Coronary Plaque Volume Research Articles

High-risk Coronary Plaque Regression in Cash-based Contingency Management Intervention Among Cocaine Users With HIV-associated Subclinical Coronary Atherosclerosis.

Cocaine use exacerbates human immunodeficiency virus (HIV)-associated subclinical coronary atherosclerosis. We investigated whether cocaine abstinence or reduced use achieved with contingency management (CM) intervention would retard high-risk coronary plaque progression among cocaine users with HIV and subclinical coronary atherosclerosis. Between March 2014 and August 2017, 76 cocaine users with HIV and coronary plaques were enrolled in a study designed to decrease cocaine use and determine whether doing so impacted progression of subclinical coronary atherosclerosis as measured by coronary artery computed tomography examinations. Of the 76, 7 did not complete the study, resulting in 69 participants. A 12-month cash-based CM intervention was implemented to promote cocaine abstinence or reduced cocaine use. Generalized estimating equation approach was used to perform longitudinal data analyses. During the 12-month CM, all 69 participants reduced cocaine use, and of these, 25 (36%; 95% confidence interval, 25%-49%) achieved cocaine abstinence. After adjusting for potential confounding factors, generalized estimating equation analyses showed that (1) endothelin-1 (ET-1) levels, a proinflammatory biomarker for endothelial dysfunction, at the 6-month and 12-month visits were significantly lower compared with baseline ET-1 ( P = 0.001 and P < 0.001, respectively), and (2) low-attenuation noncalcified coronary plaque volume, a predictor for myocardial infarction, at 12-month visit was significantly lower compared with baseline low-attenuation noncalcified coronary plaque volume ( P < 0.05). The findings of this study have not only demonstrated that CM is effective in achieving a sustained reduction in cocaine use, but also provided compelling evidence that reduction in cocaine use leads to quantifiable cardiovascular health benefits, including concurrent decrease in high-risk plaque burden and ET-1, among cocaine users with HIV-associated coronary atherosclerosis.

Coronary Computed Tomography Angiography Evaluation of Plaque Morphology and Its Relationship to HDL and Total Cholesterol to HDL Ratio

<h3>Lead Author's Financial Disclosures</h3> Nothing to disclose. <h3>Study Funding</h3> None. <h3>Background/Synopsis</h3> Traditionally non-high-density lipoprotein (non-HDL) indicators have been utilized to stratify cardiovascular risk. Population studies have demonstrated an inverse relationship between HDL cholesterol levels and cardiovascular risk, however, the mechanism by which HDL exhibits its protective effect on the cardiovascular system remains unclear. <h3>Objective/Purpose</h3> To investigate the relationship between the HDL-C level and the total cholesterol to HDL (TC/HDL) ratio with coronary artery plaque burden as determined by coronary computed tomography angiography (CCTA). <h3>Methods</h3> This is a cross-sectional study evaluating the association of HDL-C and TC/HDL ratio with coronary artery plaque volumes. We identified 190 subjects who had undergone quantitative plaque analysis and had lipoprotein values available at our institution. Plaque was analyzed quantitatively utilizing semi-automated plaque analysis software (QAngio version 2.0.5). The plaque volumes are presented as total atheroma volume normalized (TAVnorm). The HDL-C level and TC/HDL ratio were analyzed as continuous variables and categorized at clinically relevant levels. Multivariate regression models adjusted for cardiovascular risk factors were used to evaluate the association of HDL-C and TC/HDL ratio with coronary plaque volumes. <h3>Results</h3> The mean (SD) age of the 190 subjects was 58.9 (+/-9.8) years, and 63% were male. After adjustment for cardiovascular risk factors, HDL- C (>40mg/dL) is inversely associated with fibrous (p=0.003), fibrous fatty (p=0.009), low attenuation plaque (LAP) (p=0.014), total non- calcified plaque (TNCP)(p=0.003), and total plaque (TP)(p=0.005) volume but not associated with dense calcified plaque (p=0.229). TC/HDL ratio (>4.0) is directly associated with LAP (p=0.024) and not associated with fibrous, fibrofatty, TNCP, dense calcified plaque and TP volume. Notably, when examined as continuous variables, increasing HDL- C level is inversely associated with fibrous plaque, TNCP and TP volume and increasing TC/HDL ratio is directly associated with increasing fibrous plaque, and fibrous fatty plaque, LAP, TNCP and TP volume, independent of other risk factors. <h3>Conclusions</h3> There is a strong association between low HDL-C and increasing TC/HDL ratio with increasing coronary plaque volumes, independent of traditional risk factors of atherosclerosis. The findings of this study suggest mechanistic evidence supporting the protective role of HDL-C in coronary artery disease. Additionally, TC/HDL ratio offers value as a secondary treatment target beyond LDL-C, which is especially beneficial in individuals with prevalent lipid discordance, such as those with diabetes and metabolic syndrome.

