Data-driven atherosclerotic plaque profiles from QAngio-CT associated with functional impairments assessed with PET-CT

Erick Alexanderson-Rosas, Department of Nuclear Cardiology, Instituto Nacional de Cardiología Ignacio Chávez, Mexico City, Mexico; School of Medicine, Department of Physiology, Universidad Nacional Autónoma de México (UNAM), Mexico City, Mexico;
Leopoldo Pérez-de-Isla, Department of Cardiology, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria San Carlos, Universidad Complutense, Madrid, Spain
Neftalí E. Antonio-Villa, Department of Endocrinology, Instituto Nacional de Cardiología Ignacio Chávez, Mexico City, Mexico
Enrique C. Guerra, Department of Nuclear Cardiology, Instituto Nacional de Cardiología Ignacio Chávez, Mexico City, Mexico; School of Medicine, MD-PhD (PECEM) Program, Universidad Nacional Autónoma de México (UNAM), Mexico City, Mexico
Aldo Cabello-Ganem, Department of Nuclear Cardiology, Instituto Nacional de Cardiología Ignacio Chávez, Mexico City, Mexico
Leonardo Proaño-Bernal, Department of Nuclear Cardiology, Instituto Nacional de Cardiología Ignacio Chávez, Mexico City, Mexico; School of Medicine, Department of Physiology, Universidad Nacional Autónoma de México (UNAM), Mexico City, Mexico
Santiago Luna-Alcalá, Department of Nuclear Cardiology, Instituto Nacional de Cardiología Ignacio Chávez, Mexico City, Mexico
Ma. José Santa-Ana-Bayona, Department of Nuclear Cardiology, Instituto Nacional de Cardiología Ignacio Chávez, Mexico City, Mexico
Pavel Martínez-Domínguez, Department of Nuclear Cardiology, Instituto Nacional de Cardiología Ignacio Chávez, Mexico City, Mexico
Alexis D. Aparicio- Ortiz, Department of Nuclear Cardiology, Instituto Nacional de Cardiología Ignacio Chávez, Mexico City, Mexico
Isabel Carvajal-Juárez, Department of Nuclear Cardiology, Instituto Nacional de Cardiología Ignacio Chávez, Mexico City, Mexico
Joaquín Berarducci, Department of Nuclear Cardiology, Instituto Nacional de Cardiología Ignacio Chávez, Mexico City, Mexico
Javier I. Armenta-Moreno, Department of Nuclear Cardiology, Instituto Nacional de Cardiología Ignacio Chávez, Mexico City, Mexico
Nilda Espinola-Zavaleta, Department of Nuclear Cardiology, Instituto Nacional de Cardiología Ignacio Chávez, Mexico City, Mexico;; Department of Echocardiography, ABC Medical Center, IAP, Mexico City, Mexico

Objective: Although coronary artery disease (CAD) involves progressive atherosclerotic plaque dysfunction, further characterization of different cluster profiles and their impact on myocardial function has not been fully explored. Therefore, this study’s pilot aim is to identify data-driven atherosclerotic plaque clusters using coronary computed tomography angiography and correlate types with dysfunction observed by positron emission tomography/computed tomography (PET-CT). Methods: Myocardial perfusion study images of subjects with a high clinical risk of developing CAD were analyzed with semi-automated atherosclerotic plaque characterization. The K-mean clustering method was performed to detect coronary atherosclerotic plaques. An atherosclerotic plaque score was assigned to each subject according to their arteries cluster profiles and was correlated with a principal component analysis (PCA) score that evaluated myocardial perfusion, volumes, and synchrony from PET-CT. Results: Three well-differentiated clusters were identified from 95 coronary atherosclerotic plaques of 35 subjects. Cluster 1 (28.2%) was characterized by a high fibro-necrotic atherosclerotic plaque, cluster 2 (59.7%) by predominantly fibrous atherosclerotic plaque, and cluster 3 (11.9%) by a necro-calcified atherosclerotic plaque. The atherosclerotic plaque score displayed a significant correlation with the first (r = 0.42; 95% confidence interval [CI]: 0.049-0.675, p = 0.012) and third (r = 0.36; 95% CI: 0.036-0.626, p = 0.035) PCA score components. These were comprised parameters related to impairments in ventricular volume capacity, mechanical dyssynchrony, filling rates, and calcium scores in PET-CT evaluation. Conclusion: The atherosclerotic plaque clusters identified in this study could provide a pathophysiological explanation of CAD progression and potentially lead to a better characterization of the developing disease.

Keywords: Atherosclerotic plaque. Coronary artery disease. Data-driven clusters. Positron emission tomography/computed tomography.