of coronary arteries in CCTA comprises the identification of atherosclerotic plaque, as well as the grading of any coronary artery stenosis typically obtained through the CAD-Reporting and Data System (CAD-RADS). This requires analysis of the coronary lumen and plaque. While voxel-wise segmentation is a commonly used approach in various segmentation tasks, it does not guarantee topologically plausible shapes. To address this, in this work, we propose to directly infer surface meshes for coronary artery lumen and plaque based on a centerline prior and use it in the downstream task of CAD-RADS scoring. The method is developed and evaluated using a total of 2407 CCTA scans. Our method achieved lesion-wise volume intraclass correlation coefficients of 0.98, 0.79, and 0.85 for calcified, non-calcified, and total plaque volume respectively. Patient-level CAD-RADS categorization was evaluated on a representative hold-out test set of 300 scans, for which the achieved linearly weighted kappa ( κ ) was 0.75. CAD-RADS categorization on the set of 658 scans from another hospital and scanner led to a κ of 0.71. The results demonstrate that direct inference of coronary artery meshes for lumen and plaque is feasible, and allows for the automated prediction of routinely performed CAD-RADS categorization.
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An All-in-One Tool for 2D Atherosclerotic Disease Assessment and 3D Coronary Artery Reconstruction. J Cardiovasc Dev Dis 2023; 10:jcdd10030130. [PMID: 36975894 PMCID: PMC10056488 DOI: 10.3390/jcdd10030130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 03/10/2023] [Accepted: 03/17/2023] [Indexed: 03/22/2023] Open
Abstract
Diagnosis of coronary artery disease is mainly based on invasive imaging modalities such as X-ray angiography, intravascular ultrasound (IVUS) and optical coherence tomography (OCT). Computed tomography coronary angiography (CTCA) is also used as a non-invasive imaging alternative. In this work, we present a novel and unique tool for 3D coronary artery reconstruction and plaque characterization using the abovementioned imaging modalities or their combination. In particular, image processing and deep learning algorithms were employed and validated for the lumen and adventitia borders and plaque characterization at the IVUS and OCT frames. Strut detection is also achieved from the OCT images. Quantitative analysis of the X-ray angiography enables the 3D reconstruction of the lumen geometry and arterial centerline extraction. The fusion of the generated centerline with the results of the OCT or IVUS analysis enables hybrid coronary artery 3D reconstruction, including the plaques and the stent geometry. CTCA image processing using a 3D level set approach allows the reconstruction of the coronary arterial tree, the calcified and non-calcified plaques as well as the detection of the stent location. The modules of the tool were evaluated for efficiency with over 90% agreement of the 3D models with the manual annotations, while a usability assessment using external evaluators demonstrated high usability resulting in a mean System Usability Scale (SUS) score equal to 0.89, classifying the tool as “excellent”.
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Schultz J, van den Hoogen IJ, Kuneman JH, de Graaf MA, Kamperidis V, Broersen A, Jukema JW, Sakellarios A, Nikopoulos S, Tsarapatsani K, Naka K, Michalis L, Fotiadis DI, Maaniitty T, Saraste A, Bax JJ, Knuuti J. Coronary computed tomography angiography-based endothelial wall shear stress in normal coronary arteries. Int J Cardiovasc Imaging 2023; 39:441-450. [PMID: 36255544 PMCID: PMC9870961 DOI: 10.1007/s10554-022-02739-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Accepted: 09/27/2022] [Indexed: 01/27/2023]
Abstract
Endothelial wall shear stress (ESS) is a biomechanical force which plays a role in the formation and evolution of atherosclerotic lesions. The purpose of this study is to evaluate coronary computed tomography angiography (CCTA)-based ESS in coronary arteries without atherosclerosis, and to assess factors affecting ESS values. CCTA images from patients with suspected coronary artery disease were analyzed to identify coronary arteries without atherosclerosis. Minimal and maximal ESS values were calculated for 3-mm segments. Factors potentially affecting ESS values were examined, including sex, lumen diameter and distance from the ostium. Segments were categorized according to lumen diameter tertiles into small (< 2.6 mm), intermediate (2.6-3.2 mm) or large (≥ 3.2 mm) segments. A total of 349 normal vessels from 168 patients (mean age 59 ± 9 years, 39% men) were included. ESS was highest in the left anterior descending artery compared to the left circumflex artery and right coronary artery (minimal ESS 2.3 Pa vs. 1.9 Pa vs. 1.6 Pa, p < 0.001 and maximal ESS 3.7 Pa vs. 3.0 Pa vs. 2.5 Pa, p < 0.001). Men had lower ESS values than women, also after adjusting for lumen diameter (p < 0.001). ESS values were highest in small segments compared to intermediate or large segments (minimal ESS 3.8 Pa vs. 1.7 Pa vs. 1.2 Pa, p < 0.001 and maximal ESS 6.0 Pa vs. 2.6 Pa vs. 2.0 Pa, p < 0.001). A weak to strong correlation was found between ESS and distance from the ostium (ρ = 0.22-0.62, p < 0.001). CCTA-based ESS values increase rapidly and become widely scattered with decreasing lumen diameter. This needs to be taken into account when assessing the added value of ESS beyond lumen diameter in highly stenotic lesions.