*Effects of Icosapent Ethyl on Plasma Ceramides and Coronary Plaque Progression in EVAPORATE trial

Lead Author's Financial Disclosures Nothing to disclose. Study Funding None. Background/Synops Despite the beneficial effects of statins on progression of coronary atherosclerosis, significant cardiovascular (CV) risk persists in patients with residual hypertriglyceridemia. REDUCE-IT demonstrated that Icosapent ethyl (IPE) added to statins significantly reduced adverse CV outcomes in these patients. The EVAPORATE trial showed a significant reduction in coronary plaque progression in the IPE arm, offering mechanistic insights to the CV benefits of IPE. Circulating ceramide (CER) levels and CER ratios are important predictors of coronary plaque instability, progression, and adverse CV risk. Objective/Purpose We sought to compare the effect of IPE vs placebo on ceramide scores and ratios in participants enrolled in EVAPORATE trial. We further assessed correlations between CER levels and changes in coronary plaque burden and characteristics. Methods EVAPORATE is a randomized, placebo-controlled trial, using CCTA to evaluate the effects of IPE as an adjunct to statins on coronary plaque progression in a cohort with elevated triglycerides, over 18 months. A total of 63 participants from the EVAPORATE trial were included. Changes in serum levels of CER species, ratios, and scores were compared between patients receiving IPE vs placebo. Spearman's correlation was used to examine association of ceramide scores and changes in coronary plaque volumes. Results CER ratios and scores were similar between the groups at baseline. In the IPE group, the CER score was 4.27 (SD 3.02) at baseline and was 4.00 (SD 3.05) at follow-up (p=0.55). At 18 month follow-up, there was a significant increase in CER ratios, CER 16:0/24:0 and CER 18:0/24:0, in the placebo group (p=0.0018; p=0.0076, respectively), compared to no significant change in the IPE group (p=0.85; p=0.37, respectively). Changes in CER score did not correlate with changes in total plaque volumes in either group (IPE (r=0.326), placebo (r=-0.295) (p>0.05). Conclusions There were significant differences in the CER ratios in the IPE arm vs placebo arm in the EVAPORATE trial, as well as a trend to lowered CER score in the IPE group. Future studies are warranted to further characterize correlations of IPE and CER. Nothing to disclose.

Coronary computed tomography angiography evaluation of plaque morphology and its relationship to HDL and total cholesterol to HDL ratio

BackgroundWhile population studies have demonstrated that high density lipoprotein cholesterol (HDL-C) and the ratio of total cholesterol to HDL (TC/HDL) improve cardiovascular risk prediction, the mechanism by which these parameters protect the cardiovascular system remains uncertain. ObjectiveTo investigate the relationship between the HDL-C level and the total cholesterol to HDL (TC/HDL) ratio with the morphology of coronary artery plaque as determined by coronary computed tomography angiography (CCTA). MethodsThis is a cross-sectional study involving 190 subjects with stable coronary artery disease. Semi-automated plaque analysis software was utilized to quantify plaque and plaque volumes are presented as total atheroma volume normalized (TAVnorm). Multivariate regression models were used to evaluate the association of HDL-C and TC/HDL ratio with coronary plaque volumes. ResultsOf the 190 subjects the average (SD) age was 58.9 (9.8) years, with 63% being male. After adjustment for cardiovascular risk factors, HDL- C (>40 mg/dl) is inversely associated with fibrous (p = 0.003), fibrous fatty (p = 0.007), low attenuation plaque (LAP) (p = 0.007), total non-calcified plaque (TNCP) (p = 0.002) and total plaque (TP)(p = 0.004) volume. Furthermore, the TC/HDL ratio (> 4.0) is associated with fibrous (p = 0.047) and total non-calcified plaque (p = 0.039), but not with fibrofatty, LAP, dense calcified plaque, or TP volume. ConclusionThere is a strong association between low HDL-C levels and increasing TC/HDL ratio with certain types of coronary plaque characteristics, independent of traditional risk factors. The findings of this study suggest mechanistic evidence supporting the protective role of HDL-C and the TC/HDL ratio's clinical relevance in coronary artery disease management.

Longitudinal quantitative assessment of coronary atherosclerosis related to normal systolic blood pressure maintenance in the absence of established cardiovascular disease.

