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Klüner LV, Chan K, Antoniades C. Using artificial intelligence to study atherosclerosis from computed tomography imaging: A state-of-the-art review of the current literature. Atherosclerosis 2024:117580. [PMID: 38852022 DOI: 10.1016/j.atherosclerosis.2024.117580] [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: 12/11/2023] [Revised: 05/03/2024] [Accepted: 05/14/2024] [Indexed: 06/10/2024]
Abstract
With the enormous progress in the field of cardiovascular imaging in recent years, computed tomography (CT) has become readily available to phenotype atherosclerotic coronary artery disease. New analytical methods using artificial intelligence (AI) enable the analysis of complex phenotypic information of atherosclerotic plaques. In particular, deep learning-based approaches using convolutional neural networks (CNNs) facilitate tasks such as lesion detection, segmentation, and classification. New radiotranscriptomic techniques even capture underlying bio-histochemical processes through higher-order structural analysis of voxels on CT images. In the near future, the international large-scale Oxford Risk Factors And Non-invasive Imaging (ORFAN) study will provide a powerful platform for testing and validating prognostic AI-based models. The goal is the transition of these new approaches from research settings into a clinical workflow. In this review, we present an overview of existing AI-based techniques with focus on imaging biomarkers to determine the degree of coronary inflammation, coronary plaques, and the associated risk. Further, current limitations using AI-based approaches as well as the priorities to address these challenges will be discussed. This will pave the way for an AI-enabled risk assessment tool to detect vulnerable atherosclerotic plaques and to guide treatment strategies for patients.
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Affiliation(s)
- Laura Valentina Klüner
- Acute Multidisciplinary Imaging and Interventional Centre, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, Oxford NIHR Biomedical Research Centre, University of Oxford, United Kingdom
| | - Kenneth Chan
- Acute Multidisciplinary Imaging and Interventional Centre, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, Oxford NIHR Biomedical Research Centre, University of Oxford, United Kingdom
| | - Charalambos Antoniades
- Acute Multidisciplinary Imaging and Interventional Centre, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, Oxford NIHR Biomedical Research Centre, University of Oxford, United Kingdom.
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2
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Henriques J, Amaro AM, Piedade AP. Biomimicking Atherosclerotic Vessels: A Relevant and (Yet) Sub-Explored Topic. Biomimetics (Basel) 2024; 9:135. [PMID: 38534820 DOI: 10.3390/biomimetics9030135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Revised: 02/20/2024] [Accepted: 02/21/2024] [Indexed: 03/28/2024] Open
Abstract
Atherosclerosis represents the etiologic source of several cardiovascular events, including myocardial infarction, cerebrovascular accidents, and peripheral artery disease, which remain the leading cause of mortality in the world. Numerous strategies are being delineated to revert the non-optimal projections of the World Health Organization, by both designing new diagnostic and therapeutic approaches or improving the interventional procedures performed by physicians. Deeply understanding the pathological process of atherosclerosis is, therefore, mandatory to accomplish improved results in these trials. Due to their availability, reproducibility, low expensiveness, and rapid production, biomimicking physical models are preferred over animal experimentation because they can overcome some limitations, mainly related to replicability and ethical issues. Their capability to represent any atherosclerotic stage and/or plaque type makes them valuable tools to investigate hemodynamical, pharmacodynamical, and biomechanical behaviors, as well as to optimize imaging systems and, thus, obtain meaningful prospects to improve the efficacy and effectiveness of treatment on a patient-specific basis. However, the broadness of possible applications in which these biomodels can be used is associated with a wide range of tissue-mimicking materials that are selected depending on the final purpose of the model and, consequently, prioritizing some materials' properties over others. This review aims to summarize the progress in fabricating biomimicking atherosclerotic models, mainly focusing on using materials according to the intended application.
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Affiliation(s)
- Joana Henriques
- University of Coimbra, CEMMPRE, ARISE, Department of Mechanical Engineering, 3030-788 Coimbra, Portugal
| | - Ana M Amaro
- University of Coimbra, CEMMPRE, ARISE, Department of Mechanical Engineering, 3030-788 Coimbra, Portugal
| | - Ana P Piedade
- University of Coimbra, CEMMPRE, ARISE, Department of Mechanical Engineering, 3030-788 Coimbra, Portugal
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Smit JM, El Mahdiui M, de Graaf MA, Montero-Cabezas JM, Reiber JHC, Jukema JW, Scholte AJ, Knuuti J, Wijns W, Narula J, Bax JJ. Relation Between Coronary Plaque Composition Assessed by Intravascular Ultrasound Virtual Histology and Myocardial Ischemia Assessed by Quantitative Flow Ratio. Am J Cardiol 2023; 186:228-235. [PMID: 36333150 DOI: 10.1016/j.amjcard.2022.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 09/10/2022] [Accepted: 10/03/2022] [Indexed: 11/13/2022]
Abstract
Coronary plaque composition may play an important role in the induction of myocardial ischemia. Our objective was to further clarify the relation between coronary plaque composition and myocardial ischemia in patients with chest pain symptoms. The study population consisted of 103 patients who presented to the outpatient clinic or emergency department with chest pain symptoms and were referred for diagnostic invasive coronary angiography. Intravascular ultrasound virtual histology was used for the assessment of coronary plaque composition. A noncalcified plaque was defined as a combination of necrotic core and fibrofatty tissue. Quantitative flow ratio (QFR), which is a coronary angiography-based technique used to calculate fractional flow reserve without the need for hyperemia induction or for a pressure wire, was used as the reference standard for the evaluation of myocardial ischemia. Coronary artery plaques with QFR of ≤0.80 were considered abnormal-that is, ischemia-generating. In total, 149 coronary plaques were analyzed, 21 of which (14%) were considered abnormal according to QFR. The percentage of noncalcified tissue was significantly higher in plaques with abnormal QFR (38.2 ± 6.5% vs 33.1 ± 9.0%, p = 0.014). After univariable analysis, both plaque load (odds ratio [OR] per 1% increase 1.081, p <0.001) and the percentage of noncalcified tissue (OR per 1% increase 1.070, p = 0.020) were significantly associated with reduced QFR. However, after multivariable analysis, only plaque load remained significantly associated with abnormal QFR (OR per 1% increase 1.072, p <0.001). In conclusion, the noncalcified plaque area was significantly higher in hemodynamically significant coronary lesions than in nonsignificant lesions. Although an increase in the noncalcified plaque area was significantly associated with a reduced QFR, this association lost significance after adjustment for localized plaque load.
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Affiliation(s)
- Jeff M Smit
- Departments of Cardiology Leiden University Medical Center, Leiden, The Netherlands
| | - Mohammed El Mahdiui
- Departments of Cardiology Leiden University Medical Center, Leiden, The Netherlands
| | - Michiel A de Graaf
- Departments of Cardiology Leiden University Medical Center, Leiden, The Netherlands
| | | | - Johan H C Reiber
- Medis Medical Imaging, Leiden, The Netherlands; Departments of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - J Wouter Jukema
- Departments of Cardiology Leiden University Medical Center, Leiden, The Netherlands
| | - Arthur J Scholte
- Departments of Cardiology Leiden University Medical Center, Leiden, The Netherlands
| | - Juhani Knuuti
- Heart Center, University of Turku and Turku University Hospital, Turku, Finland
| | - William Wijns
- Lambe Institute for Translational Medicine and Curam, National University of Ireland Galway and Saolta University Healthcare Group, University College Hospital Galway, Galway, Ireland
| | - Jagat Narula
- Division of Cardiology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Jeroen J Bax
- Departments of Cardiology Leiden University Medical Center, Leiden, The Netherlands; Heart Center, University of Turku and Turku University Hospital, Turku, Finland.
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Wang WL, Chang FL, Yu PH. Effect of different injection rates and doses of contrast medium on the image quality of computed tomographic angiography in African grey parrots (Psittacus erithacus). BMC Vet Res 2022; 18:428. [PMID: 36482409 PMCID: PMC9733312 DOI: 10.1186/s12917-022-03524-w] [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: 09/12/2021] [Accepted: 11/22/2022] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Atherosclerosis is a common cardiovascular disease in parrots but the antemortem diagnosis is challenging. In human medicine, computed tomography angiography (CTA) has been used widely for the diagnosis of atherosclerosis. By adjusting the injection rate and total dose of contrast medium, the image quality can be improved. To test the effects of different injection conditions on the image quality of major arteries, 10 African grey parrots (Psittacus erithacus) were used. Three injection rates (0.3, 0.4, 0.5 mL/s) and three doses (740, 370, 222 mg of iodine/bird) were tested while the other variables of the studies were fixed. RESULT A higher injection dose led to a significantly higher attenuation, image noise and diameter, with a lower signal-to-noise ratio and contrast-to-noise ratio of the six major arteries. The 370 mg of iodine/bird group showed significantly better subjective image quality. Furthermore, with increasing injection rates, the prevalence of heterogeneity decreased. However, we found an increased risk of injection failure for the 0.5 mL/s groups. CONCLUSION We recommend a combination of 370 mg of iodine/bird with 0.4 mL/s for clinical use to achieve better image quality for CTA.
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Affiliation(s)
- Wen-Lin Wang
- grid.19188.390000 0004 0546 0241Institute of Veterinary Clinical Science, School of Veterinary Medicine, National Taiwan University, Number 153, Section 3, Keelung Road, Da’an District, Taipei, 10672 Taiwan ,grid.19188.390000 0004 0546 0241National Taiwan University Veterinary Hospital, Number 153, Section 3, Keelung Road, Da’an District, Taipei, 10672 Taiwan
| | - Fang-Lun Chang
- grid.19188.390000 0004 0546 0241National Taiwan University Veterinary Hospital, Number 153, Section 3, Keelung Road, Da’an District, Taipei, 10672 Taiwan
| | - Pin-Huan Yu
- grid.19188.390000 0004 0546 0241Institute of Veterinary Clinical Science, School of Veterinary Medicine, National Taiwan University, Number 153, Section 3, Keelung Road, Da’an District, Taipei, 10672 Taiwan ,grid.19188.390000 0004 0546 0241National Taiwan University Veterinary Hospital, Number 153, Section 3, Keelung Road, Da’an District, Taipei, 10672 Taiwan
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Dawson LP, Layland J. High-Risk Coronary Plaque Features: A Narrative Review. Cardiol Ther 2022; 11:319-335. [PMID: 35731471 PMCID: PMC9381667 DOI: 10.1007/s40119-022-00271-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Accepted: 06/13/2022] [Indexed: 11/30/2022] Open
Abstract
Advances in coronary plaque imaging over the last few decades have led to an increased interest in the identification of novel high-risk plaque features that are associated with cardiovascular events. Existing practices focus on risk stratification and lipid monitoring for primary and secondary prevention of cardiac events, which is limited by a lack of assessment and treatment of vulnerable plaque. In this review, we summarize the multitude of studies that have identified plaque, haemodynamic and patient factors associated with risk of acute coronary syndrome. Future progress in multi-modal imaging strategies and in our understanding of high-risk plaque features could expand treatment options for coronary disease and improve patient outcomes.
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Affiliation(s)
- Luke P Dawson
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia.,Department of Cardiology, The Alfred Hospital, Melbourne, VIC, Australia
| | - Jamie Layland
- Department of Medicine, Monash University, Clayton campus, Melbourne, VIC, Australia. .,Department of Cardiology, Peninsula Health, 2 Hastings Rd, Frankston, VIC, 3199, Australia.
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Williams MC, Earls JP, Hecht H. Quantitative assessment of atherosclerotic plaque, recent progress and current limitations. J Cardiovasc Comput Tomogr 2022; 16:124-137. [PMID: 34326003 DOI: 10.1016/j.jcct.2021.07.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 06/29/2021] [Accepted: 07/09/2021] [Indexed: 12/11/2022]
Abstract
An important advantage of computed tomography coronary angiography (CCTA) is its ability to visualize the presence and severity of atherosclerotic plaque, rather than just assessing coronary artery stenoses. Until recently, assessment of plaque subtypes on CCTA relied on visual assessment of the extent of calcified/non-calcified plaque, or visually identifying high-risk plaque characteristics. Recent software developments facilitate the quantitative assessment of plaque volume or burden on CCTA, and the identification of subtypes of plaque based on their attenuation density. These techniques have shown promise in single and multicenter studies, demonstrating that the amount and type of plaque are associated with subsequent cardiac events. However, there are a number of limitations to the application of these techniques, including the limitations imposed by the spatial resolution of current CT scanners, challenges from variations between reconstruction algorithms, and the additional time to perform these assessments. At present, these are a valuable research technique, but not yet part of routine clinical practice. Future advances that improve CT resolution, standardize acquisition techniques and reconstruction algorithms and automate image analysis will improve the clinical utility of these techniques. This review will discuss the technical aspects of quantitative plaque analysis and present pro and con arguments for the routine use of quantitative plaque analysis on CCTA.
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Affiliation(s)
- Michelle C Williams
- BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK.
| | - James P Earls
- George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Harvey Hecht
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Detection of Vulnerable Coronary Plaques Using Invasive and Non-Invasive Imaging Modalities. J Clin Med 2022; 11:jcm11051361. [PMID: 35268451 PMCID: PMC8911129 DOI: 10.3390/jcm11051361] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 02/11/2022] [Accepted: 02/25/2022] [Indexed: 11/16/2022] Open
Abstract
Acute coronary syndrome (ACS) mostly arises from so-called vulnerable coronary plaques, particularly prone for rupture. Vulnerable plaques comprise a specific type of plaque, called the thin-cap fibroatheroma (TFCA). A TCFA is characterized by a large lipid-rich necrotic core, a thin fibrous cap, inflammation, neovascularization, intraplaque hemorrhage, microcalcifications or spotty calcifications, and positive remodeling. Vulnerable plaques are often not visible during coronary angiography. However, different plaque features can be visualized with the use of intracoronary imaging techniques, such as intravascular ultrasound (IVUS), potentially with the addition of near-infrared spectroscopy (NIRS), or optical coherence tomography (OCT). Non-invasive imaging techniques, such as computed tomography coronary angiography (CTCA), cardiovascular magnetic resonance (CMR) imaging, and nuclear imaging, can be used as an alternative for these invasive imaging techniques. These invasive and non-invasive imaging modalities can be implemented for screening to guide primary or secondary prevention therapies, leading to a more patient-tailored diagnostic and treatment strategy. Systemic pharmaceutical treatment with lipid-lowering or anti-inflammatory medication leads to plaque stabilization and reduction of cardiovascular events. Additionally, ongoing studies are investigating whether modification of vulnerable plaque features with local invasive treatment options leads to plaque stabilization and subsequent cardiovascular risk reduction.
