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Nieman K, García-García HM, Hideo-Kajita A, Collet C, Dey D, Pugliese F, Weissman G, Tijssen JGP, Leipsic J, Opolski MP, Ferencik M, Lu MT, Williams MC, Bruining N, Blanco PJ, Maurovich-Horvat P, Achenbach S. Standards for quantitative assessments by coronary computed tomography angiography (CCTA): An expert consensus document of the society of cardiovascular computed tomography (SCCT). J Cardiovasc Comput Tomogr 2024:S1934-5925(24)00341-1. [PMID: 38849237 DOI: 10.1016/j.jcct.2024.05.232] [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: 03/31/2023] [Revised: 05/18/2024] [Accepted: 05/23/2024] [Indexed: 06/09/2024]
Abstract
In current clinical practice, qualitative or semi-quantitative measures are primarily used to report coronary artery disease on cardiac CT. With advancements in cardiac CT technology and automated post-processing tools, quantitative measures of coronary disease severity have become more broadly available. Quantitative coronary CT angiography has great potential value for clinical management of patients, but also for research. This document aims to provide definitions and standards for the performance and reporting of quantitative measures of coronary artery disease by cardiac CT.
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Affiliation(s)
- Koen Nieman
- Stanford University School of Medicine and Cardiovascular Institute, Stanford, CA, United States.
| | - Hector M García-García
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, United States.
| | | | - Carlos Collet
- Onze Lieve Vrouwziekenhuis, Cardiovascular Center Aalst, Aalst, Belgium
| | - Damini Dey
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, United States
| | - Francesca Pugliese
- NIHR Cardiovascular Biomedical Research Unit at Barts, William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London & Department of Cardiology, Barts Health NHS Trust, London, UK
| | - Gaby Weissman
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, United States
| | - Jan G P Tijssen
- Department of Cardiology, Academic Medical Center, Room G4-230, Meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands
| | - Jonathon Leipsic
- Department of Radiology and Medicine (Cardiology), University of British Columbia, Vancouver, BC, Canada
| | - Maksymilian P Opolski
- Department of Interventional Cardiology and Angiology, National Institute of Cardiology, Warsaw, Poland
| | - Maros Ferencik
- Knight Cardiovascular Institute, Oregon Health & Science University, Portland, OR, United States
| | - Michael T Lu
- Cardiovascular Imaging Research Center, Massachusetts General Hospital & Harvard Medical School, Boston, MA, United States
| | - Michelle C Williams
- BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
| | - Nico Bruining
- Department of Cardiology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | | | - Pal Maurovich-Horvat
- MTA-SE Cardiovascular Imaging Research Group, Medical Imaging Centre, Semmelweis University, Budapest, Hungary
| | - Stephan Achenbach
- Department of Cardiology, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany
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2
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Ansari S, Pourafkari L, Kinninger A, Manubolu V, Budoff MJ. Risk stratifying individuals with zero, minimal, and mild coronary artery calcium for cardiovascular disease by determining coronary plaque burden. J Cardiovasc Comput Tomogr 2024; 18:137-141. [PMID: 38097409 DOI: 10.1016/j.jcct.2023.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Revised: 11/15/2023] [Accepted: 12/04/2023] [Indexed: 03/09/2024]
Abstract
BACKGROUND AND AIMS Use of coronary artery calcium (CAC) continues to expand, and several different categories of risk have been developed. Some categorize CAC as <10, 11-100 and > 100, while others use CAC = 0,1-10, 11-100 and > 100 as categories. We sought to evaluate the plaque burden in patients with CAC 0, 1-10 and 11-100 to evaluate the best use of CAC scoring for risk assessment. METHODS Patients were recruited from existing prospective CCTA trials with CAC scores ≤100 and quantitative coronary plaque analysis (QAngio, Medis). CAC was categorized into three groups: zero (CAC = 0), minimal (CAC 1-10), and mild (CAC 11-100). Plaque levels (low attenuated, fibrous, fibro-fatty, dense calcified, total non-calcified) were assessed using multivariable linear regression adjusted for cardiovascular risk factors (age, ethnicity, BMI, gender, hypertension, dyslipidemia, diabetes mellitus, past smoking). RESULTS 378 subjects were included, with an average age of 53.9 ± 10.7 years and 53 % female. Among them, 51 % had 0 CAC, 16 % had minimal CAC (scores 1-10), and 33 % had mild CAC (scores 11-100). The minimal and mild CAC groups were significantly older, with higher rates of diabetes, hypertension, and hyperlipidemia. Multivariable analysis found no significant difference in low attenuated, fibro-fatty, and dense calcified plaque levels between the minimal and zero CAC groups. However, minimal CAC subjects had significantly higher fibrous, total non-calcified, and total plaque volumes than zero CAC. All plaque types were significantly higher in the mild group when comparing mild CAC to minimal CAC. CONCLUSION Individuals with minimal calcium scores (1-10) had greater noncalcified coronary plaque (NCAP) and total plaque volume than individuals with a calcium score of zero. The increased presence of NCAP and total plaque volume in the minimal CAC (1-10) is clinically significant and place those patients at higher coronary vascular disease (CVD) risk than individuals with absent CAC (CAC = zero). Therefore, the use of CAC = 0, 1-10 and 11-100 is prudent to better categorize CVD risk.