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Affiliation(s)
- Jussi Schultz
- grid.410552.70000 0004 0628 215XTurku PET Centre, Turku University Hospital and University of Turku, Kiinamyllynkatu 4-8, 20520 Turku, Finland
| | - Inge J. van den Hoogen
- grid.10419.3d0000000089452978Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Jurrien H. Kuneman
- grid.10419.3d0000000089452978Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Michiel A. de Graaf
- grid.10419.3d0000000089452978Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Vasileios Kamperidis
- Department of Cardiology, AHEPA Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Alexander Broersen
- grid.10419.3d0000000089452978Department of Radiology, Division of Image Processing, Leiden University Medical Center, Leiden, The Netherlands
| | - J. Wouter Jukema
- grid.10419.3d0000000089452978Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands ,grid.411737.7Netherlands Heart Institute, Utrecht, The Netherlands
| | - Antonis Sakellarios
- Department of Biomedical Research, FORTH-IMBB, Ioannina, Greece ,grid.9594.10000 0001 2108 7481Department of Materials Science and Engineering, Unit of Medical Technology and Intelligent Information Systems, University of Ioannina, Ioannina, Greece
| | - Sotirios Nikopoulos
- grid.9594.10000 0001 2108 7481Department of Cardiology, Medical School, University of Ioannina, Ioannina, Greece
| | - Konstantina Tsarapatsani
- Department of Biomedical Research, FORTH-IMBB, Ioannina, Greece ,grid.9594.10000 0001 2108 7481Department of Materials Science and Engineering, Unit of Medical Technology and Intelligent Information Systems, University of Ioannina, Ioannina, Greece
| | - Katerina Naka
- grid.9594.10000 0001 2108 7481Department of Cardiology, Medical School, University of Ioannina, Ioannina, Greece
| | - Lampros Michalis
- grid.9594.10000 0001 2108 7481Department of Cardiology, Medical School, University of Ioannina, Ioannina, Greece
| | - Dimitrios I. Fotiadis
- Department of Biomedical Research, FORTH-IMBB, Ioannina, Greece ,grid.9594.10000 0001 2108 7481Department of Materials Science and Engineering, Unit of Medical Technology and Intelligent Information Systems, University of Ioannina, Ioannina, Greece
| | - Teemu Maaniitty
- grid.410552.70000 0004 0628 215XTurku PET Centre, Turku University Hospital and University of Turku, Kiinamyllynkatu 4-8, 20520 Turku, Finland
| | - Antti Saraste
- grid.410552.70000 0004 0628 215XTurku PET Centre, Turku University Hospital and University of Turku, Kiinamyllynkatu 4-8, 20520 Turku, Finland ,grid.410552.70000 0004 0628 215XHeart Center, Turku University Hospital and University of Turku, Turku, Finland
| | - Jeroen J. Bax
- grid.10419.3d0000000089452978Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands ,grid.410552.70000 0004 0628 215XHeart Center, Turku University Hospital and University of Turku, Turku, Finland
| | - Juhani Knuuti
- grid.410552.70000 0004 0628 215XTurku PET Centre, Turku University Hospital and University of Turku, Kiinamyllynkatu 4-8, 20520 Turku, Finland ,grid.10419.3d0000000089452978Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
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van den Hoogen IJ, Schultz J, Kuneman JH, de Graaf MA, Kamperidis V, Broersen A, Jukema JW, Sakellarios A, Nikopoulos S, Kyriakidis S, Naka KK, Michalis L, Fotiadis DI, Maaniitty T, Saraste A, Bax JJ, Knuuti J. Detailed behaviour of endothelial wall shear stress across coronary lesions from non-invasive imaging with coronary computed tomography angiography. Eur Heart J Cardiovasc Imaging 2022; 23:1708-1716. [PMID: 35616068 PMCID: PMC10017098 DOI: 10.1093/ehjci/jeac095] [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: 12/21/2021] [Revised: 03/15/2022] [Accepted: 05/05/2022] [Indexed: 11/13/2022] Open
Abstract
AIMS Evolving evidence suggests that endothelial wall shear stress (ESS) plays a crucial role in the rupture and progression of coronary plaques by triggering biological signalling pathways. We aimed to investigate the patterns of ESS across coronary lesions from non-invasive imaging with coronary computed tomography angiography (CCTA), and to define plaque-associated ESS values in patients with coronary artery disease (CAD). METHODS AND RESULTS Symptomatic patients with CAD who underwent a clinically indicated CCTA scan were identified. Separate core laboratories performed blinded analysis of CCTA for anatomical and ESS features of coronary atherosclerosis. ESS was assessed using dedicated software, providing minimal and maximal ESS values for each 3 mm segment. Each coronary lesion was divided into upstream, start, minimal luminal area (MLA), end and downstream segments. Also, ESS ratios were calculated using the upstream segment as a reference. From 122 patients (mean age 64 ± 7 years, 57% men), a total of 237 lesions were analyzed. Minimal and maximal ESS values varied across the lesions with the highest values at the MLA segment [minimal ESS 3.97 Pa (IQR 1.93-8.92 Pa) and maximal ESS 5.64 Pa (IQR 3.13-11.21 Pa), respectively]. Furthermore, minimal and maximal ESS values were positively associated with stenosis severity (P < 0.001), percent atheroma volume (P < 0.001), and lesion length (P ≤ 0.023) at the MLA segment. Using ESS ratios, similar associations were observed for stenosis severity and lesion length. CONCLUSIONS Detailed behaviour of ESS across coronary lesions can be derived from routine non-invasive CCTA imaging. This may further improve risk stratification.