BackgroundAtherosclerosis‐related adverse events are commonly observed even in conditions with low cardiovascular (CV) risk. Longitudinal data regarding the association of normal systolic blood pressure maintenance (SBPmaintain) with coronary plaque volume changes (PVC) has been limited in adults without traditional CV disease.HypothesisNormal SBPmaintain is important to attenuate coronary atherosclerosis progression in adults without baseline CV disease.MethodsWe analyzed 95 adults (56.7 ± 8.5 years; 40.0% men) without baseline CV disease who underwent serial coronary computed tomographic angiography with mean 3.5 years of follow‐up. All participants were divided into two groups of normal SBPmaintain (follow‐up SBP < 120 mm Hg) and ≥elevated SBPmaintain (follow‐up SBP ≥ 120 mm Hg). Annualized PVC was defined as PVC divided by the interscan period.ResultsCompared to participants with normal SBPmaintain, those with ≥elevated SBPmaintain had higher annualized total PVC (mm3/year) (0.0 [0.0–2.2] vs. 4.1 [0.0–13.0]; p < .001). Baseline total plaque volume (β = .10) and the levels of SBPmaintain (β = .23) and follow‐up high‐density lipoprotein cholesterol (β = −0.28) were associated with annualized total PVC (all p < .05). The optimal cutoff of SBPmaintain for predicting plaque progression was 118.5 mm Hg (sensitivity: 78.2%, specificity: 62.5%; area under curve: 0.700; 95% confidence interval [CI]: 0.59–0.81; p < .05). SBPmaintain ≥ 118.5 mm Hg (odds ratio [OR]: 4.03; 95% CI: 1.51–10.75) and baseline total plaque volume (OR: 1.03; 95% CI: 1.01–1.06) independently influenced coronary plaque progression (all p < .05).ConclusionNormal SBPmaintain is substantial to attenuate coronary atherosclerosis progression in conditions without established CV disease.

Longitudinal Quantitative Assessment of Coronary Atherosclerotic Plaque Burden Related to Serum Hemoglobin Levels

Despite a potential role of hemoglobin in atherosclerosis, data on coronary plaque volume changes (PVC) related to serum hemoglobin levels are limited. The authors sought to evaluate coronary atherosclerotic plaque burden changes related to serum hemoglobin levels using serial coronary computed tomographic angiography (CCTA). A total of 830 subjects (age 61 ± 10 years, 51.9% male) who underwent serial CCTA were analyzed. The median interscan period was 3.2 (IQR: 2.5-4.4) years. Quantitative assessment of coronary plaques was performed at both scans. All participants were stratified into 4 groups based on the quartile of baseline hemoglobin levels. Annualized total PVC (mm3/year) was defined as total PVC divided by the interscan period. Baseline total plaque volume (mm3) was not different among all groups (group I [lowest]: 34.1 [IQR: 0.0-127.4] vs group II: 28.8 [IQR: 0.0-123.0] vs group III: 49.9 [IQR: 5.6-135.0] vs group IV [highest]: 34.3 [IQR: 0.0-130.7]; P=0.235). During follow-up, serum hemoglobin level changes (Δ hemoglobin; per 1 g/dL) was related to annualized total PVC (β =-0.114) in overall participants (P< 0.05). After adjusting for age, sex, traditional risk factors, baseline hemoglobin and creatinine levels, baseline total plaque volume, and the use of aspirin, beta-blocker, angiotensin-converting enzyme inhibitor or angiotensin receptor blocker, and statin, Δ hemoglobin significantly affected annualized total PVC in only the composite of groups I and II (β =-2.401; P=0.004). Serial CCTA findings suggest that Δ hemoglobin has an independent effect on coronary atherosclerosis. This effect might be influenced by baseline hemoglobin levels. (Progression of Atherosclerotic Plaque Determined by Computed Tomographic Angiography Imaging [PARADIGM]; NCT02803411).

MO632: Impact of Diabetic Kidney Disease on Coronary Artery Plaque Progression

Abstract BACKGROUND AND AIMS The aim of this study was to evaluate the relationship between diabetic kidney disease (DKD) and change in coronary plaque volume in asymptomatic diabetes patients. METHOD In this prospective observational study, we analyzed 79 asymptomatic type 2 diabetes patients (age, 63.7 ± 8.1 years; male, 69.3%) without prior history of coronary artery disease who underwent serial 320-row computed tomography coronary angiography with an interscan interval of more than 24 months (median 37.7 months). Total coronary plaque volume was assessed at baseline and after 3 years, using QAngio CT (MEDIS) for vessel diameters greater than 1.5 mm in the three main branches. The primary endpoint was coronary plaque progression (PP), which was defined as the absolute change in coronary plaque volume during the 3 years. PP was compared among four groups, which were divided according to the presence or absence of DKD at baseline and after 3 years, as follows: Group 1 (no DKD at baseline, no DKD after 3 years), Group 2 (DKD at baseline, no DKD after 3 years), Group 3 (no DKD at baseline, DKD after 3 years), Group 4 (DKD at baseline, DKD after 3 years)]. DKD was defined as albuminuria &amp;gt;30 mg/g Cr or eGFR &amp;lt;60 mL/min/1.73 m2. We conducted univariate linear regression analysis to assess the association of DKD groups with PP. RESULTS Plaque volumes were significantly greater in Group 4 than in Group 1 both at baseline and after 3 years (Table 1). PP was also significantly greater in Group 4 than in Group 1 (β-coefficient: 293.6, P &amp;lt; 0.01). Group 4 had greater PP compared with Group 1 after adjustment (β-coefficient: 181.6, P &amp;lt; 0.05). CONCLUSION DKD may be an independent risk factor for coronary plaque progression in asymptomatic type 2 diabetic patients without a history of cardiovascular disease. Early therapeutic intervention in such patients may prevent the onset of coronary artery disease.