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Affiliation(s)
- Salman Ansari
- California University of Science and Medicine - School of Medicine, Colton, CA, USA.
| | - Leili Pourafkari
- Department of Medicine, Lundquist Institute at Harbor-UCLA Medical Center, Los Angeles, CA, USA
| | - April Kinninger
- Department of Medicine, Lundquist Institute at Harbor-UCLA Medical Center, Los Angeles, CA, USA
| | - Venkat Manubolu
- Department of Medicine, Lundquist Institute at Harbor-UCLA Medical Center, Los Angeles, CA, USA
| | - Matthew J Budoff
- Department of Medicine, Lundquist Institute at Harbor-UCLA Medical Center, Los Angeles, CA, USA
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3
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Lima MR, Lopes PM, Ferreira AM. Use of coronary artery calcium score and coronary CT angiography to guide cardiovascular prevention and treatment. Ther Adv Cardiovasc Dis 2024; 18:17539447241249650. [PMID: 38708947 PMCID: PMC11075618 DOI: 10.1177/17539447241249650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 03/08/2024] [Indexed: 05/07/2024] Open
Abstract
Currently, cardiovascular risk stratification to guide preventive therapy relies on clinical scores based on cardiovascular risk factors. However, the discriminative power of these scores is relatively modest. The use of coronary artery calcium score (CACS) and coronary CT angiography (CCTA) has surfaced as methods for enhancing the estimation of risk and potentially providing insights for personalized treatment in individual patients. CACS improves overall cardiovascular risk prediction and may be used to improve the yield of statin therapy in primary prevention, and possibly identify patients with a favorable risk/benefit relationship for antiplatelet therapies. CCTA holds promise to guide anti-atherosclerotic therapies and to monitor individual response to these treatments by assessing individual plaque features, quantifying total plaque volume and composition, and assessing peri-coronary adipose tissue. In this review, we aim to summarize current evidence regarding the use of CACS and CCTA for guiding lipid-lowering and antiplatelet therapy and discuss the possibility of using plaque burden and plaque phenotyping to monitor response to anti-atherosclerotic therapies.
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Affiliation(s)
- Maria Rita Lima
- Department of Cardiology, Hospital Santa Cruz, Centro Hospitalar Lisboa Ocidental, Av. Prof. Dr. Reinaldo dos Santos, Carnaxide, Lisbon 2790-134, Portugal
| | - Pedro M. Lopes
- Department of Cardiology, Hospital Santa Cruz, Centro Hospitalar Lisboa Ocidental, Carnaxide, Portugal
| | - António M. Ferreira
- Department of Cardiology, Hospital Santa Cruz, Centro Hospitalar Lisboa Ocidental, Carnaxide, Portugal
- UNICA – Cardiovascular CT and MR Unit, Hospital da Luz, Lisbon, Portugal
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4
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Miller RJH, Bednarski BP, Pieszko K, Kwiecinski J, Williams MC, Shanbhag A, Liang JX, Huang C, Sharir T, Hauser MT, Dorbala S, Di Carli MF, Fish MB, Ruddy TD, Bateman TM, Einstein AJ, Kaufmann PA, Miller EJ, Sinusas AJ, Acampa W, Han D, Dey D, Berman DS, Slomka PJ. Clinical phenotypes among patients with normal cardiac perfusion using unsupervised learning: a retrospective observational study. EBioMedicine 2024; 99:104930. [PMID: 38168587 PMCID: PMC10794922 DOI: 10.1016/j.ebiom.2023.104930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 11/24/2023] [Accepted: 12/05/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND Myocardial perfusion imaging (MPI) is one of the most common cardiac scans and is used for diagnosis of coronary artery disease and assessment of cardiovascular risk. However, the large majority of MPI patients have normal results. We evaluated whether unsupervised machine learning could identify unique phenotypes among patients with normal scans and whether those phenotypes were associated with risk of death or myocardial infarction. METHODS Patients from a large international multicenter MPI registry (10 sites) with normal perfusion by expert visual interpretation were included in this cohort analysis. The training population included 9849 patients, and external testing population 12,528 patients. Unsupervised cluster analysis was performed, with separate training and external testing cohorts, to identify clusters, with four distinct phenotypes. We evaluated the clinical and imaging features of clusters and their associations with death or myocardial infarction. FINDINGS Patients in Clusters 1 and 2 almost exclusively underwent exercise stress, while patients in Clusters 3 and 4 mostly required pharmacologic stress. In external testing, the risk for Cluster 4 patients (20.2% of population, unadjusted hazard ratio [HR] 6.17, 95% confidence interval [CI] 4.64-8.20) was higher than the risk associated with pharmacologic stress (HR 3.03, 95% CI 2.53-3.63), or previous myocardial infarction (HR 1.82, 95% CI 1.40-2.36). INTERPRETATION Unsupervised learning identified four distinct phenotypes of patients with normal perfusion scans, with a significant proportion of patients at very high risk of myocardial infarction or death. Our results suggest a potential role for patient phenotyping to improve risk stratification of patients with normal imaging results. FUNDING This work was supported by the National Heart, Lung, and Blood Institute at the National Institutes of Health [R35HL161195 to PS]. The REFINE SPECT database was supported by the National Heart, Lung, and Blood Institute at the National Institutes of Health [R01HL089765 to PS]. MCW was supported by the British Heart Foundation [FS/ICRF/20/26002].
