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Lower attenuation and higher kurtosis of coronary artery calcification associated with vulnerable plaque – an agatston score propensity-matched CT radiomics study
BACKGROUND: Coronary artery calcification (CAC) burden assessed by Agatston score (AS) is currently recommended to stratify patients at risk for future acute coronary syndrome (ACS). Besides the CAC burden, the biostructure of CAC may also play a vital role in the vulnerability of CAC, which CT radi...
Autores principales: | , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BioMed Central
2023
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10045966/ https://www.ncbi.nlm.nih.gov/pubmed/36973668 http://dx.doi.org/10.1186/s12872-023-03162-6 |
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author | Huang, Eric Po-Yu Lin, Huey-Shyan Chen, Yi-Chun Li, Yi-He Huang, Yi-Luan Ju, Yu-Jeng Yu, Hsien-Chung Kicska, Gregory A. Wu, Ming-Ting |
author_facet | Huang, Eric Po-Yu Lin, Huey-Shyan Chen, Yi-Chun Li, Yi-He Huang, Yi-Luan Ju, Yu-Jeng Yu, Hsien-Chung Kicska, Gregory A. Wu, Ming-Ting |
author_sort | Huang, Eric Po-Yu |
collection | PubMed |
description | BACKGROUND: Coronary artery calcification (CAC) burden assessed by Agatston score (AS) is currently recommended to stratify patients at risk for future acute coronary syndrome (ACS). Besides the CAC burden, the biostructure of CAC may also play a vital role in the vulnerability of CAC, which CT radiomics could reveal. Propensity-score matching of the traditional risk factors and CAC burden between the ACS and asymptomatic groups could radically remove biases and allow the exploration of characteristic features of CAC in ACS. METHODS: We retrospectively identified 77 patients with ACS who had a CAC scan before percutaneous coronary intervention between 2016 and 2019. These 77 patients were one-to-two propensity-score matched for traditional risk factors of ACS and AS ranks to select 154 subjects from 2890 asymptomatic subjects. A validation cohort of 30 subjects was also enrolled. Radiomics features of each plaque were extracted and averaged in each person. Conditional logistic regression and area-under-curve analysis were used for statistical analysis. RESULTS: A higher number of coronary segments involved, lower mean, median, first quartile, and standard deviation of attenuation, and increased kurtosis of attenuation of CAC were associated with the ACS group compared to the control group (p < 0.05 for all). Multivariable analysis showed that the lower median attenuation (OR = 0.969, p < 0.001) and higher Kurtosis (OR = 18.7, p < 0.001) were associated with the ACS group. The median attenuation and kurtosis significantly increase across AS ranks 1 to 4 (p = 0.001). The AUC of kurtosis (0.727) and median attenuation (0.66) were both significantly higher than that of the standard AS (AUC = 0.502) and the number of TRF (AUC = 0.537). The best cut-off of kurtosis at 2.74 yielded an accuracy of 74%, and the cut-off of median attenuation at 196 yielded an accuracy of 68%. The accuracy of kurtosis was 64%, and the accuracy of median attenuation was 55% in the validation cohort. CONCLUSION: After propensity-matching traditional risk factors and CAC burden, CT radiomics highlighted that lower median attenuation and higher kurtosis were the CAC characteristics of vulnerable plaques. These features improve the understanding of the biomechanics of CAC evolution and enhance the value of CAC scan in ACS risk assessment. |
format | Online Article Text |
id | pubmed-10045966 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2023 |
publisher | BioMed Central |
record_format | MEDLINE/PubMed |