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Zhang L, Li L, Feng G, Fan T, Jiang H, Wang Z. Advances in CT Techniques in Vascular Calcification. Front Cardiovasc Med 2021; 8:716822. [PMID: 34660718 PMCID: PMC8511450 DOI: 10.3389/fcvm.2021.716822] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2021] [Accepted: 08/30/2021] [Indexed: 12/17/2022] Open
Abstract
Vascular calcification, a common pathological phenomenon in atherosclerosis, diabetes, hypertension, and other diseases, increases the incidence and mortality of cardiovascular diseases. Therefore, the prevention and detection of vascular calcification play an important role. At present, various techniques have been applied to the analysis of vascular calcification, but clinical examination mainly depends on non-invasive and invasive imaging methods to detect and quantify. Computed tomography (CT), as a commonly used clinical examination method, can analyze vascular calcification. In recent years, with the development of technology, in addition to traditional CT, some emerging types of CT, such as dual-energy CT and micro CT, have emerged for vascular imaging and providing anatomical information for calcification. This review focuses on the latest application of various CT techniques in vascular calcification.
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Affiliation(s)
- Lijie Zhang
- Department of Cardiology, Affiliated Hospital of Jiangsu University, Zhenjiang, China
| | - Lihua Li
- Department of Pathology, Affiliated Hospital of Jiangsu University, Zhenjiang, China
| | - Guoquan Feng
- Department of Radiology, Affiliated Hospital of Jiangsu University, Zhenjiang, China
| | - Tingpan Fan
- Department of Cardiology, Affiliated Hospital of Jiangsu University, Zhenjiang, China
| | - Han Jiang
- Department of Cardiology, Affiliated Hospital of Jiangsu University, Zhenjiang, China
| | - Zhongqun Wang
- Department of Cardiology, Affiliated Hospital of Jiangsu University, Zhenjiang, China
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Finck T, Klambauer K, Hendrich E, Will A, Martinoff S, Hadamitzky M. Radiation Dose and Image Quality of a High-Pitch Prospective Spiral First Approach in Coronary Computed Tomography Angiography (CCTA). J Cardiovasc Dev Dis 2021; 8:jcdd8100119. [PMID: 34677188 PMCID: PMC8539421 DOI: 10.3390/jcdd8100119] [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: 08/24/2021] [Revised: 09/09/2021] [Accepted: 09/23/2021] [Indexed: 11/16/2022] Open
Abstract
Objective: To investigate a high-pitch spiral first (HPSF) approach for coronary computed tomography angiography (CCTA) in an unselected patient cohort and compare diagnostic yield and radiation exposure to CCTAs acquired via conventional, non-high-pitch spiral first (NHPSF) scan regimes. Materials and Methods: All consecutive patients from 1 January 2015 to 31 December 2017 were included. Two investigation protocols (HPSF/NHPSF) were used with the aim to achieve diagnostic image quality of all coronary segments. Low-pitch secondary scans followed the initial examination if image quality was unsatisfactory. Dosage and image quality were compared between both regimes. Results: 1410 patients were subject to a HPSF and 236 patients to a NHPSF approach. While the HPSF approach led to a higher fraction of re-scans (35% vs. 11%, p < 0.001), the fraction of aggregate scans that remained non-diagnostic after considering the initial and secondary scan was comparably low for the HPSF and NHPSF approach (0.78 vs. 0%, p = 0.18). Aggregate radiation exposure in the HPSF protocol was significantly lower (1.12 mSv (IQR: 0.73, 2.10) vs. 3.96 mSv (IQR: 2.23, 8.33) p < 0.001). Conclusions: In spite of a higher number of re-scans, a HPSF approach leads to a reduction in overall radiation exposure with diagnostic yields similar to a NHPSF approach.
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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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Monosodium Urate Crystal Deposition in Coronary Artery Plaque by 128-Slice Dual-Energy Computed Tomography: An Ex Vivo Phantom and In Vivo Study. J Comput Assist Tomogr 2021; 45:856-862. [PMID: 34469909 DOI: 10.1097/rct.0000000000001222] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Monosodium uric acid (MSU) crystals may accumulate in the coronary plaque. The objective was to assess whether dual-energy computed tomography (DECT) allows for detection of MSU in coronary plaque. METHODS Patients were examined with 128-slice DECT applying a cardiac electrocardiogram-gated and peripheral extremity protocol. Patients were divided into 3 groups: gout (tophi >1 cm in peripheral joints), hyperuricemia (>6.5 mg/dL serum uric acid), and controls. The groups were matched for cardiovascular risk factors. Monosodium uric acid-positive (+) and calcified plaque were distinguished, and the coronary artery calcium score was calculated. Ex vivo phantom: MSU solutions were diluted in different NaCL solutions (5%/10%/15%/20%/25%). Coronary artery models with 2 different plaque types (MSU+ and calcified) were created. RESULTS A total of 96 patients were included (37 with gout, 33 with hyperuricemia, and 26 controls). Monosodium uric acid-positive plaques were found more often in patients with gout as compared with controls (91.9% vs 0.38%; P < 0.0001), and the number of plaques was higher (P < 0.0001). Of 102 MSU+ plaques, 26.7% were only MSU+ and 74.2% were mixed MSU+/calcified. Monosodium uric acid-positive plaque had mean 232.3 Hounsfield units (range, 213-264). Coronary artery calcium score was higher in patients with gout as compared with controls (659.1 vs 112.4 Agatston score; P < 0.001). Patients with gout had more MSU+ plaques as compared with patients with hyperuricemia (91.6% vs 2.9%; P < 0.0001), and coronary artery calcium score was higher (659.1 vs 254 Agatston score; P < 0.001), but there was no difference between patients with hyperuricemia and controls. Ex vivo phantom study: MSU crystals were detected by DECT in solutions with a concentration of 15% or greater MSU and could be distinguished from calcified. CONCLUSIONS Coronary MSU+ plaques can be detected by DECT in patients with gout.
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Measurement of Plaque Characteristics Using Coronary Computed Tomography Angiography: Achieving High Interobserver Performance. CJC Open 2021; 4:189-196. [PMID: 35198936 PMCID: PMC8843959 DOI: 10.1016/j.cjco.2021.09.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Accepted: 09/22/2021] [Indexed: 11/21/2022] Open
Abstract
Background Coronary computed tomography angiography (CCTA) is used to assess plaque characteristics, remodelling, and progression and regression. Few papers address standard operating procedures that ensure achievement of high interobserver reproducibility. Moreover, assessment of coronary artery bypass grafts has not been reported. Methods A training set of images was created of native coronary segments, spanning the full range of atheromatous disease from normal to severe, excluding totally occluded segments, and including segments with or without calcification (n = 24) and completely normal-appearing bypass grafts (n = 16). Three observers used a validated software program during a training phase to establish standard operating procedures and then to achieve high intraobserver performance based on Pearson’s correlation coefficient. Subsequently, interobserver variability for the laboratory as a whole was determined with a focus on measures of plaque volume, low- attenuation plaque (LAP), mixed plaque (MP), and calcified plaque (CP). Results We found no substantive differences in analytical issues between grafts and native vessels and emphasize the aggregated data. The range of mean total plaque percent was approximately 55% of total vessel volume with maximal interobserver mean absolute differences of 2% or less. Percent of LAP, MP, and CP demonstrated interobserver standard errors of 1% to 2% and interobserver mean absolute differences of 0% to 1%. Pearson’s correlations were all highly significant and ranged from 0.969 to 0.999. Conclusions CCTA provides a rich diversity of measures of atherosclerosis in coronary and bypass segments that are highly reproducible with experience and adherence to standard operating procedures.
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Feuchtner G, Suppersberger S, Langer C, Beyer C, Rauch S, Thurner T, Friedrich G, Dichtl W, Widmann G, Plank F, Barbieri F. The Effect of Vitamin D on Coronary Atherosclerosis: A Propensity Score Matched Case-Control Coronary CTA Study. J Cardiovasc Dev Dis 2021; 8:jcdd8080085. [PMID: 34436227 PMCID: PMC8397201 DOI: 10.3390/jcdd8080085] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 07/18/2021] [Accepted: 07/23/2021] [Indexed: 01/01/2023] Open
Abstract
Background: Vitamin D supplementation may be associated with lower cardiovascular (CV) events, but the data are controversial. It remains speculative whether vitamin D supplementation has a direct effect on coronary atherosclerosis. We therefore set out to assess the influence of vitamin D supplementation on the coronary atherosclerosis profile quantified by coronary computed tomography angiography (CTA) in a retrospective case–control cohort study. Methods: 176 patients (age: 62.4 ± 10.4) referred to coronary CTA for clinical indications were included. A total of 88 patients receiving vitamin D supplementation (mean duration 65.3 ± 81 months) were 1:1 propensity score matched with 88 controls for age, gender, smoking, arterial hypertension, positive family history, dyslipidemia, and diabetes. Coronary stenosis severity (CAD-RADSTM), mixed plaque burden (weighted for non-calcified), high-risk-plaque (HRP) features, and plaque density (HU) were quantified by CTA. Serum 25-hydroxyvitamin D (OH)-levels were measured in 138 patients and categorized into four groups (0: <20 ng/mL; 1: 20–40 ng/mL; 2: 40–60 ng/mL; and 3: >60 ng/mL) and compared with CTA. Results: The prevalence of atherosclerosis by CTA was similar in both groups (75.6% versus 74.3%, p = 0.999), >50% coronary stenosis was slightly higher in controls (p = 0.046), but stenosis severity score (CAD-RADS) was not different (p = 0.106). Mixed plaque burden (weighted for non-calcified) was lower in patients receiving vitamin D supplementation (p = 0.002) and high-risk-plaque prevalence was markedly lower (3.8% versus 32%, p < 0.001). CT plaque density (HU) was higher (p < 0.001) in the vitamin D group. Patients with serum vitamin D (OH) levels >60 ng/mL had higher plaque density (p = 0.04), indicating more calcified and less vulnerable plaque. Conclusions: In this retrospective case–control cohort study, vitamin D supplementation was associated with less high-risk plaque, less non-calcified plaque burden, and a higher calcified plaque independent of CV risk factors.
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Affiliation(s)
- Gudrun Feuchtner
- Department of Radiology, Medical University of Innsbruck, 6020 Innsbruck, Austria; (G.F.); (S.S.); (C.L.); (S.R.); (G.W.)
| | - Simon Suppersberger
- Department of Radiology, Medical University of Innsbruck, 6020 Innsbruck, Austria; (G.F.); (S.S.); (C.L.); (S.R.); (G.W.)
| | - Christian Langer
- Department of Radiology, Medical University of Innsbruck, 6020 Innsbruck, Austria; (G.F.); (S.S.); (C.L.); (S.R.); (G.W.)
| | - Christoph Beyer
- Department of Internal Medicine III, Medical University of Innsbruck, 6020 Innsbruck, Austria; (C.B.); (G.F.); (W.D.); (F.P.)
| | - Stefan Rauch
- Department of Radiology, Medical University of Innsbruck, 6020 Innsbruck, Austria; (G.F.); (S.S.); (C.L.); (S.R.); (G.W.)
| | | | - Guy Friedrich
- Department of Internal Medicine III, Medical University of Innsbruck, 6020 Innsbruck, Austria; (C.B.); (G.F.); (W.D.); (F.P.)
| | - Wolfgang Dichtl
- Department of Internal Medicine III, Medical University of Innsbruck, 6020 Innsbruck, Austria; (C.B.); (G.F.); (W.D.); (F.P.)
| | - Gerlig Widmann
- Department of Radiology, Medical University of Innsbruck, 6020 Innsbruck, Austria; (G.F.); (S.S.); (C.L.); (S.R.); (G.W.)
| | - Fabian Plank
- Department of Internal Medicine III, Medical University of Innsbruck, 6020 Innsbruck, Austria; (C.B.); (G.F.); (W.D.); (F.P.)
| | - Fabian Barbieri
- Department of Internal Medicine III, Medical University of Innsbruck, 6020 Innsbruck, Austria; (C.B.); (G.F.); (W.D.); (F.P.)
- Department of Cardiology, Charité University Medicine, Campus Benjamin Franklin, 12203 Berlin, Germany
- Correspondence: ; Tel.: +43-512-504-82546
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Chen X, Dang Y, Hu H, Ma S, Ma Y, Wang K, Liu T, Lu X, Hou Y. Pericoronary adipose tissue attenuation assessed by dual-layer spectral detector computed tomography is a sensitive imaging marker of high-risk plaques. Quant Imaging Med Surg 2021; 11:2093-2103. [PMID: 33936990 DOI: 10.21037/qims-20-860] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Background The pericoronary fat attenuation index (FAI) derived from conventional polychromatic computed tomography (CT) can capture the presence of coronary inflammation. However, conventional polychromatic CT has limitations in material component differentiation, and spectral CT could have a better ability to discriminate tissue characteristics. Hence, this study sought to assess pericoronary adipose tissue (PCAT) attenuation using spectral CT and explore its association with atherosclerotic plaque characteristics. Methods We enrolled 104 patients with coronary atherosclerosis who met the inclusion criteria and underwent coronary CT angiography with dual-layer spectral detector computed tomography (SDCT). Plaque anatomical characteristics were measured, and the PCAT attenuation was assessed by polychromatic images (CTpoly), virtual mono-energetic images at 40 keV (CT40 keV), the slope of spectral attenuation curve (λHU), and the effective atomic number (Zeff). The association of PCAT attenuation indicators with the presence of high-risk plaques was analyzed, along with the indicators' ability to identify high-risk plaques. Results PCAT attenuation indicators around high-risk plaques were higher than those around non-high-risk plaques, especially CT40 keV [-153.76±24.97 (non-high-risk plaque) vs. -119.87±22.74 (high-risk plaque), P<0.001]. CT40 keV was a predictive factor of high-risk plaques, and high CT40 keV (≥-120.60 HU) could assist in the identification of high-risk plaques, with an area under the curve of 0.883 (95% CI: 0.83-0.94, P<0.05). Conclusions PCAT surrounding high-risk plaques showed higher attenuation; a finding that has been associated with coronary artery inflammation. The metrics derived from SDCT, especially CT40 keV, showed higher discriminatory power for detecting changes in PCAT attenuation than polychromatic CT. PCAT attenuation assessed by CT40 keV may provide a novel imaging marker of plaque vulnerability.