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Affiliation(s)
| | - Jussi Schultz
- Turku PET Centre, Turku University Hospital and University of Turku, Kiinamyllynkatu 4-8, Turku 20520, Finland
| | - Jurrien H Kuneman
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Michiel A de Graaf
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Vasileios Kamperidis
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Alexander Broersen
- Department of Radiology, Division of Image Processing, Leiden University Medical Center, Leiden, The Netherlands
| | - J Wouter Jukema
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Antonis Sakellarios
- Department of Biomedical Research, FORTH-IMBB, Ioannina, Greece.,Unit of Medical Technology and Intelligent Information Systems, Department of Materials Science and Engineering, University of Ioannina, Ioannina, Greece
| | - Sotirios Nikopoulos
- Department of Cardiology, Medical School, University of Ioannina, Ioannina, Greece
| | - Savvas Kyriakidis
- Department of Biomedical Research, FORTH-IMBB, Ioannina, Greece.,Unit of Medical Technology and Intelligent Information Systems, Department of Materials Science and Engineering, University of Ioannina, Ioannina, Greece
| | - Katerina K Naka
- Department of Cardiology, Medical School, University of Ioannina, Ioannina, Greece
| | - Lampros Michalis
- Department of Cardiology, Medical School, University of Ioannina, Ioannina, Greece
| | - Dimitrios I Fotiadis
- Department of Biomedical Research, FORTH-IMBB, Ioannina, Greece.,Unit of Medical Technology and Intelligent Information Systems, Department of Materials Science and Engineering, University of Ioannina, Ioannina, Greece
| | - Teemu Maaniitty
- Turku PET Centre, Turku University Hospital and University of Turku, Kiinamyllynkatu 4-8, Turku 20520, Finland
| | - Antti Saraste
- Turku PET Centre, Turku University Hospital and University of Turku, Kiinamyllynkatu 4-8, Turku 20520, Finland.,Heart Center, Turku University Hospital and University of Turku, Turku, Finland
| | - Jeroen J Bax
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands.,Heart Center, Turku University Hospital and University of Turku, Turku, Finland
| | - Juhani Knuuti
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands.,Turku PET Centre, Turku University Hospital and University of Turku, Kiinamyllynkatu 4-8, Turku 20520, Finland
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5
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Ultrasonic Imaging of Cardiovascular Disease Based on Image Processor Analysis of Hard Plaque Characteristics. BIOMED RESEARCH INTERNATIONAL 2022; 2022:4304524. [PMID: 36277887 PMCID: PMC9584660 DOI: 10.1155/2022/4304524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 09/07/2022] [Accepted: 09/22/2022] [Indexed: 11/17/2022]
Abstract
Cardiovascular disease detection and analysis using ultrasonic imaging expels errors in manual clinical trials with precise outcomes. It requires a combination of smart computing systems and intelligent image processors. The disease characteristics are analyzed based on the configuration and precise tuning of the processing device. In this article, a characteristic extraction technique (CET) using knowledge learning (KL) is introduced to improve the analysis precision. The proposed method requires optimal selection of disease features and trained similar datasets for improving the characteristic extraction. The disease attributes and accuracy are identified using the standard knowledge update. The image and data features are segmented using the variable processor configuration to prevent false rates. The false rates due to unidentifiable plaque characteristics result in weak knowledge updates. Therefore, the segmentation and data extraction are unanimously performed to prevent feature misleads. The knowledge base is updated using the extracted and identified plaque characteristics for consecutive image analysis. The processor configurations are manageable using the updated knowledge and characteristics to improve precision. The proposed method is verified using precision, characteristic update, training rate, extraction ratio, and time factor.
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6
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Kigka VI, Georga E, Tsakanikas V, Kyriakidis S, Tsompou P, Siogkas P, Michalis LK, Naka KK, Neglia D, Rocchiccioli S, Pelosi G, Fotiadis DI, Sakellarios A. Machine Learning Coronary Artery Disease Prediction Based on Imaging and Non-Imaging Data. Diagnostics (Basel) 2022; 12:diagnostics12061466. [PMID: 35741275 PMCID: PMC9221964 DOI: 10.3390/diagnostics12061466] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Revised: 06/06/2022] [Accepted: 06/11/2022] [Indexed: 11/16/2022] Open
Abstract
The prediction of obstructive atherosclerotic disease has significant clinical meaning for the decision making. In this study, a machine learning predictive model based on gradient boosting classifier is presented, aiming to identify the patients of high CAD risk and those of low CAD risk. The machine learning methodology includes five steps: the preprocessing of the input data, the class imbalance handling applying the Easy Ensemble algorithm, the recursive feature elimination technique implementation, the implementation of gradient boosting classifier, and finally the model evaluation, while the fine tuning of the presented model was implemented through a randomized search optimization of the model’s hyper-parameters over an internal 3-fold cross-validation. In total, 187 participants with suspicion of CAD previously underwent CTCA during EVINCI and ARTreat clinical studies and were prospectively included to undergo follow-up CTCA. The predictive model was trained using imaging data (geometrical and blood flow based) and non-imaging data. The overall predictive accuracy of the model was 0.81, using both imaging and non-imaging data. The innovative aspect of the proposed study is the combination of imaging-based data with the typical CAD risk factors to provide an integrated CAD risk-predictive model.
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Affiliation(s)
- Vassiliki I. Kigka
- Unit of Medical Technology and Intelligent Information Systems, Department of Materials Science and Engineering, University of Ioannina, GR 45110 Ioannina, Greece; (V.I.K.); (E.G.); (V.T.); (S.K.); (P.T.); (P.S.); (D.I.F.)
- Institute of Molecular Biology and Biotechnology, Department of Biomedical Research—FORTH, University Campus of Ioannina, GR 45110 Ioannina, Greece
| | - Eleni Georga
- Unit of Medical Technology and Intelligent Information Systems, Department of Materials Science and Engineering, University of Ioannina, GR 45110 Ioannina, Greece; (V.I.K.); (E.G.); (V.T.); (S.K.); (P.T.); (P.S.); (D.I.F.)
- Institute of Molecular Biology and Biotechnology, Department of Biomedical Research—FORTH, University Campus of Ioannina, GR 45110 Ioannina, Greece
| | - Vassilis Tsakanikas
- Unit of Medical Technology and Intelligent Information Systems, Department of Materials Science and Engineering, University of Ioannina, GR 45110 Ioannina, Greece; (V.I.K.); (E.G.); (V.T.); (S.K.); (P.T.); (P.S.); (D.I.F.)
- Institute of Molecular Biology and Biotechnology, Department of Biomedical Research—FORTH, University Campus of Ioannina, GR 45110 Ioannina, Greece
| | - Savvas Kyriakidis
- Unit of Medical Technology and Intelligent Information Systems, Department of Materials Science and Engineering, University of Ioannina, GR 45110 Ioannina, Greece; (V.I.K.); (E.G.); (V.T.); (S.K.); (P.T.); (P.S.); (D.I.F.)
- Institute of Molecular Biology and Biotechnology, Department of Biomedical Research—FORTH, University Campus of Ioannina, GR 45110 Ioannina, Greece
| | - Panagiota Tsompou
- Unit of Medical Technology and Intelligent Information Systems, Department of Materials Science and Engineering, University of Ioannina, GR 45110 Ioannina, Greece; (V.I.K.); (E.G.); (V.T.); (S.K.); (P.T.); (P.S.); (D.I.F.)
| | - Panagiotis Siogkas
- Unit of Medical Technology and Intelligent Information Systems, Department of Materials Science and Engineering, University of Ioannina, GR 45110 Ioannina, Greece; (V.I.K.); (E.G.); (V.T.); (S.K.); (P.T.); (P.S.); (D.I.F.)
