Carotid wall stress calculated with continuous intima-media thickness assessment using B-mode ultrasound

Cardiovascular risk is normally assessed using clinical risk factors but it can be refined using non-invasive infra-clinical markers. Intima-Media Thickness (IMT) is recognized as an early indicator of cardiovascular disease. Carotid Wall Stress (CWS) can be calculated using arterial pressure and carotid size (diameter and IMT). Generally, IMT is measured during diastole when it reaches its maximum value. However, it changes during the cardiac cycle and a time-dependant waveform can be obtained using B-mode ultrasound images. In this work we calculated CWS considering three different approaches for IMT assessment: (i) constant IMT (standard diastolic value), (ii) estimated IMT from diameter waveform (assuming a constant cross-sectional wall area) and (iii) continuously measured IMT. Our results showed that maximum wall stress depends on the IMT estimation method. Systolic CWS progressively increased using the three approaches (p<0.024). We conclude that maximum CWS is highly dependent on wall thickness and accurate IMT measures during systole should be encouraged.Fil: Pascaner, Ariel Fernando. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Universidad Favaloro; ArgentinaFil: Craiem, Damian. Universidad Favaloro; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Casciaro, Mariano Ezequiel. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Universidad Favaloro; ArgentinaFil: Danielo, R.. Fundación Favaloro; ArgentinaFil: Graf Caride, Diego Sebastián. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Universidad Favaloro; ArgentinaFil: Guevara, E.. Fundación Favaloro; Argentin

Geometría vascular y aterosclerosis en sujetos de mediana edad con dolor torácico

Introducción: Las placas ateroscleróticas se distribuyen principalmente en los segmentos proximales y bifurcaciones de los vasos, siendo ello atribuido a las fuerzas de rozamiento vascular. En este estudio presentamos un modelo matemático tridimensional aplicado a individuos con y sin lesiones, acerca del el papel de la disposición geométrica de las arterias en este fenómeno. Métodos: A un total de 90 pacientes de mediana edad que sufrieron dolor torácico se les practicó una coronariografía por Tomografía Multicorte de 64 Filas. Las imágenes se procesaron con un método validado sobre un fantoma con angulaciones que cubrían de 15 a 75 grados y un algoritmo computarizado capaz de ajustar y rotar esta estructura para analizar los segmentos arteriales sinuosos. Resultados: Se distribuyeron los pacientes según la presencia de lesiones ateroscleróticas (n=45) o a su ausencia (n=45). No se encontraron diferencias significativas en los grupos de acuerdo con la edad o con los factores de riesgo tradicionales. Del grupo con placas, la distancia desde el ostium del tronco de la coronaria izquierda hasta su bifurcación fue 7,508 ± 8,98 mm; el espesor de la pared fue de 1,742 ± 0,55 mm. Al comparar la distribución espacial de los vasos dentro de los grupos ¯ con o sin placas¯, se observó que el ángulo formado por la arteria circunfleja y el de la descendente anterior fue de 71,9° ± 18,46 Vs 61,59° ± 21,87, p = 0,017 entre los que tenían sobre los que no poseían lesiones. El radio y volumen de la descendente anterior resultaron elevados (1,85 ± 0,31 Vs 1,65 ± 0,29, y 212,98 mm Vs 154,79 mm respectivamente, p = 0,01). No hubo asociación con las características de la población.Conclusiones: El radio, ángulo y volúmenes de las arterias parecen estar asociados a la existencia de lesiones arteroscleróticas (con independencia) de la edad y factores de riesgo tradicionales, particularmente en los segmentos proximales a las arterias

Three-dimensional evaluation of thoracic aorta enlargement and unfolding in hypertensive men using non-contrast computed tomography.