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Affiliation(s)
- Xujiao Chen
- Radiology Department, Shengjing Hospital of China Medical University, Shenyang, China
| | - Yuxue Dang
- Radiology Department, Shengjing Hospital of China Medical University, Shenyang, China
| | - Hong Hu
- Radiology Department, Shengjing Hospital of China Medical University, Shenyang, China
| | - Shaowei Ma
- Department of Cardiology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Yue Ma
- Radiology Department, Shengjing Hospital of China Medical University, Shenyang, China
| | - Kunhua Wang
- Radiology Department, People's Hospital of Liaoning Province, Shenyang, China
| | - Ting Liu
- Radiology Department, the First Affiliated Hospital of China Medical University, Shenyang, China
| | - Xiaomei Lu
- CT Clinical Science, Philips Healthcare, Shenyang, China
| | - Yang Hou
- Radiology Department, Shengjing Hospital of China Medical University, Shenyang, China
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15
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Senoner T, Plank F, Langer C, Beyer C, Steinkohl F, Barbieri F, Adukauskaite A, Widmann G, Friedrich G, Dichtl W, Feuchtner GM. Smoking and obesity predict high-risk plaque by coronary CTA in low coronary artery calcium score (CACS). J Cardiovasc Comput Tomogr 2021; 15:499-505. [PMID: 33933380 DOI: 10.1016/j.jcct.2021.04.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 04/12/2021] [Accepted: 04/17/2021] [Indexed: 01/19/2023]
Abstract
BACKGROUND The AHA recommends statins in patients with CACS>100 AU. However in patients with low CACS (1-99 AU), no clear statement is provided, leaving the clinician in a grey-zone. High-risk plaque (HRP) criteria by coronary CTA are novel imaging biomarkers indicating a higher a-priori cardiovascular (CV) risk, which could help for decision-making. Therefore the objective of our study was to identify which CV-risk factors predict HRP in patients with low CACS 1-99. METHODS 1003 symptomatic patients with low-to-intermediate risk, a clinical indication for coronary computed tomography angiography (CCTA) and who had a coronary artery calcium score (CACS) between 1 and 99 AU, were enrolled. CCTA analysis included: stenosis severity and HRP-criteria: low-attenuation plaque (LAP <30HU, <60HU and <90HU) napkin-ring-sign, spotty calcification and positive remodeling. Multivariate regression models were created for predicting HRP-criteria by the major 5 cardiovascular risk factors (CVRF) (smoking, arterial hypertension, positive family history, dyslipidemia, diabetes) and obesity (BMI>25 kg/m2). RESULTS 304 (33.5%) were smokers. 20.4% of smokers had HRP compared with only 14.9% of non-smokers (p = 0.045). Male gender was associated with HRP (p < 0.001). Smoking but not the other 5 CVRF had the most associations with HRP-criteria (LAP<60HU/≥2 criteria:OR 1.59; 95%CI:1.07-2.35), LAP<90HU (OR 1.57; 95%CI:1.01-2.43), Napkin-Ring-Sign (OR 1.78; 95%CI:1.02-3.1) and positive remodelling (OR 1.54; 95%CI:1.09-2.19). Smoking predicted fibrofatty LAP<90HU in males only. Obesity predicted LAP<60HU in both females and males. CONCLUSIONS In patients with low CACS 1-99AU, male gender, smoking and obesity, but not the other CVRF predict HRP. These patients would rather benefit from intensification of primary CV-prevention measures such as statins.
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Affiliation(s)
- Thomas Senoner
- Department of Internal Medicine III- Cardiology, Innsbruck Medical University, Austria
| | - Fabian Plank
- Department of Internal Medicine III- Cardiology, Innsbruck Medical University, Austria
| | | | - Christoph Beyer
- Department of Radiology, Innsbruck Medical University, Austria
| | | | - Fabian Barbieri
- Department of Internal Medicine III- Cardiology, Innsbruck Medical University, Austria
| | - Agne Adukauskaite
- Department of Internal Medicine III- Cardiology, Innsbruck Medical University, Austria
| | - Gerlig Widmann
- Department of Radiology, Innsbruck Medical University, Austria
| | - Guy Friedrich
- Department of Internal Medicine III- Cardiology, Innsbruck Medical University, Austria
| | - Wolfgang Dichtl
- Department of Internal Medicine III- Cardiology, Innsbruck Medical University, Austria
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Boldeanu I, Sadouni M, Mansour S, Baril JG, Trottier B, Soulez G, S Chin A, Leipsic J, Tremblay C, Durand M, Chartrand-Lefebvre C. Prevalence and Characterization of Subclinical Coronary Atherosclerotic Plaque with CT among Individuals with HIV: Results from the Canadian HIV and Aging Cohort Study. Radiology 2021; 299:571-580. [PMID: 33876969 DOI: 10.1148/radiol.2021203297] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Background People living with HIV (PLWH) have a higher risk of myocardial infarction. Coronary atherosclerotic plaque CT characterization helps to predict cardiovascular risk. Purpose To measure CT characteristics of coronary plaque in PLWH without known cardiovascular disease and healthy volunteers without HIV. Materials and Methods In this prospective study, noncontrast CT (all participants, n = 265) was used for coronary artery calcium (CAC) scoring in asymptomatic PLWH and healthy volunteers without HIV, without known cardiovascular disease, from 2012 to 2019. At coronary CT angiography (n = 233), prevalence, frequency, and volume of calcified, mixed, and noncalcified plaque were measured. Poisson regressions were used with adjustment for cardiovascular risk factors. Results There were 181 PLWH (mean age, 56 years ± 7; 167 men) and 84 healthy volunteers (mean age, 57 years ± 8; 65 men) evaluated by using noncontrast CT. CT angiography was performed in 155 PLWH and 78 healthy volunteers. Median 10-year Framingham risk score was not different between PLWH and healthy volunteers (10% vs 9%, respectively; P = .45), as were CAC score (odds ratio [OR], 1.06; 95% CI: 0.58, 1.94; P = .85) and overall plaque prevalence (prevalence ratio, 1.07; 95% CI: 0.86, 1.32; P = .55) after adjustment for cardiovascular risk. Noncalcified plaque prevalence (prevalence ratio, 2.5; 95% CI: 1.07, 5.67; P = .03) and volume (OR, 2.8; 95% CI: 1.05, 7.40; P = .04) were higher in PLWH. Calcified plaque frequency was reduced in PLWH (OR, 0.6; 95% CI: 0.40, 0.91; P = .02). Treatment with protease inhibitors was associated with higher volume of overall (OR, 1.8; 95% CI: 1.09, 2.85; P = .02) and mixed plaque (OR, 1.6; 95% CI: 1.04, 2.45; P = .03). Conclusion Noncalcified coronary plaque burden at coronary CT angiography was two- to threefold higher in asymptomatic people living with HIV without known cardiovascular disease compared with healthy volunteers without HIV. © RSNA, 2021 Online supplemental material is available for this article. See also the editorial by Lai in this issue.
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Affiliation(s)
- Irina Boldeanu
- From the Departments of Radiology (I.B., M.S., G.S., A.S.C., C.C.L.), Cardiology (S.M.), Family Medicine (J.G.B., B.T.), Microbiology (C.T.) and Internal Medicine (M.D.), University of Montreal Hospital (CHUM), 1051 Sanguinet St, Montréal, QC, Canada H2X 0C1; and Department of Radiology, Providence Health Care, Vancouver, Canada (J.L.). Members of the Canadian HIV and Aging Cohort Study Group are listed in the acknowledgments
| | - Manel Sadouni
- From the Departments of Radiology (I.B., M.S., G.S., A.S.C., C.C.L.), Cardiology (S.M.), Family Medicine (J.G.B., B.T.), Microbiology (C.T.) and Internal Medicine (M.D.), University of Montreal Hospital (CHUM), 1051 Sanguinet St, Montréal, QC, Canada H2X 0C1; and Department of Radiology, Providence Health Care, Vancouver, Canada (J.L.). Members of the Canadian HIV and Aging Cohort Study Group are listed in the acknowledgments
| | - Samer Mansour
- From the Departments of Radiology (I.B., M.S., G.S., A.S.C., C.C.L.), Cardiology (S.M.), Family Medicine (J.G.B., B.T.), Microbiology (C.T.) and Internal Medicine (M.D.), University of Montreal Hospital (CHUM), 1051 Sanguinet St, Montréal, QC, Canada H2X 0C1; and Department of Radiology, Providence Health Care, Vancouver, Canada (J.L.). Members of the Canadian HIV and Aging Cohort Study Group are listed in the acknowledgments
| | - Jean-Guy Baril
- From the Departments of Radiology (I.B., M.S., G.S., A.S.C., C.C.L.), Cardiology (S.M.), Family Medicine (J.G.B., B.T.), Microbiology (C.T.) and Internal Medicine (M.D.), University of Montreal Hospital (CHUM), 1051 Sanguinet St, Montréal, QC, Canada H2X 0C1; and Department of Radiology, Providence Health Care, Vancouver, Canada (J.L.). Members of the Canadian HIV and Aging Cohort Study Group are listed in the acknowledgments
| | - Benoît Trottier
- From the Departments of Radiology (I.B., M.S., G.S., A.S.C., C.C.L.), Cardiology (S.M.), Family Medicine (J.G.B., B.T.), Microbiology (C.T.) and Internal Medicine (M.D.), University of Montreal Hospital (CHUM), 1051 Sanguinet St, Montréal, QC, Canada H2X 0C1; and Department of Radiology, Providence Health Care, Vancouver, Canada (J.L.). Members of the Canadian HIV and Aging Cohort Study Group are listed in the acknowledgments
| | - Gilles Soulez
- From the Departments of Radiology (I.B., M.S., G.S., A.S.C., C.C.L.), Cardiology (S.M.), Family Medicine (J.G.B., B.T.), Microbiology (C.T.) and Internal Medicine (M.D.), University of Montreal Hospital (CHUM), 1051 Sanguinet St, Montréal, QC, Canada H2X 0C1; and Department of Radiology, Providence Health Care, Vancouver, Canada (J.L.). Members of the Canadian HIV and Aging Cohort Study Group are listed in the acknowledgments
| | - Anne S Chin
- From the Departments of Radiology (I.B., M.S., G.S., A.S.C., C.C.L.), Cardiology (S.M.), Family Medicine (J.G.B., B.T.), Microbiology (C.T.) and Internal Medicine (M.D.), University of Montreal Hospital (CHUM), 1051 Sanguinet St, Montréal, QC, Canada H2X 0C1; and Department of Radiology, Providence Health Care, Vancouver, Canada (J.L.). Members of the Canadian HIV and Aging Cohort Study Group are listed in the acknowledgments
| | - Jonathon Leipsic
- From the Departments of Radiology (I.B., M.S., G.S., A.S.C., C.C.L.), Cardiology (S.M.), Family Medicine (J.G.B., B.T.), Microbiology (C.T.) and Internal Medicine (M.D.), University of Montreal Hospital (CHUM), 1051 Sanguinet St, Montréal, QC, Canada H2X 0C1; and Department of Radiology, Providence Health Care, Vancouver, Canada (J.L.). Members of the Canadian HIV and Aging Cohort Study Group are listed in the acknowledgments
| | - Cécile Tremblay
- From the Departments of Radiology (I.B., M.S., G.S., A.S.C., C.C.L.), Cardiology (S.M.), Family Medicine (J.G.B., B.T.), Microbiology (C.T.) and Internal Medicine (M.D.), University of Montreal Hospital (CHUM), 1051 Sanguinet St, Montréal, QC, Canada H2X 0C1; and Department of Radiology, Providence Health Care, Vancouver, Canada (J.L.). Members of the Canadian HIV and Aging Cohort Study Group are listed in the acknowledgments
| | - Madeleine Durand
- From the Departments of Radiology (I.B., M.S., G.S., A.S.C., C.C.L.), Cardiology (S.M.), Family Medicine (J.G.B., B.T.), Microbiology (C.T.) and Internal Medicine (M.D.), University of Montreal Hospital (CHUM), 1051 Sanguinet St, Montréal, QC, Canada H2X 0C1; and Department of Radiology, Providence Health Care, Vancouver, Canada (J.L.). Members of the Canadian HIV and Aging Cohort Study Group are listed in the acknowledgments
| | - Carl Chartrand-Lefebvre
- From the Departments of Radiology (I.B., M.S., G.S., A.S.C., C.C.L.), Cardiology (S.M.), Family Medicine (J.G.B., B.T.), Microbiology (C.T.) and Internal Medicine (M.D.), University of Montreal Hospital (CHUM), 1051 Sanguinet St, Montréal, QC, Canada H2X 0C1; and Department of Radiology, Providence Health Care, Vancouver, Canada (J.L.). Members of the Canadian HIV and Aging Cohort Study Group are listed in the acknowledgments
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- From the Departments of Radiology (I.B., M.S., G.S., A.S.C., C.C.L.), Cardiology (S.M.), Family Medicine (J.G.B., B.T.), Microbiology (C.T.) and Internal Medicine (M.D.), University of Montreal Hospital (CHUM), 1051 Sanguinet St, Montréal, QC, Canada H2X 0C1; and Department of Radiology, Providence Health Care, Vancouver, Canada (J.L.). Members of the Canadian HIV and Aging Cohort Study Group are listed in the acknowledgments
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Senoner T, Plank F, Beyer C, Langer C, Birkl K, Steinkohl F, Widmann G, Barbieri F, Adukauskaite A, Friedrich G, Bauer A, Dichtl W, Feuchtner GM. Gender Differences in the Atherosclerosis Profile by Coronary CTA in Coronary Artery Calcium Score Zero Patients. J Clin Med 2021; 10:1220. [PMID: 33804095 PMCID: PMC8000978 DOI: 10.3390/jcm10061220] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Revised: 03/07/2021] [Accepted: 03/11/2021] [Indexed: 11/17/2022] Open
Abstract
Background: The coronary artery calcium score (CACS) is a powerful tool for cardiovascular risk stratification. Coronary computed tomography angiography (CTA) allows for a more distinct analysis of atherosclerosis. The aim of the study was to assess gender differences in the atherosclerosis profile of CTA in patients with a CACS of zero. Methods: A total of 1451 low- to intermediate-risk patients (53 ± 11 years; 51% females) with CACS <1.0 Agatston units (AU) who underwent CTA and CACS were included. Males and females were 1:1 propensity score-matched. CTA was evaluated for stenosis severity (Coronary Artery Disease - Reporting and Data System (CAD-RADS) 0-5: minimal <25%, mild 25-49%, moderate 50-69%, severe ≥70%), mixed-plaque burden (G-score), and high-risk plaque (HRP) criteria (low-attenuation plaque, spotty calcification, napkin-ring sign, and positive remodeling). All-cause mortality, cardiovascular mortality, and major cardiovascular events (MACEs) were collected. Results: Among the patients, 88.8% had a CACS of 0 and 11.2% had an ultralow CACS of 0.1-0.9 AU. More males than females (32.1% vs. 20.3%; p < 0.001) with a CACS of 0 had atherosclerosis, while, among those with an ultralow CACS, there was no difference (88% vs. 87.1%). Nonobstructive CAD (25.9% vs. 16.2%; p < 0.001), total plaque burden (2.2 vs. 1.4; p < 0.001), and HRP were found more often in males (p < 0.001). After a follow-up of mean 6.6 ± 4.2 years, all-cause mortality was higher in females (3.5% vs. 1.8%, p = 0.023). Cardiovascular mortality and MACEs were low (0.2% vs. 0%; p = 0.947 and 0.3% vs. 0.6%; p = 0.790) for males vs. females, respectively. Females were more often symptomatic for chest pain (70% vs. 61.6%; p = 0.004). (4) Conclusions: In patients with a CACS of 0, males had a higher prevalence of atherosclerosis, a higher noncalcified plaque burden, and more HRP criteria. Nonetheless, females had a worse long-term outcome and were more frequently symptomatic.