- Institute of Molecular Biology and Biotechnology, Department of Biomedical Research—FORTH, University Campus of Ioannina, GR 45110 Ioannina, Greece
| | - Lampros K. Michalis
- Department of Cardiology, Medical School, University of Ioannina, GR 45110 Ioannina, Greece; (L.K.M.); (K.K.N.)
| | - Katerina K. Naka
- Department of Cardiology, Medical School, University of Ioannina, GR 45110 Ioannina, Greece; (L.K.M.); (K.K.N.)
| | - Danilo Neglia
- Fondazione Toscana Gabriele Monasterio, IT 56126 Pisa, Italy;
| | - Silvia Rocchiccioli
- Institute of Clinical Physiology, National Research Council, IT 56124 Pisa, Italy; (S.R.); (G.P.)
| | - Gualtiero Pelosi
- Institute of Clinical Physiology, National Research Council, IT 56124 Pisa, Italy; (S.R.); (G.P.)
| | - Dimitrios I. Fotiadis
- Unit of Medical Technology and Intelligent Information Systems, Department of Materials Science and Engineering, University of Ioannina, GR 45110 Ioannina, Greece; (V.I.K.); (E.G.); (V.T.); (S.K.); (P.T.); (P.S.); (D.I.F.)
- Institute of Molecular Biology and Biotechnology, Department of Biomedical Research—FORTH, University Campus of Ioannina, GR 45110 Ioannina, Greece
| | - Antonis Sakellarios
- Unit of Medical Technology and Intelligent Information Systems, Department of Materials Science and Engineering, University of Ioannina, GR 45110 Ioannina, Greece; (V.I.K.); (E.G.); (V.T.); (S.K.); (P.T.); (P.S.); (D.I.F.)
- Institute of Molecular Biology and Biotechnology, Department of Biomedical Research—FORTH, University Campus of Ioannina, GR 45110 Ioannina, Greece
- Correspondence: ; Tel.: +30-26510-07848
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7
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Sakellarios AI, Siogkas P, Kigka V, Tsompou P, Pleouras D, Kyriakidis S, Karanasiou G, Pelosi G, Nikopoulos S, Naka KK, Rocchiccioli S, Michalis LK, Fotiadis DI. Error Propagation in the Simulation of Atherosclerotic Plaque Growth and the Prediction of Atherosclerotic Disease Progression. Diagnostics (Basel) 2021; 11:diagnostics11122306. [PMID: 34943545 PMCID: PMC8699876 DOI: 10.3390/diagnostics11122306] [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: 10/21/2021] [Revised: 11/23/2021] [Accepted: 12/06/2021] [Indexed: 11/16/2022] Open
Abstract
Assessments of coronary artery disease can be achieved using non-invasive computed tomography coronary angiography (CTCA). CTCA can be further used for the 3D reconstruction of the coronary arteries and the development of computational models. However, image acquisition and arterial reconstruction introduce an error which can be propagated, affecting the computational results and the accuracy of diagnostic and prognostic models. In this work, we investigate the effect of an imaging error, propagated to a diagnostic index calculated using computational modelling of blood flow and then to prognostic models based on plaque growth modelling or binary logistic predictive modelling. The analysis was performed utilizing data from 20 patients collected at two time points with interscan period of six years. The collected data includes clinical and risk factors, biological and biohumoral data, and CTCA imaging. The results demonstrated that the error propagated and may have significantly affected some of the final outcomes. The calculated propagated error seemed to be minor for shear stress, but was major for some variables of the plaque growth model. In parallel, in the current analysis SmartFFR was not considerably affected, with the limitation of only one case located into the gray zone.
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Affiliation(s)
- Antonis I. Sakellarios
- Department of Biomedical Research, Institute of Molecular Biology and Biotechnology—FORTH, University Campus of Ioannina, 45110 Ioannina, Greece; (P.S.); (V.K.); (P.T.); (S.K.); (G.K.); (D.I.F.)
- Unit of Medical Technology and Intelligent Information Systems, Department of Materials Science and Engineering, University of Ioannina, 45110 Ioannina, Greece;
- Correspondence: ; Tel.: +30-265-100-7837
| | - Panagiotis Siogkas
- Department of Biomedical Research, Institute of Molecular Biology and Biotechnology—FORTH, University Campus of Ioannina, 45110 Ioannina, Greece; (P.S.); (V.K.); (P.T.); (S.K.); (G.K.); (D.I.F.)
- Unit of Medical Technology and Intelligent Information Systems, Department of Materials Science and Engineering, University of Ioannina, 45110 Ioannina, Greece;
| | - Vassiliki Kigka
- Department of Biomedical Research, Institute of Molecular Biology and Biotechnology—FORTH, University Campus of Ioannina, 45110 Ioannina, Greece; (P.S.); (V.K.); (P.T.); (S.K.); (G.K.); (D.I.F.)
- Unit of Medical Technology and Intelligent Information Systems, Department of Materials Science and Engineering, University of Ioannina, 45110 Ioannina, Greece;
| | - Panagiota Tsompou
- Department of Biomedical Research, Institute of Molecular Biology and Biotechnology—FORTH, University Campus of Ioannina, 45110 Ioannina, Greece; (P.S.); (V.K.); (P.T.); (S.K.); (G.K.); (D.I.F.)
- Unit of Medical Technology and Intelligent Information Systems, Department of Materials Science and Engineering, University of Ioannina, 45110 Ioannina, Greece;
| | - Dimitrios Pleouras
- Unit of Medical Technology and Intelligent Information Systems, Department of Materials Science and Engineering, University of Ioannina, 45110 Ioannina, Greece;
| | - Savvas Kyriakidis
- Department of Biomedical Research, Institute of Molecular Biology and Biotechnology—FORTH, University Campus of Ioannina, 45110 Ioannina, Greece; (P.S.); (V.K.); (P.T.); (S.K.); (G.K.); (D.I.F.)
| | - Georgia Karanasiou
- Department of Biomedical Research, Institute of Molecular Biology and Biotechnology—FORTH, University Campus of Ioannina, 45110 Ioannina, Greece; (P.S.); (V.K.); (P.T.); (S.K.); (G.K.); (D.I.F.)