Cardiovascular events and atherosclerosis in patients with type 2 diabetes and impaired glucose tolerance: What are the medical treatments to prevent cardiovascular events in such patients?

Type 2 diabetes mellitus and impaired glucose tolerance (IGT) significantly induce advanced coronary artery disease and systemic atherosclerosis. Thus, type 2 diabetes mellitus and IGT are traditional risk factors of cardiovascular disease. In contrast, acute coronary syndrome is frequently caused by the rupture of coronary atherosclerotic plaques, which reduces patients’ quality of life and might result in death. To date, many trials have sought to identify ways to determine the coronary plaque volume and its vulnerability, and many studies have shown that some specific antihyperglycemic agents might prevent coronary or carotid plaque progression, decrease plaque volume, induce plaque stability, and improve clinical outcomes in patients with type 2 diabetes mellitus and IGT. This article reviews the following: (i) the association between coronary or carotid plaques and abnormal glucose tolerance, including type 2 diabetes mellitus; and (ii) the effects of oral antihyperglycemic drugs to improve clinical outcomes and stabilize atherosclerotic plaques in patients with type 2 diabetes mellitus and IGT.

Differences of inflammatory cytokine profile in patients with vulnerable plaque: A coronary CTA study

Background and aimsVarious pro- and anti-inflammatory biomarkers are involved in the process of atherosclerosis. We analyzed the association of different biomarkers with coronary plaque volume and vulnerable plaque subcomponents. MethodsIn 301 patients undergoing coronary CT angiography (CTA), total coronary plaque volume (TPV) and subcomponents including non-calcified plaque volume (NCPV) and vulnerable plaque burden were quantified using semi-automated software. Serum was analyzed for various cytokines. ResultsOut of 301 patients, 207 (69%) were male. The mean age was 59 ± 10 years. Patients were divided using the median of TPV, NCPV and vulnerable plaque burden. In univariable analysis, patients with high TPV, high NCPV and high vulnerable plaque burden showed significant higher serum levels for IFNƔ, IL-1a, −2, −4, −10 and −17 and significant lower levels for IL-8 and MCP-1 (all p < 0.05). Multivariable analysis showed positive associations between high vulnerable plaque burden, IL-1a (OR 2.60, p = 0.001) and Eotaxin (OR 1.89, p = 0.020), and inverse association to MCP-1 (OR 0.33, p < 0.001), independent of age, gender and CVRF.In exploratory subanalyses, patients with presence of atherosclerosis (n = 247; 82%) showed significantly higher levels of IL-17 in all subgroups with high vulnerable plaque burden, irrespective of overall plaque volume (all p < 0.001). ConclusionsThe cytokine profile significantly differs between patients with high and low coronary plaque volume. IL-1a and IL-17 seem to play a major proatherogenic role in vulnerable plaque formation, whereas MCP-1 paradoxically portends protective effects. Longitudinal studies with serial cytokine testing are needed to identify potential targets for therapeutic interventions.

Coronary CTA plaque volume severity stages according to invasive coronary angiography and FFR

BackgroundAtherosclerotic plaque characterization by coronary computed tomography angiography (CCTA) enables quantification of coronary artery disease (CAD) burden and type, which has been demonstrated as the strongest discriminant of future risk of major adverse cardiac events (MACE). To date, there are no clinically useful thresholds to assist with understanding a patient's disease burden and guide diagnosis and management, as there exists with coronary artery calcium (CAC) scoring. The purpose of this manuscript is to establish clinically relevant plaque stages and thresholds based on evidence from invasive angiographic stenosis (ICA) and fractional flow reserve (FFR) data. Methods303 patients underwent CCTA prior to ICA and FFR for an AHA/ACC clinical indication. Quantitative computed tomography (QCT) was performed for total plaque volume (TPV, mm3) and percent atheroma volume (PAV, %). We segmented atherosclerosis by composition for low-density non-calcified plaque (LD-NCP), non-calcified plaque (NCP), and calcified plaque (CP). ICAs were evaluated by quantitative coronary angiography (QCA) for all coronary segments for % diameter stenosis. The relationship of atherosclerotic plaque burden and composition by QCT to ICA stenosis extent and severity by QCA and presence of ischemia by FFR was assessed to develop 4 distinct disease stages. ResultsThe mean age of the patients was 64.4 ​± ​10.2 years; 71% male. At the 50% QCA stenosis threshold, QCT revealed a mean PAV of 9.7 (±8.2)% and TPV of 436 (±444.9)mm3 for those with non-obstructive CAD; PAV of 11.7 (±8.0)% and TPV of 549.3 (±408.3) mm3 for 1 vessel disease (1VD), PAV of 17.8 (±9.8)% and TPV of 838.9 (±550.7) mm3 for 2VD, and PAV of 19.2 (±8.2)% and TPV of 799.9 (±357.4) mm3 for 3VD/left main disease (LMD). Non-ischemic patients (FFR >0.8) had a mean PAV of 9.2 (±7.3) % and TPV of 422.9 (±387.9 ​mm3) while patients with at least one vessel ischemia (FFR ≤0.8) had a PAV of 15.2 (±9.5)% and TPV of 694.6 (±485.1). Definition of plaque stage thresholds of 0, 250, 750 ​mm3 and 0, 5, and 15% PAV resulted in 4 clinically distinct stages in which patients with no, nonobstructive, single VD and multi-vessel disease were optimally distributed. ConclusionAtherosclerotic plaque burden by QCT is related to stenosis severity and extent as well as ischemia. We propose staging of CAD atherosclerotic plaque burden using the following definitions: Stage 0 (Normal, 0% PAV, 0 ​mm3 TPV), Stage 1 (Mild, >0–5% PAV or >0–250 ​mm3 TPV), Stage 2 (Moderate, >5–15% PAV or >250–750 ​mm3 TPV) and Stage 3 (Severe, >15% PAV or >750 mm3 TPV).

