Total Plaque Volume Research Articles

Abstract 17494: The Incremental Risk Prediction of Cardiac CTA-Derived Quantitative Atherosclerosis in the International Advance Registry

Background: We sought to assess the incremental prognostic utility of AI-enabled quantitative coronary plaque assessment (AI-QCPA) beyond stenosis severity and FFR CT , for the prediction of late revascularization and MACE in the large prospective international ADVANCE registry. Methods: 4737 participants were submitted for AI-QCPA evaluation. Total plaque volume (TPV), calcified plaque volume (CPV), non-calcified plaque volume (NCPV), and low attenuated plaque volume (LAPV) were quantified. In addition, total percent plaque volume (TPAV) and its components were calculated (PV/Vessel Volume * 100). Demographics, stenosis severity, lowest FFR CT , and Delta FFR CT were also recorded. To explore the relationship between plaque measures and MACE (death, myocardial infarction, and unplanned hospitalization leading to revascularization) and late revascularization (>90 days) we performed Kaplan Meier event free outcomes analyses following adjustments for stenosis severity, FFR CT and Delta FFR CT . Results: AI-QCPA was available in 4430 subjects. Mean (SD) TPV was 542.4 ± 522.5 mm 3 . Optimal cutpoints of plaque metrics were predictive of MACE and/or late revascularization when adjusted-TPV (HR- 1.45 CI- 1.06-1.98; P=0.02); CPV (HR- 1.65 CI- 1.21- 2.26; p=0.002); NCPV (HR 1.43 CI- 1.02-1.99; P=0.04) and LAPV (HR- 2.23 CI 1.62-3.07; P=0.03 . Stronger risk prediction was achieved by plaque measures adjusted for vessel volume: TPAV (HR 1.92 CI 1.40- 2.64 P<0.001). This incremental risk discrimination of quantitative plaque measures remained significant as a predictor of MACE alone- TPV- (HR 1.84 CI 1.02- 3.29 P=0.04) TPAV (HR 3.33 CI- 1.85- 6.02 P<0.0001) (Figure 1). Conclusions: In this large prospective international registry, AI-QCPA provided incremental risk discrimination for MACE and late revascularization beyond stenosis severity and FFR CT .

Validation and Reproducibility of Total Plaque Thickness in Carotid and Femoral Arteries Using Ultrasound

Plaque burden quantification by ultrasound improves cardiovascular (CV) risk prediction. However, measuring total plaque volume (TPV) with 3-D ultrasound, the current gold standard, is time consuming. In the present study we investigated the reproducibility of weighted total plaque thickness (wTPT) measured by 2-D ultrasound and its correlation with TPV. Participants in an ongoing study of subclinical atherosclerosis and CV risk with no known atherosclerotic CV disease but who were found to have one or more plaques in carotid or femoral arteries by 2-D ultrasound were included. A total of 34 women and 26 men (mean age: 59.4 y, standard deviation: 8.7) underwent primary 2-D and 3-D ultrasound examinations. Participants then underwent a 2-D ultrasound examination by another radiologist blinded to the first radiologist's findings. Finally, all participants underwent a follow-up 2-D ultrasound by the first radiologist. Comparison of wTPT measurements between the 2-D studies revealed no significant difference (mean difference: 0.29 mm, 95% confidence interval [CI]: -0.48 to 1.17). Inter-observer and intra-observer analyses revealed intraclass correlation coefficients of 0.97 (95% CI: 0.96-0.98) and 1.0 (95% CI: 0.99-1.00), respectively. wTPT correlated with TPV (Spearman's ρ=0.98, 95% CI: 0.96-0.99). Elapsed time for assessing wTPT was less than that for TPV (mean difference: 36.1 min, 95% CI: 26.0-46.3). wTPT had high reproducibility and correlation with TPV while requiring substantially less time. Future studies addressing the role of wTPT in predicting CV disease are needed.

Abstract 14650: Risk Stratifying Individuals With Zero, Minimal, and Mild Coronary Artery Calcium for Cardiovascular Disease by Determining Coronary Plaque Burden