- Unit of Medical Technology and Intelligent Information Systems, Department of Materials Science and Engineering, University of Ioannina, 45110 Ioannina, Greece;
| | - Gualtiero Pelosi
- Institute of Clinical Physiology, National Research Council, 56124 Pisa, Italy; (G.P.); (S.R.)
| | - Sotirios Nikopoulos
- Department of Cardiology, Medical School, University of Ioannina, 45110 Ioannina, Greece; (S.N.); (K.K.N.); (L.K.M.)
| | - Katerina K. Naka
- Department of Cardiology, Medical School, University of Ioannina, 45110 Ioannina, Greece; (S.N.); (K.K.N.); (L.K.M.)
| | - Silvia Rocchiccioli
- Institute of Clinical Physiology, National Research Council, 56124 Pisa, Italy; (G.P.); (S.R.)
| | - Lampros K. Michalis
- Department of Cardiology, Medical School, University of Ioannina, 45110 Ioannina, Greece; (S.N.); (K.K.N.); (L.K.M.)
| | - Dimitrios I. Fotiadis
- Department of Biomedical Research, Institute of Molecular Biology and Biotechnology—FORTH, University Campus of Ioannina, 45110 Ioannina, Greece; (P.S.); (V.K.); (P.T.); (S.K.); (G.K.); (D.I.F.)
- Unit of Medical Technology and Intelligent Information Systems, Department of Materials Science and Engineering, University of Ioannina, 45110 Ioannina, Greece;
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8
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Sakellarios AI, Tsompou P, Kigka V, Karanasiou G, Tsarapatsani K, Kyriakidis S, Karanasiou G, Siogkas P, Nikopoulos S, Rocchiccioli S, Pelosi G, Michalis LK, Fotiadis DI. A proof-of-concept study for the prediction of the de-novo atherosclerotic plaque development using finite elements . ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2021; 2021:4354-4357. [PMID: 34892184 DOI: 10.1109/embc46164.2021.9629792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
The type of the atherosclerotic plaque has significant clinical meaning since plaque vulnerability depends on its type. In this work, we present a computational approach which predicts the development of new plaques in coronary arteries. More specifically, we employ a multi-level model which simulates the blood fluid dynamics, the lipoprotein transport and their accumulation in the arterial wall and the triggering of inflammation using convection-diffusion-reaction equations and in the final level, we estimate the plaque volume which causes the arterial wall thickening. The novelty of this work relies on the conceptual approach that using the information from 94 patients with computed tomography coronary angiography (CTCA) imaging at two time points we identify the correlation of the computational results with the real plaque components detected in CTCA. In the next step, we use these correlations to generate two types of de-novo plaques: calcified and non-calcified. Evaluation of the model's performance is achieved using eleven patients, who present de-novo plaques at the follow-up imaging. The results demonstrate that the computationally generated plaques are associated significantly with the real plaques indicating that the proposed approach could be used for the prediction of specific plaque type formation.
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Recent Trends in Artificial Intelligence-Assisted Coronary Atherosclerotic Plaque Characterization. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph181910003. [PMID: 34639303 PMCID: PMC8508413 DOI: 10.3390/ijerph181910003] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 09/12/2021] [Accepted: 09/17/2021] [Indexed: 01/21/2023]
Abstract
Coronary artery disease is a major cause of morbidity and mortality worldwide. Its underlying histopathology is the atherosclerotic plaque, which comprises lipid, fibrous and—when chronic—calcium components. Intravascular ultrasound (IVUS) and intravascular optical coherence tomography (IVOCT) performed during invasive coronary angiography are reference standards for characterizing the atherosclerotic plaque. Fine image spatial resolution attainable with contemporary coronary computed tomographic angiography (CCTA) has enabled noninvasive plaque assessment, including identifying features associated with vulnerable plaques known to presage acute coronary events. Manual interpretation of IVUS, IVOCT and CCTA images demands scarce physician expertise and high time cost. This has motivated recent research into and development of artificial intelligence (AI)-assisted methods for image processing, feature extraction, plaque identification and characterization. We performed parallel searches of the medical and technical literature from 1995 to 2021 focusing respectively on human plaque characterization using various imaging modalities and the use of AI-assisted computer aided diagnosis (CAD) to detect and classify atherosclerotic plaques, including their composition and the presence of high-risk features denoting vulnerable plaques. A total of 122 publications were selected for evaluation and the analysis was summarized in terms of data sources, methods—machine versus deep learning—and performance metrics. Trends in AI-assisted plaque characterization are detailed and prospective research challenges discussed. Future directions for the development of accurate and efficient CAD systems to characterize plaque noninvasively using CCTA are proposed.
