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Zhang Y, Liu P, Tang LJ, Lin PM, Li R, Luo HR, Luo P. Basing on the machine learning model to analyse the coronary calcification score and the coronary flow reserve score to evaluate the degree of coronary artery stenosis. Comput Biol Med 2023; 163:107130. [PMID: 37329614 DOI: 10.1016/j.compbiomed.2023.107130] [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: 03/19/2023] [Revised: 05/23/2023] [Accepted: 06/01/2023] [Indexed: 06/19/2023]
Abstract
AIM To obtain the coronary artery calcium score (CACS) for each branch in coronary artery computed tomography angiography (CCTA) examination combined with the flow fraction reserve (FFR) of each branch in the coronary artery detected by CT and apply a machine learning model (ML) to analyse and predict the severity of coronary artery stenosis. METHODS All patients who underwent coronary computed tomography angiography (CCTA) from January 2019 to April 2022 in the HOSPITAL (T.C.M) AFFILIATED TO SOUTHWEST MEDICAL UNIVERSITY) were retrospectively screened, and their sex, age, characteristics of lipid-containing lesions, coronary calcium score (CACS) and CT-FFR values were collected. Five machine learning models, random forest (RF), k-nearest neighbour algorithm (KNN), kernel logistic regression, support vector machine (SVM) and radial basis function neural network (RBFNN), were used as predictive models to evaluate the severity of coronary stenosis. RESULTS Among the five machine learning models, the SVM model achieved the best prediction performance, and the prediction accuracy of mild stenosis was up to 90%. Second, age and male sex were important influencing factors of increasing CACS and decreasing CT-FFR. Moreover, the critical CACS value of myocardial ischemia >200.70 was calculated. CONCLUSION Through computer machine learning model analysis, we prove the importance of CACS and FFR in predicting coronary stenosis, especially the prominent vector machine model, which promotes the application of artificial intelligence computer learning methods in the field of medical analysis.
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Affiliation(s)
- Ying Zhang
- State Key Laboratories for Quality Research in Chinese Medicines, Faculty of Pharmacy, Macau University of Science and Technology, Macau; Department of Anaesthesiology, HOSPITAL (T.C.M) AFFILIATED TO SOUTHWEST MEDICAL UNIVERSITY), Lu Zhou, (646000), Sichuan, China.
| | - Ping Liu
- Department of Anaesthesiology, HOSPITAL (T.C.M) AFFILIATED TO SOUTHWEST MEDICAL UNIVERSITY), Lu Zhou, (646000), Sichuan, China.
| | - Li-Jia Tang
- Department of Anaesthesiology, HOSPITAL (T.C.M) AFFILIATED TO SOUTHWEST MEDICAL UNIVERSITY), Lu Zhou, (646000), Sichuan, China.
| | - Pei-Min Lin
- Department of Anaesthesiology, HOSPITAL (T.C.M) AFFILIATED TO SOUTHWEST MEDICAL UNIVERSITY), Lu Zhou, (646000), Sichuan, China.
| | - Run Li
- Department of Anaesthesiology, HOSPITAL (T.C.M) AFFILIATED TO SOUTHWEST MEDICAL UNIVERSITY), Lu Zhou, (646000), Sichuan, China.
| | - Huai-Rong Luo
- State Key Laboratories for Quality Research in Chinese Medicines, Faculty of Pharmacy, Macau University of Science and Technology, Macau.
| | - Pei Luo
- State Key Laboratories for Quality Research in Chinese Medicines, Faculty of Pharmacy, Macau University of Science and Technology, Macau.
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Tsugu T, Tanaka K, Nagatomo Y, Belsack D, Argacha JF, Cosyns B, De Maeseneer M, De Mey J. Impact of ramus coronary artery on computed tomography derived fractional flow reserve (FFR CT ) in no apparent coronary artery disease. Echocardiography 2023; 40:103-112. [PMID: 36607158 DOI: 10.1111/echo.15526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 12/07/2022] [Accepted: 12/21/2022] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND The ramus artery contributes to the development of turbulence, which may influence computed tomography (CT) derived fractional flow reserve (FFRCT ) even without coronary artery disease (CAD). The relationship between ramus-induced turbulence and FFRCT is unclear. METHOD AND RESULTS A total of 120 patients with <20% coronary stenosis assessed by both FFRCT and invasive coronary angiography were evaluated. The patients were divided into three groups: absent-ramus (n = 72), small-ramus that could not be analyzed by FFRCT (n = 18), and large-ramus that could be analyzed by FFRCT (n = 30). FFRCT measurements were performed at the proximal and distal segments of the left anterior descending (LAD), left circumflex (LCX), and ramus artery. With absent-ramus and small-absent ramus groups, FFRCT was measured at the distal end of the left main trunk at the same level for the proximal segments of the LAD and LCX. In absent-ramus group, proximal FFRCT showed no significant differences between three vessels (LAD = .96 ± .02; MID = .97 ± .02; LCX = .97 ± .02). However, in small and large-ramus groups, proximal FFRCT was significantly higher in the ramus artery than LAD and LCX (small-ramus, LAD = .95 ± .03, Ramus = .97 ± .02, LCX = .95 ± .03; large-ramus: LAD = .95 ± .03, Ramus = .98 ± .01; LCX = .96 ± .03; p < .05). A large ramus was associated with a higher prevalence of a distal FFRCT ≤.80 (odds ratio 7.0, 95% CI 1.2-40.1, p = .03). A proximal ramus diameter predicted distal FFRCT ≤.80 (cut-off 2.1 mm, AUC .76, sensitivity 100%, specificity 52%, 95% CI .61-.90). CONCLUSIONS The presence of a large-ramus artery may cause an FFRCT decline in no apparent CAD.