Heritability of Coronary Artery Disease: Insights From a Classical Twin Study.

Background:Genetics have a strong influence on calcified atherosclerotic plaques; however, data regarding the heritability of noncalcified plaque volume are scarce. We aimed to evaluate genetic versus environmental influences on calcium (coronary artery calcification) score, noncalcified and calcified plaque volumes by coronary computed tomography angiography in adult twin pairs without known coronary artery disease.Methods:In the prospective BUDAPEST-GLOBAL (Burden of Atherosclerotic Plaques Study in Twins—Genetic Loci and the Burden of Atherosclerotic Lesions) classical twin study, we analyzed twin pairs without known coronary artery disease. All twins underwent coronary computed tomography angiography to assess coronary atherosclerotic plaque volumes. Structural equation models were used to quantify the contribution of additive genetic, common environmental, and unique environmental components to plaque volumes adjusted for age, gender, or atherosclerotic cardiovascular disease risk estimate and statin use.Results:We included 196 twins (mean age±SD, 56±9 years, 63.3% females), 120 monozygotic and 76 same-gender dizygotic pairs. Using structural equation models, noncalcified plaque volume was predominantly determined by environmental factors (common environment, 63% [95% CI, 56%–67%], unique environment, 37% [95% CI, 33%–44%]), while coronary artery calcification score and calcified plaque volumes had a relatively strong genetic heritability (additive genetic, 58% [95% CI, 50%–66%]; unique environmental, 42% [95% CI, 34%–50%] and additive genetic, 78% [95% CI, 73%–80%]; unique environmental, 22% [95% CI, 20%–27%]), respectively.Conclusions:Noncalcified plaque volume is mainly influenced by shared environmental factors, whereas coronary artery calcification score and calcified plaque volume are more determined by genetics. These findings emphasize the importance of early lifestyle interventions in preventing coronary plaque formation.Registration:URL: https://www.clinicaltrials.gov; Unique identifier: NCT01738828.

Rationale for different formulations of omega-3 fatty acids leading to differences in residual cardiovascular risk reduction

Rationale for different formulations of omega-3 fatty acids leading to differences in residual cardiovascular risk reduction

Pitavastatin: Coronary Atherosclerotic Plaques Changes and Cardiovascular Prevention

Stains remain the first therapeutic approach in patients with dyslipidemia to control plasma lipids levels and cardiovascular risk. Multiple clinical trials have demonstrated the benefits of statins in reducing major cardiovascular adverse events in primary and secondary prevention. Moreover, in patients with coronary artery disease, statins decrease coronary atherosclerotic plaque volume and composition, inducing atheroma stabilization. Pitavastatin, is a new-generation lipophilic statin, indicated for the treatment of dyslipidemia and prevention of cardiovascular diseases. The purpose of this review, the first at our knowledge on this topic, is to summarize and examine the current knowledge about the effectiveness of pitavastatin in patients with coronary artery disease. The available data suggest that pitavastatin significantly, lowers the rate of adverse cardiovascular events, in patients at a high risk of atherosclerotic disease, with stable angina pectoris or with acute coronary syndrome. Moreover intravascular ultrasound have shown that pitavastatin induces favorable changes in plaque morphology, increasing the fibrous cap thickness, and decreasing both plaque and lipid volume indexes. Globally the efficacy of pitavastatin is greater or similar to other statins.

