Coronary Computed Tomography Angiography Scans Research Articles

Ultra-low-dose coronary CT angiography via super-resolution deep learning reconstruction: impact on image quality, coronary plaque, and stenosis analysis.

To exploit the capability of super-resolution deep learning reconstruction (SR-DLR) to save radiation exposure from coronary CT angiography (CCTA) and assess its impact on image quality, coronary plaque quantification and characterization, and stenosis severity analysis. This prospective study included 50 patients who underwent low-dose (LD) and subsequent ultra-low-dose (ULD) CCTA scans. LD CCTA images were reconstructed with hybrid iterative reconstruction (HIR) and ULD CCTA images were reconstructed with HIR and SR-DLR. The objective parameters and subjective scores were compared. Coronary plaques were classified into three components: necrotic, fibrous or calcified content, with absolute volumes (mm3) recorded, and further characterized by percentage of calcified content. The four main coronary arteries were evaluated for the presence of stenosis. Moreover, 48 coronary segments in 9 patients were evaluated for the presence of significant stenosis, with invasive coronary angiography as a reference. Effective dose decreased by 60% from LD to ULD CCTA scans (2.01 ± 0.84 mSv vs. 0.80 ± 0.34 mSv, p < 0.001). ULD SR-DLR was non-inferior or even superior to LD HIR in terms of image quality and showed excellent agreements with LD HIR on the plaque volumes, characterization, and stenosis analysis (ICCs > 0.8). Moreover, there was no evidence of a difference in detecting significant coronary stenosis between the LD HIR and ULD SR-DLR (AUC: 0.90 vs. 0.89; p = 1.0). SR-DLR led to significant radiation dose savings from CCTA while ensuring high image quality and excellent performance in coronary plaque and stenosis analysis. Question How can radiation dose for coronary CT angiography be reduced without compromising image quality or affecting clinical decisions? Finding Super-resolution deep learning reconstruction (SR-DLR) algorithm allows for 60% dose reduction while ensuring high image quality and excellent performance in coronary plaque and stenosis analysis. Clinical relevance Dose optimization via SR-DLR has no detrimental effect on image quality, coronary plaque quantification and characterization, and stenosis severity analysis, which paves the way for its implementation in clinical practice.

Impact of Cordyceps sinensis on coronary computed tomography angiography image quality and renal function in a beagle model of renal impairment

ObjectiveThis study aims to investigate the protective effects of Cordyceps sinensis against renal injury induced by low-dose contrast medium (CM) in coronary computed tomography angiography (CCTA) imaging, and to evaluate its efficacy using functional magnetic resonance imaging (fMRI).MethodsTwenty Beagle dogs with induced renal insufficiency were enrolled in the study and randomly assigned to one of four groups (n = 5 per group). Group A received Cordyceps sinensis for 1 week prior to undergoing heart rate-dependent personalized CM CCTA scanning; Group B received Cordyceps sinensis for 1 week followed by conventional dose CM CCTA scanning; Group C did not receive Cordyceps sinensis but underwent HR-dependent CM CCTA scanning; and Group D did not receive Cordyceps sinensis but underwent conventional dose CM CCTA scanning. Renal function was assessed using MRI before and after the intervention, with IVIM (Intravoxel Incoherent Motion) and BOLD (Blood Oxygen Level Dependent) imaging of the kidneys. Key parameters, including the pure diffusion coefficient (D), pseudo-diffusion coefficient (D*), perfusion fraction (f), and R2*values, were quantified. Laboratory renal function markers were measured multiple times before and after the intervention, and their correlation with fMRI parameters was analyzed.ResultsCCTA imaging revealed that the CT values of the major coronary artery branches in all groups met the international diagnostic criteria for coronary arteries. No statistically significant differences in image quality were observed among the four groups (P &amp;gt; 0.05). In Groups A and D, significant changes were observed in renal function parameters, as well as in D, D*, f, and R2* values, both pre- and post-CCTA (P &amp;lt; 0.05). However, Groups B and C exhibited no significant changes pre- and post-CCTA (P &amp;gt; 0.05). A significant correlation was found between MRI parameters and laboratory renal function markers, with excellent inter- and intra-observer reproducibility, and high repeatability in the measurements.ConclusionHR-dependent personalized CM CCTA imaging did not compromise image quality. Administration of Cordyceps sinensis demonstrated a potential protective effect on renal function. The combination of IVIM and BOLD functional MRI offers a reliable, non-invasive approach to assess the protective effects of Cordyceps sinensis on renal injury induced by low-dose CCTA in Beagle dogs.