Background and Aims: Previous research has often categorized minimal CAC (1-10) and 0 CAC into a single low-risk category for CVD. However, the clinical significance of plaque burden between these two groups remains unclear. We sought to determine the plaque burden in individuals with CAC scores of 0, 1-10, and 11-100 to specify a more accurate risk stratification for minimal and 0 CAC scores. Methods: Retrospectively reviewed patients with CAC scores ≤100 and performed quantitative coronary plaque analysis (QAngio, Medis). CAC was categorized into three groups: zero (CAC=0), minimal (CAC 1-10), and mild (CAC 11-100). Plaque levels (low attenuated, fibrous, fibro-fatty, dense calcified, total non-calcified) were assessed using multivariable linear regression adjusted for cardiovascular risk factors (age, ethnicity, BMI, gender, hypertension, dyslipidemia, diabetes mellitus, past smoking) Results: 378 subjects were included, with an average age of 53.9±10.7 years and 53% female. Among them, 51% had 0 CAC, 16% had minimal CAC (scores 1-10), and 33% had mild CAC (scores 11-100). The minimal and mild CAC groups were significantly older, with higher rates of diabetes, hypertension, and hyperlipidemia. Multivariable analysis found no significant difference in low attenuated, fibro-fatty, and dense calcified plaque levels between the minimal and 0 CAC groups. However, minimal CAC subjects had significantly higher fibrous, total non-calcified, and total plaque volumes than zero CAC ( Table 3 ). All plaque types were significantly higher in the mild group when comparing mild CAC to minimal CAC." Conclusion: This study shows higher noncalcified coronary plaque and total plaque volume in individuals with minimal calcium scores (1-10) compared to those with 0 CAC. These findings hold clinical significance, challenging previous categorization of minimal CAC as low-risk. Therefore, those with minimal CAC scores need a more accurate risk stratification approach.

Abstract 11776: Sex Differences in Coronary Artery Disease Characteristics Among Patients With Type 2 Myocardial Infarction: Results From the Prospective DEFINE-Type 2 MI Study

Background: Type 2 Myocardial Infarction (T2MI) is a result of coronary supply and demand imbalance and is associated with a poor prognosis. It is crucial to identify potential sex-based differences in the prevalence and nature of coronary artery disease (CAD) within this specific population. Retrospective analyses are limited by selection bias, unequal proportions of male and female subjects, and lack of angiographic definition. Hypothesis: In patients with T2MI, women and men will have unique characteristics. Aim: To evaluate sex-based differences in presentation, prevalence/characteristics of CAD and clinical management of T2MI. Methods: In a single-center prospective study, patients with strictly adjudicated T2MI underwent coronary computed tomography angiography and Fractional Flow Reserve (FFR CT ) and quantitative plaque assessment was performed. Results: Of 50 study participants enrolled, 50% were women. Women with T2MI were older than men with T2MI (72.2 ± 10.1 vs. 64 ± 11.3 years; p = 0.009) but otherwise had similar baseline characteristics. A broad and similar mix of T2MI precipitants were present among both sexes. Ischemic ST depression was more common in women (64% vs. 32%; p = 0.05) while men were more likely to have T wave inversion (68% vs. 36%; p = 0.05). Women and men had comparable CAC scores (median [Q1, Q3] 152 [45, 762] vs. 234 [56, 422]; p = 0.07). Prevalence of any CAD (100% vs. 84%; p = 0.12), obstructive CAD (28% vs. 24%; p = 1.0), and hemodynamically significant focal stenosis with FFR CT < 0.80 (64% vs. 56%; p = 0.08) were similar between men and women. While total plaque volumes were similar between men and women, women had significantly lower levels of low-attenuation plaque (median [Q1, Q3]: 3 [1,7] vs. 9 [3, 14]; p = 0.03). Men and women did not significantly differ in percentile of plaque burden. Both sexes showed comparable increases in the utilization of aspirin (OR = 0.67; p = 0.53), beta blockers (OR = 0.76; p = 0.71), and statins (OR = 0.22; p = 0.08) by discharge. Conclusions: This prospective study of using FFRCT in T2MI identifies similarities and differences in clinical presentation and CAD characteristics of T2MI in both men and women. These findings may be helpful in improving the identification and management of T2MI.

Abstract 14729: Association of Iliac Artery Non-Calcified Plaque Volume and Acute Limb Ischemia: Insights From the VOYAGER PAD Angiographic Core Lab

Introduction/Background: Acute limb ischemia (ALI) is a severe complication of peripheral artery disease. Lipid lowering and antithrombotic therapies reduce ALI but pathologic studies have described thrombus in distal arteries without plaque, suggesting that artery to artery embolism from proximal (aortic-iliac) athero-thrombosis may be a key driver. Research Questions/Hypothesis: We hypothesized that the burden and character of atherosclerosis in the iliac arteries of patients with PAD would be associated with long term risk of ALI. Methods: VOYAGER PAD enrolled 6,554 patients with PAD and collected 2,200 baseline angiograms in 1,664 patients including 400 CT angiograms enabling plaque characterization. A case-control of 9 who had ALI during follow up and 9 controls were matched on anatomic and patient characteristics, type of index revascularization and disease pattern. Images were read by a blinded, independent imaging core lab. Results/Data: Of the 9 ALI cases, 45% had iliac artery occlusion and 55% had distal artery occlusion. Plaque characteristics were different in cases relative to controls including significantly greater non-calcified plaque volume (OR 2.36, 95% CI 1.05 - 9.38, p=0.03) as well as similar trends for low attenuation plaque (OR 1.65, 95% CI 0.89 - 4.72, p=0.05), and plaque burden (OR 1.16, 95% CI 1.00 - 1.25, p=0.03, Figure). In patients who experienced ALI, there was a trend for greater non-calcified plaque in the limb that experienced the ALI relative to the contra-lateral limb (index 7.2 vs contra-lateral 5.4, p=0.08). Conclusions: In a case-control series, total non-calcified plaque volume and overall plaque burden in the iliac arteries were associated with future ALI over 3 years. Based on the observations in this case-control, we are now analyzing plaque and outcomes in the full cohort. These data are hypothesis generating and suggest that plaque characteristics may be associated with ALI and may serve a surrogate marker of risk.