Evaluation of the Efficacy of Statins in the Treatment of Coronary Artery Plaque Using Dual-Source Spiral Computed Tomography Image Features under Deep Learning

This study aimed at discussing deep learning-based dual-source spiral computed tomography (DSCT) image in the evaluation of the efficacy of statins in the treatment of coronary artery plaque. A convolutional neural network (CNN) algorithm was proposed in this study. On this basis, the model was improved, the Res-Net network was applied to reconstruct the computed tomography (CT) image, and the deep learning network model Mask R-CNN was constructed to enhance the ability of image reconstruction. Then, 80 patients with coronary artery disease who were treated in hospital were selected as the research objects and divided into a control group (n = 40) and an observation group (n = 40). There were 21 male patients and 19 female patients in the control group, with an average age of 52 ± 3.2 years; there were 24 male patients and 16 female patients in the observation group, with an average age of 51 ± 2.4 years. The observation group was reconstructed with the constructed model, and patients in the control group received traditional CT. The interval between two examinations was 6–12 months, with an average interval of 8 ± 1.78 months. During the interval, all patients received conservative treatment mainly with atorvastatin. The general data of the two groups were comparable without statistical significance ( P &gt; 0.05 ). A network model was constructed to measure the coronary plaque and vascular volume of the patients, and the images were reconstructed on the Res-Net network. The loss value of Res-Net network was stable at the lowest level around 0.02, showing a very fast effect in the training process. After statin treatment, the vascular volume and coronary plaque volume of the patients were decreased obviously ( P &lt; 0.05 ). The average time spent in the network model was 1.20 seconds. The average time spent in the measurement of each disc by doctors A, B, and C was 186 seconds, 158 seconds, and 142 seconds, respectively. The construction of network model markedly improved the speed of CT image diagnosis and treatment. In conclusion, the Res-Net network model proposed in this study had certain feasibility and effectiveness for dual-source CT (DSCT) image segmentation and could effectively improve the clinical information evaluation of CT images from patients with coronary artery disease, which had important reference value for the development of intelligent medical equipment. It could provide a new diagnostic method for clinical prediction and diagnosis of coronary artery disease (CAD).

Meta-Analysis of 19 Clinical Trials using Omega-3 Fatty Acids Indicate Distinct Outcomes for Icosapent Ethyl

<h3>Lead Author's Financial Disclosures</h3> Nothing to disclose. <h3>Study Funding</h3> None. <h3>Background/Synopsis</h3> Consumption of the omega-3 fatty acids (O3FAs) eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) has been associated with a lower risk of cardiovascular disease (CVD). However, randomized clinical trials have failed to show consistent benefit with O3FAs in patients receiving contemporary medical care. Recent trials suggest that the formulation may have an important influence on clinical outcomes. <h3>Objective/Purpose</h3> We conducted a meta-analysis of 19 trials using both mixed O3FA products as well as prescription icosapent ethyl (IPE), which is the ethyl ester of EPA. <h3>Methods</h3> The current meta-analysis includes 15 randomized controlled trials with endpoints including non-fatal myocardial infarction (MI), coronary heart disease (CHD) death, total CHD, CVD death, total CVD, total stroke and major vascular events. The pooled rate ratios (RRs) were calculated using a fixed method. This meta-analysis also includes 4 clinical trials that assess the effect of O3FAs on coronary plaque volume and stability. All trials involved formulations with EPA alone (IPE) or in combination with DHA. <h3>Results</h3> Out of 19 trials using omega-3 fatty acids in patients with CVD risk, 5 of them employed IPE, all of which (100%) met the defined endpoints in statin treated patients. The remaining 14 trials used a combination of EPA and DHA. While only 4 (28%) met the defined endpoint, these trials with mixed O3FAs did not require statin use. <h3>Conclusions</h3> A meta-analysis of 19 CVD trials indicate that only IPE treatment was associated with reduced clinical events in statin-treated patients compared to mixed O3FAs. The basis for the distinct benefits of IPE are not fully understood but appear to be related to broad pleiotropic actions that correlate with on-treatment EPA levels. Elucidating such mechanisms for EPA will provide further insights into our understanding of CVD intervention.

Variability of the Plasma Lipidome and Subclinical Coronary Atherosclerosis

While the risk of acute coronary events has been associated with biological variability of circulating cholesterol, the association with variability of other atherogenic lipids remains less understood. We evaluated the longitudinal variability of 284 lipids and investigated their association with asymptomatic coronary atherosclerosis. Approach and Results: Circulating lipids were extracted from fasting blood samples of 83 community-sampled symptom-free participants (age 41-75 years), collected longitudinally over 6 months. Three types of coronary plaque volume (calcified, lipid-rich, and fibrotic) were quantified using computed tomography coronary angiogram. We first deconvoluted between-subject (CVg) and within-subject (CVw) lipid variabilities. We then tested whether the mean lipid abundance was different across groups categorized by Framingham risk score and plaques phenotypes (lipid-rich, fibrotic, and calcified). Finally, we investigated whether visit-to-visit variability of each lipid was associated with plaque burden. Most lipids (72.5%) exhibited higher CVg than CVw. Among the lipids (n=145) with 1.2-fold higher CVg than CVw, 26 species including glycerides and ceramides were significantly associated with Framingham risk score and the 3 plaque phenotypes (false discovery rate <0.05). In an exploratory analysis of person-specific visit-to-visit variability without multiple testing correction, high variability of 3 lysophospholipids (lysophosphatidylethanolamines 16:0, 18:0, and lysophosphatidylcholine O-18:1) was associated with lipid-rich and fibrotic (noncalcified) plaque volume while high variability of diacylglycerol 18:1_20:0, triacylglycerols 52:2, 52:3, and 52:4, ceramide d18:0/20:0, dihexosylceramide d18:1/16:0, and sphingomyelin 36:3 was associated with calcified plaque volume. High person-specific longitudinal variation of specific nonsterol lipids is associated with the burden of subclinical coronary atherosclerosis. Larger studies are needed to confirm these exploratory findings.