Composite cardiac computed tomography angiography score for improved risk assessment in chronic coronary syndromes

Agatston score, the degree of lumen narrowing categorized by CAD-RADS, high-risk atherosclerotic plaque features and pericoronary adipose tissue attenuation (PCAT) are parameters, which can be assessed non-invasively by coronary computed tomography angiography (CCTA) and aid risk stratification in patients with chronic coronary syndromes (CCS). However, few studies have so far compared the prognostic value of all those parameters together. To develop and test the prognostic value of a composite CCTA score, derived from Agatston score, CAD-RADS, high-risk plaques and PCAT in patients undergoing CCTA due to CCS. Consecutive patients with clinical indication for CCTA and available clinical follow-up of ≥ 6 months after the CCTA examination were included. (i) Agatston score, (ii) CAD-RADS, (iii) the number of plaques with at least one high-risk feature and (iv) PCAT in the proximal 4 cm of the right coronary artery (RCA) were measured, and a composite CCTA score was generated considering all four parameters. The primary endpoint encompassed all-cause mortality, myocardial infarction, and coronary revascularization (> 60 days after the CCTA scan) during follow-up. In total, 759 patients (median age 68.0 (IQR 59.0–76.0) years, 352 (46.4%) female) were included. During a median follow-up of 591.5 (IQR 505.5-686.8) days, 39 (5.1%) patients reached the primary endpoint. Cox-proportional regression demonstrated that the Agatston score, the number of high-risk plaques and CAD-RADS predicted the primary endpoint, independent of age and conventional cardiovascular risk factors. The number of high-risk plaques per patient provided the most robust prediction of the primary endpoint (HR = 2.74, 95%CI = 1.56–4.80, p < 0.001), whereas the composite CCTA score outperformed all other parameters (HR = 1.54, 95%CI = 1.19–1.98, p < 0.001). The Agatston score, CAD-RADS and high-risk plaque features may provide complementary prognostic information in patients with CCS. A composite CCTA score, derived by these imaging markers may identify high-risk individuals, who may benefit from more intensified treatment and clinical follow-up in future studies.

Serial assessment of coronary artery inflammation using cardiac CT in anthracycline chemotherapy for breast cancer.

There is limited evidence of the pericoronary fat attenuation index (FAI) as an imaging marker to assess cancer therapy-related cardiovascular toxicity. We aimed to measure FAI in four consecutive coronary CT angiography (CTA) scans before and 3, 6, and 12 months after anthracycline treatment in patients with breast cancer to determine trends in dynamic changes in FAI after treatment. We performed a post hoc analysis of a prospective study (between August 2019 and July 2020) in which anthracycline-induced myocardial injury was evaluated using cardiac CT. FAI was quantified using coronary CTA images before and 3, 6, and 12 months after anthracycline treatment. The FAIs of the three coronary arteries were averaged to calculate the FAI (Total). FAI was analyzed on 14 patients with breast cancer who had adequate CT image quality (mean age, 62 years ± 11 (SD); 14 women). During the observation period, all 14 patients treated with anthracycline developed mild asymptomatic cardiac dysfunction related to cancer treatment (CTRCD). FAI (Total) showed a gradual increase during the observation period compared to baseline (baseline: -77.3 ± 5.6 HU, 3 months: -77.1 ± 4.8 HU, 6 months: -76.5 ± 5.4 HU, 12 months: -73.8 ± 5.8 HU). FAI (Total) was significantly elevated at 12 months compared to baseline (p < 0.001). In patients with breast cancer, FAI showed a gradual increase at 3, 6, and 12 months after treatment with anthracyclines compared to before treatment. FAI may be used as an imaging biomarker of coronary artery inflammation in the follow-up of anthracycline therapy and may contribute to the personalization of therapy through early detection of coronary toxicity. Question Is pericoronary fat attenuation index (FAI) a potential imaging biomarker for assessing changes in pericoronary adipose tissue related to cancer therapy-related cardiovascular toxicity? Findings In 14 patients with breast cancer, FAI showed a gradual increase at 3, 6, and 12 months after treatment with anthracyclines compared to before treatment. Clinical relevance FAI may be an imaging biomarker for the detection and treatment of cancer therapy-related cardiovascular toxicity.

Characterizing Cardiac Adipose Tissue in Post-AMI Patients via CT Imaging: A Comparative Cross-sectional Study.

To identify differences in CT-derived perivascular (PVAT) and epicardial adipose tissue (EAT) characteristics that may indicate inflammatory status differences between post-treatment acute myocardial infarction (AMI) and stable coronary artery disease (CAD) patients. A cohort of 205 post-AMI patients (age 59.8±9.2, 92.2% male) was propensity-matched with 205 stable CAD patients (age 60.5±10.0, 90.2% male). Coronary CT angiography and non-contrast CT scans were performed to assess PVAT mean attenuation across major coronary segments and EAT mean attenuation and volumes, respectively. For post-AMI patients, CT scans were conducted 28.6 ± 13.8 days after the AMI incidence. Post-AMI patients showed higher non-culprit PVAT and EAT mean attenuation than stable CAD patients (8.01HU, 95% CI 5.90 to 10.11 HU, p<0.001, 2.48 HU, 95% CI 0.83 to 4.13 HU, p=0.003, respectively). The EAT volume percentage at higher attenuation levels was higher in post-AMI patients compared to stable CAD (33.93cm3, 95% CI 16.86 to 51.00 cm3, p<0.001), with the difference maximized at the -70 HU threshold (4.75%, 95% CI 3.64% to 5.87%, p<0.001). PVAT mean attenuation positively correlated with EAT mean attenuations and the percentage of EAT volume >-70 HU (p<0.001 for both). Post-AMI patients showed higher PVAT and EAT attenuation than stable CAD patients, potentially indicating AMI-associated inflammatory cardiac adipose tissue changes. -70 HU can act as a potential cut-off for inflamed EAT. These findings highlight the potential of using CT-derived adipose tissue characteristics to assess inflammation and guide post-AMI management strategies.