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Affiliation(s)
- Toshimitsu Tsugu
- Department of Radiology, Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - Kaoru Tanaka
- Department of Radiology, Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - Yuji Nagatomo
- Department of Cardiology, National Defense Medical College Hospital, Tokorozawa, Japan
| | - Dries Belsack
- Department of Radiology, Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - Jean-François Argacha
- Cardiology, Centrum voor Hart- en Vaatziekten, Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - Bernard Cosyns
- Cardiology, Centrum voor Hart- en Vaatziekten, Universitair Ziekenhuis Brussel, Brussels, Belgium
| | | | - Johan De Mey
- Department of Radiology, Universitair Ziekenhuis Brussel, Brussels, Belgium
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Tsugu T, Tanaka K, Nagatomo Y, Belsack D, Devos H, Buls N, Cosyns B, Argacha JF, De Maeseneer M, De Mey J. Impact of coronary bifurcation angle on computed tomography derived fractional flow reserve in coronary vessels with no apparent coronary artery disease. Eur Radiol 2023; 33:1277-1285. [PMID: 36114847 PMCID: PMC9889442 DOI: 10.1007/s00330-022-09125-3] [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: 01/27/2022] [Revised: 07/04/2022] [Accepted: 08/19/2022] [Indexed: 02/04/2023]
Abstract
OBJECTIVES Computed tomography (CT) derived fractional flow reserve (FFRCT) decreases from the proximal to the distal part due to a variety of factors. The energy loss due to the bifurcation angle may potentially contribute to a progressive decline in FFRCT. However, the association of the bifurcation angle with FFRCT is still not entirely understood. This study aimed to investigate the impact of various bifurcation angles on FFRCT decline below the clinically crucial relevance of 0.80 in vessels with no apparent coronary artery disease (CAD). METHODS A total of 83 patients who underwent both CT angiography including FFRCT and invasive coronary angiography, exhibiting no apparent CAD were evaluated. ΔFFRCT was defined as the change in FFRCT from the proximal to the distal in the left anterior descending artery (LAD) and left circumflex artery (LCX). The bifurcation angle was calculated from three-dimensional volume rendered images. Vessel morphology and plaque characteristics were also assessed. RESULTS ΔFFRCT significantly correlated with the bifurcation angle (LAD angle, r = 0.35, p = 0.001; LCX angle, r = 0.26, p = 0.02) and vessel length (LAD angle, r = 0.30, p = 0.005; LCX angle, r = 0.49, p < 0.0001). In LAD, vessel length was the strongest predictor for distal FFRCT of ≤ 0.80 (β-coefficient = 0.55, p = 0.0003), immediately followed by the bifurcation angle (β-coefficient = 0.24, p = 0.02). The bifurcation angle was a good predictor for a distal FFRCT ≤ 0.80 (LAD angle, cut-off 31.0°, AUC 0.70, sensitivity 74%, specificity 68%; LCX angle, cut-off 52.6°, AUC 0.86, sensitivity 88%, specificity 85%). CONCLUSIONS In vessels with no apparent CAD, vessel length was the most influential factor on FFRCT, directly followed by the bifurcation angle. KEY POINTS • Both LAD and LCX bifurcation angles are factors influencing FFR CT. • Bifurcation angle is one of the predictors of a distal FFRCT of ≤ 0.80 and an optimal cut-off value of 31.0° for the LAD and 52.6° for the LCX. • Bifurcation angle should be taken into consideration when interpreting numerical values of FFRCT.