Abstract 10328: Eicosapentaenoic Acid versus Mixed Eicosapentaenoic/Docosahexaenoic Acid Added to Statin Therapy for Reducing Plaque Volume in Coronary Atherosclerosis: A Systematic Review and Meta-Analysis of Prospective Randomized Trials

Introduction: Multiple trials demonstrate efficacy of eicosapentaenoic acid (EPA) for lowering cardiovascular risk. Imaging studies suggest this benefit may relate to measurable effects on coronary plaque. Interestingly, EPA mixed with docosahexaenoic acid (DHA) has largely failed to show clinical benefit. The differential effects of EPA and EPA/DHA on coronary plaque burden and characteristics, including prognostically significant features such as lipid volume, remain unclear. Methods: We performed a systematic review of clinical trials that longitudinally measured coronary plaque volume in patients randomized to statin+EPA or statin+EPA/DHA versus statin alone, and performed network meta-analysis to estimate the standardized mean difference (SMD) of these treatments in percent change of total plaque volume and plaque lipid volume. Results: Ten trials comprising 860 patients met inclusion criteria among 535 articles. Four studies used intravascular ultrasound, three used coronary CTA, and three used optical coherence tomography. Among statin, statin+EPA, and statin+EPA/DHA treatments, random effects analysis yielded changes of +1.7% [-2.8%, +6.3%], -11.0% [-20.7%, -1.3%], and -3.4% [-14.5%, +7.8%] in total plaque volume and +3.1% [-1.6%, +7.8%], -19.8% [-27.5%, -12.1%], and -6.4% [-20.3%, +7.5%] in plaque lipid volume. Compared with statin, statin+EPA achieved greater percent reduction in coronary plaque volume (total volume: SMD = 0.92, P = 0.002; lipid volume: SMD = 1.04, P = 0.003) but statin+EPA/DHA showed no difference (total volume: SMD = 0.19, P = 0.58; lipid volume: SMD = 0.42, P = 0.38). Conclusions: In this most up-to-date meta-analysis, EPA as an adjunct to statins is associated with significant reductions in coronary plaque burden, including plaque lipid volume - unlike EPA/DHA combinations. These differential effects on coronary atherosclerosis offer mechanistic insights to observed clinical benefits of statin+EPA therapy.

Abstract 11478: Epicardial Adipose Tissue Volume - Relationship with Coronary Artery Plaque Vulnerability and Myocardial Ischemia in Non-Obstructive Coronary Artery Disease

Introduction: Myocardial ischemia is common among patients with chest pain and non-obstructive coronary artery disease (CAD). Epicardial adipose tissue (EAT) accumulation has been associated with inflammation, atherosclerosis and microvascular dysfunction. Accordingly, we hypothesised that EAT volume is associated with coronary plaque vulnerability and myocardial ischemia in patients with non-obstructive CAD. Methods: We included 125 patients with chest pain and non-obstructive CAD by coronary computed tomography angiography (CCTA). EAT volume was quantified on non-contrast cardiac computed tomography images by a semiautomatic analysis software. CCTA images were analysed with respect to plaque volume and composition. Plaque vulnerability was assessed as total coronary non-calcified plaque volume and positive remodelling index &gt;1.10. Myocardial ischemia was detected by contrast dobutamine stress echocardiography. Patients were grouped in tertiles of EAT volume and high EAT volume was defined as volumes in the highest tertile (≥125 ml). Results: In the total study population (median age 63(58, 69) years and 58% women), the median EAT volume was 104 (77, 141) ml. High EAT volume was more common in men and associated with higher BMI, hypertension and positive remodelling (all p&lt;0.05). There was no difference in age, prevalence of diabetes, total non-calcified plaque volume or presence of myocardial ischemia between groups (all p≥0.34). This was confirmed in univariable logistic regression analyses (Table). After adjusting for covariables in a multivariable model, the association between positive remodelling and high EAT volume was attenuated (Table). Conclusion: High EAT volume was associated with positive remodelling, but not with total non-calcified plaque volume or myocardial ischemia, and the association was attenuated after multivariable adjustments.

Deep Learning Algorithms-Based CT Images in Glucocorticoid Therapy in Asthma Children with Small Airway Obstruction.