Automated classification of coronary LEsions fRom coronary computed Tomography angiography scans with an updated deep learning model: ALERT study.

The use of deep learning models for quantitative measurements on coronary computed tomography angiography (CCTA) may reduce inter-reader variability and increase efficiency in clinical reporting. This study aimed to investigate the diagnostic performance of a recently updated deep learning model (CorEx-2.0) for quantifying coronary stenosis, compared separately with two expert CCTA readers as references. This single-center retrospective study included 50 patients that underwent CCTA to rule out obstructive coronary artery disease between 2017-2022. Two expert CCTA readers and CorEx-2.0 independently assessed all 150 vessels using Coronary Artery Disease-Reporting and Data System (CAD-RADS). Inter-reader agreement analysis and diagnostic performance of CorEx-2.0, compared with each expert reader as references, were evaluated using percent agreement, Cohen's kappa for the binary CAD-RADS classification (CAD-RADS 0-3 versus 4-5) at patient level, and linearly weighted kappa for the 6-group CAD-RADS classification at vessel level. Overall, 50 patients and 150 vessels were evaluated. Inter-reader agreement using the binary classification at patient level was 91.8% (45/49) with a Cohen's kappa of 0.80. For the 6-group classification at vessel level, inter-reader agreement was 67.6% (100/148) with a linearly weighted kappa of 0.77. CorEx-2.0 showed 100% sensitivity for detecting CAD-RADS ≥ 4 and kappa values of 0.86 versus both readers using the binary classification at patient level. For the 6-group classification at vessel level, CorEx-2.0 demonstrated weighted kappa values of 0.71 versus reader 1 and 0.73 versus reader 2. CorEx-2.0 identified all patients with severe stenosis (CAD-RADS ≥ 4) compared with expert readers and approached expert reader performance at vessel level (weighted kappa > 0.70). Question Can deep learning models improve objectivity in coronary stenosis grading and reporting as coronary CT angiography (CTA) workloads rise? Findings The deep learning model (CorEx-2.0) identified all patients with severe stenoses when compared with expert readers and approached expert reader performance at vessel level. Clinical relevance CorEx-2.0 is a reliable tool for identifying patients with severe stenoses (≥ 70%), underscoring the potential of using this deep learning model to prioritize coronary CTA reading by flagging patients at risk of severe obstructive coronary artery disease.

Increased prevalence of coronary atherosclerosis in cancer survivors: A retrospective matched cross-sectional study with coronary CT angiography.

Cancer and cancer treatment may accelerate the development of cardiovascular disease. With the improved prognosis of cancer survivors, cardiovascular events are increasing in this patient group. However, it is unknown whether the prevalence of coronary atherosclerosis is increased in patients with a history of cancer. This study aims to evaluate the prevalence and severity of coronary atherosclerosis in different age groups of cancer survivors compared to matched controls. Consecutive cancer survivors aged > 30 years who underwent evaluation for stable coronary artery disease with coronary computed tomography angiography (CCTA) were included in this retrospective study. Propensity score matching was performed and cancer survivors were matched 1:2 to a control population without oncological history. The presence of coronary atherosclerosis was assessed in both groups. The study population consisted of 312 cancer survivors and 624 matched controls. Median age at CCTA scan was 59.2 [50.3-67.5] years and 66.0% was female. Coronary atherosclerosis was observed in 257 (82.4%) cancer survivors compared to 459 (73.6%) control patients with an Odds Ratio (OR) of 1.68 [95% CI: 1.19-2.36], P = .003. Mainly younger cancer survivors aged between 30 and 59 years had an increased prevalence of coronary atherosclerosis with an OR of 2.21 [95% CI: 1.40-3.49] compared to control patients (P = .001). In addition, thoracic radiotherapy showed a significant association with increased prevalence of atherosclerosis in the younger population with an OR of 3.29 ([95% CI: 1.70-6.38], P < .001). Patients with a history cancer have an increased prevalence of coronary atherosclerosis on CCTA compared to matched patients without cancer. This effect was most pronounced in younger patients aged 30 to 59 years.

End-to-end deep-learning model for the detection of coronary artery stenosis on coronary CT images

PurposeWe examined whether end-to-end deep-learning models could detect moderate (≥50%) or severe (≥70%) stenosis in the left anterior descending artery (LAD), right coronary artery (RCA) or left circumflex artery (LCX)...

Plasma proteomics improves prediction of coronary plaque progression.