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Affiliation(s)
- Robert J H Miller
- Departments of Medicine (Division of Artificial Intelligence in Medicine), Biomedical Sciences, and Imaging, Cedars-Sinai Medical Center, Los Angeles, CA, USA; Department of Cardiac Sciences, University of Calgary and Libin Cardiovascular Institute, Calgary, AB, Canada
| | - Bryan P Bednarski
- Departments of Medicine (Division of Artificial Intelligence in Medicine), Biomedical Sciences, and Imaging, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Konrad Pieszko
- Departments of Medicine (Division of Artificial Intelligence in Medicine), Biomedical Sciences, and Imaging, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Jacek Kwiecinski
- Departments of Medicine (Division of Artificial Intelligence in Medicine), Biomedical Sciences, and Imaging, Cedars-Sinai Medical Center, Los Angeles, CA, USA; Department of Interventional Cardiology and Angiology, Institute of Cardiology, Warsaw, Poland
| | - Michelle C Williams
- Departments of Medicine (Division of Artificial Intelligence in Medicine), Biomedical Sciences, and Imaging, Cedars-Sinai Medical Center, Los Angeles, CA, USA; British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom
| | - Aakash Shanbhag
- Departments of Medicine (Division of Artificial Intelligence in Medicine), Biomedical Sciences, and Imaging, Cedars-Sinai Medical Center, Los Angeles, CA, USA; Signal and Image Processing Institute, Ming Hsieh Department of Electrical and Computer Engineering, University of Southern California, Los Angeles, CA, USA
| | - Joanna X Liang
- Departments of Medicine (Division of Artificial Intelligence in Medicine), Biomedical Sciences, and Imaging, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Cathleen Huang
- Departments of Medicine (Division of Artificial Intelligence in Medicine), Biomedical Sciences, and Imaging, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Tali Sharir
- Department of Nuclear Cardiology, Assuta Medical Centers, Tel Aviv, Israel; Israel and Ben Gurion University of the Negev, Beer Sheba, Israel
| | - M Timothy Hauser
- Department of Nuclear Cardiology, Oklahoma Heart Hospital, Oklahoma City, OK, USA
| | - Sharmila Dorbala
- Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Brigham and Women's Hospital, Boston, MA, USA
| | - Marcelo F Di Carli
- Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Brigham and Women's Hospital, Boston, MA, USA
| | - Mathews B Fish
- Oregon Heart and Vascular Institute, Sacred Heart Medical Center, Springfield, OR, USA
| | - Terrence D Ruddy
- Division of Cardiology, University of Ottawa Heart Institute, Ottawa, ON, Canada
| | | | - Andrew J Einstein
- Division of Cardiology, Department of Medicine and Department of Radiology, Columbia University Irving Medical Center and New York-Presbyterian Hospital, New York, NY, USA
| | - Philipp A Kaufmann
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Zurich, Switzerland
| | - Edward J Miller
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Albert J Sinusas
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Wanda Acampa
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", Naples, Italy
| | - Donghee Han
- Departments of Medicine (Division of Artificial Intelligence in Medicine), Biomedical Sciences, and Imaging, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Damini Dey
- Departments of Medicine (Division of Artificial Intelligence in Medicine), Biomedical Sciences, and Imaging, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Daniel S Berman
- Departments of Medicine (Division of Artificial Intelligence in Medicine), Biomedical Sciences, and Imaging, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Piotr J Slomka
- Departments of Medicine (Division of Artificial Intelligence in Medicine), Biomedical Sciences, and Imaging, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
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Williams MC, Bednarski BP, Pieszko K, Miller RJH, Kwiecinski J, Shanbhag A, Liang JX, Huang C, Sharir T, Dorbala S, Di Carli MF, Einstein AJ, Sinusas AJ, Miller EJ, Bateman TM, Fish MB, Ruddy TD, Acampa W, Hauser MT, Kaufmann PA, Dey D, Berman DS, Slomka PJ. Unsupervised learning to characterize patients with known coronary artery disease undergoing myocardial perfusion imaging. Eur J Nucl Med Mol Imaging 2023; 50:2656-2668. [PMID: 37067586 PMCID: PMC10317876 DOI: 10.1007/s00259-023-06218-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 03/29/2023] [Indexed: 04/18/2023]
Abstract
PURPOSE Patients with known coronary artery disease (CAD) comprise a heterogenous population with varied clinical and imaging characteristics. Unsupervised machine learning can identify new risk phenotypes in an unbiased fashion. We use cluster analysis to risk-stratify patients with known CAD undergoing single-photon emission computed tomography (SPECT) myocardial perfusion imaging (MPI). METHODS From 37,298 patients in the REFINE SPECT registry, we identified 9221 patients with known coronary artery disease. Unsupervised machine learning was performed using clinical (23), acquisition (17), and image analysis (24) parameters from 4774 patients (internal cohort) and validated with 4447 patients (external cohort). Risk stratification for all-cause mortality was compared to stress total perfusion deficit (< 5%, 5-10%, ≥10%). RESULTS Three clusters were identified, with patients in Cluster 3 having a higher body mass index, more diabetes mellitus and hypertension, and less likely to be male, have dyslipidemia, or undergo exercise stress imaging (p < 0.001 for all). In the external cohort, during median follow-up of 2.6 [0.14, 3.3] years, all-cause mortality occurred in 312 patients (7%). Cluster analysis provided better risk stratification for all-cause mortality (Cluster 3: hazard ratio (HR) 5.9, 95% confidence interval (CI) 4.0, 8.6, p < 0.001; Cluster 2: HR 3.3, 95% CI 2.5, 4.5, p < 0.001; Cluster 1, reference) compared to stress total perfusion deficit (≥10%: HR 1.9, 95% CI 1.5, 2.5 p < 0.001; < 5%: reference). CONCLUSIONS Our unsupervised cluster analysis in patients with known CAD undergoing SPECT MPI identified three distinct phenotypic clusters and predicted all-cause mortality better than ischemia alone.
