Cardiac computed tomography radiomics for the non-invasive assessment of coronary inflammation

Radiomics, via the extraction of quantitative information from conventional radiologic images, can identify imperceptible imaging biomarkers that can advance the characterization of coronary plaques and the surrounding adipose tissue. Such an approach can unravel the underlying pathophysiology of atherosclerosis which has the potential to aid diagnostic, prognostic and, therapeutic decision making. Several studies have demonstrated that radiomic analysis can characterize coronary atherosclerotic plaques with a level of accuracy comparable, if not superior, to current conventional qualitative and quantitative image analysis. While there are many milestones still to be reached before radiomics can be integrated into current clinical practice, such techniques hold great promise for improving the imaging phenotyping of coronary artery disease.Kevin Cheng, Andrew Lin, Jeremy Yuvaraj, Stephen J. Nicholls and Dennis T.L. Won

Atherogenic index of plasma is associated with epicardial adipose tissue volume assessed on coronary computed tomography angiography

Published online: 10 June 2022The atherogenic index of plasma (AIP) is a novel biomarker of atherogenic dyslipidaemia (AD), but its relationship with cardiac adipose tissue depots is unknown. We aimed to assess the association of AD with cardiac adipose tissue parameters on coronary computed tomography angiography (CCTA). We studied 161 patients who underwent CCTA between 2008 and 2011 (age 59.0 ± 14.0 years). AD was defined as triglyceride (TG) > 1.7 mmol/L and HDL 3, age, male sex and type II diabetes when corrected for traditional risk factors and plaque burden. AIP is associated with increased EAT volume, but not PCAT-a, after multivariable adjustment. These findings indicate AIP is associated with adverse adipose tissue changes which may increase coronary risk.Jeremy Yuvaraj, Mourushi Isa, Zhu Chung Che, Egynne Lim, Nitesh Nerlekar, Stephen J. Nicholls, Sujith Seneviratne, Andrew Lin, Damini Dey and Dennis T. L. Won

Inflammation in coronary atherosclerosis and its therapeutic implications

OnlinePubl.Atherosclerotic coronary artery disease has a complex pathogenesis which extends beyond cholesterol intimal infiltration. It involves chronic inflammation of the coronary artery wall driven by systemic and local activation of both the adaptive and innate immune systems, which can ultimately result in the rupture or erosion of atherosclerotic plaque, leading to thrombosis and myocardial infarction (MI). Despite current best practice care, including the widespread use of cholesterol-lowering statins, atherothrombotic cardiovascular events recur at alarming rates post-MI. To a large extent, this reflects residual inflammation that is not adequately controlled by contemporary treatment. Consequently, there has been increasing interest in the pharmacological targeting of inflammation to improve outcomes in atherosclerotic cardiovascular disease. This has comprised both novel pathway-specific agents, most notably the anti-interleukin-1 beta monoclonal antibody, canakinumab, and the repurposing of established, broad-acting drugs, such as colchicine, that are already approved for the management of other inflammatory conditions. Here we discuss the importance of inflammation in mediating atherosclerosis and its complications and provide a timely update on "new" and "old" anti-inflammatory therapies currently being investigated to target it.Nicholas J. Montarello, Mau T. Nguyen, Dennis T.L. Wong, Stephen J. Nicholls, Peter J. Psalti

Current state-of-play in spontaneous coronary artery dissection

For over 80 years, spontaneous coronary artery dissection (SCAD) has been recognised as a cause of myocardial infarction. SCAD is described as a non-iatrogenic, non-atherosclerotic coronary artery dissection, resulting in formation of a false lumen or intramural haematoma in the coronary artery wall that compresses the true lumen, often compromising myocardial blood flow. In early literature, the incidence of SCAD in acute coronary syndrome (ACS) was underestimated. Recent advances in awareness and widespread early angiographic investigation in ACS has led to important shifts in our understanding of the prevalence, predisposing causes, natural history, aetiology, clinical and angiographic features, management, and prognosis of SCAD. It is now well understood that SCAD predominantly affects women and is responsible for around 20% of ACS presentations in females below the age of 60. Despite this, SCAD is still often overlooked and misdiagnosed as atherosclerotic disease. Misdiagnosis is multifactorial; with contributing factors including a low clinical index of suspicion, particularly in young females, a lack of clinician familiarity with angiographic variants, and limitations of angiography. Although increasing evidence suggests that optimal management is distinct from atherosclerotic coronary artery disease, many questions remain unanswered regarding the pathogenesis and optimal treatment of SCAD, heralding prospective research to answer these questions. This review aims to give a current clinical perspective on SCAD and highlight the importance of familiarity and vigilance with this condition when diagnosing and treating ACS.Kyle B. Franke, Dennis T. L. Wong, Angus Baumann, Stephen J. Nicholls, Rajiv Gulati, Peter J. Psalti