Coronary computed tomography angiography (CCTA) offers detailed imaging of plaque burden and composition, with plaque progression being a key determinant of future cardiovascular events. As repeated CCTA scans are burdensome and costly, there is a need for non-invasive identification of plaque progression. This study evaluated whether combining proteomics with traditional risk factors can detect patients at risk for accelerated plaque progression. This long-term follow-up study included 97 participants who underwent two CCTA scans and plasma proteomics analysis using the Olink platform. Accelerated plaque progression was defined as rates above the median for percent atheroma volume (PAV), percent noncalcified plaque volume (NCPV), and percent calcified plaque volume (CPV). High-risk plaque (HRP) was identified by positive remodeling or low-density plaque at baseline and/or follow-up. Significant proteins associated with PAV, NCPV, CPV, and HRP development were incorporated into predictive models. The mean baseline age was 58.0±7.4 years, with 63 (65%) male, and a median follow-up of 8.5±0.6 years. The area under the curve (AUC) for accelerated PAV progression increased from 0.830 with traditional risk factors and baseline plaque volume to 0.909 with the protein panel (p=0.023). For NCPV progression, AUC improved from 0.685 to 0.825 (p=0.008), while no improvement was observed for CPV progression. For HRP development, AUC increased from 0.791 to 0.860 with the protein panel (p=0.036). Integrating proteomics with traditional risk factors enhances the prediction of accelerated plaque progression and high-risk plaque development, potentially improving risk stratification and treatment decisions without the need for repeated CCTAs.

Characterizing Nonculprit Lesions and Perivascular Adipose Tissue of Patients Following Acute Myocardial Infarction Using Coronary Computed Tomography Angiography: A Comparative Study.

The comparison of coronary computed tomography angiography plaques and perivascular adipose tissue (PVAT) between patients with acute myocardial infarction (AMI) posttreatment and patients with stable coronary artery disease is poorly understood. Our objective was to evaluate the differences in coronary computed tomography angiography-quantified plaque and PVAT characteristics in patients post-AMI and identify signs of residual inflammation. We analyzed 205 patients (age, 59.77±9.24 years; 92.20% men) with AMI ≤1 month and matched them with 205 patients with stable coronary artery disease (age, 60.52±10.04 years; 90.24% men) based on age, sex, and cardiovascular risk factors. Coronary computed tomography angiography scans were assessed for nonculprit plaque and vessel characteristics, plaque volumes by composition, high-risk plaques, and PVAT mean attenuation. Both patient groups exhibited similar noncalcified plaque volumes (383.35±313.23 versus 378.63±426.25 mm3, P=0.899). However, multivariable analysis revealed that patients post-AMI had a greater patient-wise noncalcified plaque volume ratio (estimate, 0.089 [95% CI, 0.053-0.125], P<0.001), largely attributed to a higher fibrofatty and necrotic core volume ratio, along with higher peri-lesion PVAT mean attenuation (estimate, 3.968 [95% CI, 2.556-5.379], P<0.001). When adjusted for vessel length, patients post-AMI had more high-risk plaques (estimate, 0.417 [95% CI, 0.298-0.536], P<0.001) per patient. Patients post-AMI displayed heightened noncalcified plaque components, largely due to fibrofatty and necrotic core content, more high-risk plaques, and increased PVAT mean attenuation on a per-patient level, highlighting the necessity for refined risk assessment in patients with AMI after treatment.

Interscan reproducibility of computed tomography derived coronary plaque volume measurements using a semi-automated analysis software

Abstract Background Coronary computed tomography angiography (CCTA) enables detailed quantification and characterization of coronary atherosclerotic plaque, offering diagnostic and prognostic value. Despite the growing demand for accurate plaque analysis, studies on interscan reproducibility of automated plaque quantification are limited in number and size. Moreover, impact of clinical and technical factors on the reproducibility of plaque assessment tools are scarce. Purpose The objective of this study was to assess the interscan reproducibility of CCTA-derived plaque volume measurements and the implications of clinical and technical characteristics on interscan reproducibility. Methods A total of 101 patients with known coronary artery disease underwent two CCTA scans within hour interval using identical CT acquisition protocol. Coronary plaque volume measurements were quantified on a per-patient level using a contemporary semi-automated plaque analysis software. Results There was no statistically significant difference in median plaque volumes between the first and second scan. The direct correlation was excellent for volumes of non-calcified plaque (NCP), calcified plaque (CP), and total plaque (TP) across all analyses (Pearson’s coefficient 0.96 to 0.99), while moderate for low-density non-calcified plaque (LD-NCP) volumes (Pearson’s coefficient 0.77). Bland Altman analyses demonstrated high interscan agreement with narrow absolute and relative limits of agreement (LoA) across plaque subtypes, except for LD-NCP volumes (Table 1). Interscan reproducibility on CP volumes was affected by CT image quality with narrower LoA in scans with the highest image quality score (p = 0.003), or lowest image reconstructive iteration level (p &amp;lt;0.001). Limits of agreement were significantly narrower for NCP, CP, and TP volumes in lesions located in LAD compared to non-LAD lesions (p &amp;lt;0.001). However, no significant difference in LoA was present when comparing patients according to BMI (&amp;lt;27 and ≥27 kg/m2), heart rate (&amp;lt;65 and ≥65 beats per minute), or Agatston score (&amp;lt;193 and ≥193). Conclusions This comprehensive interscan reproducibility study revealed good agreement in the measurement of plaque subtypes. Adding new insight to existing literature, we have demonstrated that factors such as image quality, image reconstructive algorithms, and lesion location affect the reproducibility of plaque volume measurements. CT-derived plaque quantification using a semi-automated plaque analysis software holds potential for monitoring disease progression or regression in patients with CAD, provided high CCTA image quality.