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Merkulova IN, Shariya MA, Mironov VM, Shabanova MS, Veselova TN, Gaman SA, Barysheva NA, Shakhnovich RM, Zhukova NI, Sukhinina TS, Staroverov II, Ternovoy SK. [Computed Tomography Coronary Angiography Possibilities in "High Risk" Plaque Identification in Patients with non-ST-Elevation Acute Coronary Syndrome: Comparison with Intravascular Ultrasound]. ACTA ACUST UNITED AC 2021; 60:64-75. [PMID: 33522469 DOI: 10.18087/cardio.2020.12.n1304] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 10/26/2020] [Indexed: 11/18/2022]
Abstract
Aim To evaluate structural characteristics of atherosclerotic plaques (ASP) by coronary computed tomography arteriography (CCTA) and intravascular ultrasound (IVUS).Material and methods This study included 37 patients with acute coronary syndrome (ACS). 64-detector-row CCTA, coronarography, and grayscale IVUS were performed prior to coronary stenting. The ASP length and burden, remodeling index (RI), and known CT signs of unstable ASP (presence of dot calcification, positive remodeling of the artery in the ASP area, irregular plaque contour, presence of a peripheral high-density ring and a low-density patch in the ASP). The ASP type and signs of rupture or thrombosis were determined by IVUS.Results The IVUS study revealed 45 unstable ASP (UASP), including 25 UASP with rupture and 20 thin-cap fibroatheromas (TCFA), and 13 stable ASP (SASP). No significant differences were found between distribution of TCFA and ASP with rupture among symptom-associated plaques (SAP, n=28) and non-symptom-associated plaques (NSAP, n=30). They were found in 82.1 and 73.3 % of cases, respectively (p>0.05), which indicated generalization of the ASP destabilization process in the coronary circulation. However, the incidence of mural thrombus was higher for SAP (53.5 and 16.6 % of ASP, respectively; p<0.001). There was no difference between UASP and SASP in the incidence of qualitative ASP characteristics or in values of quantitative ASP characteristics, including known signs of instability, except for the irregular contour, which was observed in 92.9 % of UASP and 46.1 % of SASP (p=0.0007), and patches with X-ray density ≤46 HU, which were detected in 83.3 % of UASP and 46.1 % of SASP (р=0.01). The presence of these CT criteria 11- and 7-fold increased the likelihood of unstable ASP (odd ratio (OR), 11.1 at 95 % confidence interval (CI), from 2.24 to 55.33 and OR, 7.0 at 95 % CI, from 5.63 to 8.37 for the former and the latter criterion, respectively).Conclusion According to IVUS data, two X-ray signs are most characteristic for UASP, the irregular contour and a patch with X-ray density ≤46 HU. The presence of these signs 11- and 7-fold, respectively, increases the likelihood of unstable ASP.
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Affiliation(s)
- I N Merkulova
- Institute of Clinical Cardiology, National Medical Research Center of Cardiology, Ministry of Healthcare Russian Federation, Moscow
| | - M A Shariya
- Institute of Clinical Cardiology, National Medical Research Center of Cardiology, Ministry of Healthcare Russian Federation, Moscow
| | - V M Mironov
- Institute of Clinical Cardiology, National Medical Research Center of Cardiology, Ministry of Healthcare Russian Federation, Moscow
| | - M S Shabanova
- Institute of Clinical Cardiology, National Medical Research Center of Cardiology, Ministry of Healthcare Russian Federation, Moscow
| | - T N Veselova
- Institute of Clinical Cardiology, National Medical Research Center of Cardiology, Ministry of Healthcare Russian Federation, Moscow
| | - S A Gaman
- Institute of Clinical Cardiology, National Medical Research Center of Cardiology, Ministry of Healthcare Russian Federation, Moscow
| | - N A Barysheva
- Institute of Clinical Cardiology, National Medical Research Center of Cardiology, Ministry of Healthcare Russian Federation, Moscow
| | - R M Shakhnovich
- Institute of Clinical Cardiology, National Medical Research Center of Cardiology, Ministry of Healthcare Russian Federation, Moscow
| | - N I Zhukova
- Institute of Clinical Cardiology, National Medical Research Center of Cardiology, Ministry of Healthcare Russian Federation, Moscow
| | - T S Sukhinina
- Institute of Clinical Cardiology, National Medical Research Center of Cardiology, Ministry of Healthcare Russian Federation, Moscow
| | - I I Staroverov
- Institute of Clinical Cardiology, National Medical Research Center of Cardiology, Ministry of Healthcare Russian Federation, Moscow
| | - S K Ternovoy
- Institute of Clinical Cardiology, National Medical Research Center of Cardiology, Ministry of Healthcare Russian Federation, Moscow
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Pleouras D, Sakellarios A, Rigas G, Karanasiou GS, Tsompou P, Karanasiou G, Kigka V, Kyriakidis S, Pezoulas V, Gois G, Tachos N, Ramos A, Pelosi G, Rocchiccioli S, Michalis L, Fotiadis DI. A Novel Approach to Generate a Virtual Population of Human Coronary Arteries for In Silico Clinical Trials of Stent Design. IEEE OPEN JOURNAL OF ENGINEERING IN MEDICINE AND BIOLOGY 2021; 2:201-209. [PMID: 35402969 PMCID: PMC8901009 DOI: 10.1109/ojemb.2021.3082328] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 05/06/2021] [Accepted: 05/17/2021] [Indexed: 11/15/2022] Open
Abstract
Goal: To develop a cardiovascular virtual population using statistical modeling and computational biomechanics. Methods: A clinical data augmentation algorithm is implemented to efficiently generate virtual clinical data using a real clinical dataset. An atherosclerotic plaque growth model is employed to 3D reconstructed coronary arterial segments to generate virtual coronary arterial geometries (geometrical data). Last, the combination of the virtual clinical and geometrical data is achieved using a methodology that allows for the generation of a realistic virtual population which can be used in in silico clinical trials. Results: The results show good agreement between real and virtual clinical data presenting a mean gof 0.1 ± 0.08. 400 virtual coronary arteries were generated, while the final virtual population includes 10,000 patients. Conclusions: The virtual arterial geometries are efficiently matched to the generated clinical data, both increasing and complementing the variability of the virtual population.