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Affiliation(s)
- Michelle C Williams
- Departments of Medicine (Division of Artificial Intelligence in Medicine), Biomedical Sciences, and Imaging, Cedars-Sinai Medical Center, 8700 Beverly Boulevard, Ste. Metro 203, Los Angeles, CA, 90048, USA
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
| | - Bryan P Bednarski
- Departments of Medicine (Division of Artificial Intelligence in Medicine), Biomedical Sciences, and Imaging, Cedars-Sinai Medical Center, 8700 Beverly Boulevard, Ste. Metro 203, Los Angeles, CA, 90048, USA
| | - Konrad Pieszko
- Departments of Medicine (Division of Artificial Intelligence in Medicine), Biomedical Sciences, and Imaging, Cedars-Sinai Medical Center, 8700 Beverly Boulevard, Ste. Metro 203, Los Angeles, CA, 90048, USA
| | - Robert J H Miller
- Departments of Medicine (Division of Artificial Intelligence in Medicine), Biomedical Sciences, and Imaging, Cedars-Sinai Medical Center, 8700 Beverly Boulevard, Ste. Metro 203, Los Angeles, CA, 90048, USA
- Department of Cardiac Sciences, University of Calgary, Calgary, AB, Canada
| | - Jacek Kwiecinski
- Departments of Medicine (Division of Artificial Intelligence in Medicine), Biomedical Sciences, and Imaging, Cedars-Sinai Medical Center, 8700 Beverly Boulevard, Ste. Metro 203, Los Angeles, CA, 90048, USA
- Department of Interventional Cardiology and Angiology, Institute of Cardiology, Warsaw, Poland
| | - Aakash Shanbhag
- Departments of Medicine (Division of Artificial Intelligence in Medicine), Biomedical Sciences, and Imaging, Cedars-Sinai Medical Center, 8700 Beverly Boulevard, Ste. Metro 203, Los Angeles, CA, 90048, USA
| | - Joanna X Liang
- Departments of Medicine (Division of Artificial Intelligence in Medicine), Biomedical Sciences, and Imaging, Cedars-Sinai Medical Center, 8700 Beverly Boulevard, Ste. Metro 203, Los Angeles, CA, 90048, USA
| | - Cathleen Huang
- Departments of Medicine (Division of Artificial Intelligence in Medicine), Biomedical Sciences, and Imaging, Cedars-Sinai Medical Center, 8700 Beverly Boulevard, Ste. Metro 203, Los Angeles, CA, 90048, USA
| | - Tali Sharir
- Department of Nuclear Cardiology, Assuta Medical Centers, Tel Aviv, and Ben Gurion University of the Negev, Beer Sheba, Israel
| | - Sharmila Dorbala
- Department of Radiology, Division of Nuclear Medicine and Molecular Imaging, Brigham and Women's Hospital, Boston, MA, USA
| | - Marcelo F Di Carli
- Department of Radiology, Division of Nuclear Medicine and Molecular Imaging, Brigham and Women's Hospital, Boston, MA, USA
| | - Andrew J Einstein
- Division of Cardiology, Department of Medicine, and Department of Radiology, Columbia University Irving Medical Center and New York-Presbyterian Hospital, New York, NY, USA
| | - Albert J Sinusas
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Edward J Miller
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA
| | | | - Mathews B Fish
- Oregon Heart and Vascular Institute, Sacred Heart Medical Center, Springfield, OR, USA
| | - Terrence D Ruddy
- Division of Cardiology, University of Ottawa Heart Institute, Ottawa, ON, Canada
| | - Wanda Acampa
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", Naples, Italy
| | - M Timothy Hauser
- Department of Nuclear Cardiology, Oklahoma Heart Hospital, Oklahoma City, OK, USA
| | - Philipp A Kaufmann
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Zurich, Switzerland
| | - Damini Dey
- Departments of Medicine (Division of Artificial Intelligence in Medicine), Biomedical Sciences, and Imaging, Cedars-Sinai Medical Center, 8700 Beverly Boulevard, Ste. Metro 203, Los Angeles, CA, 90048, USA
| | - Daniel S Berman
- Departments of Medicine (Division of Artificial Intelligence in Medicine), Biomedical Sciences, and Imaging, Cedars-Sinai Medical Center, 8700 Beverly Boulevard, Ste. Metro 203, Los Angeles, CA, 90048, USA
| | - Piotr J Slomka
- Departments of Medicine (Division of Artificial Intelligence in Medicine), Biomedical Sciences, and Imaging, Cedars-Sinai Medical Center, 8700 Beverly Boulevard, Ste. Metro 203, Los Angeles, CA, 90048, USA.
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Cho SG, Lee JE, Kim HY, Song HC, Kim YH. Association between myocardial ischemia and plaque characteristics in chronic total occlusion. J Nucl Cardiol 2023; 30:388-398. [PMID: 35836093 DOI: 10.1007/s12350-022-03020-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 05/02/2022] [Indexed: 10/17/2022]
Abstract
BACKGROUND Myocardial ischemia varies in chronic total occlusion (CTO) despite the occluded artery. We analyzed whether it is associated with the plaque characteristics of the occluded segment. METHODS We retrospectively enrolled 100 patients with CTO who underwent myocardial perfusion single-photon emission computed tomography (SPECT) and coronary computed tomography angiography (CCTA) within 2 months. CTO-related ischemia was classified as moderate to severe (summed difference score [SDS] of the CTO territory ≥ 5) or mild or none (SDS < 5) on SPECT. Using CCTA, the atherosclerotic plaques of the occluded segment were subdivided into low-density (- 100-30 HU), intermediate-density (31-350 HU), and high-density (351-1000 HU) plaques. The plaque composition was compared according to the severity of CTO-related ischemia. RESULTS Moderate-to-severe CTO-related ischemia (n = 23) showed significantly higher proportion of intermediate-density plaques (72.4% vs. 64.0%), intermediate/low-density (7.10 vs. 3.65) and intermediate-to-high/low-density (7.78 vs. 3.80) plaque ratios, frequent shorter occlusion (30% vs. 6%), and lower volume (26.5 mm3 vs. 58.8 mm3) and proportion (11.4% vs. 20.8%) of low-density plaques. Multivariable analysis revealed significant associations between higher proportion of intermediate-density plaques and moderate-to-severe CTO-related ischemia, independent of occlusion length. CONCLUSION Higher proportion of intermediate-density plaques in the occluded segment was associated with the moderate-to-severe CTO-related ischemia.