spelling | pubmed-100459662023-03-29 Lower attenuation and higher kurtosis of coronary artery calcification associated with vulnerable plaque – an agatston score propensity-matched CT radiomics study Huang, Eric Po-Yu Lin, Huey-Shyan Chen, Yi-Chun Li, Yi-He Huang, Yi-Luan Ju, Yu-Jeng Yu, Hsien-Chung Kicska, Gregory A. Wu, Ming-Ting BMC Cardiovasc Disord Research BACKGROUND: Coronary artery calcification (CAC) burden assessed by Agatston score (AS) is currently recommended to stratify patients at risk for future acute coronary syndrome (ACS). Besides the CAC burden, the biostructure of CAC may also play a vital role in the vulnerability of CAC, which CT radiomics could reveal. Propensity-score matching of the traditional risk factors and CAC burden between the ACS and asymptomatic groups could radically remove biases and allow the exploration of characteristic features of CAC in ACS. METHODS: We retrospectively identified 77 patients with ACS who had a CAC scan before percutaneous coronary intervention between 2016 and 2019. These 77 patients were one-to-two propensity-score matched for traditional risk factors of ACS and AS ranks to select 154 subjects from 2890 asymptomatic subjects. A validation cohort of 30 subjects was also enrolled. Radiomics features of each plaque were extracted and averaged in each person. Conditional logistic regression and area-under-curve analysis were used for statistical analysis. RESULTS: A higher number of coronary segments involved, lower mean, median, first quartile, and standard deviation of attenuation, and increased kurtosis of attenuation of CAC were associated with the ACS group compared to the control group (p < 0.05 for all). Multivariable analysis showed that the lower median attenuation (OR = 0.969, p < 0.001) and higher Kurtosis (OR = 18.7, p < 0.001) were associated with the ACS group. The median attenuation and kurtosis significantly increase across AS ranks 1 to 4 (p = 0.001). The AUC of kurtosis (0.727) and median attenuation (0.66) were both significantly higher than that of the standard AS (AUC = 0.502) and the number of TRF (AUC = 0.537). The best cut-off of kurtosis at 2.74 yielded an accuracy of 74%, and the cut-off of median attenuation at 196 yielded an accuracy of 68%. The accuracy of kurtosis was 64%, and the accuracy of median attenuation was 55% in the validation cohort. CONCLUSION: After propensity-matching traditional risk factors and CAC burden, CT radiomics highlighted that lower median attenuation and higher kurtosis were the CAC characteristics of vulnerable plaques. These features improve the understanding of the biomechanics of CAC evolution and enhance the value of CAC scan in ACS risk assessment. BioMed Central 2023-03-27 /pmc/articles/PMC10045966/ /pubmed/36973668 http://dx.doi.org/10.1186/s12872-023-03162-6 Text en © The Author(s) 2023 https://creativecommons.org/licenses/by/4.0/Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) . The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/ (https://creativecommons.org/publicdomain/zero/1.0/) ) applies to the data made available in this article, unless otherwise stated in a credit line to the data. |
spellingShingle | Research Huang, Eric Po-Yu Lin, Huey-Shyan Chen, Yi-Chun Li, Yi-He Huang, Yi-Luan Ju, Yu-Jeng Yu, Hsien-Chung Kicska, Gregory A. Wu, Ming-Ting Lower attenuation and higher kurtosis of coronary artery calcification associated with vulnerable plaque – an agatston score propensity-matched CT radiomics study |
title | Lower attenuation and higher kurtosis of coronary artery calcification associated with vulnerable plaque – an agatston score propensity-matched CT radiomics study |
title_full | Lower attenuation and higher kurtosis of coronary artery calcification associated with vulnerable plaque – an agatston score propensity-matched CT radiomics study |
title_fullStr | Lower attenuation and higher kurtosis of coronary artery calcification associated with vulnerable plaque – an agatston score propensity-matched CT radiomics study |
title_full_unstemmed | Lower attenuation and higher kurtosis of coronary artery calcification associated with vulnerable plaque – an agatston score propensity-matched CT radiomics study |
title_short | Lower attenuation and higher kurtosis of coronary artery calcification associated with vulnerable plaque – an agatston score propensity-matched CT radiomics study |
title_sort | lower attenuation and higher kurtosis of coronary artery calcification associated with vulnerable plaque – an agatston score propensity-matched ct radiomics study |
topic | Research |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10045966/ https://www.ncbi.nlm.nih.gov/pubmed/36973668 http://dx.doi.org/10.1186/s12872-023-03162-6 |
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