How early can atherosclerosis be detected by coronary CT angiography? Insights from quantitative CT analysis of serial scans in the PARADIGM trial

BackgroundNon-obstructing small coronary plaques may not be well recognized by expert readers during coronary computed tomography angiography (CCTA) evaluation. Recent developments in atherosclerosis imaging quantitative computed tomography (AI-QCT) enabled by machine learning allow for whole-heart coronary phenotyping of atherosclerosis, but its diagnostic role for detection of small plaques on CCTA is unknown. MethodsWe performed AI-QCT in patients who underwent serial CCTA in the multinational PARADIGM study. AI-QCT results were verified by a level III experienced reader, who was blinded to baseline and follow-up status of CCTA. This retrospective analysis aimed to characterize small plaques on baseline CCTA and evaluate their serial changes on follow-up imaging. Small plaques were defined as a total plaque volume <50 ​mm3. ResultsA total of 99 patients with 502 small plaques were included. The median total plaque volume was 6.8 ​mm3 (IQR 3.5–13.9 ​mm3), most of which was non-calcified (median 6.2 ​mm3; 2.9–12.3 ​mm3). The median age at the time of baseline CCTA was 61 years old and 63% were male. The mean interscan period was 3.8 ​± ​1.6 years. On follow-up CCTA, 437 (87%) plaques were present at the same location as small plaques on baseline CCTA; 72% were larger and 15% decreased in volume. The median total plaque volume and non-calcified plaque volume increased to 18.9 ​mm3 (IQR 8.3–45.2 ​mm3) and 13.8 ​mm3 (IQR 5.7–33.4 ​mm3), respectively, among plaques that persisted on follow-up CCTA. Small plaques no longer visualized on follow-up CCTA were significantly more likely to be of lower volume, shorter in length, non-calcified, and more distal in the coronary artery, as compared with plaques that persisted at follow-up. ConclusionIn this retrospective analysis from the PARADIGM study, small plaques (<50 ​mm3) identified by AI-QCT persisted at the same location and were often larger on follow-up CCTA.

Prognostic value of plaque volume combined with CT fractional flow reserve in patients with suspected coronary artery disease

To investigate the prognostic value of quantitative plaque volume on coronary computed tomography (CT) angiography (CTA) combined with CT fractional flow reserve (CT-FFR) for major adverse cardiac events (MACE) in suspected coronary artery disease (CAD) patients. Patients who underwent coronary CTA with clinically suspected CAD were enrolled retrospectively in this study. Patients' baseline, Framingham Risk Score (FRS), coronary CTA plaque assessment, and CT-FFR were analysed retrospectively. Study outcomes included rehospitalisation and MACE (ST-segment elevation myocardial infarction, unstable angina, or non-ST-segment elevation myocardial infarction, revascularisation, and cardiac death). There were 251 patients in the study, with a follow-up period of 1-6.58 years. Mean age was 61.16±10.45 years and 146 (58%) patients were male. Higher CT-adapted Leaman score and quantitative plaque volume were found in patients with FRS >0.2 regardless of categorical or continuous variables. Coronary scores, quantitative plaque parameters, and CT-FFR were associated with MACE and rehospitalisation in univariate analysis. In model 1, CT-FFR was associated with MACE in multivariate Cox analysis when adjusted for FRS and CT-adapted Leaman score. Quantitative plaque parameters including calcified plaque volume, fibro-fatty plaque volume, low-attenuation plaque volume, non-calcified plaque volume, and total plaque volume were significantly associated with MACE and improved overall prognostic performance in a model adjusted for CT-FFR. Additional quantitative plaque volume and CT-FFR further improve the predictive incremental value based on risk factor scores for prognostic prediction in patients. Adding quantitative plaque volume combined with CT-FFR analysis to anatomical and clinical assessment will be further beneficial to predict patients' prognosis of MACE.