CT image information data under deep learning algorithms was adopted to evaluate small airway function and analyze the clinical efficacy of different glucocorticoid administration ways in asthmatic children with small airway obstruction. The Res-NET in the deep learning algorithm was used to perform feature extraction, summary classification, and other reconstruction of CT images. A deep learning network model Mask-R-CNN was constructed to enhance the ability of image reconstruction. A total of 118 children hospitalized with acute exacerbation of asthma in the hospital were recruited. After acute exacerbation treatment, 96 children with asthma were screened out for small airway obstruction, which were divided into glucocorticoid aerosol inhalation group (group A, 32 cases), glucocorticoid combined with bronchodilator aerosol inhalation group (group B, 32 cases), and oral hormone therapy group (group C, 32 cases). Asthmatic children with small airway obstruction were screened after acute exacerbation treatment and were rolled into glucocorticoid aerosol inhalation group (group A), glucocorticoid combined with bronchodilators aerosol inhalation group (group B), and oral hormone therapy group (group C). Lung function indicators (maximal mid-expiratory flow (MMEF75 and 25), 50% forced expiratory flow (FEF50), and 75% forced expiratory flow (FEF75)), FeNO level, and airway inflammation indicators (IL-6, IL-35, and eosinophilic (EOS)) were compared before and one month after treatment. The ratio of airway wall thickness to outer diameter (T/D) and the percentage of airway wall area to total airway area (WA%) were measured by e-Health high-resolution CT (HRCT). The constructed network model was used to measure the patient's coronary artery plaque and blood vessel volume, and the image was reconstructed on the Res-Net network. It was found that the MSE value of the Res-Net network was the lowest, and the efficiency was very high during the training process. T/D and WA (%) of asthmatic children with small airway obstruction after treatment were significantly lower than those before treatment (P < 0.01). After treatment, MMEF75/25 and FEF75 were significantly higher than those before treatment (P < 0.05). Lung function-related indicator FEF50 was significantly higher than that before treatment (P < 0.01). FeNO level after treatment was remarkably lower than that before treatment (P < 0.01). In addition, lung function-related indicators, airway inflammation indicators, and FeNO level improved the most in group C, followed by group B, and those improvements in group A were the least obvious, with great differences among groups (P < 0.05). In summary, the Res-Net model proposed was of certain feasibility and effectiveness for CT image segmentation and can effectively improve the clinical evaluation of patient CT image information. Glucocorticoids could improve small airway function and airway inflammation in asthmatic children with small airway obstruction, and oral corticosteroids were more effective than aerosol inhalation therapy.

Effect of diabetes mellitus on coronary plaque characteristics and progression by serial Coronary Computed Tomography Angiography (CCTA)

Abstract Background Diabetes Mellitus (DM) is a major risk factor for coronary artery disease (CAD) and associated poor outcomes. There is a higher incidence of major adverse cardiac events in patients with DM than those without DM. Coronary plaque characteristics measured by CCTA are correlated with adverse cardiovascular (CV) outcomes. Purpose We sought to evaluate coronary plaque characteristics as well as rates of progression of coronary plaque burden as measured by serial CCTA in patients with DM and those without DM. Methods The study population included a total of 403 participants (mean age 61.4±11.4 years, 53% men; median scan interval 1.5 years) who were prospectively enrolled in serial CCTA trials. We identified 212 participants with DM and 191 participants without DM, who had undergone serial CCTA. Coronary Plaque volumes were measured and characterized as low attenuation plaque (LAP), total non-calcified plaque (TNCP) and total plaque (TP) using semi-automated plaque analysis software (Qangio medis). Multivariate linear regression was used to examine the effect of DM on coronary plaque progression. Results Patients with DM had greater rates of progression of normalized TP volume (median change in annualized plaque (IQR): 39.1 (9.9–114.4) in DM vs 23.5 (4.1–63.8) mm3 in non-DM, p=0.001), TNCP volume (21.6 (3.3–60.8) in DM vs 8.7 (0.1–35.6) mm3 in non-DM, p=0.003) and LAP volumes (0.7 (−0.6 to 7.8) in DM vs 0.1 (−0.4 to 1.9) mm3 in non-DM, p=0.04). After adjusting for relevant risk factors and baseline plaque, the annualized rates of progression were higher in patients with DM by 28% for TP (p=0.004), 27% for TNCP (p=0.011), 23% for fibrous plaque (p=0.026) and by 42% LAP (p=0.050), compared to those without DM. Conclusion Patients with DM have significantly higher rates of coronary plaque progression, including vulnerable LAP, than those without DM. Our findings reveal differences in rates, burden and characteristics of coronary plaque progression in patients with DM vs those without DM. These results provide mechanistic understanding of natural history of coronary atherosclerosis in this vulnerable population, that could explain the increased risk of CV events among patients with DM. Coronary atherosclerotic phenotyping by CCTA could serve as a potential surrogate measure for risk stratification and evaluation in clinical trials to examine therapeutic strategies in this vulnerable population. Funding Acknowledgement Type of funding sources: None.