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Affiliation(s)
- Sang-Geon Cho
- Department of Nuclear Medicine, Chonnam National University Hospital, 42, Jebong-ro, Dong-gu, Gwangju, 61469, Republic of Korea
| | - Jong Eun Lee
- Department of Radiology, Chonnam National University Hospital, Gwangju, Republic of Korea
| | - Hyung Yoon Kim
- Department of Cardiovascular Medicine, Chonnam National University Hospital, Gwangju, Republic of Korea
| | - Ho-Chun Song
- Department of Nuclear Medicine, Chonnam National University Hospital, 42, Jebong-ro, Dong-gu, Gwangju, 61469, Republic of Korea.
- Department of Nuclear Medicine, Chonnam National University Medical School, Gwangju, Republic of Korea.
| | - Yun-Hyeon Kim
- Department of Radiology, Chonnam National University Hospital, Gwangju, Republic of Korea
- Department of Radiology, Chonnam National University Medical School, Gwangju, Republic of Korea
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7
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Kampaktsis PN, Emfietzoglou M, Al Shehhi A, Fasoula NA, Bakogiannis C, Mouselimis D, Tsarouchas A, Vassilikos VP, Kallmayer M, Eckstein HH, Hadjileontiadis L, Karlas A. Artificial intelligence in atherosclerotic disease: Applications and trends. Front Cardiovasc Med 2023; 9:949454. [PMID: 36741834 PMCID: PMC9896100 DOI: 10.3389/fcvm.2022.949454] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2022] [Accepted: 12/28/2022] [Indexed: 01/21/2023] Open
Abstract
Atherosclerotic cardiovascular disease (ASCVD) is the most common cause of death globally. Increasing amounts of highly diverse ASCVD data are becoming available and artificial intelligence (AI) techniques now bear the promise of utilizing them to improve diagnosis, advance understanding of disease pathogenesis, enable outcome prediction, assist with clinical decision making and promote precision medicine approaches. Machine learning (ML) algorithms in particular, are already employed in cardiovascular imaging applications to facilitate automated disease detection and experts believe that ML will transform the field in the coming years. Current review first describes the key concepts of AI applications from a clinical standpoint. We then provide a focused overview of current AI applications in four main ASCVD domains: coronary artery disease (CAD), peripheral arterial disease (PAD), abdominal aortic aneurysm (AAA), and carotid artery disease. For each domain, applications are presented with refer to the primary imaging modality used [e.g., computed tomography (CT) or invasive angiography] and the key aim of the applied AI approaches, which include disease detection, phenotyping, outcome prediction, and assistance with clinical decision making. We conclude with the strengths and limitations of AI applications and provide future perspectives.
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Affiliation(s)
- Polydoros N. Kampaktsis
- Division of Cardiology, Columbia University Irving Medical Center, New York, NY, United States,*Correspondence: Polydoros N. Kampaktsis,
| | - Maria Emfietzoglou
- Heart Centre, John Radcliffe Hospital, Oxford University Hospitals, NHS Foundation Trust, Oxford, United Kingdom
| | - Aamna Al Shehhi
- Department of Biomedical Engineering, Khalifa University of Science and Technology, Abu Dhabi, United Arab Emirates
| | - Nikolina-Alexia Fasoula
- Institute of Biological and Medical Imaging, Helmholtz Zentrum München, Neuherberg, Germany,School of Medicine, Chair of Biological Imaging at the Central Institute for Translational Cancer Research (TranslaTUM), Technical University of Munich, Munich, Germany
| | - Constantinos Bakogiannis
- Third Department of Cardiology, Hippokration University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Dimitrios Mouselimis
- Third Department of Cardiology, Hippokration University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Anastasios Tsarouchas
- Third Department of Cardiology, Hippokration University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Vassilios P. Vassilikos
- Third Department of Cardiology, Hippokration University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Michael Kallmayer
- Department for Vascular and Endovascular Surgery, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Hans-Henning Eckstein
- Department for Vascular and Endovascular Surgery, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany,DZHK (German Centre for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
| | - Leontios Hadjileontiadis
- Department of Biomedical Engineering, Khalifa University of Science and Technology, Abu Dhabi, United Arab Emirates,Healthcare Innovation Center, Khalifa University of Science and Technology, Abu Dhabi, United Arab Emirates,Department of Electrical and Computer Engineering, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Angelos Karlas
- Institute of Biological and Medical Imaging, Helmholtz Zentrum München, Neuherberg, Germany,School of Medicine, Chair of Biological Imaging at the Central Institute for Translational Cancer Research (TranslaTUM), Technical University of Munich, Munich, Germany,Department for Vascular and Endovascular Surgery, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany,DZHK (German Centre for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
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8
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Baskaran L, Lee JK, Ko MSM, Al’Aref SJ, Neo YP, Ho JS, Huang W, Yoon YE, Han D, Nakanishi R, Tan SY, Al-Mallah M, Budoff MJ, Shaw LJ. Comparing the pooled cohort equations and coronary artery calcium scores in a symptomatic mixed Asian cohort. Front Cardiovasc Med 2023; 10:1059839. [PMID: 36733301 PMCID: PMC9887040 DOI: 10.3389/fcvm.2023.1059839] [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: 10/02/2022] [Accepted: 01/02/2023] [Indexed: 01/18/2023] Open
Abstract