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Affiliation(s)
- Thomas Senoner
- Department of Internal Medicine III—Cardiology and Angiology, Innsbruck Medical University, 6020 Innsbruck, Austria; (F.P.); (F.B.); (A.A.); (G.F.); (A.B.); (W.D.)
| | - Fabian Plank
- Department of Internal Medicine III—Cardiology and Angiology, Innsbruck Medical University, 6020 Innsbruck, Austria; (F.P.); (F.B.); (A.A.); (G.F.); (A.B.); (W.D.)
| | - Christoph Beyer
- Department of Radiology, Innsbruck Medical University, 6020 Innsbruck, Austria; (C.B.); (C.L.); (K.B.); (F.S.); (G.W.)
| | - Christian Langer
- Department of Radiology, Innsbruck Medical University, 6020 Innsbruck, Austria; (C.B.); (C.L.); (K.B.); (F.S.); (G.W.)
| | - Katharina Birkl
- Department of Radiology, Innsbruck Medical University, 6020 Innsbruck, Austria; (C.B.); (C.L.); (K.B.); (F.S.); (G.W.)
| | - Fabian Steinkohl
- Department of Radiology, Innsbruck Medical University, 6020 Innsbruck, Austria; (C.B.); (C.L.); (K.B.); (F.S.); (G.W.)
- Department of Radiology, St. Vinzenz Hospital, 6511 Zams, Austria
| | - Gerlig Widmann
- Department of Radiology, Innsbruck Medical University, 6020 Innsbruck, Austria; (C.B.); (C.L.); (K.B.); (F.S.); (G.W.)
| | - Fabian Barbieri
- Department of Internal Medicine III—Cardiology and Angiology, Innsbruck Medical University, 6020 Innsbruck, Austria; (F.P.); (F.B.); (A.A.); (G.F.); (A.B.); (W.D.)
| | - Agne Adukauskaite
- Department of Internal Medicine III—Cardiology and Angiology, Innsbruck Medical University, 6020 Innsbruck, Austria; (F.P.); (F.B.); (A.A.); (G.F.); (A.B.); (W.D.)
| | - Guy Friedrich
- Department of Internal Medicine III—Cardiology and Angiology, Innsbruck Medical University, 6020 Innsbruck, Austria; (F.P.); (F.B.); (A.A.); (G.F.); (A.B.); (W.D.)
| | - Axel Bauer
- Department of Internal Medicine III—Cardiology and Angiology, Innsbruck Medical University, 6020 Innsbruck, Austria; (F.P.); (F.B.); (A.A.); (G.F.); (A.B.); (W.D.)
| | - Wolfgang Dichtl
- Department of Internal Medicine III—Cardiology and Angiology, Innsbruck Medical University, 6020 Innsbruck, Austria; (F.P.); (F.B.); (A.A.); (G.F.); (A.B.); (W.D.)
| | - Gudrun M. Feuchtner
- Department of Radiology, Innsbruck Medical University, 6020 Innsbruck, Austria; (C.B.); (C.L.); (K.B.); (F.S.); (G.W.)
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Taron J, Lee S, Aluru J, Hoffmann U, Lu MT. A review of serial coronary computed tomography angiography (CTA) to assess plaque progression and therapeutic effect of anti-atherosclerotic drugs. Int J Cardiovasc Imaging 2020; 36:2305-2317. [PMID: 32076919 PMCID: PMC7434668 DOI: 10.1007/s10554-020-01793-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Accepted: 02/10/2020] [Indexed: 12/15/2022]
Abstract
Change in coronary artery plaque on serial catheter intravascular ultrasound (IVUS) is an established technique to monitor the therapeutic effect of drugs on coronary atherosclerosis. Recent advances in coronary computed tomography angiography (CTA) now allow for non-invasive assessment of change in coronary plaque. Because coronary CTA is noninvasive, it enables clinical trials with lower-risk populations, higher retention rates, and lower costs. This review presents an overview of serial coronary CTA as a noninvasive imaging technique to gauge the therapeutic effect of anti-atherosclerotic therapies. Furthermore, it reviews the increasing use of serial CTA as an imaging endpoint in completed and ongoing clinical trials.
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Affiliation(s)
- Jana Taron
- Department of Radiology, Cardiovascular Imaging Research Center, Massachusetts General Hospital, Harvard Medical School, 165 Cambridge Street, Boston, MA, 02114, USA.
- Department for Diagnostic and Interventional Radiology, University Hospital Tübingen, Tübingen, Germany.
| | - Saeyun Lee
- Division of Rheumatology/Immunology/Pulmonology, Emory University School of Medicine, Atlanta, USA
| | - John Aluru
- Cardiovascular Imaging Core Laboratory, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, USA
| | - Udo Hoffmann
- Department of Radiology, Cardiovascular Imaging Research Center, Massachusetts General Hospital, Harvard Medical School, 165 Cambridge Street, Boston, MA, 02114, USA
| | - Michael T Lu
- Department of Radiology, Cardiovascular Imaging Research Center, Massachusetts General Hospital, Harvard Medical School, 165 Cambridge Street, Boston, MA, 02114, USA
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Prevalence of coronary artery disease in symptomatic patients with zero coronary artery calcium score in different age population. Int J Cardiovasc Imaging 2020; 37:723-729. [PMID: 32979114 DOI: 10.1007/s10554-020-02028-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Accepted: 09/12/2020] [Indexed: 10/23/2022]
Abstract
There is controversy about whether symptomatic population with coronary artery calcium score (CACS) of zero have coronary artery disease (CAD) and the distribution at different ages. We sought to analyze the prevalence of CAD in symptomatic patients with zero CACS, especially in different age groups. We studied patients suspected of CAD and underwent CACS scan and coronary computed tomography angiography (CTA). We included patients with CACS of zero. Clinical data was collected to achieve information on demographic characteristics and risk factors. The presence of plaque and obstructive CAD were analyzed based on coronary CTA. The association between age and the prevalence of plaque and obstructive CAD was evaluated.Overall 5514 patients (51.1% men; mean age 54.40 years) were analyzed, of whom 4120 (74.72%) with normal coronary artery, 1394 (25.28%) with plaque and 514 (9.32%) with obstructive CAD. The prevalence of plaque and obstructive CAD increased significantly with age (p < 0.001). Age was significantly associated with the risk of developing plaque and obstructive CAD in the unadjusted model and multivariate model. Taking age less than 40 as a reference, risk ratios (RRs) of prevalence of plaque increased with age in the multivariate model (RR = 2.353 for 40-50, RR = 6.489 for > 70). RRs of prevalence of obstructive CAD also increased with age in the multivariate model (RR = 2.075 for 40-50, RR = 4.102 for > 70). Quite a few CAD could occur in symptomatic patients with CACS of zero, especially in old patients. Coronary CTA was required to exclude CAD in this cohort.
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Chuang TL, Koo M, Wang YF. Association of Bone Mineral Density and Coronary Artery Calcification in Patients with Osteopenia and Osteoporosis. Diagnostics (Basel) 2020; 10:diagnostics10090699. [PMID: 32947910 PMCID: PMC7555969 DOI: 10.3390/diagnostics10090699] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2020] [Revised: 09/10/2020] [Accepted: 09/15/2020] [Indexed: 12/11/2022] Open
Abstract
The aim of this study was to investigate the association between bone mineral density (BMD) and coronary artery calcification (CAC) in adults with osteopenia or osteoporosis. A retrospective medical review study was conducted in a regional hospital in southern Taiwan. Medical records of patients who underwent both a coronary computed tomography scan and a BMD measurement were identified. Multinomial logistic regression analyses were used to assess the association between BMD and CAC levels in patients with osteopenia or osteoporosis. Of the 246 patients, 119 were female and 42.3% had CAC. For patients with osteopenia, after adjusting for the significant factors of CAC, no significant association was observed between BMD with either moderate CAC (0 < CAC score ≤ 100) or high CAC (CAC score > 100). However, in patients with osteoporosis, after adjusting for the significant factors of CAC, BMD in the lumbar spine was inversely associated with moderate CAC (odds ratio = 0.38, p = 0.035). In conclusion, a lower BMD in the lumbar spine was associated with an increased risk of moderate CAC in patients with osteoporosis. It is crucial to take action to maintain bone health, particularly in those who already have osteoporosis, to reduce the risk of developing CAC and its associated morbidity and mortality.
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Affiliation(s)
- Tzyy-Ling Chuang
- Department of Nuclear Medicine, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi 62247, Taiwan;
- School of Medicine, Tzu Chi University, Hualien City, Hualien 97004, Taiwan
| | - Malcolm Koo
- Department of Nursing, Tzu Chi University of Science and Technology, Hualien City, Hualien 97005, Taiwan;
| | - Yuh-Feng Wang
- Department of Nuclear Medicine, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi 62247, Taiwan;
- School of Medicine, Tzu Chi University, Hualien City, Hualien 97004, Taiwan
- Center of Preventive Medicine, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi 62247, Taiwan
- Correspondence:
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Yin WH, Zhang Y, Li XN, Wang HY, An YQ, Sun Y, Hou ZH, Gao Y, Lu B, Zheng Z. In Vivo Detection of Lipid-Core Plaques by Coronary CT Angiography: A Head-to-Head Comparison with Histologic Findings. Korean J Radiol 2020; 21:210-217. [PMID: 31997596 PMCID: PMC6992437 DOI: 10.3348/kjr.2019.0557] [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: 07/31/2019] [Accepted: 10/31/2019] [Indexed: 11/15/2022] Open
Abstract
Objective We sought to distinguish lipid plaques using a CT quantitative pixel density histogram, based on the pathological diagnosis of lipid cores as the gold standard. Materials and Methods Eight patients awaiting heart transplantation due to end-stage coronary heart disease underwent coronary CT angiography (CCTA) spectroscopy prior to heart transplantation; coronary artery pathological analysis was performed for all patients. Lipid-core plaques were defined pathologically as manifesting a lipid core diameter > 200 µm, a circumference > 60 degrees, and a cap thickness < 450 µm. The percentage distributions of CT pixel attenuation ≤ 20, 30, 40, and 50 HU were calculated using quantitative histogram analysis. Results A total of 271 transverse sections were co-registered between CCTA and pathological analysis. Overall, 26 lipid cores and 16 fibrous plaques were identified by pathological analysis. There was no significant difference in median CT attenuation between the lipid and fibrous plaques (51 HU [interquartile range, 46–63] vs. 57 HU [interquartile range, 50–64], p = 0.659). The median percentage of CT pixel attenuation ≤ 30 HU accounted for 11% (5–17) of lipid-core plaques and 0% (0–2) of fibrous plaques (p < 0.001). The sensitivity and specificity of the method for diagnosing lipid plaques by the average CT pixel attenuation ≤ 30 HU were 80.8% and 87.5%, respectively. The area under the receiver operator characteristics curve was 0.898 (95% confidence interval: 0.765–0.970; 3.0% was the best cut-off value). The diagnostic performance was significantly higher than those of the average pixel CT attenuation percentages ≤ 20, 40, and 50 HU and the mean CT attenuation (p < 0.05). Conclusion In in vivo conditions, with the pathological lipid core as the gold standard, quantification of the percentage of average CT pixel attenuation ≤ 30 HU in the histogram can be useful for accurate identification of lipid plaques.