Real-world approach to comprehensive artificial intelligence-aided CT evaluation of coronary artery disease in 530 patients: A retrospective study

PurposeRecent guidelines provide broader support for the use of less invasive imaging modalities for the evaluation of patients with stable chest pain. Coronary CT angiography (CCTA) uses increasingly sophisticated techniques to improve evaluation of coronary lesions. The purpose of this study is to describe one center's experience implementing AI-assisted advanced imaging techniques to diagnose coronary artery disease. Materials & methodsRetrospective study of patients who had AI-assisted CCTA interpretation, including a subgroup who underwent fractional flow reserve CT (FFR-CT) and invasive coronary angiography. Descriptive statistics summarized baseline characteristics and univariate statistics compared findings between groups of patients with and without anatomically and hemodynamically significant lesions based on FFR-CT. For patients who underwent invasive coronary angiography, concordance between CCTA and angiography was evaluated. ResultsOf 532 included patients, AI-assisted CCTA identified statistically significant difference in calcification scores, plaque types and total plaque volume between lesions <50% and ≥50% stenosis. CCTA results were mostly concordant with invasive coronary angiography. Importantly, we identified a subset of patients with less than 50% anatomical stenosis that demonstrated physiologically significant stenosis on FFR-CT and invasive coronary angiography. ConclusionsAI-assisted CCTA and other advanced techniques are a tool to support high quality diagnostic assessment of coronary lesions in a clinical environment. Combined CCTA with FFRCT in mild to moderate coronary stenosis identifies patients with hemodynamically significant stenosis even when quantitative stenosis is <50%. Implementation of AI-assisted coronary CT angiography is feasible in a community hospital setting, but these technologies do not replace the need for expert review and clinical correlation.

Impact of visceral fat on coronary artery disease as defined by quantitative computed tomography angiography.

Obesity is associated with all-cause mortality and cardiovascular disease (CVD). Visceral fat (VF) is an important CVD risk metric given its independent correlation with myocardial infarction and stroke. This study aims to clarify the relationship between the presence and severity of VF with the presence and severity of coronary artery plaque. In 145 consecutive asymptomatic patients, atherosclerosis imaging-quantitative computed tomography was performed for total plaque volume (TPV) and percentage atheroma volume, as well as the volume of noncalcified plaque (NCP), calcified plaque, and low-density NCP (LD-NCP), diameter stenosis, and vascular remodeling. This study also included VF analysis and subcutaneous fat analysis, recording of outer waist circumference, and percentage body fat analysis. The mean age of the patients was 56.1 [SD 8.5] years, and 84.0% were male. Measures of visceral adiposity (mean [SD, Q1-Q3 thresholds]) included estimated body fat, 28.7% (9.0%, 24.1%-33.0%); VF, 169.8 cm2 (92.3, 102.0-219.0 cm2 ); and subcutaneous fat, 223.6 mm2 (114.2, 142.5-288.0 mm2 ). The Spearman correlation coefficients of VF and plaque volume included TPV 0.22 (p = 0.0074), calcified plaque 0.12 (p = 0.62), NCP 0.25 (p = 0.0023), and LD-NCP 0.37 (p < 0.0001). There was a progression of the median coronary plaque volume for each quartile of VF including TPV (Q1: 19.8, Q2: 48.1, Q3: 86.4, and Q4: 136.6 mm3 [p = 0.0098]), NCP (Q1: 15.7, Q2: 35.4, Q3: 86.4, and Q4: 136.6 mm3 [p = 0.0032]), and LD-NCP (Q1: 0.6, Q2: 0.81, Q3: 2.0, and Q4: 5.0 mm3 [p < 0.0001]). These findings demonstrate progression with regard to VF and TPV, NCP volume, and LD-NCP volume. Notably, there was a progression of VF and amount of LD-NCP, which is known to be high risk for future cardiovascular events. A consistent progression may indicate the future utility of VF in CVD risk stratification.

Predicting coronary plaque progression with conventional plaque parameters and radiomics features derived from coronary CT angiography.