Background The value of pooled cohort equations (PCE) as a predictor of major adverse cardiovascular events (MACE) is poorly established among symptomatic patients. Coronary artery calcium (CAC) assessment further improves risk prediction, but non-Western studies are lacking. This study aims to compare PCE and CAC scores within a symptomatic mixed Asian cohort, and to evaluate the incremental value of CAC in predicting MACE, as well as in subgroups based on statin use. Methods Consecutive patients with stable chest pain who underwent cardiac computed tomography were recruited. Logistic regression was performed to determine the association between risk factors and MACE. Cohort and statin-use subgroup comparisons were done for PCE against Agatston score in predicting MACE. Results Of 501 patients included, mean (SD) age was 53.7 (10.8) years, mean follow-up period was 4.64 (0.66) years, 43.5% were female, 48.3% used statins, and 50.0% had no CAC. MI occurred in 8 subjects while 9 subjects underwent revascularization. In the general cohort, age, presence of CAC, and ln(Volume) (OR = 1.05, 7.95, and 1.44, respectively) as well as age and PCE score for the CAC = 0 subgroup (OR = 1.16 and 2.24, respectively), were significantly associated with MACE. None of the risk factors were significantly associated with MACE in the CAC > 0 subgroup. Overall, the PCE, Agatston, and their combination obtained an area under the receiver operating characteristic curve (AUC) of 0.501, 0.662, and 0.661, respectively. Separately, the AUC of PCE, Agatston, and their combination for statin non-users were 0.679, 0.753, and 0.734, while that for statin-users were 0.585, 0.615, and 0.631, respectively. Only the performance of PCE alone was statistically significant (p = 0.025) when compared between statin-users (0.507) and non-users (0.783). Conclusion In a symptomatic mixed Asian cohort, age, presence of CAC, and ln(Volume) were independently associated with MACE for the overall subgroup, age and PCE score for the CAC = 0 subgroup, and no risk factor for the CAC > 0 subgroup. Whilst the PCE performance deteriorated in statin versus non-statin users, the Agatston score performed consistently in both groups.
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Affiliation(s)
- Lohendran Baskaran
- Department of Cardiology, National Heart Centre Singapore, Singapore, Singapore,Duke-NUS Medical School, National University of Singapore, Singapore, Singapore,*Correspondence: Lohendran Baskaran,
| | - Jing Kai Lee
- Duke-NUS Medical School, National University of Singapore, Singapore, Singapore
| | - Michelle Shi Min Ko
- Duke-NUS Medical School, National University of Singapore, Singapore, Singapore
| | - Subhi J. Al’Aref
- Division of Cardiology, Department of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, United States
| | - Yu Pei Neo
- Duke-NUS Medical School, National University of Singapore, Singapore, Singapore
| | - Jien Sze Ho
- Department of Cardiology, National Heart Centre Singapore, Singapore, Singapore,Duke-NUS Medical School, National University of Singapore, Singapore, Singapore
| | - Weiting Huang
- Department of Cardiology, National Heart Centre Singapore, Singapore, Singapore,Duke-NUS Medical School, National University of Singapore, Singapore, Singapore
| | | | - Donghee Han
- Department of Imaging, Cedars-Sinai Medical Center, Los Angeles, CA, United States
| | - Rine Nakanishi
- Department of Cardiovascular Medicine, Toho University Graduate School of Medicine, Tokyo, Japan
| | - Swee Yaw Tan
- Department of Cardiology, National Heart Centre Singapore, Singapore, Singapore,Duke-NUS Medical School, National University of Singapore, Singapore, Singapore
| | - Mouaz Al-Mallah
- Houston Methodist DeBakey Heart and Vascular Center, Houston Methodist Hospital, Houston, TX, United States
| | - Matthew J. Budoff
- Department of Medicine, Lundquist Institute at Harbor-UCLA Medical Center, Torrance, CA, United States
| | - Leslee J. Shaw
- Icahn School of Medicine at Mount Sinai, Blavatnik Family Women’s Health Research Institute, New York, NY, United States
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Moore J, Lakshmanan S, Manubolu VS, Kinninger A, Stojan G, Goldman DW, Petri M, Budoff M, Karpouzas GA. Coronary plaque progression is greater in systemic lupus erythematosus than rheumatoid arthritis. Coron Artery Dis 2023; 34:52-58. [PMID: 36421035 DOI: 10.1097/mca.0000000000001205] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Systemic lupus erythematosus (SLE) and rheumatoid arthritis (RA) are associated with a high incidence of cardiovascular disease. Coronary atherosclerosis, particularly total plaque and noncalcified plaque on coronary computed tomography angiography (CCTA) has been correlated with cardiovascular events. We compared baseline coronary plaque burden and progression by serial CCTA in SLE and RA patients. METHODS We prospectively evaluated 44 patients who underwent serial CCTA examinations to quantify coronary plaque progression, 22 SLE patients, and 22 age- and sex-matched RA patients. Semiautomated plaque software was used for quantitative plaque assessment. Linear regression examined the effect of SLE diagnosis (versus RA) on annualized change in natural log-transformed total normalized atheroma volume (ln-TAV norm ) for low-attenuation, fibrofatty, fibrous, total noncalcified, densely calcified, and total plaque. RESULTS No quantitative differences for any plaque types were observed at baseline between SLE and RA patients ( P = 0.330-0.990). After adjustment for baseline plaque and cardiovascular risk factors, the increase in ln-TAV norm was higher in SLE than RA patients for fibrous [Exp-β: 0.202 (0.398), P = 0.0003], total noncalcified [Exp-β: 0.179 (0.393), P = 0.0001], and total plaque volume [Exp-β: 0.154 (0.501), P = 0.0007], but not for low-attenuation, fibrofatty, or densely calcified plaque ( P = 0.103-0.489). Patients with SLE had 80% more fibrous, 82% more noncalcified, and 85% more total plaque increase than those with RA. CONCLUSION Coronary plaque volume was similar in RA and SLE at baseline. Progression was greater in SLE, which may explain the greater cardiovascular risk in this disease. Further research to evaluate screening and management strategies for cardiovascular disease in these high-risk patients is warranted.