Increased prevalence of coronary atherosclerosis in cancer survivors: a matched cross-sectional study with coronary CT angiography

Abstract Background Cancer and atherosclerosis share many risk factors. Although cardiovascular disease is highly prevalent among cancer survivors, it is unknown whether coronary atherosclerosis is present at a younger age in patients with a history of cancer. Purpose The purpose of this study is to evaluate the prevalence of coronary atherosclerosis in different age groups of patients with a history of cancer compared to matched controls. Methods Consecutive patients with a history of cancer aged &amp;gt;30 years who underwent evaluation for coronary artery disease with coronary computed tomography angiography (CCTA) between 2010 and 2023 were included in this cross-sectional study. Patients with a history of cancer were matched 1:2 to a control population without oncological history using propensity score matching. Patients were matched on age, gender, body mass index, hypercholesterolemia, hypertension, diabetes, use of statins and smoking status. The presence of atherosclerosis in the main coronary arteries was compared between the groups. Results The study population consisted of 313 patients with an oncological history and 626 matched control patients. The median age during CCTA scan was 59.4 [50.4-67.5] years and 66.1% of the patients were female. Coronary atherosclerosis was observed in 258 (82.4%) patients with a history of cancer compared to 461 (73.6%) control patients with a risk ratio of 1.12 [95% CI: 1.04-1.20], p&amp;lt;0.01. Mainly younger patients with a history of cancer aged between 30-59 years had a significant increased prevalence of coronary atherosclerosis with a risk ratio of 1.18 [1.04-1.33] compared to healthy controls (p=0.02). In our study population, thoracic radiotherapy was not associated with an increased prevalence of coronary atherosclerosis. Calcified plaques were observed more frequently in patients with a history of cancer (14.4% vs. 9.3% respectively, p=0.018). Conclusion Patients with a history cancer have a higher prevalence of coronary atherosclerosis as observed on CCTA compared to matched patients without cancer. This effect was most pronounced in younger patients aged 30-59 years. There is an unmet need to define strategies for cardiovascular disease monitoring and prevention in this growing patient population of patients with a history of cancer.Presence of coronary atherosclerosisRadiotherapy and atherosclerosis

Prognostic value of quantitative anatomical and functional measures of coronary artery disease in diabetic and non-diabetic patients

Abstract Background Diabetes is associated with increased risk of coronary artery disease (CAD). However, the relative prognostic importance of anatomical and functional findings of CAD in the presence vs. absence of diabetes is incompletely understood. Technological advances have made quantitative analysis of coronary artery plaques and stenosis feasible by coronary computed tomography angiography (CTA). In turn, positron emission tomography (PET) enables absolute quantification of myocardial blood flow (MBF). Purpose To study long-term prognostic value of quantified severity of coronary atherosclerosis and myocardial perfusion in non-diabetic vs. diabetic patients with suspected CAD. Methods From two academic medical centres, we identified symptomatic patients with suspected CAD who had undergone coronary CTA and [15O]H2O PET myocardial perfusion imaging during adenosine stress. Based on artificial intelligence -guided quantitative analysis of coronary CTA scans, the anatomical severity of CAD was measured as the presence of obstructive CAD (≥50% diameter stenosis) and percent atheroma volume (PAV; higher vs. lower than median). The functional severity of CAD was measured as the presence of regional myocardial ischemia (≥2 adjacent segments with stress MBF &amp;lt;2.3 ml/g/min) and global stress MBF (&amp;lt;2.2 ml/g/min vs. ≥ 2.2 ml/g/min) by PET. Annual rates of adverse events (AER) including all-cause mortality, myocardial infarction (MI), and unstable angina pectoris (UAP) were evaluated. Results Among 1311 patients, 251 (19%) had diabetes. Patients with diabetes had more frequently obstructive CAD (55% vs. 43%, p&amp;lt;0.001) and regional myocardial ischemia (51% vs. 43%, p=0.015), higher plaque burden by PAV (12% vs. 7%, p&amp;lt;0.001), and lower global stress MBF (2.78 ml/g/min vs. 3.05 ml/g/min, p&amp;lt;0.001). During median follow-up of 7.1 years, 171 (13.0%) patients experienced AE (85 deaths, 56 MIs, and 30 UAPs). Patients with diabetes had higher AER than non-diabetic patients (3.1% vs. 1.6%, p&amp;lt;0.001). The presence of obstructive stenosis was associated with increased AER in non-diabetic (2.6% vs. 1.0%, p&amp;lt;0.001) and diabetic patients (4.2% vs. 1.9%, p&amp;lt;0.001). High plaque burden by PAV was associated with increased AER in non-diabetic (2.8% vs. 0.7%, p&amp;lt;0.001) and diabetic patients (3.9% vs. 1.7%, p&amp;lt;0.001). The presence of regional myocardial ischemia was associated with increased AER in non-diabetic (2.5% vs. 1.1%, p&amp;lt;0.001), but not in diabetic patients (3.4% vs. 2.7%, p=0.238). Low global stress MBF was associated with increased AER in non-diabetic (2.9% vs. 1.3%, p&amp;lt;0.001), but not among diabetic patients (3.2% vs. 3.0%, p=0.286). Conclusions Diabetes was associated with more advanced CAD. Quantified severity of anatomical findings predicted long-term adverse outcome in non-diabetic and diabetic patients. In contrast, functional imaging risk stratified non-diabetic patients, whereas diabetic patients had impaired long-term outcome irrespective of perfusion findings.