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Affiliation(s)
- Wei Hua Yin
- Department of Radiology, Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yan Zhang
- Department of Radiology, Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.,Department of Radiology, Affiliated Hospital of Guizhou Medical University, Guiyang, China
| | - Xiang Nan Li
- Department of Radiology, Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Hong Yue Wang
- Department of Pathology, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yun Qiang An
- Department of Radiology, Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yang Sun
- Department of Pathology, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Zhi Hui Hou
- Department of Radiology, Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yang Gao
- Department of Radiology, Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Bin Lu
- Department of Radiology, Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
| | - Zhe Zheng
- Department of Cardiac Surgery, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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How atherosclerosis defines ischemia: Atherosclerosis quantification and characterization as a method for determining ischemia. J Cardiovasc Comput Tomogr 2020; 14:394-399. [DOI: 10.1016/j.jcct.2019.10.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Revised: 10/04/2019] [Accepted: 10/27/2019] [Indexed: 01/23/2023]
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Feuchtner G, Langer C, Barbieri F, Beyer C, Dichtl W, Friedrich G, Schgoer W, Widmann G, Plank F. The effect of omega-3 fatty acids on coronary atherosclerosis quantified by coronary computed tomography angiography. Clin Nutr 2020; 40:1123-1129. [PMID: 32778459 DOI: 10.1016/j.clnu.2020.07.016] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 06/09/2020] [Accepted: 07/13/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND & AIMS Data on the effects omega-3 fatty acids on coronary artery disease (CAD) are contradictory. While a recent metanalysis could not show improved cardiovascular outcomes, anti-atherogenic mechanisms are well known. OBJECTIVE Aim was to assess the influence of Omega-3 polyunsaturated long-chain fatty acids (PUFA) supplementation on coronary atherosclerosis quantified by coronary computed tomography angiography (CTA). METHODS 106 patients (59.4y± 10.7; 50% females) with low-to-intermediate risk referred to CTA were included. 53 patients under omega 3-PUFA (docosahexaenoic acid, DHA and eicosapentaenoic acid, EPA) supplementation were retrospectively matched with 53 controls (CR) for age, gender and coronary risk profile (smoking, arterial hypertension, family history, dyslipidemia, c-LDL, Cholesterol, TG, diabetes) (1:1, propensity score) and lifestyle habits (exercise, alcohol consumption and nutrition). CTA analysis included 1) stenosis severity score >70%severe, 50-70% moderate, 25-50%mild, <25% minimal), 2) total plaque burden (segment involvement score (SIS) and mixed non-calcified plaque burden (G-score) and 3) high-risk-plaque features (Napkin-Ring-Sign, low attenuation plaque (LAP), spotty calcification<3 mm, RI>1.1). CT-Density (Hounsfield Units, HU) of plaque was quantified by CTA. RESULTS Prevalence of coronary atherosclerosis (any plaque: 83% vs. 90.6%, p = 0.252), >50% stenosis and stenosis severity score (p = 0.134) were not different between groups. Total and non-calcified plaque burden scores were lower in the omega-3 group (2.7 vs. 3.5, p = 0.08 and 4.5 vs. 7.4, p = 0.027 for SIS and G-score, resp.). Coronary artery calcium score (CACS) was similar (84.7 vs. 87.1AU). High-risk-plaque prevalence was lower in the Omega-3 group (3.8% vs. 32%, p < 0.001); the number of high-risk-plaques (p < 0.001) and Napkin-Ring-Sign prevalence was lower (3.8% vs. 20.9%) (p < 0.001), resp. CT-density (HU) of plaque was higher in the Omega-3 group (131.6 ± 2 vs. 62.1 ± 27, p = 0.02) indicating more fibrous-dense plaque component rather than lipid-rich atheroma. Mean duration of Omega-3 intake was 38.6 ± 52 months (range, 2-240). CONCLUSIONS Omega-3-PUFA supplementation is associated with less coronary atherosclerotic "high-risk" plaque (lipid-rich) and lower total non-calcified plaque burden independent on cardiovascular risk factors. Our study supports direct anti-atherogenic effects of Omega-3-PUFA.
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Affiliation(s)
| | | | - Fabian Barbieri
- Department of Internal Medicine III- Cardiology, Innsbruck Medical University, Austria
| | - Christoph Beyer
- Department of Radiology, Innsbruck Medical University, Austria
| | - Wolfgang Dichtl
- Department of Internal Medicine III- Cardiology, Innsbruck Medical University, Austria
| | - Guy Friedrich
- Department of Internal Medicine III- Cardiology, Innsbruck Medical University, Austria
| | - Wilfried Schgoer
- Department of Internal Medicine III- Cardiology, Innsbruck Medical University, Austria
| | - Gerlig Widmann
- Department of Radiology, Innsbruck Medical University, Austria
| | - Fabian Plank
- Department of Internal Medicine III- Cardiology, Innsbruck Medical University, Austria
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Coronary atherosclerosis profile in patients with end-stage liver disease prior to liver transplantation due to alcoholic fatty liver: a coronary CTA study. Eur Radiol 2020; 31:494-503. [PMID: 32749590 PMCID: PMC7755634 DOI: 10.1007/s00330-020-07037-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Revised: 02/13/2020] [Accepted: 06/16/2020] [Indexed: 12/26/2022]
Abstract
OBJECTIVES To assess the coronary atherosclerosis profile by coronary computed tomography angiography (CTA) in patients with end-stage liver disease (ESLD) due to alcohol-related liver disease (ARLD) evaluated for liver transplantation (LT), in a retrospective matched case-controlled cohort study. METHODS One hundred forty patients (age 60.6 years ± 9.8, 20.7% females) who underwent coronary CTA were included. Seventy patients with ESLD due to ARLD (ESLD-alc) were propensity score (1:1) matched for age, gender, and the major 5 cardiovascular risk factors with healthy controls. CTA analysis included the following: stenosis severity according to CAD-RADS as (0) = no, (1) minimal < 25%, (2) mild 25-50%, (3) moderate 50-70%, and (4) severe > 70% stenosis, total mixed plaque burden weighted for non-calcified component (G-score) and high-risk plaque criteria (Napkin-Ring, low attenuation plaque, spotty calcification, positive remodeling). RESULTS Prevalence of coronary artery disease (CAD) was high (84.4%) in the ESLD-alc group but similar to controls. Stenosis severity was similar (CAD-RADS, 1.9 vs. 2.2, p = 0.289). High-grade stenosis (> 70%) was observed in 12.5% of ESLD-alc patients. High-risk plaques were less frequent in the ESLD-alc cohort as compared to controls (4.5% vs. 37.5%, p < 0.001), and total mixed plaque burden was lower (G-score, 4.9 versus 7.4, p = 0.001). Plaque density was lower in controls (56.6HU ± 3.2 vs. 91.3HU ± 4.5, p = 0.007) indicating more lipid-rich in controls, but higher mixed fibro-calcific plaque component in those with alcohol-related ESLD. CONCLUSION Patients with alcohol-related ESLD exhibit more mixed fibro-calcified plaques but less plaque with high-risk features and less fibro-fatty plaque burden, while total CAD prevalence is high. KEY POINTS • Patients with ESLD prior to LT have a high total prevalence of CAD and stenosis severity, which is similar to those of healthy controls with an identical cardiovascular risk profile. • Patients with ESLD prior to LT due to alcohol abuse have more calcific but less fibro-fatty plaque and less high-risk plaque. • CTA seems to be a useful imaging technique for risk stratification prior to LT.
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Feuchtner GM, Langer C, Senoner T, Barbieri F, Beyer C, Bonaros N, Schachner T, Friedrich G, Baldauf B, Taylor CA, Klauser A, Rauch S, Leipsic J, Dichtl W, Widmann G, De Cecco CN, Plank F. Differences in coronary vasodilatory capacity and atherosclerosis in endurance athletes using coronary CTA and computational fluid dynamics (CFD): Comparison with a sedentary lifestyle. Eur J Radiol 2020; 130:109168. [PMID: 32739779 DOI: 10.1016/j.ejrad.2020.109168] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 06/04/2020] [Accepted: 07/05/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND The aim was to assess the effect of endurance exercise on coronary vasodilatory capacity and atherosclerosis by coronary computed tomography angiography (CTA) and computational fluid dynamic (CFD) modelling. METHODS 100 subjects (age 56.2y±11, 29 females) who underwent coronary CTA were included into this retrospectively matched cohort study. Endurance athletes (≥1 h per unit and ≥3 times per week training) were compared to controls with a sedentary lifestyle, and within subgroups with and without sublingual nitroglycerin preparation. CTA image analysis included coronary stenosis severity (CADRADS), total (segment involvement score = SIS) and mixed plaque burden (G-score), high-risk plaque criteria, the coronary artery calcium score (CACS) and CFD analysis including Fractional Flow Reserve (FFRCT), myocardial mass (M), total vessel lumen volume (V) and volume-to-mass (V/M) ratio. RESULTS The prevalence of atherosclerosis by CTA was 65.4 % and >50 % coronary stenosis was found in 17.3 % of athletes. Coronary stenosis severity (CADRADS), total and mixed non-calcified plaque burden (SIS and G-score) were lower in athletes (p = 0.003 and p < 0.001) but not CACS (p = 0.055) and less high-risk plaques were found (p < 0.001). The G-score was correlated with distal FFRCT (p = 0.025). V/M-ratio was different between athletes who received nitroglycerin compared with those who did not (V/M: 21.1 vs. 14.8; p < 0.001), but these differences were not observed in the control subjects. CONCLUSION Endurance training improves coronary vasodilatory capacity and reduces high-risk plaque and mixed non-calcifed plaque burden as assessed by coronary CTA angiography. Our study may advocate coronary CTA with FFRCT for evaluation of coronary artery disease in endurance athletes.
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Affiliation(s)
| | | | - Thomas Senoner
- Department of Internal Medicine III- Cardiology, Innsbruck Medical University, Austria
| | - Fabian Barbieri
- Department of Internal Medicine III- Cardiology, Innsbruck Medical University, Austria
| | - Christoph Beyer
- Department of Radiology, Innsbruck Medical University, Austria
| | - Nikolaos Bonaros
- Department of Cardiac Surgery, Innsbruck Medical University, Austria
| | - Thomas Schachner
- Department of Cardiac Surgery, Innsbruck Medical University, Austria
| | - Guy Friedrich
- Department of Internal Medicine III- Cardiology, Innsbruck Medical University, Austria
| | - Benito Baldauf
- ISAG- Institute for Sport and Alpin- and Healthmedicine, Innsbruck, Austria
| | - Charles A Taylor
- Stanford University, Dept. Bioengineering, Palo Alto, San Francisco, USA
| | - Andrea Klauser
- Department of Radiology, Innsbruck Medical University, Austria
| | - Stefan Rauch
- Department of Radiology, Innsbruck Medical University, Austria
| | - Jonathon Leipsic
- University of British Columbia, Vancouver, Dept. Radiology BC Canada
| | - Wolfgang Dichtl
- Department of Internal Medicine III- Cardiology, Innsbruck Medical University, Austria
| | - Gerlig Widmann
- Department of Radiology, Innsbruck Medical University, Austria
| | | | - Fabian Plank
- Department of Internal Medicine III- Cardiology, Innsbruck Medical University, Austria
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Stepniak K, Ursani A, Paul N, Naguib H. Novel 3D printing technology for CT phantom coronary arteries with high geometrical accuracy for biomedical imaging applications. ACTA ACUST UNITED AC 2020. [DOI: 10.1016/j.bprint.2020.e00074] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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27
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Senoner T, Plank F, Barbieri F, Beyer C, Birkl K, Widmann G, Adukauskaite A, Friedrich G, Dichtl W, Feuchtner GM. Added value of high-risk plaque criteria by coronary CTA for prediction of long-term outcomes. Atherosclerosis 2020; 300:26-33. [DOI: 10.1016/j.atherosclerosis.2020.03.019] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Revised: 03/18/2020] [Accepted: 03/25/2020] [Indexed: 11/30/2022]
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Current Advances in the Diagnostic Imaging of Atherosclerosis: Insights into the Pathophysiology of Vulnerable Plaque. Int J Mol Sci 2020; 21:ijms21082992. [PMID: 32340284 PMCID: PMC7216001 DOI: 10.3390/ijms21082992] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Revised: 04/02/2020] [Accepted: 04/15/2020] [Indexed: 12/13/2022] Open
Abstract
Atherosclerosis is a lipoprotein-driven inflammatory disorder leading to a plaque formation at specific sites of the arterial tree. After decades of slow progression, atherosclerotic plaque rupture and formation of thrombi are the major factors responsible for the development of acute coronary syndromes (ACSs). In this regard, the detection of high-risk (vulnerable) plaques is an ultimate goal in the management of atherosclerosis and cardiovascular diseases (CVDs). Vulnerable plaques have specific morphological features that make their detection possible, hence allowing for identification of high-risk patients and the tailoring of therapy. Plaque ruptures predominantly occur amongst lesions characterized as thin-cap fibroatheromas (TCFA). Plaques without a rupture, such as plaque erosions, are also thrombi-forming lesions on the most frequent pathological intimal thickening or fibroatheromas. Many attempts to comprehensively identify vulnerable plaque constituents with different invasive and non-invasive imaging technologies have been made. In this review, advantages and limitations of invasive and non-invasive imaging modalities currently available for the identification of plaque components and morphologic features associated with plaque vulnerability, as well as their clinical diagnostic and prognostic value, were discussed.