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Affiliation(s)
| | - Antonis Sakellarios
- Department of Biomedical ResearchFORTH-IMBB GR 45110 Ioannina Greece
- Unit of Medical Technology and Intelligent Information Systems, Department of Materials Science and EngineeringUniversity of Ioannina GR 45110 Greece
| | - George Rigas
- Unit of Medical Technology and Intelligent Information Systems, Department of Materials Science and EngineeringUniversity of Ioannina GR 45110 Greece
| | | | - Panagiota Tsompou
- Unit of Medical Technology and Intelligent Information Systems, Department of Materials Science and EngineeringUniversity of Ioannina GR 45110 Greece
| | - Gianna Karanasiou
- Department of Biomedical ResearchFORTH-IMBB GR 45110 Ioannina Greece
| | - Vassiliki Kigka
- Unit of Medical Technology and Intelligent Information Systems, Department of Materials Science and EngineeringUniversity of Ioannina GR 45110 Greece
| | - Savvas Kyriakidis
- Department of Biomedical ResearchFORTH-IMBB GR 45110 Ioannina Greece
| | - Vasileios Pezoulas
- Unit of Medical Technology and Intelligent Information Systems, Department of Materials Science and EngineeringUniversity of Ioannina GR 45110 Greece
| | - George Gois
- Department of Biomedical ResearchFORTH-IMBB GR 45110 Ioannina Greece
| | - Nikolaos Tachos
- Department of Biomedical ResearchFORTH-IMBB GR 45110 Ioannina Greece
| | - Aidonis Ramos
- Department of Cardiology, Medical SchoolUniversity of Ioannina Ioannina GR 45110 Greece
| | - Gualtiero Pelosi
- Institute of Clinical PhysiologyNational Research Council 56124 Pisa Italy
| | | | - Lampros Michalis
- Department of Cardiology, Medical SchoolUniversity of Ioannina Ioannina GR 45110 Greece
| | - Dimitrios I Fotiadis
- Department of Biomedical ResearchFORTH-IMBB GR 45110 Ioannina Greece
- Unit of Medical Technology and Intelligent Information Systems, Department of Materials Science and EngineeringUniversity of Ioannina GR 45110 Greece
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Pleouras DS, Sakellarios AI, Tsompou P, Kigka V, Kyriakidis S, Rocchiccioli S, Neglia D, Knuuti J, Pelosi G, Michalis LK, Fotiadis DI. Simulation of atherosclerotic plaque growth using computational biomechanics and patient-specific data. Sci Rep 2020; 10:17409. [PMID: 33060746 PMCID: PMC7562914 DOI: 10.1038/s41598-020-74583-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Accepted: 09/24/2020] [Indexed: 11/08/2022] Open
Abstract
Atherosclerosis is the one of the major causes of mortality worldwide, urging the need for prevention strategies. In this work, a novel computational model is developed, which is used for simulation of plaque growth to 94 realistic 3D reconstructed coronary arteries. This model considers several factors of the atherosclerotic process even mechanical factors such as the effect of endothelial shear stress, responsible for the initiation of atherosclerosis, and biological factors such as the accumulation of low and high density lipoproteins (LDL and HDL), monocytes, macrophages, cytokines, nitric oxide and formation of foams cells or proliferation of contractile and synthetic smooth muscle cells (SMCs). The model is validated using the serial imaging of CTCA comparing the simulated geometries with the real follow-up arteries. Additionally, we examine the predictive capability of the model to identify regions prone of disease progression. The results presented good correlation between the simulated lumen area (P < 0.0001), plaque area (P < 0.0001) and plaque burden (P < 0.0001) with the realistic ones. Finally, disease progression is achieved with 80% accuracy with many of the computational results being independent predictors.
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Affiliation(s)
- Dimitrios S Pleouras
- Department of Biomedical Research, Institute of Molecular Biology and Biotechnology - FORTH, University Campus of Ioannina, 45110, Ioannina, Greece
| | - Antonis I Sakellarios
- Department of Biomedical Research, Institute of Molecular Biology and Biotechnology - FORTH, University Campus of Ioannina, 45110, Ioannina, Greece
| | - Panagiota Tsompou
- Department of Biomedical Research, Institute of Molecular Biology and Biotechnology - FORTH, University Campus of Ioannina, 45110, Ioannina, Greece
- Unit of Medical Technology and Intelligent Information Systems, Department of Materials Science and Engineering, University of Ioannina, PO BOX 1186, 45110, Ioannina, Greece
| | - Vassiliki Kigka
- Department of Biomedical Research, Institute of Molecular Biology and Biotechnology - FORTH, University Campus of Ioannina, 45110, Ioannina, Greece
- Unit of Medical Technology and Intelligent Information Systems, Department of Materials Science and Engineering, University of Ioannina, PO BOX 1186, 45110, Ioannina, Greece
| | - Savvas Kyriakidis
- Department of Biomedical Research, Institute of Molecular Biology and Biotechnology - FORTH, University Campus of Ioannina, 45110, Ioannina, Greece
| | - Silvia Rocchiccioli
- Institute of Clinical Physiology, National Research Council, 56124, Pisa, Italy
| | - Danilo Neglia
- Fondazione Toscana G. Monasterio, 56124, Pisa, Italy
| | - Juhani Knuuti
- Turku PET Centre, University of Turku, and Turku University Hospital, Turku, Finland
| | - Gualtiero Pelosi
- Institute of Clinical Physiology, National Research Council, 56124, Pisa, Italy
| | - Lampros K Michalis
- Department of Cardiology, Medical School, University of Ioannina, 45110, Ioannina, Greece
| | - Dimitrios I Fotiadis
- Department of Biomedical Research, Institute of Molecular Biology and Biotechnology - FORTH, University Campus of Ioannina, 45110, Ioannina, Greece.
- Unit of Medical Technology and Intelligent Information Systems, Department of Materials Science and Engineering, University of Ioannina, PO BOX 1186, 45110, Ioannina, Greece.
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Pleouras DS, Sakellarios AI, Loukas VS, Kyriakidis S, Fotiadis DI. Prediction of the development of coronary atherosclerotic plaques using computational modeling in 3D reconstructed coronary arteries. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2020; 2020:2808-2811. [PMID: 33018590 DOI: 10.1109/embc44109.2020.9176219] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
In this work we present a novel method for the prediction and generation of atherosclerotic plaques. This is performed in a two-step approach, by employing first a multilevel computational plaque growth model and second a correlation between the model's results and the 3D reconstructed follow-up plaques. In particular, computer tomography coronary angiography (CTCA) data and blood tests were collected from patients at two time points. Using the baseline data, the plaque growth is simulated using a multi-level computational model which includes: i) modeling of the blood flow dynamics, ii) modeling of low and high density lipoproteins and monocytes' infiltration in the arterial wall, and the species reactions during the atherosclerotic process, and iii) modeling of the arterial wall thickening. The correlation between the followup plaques and the simulated plaque density distribution resulted to the extraction of a threshold of the plaque density, that can be used to identify plaque areas.Clinical Relevance- The methodology presented in this work is a first step to the prediction of the plaque shape and location of patients with atherosclerosis and could be used as an additional tool for patient-specific risk stratification.
