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

摘要 尽管抗逆转录病毒疗法(ART)取得了成功，但艾滋病毒携带者患上 冠状动脉疾病。尽管18F-FDG-PET显示动脉炎症增加 与HIV和亚临床动脉粥样硬化患者的高危斑块特征(HRPF)相关，没有 充分抑制病毒的最佳治疗HIV感染者的动脉炎症增加的证据， 低心血管风险，当将成像结果与HIV检测结果进行比较时，没有已知的CAD- 未感染的对照组。这些发现表明，HIV相关的动脉粥样硬化可能是由多种因素引发的。 除了艾滋病毒相关的炎症，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 使用可改变HIV对亚临床冠状动脉粥样硬化的影响。在DA035632的支持下，本研究 研究小组招募了102名每天吸食可卡因的人(包括84名感染艾滋病毒的人)进行冠状动脉CT增强扫描 血管造影术(CCTA)-确认明显(直径50%)冠状动脉狭窄，并采用现金- 系统地加强可卡因戒除的激励方法。研究表明，这一点还在继续 可卡因的使用导致冠状动脉斑块体积的增加，而戒除或减少可卡因的使用则导致斑块 体积回归。然而，可卡因的使用是否会影响感染艾滋病毒的可卡因的斑块特征 用户尚未接受调查。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梗阻性狭窄的因素，而且HRPF独立于 冠状动脉管腔狭窄的严重程度。然而，确定冠心病的最强预测因子 目前，餐巾环标志(NRS)这四个HRPF仅基于专家的主观意见。地标性建筑 心血管放射组学研究计算了每个冠状动脉斑块的4440个放射组学特征，并确定了 这些参数的子集预测了NRS，这是急性心肌梗死预后影像标志物的定性特征 冠状动脉综合征。很可能通过心脏放射学方法，两者之间的联系 可卡因的使用和这一关键的生物标志物将进一步得到澄清。拟议研究的目的是 检查可卡因的使用是否影响感染艾滋病毒的可卡因使用者的斑块特征。建议进行的研究 将对DA035632上102名参与者的成像数据进行放射学分析。的具体目标 这项研究是：(1)检验持续使用可卡因是否与NRS及其相关 有显著冠状动脉斑块的HIV感染可卡因使用者的放射学特征，(2)检查 戒除或减少使用可卡因可改善HIV感染者的NRS及其相关的放射组学特征 可卡因使用者有明显的冠状动脉斑块，(3)比较NRS及其相关的放射组学特征 HIV感染和未感染的参与者之间的关系，以及(4)验证本研究产生的发现。

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.