Epicardial adipose tissue volume and density are associated with heart failure with improved ejection fraction

Abstract Background Heart failure (HF) with improved ejection fraction (EF, HFimpEF) gains increasing attention as a distinct HF subtype, characterized by left ventricular reverse remodeling and myocardial recovery. Multiple cardiometabolic factors are implicated in this process. Epicardial adipose tissue (EAT), emerging as an endocrine and paracrine organ, contributes to the onset and progression of HF. However, the relation between EAT and the incidence of HFimpEF is still unclear. Methods A total of 203 hospitalized HF patients with reduced EF (HFrEF, EF≤ 40%) who underwent coronary CT angiography (CCTA) during index hospitalization were consecutively enrolled between November 2011 and December 2022. Routine follow-up and repeat echocardiograms were performed. The incidence of HFimpEF was defined as (1) an absolute EF improvement ≥10% and (2) a second EF &amp;gt; 40% (at least 3 months apart). EAT volume and density were semiautomatically quantified on non-enhanced series of CCTA scans. Results During a median follow-up of 8.6 (4.9~13.3) months, 104 (51.2%) patients developed HFimpEF. Compared with HFrEF patients, HFimpEF patients had lower EAT volume (126.03 ± 57.71 cm3 vs 182.74 ± 82.99 cm3 , P&amp;lt; 0.001) and higher EAT density (-74.92 ± 6.84 HU vs -78.76 ± 6.28 HU, P&amp;lt; 0.001) both in ischemic and non-ischemic HF patients. EAT density was inversely correlated with EAT volume (r= -0.33, P&amp;lt; 0.001). Multivariate analysis showed lower EAT volume (OR: 0.881 [95% CI 0.821~0.939]) and higher density (OR: 2.354 [95% CI 1.314~4.415]) were both independently associated with the incidence of HFimpEF, after adjusting for conventional risk factors, pharmacological therapies and baseline anthropometric parameters including body mass index. Subgroup analysis revealed that the association between EAT properties and HFimpEF was not modified by HF etiology. Conclusions This study reveals that lower EAT volume and higher EAT density are associated with development of HFimpEF. Therapies targeted at reducing EAT quantity and improving its quality might provide favorable effects on myocardial recovery in HF patients.

AI-enabled cardiac chambers volumetry in non-contrast coronary artery calcium CT scans vs. contrast-enhanced coronary CT angiography scans in the same patients

Abstract Introduction We have developed an AI-enabled automated volumetry of cardiac chambers (AutoChamber) that works both on non-contrast ECG-gated cardiac CT scans used for coronary artery calcium (CAC) score, and non-contrast non-gated lung cancer screening CT scans. We have recently reported the agreement between AutoChamber measurements vs cardiac MRI measurements. Here we report AutoChamber results on non-contrast CAC scans and contrast enhanced coronary CT angiography (CTA). Methods We have obtained CT images from a previously published study in which 131 cases underwent non-contrast CAC and contrast enhanced CCTA at research institute. The cases consisted of 52.4% women with ages 55.0 ± 10.1 years. The cardiac chambers volume in 131 cases of contrast enhanced CCTA were measured using automated chamber volumetry by Philips Brilliance Volume v 4.5; Philips Healthcare. Results The correlations between Philips’ automated chamber volumetry in contrast enhanced CCTA scans versus AutoChamber automated volumetry in non-contrast CAC scans for left atrium (LA), left ventricle (LV), right atrium (RA), right ventricle (RV), and left ventricular wall (LVW) volume were 0.73, 0.65, 0.85, 0.93, 0.90, respectively (P for all &amp;lt;0.01). Conclusion AI-enabled AutoChamber volumetry based on non-contrast cardiac scans is feasible, and correlates reasonably well with contrast-enhanced cardiac CT scans. Further studies are warranted to reproduce these results and explore the add-on value of AutoChamber to CAC scans.

AI-enabled automated cardiac chambers volumetry in non-contrast ECG-gated cardiac scans vs. non-contrast non-gated lung scans