Aging produces a simultaneous thoracic aorta (TA) enlargement and unfolding. We sought to analyze the impact of hypertension on these geometric changes. Non-contrast computed tomography images were obtained from coronary artery calcium scans, including the entire aortic arch, in 200 normotensive and 200 hypertensive asymptomatic men. An automated algorithm reconstructed the vessel in three-dimensions, estimating orthogonal aortic sections along the whole TA pathway, and calculated several geometric descriptors to assess TA morphology. Hypertensive patients were older with respect to normotensive (P<0.001). Diameter and volume of TA ascending, arch and descending segments were higher in hypertensive patients with respect to normotensive (P<0.001) and differences persisted after adjustment for age. Hypertension produced an accelerated unfolding effect on TA shape. We found increments in aortic arch width (P<0.001), radius of curvature (P<0.001) and area under the arch curve (P<0.01) with a concomitant tortuosity decrease (P<0.05) and no significant change in aortic arch height. Overall, hypertension produced an equivalent effect of 2−7-years of aging. In multivariate analysis adjusted for age and hypertension treatment, diastolic pressure was more associated to TA size and shape changes than systolic pressure. These data suggest that hypertension accelerates TA enlargement and unfolding deformation with respect to the aging effect.Fil: Craiem, Damian. Hôpital Européen Georges-Pompidou; Francia. Universidad Favaloro; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Chironi, G.. Hôpital Européen Georges-Pompidou; Francia. Universite de Paris V; FranciaFil: Casciaro, Mariano Ezequiel. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Universidad Favaloro; ArgentinaFil: Redheuil, A.. Universite de Paris V; Francia. Inserm; Francia. Hôpital Européen Georges-Pompidou; FranciaFil: Mousseaux, E.. Hôpital Européen Georges-Pompidou; Francia. Inserm; Francia. Universite de Paris V; FranciaFil: Simon, A.. Hôpital Européen Georges-Pompidou; Francia. Universite de Paris V; Franci

Thoracic Aorta Calcium Detection and Quantification Using Convolutional Neural Networks in a Large Cohort of Intermediate-Risk Patients

Arterial calcification is an independent predictor of cardiovascular disease (CVD) events whereas thoracic aorta calcium (TAC) detection might anticipate extracoronary outcomes. In this work, we trained six convolutional neural networks (CNNs) to detect aortic calcifications and to automate the TAC score assessment in intermediate CVD risk patients. Cardiac computed tomography images from 1415 patients were analyzed together with their aortic geometry previously assessed. Orthogonal patches centered in each aortic candidate lesion were reconstructed and a dataset with 19,790 images (61% positives) was built. Three single-input 2D CNNs were trained using axial, coronal and sagittal patches together with two multi-input 2.5D CNNs combining the orthogonal patches and identifying their best regional combination (BRC) in terms of lesion location. Aortic calcifications were concentrated in the descending (66%) and aortic arch (26%) portions. The BRC of axial patches to detect ascending or aortic arch lesions and sagittal images for the descending portion had the best performance: 0.954 F1-Score, 98.4% sensitivity, 87% of the subjects correctly classified in their TAC category and an average false positive TAC score per patient of 30. A CNN that combined axial and sagittal patches depending on the candidate aortic location ensured an accurate TAC score prediction

Calcifications of the thoracic aorta on extended non-contrast-enhanced cardiac CT

<p>This spreadsheet contains measurements of thoracic aorta calcification (TAC) in 970 asymptomatic patients from an article titled "Calcifications of the thoracic aorta on extended non-contrast-enhanced cardiac CT" and published in PlusONE. Calcifications were quantified using the Agatston method. The thoracic aorta was divided into 5 segments as describes in the publication. The scan covered the aortic arch.The number of calcifications and the cumulative Agatston score are informed per segment. The length of each segment is informed in cm. Risk factors as hypertension (HTA), hypercholesterolemia (HCT), smoking status, diabetes and the presence of coronary artery calcium (CAC) and are also included for each patient.</p

Proportion of patients with calcifications across thoracic aorta segments separated by age tertiles.

<p>Proportion of patients with calcifications across thoracic aorta segments separated by age tertiles.</p

Stratified analysis to identify candidate patients for reclassification.

<p>Group 1: CAC = 0 and extended TAC = 0 (free of calcium). Group 2: CAC>0 or standard TAC>0. Group 3: CAC = 0 and standard TAC = 0 and extended TAC>0. CAC = Coronary artery calcium. Standard TAC was calculated only including segments 1 and 5. Extended TAC included all 5 segments (see <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0109584#pone-0109584-g001" target="_blank">Figure 1C</a>).</p><p>*p<0.05 with respect to Group1.</p>+<p>p<0.05 with respect to Group 2.</p><p>Patients were separated into subjects free of calcium (Group 1), those assessed with traditionally measured method (Group 2) and candidates for reclassifications that were exclusively assesed with the proposed extended method (Group 3).</p><p>Stratified analysis to identify candidate patients for reclassification.</p

Population description. Continuous variables are expressed as mean±SD.

<p>Population description. Continuous variables are expressed as mean±SD.</p

Presence and extent of coronary artery and thoracic aorta calcifications. Presence/absence of calcium and Agatston scores are reported.

<p>Standard TAC was calculated only including segments 1 and 5. Extended TAC included all 5 segments as in <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0109584#pone-0109584-g001" target="_blank">Figure 1C</a>.</p><p>Presence and extent of coronary artery and thoracic aorta calcifications. Presence/absence of calcium and Agatston scores are reported.</p