Is spontaneous coronary artery dissection (SCAD) related to vascular inflammation and epicardial fat? – insights from computed tomography coronary angiography

Abstract not available.Jeremy Yuvaraj, Andrew Lin, Nitesh Nerlekar, Hashrul Rashid, James D. Cameron, Sujith Seneviratne, Stephen Nicholls, Peter J. Psaltis, Dennis T.L. Won

Quantitative and qualitative coronary plaque assessment using computed tomography coronary angiography: a comparison with intravascular ultrasound

BACKGROUND:To compare computed tomography coronary angiography (CTCA) with intravascular ultrasound (IVUS) in quantitative and qualitative plaque assessment. METHODS:Patients who underwent IVUS and CTCA within 3 months for suspected coronary artery disease were retrospectively studied. Plaque volumes on CTCA were quantified manually and with automated-software and were compared to IVUS. High-risk plaque features were compared between CTCA and IVUS. RESULTS:There were 769 slices in 32 vessels (27 patients). Manual plaque quantification on CTCA was comparable to IVUS per slice (mean difference of 0.06±0.07, p=0.44; Bland-Altman 95% limits of agreement -2.19-2.08 mm3, bias of -0.06mm3) and per vessel (3.1mm3 ± -2.85mm3, p=0.92). In contrast, there was significant difference between automated-software and IVUS per slice (2.3±0.09mm3, p<0.001; 95% LoA -6.78 to 2.25mm3, bias of -2.2mm3) and per vessel (33.04±10.3 mm3, p<0.01). The sensitivity, specificity, positive and negative predictive value of CTCA to detect plaques that had features of echo-attenuation on IVUS was 93.3%, 99.6%, 93.3% and 99.6% respectively. The association of ≥2 high-risk plaque features on CTCA with echo attenuation (EA) plaque features on IVUS was excellent (86.7%, 99.6%, 92.9% and 99.2%). In comparison, the association of high-risk plaque features on CTCA and plaques with echo-lucency on IVUS was only modest. CONCLUSION:Plaque volume quantification by manual CTCA method is accurate when compared to IVUS. The presence of at least two high-risk plaque features on CTCA is associated with plaque features of echo attenuation on IVUS.Ravi Kiran Munnur, Jordan Andrews ... Peter Psaltis ... Stephen Nicholls ... Jordan Andrews ... Yu Kataoka ... et al

Tandem lesions associate with angiographic progression of coronary artery stenoses

Available online 3 May 2024Background: Although the clinical factors associated with progression of coronary artery disease have been well studied, the angiographic predictors are less defined. Objectives: Our objective was to study the clinical and angiographic factors that associate with progression of coronary artery stenoses. Methods: We conducted a retrospective analysis of consecutive patients undergoing multiple, clinically indicated invasive coronary angiograms with an interval greater than 6 months, between January 2013 and December 2016. Lesion segments were analysed using Quantitative Coronary Angiography (QCA) if a stenosis ≥ 20 % was identified on either angiogram. Stenosis progression was defined as an increase ≥ 10 % in stenosis severity, with progressor groups analysed on both patient and lesion levels. Mixed-effects regression analyses were performed to evaluate factors associated with progression of individual stenoses. Results: 199 patients were included with 881 lesions analysed. 108 (54.3 %) patients and 186 (21.1 %) stenoses were classified as progressors. The median age was 65 years (IQR 56–73) and the median interval between angiograms was 2.1 years (IQR 1.2–3.0). On a patient level, age, number of lesions and presence of multivessel disease at baseline were each associated with progressor status. On a lesion level, presence of a stenosis downstream (OR 3.07, 95 % CI 2.04–4.63, p < 0.001) and circumflex artery stenosis location (OR 1.81, 95 % CI 1.21–2.7, p = 0.004) were associated with progressor status. Other lesion characteristics did not significantly impact progressor status or change in stenosis severity. Conclusion: Coronary lesions which have a downstream stenosis may be at increased risk of stenosis progression. Further research into the mechanistic basis of this finding is required, along with its implications for plaque vulnerability and clinical outcomes.Kyle B. Franke, Nicholas J. Montarello, Adam J. Nelson, Jessica A. Marathe, Dennis T.L. Wong, Rosanna Tavella, Margaret Arstall, Christopher Zeitz, Matthew I. Worthley, John F. Beltrame, Peter J. Psalti

Myocardial infarction associates with a distinct pericoronary adipose tissue radiomic phenotype: a prospective case-control study

Abstract not available.Andrew Lin, Márton Kolossváry, Jeremy Yuvaraj, Sebastien Cadet, Priscilla A. McElhinney, Cathy Jiang, Nitesh Nerlekar, Stephen J. Nicholls, Piotr J. Slomka, Pál Maurovich-Horvat, Dennis T.L. Wong, Damini De