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Kigka VI, Sakellarios AI, Georga EI, Siogkas P, Tsompou P, Kyriakidis S, Rocchiccioli S, Pelosi G, Naka K, Michalis LK, Fotiadis DI. Site specific prediction of PCI stenting based on imaging and biomechanics data using gradient boosting tree ensembles. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2020; 2020:2812-2815. [PMID: 33018591 DOI: 10.1109/embc44109.2020.9175612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Cardiovascular diseases are nowadays considered as the main cause of morbidity and mortality worldwide. Coronary Artery Disease (CAD), the most typical form of cardiovascular disease is diagnosed by a variety of imaging modalities, both invasive and non-invasive, which involve either risk implications or high cost. Therefore, several attempts have been undertaken to early diagnose and predict either the high CAD risk patients or the cardiovascular events, implementing machine learning techniques. The purpose of this study is to present a classification scheme for the prediction of Percutaneous Coronary Intervention (PCI) stenting placement, using image-based data. The proposed classification model is a gradient boosting classifier, incorporated into a class imbalance handling technique, the Easy ensemble scheme and aims to classify coronary segments into high CAD risk and low CAD risk, based on their PCI placement. Through this study, we investigate the importance of image based features, concluding that the combination of the coronary degree of stenosis and the fractional flow reserve achieves accuracy 78%.
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15
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Gerke O. Reporting Standards for a Bland-Altman Agreement Analysis: A Review of Methodological Reviews. Diagnostics (Basel) 2020; 10:E334. [PMID: 32456091 PMCID: PMC7278016 DOI: 10.3390/diagnostics10050334] [Citation(s) in RCA: 77] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Revised: 05/05/2020] [Accepted: 05/20/2020] [Indexed: 12/28/2022] Open
Abstract
The Bland-Altman Limits of Agreement is a popular and widespread means of analyzing the agreement of two methods, instruments, or raters in quantitative outcomes. An agreement analysis could be reported as a stand-alone research article but it is more often conducted as a minor quality assurance project in a subgroup of patients, as a part of a larger diagnostic accuracy study, clinical trial, or epidemiological survey. Consequently, such an analysis is often limited to brief descriptions in the main report. Therefore, in several medical fields, it has been recommended to report specific items related to the Bland-Altman analysis. The present study aimed to identify the most comprehensive and appropriate list of items for such an analysis. Seven proposals were identified from a MEDLINE/PubMed search, three of which were derived by reviewing anesthesia journals. Broad consensus was seen for the a priori establishment of acceptability benchmarks, estimation of repeatability of measurements, description of the data structure, visual assessment of the normality and homogeneity assumption, and plotting and numerically reporting both bias and the Bland-Altman Limits of Agreement, including respective 95% confidence intervals. Abu-Arafeh et al. provided the most comprehensive and prudent list, identifying 13 key items for reporting (Br. J. Anaesth. 2016, 117, 569-575). An exemplification with interrater data from a local study accentuated the straightforwardness of transparent reporting of the Bland-Altman analysis. The 13 key items should be applied by researchers, journal editors, and reviewers in the future, to increase the quality of reporting Bland-Altman agreement analyses.
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Affiliation(s)
- Oke Gerke
- Department of Nuclear Medicine, Odense University Hospital, Kløvervænget 47, 5000 Odense, Denmark;
- Department of Clinical Research, University of Southern Denmark, 5000 Odense, Denmark
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Sakellarios A, Correia J, Kyriakidis S, Georga E, Tachos N, Siogkas P, Sans F, Stofella P, Massimiliano V, Clemente A, Rocchiccioli S, Pelosi G, Filipovic N, Fotiadis DI. A cloud-based platform for the non-invasive management of coronary artery disease. ENTERP INF SYST-UK 2020. [DOI: 10.1080/17517575.2020.1746975] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Antonis Sakellarios
- Department of Biomedical Research, Institute of Molecular Biology and Biotechnology – FORTH, University Campus of Ioannina, Ioannina, Greece
- Unit of Medical Technology and Intelligent Information Systems, Department of Materials Science and Engineering, University of Ioannina, Ioannina, Greece
| | | | - Savvas Kyriakidis
- Department of Biomedical Research, Institute of Molecular Biology and Biotechnology – FORTH, University Campus of Ioannina, Ioannina, Greece
| | - Elena Georga
- Department of Biomedical Research, Institute of Molecular Biology and Biotechnology – FORTH, University Campus of Ioannina, Ioannina, Greece
- Unit of Medical Technology and Intelligent Information Systems, Department of Materials Science and Engineering, University of Ioannina, Ioannina, Greece
| | - Nikolaos Tachos
- Department of Biomedical Research, Institute of Molecular Biology and Biotechnology – FORTH, University Campus of Ioannina, Ioannina, Greece
- Unit of Medical Technology and Intelligent Information Systems, Department of Materials Science and Engineering, University of Ioannina, Ioannina, Greece
| | - Panagiotis Siogkas
- Department of Biomedical Research, Institute of Molecular Biology and Biotechnology – FORTH, University Campus of Ioannina, Ioannina, Greece
- Unit of Medical Technology and Intelligent Information Systems, Department of Materials Science and Engineering, University of Ioannina, Ioannina, Greece
| | | | | | | | - Alberto Clemente
- Department of Radiology, Fondazione Toscana Gabriele Monasterio, Pisa and Massa, Italy
| | | | - Gualtiero Pelosi
- Institute of Clinical Physiology, National Research Council, Pisa, Italy
| | - Nenad Filipovic
- Faculty of Engineering, University of Kragujevac, Kragujevac, Serbia
| | - Dimitrios I. Fotiadis
- Department of Biomedical Research, Institute of Molecular Biology and Biotechnology – FORTH, University Campus of Ioannina, Ioannina, Greece
- Unit of Medical Technology and Intelligent Information Systems, Department of Materials Science and Engineering, University of Ioannina, Ioannina, Greece
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