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Affiliation(s)
- Toshimitsu Tsugu
- Department of Radiology, Universitair Ziekenhuis Brussel, Laarbeeklaan 101, 1090 Jette, Brussels, Belgium
| | - Kaoru Tanaka
- Department of Radiology, Universitair Ziekenhuis Brussel, Laarbeeklaan 101, 1090 Jette, Brussels, Belgium
| | - Yuji Nagatomo
- Department of Cardiology, National Defense Medical College Hospital, Tokorozawa, Japan
| | - Dries Belsack
- Department of Radiology, Universitair Ziekenhuis Brussel, Laarbeeklaan 101, 1090 Jette, Brussels, Belgium
| | - Hannes Devos
- Department of Radiology, Universitair Ziekenhuis Brussel, Laarbeeklaan 101, 1090 Jette, Brussels, Belgium
| | - Nico Buls
- Department of Radiology, Universitair Ziekenhuis Brussel, Laarbeeklaan 101, 1090 Jette, Brussels, Belgium
| | - Bernard Cosyns
- Cardiology, Centrum voor Hart-en Vaatziekten, Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - Jean-François Argacha
- Cardiology, Centrum voor Hart-en Vaatziekten, Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - Michel De Maeseneer
- Department of Radiology, Universitair Ziekenhuis Brussel, Laarbeeklaan 101, 1090 Jette, Brussels, Belgium
| | - Johan De Mey
- Department of Radiology, Universitair Ziekenhuis Brussel, Laarbeeklaan 101, 1090 Jette, Brussels, Belgium
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Murasato Y, Meno K, Mori T, Tanenaka K. Impact of coronary bifurcation angle on the pathogenesis of atherosclerosis and clinical outcome of coronary bifurcation intervention–A scoping review. PLoS One 2022; 17:e0273157. [PMID: 35976920 PMCID: PMC9385039 DOI: 10.1371/journal.pone.0273157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Accepted: 08/03/2022] [Indexed: 12/03/2022] Open
Abstract
Background A coronary bifurcation stenting is still a challenging issue due to frequent restenosis and stent thrombosis even with drug-eluting stents. The bifurcation angle (BA) between a main vessel and a side branch is one of the crucial determinants of coronary flow and shear stress that affect the plaque distribution. Previous bench and clinical studies have evaluated the impact of the BA between the proximal main vessel and the side branch (Angle A) and the BA between the distal main vessel and the side branch (Angle B) on the clinical outcomes of bifurcation stenting. However, the impact has not yet been fully elucidated due to a lack of statistical power or different manner of the assessment of BA. Objectives To analyze the published studies on coronary artery BA, the modalities used for assessment, and the impact of BA on interventions and attempt to define the pre-procedural protocols. Data sources A scoping review was performed using the Joanna Briggs Institute Methodology. A total of 52 relevant references were selected from PubMed, Cochrane Library, and CINAHL databases and categorized into three topic areas. Results and conclusions A wider Angle A is associated with the increased likelihood of carina shift and a wider Angle B, with that of side branch occlusion. A wider Angle B promotes stent malapposition and deformation in the side branch ostium and has been reported as an independent predictor of major adverse cardiac events after bifurcation stenting; however, improvement of the drug-eluting stent, refinement of the stenting technique, and accurate 3-dimensional assessment may attenuate the adverse clinical impact of a wider BA. Implications of key findings Assessment of the BA is necessary to predict the effect of bifurcation intervention procedure on the stent configuration and coronary flow at the bifurcated vessels. This will help to optimize stent selection and the stenting technique.
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Affiliation(s)
- Yoshinobu Murasato
- Department of Cardiology, Clinical Research Institute, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan
- * E-mail:
| | - Kyohei Meno
- Department of Cardiology, Clinical Research Institute, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan
| | - Takahiro Mori
- Department of Cardiology, Clinical Research Institute, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan
| | - Katsuhiko Tanenaka
- Department of Cardiology, Clinical Research Institute, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan
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Sane R, Mandole R, Amin G. Use of reverse diet kit as a treatment to regress atheroma in a known CAD patient: A case report. J Ayurveda Integr Med 2021; 13:100511. [PMID: 34973885 PMCID: PMC8814396 DOI: 10.1016/j.jaim.2021.08.004] [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: 12/03/2020] [Revised: 08/04/2021] [Accepted: 08/06/2021] [Indexed: 11/28/2022] Open
Abstract
The way people eat have changed rapidly across the globe and is one of the reasons for developing coronary artery disease (CAD). Atheroma is caused due to the accumulation of fatty deposits and scar tissue leading to the degeneration of the walls of the arteries, restriction of the circulation and a risk of thrombosis. This single case experimental study shows that regression in atheroma may be achieved by replacing the normal diet with a low calories diet used in the reverse diet kit. The patient complained of angina on minor exertion. Post admission the patient underwent a computed tomography angiogram (CT-angiogram) to measure the plaque volumes of left anterior descending artery (LAD), left circumflex artery (LXC) and right coronary artery (RCA) of the heart. The patient was monitored for 12 weeks with the administration of reverse diet as a treatment method. The change in weight, blood pressure and heart rate was monitored every week. After 12 weeks, CT-angiogram was performed again. There was a 7.3 kg decrease in weight along with normalization of blood pressure (BP). A 92.8 mm3 regression of the total atheroma volume was observed. The diet provided may help in reducing atheroma burden in this CAD patient.
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Affiliation(s)
- Rohit Sane
- Madhavbaug Cardiac Hospitals and Clinics, India
| | - Rahul Mandole
- Department of Research Development, Madhavbaug Cardiac Clinic and Hospital, Thane, Maharashtra, India.
| | - Gurudatta Amin
- Madhavbaug Cardiac Clinic and Hospital, Thane, Maharashtra, India
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