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Senoner T, Plank F, Beyer C, Langer C, Birkl K, Steinkohl F, Widmann G, Barbieri F, Adukauskaite A, Friedrich G, Dichtl W, Feuchtner GM. Does coronary calcium score zero reliably rule out coronary artery disease in low-to-intermediate risk patients? A coronary CTA study. J Cardiovasc Comput Tomogr 2020; 14:155-161. [DOI: 10.1016/j.jcct.2019.09.009] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2019] [Revised: 08/04/2019] [Accepted: 09/21/2019] [Indexed: 12/21/2022]
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Chuang TL, Chuang MH, Koo M, Lin CH, Wang YF. Association of bone mineral density and trabecular bone score with cardiovascular disease. Tzu Chi Med J 2020; 32:234-239. [PMID: 32955509 PMCID: PMC7485677 DOI: 10.4103/tcmj.tcmj_234_19] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Revised: 11/15/2019] [Accepted: 12/03/2019] [Indexed: 12/14/2022] Open
Abstract
Traditionally, osteoporosis and cardiovascular disease (CVD) are considered as separate chronic diseases. Increasing evidence now links osteoporosis with hypertension, abnormal lipid metabolism, atherosclerosis, vascular calcification (VC), and congestive heart failure. VC coexists with bone loss, and aortic calcification is a strong predictor of low bone mineral density (BMD) and fragility fractures. The same holds true for coronary artery calcification (CAC): the lower the BMD, the higher the CAC. Trabecular bone score (TBS) iNsight software can analyze the existing BMD database to obtain the bony microstructure score (TBS). Many TBS-related studies include fracture risk, normal aging, diabetes, potential genes, obesity, and asthma severity prediction. The inverse relationship of TBS to VC may provide insight into bone–vascular interactions in chronic kidney disease. A higher TBS has been associated with moderate, but not high, CAC. One explanation is that bone microstructural remodeling becomes more active during early coronary calcification. Increased risk of 10-year likelihood of hip fracture and major osteoporotic fracture as estimated by the fracture risk assessment tool FRAX® is significantly and independently associated with more severe CAC scores. Dual-energy X-ray absorptiometry and FRAX® can be used to predict fracture risk and CAC scores, identifying patients who may benefit from early intervention. This review will discuss the relationship and possible mechanism of BMD, TBS, and FRAX® with CVD and VC or CAC.
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Affiliation(s)
- Tzyy-Ling Chuang
- Department of Nuclear Medicine, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi, Taiwan.,School of Medicine, Tzu Chi University, Hualien, Taiwan
| | - Mei-Hua Chuang
- Faculty of Pharmacy, National Yang-Ming University, Taipei, Taiwan.,Department of Pharmacology, School of Medicine, Tzu Chi University, Hualien, Taiwan
| | - Malcolm Koo
- Graduate Institute of Long-Term Care, Tzu Chi University of Science and Technology, Hualien, Taiwan
| | - Chun-Hung Lin
- Department of General Surgery, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi, Taiwan
| | - Yuh-Feng Wang
- Department of Nuclear Medicine, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi, Taiwan.,School of Medicine, Tzu Chi University, Hualien, Taiwan.,Center of Preventive Medicine, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi, Taiwan
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Achenbach S. Imaging the Vulnerable Plaque on Coronary CTA. JACC Cardiovasc Imaging 2019; 13:1418-1421. [PMID: 31864980 DOI: 10.1016/j.jcmg.2019.11.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Accepted: 11/07/2019] [Indexed: 11/29/2022]
Affiliation(s)
- Stephan Achenbach
- Department of Cardiology, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany.
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Hou ZH, Lu B, Li ZN, An YQ, Gao Y, Yin WH. Coronary Atherosclerotic Plaque Volume Quantified by Computed Tomographic Angiography in Smokers Compared to Nonsmokers. Acad Radiol 2019; 26:1581-1588. [PMID: 31072767 DOI: 10.1016/j.acra.2019.03.017] [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: 01/07/2019] [Revised: 03/08/2019] [Accepted: 03/11/2019] [Indexed: 10/26/2022]
Abstract
RATIONALE AND OBJECTIVES We sought to compare the prevalence and volume of lipid plaque, fibrous plaque, and calcified plaque in patients with smokers versus nonsmokers. MATERIALS AND METHODS We studied consecutive patients suspected of coronary artery disease and who underwent coronary computed tomography angiography. A structured interview and review of existing clinical data was conducted before computed tomography angiography to collect information on demographic characteristics, the presence of cardiovascular risk factors. The volume of lipid, fibrous, and calcified plaque were automatically calculated and marked in different colors according to predefined Hounsfield unit thresholds. The prevalence and volume of plaques were compared between smokers and nonsmokers. RESULTS Overall 6380 patients (3351 men and 3029 women, mean age 55.35 years) were finally analyzed, of whom 2075 (32.5%) were smokers, and 4305 (67.5%) were never smokers. The prevalence of any plaque in smokers was significantly higher compared to never smokers (47.7% vs. 32.3%, p < 0.001). Smoking was an independent risk factor of the presence of any plaque after correcting for age, gender, body mass index, hypertension, dyslipidemia, diabetes, and family history in a multivariate model (odds ratio = 1.250 (1.088-1.437), p = 0.002). The volume of lipid plaque, fibrous plaque, calcified plaque, and total plaque in smokers was significantly greater than nonsmokers (p < 0.001). CONCLUSION The prevalence and volume of lipid plaque, fibrous plaque, and calcified plaque were significantly higher in smokers versus never smokers.
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Feuchtner GM, Barbieri F, Langer C, Beyer C, Widmann G, Friedrich GJ, Cartes-Zumelzu F, Plank F. Non obstructive high-risk plaque but not calcified by coronary CTA, and the G-score predict ischemia. J Cardiovasc Comput Tomogr 2019; 13:305-314. [DOI: 10.1016/j.jcct.2019.01.010] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Revised: 11/11/2018] [Accepted: 01/03/2019] [Indexed: 01/28/2023]
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Coronary atherosclerosis characteristics in HIV-infected patients on long-term antiretroviral therapy: insights from coronary computed tomography-angiography. AIDS 2019; 33:1853-1862. [PMID: 31259763 DOI: 10.1097/qad.0000000000002297] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE The aim of the study was to assess coronary artery disease (CAD) characteristics by coronary computed tomography-angiography (CCTA) in individuals with HIV infection on long-term antiretroviral therapy (ART) DESIGN:: Retrospective case-controlled matched cohort study. METHODS Sixty-nine HIV-positive patients who underwent 128-slice dual source CCTA (mean age 54.9 years, 26.1% women) with mean 17.8 ± 9.4 years of HIV infection and a mean duration on ART of 13 ± 7.3 years were propensity score-matched (1 : 1) for age, sex, BMI, and five cardiovascular risk factors with 69 controls. CCTA was evaluated for stenosis severity [according to Coronary Artery Disease - Reporting and Data System (CAD-RADS)], total plaque burden [segment involvement score (SIS) and mixed-noncalcified plaque burden (G-score)]. As inflammatory biomarkers, high-risk plaque (HRP) features (napkin-ring sign, low-attenuation plaque, spotty calcification, positive remodeling), perivascular fat attenuation index (FAI), and ectatic coronary arteries were assessed. RESULTS CAD-RADS was higher in HIV-positive participants as compared with controls (2.21 ± 1.4 vs. 1.69 ± 1.5, P = 0.031). A higher prevalence of CAD and G-score (P = 0.043 and P = 0.003) was found. HRP prevalence [23 (34.3%) vs. 8 (12.1%); P = 0.002] and the number of HRP (36 vs. 10, P < 0.001) were higher in HIV-positive individuals. A perivascular FAI greater than -70 Hounsfield units was present in 27.8% of HRP. Ectatic coronary arteries were found in 10 (14.5%) HIV-positive persons vs. 0% in controls (P = 0.003). CONCLUSION Noncalcified and HRP burden in HIV-infected individuals on long-term ART is higher and associated with higher cardiovascular risk. Moreover, HIV-positive individuals displayed a higher stenosis severity (CAD-RADS) and more ectatic coronary arteries compared with the control group.
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Nakanishi R, Motoyama S, Leipsic J, Budoff MJ. How accurate is atherosclerosis imaging by coronary computed tomography angiography? J Cardiovasc Comput Tomogr 2019; 13:254-260. [DOI: 10.1016/j.jcct.2019.06.005] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Revised: 05/11/2019] [Accepted: 06/10/2019] [Indexed: 02/01/2023]
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Advanced atherosclerosis imaging by CT: Radiomics, machine learning and deep learning. J Cardiovasc Comput Tomogr 2019; 13:274-280. [DOI: 10.1016/j.jcct.2019.04.007] [Citation(s) in RCA: 61] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Revised: 03/24/2019] [Accepted: 04/15/2019] [Indexed: 01/05/2023]
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Kigka VI, Sakellarios A, Kyriakidis S, Rigas G, Athanasiou L, Siogkas P, Tsompou P, Loggitsi D, Benz DC, Buechel R, Lemos PA, Pelosi G, Michalis LK, Fotiadis DI. A three-dimensional quantification of calcified and non-calcified plaques in coronary arteries based on computed tomography coronary angiography images: Comparison with expert's annotations and virtual histology intravascular ultrasound. Comput Biol Med 2019; 113:103409. [PMID: 31480007 DOI: 10.1016/j.compbiomed.2019.103409] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Revised: 08/23/2019] [Accepted: 08/23/2019] [Indexed: 12/31/2022]
Abstract
The detection, quantification and characterization of coronary atherosclerotic plaques has a major effect on the diagnosis and treatment of coronary artery disease (CAD). Different studies have reported and evaluated the noninvasive ability of Computed Tomography Coronary Angiography (CTCA) to identify coronary plaque features. The identification of calcified plaques (CP) and non-calcified plaques (NCP) using CTCA has been extensively studied in cardiovascular research. However, NCP detection remains a challenging problem in CTCA imaging, due to the similar intensity values of NCP compared to the perivascular tissue, which surrounds the vasculature. In this work, we present a novel methodology for the identification of the plaque burden of the coronary artery and the volumetric quantification of CP and NCP utilizing CTCA images and we compare the findings with virtual histology intravascular ultrasound (VH-IVUS) and manual expert's annotations. Bland-Altman analyses were employed to assess the agreement between the presented methodology and VH-IVUS. The assessment of the plaque volume, the lesion length and the plaque area in 18 coronary lesions indicated excellent correlation with VH-IVUS. More specifically, for the CP lesions the correlation of plaque volume, lesion length and plaque area was 0.93, 0.84 and 0.85, respectively, whereas the correlation of plaque volume, lesion length and plaque area for the NCP lesions was 0.92, 0.95 and 0.81, respectively. In addition to this, the segmentation of the lumen, CP and NCP in 1350 CTCA slices indicated that the mean value of DICE coefficient is 0.72, 0.7 and 0.62, whereas the mean HD value is 1.95, 1.74 and 1.95, for the lumen, CP and NCP, respectively.
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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; Institute of Molecular Biology and Biotechnology, Dept. of Biomedical Research Institute - 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; Institute of Molecular Biology and Biotechnology, Dept. of Biomedical Research Institute - 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; Institute of Molecular Biology and Biotechnology, Dept. of Biomedical Research Institute - FORTH, University Campus of Ioannina, GR 45110, Ioannina, Greece
| | - George Rigas
- Unit of Medical Technology and Intelligent Information Systems, Department of Materials Science and Engineering, University of Ioannina, GR 45110, Ioannina, Greece; Institute of Molecular Biology and Biotechnology, Dept. of Biomedical Research Institute - FORTH, University Campus of Ioannina, GR 45110, Ioannina, Greece
| | - Lambros Athanasiou
- Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, MA, 02139, United States
| | - Panagiotis Siogkas
- Unit of Medical Technology and Intelligent Information Systems, Department of Materials Science and Engineering, University of Ioannina, GR 45110, Ioannina, Greece; Institute of Molecular Biology and Biotechnology, Dept. of Biomedical Research Institute - 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
| | | | - Dominik C Benz
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Ramistrasse 100, 8091, Zurich, Switzerland
| | - Ronny Buechel
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Ramistrasse 100, 8091, Zurich, Switzerland
| | - Pedro A Lemos
- Dept. of Interventional Cardiology, Heart Institute, University of São Paulo Medical School, São Paulo-SP, 05403-000, Brazil; Dept. of Interventional Cardiology, Hospital Israelita Albert Einstein, Sao Paulo-SP, 05652-000, Brazil
| | - Gualtiero Pelosi
- Institute of Clinical Physiology, National Research Council, Pisa, IT 56124, Italy
| | - Lampros K Michalis
- Dept. of Interventional Cardiology, Medical School, University of Ioannina, GR 45110, Ioannina, Greece
| | - Dimitrios I Fotiadis
- Unit of Medical Technology and Intelligent Information Systems, Department of Materials Science and Engineering, University of Ioannina, GR 45110, Ioannina, Greece; Institute of Molecular Biology and Biotechnology, Dept. of Biomedical Research Institute - FORTH, University Campus of Ioannina, GR 45110, Ioannina, Greece.
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Relationship of exercise to coronary artery disease extent, severity and plaque type: A coronary computed tomography angiography study. J Cardiovasc Comput Tomogr 2019; 13:34-40. [DOI: 10.1016/j.jcct.2019.02.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2018] [Revised: 02/06/2019] [Accepted: 02/11/2019] [Indexed: 12/11/2022]
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Does the Tube Voltage Affect the Characterization of Coronary Plaques on 100- and 120-kVp Computed Tomography Scans. J Comput Assist Tomogr 2019; 43:416-422. [PMID: 30762654 DOI: 10.1097/rct.0000000000000845] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE The aim of this study was to compare the diagnostic performance of 100- and 120-kVp coronary computed tomography (CT) angiography (CCTA) scans for the identification of coronary plaque components. METHODS We included 116 patients with coronary plaques who underwent CCTA and integrated backscatter intravascular ultrasound studies. On 100-kVp scans, we observed 24 fibrous and 24 fatty/fibrofatty plaques; on 120-kVp scans, we noted 27 fibrous and 41 fatty/fibrofatty plaques. We compared the fibrous and the fatty/fibrofatty plaques, the CT number of the coronary lumen, and the radiation dose on scans obtained at 100 and 120 kVp. We also compared the area under the receiver operating characteristic (ROC) curve of the coronary plaques on 100- and 120-kVp scans with their ROC curves on integrated backscatter intravascular ultrasound images. RESULTS The mean CT numbers of fatty and fatty/fibrofatty plaques were 5.71 ± 36.5 and 76.6 ± 33.7 Hounsfield units (HU), respectively, on 100-kVp scans; on 120-kVp scans, they were 13.9 ± 29.4 and 54.5 ± 22.3 HU, respectively. The CT number of the coronary lumen was 323.1 ± 81.2 HU, and the radiation dose was 563.7 ± 81.2 mGy-cm on 100-kVp scans; these values were 279.3 ± 61.8 HU and 819.1 ± 115.1 mGy-cm on 120-kVp scans. The results of ROC curve analysis identified 30.5 HU as the optimal diagnostic cutoff value for 100-kVp scans (area under the curve = 0.93, 95% confidence interval = 0.87-0.99, sensitivity = 95.8%, specificity = 78.9%); for 120-kVp plaque images, the optimal cutoff was 37.4 HU (area under the curve = 0.87, 95% confidence interval = 0.79-0.96, sensitivity = 82.1%, specificity = 85.7%). CONCLUSIONS For the discrimination of coronary plaque components, the diagnostic performance of 100- and 120-kVp CCTA scans is comparable.