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Affiliation(s)
- Jeff Moore
- Chronic Disease Clinical Research Center, The Lundquist Institute for Biomedical Innovation at the Harbor University of California Los Angeles Medical Center, Torrance
- School of Exercise and Nutritional Sciences, San Diego State University, San Diego, California
| | - Suvasini Lakshmanan
- Chronic Disease Clinical Research Center, The Lundquist Institute for Biomedical Innovation at the Harbor University of California Los Angeles Medical Center, Torrance
| | - Venkat Sanjay Manubolu
- Chronic Disease Clinical Research Center, The Lundquist Institute for Biomedical Innovation at the Harbor University of California Los Angeles Medical Center, Torrance
| | - April Kinninger
- Chronic Disease Clinical Research Center, The Lundquist Institute for Biomedical Innovation at the Harbor University of California Los Angeles Medical Center, Torrance
| | - George Stojan
- Division of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Daniel W Goldman
- Division of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Michelle Petri
- Division of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Matthew Budoff
- Chronic Disease Clinical Research Center, The Lundquist Institute for Biomedical Innovation at the Harbor University of California Los Angeles Medical Center, Torrance
| | - George A Karpouzas
- Chronic Disease Clinical Research Center, The Lundquist Institute for Biomedical Innovation at the Harbor University of California Los Angeles Medical Center, Torrance
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Weng ST, Lai QL, Cai MT, Wang JJ, Zhuang LY, Cheng L, Mo YJ, Liu L, Zhang YX, Qiao S. Detecting vulnerable carotid plaque and its component characteristics: Progress in related imaging techniques. Front Neurol 2022; 13:982147. [PMID: 36188371 PMCID: PMC9515377 DOI: 10.3389/fneur.2022.982147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 08/29/2022] [Indexed: 11/30/2022] Open
Abstract
Carotid atherosclerotic plaque rupture and thrombosis are independent risk factors for acute ischemic cerebrovascular disease. Timely identification of vulnerable plaque can help prevent stroke and provide evidence for clinical treatment. Advanced invasive and non-invasive imaging modalities such as computed tomography, magnetic resonance imaging, intravascular ultrasound, optical coherence tomography, and near-infrared spectroscopy can be employed to image and classify carotid atherosclerotic plaques to provide clinically relevant predictors used for patient risk stratification. This study compares existing clinical imaging methods, and the advantages and limitations of different imaging techniques for identifying vulnerable carotid plaque are reviewed to effectively prevent and treat cerebrovascular diseases.
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Affiliation(s)
- Shi-Ting Weng
- The Second Clinical Medical College, Zhejiang Chinese Medicine University, Hangzhou, China
| | - Qi-Lun Lai
- Department of Neurology, Zhejiang Hospital, Hangzhou, China
| | - Meng-Ting Cai
- Department of Neurology, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Jun-Jun Wang
- Department of Neurology, Zhejiang Hospital, Hangzhou, China
| | - Li-Ying Zhuang
- Department of Neurology, Zhejiang Hospital, Hangzhou, China
| | - Lin Cheng
- Department of Neurology, Zhejiang Hospital, Hangzhou, China
| | - Ye-Jia Mo
- Department of Neurology, Zhejiang Hospital, Hangzhou, China
| | - Lu Liu
- Department of Neurology, Zhejiang Hospital, Hangzhou, China
| | - Yin-Xi Zhang
- Department of Neurology, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
- *Correspondence: Yin-Xi Zhang
| | - Song Qiao
- Department of Neurology, Zhejiang Hospital, Hangzhou, China
- Song Qiao
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Muscogiuri G, Guglielmo M, Serra A, Gatti M, Volpato V, Schoepf UJ, Saba L, Cau R, Faletti R, McGill LJ, De Cecco CN, Pontone G, Dell’Aversana S, Sironi S. Multimodality Imaging in Ischemic Chronic Cardiomyopathy. J Imaging 2022; 8:jimaging8020035. [PMID: 35200737 PMCID: PMC8877428 DOI: 10.3390/jimaging8020035] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2021] [Revised: 01/23/2022] [Accepted: 01/27/2022] [Indexed: 02/01/2023] Open
Abstract
Ischemic chronic cardiomyopathy (ICC) is still one of the most common cardiac diseases leading to the development of myocardial ischemia, infarction, or heart failure. The application of several imaging modalities can provide information regarding coronary anatomy, coronary artery disease, myocardial ischemia and tissue characterization. In particular, coronary computed tomography angiography (CCTA) can provide information regarding coronary plaque stenosis, its composition, and the possible evaluation of myocardial ischemia using fractional flow reserve CT or CT perfusion. Cardiac magnetic resonance (CMR) can be used to evaluate cardiac function as well as the presence of ischemia. In addition, CMR can be used to characterize the myocardial tissue of hibernated or infarcted myocardium. Echocardiography is the most widely used technique to achieve information regarding function and myocardial wall motion abnormalities during myocardial ischemia. Nuclear medicine can be used to evaluate perfusion in both qualitative and quantitative assessment. In this review we aim to provide an overview regarding the different noninvasive imaging techniques for the evaluation of ICC, providing information ranging from the anatomical assessment of coronary artery arteries to the assessment of ischemic myocardium and myocardial infarction. In particular this review is going to show the different noninvasive approaches based on the specific clinical history of patients with ICC.