To determine the value of combining conventional plaque parameters and radiomics features derived from coronary computed tomography angiography (CCTA) for predicting coronary plaque progression. Clinical data and CCTA images of 400 patients who underwent at least two CCTA examinations between January 2009 and August 2020 were analyzed retrospectively. Diameter stenosis, total plaque volume and burden, calcified plaque volume and burden, noncalcified plaque volume and burden (NCPB), pericoronary fat attenuation index (FAI), and other conventional plaque parameters were recorded. The patients were assigned to a training cohort (n = 280) and a validation cohort (n = 120) in a 7:3 ratio using a stratified random splitting method. The area under the receiver operating characteristics curve (AUC) was used to evaluate the predictive abilities of conventional parameters (model 1), radiomics features (model 2), and their combination (model 3). FAI and NCPB were identified as independent risk factors for coronary plaque progression in the training cohort. Both model 2 (training cohort AUC: 0.814, p < 0.001; validation cohort AUC: 0.729, p = 0.288) and model 3 (training cohort AUC: 0.824, p < 0.001; validation cohort AUC: 0.758, p = 0.042) had better diagnostic performances in predicting plaque progression than model 1 (training cohort AUC: 0.646; validation cohort AUC: 0.654). Moreover, model 3 was slightly higher than model 2, although not statistically significant. The combination of conventional coronary plaque parameters and CCTA-derived radiomics features had a better ability to predict plaque progression than conventional parameters alone. The conventional coronary plaque characteristics such as noncalcified plaque burden, pericoronary fat attenuation index, and radiomics features derived from CCTA can identify plaques prone to progression, which is helpful for further clinical decision-making of coronary artery disease. • FAI and NCPB were identified as independent risk factors for predicting plaque progression. • Coronary plaque radiomics features were more advantageous than conventional parameters in predicting plaque progression. • The combination of conventional coronary plaque parameters and radiomics features could significantly improve the predictive ability of plaque progression over conventional parameters alone.

Epicardial adipose tissue volume, plaque vulnerability and myocardial ischemia in non-obstructive coronary artery disease

BackgroundEpicardial adipose tissue (EAT) accumulation has been associated with inflammation, atherosclerosis and microvascular dysfunction. Whether increased EAT volume is associated with coronary plaque vulnerability and demand myocardial ischemia in patients with non-obstructive coronary artery disease (CAD) is less explored. MethodsIn 125 patients (median age 63[58, 69] years and 58% women) with chest pain and non-obstructive CAD, EAT volume was quantified on non-contrast cardiac CT images. EAT volume in the highest tertile (>125 ml) was defined as high EAT volume. Total coronary plaque volume and plaque vulnerability were quantified by coronary CT angiography (CCTA). Demand myocardial ischemia was detected by contrast dobutamine stress echocardiography. ResultsHigh EAT volume was more common in men and associated with higher BMI, hypertension, increased left ventricular mass index (LVMi), C-reactive protein (CRP) and positive remodelling (all p < 0.05). There was no difference in age, coronary calcium score, total and non-calcified plaque volume or presence of demand myocardial ischemia between groups (all p ≥ 0.34). In a multivariable model, obesity (p = 0.006), hypertension (p = 0.007) and LVMi (p = 0.016) were independently associated with high EAT volume. Including plaque vulnerability in an alternative model, positive remodelling (p = 0.038) was independently associated with high EAT volume. ConclusionIn non-obstructive CAD, high EAT volume was associated with cardiometabolic risk factors, inflammation and plaque vulnerability, while there was no association with demand myocardial ischemia or coronary plaque volume. Following our results, the role of EAT volume as a biomarker in non-obstructive CAD remains unclear.

Age- and Sex-Specific Nomographic CT Quantitative Plaque Data From a Large International Cohort

BackgroundWith growing adoption of coronary computed tomographic angiography (CTA), there is increasing evidence for and interest in the prognostic importance of atherosclerotic plaque volume. Manual tools for plaque segmentation are cumbersome, and their routine implementation in clinical practice is limited. ObjectivesThe aim of this study was to develop nomographic quantitative plaque values from a large consecutive multicenter cohort using coronary CTA. MethodsQuantitative assessment of total atherosclerotic plaque and plaque subtype volumes was performed in patients undergoing clinically indicated coronary CTA, using an Artificial Intelligence–Enabled Quantitative Coronary Plaque Analysis tool. ResultsA total of 11,808 patients were included in the analysis; their mean age was 62.7 ± 12.2 years, and 5,423 (45.9%) were women. The median total plaque volume was 223 mm3 (IQR: 29-614 mm3) and was significantly higher in male participants (360 mm3; IQR: 78-805 mm3) compared with female participants (108 mm3; IQR: 10-388 mm3) (P < 0.0001). Total plaque increased with age in both male and female patients. Younger patients exhibited a higher prevalence of noncalcified plaque. The distribution of total plaque volume and its components was reported in every decile by age group and sex. ConclusionsThe authors developed pragmatic age- and sex-stratified percentile nomograms for atherosclerotic plaque measures using findings from coronary CTA. The impact of age and sex on total plaque and its components should be considered in the risk-benefit analysis when treating patients. Artificial Intelligence–Enabled Quantitative Coronary Plaque Analysis work flows could provide context to better interpret coronary computed tomographic angiographic measures and could be integrated into clinical decision making.

Impact of immune checkpoint inhibitors on atherosclerosis progression in patients with lung cancer

BackgroundPatients with lung cancer face a heightened risk of atherosclerosis-related cardiovascular events. Despite the strong scientific rationale, there is currently a lack of clinical evidence examining the impact of immune...