Abstract Introduction We have developed an AI-enabled automated volume measurement of cardiac chambers (AutoChamber) that works on ECG-gated coronary artery calcium scans and correlates well with contrast enhanced coronary CT angiography scans. We have recently reported that increased left atrial volume measured by AutoChamber is a strong predictor of new onset atrial fibrillation (AF) in asymptomatic individuals of Multi-Ethnic Study of Atherosclerosis (MESA). In this study, we compare the volumetry results in ECG- gated CAC scans with those of non-gated full-chest lung cancer screening scans in the same individuals. Methods We have studied 169 cases of paired ECG-gated cardiac CT scans and non-gated lung scans obtained from Harbor UCLA. Mean±SD for age was 62.1±10.0 years with 52% female participants. All cases were asymptomatic and were scanned for preventive health assessment. AutoChamber was run on all cases by an independent operator who was not involved in data analysis. P value was calculated using a two-tailed test of significance with α=0.05. Results AutoChamber in cardiac scans vs lung scans reported volume (Mean±SD) for left atrium (LA) was 63.8 ± 18.5 vs. 65.5 ± 19.4, left ventricle (LV) 102.8 ± 25.3 vs. 105.5 ± 25.2, right atrium (RA) 81.9 ± 20.5 vs. 85.7 ± 21.9 right ventricle (RV), 140.7 ± 34.2 vs. 134.2 ± 33.7, left ventricle wall (LVW) 113.0 ± 26.6 vs. 109.7 ± 27.0 respectively (P &amp;lt; 0.0001). Strong correlation was shown between cardiac and lung scans for each cardiac chamber: LA (R = 0.92), LV (R = 0.93), RA (R = 0.91), RV (R = 0.92), and left ventricular wall (LVW) R = 0.95. Conclusions AutoChamber volumetry results are similar in ECG-gated cardiac scans vs non-gated full-chest lung scans. This AI-enabled automated tool is promising as it can provide added value to patients undergoing coronary calcium and lung cancer screening scans flagging enlarged cardiac chambers at risk of AF and heart failure.

Bioactive lipids improve serum HDL and PON1 activities in coronary artery disease patients: Ex-vivo study

Atherosclerotic cardiovascular disease (CVD) remains a leading cause of vascular disease worldwide. Atherosclerosis is characterized by the accumulation of lipids and oxidized lipids on the blood vessel walls. Coronary artery disease (CAD) is the most common display of atherosclerotic CVD. We investigated the effects of the bioactive lipids as lyso-diacylglyceryltrimethylhomoserine (lyso-DGTS (20,5,0)) and its derivative oleoyl-N-trimethyl homoserine amide (oleoyl amide-MHS) on the properties and functionality of HDL and paraoxonase 1 (PON1) activities in the serum of individuals who exhibited arterial plaque as observed by coronary CT angiography (CCTA). The study included two independent groups comprising 40 patients who had undergone arterial CCTA scans at Ziv Medical Center for various medical indications. The CAD group included 20 patients with coronary artery plaques with luminal stenosis of more than 50% in a major coronary vessel. The control group consisted of 20 healthy patients (patients without artery plaques). Serum samples from CAD patients exhibited lower serum PON1 and cholesterol efflux activities and higher pro-inflammatory than the control group. HDL isolated from CAD patients contains elevated levels of oxidizing lipids (specifically lyso- phosphatidyl ethanolamines and lyso-phosphocholines(compared to the control. However, incubation of the CAD patients' serum with lyso-DGTS and oleoyl amide-MHS restored the antiatherogenic activities of HDL. The lipids increased serum PON1 activities, enhanced apoB-depleted serum cholesterol-efflux activity, and elevated the serum's anti-inflammatory properties. The results of the present study suggest the potential of the bioactive lipids lyso-DGTS and oleoyl amide-MHS to attenuate atherosclerosis via the improvement of dysfunctional HDL properties and PON1 activities. Further, in-vivo experiments are needed to assess the athero-protective effect of the lipids.

Performance of artificial intelligence in detecting the chronic total occlusive lesions of coronary artery based on coronary computed tomographic angiography.

Coronary chronic total occlusion (CTO) increases the risk of developing major adverse cardiovascular events (MACE) and cardiogenic shock. Coronary computed tomography angiography (CCTA) is a safe, noninvasive method to diagnose CTO lesions. With the development of artificial intelligence (AI), AI has been broadly applied in cardiovascular images, but AI-based detection of CTO lesions from CCTA images is difficult. We aim to evaluate the performance of AI in detecting the CTO lesions of coronary arteries based on CCTA images. We retrospectively and consecutively enrolled patients with 50% stenosis, 50-99% stenosis, and CTO lesions who received CCTA scans between June 2021 and June 2022 in Beijing Anzhen Hospital. Four-fifths of them were randomly assigned to the training dataset, while the rest (1/5) were randomly assigned to the testing dataset. Performance of the AI-assisted CCTA (CCTA-AI) in detecting the CTO lesions was evaluated through sensitivity, specificity, positive predictive value, negative predictive value, accuracy, and receiver operating characteristic analysis. With invasive coronary angiography as the reference, the diagnostic performance of AI method and manual method was compared. A total of 537 patients with 1,569 stenotic lesions (including 672 lesions with <50% stenosis, 493 lesions with 50-99% stenosis, and 404 CTO lesions) were enrolled in our study. CCTA-AI saved 75% of the time in post-processing and interpreting the CCTA images when compared to the manual method (116±15 vs. 472±45 seconds). In the testing dataset, the accuracy of CCTA-AI in detecting CTO lesions was 86.2% (79.0%, 90.3%), with the area under the curve of 0.874. No significant difference was found in detecting CTO lesions between AI and manual methods (P=0.53). AI can automatically detect CTO lesions based on CCTA images, with high diagnostic accuracy and efficiency.

