The Impact of Cocaine Abstinence or Reduced Use on Radiomic Features of Noncalcified Coronary Plaques in HIV-Infected Cocaine Users with Silent Coronary Artery Disease

戒断或减少使用可卡因对患有无症状冠状动脉疾病的 HIV 感染可卡因使用者非钙化冠状动脉斑块放射学特征的影响

• 批准号: 9795066
• 负责人: SHENGHAN LAI
• 金额: $ 20.47万
• 依托单位: JOHNS HOPKINS UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-04-01 至 2021-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9795066
• 关键词: AIDS prevention; Abstinence; Adult; Algorithms; Angiography; Artificial Intelligence; Atherosclerosis; Baltimore; Biological Markers; Caliber; Cardiac; Cardiovascular system; Characteristics; Chronic; Cocaine; Cocaine Users; Comorbidity; Computer software; Computers; Coronary; Coronary Arteriosclerosis; Coronary Stenosis; Coronary artery; Data; Enrollment; Event; Expert Opinion; Future; HIV; HIV antiretroviral; Heart; Heart Diseases; Image; Incentives; Individual; Inflammation; Knowledge; Laboratories; Learning; Machine Learning; Paper; Participant; Publishing; Research; Risk; Rupture; Severities; Stenosis; Techniques; Viral; Visual; X-Ray Computed Tomography; acute coronary syndrome; antiretroviral therapy; base; cardiovascular risk factor; clinical practice; cocaine use; contrast enhanced; coronary plaque; experience; fluorodeoxyglucose; fluorodeoxyglucose positron emission tomography; high risk; imaging biomarker; improved; mortality; prognostic; radiomics; success; tool

ABSTRACT Despite the success of antiretroviral therapy (ART), individuals living with HIV experience an increased risk of coronary artery disease (CAD). Although increased arterial inflammation on 18F-FDG-PET was shown to be associated with high risk plaque features (HRPFs) in those with HIV and subclinical atherosclerosis, there is no evidence of increased arterial inflammation in optimally treated HIV-infected adults with full viral suppression, low cardiovascular risk and no known CAD when the imaging results are compared to those from HIV- uninfected controls. These findings suggest that HIV-associated atherosclerosis may be triggered by factors other than HIV-associated inflammation such as traditional cardiovascular risk factors or cocaine use. Other evidence indicates that cocaine is associated with coronary atherosclerosis. It was also shown that cocaine use modifies the effect of HIV on subclinical coronary atherosclerosis. Supported by DA035632, this research team enrolled 102 daily cocaine users (including 84 HIV-infected) with contrast-enhanced coronary CT angiography (CCTA)-confirmed significant (>50% in diameter) coronary stenosis, and employed a cash- incentive approach to systematically reinforce cocaine abstinence. The study demonstrated that continued cocaine use led to coronary plaque volume progression, while abstinent or reduced cocaine use led to plaque volume regression. However, whether cocaine use influences plaque characteristics in HIV-infected cocaine users has not been investigated. Plaque characteristics are important because rupture-prone coronary plaques might not necessarily be only those, which cause obstructive stenosis, and that HRPFs are independent of the severity of coronary artery luminal stenosis. However, identification of the strongest predictor of CAD among four HRPFs, the napkin-ring sign (NRS), at present, is based only on expert subjective opinion. A landmark cardiovascular radiomics study calculated 4,440 radiomic features for each coronary plaque and identified a subset of these parameters which predicted NRS, a qualitative feature of prognostic imaging marker of acute coronary syndrome. It is quite possible that with the cardiac radiomic approach, the association between cocaine use and this critical biomarker will be further clarified. The objective of the proposed study is to examine whether cocaine use influences plaque features in HIV-infected cocaine users. The proposed study will perform radiomic analyses on the imaging data from 102 participants on DA035632. The specific aims of this study are: (1) To examine whether continued cocaine use is associated with the NRS and its associated radiomic features in HIV-infected cocaine users with significant coronary plaques, (2) To examine whether abstinent or reduced cocaine use ameliorated NRS and its associated radiomic features in HIV-infected cocaine users with significant coronary plaques, (3) To compare NRS and its associated radiomic features between HIV infected and uninfected participants, and (4) To validate the findings generated from this study.

抽象的 尽管抗逆转录病毒疗法（ART）取得了成功，但艾滋病毒感染者的感染风险仍然增加 冠状动脉疾病（CAD）。尽管 18F-FDG-PET 显示动脉炎症增加 与 HIV 感染者和亚临床动脉粥样硬化患者的高风险斑块特征 (HRPF) 相关，目前尚无 有证据表明，在完全抑制病毒的情况下，经过最佳治疗的艾滋病毒感染者的动脉炎症增加， 与 HIV 的成像结果进行比较时，心血管风险较低且没有已知的 CAD 未感染的对照。这些发现表明，艾滋病毒相关的动脉粥样硬化可能是由多种因素引发的 除了与艾滋病毒相关的炎症之外，例如传统的心血管危险因素或可卡因的使用。其他 有证据表明可卡因与冠状动脉粥样硬化有关。研究还表明，可卡因 使用改变了艾滋病毒对亚临床冠状动脉粥样硬化的影响。本研究得到 DA035632 的支持 研究小组招募了 102 名每日可卡因使用者（其中 84 名 HIV 感染者）进行了对比增强冠状动脉 CT 扫描 血管造影（CCTA）-确认显着（直径> 50％）冠状动脉狭窄，并采用现金- 系统地加强可卡因戒断的激励方法。研究表明，持续 使用可卡因会导致冠状动脉斑块体积增大，而戒断或减少使用可卡因则会导致斑块体积增大 体积回归。然而，可卡因的使用是否会影响艾滋病毒感染的可卡因的斑块特征 用户尚未被调查。斑块特征很重要，因为容易破裂的冠状动脉斑块 可能不一定只是那些导致阻塞性狭窄的因素，并且 HRPF 独立于 冠状动脉管腔狭窄的严重程度。然而，确定 CAD 最强的预测因素 四个HRPF，即餐巾环标志（NRS），目前仅基于专家的主观意见。一个里程碑 心血管放射组学研究计算了每个冠状动脉斑块的 4,440 个放射组学特征，并确定了 这些参数的子集预测了 NRS，这是急性胰腺炎预后成像标记物的定性特征。 冠状动脉综合征。通过心脏放射学方法，很可能发现 可卡因的使用和这一关键生物标志物将得到进一步澄清。拟议研究的目的是 检查可卡因的使用是否会影响感染艾滋病毒的可卡因使用者的斑块特征。拟议的研究 将对 DA035632 上 102 名参与者的成像数据进行放射组学分析。具体目标 本研究的目的是： (1) 检验持续使用可卡因是否与 NRS 及其相关 具有明显冠状动脉斑块的 HIV 感染可卡因使用者的放射组学特征，(2) 检查是否 戒除或减少可卡因使用可改善 HIV 感染者的 NRS 及其相关放射组学特征 具有明显冠状动脉斑块的可卡因使用者，(3) 比较 NRS 及其相关放射组学特征 HIV 感染者和未感染者之间的比较，以及 (4) 验证本研究的结果。