Association between coronary inflammation measured by FAT attenuation index and CT features of atheromatous plaque vulnerability

Abstract Funding Acknowledgements Type of funding sources: Public grant(s) – EU funding. Main funding source(s): This research has been funded by the research grant Intel-FAT, proposal registration code PN-III-P4-ID-PCE-2020-2861, contract number PCE 206/2021, Project funded by the European Union and the Government of Romania through the Ministry of European Funds, and the Doctoral School of the “George Emil Palade” University of Medicine, Pharmacy, Science and Technology of Târgu Mureș, Romania. Background Coronary computed tomography angiography (CCTA) is a rapidly evolving tool for the assessment of coronary artery disease (CAD), being able to characterise not only the degree of coronary artery stenosis but also the presence and severity of coronary plaque vulnerability. Fat attenuation index (FAI) is a recently developed marker of coronary inflammation, based on the gradient of CT density at the level of pericoronary fat. Purpose The aim of our study is to investigate the correlation between (1) coronary inflammation as assessed by FAI score, and (2) vulnerability degree of atheromatous coronary plaques, as assesses by presence and severity of CT features of vulnerability at the level of coronary plaques. Methods A total of 54 patients who underwent 128-slice CCTA for chest pain, and having at least one vulnerable coronary plaque, were enrolled in the study. Vulnerable plaques were defined as plaques showing at least one of the following on CT scan: low attenuation plaque, napkin-ring sign, spotty calcifications, or positive remodeling. In total, 114 vulnerable plaques were identified and analyzed using the advanced via Syngo.via Frontier software. FAI score was determined using the FAI technology patented by Caristo. Results The FAI score of coronary inflamamtion was significantly correlated with the total plaque volume at the level of left anterior descendent artery (LAD) (p = 0,01), respectively with the calcified plaque volume at the level of the circumflex artery (p = 0,02). Receiver operating characteristic (ROC) analysis for the correlation between the FAI score and the presence of the Napkin Ring Sign (NRS) showed a significant correlation for plaques located on LAD (AUC 0,729; 95%CI 0,585 – 0,845; p = 0,01), and lefty circumflex artery (AUC 0,745; 95%CI 0,601–0,859; p = 0,032), but not for the right coronary artery (AUC 0,636; 95%CI 0,487–0,767; p = 0,25). Furthermore, the ROC analysis identified a good correlation between the FAI score and the presence of spotty calcification or positive coronary remodeling (AUC 0,777, p = 0,0004, respectively AUC 0,717, p = 0,0081). Conclusion Coronary inflammation measured by FAT attenuation index is significantly correlated with the presence of CT vulnerability features in the coronary tree.

A Propensity-Matched Comparison of Ischemic Brain Lesions on Postprocedural MRI in Endovascular versus Open Carotid Artery Reconstruction.

(1) Study purpose: The aim of our prospective single-center, matched case-control study was to compare the number and volume of acute ischemic brain lesions following carotid endarterectomy (CEA) versus carotid artery stenting (CAS) using a propensity-matched design. (2) Methods: Carotid bifurcation plaques were analyzed by using VascuCAP software on CT angiography (CTA) images. The number and volume of acute and chronic ischemic brain lesions were assessed on MRI scans taken 12-48 h after the procedures. Propensity score-based matching was performed at a 1:1 ratio to compare the ischemic lesions on postinterventional MR. (3) Results: A total of 107 patients (CAS, N = 33; CEA, N = 74) were included in the study. There were significant differences in smoking (p = 0.003), total calcification plaque volume (p = 0.004), and lengths of the lesion (p = 0.045) between the CAS and CEA groups. Propensity score matching resulted in 21 matched pairs of patients. Acute ischemic brain lesions were detected in ten patients (47.6%) of the matched CAS group and in three patients (14.2%) in the matched CEA group (p = 0.02). The volume of acute ischemic brain lesions was significantly larger (p = 0.04) in the CAS group than in the CEA group. New ischemic brain lesions were not associated with neurological symptoms in either group. (4) Conclusions: Procedure-related new acute ischemic brain lesions occurred significantly more frequently in the propensity-matched CAS group.