Polygenic Risk Is Associated With Long-Term Coronary Plaque Progression and High-Risk Plaque

The longitudinal relation between coronary artery disease (CAD) polygenic risk score (PRS) and long-term plaque progression and high-risk plaque (HRP) features is unknown. The goal of this study was to investigate the impact of CAD PRS on long-term coronary plaque progression and HRP. Patients underwent CAD PRS measurement and prospective serial coronary computed tomography angiography (CTA) imaging. Coronary CTA scans were analyzed with a previously validated artificial intelligence-based algorithm (atherosclerosis imaging-quantitative computed tomography imaging). The relationship between CAD PRS and change in percent atheroma volume (PAV), percent noncalcified plaque progression, and HRP prevalence was investigated in linear mixed-effect models adjusted for baseline plaque volume and conventional risk factors. A total of 288 subjects (mean age 58 ± 7 years; 60% male) were included in this study with a median scan interval of 10.2 years. At baseline, patients with a high CAD PRS had a more than 5-fold higher PAV than those with a low CAD PRS (10.4% vs 1.9%; P< 0.001). Per 10 years of follow-up, a 1 SD increase in CAD PRS was associated with a 0.69% increase in PAV progression in the multivariable adjusted model. CAD PRS provided additional discriminatory benefit for above-median noncalcified plaque progression during follow-up when added to a model with conventional risk factors (AUC: 0.73 vs 0.69; P = 0.039). Patients with high CAD PRS had an OR of 2.85 (95%CI: 1.14-7.14; P = 0.026) and 6.16 (95%CI: 2.55-14.91; P< 0.001) for having HRP at baseline and follow-up compared with those with low CAD PRS. Polygenic risk is strongly associated with future long-term plaque progression and HRP in patients suspected of having CAD.

Development and first implementation of a novel multi-modality cardiac motion and dosimetry phantom for radiotherapy applications.

Cardiac applications in radiation therapy are rapidly expanding including magnetic resonance guided radiation therapy (MRgRT) for real-time gating for targeting and avoidance near the heart or treating ventricular tachycardia (VT). This work describes the development and implementation of a novel multi-modality and magnetic resonance (MR)-compatible cardiac phantom. The patient-informed 3D model was derived from manual contouring of a contrast-enhanced Coronary Computed Tomography Angiography scan, exported as a Stereolithography model, then post-processed to simulate female heart with an average volume. The model was 3D-printed using Elastic50A to provide MR contrast to water background. Two rigid acrylic modules containing cardiac structures were designed and assembled, retrofitting to an MR-safe programmable motor to supply cardiac and respiratory motion in superior-inferior directions. One module contained a cavity for an ion chamber (IC), and the other was equipped with multiple interchangeable cavities for plastic scintillation detectors (PSDs). Images were acquired on a 0.35 T MR-linac for validation of phantom geometry, motion, and simulated online treatment planning and delivery. Three motion profiles were prescribed: patient-derived cardiac (sine waveform, 4.3mm peak-to-peak, 60 beats/min), respiratory (cos4 waveform, 30mm peak-to-peak, 12 breaths/min), and a superposition of cardiac (sine waveform, 4mm peak-to-peak, 70 beats/min) and respiratory (cos4 waveform, 24mm peak-to-peak, 12 breaths/min). The amplitude of the motion profiles was evaluated from sagittal cine images at eight frames/s with a resolution of 2.4mm × 2.4mm. Gated dosimetry experiments were performed using the two module configurations for calculating dose relative to stationary. A CT-based VT treatment plan was delivered twice under cone-beam CT guidance and cumulative stationary doses to multi-point PSDs were evaluated. No artifacts were observed on any images acquired during phantom operation. Phantom excursions measured 49.3±25.8%/66.9±14.0%, 97.0±2.2%/96.4±1.7%, and 90.4±4.8%/89.3±3.5% of prescription for cardiac, respiratory, and cardio-respiratory motion profiles for the 2-chamber (PSD) and 12-substructure (IC) phantom modules respectively. In the gated experiments, the cumulative dose was<2% from expected using the IC module. Real-time dose measured for the PSDs at 10Hz acquisition rate demonstrated the ability to detect the dosimetric consequences of cardiac, respiratory, and cardio-respiratory motion when sampling of different locations during a single delivery, and the stability of our phantom dosimetric results over repeated cycles for the high dose and high gradient regions. For the VT delivery, high dose PSD was<1% from expected (5-6 cGy deviation of 5.9Gy/fraction) and high gradient/low dose regions had deviations<3.6% (6.3 cGy less than expected 1.73Gy/fraction). A novel multi-modality modular heart phantom was designed, constructed, and used for gated radiotherapy experiments on a 0.35 T MR-linac. Our phantom was capable of mimicking cardiac, cardio-respiratory, and respiratory motion while performing dosimetric evaluations of gated procedures using IC and PSD configurations. Time-resolved PSDs with small sensitive volumes appear promising for low-amplitude/high-frequency motion and multi-point data acquisition for advanced dosimetric capabilities. Illustrating VT planning and delivery further expands our phantom to address the unmet needs of cardiac applications in radiotherapy.