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Ryan T, Affandi JS, Gahungu N, Dwivedi G. Noninvasive Cardiovascular Imaging: Emergence of a Powerful Tool for Early Identification of Cardiovascular Risk in People Living With HIV. Can J Cardiol 2018; 35:260-269. [PMID: 30825948 DOI: 10.1016/j.cjca.2018.11.036] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Revised: 11/06/2018] [Accepted: 11/20/2018] [Indexed: 12/31/2022] Open
Abstract
Antiretroviral therapy (ART) has been pivotal in prolonging the lifespan of people living with HIV (PLWH). However, this also simultaneously increases their risk of cardiovascular disease (CVD) either related to ART, aging, hypertension, immunosenescence, inflammation, immune activation, or other comorbidities. Although the use of risk markers has greatly enhanced the field of cardiovascular (CV) medicine and improved the prognosis and early diagnosis in the general population, this strategy has not been clearly elucidated in PLWH. Developing accurate risk algorithms for PLWH requires an innate understanding of mechanistic factors influencing their risks. Early identification of CV risk will significantly enhance the prospects of PLWH living longer and relatively healthily. Herein, we discuss the use of multimodality noninvasive CV imaging as robust markers for ameliorating CV risk. The ability to prognosticate CV risk and hence prevent CV events in PLWH would represent an important advance in CV medicine, allowing precise detection and early institution of preventative strategies. Using novel CV imaging modalities and strategies would have a positive impact on precision medicine in this patient cohort.
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Affiliation(s)
- Timothy Ryan
- Fiona Stanley Hospital, Murdoch, Western Australia, Australia
| | - Jacquita S Affandi
- School of Public Health, Curtin University, Bentley, Western Australia, Australia; Harry Perkins Institute of Medical Research, Murdoch, Western Australia, Australia
| | - Nestor Gahungu
- Royal Perth Hospital, Perth, Western Australia, Australia
| | - Girish Dwivedi
- Fiona Stanley Hospital, Murdoch, Western Australia, Australia; Harry Perkins Institute of Medical Research, Murdoch, Western Australia, Australia; The University of Western Australia, Crawley, Western Australia, Australia.
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Mrgan M, Gram J, Hecht Olsen M, Dey D, Linde Nørgaard B, Gram J, Rønnow Sand NP. Sex differences in coronary plaque composition evaluated by coronary computed tomography angiography in newly diagnosed Type 2 diabetes: association with low-grade inflammation. Diabet Med 2018; 35:1588-1595. [PMID: 29931809 DOI: 10.1111/dme.13768] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/20/2018] [Indexed: 12/23/2022]
Abstract
AIM To determine differences in coronary plaque composition and inflammatory biomarkers between men and women with newly diagnosed Type 2 diabetes without known cardiovascular disease. METHODS A total of 88 people with newly diagnosed (<1 year) Type 2 diabetes underwent contrast-enhanced coronary computed tomography angiography. Advanced coronary plaque analysis was performed using semi-automated software. Plasma concentrations of inflammatory biomarkers were determined. RESULTS There were no significant differences between men (n=60) and women (n=28) regarding age or cardiovascular risk factors (all P>0.05). The median (quartiles) serum levels of fibrinogen [10.9 (9.8-12.6) μmol/l vs 9.7 (8.8-10.9) μmol/l], fibrin d-dimer [0.3 (0.2-0.4) mg/l vs 0.27 (0.2-0.4) mg/l] and C-reactive protein [3.1 (1.1-5.2) mg/l vs (0.8-2.6) 1.6 mg/l] were significantly higher in women (all P<0.05). Overall, men more often had multi-vessel involvement [28 men (47%) vs 4 women (14%)], and higher total plaque burden [median (quartiles) 11.6 (2.3-36.0)% vs 2.0 (0.4-5.4)%; both P<0.05]. The median (quartiles) total plaque volume [269.9 (62.6-641.9) mm3 vs 61.1 (7.6-239.9) mm3 ] and absolute calcified plaque volume [33.5 (8.3-148.3) mm3 vs 4.7 (0.9-17.3) mm3 ] were higher in men (both P<0.05). Women had a lower relative proportion of the calcified plaque component [median (quartiles) 7.8 (4.7-15.4)% vs 23.7 (8.4-31.1)%] and a higher relative proportion (median [quartiles]) of the non-low-density non-calfied plaque component [77.6 (66.0-86.0)% vs 63.6 (54.0-72.9)%; both P<0.05]. CONCLUSIONS In people with newly diagnosed Type 2 diabetes, women had lower absolute coronary plaque volumes but a more unfavourable plaque composition and enhanced systemic inflammation compared with men.
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Affiliation(s)
- M Mrgan
- Department of Cardiology, Hospital of Southwest Denmark, Esbjerg, Denmark
| | - J Gram
- Unit for Thrombosis Research, University of Southern Denmark, Odense, Denmark
- Department of Clinical Biochemistry, Hospital of Southwest Denmark, Esbjerg, Denmark
| | - M Hecht Olsen
- Cardiology Section, Department of Internal Medicine, Holbaek Hospital, Holbaek, Denmark
- Centre for Individualized Medicine in Arterial Diseases (CIMA), Odense University Hospital, University of Southern Denmark, Odense, Denmark
| | - D Dey
- Department of Biomedical Sciences (Biomedical Imaging Research Institute), Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - B Linde Nørgaard
- Department of Cardiology, Aarhus University Hospital, Skejby, Aarhus, Denmark
| | - J Gram
- Department of Endocrinology, Hospital of Southwest Denmark, Esbjerg, Denmark
| | - N P Rønnow Sand
- Department of Cardiology, Hospital of Southwest Denmark, Esbjerg, Denmark
- Institute of Regional Health Research, University of Southern, Denmark, Odense
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Quantitative measurement of lipid rich plaque by coronary computed tomography angiography: A correlation of histology in sudden cardiac death. Atherosclerosis 2018; 275:426-433. [DOI: 10.1016/j.atherosclerosis.2018.05.024] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Revised: 05/08/2018] [Accepted: 05/16/2018] [Indexed: 11/21/2022]
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Saleh M, Alfaddagh A, Elajami TK, Ashfaque H, Haj-Ibrahim H, Welty FK. Diastolic blood pressure predicts coronary plaque volume in patients with coronary artery disease. Atherosclerosis 2018; 277:34-41. [PMID: 30170222 DOI: 10.1016/j.atherosclerosis.2018.07.031] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Revised: 07/19/2018] [Accepted: 07/25/2018] [Indexed: 01/05/2023]
Abstract
BACKGROUND AND AIMS Hypertension is associated with increased clinical and subclinical coronary artery disease (CAD); however, the relationship between blood pressure and coronary plaque volume is unclear. We examined the effect of systolic blood pressure (SBP) and diastolic blood pressure (DBP) on coronary artery plaque volume. METHODS 285 subjects with stable CAD on statin therapy underwent coronary computed tomographic angiography to measure volume of fatty, fibrous, noncalcified, calcified and total coronary plaque. RESULTS Mean (SD) age was 63.1 (7.7); mean (SD) LDL-C, 78.7 mg/dL (28.5). Compared to the highest DBP tertile (>76 mmHg), those in the lowest DBP tertile (≤68 mmHg) had lower volumes of fatty: 10.0 vs. 7.7 mm3/mm, (p trend = 0.042), fibrous: 19.6 vs. 13.8 mm3/mm (p trend = 0.011), non-calcified: 29.7 vs. 22.5 mm3/mm (p trend = 0.017) and total plaque: 37.8 vs. 25.1 mm3/mm (p trend = 0.010) whereas there was no relationship with SBP tertiles. Similarly, when examined as a continuous variable, higher DBP was a significant independent predictor of higher plaque volume after multivariate adjustment: for every 1 mmHg increase in DBP, fibrous plaque increased 0.128 mm3/mm (p = 0.022), noncalcified plaque increased 0.176 mm3/mm (p = 0.045), calcified plaque increased 0.096 mm3/mm (p = 0.001) and total plaque increased 0.249 mm3/mm (p = 0.019) whereas SBP ranging from 95 to 154 mmHg did not predict plaque volume. CONCLUSIONS Level of DBP predicts coronary plaque with a DBP tertile ≤68 mmHg associated with the least amount of coronary plaque in subjects with LDL-C < 80 mg/dL.
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Affiliation(s)
- Mohamad Saleh
- Division of Cardiology, Beth Israel Deaconess Medical Center, Boston, MA, 02215, USA
| | - Abdulhamied Alfaddagh
- Division of Cardiology, Beth Israel Deaconess Medical Center, Boston, MA, 02215, USA
| | - Tarec K Elajami
- Division of Cardiology, Beth Israel Deaconess Medical Center, Boston, MA, 02215, USA
| | - Hasan Ashfaque
- Division of Cardiology, Beth Israel Deaconess Medical Center, Boston, MA, 02215, USA
| | - Huzifa Haj-Ibrahim
- Division of Cardiology, Beth Israel Deaconess Medical Center, Boston, MA, 02215, USA
| | - Francine K Welty
- Division of Cardiology, Beth Israel Deaconess Medical Center, Boston, MA, 02215, USA.
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Hell MM, Motwani M, Otaki Y, Cadet S, Gransar H, Miranda-Peats R, Valk J, Slomka PJ, Cheng VY, Rozanski A, Tamarappoo BK, Hayes S, Achenbach S, Berman DS, Dey D. Quantitative global plaque characteristics from coronary computed tomography angiography for the prediction of future cardiac mortality during long-term follow-up. Eur Heart J Cardiovasc Imaging 2018; 18:1331-1339. [PMID: 28950315 DOI: 10.1093/ehjci/jex183] [Citation(s) in RCA: 85] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Accepted: 06/22/2017] [Indexed: 11/14/2022] Open
Abstract
Aims Adverse plaque characteristics determined by coronary computed tomography angiography (CTA) have been associated with future cardiac events. Our aim was to investigate whether quantitative global per-patient plaque characteristics from coronary CTA can predict subsequent cardiac death during long-term follow-up. Methods and results Out of 2748 patients without prior history of coronary artery disease undergoing CTA with dual-source CT, 32 patients suffered cardiac death (mean follow-up of 5 ± 2 years). These patients were matched to 32 controls by age, gender, risk factors, and symptoms (total 64 patients, 59% male, age 69 ± 10 years). Coronary CTA data sets were analysed by semi-automated software to quantify plaque characteristics over the entire coronary tree, including total plaque volume, volumes of non-calcified plaque (NCP), low-density non-calcified plaque (LD-NCP, attenuation <30 Hounsfield units), calcified plaque (CP), and corresponding burden (plaque volume × 100%/vessel volume), as well as stenosis and contrast density difference (CDD, maximum percent difference in luminal attenuation/cross-sectional area compared to proximal cross-section). In patients who died from cardiac cause, NCP, LD-NCP, CP and total plaque volumes, quantitative stenosis, and CDD were significantly increased compared to controls (P < 0.025 for all). NCP > 146 mm³ [hazards ratio (HR) 2.24; 1.09-4.58; P = 0.027], LD-NCP > 10.6 mm³ (HR 2.26; 1.11-4.63; P = 0.025), total plaque volume > 179 mm³ (HR 2.30; 1.12-4.71; P = 0.022), and CDD > 35% in any vessel (HR 2.85;1.4-5.9; P = 0.005) were associated with increased risk of future cardiac death, when adjusted for segment involvement score. Conclusion Among quantitative global plaque characteristics, total, non-calcified, and low-density plaque volumes as well as CDD predict cardiac death in long-term follow-up.