Value of fractional flow reserve derived from coronary computed tomographic angiography and plaque quantitative analysis in predicting adverse outcomes of non-obstructive coronary heart disease

To investigate the value of coronary computed tomographic angiography (CCTA)-based fractional flow reserve (CT-FFR) and plaque quantitative analysis in predicting adverse outcomes in patients with non-obstructive coronary heart disease (CAD). Clinical data of patients with non-obstructive CAD who underwent CCTA at the Affiliated Hospital of Jiangnan University from March 2014 to March 2018 were retrospectively analyzed and followed up, and the occurrence of major adverse cardiovascular event (MACE) was recorded. The patients were divided into MACE and non-MACE groups according to the occurrence of MACE. The clinical data, CCTA plaque characteristics including plaque length, stenosis degree, minimum lumen area, total plaque volume, non-calcified plaque volume, calcified plaque volume, plaque burden (PB) and remodelling index (RI), and CT-FFR were compared between the two groups. Multivaritate Cox proportional risk model was used to evaluate the relationship between clinical factors, CCTA parameters and MACE. The receiver operator characteristic curve (ROC curve) was used to assess the predictive power of outcome prediction model based on different CCTA parameters. Finally 217 patients were included, of which 43 (19.8%) had MACE and 174 (80.2%) did not. The median follow-up interval was 24 (16, 30) months. The CCTA showed that patients in the MACE group had more severe stenosis than that in the non-MACE group [(44.3±3.8)% vs. (39.5±2.5)%], larger total plaque volume and non-calcified plaque volume [total plaque volume (mm3): 275.1 (197.1, 376.9), non-calcified plaque volume (mm3): 161.5 (114.5, 307.8) vs. 117.9 (77.7, 185.5)], PB and RI were larger [PB: 50.2% (42.1%, 54.8%) vs. 45.1% (38.2%, 51.7%), RI: 1.19 (0.93, 1.29) vs. 1.03 (0.90, 1.22)], CT-FFR value was lower [0.85 (0.80, 0.88) vs. 0.92 (0.87, 0.97)], and the differences were statistically significant (all P < 0.05). Cox regression analysis showed that non-calcified plaques volume [hazard ratio (HR) = 1.005. 95% confidence interval (95%CI) was 1.025-4.866], PB ≥ 50% (HR = 3.146, 95%CI was 1.443-6.906), RI ≥ 1.10 (HR = 2.223, 95%CI was 1.002-1.009) and CT-FFR ≤ 0.87 (HR = 2.615, 95%CI was 1.016-6.732) were independent predictors of MACE (all P < 0.05). The model based on CCTA stenosis degree+CT-FFR+quantitative plaque characteristics (including non-calcified plaque volume, RI, PB) [area under the ROC curve (AUC) = 0.91, 95%CI was 0.87-0.95] had significantly better predictive efficacy for adverse outcomes than the model based on CCTA stenosis degree (AUC = 0.63, 95%CI was 0.54-0.71) and the model based on CCTA stenosis degree+CT-FFR (AUC = 0.71, 95%CI was 0.63-0.79; both P < 0.01). CT-FFR and plaque quantitative analysis based on CCTA are helpful in predicting adverse outcomes in patients with non-obstructive CAD. Non-calcified plaque volume, RI, PB and CT-FFR are important predictors of MACE. Compared with the prediction model based on stenosis degree and CT-FFR, the combined plaque quantitative index can significantly improve the prediction efficiency of adverse outcomes in patients with non-obstructive CAD.

Effects of intensive lipid lowering compared with moderate-intensity lipid lowering on coronary atherosclerotic plaque phenotype and major adverse cardiovascular events in adults with low to intermediate 10-year ASCVD risk (ILLUMINATION study): protocol for a multicentre, open-label, blinded-endpoint, randomised controlled trial

IntroductionCurrent guidelines recommend moderate-intensity lipid lowering (low-density lipoprotein cholesterol, LDL-C of <2.6 mmol/L or 30%–49% reduction from the baseline) for patients with intermediate 10-year atherosclerotic cardiovascular disease (ASCVD) risk. The...

Predictive value of DEEPVESSEL-fractional flow reserve and quantitative plaque analysis based on coronary CT angiography for major adverse cardiac events

To investigate the predictive value of the combination of DEEPVESSEL-fractional flow reserve (DVFFR) and quantitative plaque analysis using coronary computed tomographic angiography (CCTA) for major adverse cardiac events (MACE). In this retrospective study, data from 69 vessels from 58 consecutive patients were collected. These patients who underwent coronary angiography (CAG) with DVFFR were divided into MACE-positive and MACE-negative groups. DVFFR measurements were obtained from CCTA images acquired before CAG, and an FFR or DVFFR value≤0.80 was considered haemodynamically significant. CCTA images were analysed quantitatively using automated software to obtain the following indices: total plaque volume (TPV) and burden (TPB), calcified plaque volume (CPV) and burden (CPB), non-calcified plaque volume (NCPV) and burden (NCPB), low-attenuation plaque (LAP), minimum lumen area (MLA), stenosis grade (SG) and lesion length (LL). Univariate and multivariate logistic regression, correlation, and receiver operating characteristic (ROC) analyses were used for statistical analysis. DVFFR was highly correlated with invasive FFR (R=0.728), and the Bland-Altman plot showed good agreement between DVFFR and FFR (95% CI: -0.109-0.087) on a per-vessel level. DVFFR showed a high diagnostic performance in identifying abnormal haemodynamic vessels, with an area under the ROC curve (AUC) of 0.984. In multivariate analysis, the following biomarkers were predictors of MACE: DVFFR ≤ 0.8, SG, TPB, NCPB, and LL values. The combination of the above independent risk factors yielded the most valuable prediction for MACE (AUC:0.888). DVFFR was highly correlated with FFR with satisfactory diagnostic accuracy. DVFFR, together with plaque analysis indices, yielded valuable predictions for MACE.