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Affiliation(s)
- Giuseppe Muscogiuri
- Department of Radiology, Istituto Auxologico Italiano IRCCS, San Luca Hospital, University Milano Bicocca, 20149 Milan, Italy
- Correspondence: ; Tel.: +39-329-404-9840
| | - Marco Guglielmo
- Department of Cardiology, Division of Heart and Lungs, Utrecht University, Utrecht University Medical Center, 3584 Utrecht, The Netherlands;
| | - Alessandra Serra
- Department of Radiology, Azienda Ospedaliero Universitaria (A.O.U.), di Cagliari-Polo di Monserrato, 09042 Cagliari, Italy; (A.S.); (L.S.); (R.C.)
| | - Marco Gatti
- Radiology Unit, Department of Surgical Sciences, University of Turin, 10124 Turin, Italy; (M.G.); (R.F.)
| | - Valentina Volpato
- Department of Cardiac, Neurological and Metabolic Sciences, Istituto Auxologico Italiano IRCCS, San Luca Hospital, University Milano Bicocca, 20149 Milan, Italy;
| | - Uwe Joseph Schoepf
- Department of Radiology and Radiological Science, MUSC Ashley River Tower, Medical University of South Carolina, 25 Courtenay Dr, Charleston, SC 29425, USA; (U.J.S.); (L.J.M.)
| | - Luca Saba
- Department of Radiology, Azienda Ospedaliero Universitaria (A.O.U.), di Cagliari-Polo di Monserrato, 09042 Cagliari, Italy; (A.S.); (L.S.); (R.C.)
| | - Riccardo Cau
- Department of Radiology, Azienda Ospedaliero Universitaria (A.O.U.), di Cagliari-Polo di Monserrato, 09042 Cagliari, Italy; (A.S.); (L.S.); (R.C.)
| | - Riccardo Faletti
- Radiology Unit, Department of Surgical Sciences, University of Turin, 10124 Turin, Italy; (M.G.); (R.F.)
| | - Liam J. McGill
- Department of Radiology and Radiological Science, MUSC Ashley River Tower, Medical University of South Carolina, 25 Courtenay Dr, Charleston, SC 29425, USA; (U.J.S.); (L.J.M.)
| | - Carlo Nicola De Cecco
- Division of Cardiothoracic Imaging, Nuclear Medicine and Molecular Imaging, Department of Radiology and Imaging Sciences, Emory University, Atlanta, GA 30322, USA;
| | | | - Serena Dell’Aversana
- Department of Radiology, Ospedale S. Maria Delle Grazie—ASL Napoli 2 Nord, 80078 Pozzuoli, Italy;
| | - Sandro Sironi
- School of Medicine and Post Graduate School of Diagnostic Radiology, University of Milano-Bicocca, 20126 Milan, Italy;
- Department of Radiology, ASST Papa Giovanni XXIII, 24127 Bergamo, Italy
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12
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Machine Learning Consensus Clustering Approach for Hospitalized Patients with Dysmagnesemia. Diagnostics (Basel) 2021; 11:diagnostics11112119. [PMID: 34829467 PMCID: PMC8619519 DOI: 10.3390/diagnostics11112119] [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: 09/23/2021] [Revised: 11/12/2021] [Accepted: 11/13/2021] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND The objectives of this study were to classify patients with serum magnesium derangement on hospital admission into clusters using unsupervised machine learning approach and to evaluate the mortality risks among these distinct clusters. METHODS Consensus cluster analysis was performed based on demographic information, principal diagnoses, comorbidities, and laboratory data in hypomagnesemia (serum magnesium ≤ 1.6 mg/dL) and hypermagnesemia cohorts (serum magnesium ≥ 2.4 mg/dL). Each cluster's key features were determined using the standardized mean difference. The associations of the clusters with hospital mortality and one-year mortality were assessed. RESULTS In hypomagnesemia cohort (n = 13,320), consensus cluster analysis identified three clusters. Cluster 1 patients had the highest comorbidity burden and lowest serum magnesium. Cluster 2 patients had the youngest age, lowest comorbidity burden, and highest kidney function. Cluster 3 patients had the oldest age and lowest kidney function. Cluster 1 and cluster 3 were associated with higher hospital and one-year mortality compared to cluster 2. In hypermagnesemia cohort (n = 4671), the analysis identified two clusters. Compared to cluster 1, the key features of cluster 2 included older age, higher comorbidity burden, more hospital admissions primarily due to kidney disease, more acute kidney injury, and lower kidney function. Compared to cluster 1, cluster 2 was associated with higher hospital mortality and one-year mortality. CONCLUSION Our cluster analysis identified clinically distinct phenotypes with differing mortality risks in hospitalized patients with dysmagnesemia. Future studies are required to assess the application of this ML consensus clustering approach to care for hospitalized patients with dysmagnesemia.
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