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Affiliation(s)
- Michaela M Hell
- Department of Cardiology, Faculty of Medicine, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Ulmenweg 18, 91054 Erlangen, Germany
| | - Manish Motwani
- Cedars-Sinai Medical Center, Cedars-Sinai Heart Institute and Departments of Imaging and Medicine, 8700 Beverly Blvd., Los Angeles, CA 90048, USA
| | - Yuka Otaki
- Cedars-Sinai Medical Center, Cedars-Sinai Heart Institute and Departments of Imaging and Medicine, 8700 Beverly Blvd., Los Angeles, CA 90048, USA
| | - Sebastien Cadet
- Cedars-Sinai Medical Center, Cedars-Sinai Heart Institute and Departments of Imaging and Medicine, 8700 Beverly Blvd., Los Angeles, CA 90048, USA
| | - Heidi Gransar
- Cedars-Sinai Medical Center, Cedars-Sinai Heart Institute and Departments of Imaging and Medicine, 8700 Beverly Blvd., Los Angeles, CA 90048, USA
| | - Romalisa Miranda-Peats
- Cedars-Sinai Medical Center, Cedars-Sinai Heart Institute and Departments of Imaging and Medicine, 8700 Beverly Blvd., Los Angeles, CA 90048, USA
| | - Jacob Valk
- Cedars-Sinai Medical Center, Cedars-Sinai Heart Institute and Departments of Imaging and Medicine, 8700 Beverly Blvd., Los Angeles, CA 90048, USA
| | - Piotr J Slomka
- Cedars-Sinai Medical Center, Cedars-Sinai Heart Institute and Departments of Imaging and Medicine, 8700 Beverly Blvd., Los Angeles, CA 90048, USA
| | - Victor Y Cheng
- Oklahoma Heart Institute, 1265 S. Utica Avenue Suite 300, Tulsa, OK 74104, USA
| | - Alan Rozanski
- Mount Sinai St Lukes Hospital Cardiology, Division of Cardiology, 1111 Amsterdam Ave FL 3, New York, NY 10025, USA
| | - Balaji K Tamarappoo
- Cedars-Sinai Medical Center, Cedars-Sinai Heart Institute and Departments of Imaging and Medicine, 8700 Beverly Blvd., Los Angeles, CA 90048, USA
| | - Sean Hayes
- Cedars-Sinai Medical Center, Cedars-Sinai Heart Institute and Departments of Imaging and Medicine, 8700 Beverly Blvd., Los Angeles, CA 90048, USA
| | - Stephan Achenbach
- Department of Cardiology, Faculty of Medicine, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Ulmenweg 18, 91054 Erlangen, Germany
| | - Daniel S Berman
- Cedars-Sinai Medical Center, Cedars-Sinai Heart Institute and Departments of Imaging and Medicine, 8700 Beverly Blvd., Los Angeles, CA 90048, USA
| | - Damini Dey
- Cedars-Sinai Medical Center, Biomedical Imaging Research Institute, Los Angeles, CA 90048, USA
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Cardiac CT: Technological Advances in Hardware, Software, and Machine Learning Applications. CURRENT CARDIOVASCULAR IMAGING REPORTS 2018; 11. [PMID: 31656551 DOI: 10.1007/s12410-018-9459-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Purpose of Review Multidetector row computed tomography (CT) allows noninvasive imaging of the heart and coronary arteries. The purpose of this review is to briefly summarize recent advances in CT hardware and software technology, and machine learning applications for cardiovascular imaging. Recent Findings In the last decades, there have been significant improvements in CT hardware focusing on faster gantry rotation resulting in improved temporal resolution. Concurrent hardware improvements include improved spatial resolution and higher coverage of the patient, enabling faster acquisition. Advances in cardiac CT software include methods for measurement of noninvasive FFR, coronary plaque characterization, and adipose tissue characteristics around the heart. Machine learning approaches using cardiac CT have been shown to improve both risk of prognosis and lesion-specific ischemia. Summary Recent advances in CT hardware and software have expanded the clinical utility of CT for cardiovascular imaging. In the next decades, continued advances can be anticipated in these areas, and in machine learning applications in cardiac CT, as they are incorporated into clinical routine for image acquisition, image analysis, and prediction of patient outcomes.
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Feuchtner G, Kerber J, Burghard P, Dichtl W, Friedrich G, Bonaros N, Plank F. The high-risk criteria low-attenuation plaque <60 HU and the napkin-ring sign are the most powerful predictors of MACE: a long-term follow-up study. Eur Heart J Cardiovasc Imaging 2018; 18:772-779. [PMID: 27502292 DOI: 10.1093/ehjci/jew167] [Citation(s) in RCA: 89] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2016] [Accepted: 07/16/2016] [Indexed: 01/14/2023] Open
Abstract
Aims To assess the prognostic value of coronary CT angiography (CTA) for prediction of major adverse cardiac events (MACE) over a long-term follow-up period. Methods and Results A total of 1469 low-to-intermediate-risk patients (65.9 years; 44.2% females) were included in our prospective cohort study. CTA was evaluated for (i) stenosis severity (minimal <10%; mild <50%; moderate 50-70%; severe >70%), (ii) plaque types (calcified, mixed dominantly calcified, mixed dominantly non-calcified, non-calcified), and (iii) high-risk plaque criteria [low-attenuation plaque (LAP) quantified by HU, napkin-ring (NR) sign, spotty calcification <3 mm, and remodelling index (RI)]. Over a follow-up of mean 7.8 years, MACE rate was 41 (2.8%) and 0% in patients with negative CTA. MACE rate increased along with stenosis severity by CTA (from 1.3 to 7.8%) (P < 0.001) and was higher in T3/T4 plaques than in T2/T1 (7.8 vs. 1.9%; P < 0.0001). LAP density was lower (35.2 HU ± 32 vs. 108.8 HU ± 53) (P < 0.001) and both NR-sign prevalence with n = 26 (63.4%) vs. n = 40 (28%) and LAP <30, <60, and <90 HU prevalence with 46.3-78% vs. 2.4-7% were higher in the MACE group (P < 0.001). On univariate and unadjusted multivariable proportional Hazards model, LAP <60 HU and NR were the strongest MACE predictors (HR 4.96; 95% CI: 2.0-12.2 and HR 3.85; 95% CI: 1.7-8.6) (P < 0.0001), while spotty calcification (HR 2.2; 95% CI: 1.1-4.3, P < 0.001), stenosis severity, and plaque type (HR 1.5; 95% CI: 1.1-2.3 and HR 1.7; 95% CI: 1.1-2.6) (P < 0.001) were less powerful. After adjusting for risk factors, CTA stenosis severity, and plaque type, LAP <60 HU and the NR sign remained significant (P < 0.001), while the effect of NR sign was even enhancing. HRP criteria were independent predictors from other risk factors. Conclusion Prognosis is excellent over a long-term period if CTA is negative and worsening with an increasing non-calcifying plaque component. LAP <60 HU and NR sign are the most powerful MACE predictors.
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Affiliation(s)
- Gudrun Feuchtner
- Department of Radiology, Innsbruck Medical University,Anichstr. 35, A-6020 Innsbruck, Austria
| | - Johannes Kerber
- Department of Radiology, Innsbruck Medical University,Anichstr. 35, A-6020 Innsbruck, Austria
| | - Philipp Burghard
- Department of Radiology, Innsbruck Medical University,Anichstr. 35, A-6020 Innsbruck, Austria
| | - Wolfgang Dichtl
- Department of Internal Medicine III-Cardiology, Innsbruck Medical University, Innsbruck, Austria
| | - Guy Friedrich
- Department of Internal Medicine III-Cardiology, Innsbruck Medical University, Innsbruck, Austria
| | - Nikolaos Bonaros
- Department of Cardiac Surgery, Innsbruck Medical University, Innsbruck, Austria
| | - Fabian Plank
- Department of Radiology, Innsbruck Medical University, Anichstr. 35, A-6020 Innsbruck, Austria.,Department of Internal Medicine III-Cardiology, Innsbruck Medical University, Innsbruck, Austria
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Song FX, Zhou J, Zhou JJ, Shi YX, Zeng MS, Zhang ZY, Lv P, Sheng RF. The diagnosis of coronary plaque stability by multi-slice computed tomography coronary angiography. J Thorac Dis 2018; 10:2365-2376. [PMID: 29850142 DOI: 10.21037/jtd.2018.04.43] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Background Coronary computed tomographic angiography is a robust non-invasive method to assess coronary artery disease (CAD) and analyze coronary plaque stability, especially for the non-calcified plaques. The aim of this study was to investigate the differential characteristics between the unstable coronary plaques and the stable coronary plaques using multi-slice computed tomography (MSCT). Methods Sixty patients with coronary heart disease (37 unstable plaques and 31 stable plaques) were included. The napkin ring thickness, napkin-ring sign, plaque CT attenuation and degree of lumen stenosis were retrospectively analyzed. The diagnostic performances of MSCT were determined to predict the unstable plaques. The difference was statistically significant if P<0.05. Results The napkin ring thickness of the unstable plaques was thinner than that of the stable plaques (P<0.05). The napkin-ring sign was more frequently observed in the unstable group (89.2%) than the stable group (22.6%, P<0.05). The average CT value of the unstable plaques (26.8±17.8 HU) was lower than that of the stable plaques (68.5±25.5 HU, P<0.05). The unstable plaques had more severe lumen stenosis or occlusion (70.3%) than the stable plaques (41.9%, P<0.05). The measurable napkin ring thickness of the plaques with a cutoff value of 0.8 mm and an accuracy of 89.5% was one independent factor to predict unstable plaques. The optimal combined threshold of the napkin-ring sign and/or the plaque CT value of 53 HU with an accuracy of 80.9% was to predict unstable plaques. Conclusions The optimal combined threshold of the napkin-ring sign and/or the plaque CT value ≤53 HU may be a good indicator to predict the unstable plaques in patients with CAD. The subgroup of measurable napkin ring thickness of the non-calcified plaques may also be an independent factor to predict the unstable plaques in patients with CAD.
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Affiliation(s)
- Feng-Xiang Song
- Department of Radiology, Shanghai Public Health Clinical Center, Shanghai 201508, China
| | - Jun Zhou
- Department of Nuclear Medicine, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Jian-Jun Zhou
- Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Yu-Xin Shi
- Department of Radiology, Shanghai Public Health Clinical Center, Shanghai 201508, China
| | - Meng-Su Zeng
- Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Zhi-Yong Zhang
- Department of Radiology, Shanghai Public Health Clinical Center, Shanghai 201508, China
| | - Peng Lv
- Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Ruo-Fan Sheng
- Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai 200032, China
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Nakanishi R, Alani A, Matsumoto S, Li D, Fahmy M, Abraham J, Dailing C, Broersen A, Kitslaar PH, Nasir K, Min JK, Budoff MJ. Changes in Coronary Plaque Volume: Comparison of Serial Measurements on Intravascular Ultrasound and Coronary Computed Tomographic Angiography. Tex Heart Inst J 2018; 45:84-91. [PMID: 29844740 DOI: 10.14503/thij-15-5212] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Serial measurements of coronary plaque volume have been used to evaluate drug efficacy in atherosclerotic progression. However, the usefulness of computed tomography for this purpose is unknown. We investigated whether the change in total plaque volume on coronary computed tomographic angiography is associated with the change in segment plaque volume on intravascular ultrasound. We prospectively enrolled 11 consecutive patients (mean age, 56.3 ± 5 yr; 6 men) who were to undergo serial invasive coronary angiographic examinations with use of grayscale intravascular ultrasound and coronary computed tomography, performed <180 days apart at baseline and from 1 to 2 years later. Subjects underwent 186 serial measurements of total plaque volume on coronary computed tomography and 22 of segmental plaque volume on intravascular ultrasound. We used semiautomated software to examine percentage relationships and changes between total plaque and segmental plaque volumes. No significant correlations were found between percentages of total coronary and segment coronary plaque volume, nor between normalized coronary plaque volume. However, in the per-patient analysis, there were strong correlations between the imaging methods for changes in total coronary and segment coronary plaque volume (r=0.62; P=0.04), as well as normalized plaque volume (r=0.82; P=0.002). Per-patient change in plaque volume on coronary computed tomography is significantly associated with that on intravascular ultrasound. Computed tomographic angiography may be safer and more widely available than intravascular ultrasound for evaluating atherosclerotic progression in coronary arteries. Larger studies are warranted.
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49
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Optimization of Computed Tomography Coronary Angiography for Improved Plaque Detection. J Comput Assist Tomogr 2018; 42:240-247. [PMID: 28937481 DOI: 10.1097/rct.0000000000000663] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
OBJECTIVE The study aims to optimize visualization of the coronary wall during computed tomography coronary angiography. METHODS A coronary plaque phantom was scanned on a wide-volume computed tomography scanner. Spatial resolution, contrast resolution, and vessel wall thickness were measured at different x-ray tube currents and voltages. RESULTS Spatial resolution ranged from 0.385 to 0.625 mm and was significantly lower at higher currents. Contrast-to-noise ratio was significantly higher at higher currents. The most accurate wall thickness measurements were quantified at 300 and 400 mA for 80 and 100 kVp and 300 mA for 120 and 135 kVp. CONCLUSIONS Lower spatial resolution at higher currents was due to added blur from increased focal spot size. Contrast-to-noise ratio was higher at higher currents owing to decreased quantum noise. Wall thickness was measured more accurately at intermediate currents with midrange contrast-to-noise ratio but optimal spatial resolution. For accurate coronary wall thickness measurement, contrast-to-noise ratio is compromised to achieve optimal spatial resolution.
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Integrated prediction of lesion-specific ischaemia from quantitative coronary CT angiography using machine learning: a multicentre study. Eur Radiol 2018; 28:2655-2664. [PMID: 29352380 DOI: 10.1007/s00330-017-5223-z] [Citation(s) in RCA: 104] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2017] [Revised: 11/20/2017] [Accepted: 11/29/2017] [Indexed: 12/22/2022]
Abstract
OBJECTIVES We aimed to investigate if lesion-specific ischaemia by invasive fractional flow reserve (FFR) can be predicted by an integrated machine learning (ML) ischaemia risk score from quantitative plaque measures from coronary computed tomography angiography (CTA). METHODS In a multicentre trial of 254 patients, CTA and invasive coronary angiography were performed, with FFR in 484 vessels. CTA data sets were analysed by semi-automated software to quantify stenosis and non-calcified (NCP), low-density NCP (LD-NCP, < 30 HU), calcified and total plaque volumes, contrast density difference (CDD, maximum difference in luminal attenuation per unit area) and plaque length. ML integration included automated feature selection and model building from quantitative CTA with a boosted ensemble algorithm, and tenfold stratified cross-validation. RESULTS Eighty patients had ischaemia by FFR (FFR ≤ 0.80) in 100 vessels. Information gain for predicting ischaemia was highest for CDD (0.172), followed by LD-NCP (0.125), NCP (0.097), and total plaque volumes (0.092). ML exhibited higher area-under-the-curve (0.84) than individual CTA measures, including stenosis (0.76), LD-NCP volume (0.77), total plaque volume (0.74) and pre-test likelihood of coronary artery disease (CAD) (0.63); p < 0.006. CONCLUSIONS Integrated ML ischaemia risk score improved the prediction of lesion-specific ischaemia by invasive FFR, over stenosis, plaque measures and pre-test likelihood of CAD. KEY POINTS • Integrated ischaemia risk score improved prediction of ischaemia over quantitative plaque measures • Integrated ischaemia risk score showed higher prediction of ischaemia than standard approach • Contrast density difference had the highest information gain to identify lesion-specific ischaemia.
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