Associations between the serum triglyceride-glucose index and pericoronary adipose tissue attenuation and plaque features using dual-layer spectral detector computed tomography: a cross-sectional study.

The triglyceride-glucose (TyG) index is a reliable alternative marker for insulin resistance (IR). Pericoronary adipose tissue (PCAT) can indirectly reflect coronary inflammation. IR and coronary inflammation play a key role in the development and progression of coronary atherosclerosis. Therefore, this study investigated the relationships between the TyG index, PCAT and atherosclerotic plaque characteristics to explore whether IR might lead to coronary artery atherosclerosis progression by inducing coronary inflammation. We retrospectively collected data on patients with chest pain who underwent coronary computed tomography angiography using spectral detector computed tomography at our institution from June to December 2021. The patients were grouped based on their TyG index levels: T1 (low), T2 (medium), and T3 (high). Each patient was assessed for total plaque volume, plaque load, maximum stenosis, the plaque component volume proportion, high-risk plaques(HRPs), and plaque characteristics (including low attenuation plaques, positive remodeling, a napkin ring sign, and spot calcification). PCAT quantification was performed on the proximal right coronary artery using the fat attenuation index (FAI) measured from a conventional multicolor computed tomography image (FAI120kVp), a spectral virtual single-energy image (FAI40keV), and the slope of the spectral HU curve (λHU). We enrolled 201 patients. The proportion of patients with maximum plaque stenosis, positive remodeling, low-density plaques, and HRPs increased as the TyG index level increased. Moreover, the FAI40keV and λHU significantly differed among the three groups, and we identified good positive correlations between FAI40keV and λHU and the TyG index (r = 0.319, P <0.01 and r = 0.325, P <0.01, respectively). FAI120kVp did not significantly differ among the groups. FAI40keV had the highest area under the curve, with an optimal cutoff value of -130.5 HU for predicting a TyG index value of ≥9.13. The multivariate linear regression analysis demonstrated that FAI40keV and λHU were independently positively related to a high TyG index level (standardized regression coefficients: 0.117 [P <0.001] and 0.134 [P <0.001], respectively). Patients with chest pain and a higher TyG index level were more likely to have severe stenosis and HRPs. Moreover, FAI40keV and λHU had good correlations with the serum TyG index, which may noninvasively reflect PCAT inflammation under insulin resistance. These results could help explain the mechanism of plaque progression and instability in patients with insulin resistance might be related to IR-induced coronary inflammation.

High-quality annotations for deep learning enabled plaque analysis in SCAPIS cardiac computed tomography angiography

BackgroundPlaque analysis with coronary computed tomography angiography (CCTA) is a promising tool to identify high risk of future coronary events. The analysis process is time-consuming, and requires highly trained readers. Deep learning models have proved to excel at similar tasks, however, training these models requires large sets of expert-annotated training data. The aims of this study were to generate a large, high-quality annotated CCTA dataset derived from Swedish CArdioPulmonary BioImage Study (SCAPIS), report the reproducibility of the annotation core lab and describe the plaque characteristics and their association with established risk factors. Methods and resultsThe coronary artery tree was manually segmented using semi-automatic software by four primary and one senior secondary reader. A randomly selected sample of 469 subjects, all with coronary plaques and stratified for cardiovascular risk using the Systematic Coronary Risk Evaluation (SCORE), were analyzed. The reproducibility study (n = 78) showed an agreement for plaque detection of 0.91 (0.84–0.97). The mean percentage difference for plaque volumes was −0.6% the mean absolute percentage difference 19.4% (CV 13.7%, ICC 0.94). There was a positive correlation between SCORE and total plaque volume (rho = 0.30, p < 0.001) and total low attenuation plaque volume (rho = 0.29, p < 0.001). ConclusionsWe have generated a CCTA dataset with high-quality plaque annotations showing good reproducibility and an expected correlation between plaque features and cardiovascular risk. The stratified data sampling has enriched high-risk plaques making the data well suited as training, validation and test data for a fully automatic analysis tool based on deep learning.