Pericoronary fat: MACE risk from non-contrast CT and the role of iodine perfusion in contrast CT

冠状动脉周围脂肪：平扫CT的MACE风险及增强CT中碘灌流的作用 摘要 冠状动脉周围脂肪组织(PCAT)炎症是冠状动脉疾病中一个重要的新兴概念。 舒缓，从而产生了由外而内的理论，即PCAT内由血管传递的炎症细胞- 血管，影响动脉粥样硬化斑块的进展。使用心血管CT图像，我们将使用ad- 先进的图像处理和人工智能，以更好地了解冠脉周围脂肪的外观和预测主要广告 心血管事件(MACE)。由于心血管疾病仍然是#年最常见的死亡原因 美国，改进的早期检测、疾病预测和患者管理将对以下方面的健康产生积极影响 很多人。使用心脏CT成像(血管造影术，CCTA；灌注，CCTP；和钙质评分，CTCS) 在优雅的实验和分析中，我们将阐明冠脉周围脂肪评估，并创造一个新的，INEX- 适合于筛查的冠脉周围脂肪的沉默性CTCS评估。作为主要的冠脉周围脂肪炎症- CCTA的信息特征是HU升高，我们将使用CCTP来评估冠脉周围脂肪灌注，并阐明 碘对现有CCTA征象的作用，包括因梗阻性病变充盈率不同而引起的混淆。 放松点。使用配对图像，我们将CTCS冠脉周围脂肪特征与来自CCTA的已建立的特征相关联。 使用CTCS检查中适当的冠脉周围脂肪特征，我们将预测主要的不良心脏事件。 没有碘的(Mace)混淆，并与阿加斯顿相结合，得到更好的预测。大型CTC 队列使有趣的研究成为可能。例如，使用冠状动脉风险发展系列 在年轻成人(CARDIA)研究中，我们将确定冠状动脉周围脂肪特征是否先于冠心病的出现。 证明了“由外而内”理论的可信度。CTCS考试在许多机构都很便宜(≤$99)- 特兹。在大学医院(UH)，我们的国家认可的免费CTCS计划目前正在服务 &gt；每年13,000名患者，归档&gt；65,000例，将为大数据、机器/深度提供机会 PCAT的学习分析。此外，来自PCAT Plus Agatston的改进的MACE预测将使 未来关于健康差异、基因、心脏代谢风险、并存疾病(如糖尿病和银屑病)的大量研究 SIS)和心脏肿瘤学。为了实现目标，我们组建了一支世界级的生物医学工程团队- 大学医院/CWRU的NERS和内科科学家对心血管CT图像有深入的了解- ING和动脉粥样硬化的生物学。这项提议最终将推动预测医学领域的发展， 推动新的方法来先发制人地检测高危患者，以便他们可以接受循证治疗 派。

Pericoronary fat: MACE risk from non-contrast CT and the role of iodine perfusion in contrast CT Summary Pericoronary adipose tissue (PCAT) inflammation is an important, emerging concept in coronary artery dis- ease, giving rise to the “outside-in” theory where inflammatory cells within PCAT, delivered by the vasa- vasorum, influence atherosclerosis plaque progression. Using cardiovascular CT images, we will use ad- vanced image processing and AI to better understand pericoronary fat appearance and to predict major ad- verse cardiovascular events (MACE). As cardiovascular disease remains the most common cause of death in the US, improved early detection, disease prediction, and patient management will positively impact health for many individuals. Using cardiac CT imaging (angiography, CCTA; perfusion, CCTP; and calcium score, CTCS) in elegant experiments and analyses, we will elucidate pericoronary fat assessments and create a new, inex- pensive CTCS assessment of pericoronary fat suitable for screening. As the principal pericoronary fat inflam- mation feature in CCTA is elevated HU, we will use CCTP to assess pericoronary fat perfusion and clarify the role of iodine on existing CCTA signatures, including confounds due to varying filling rates with obstructive dis- ease. Using paired images, we will associate CTCS pericoronary fat features to established ones from CCTA. Using appropriate pericoronary fat features from CTCS exams, we will predict major adverse cardiac events (MACE) without the iodine confound and combine with Agatston to get an even better prediction. Large CTCS cohorts enable interesting research studies. For example, using the serial Coronary Artery Risk Development in Young Adults (CARDIA) study, we will determine if pericoronary fat features precede the appearance of cal- cifications, giving credence to the “outside-in” theory. The CTCS exam is inexpensive (≤$99) at many institu- tions. At University Hospitals (UH), our nationally acknowledged free CTCS program currently servicing >13,000 patients/year with an archive of >65,000 cases, will provide an opportunity for big data, machine/deep learning analysis of PCAT. In addition, improved MACE prediction from PCAT plus Agatston will enable multi- ple future studies on health disparities, genes, cardiometabolic risk, co-morbidities (e.g., diabetes and psoria- sis), and cardio-oncology. To accomplish goals, we have assembled a world class team of biomedical engi- neers and physician scientists at University Hospitals/CWRU with deep knowledge of cardiovascular CT imag- ing and the biology of atherosclerosis. This proposal will ultimately advance the field of predictive medicine and propel new ways to pre-emptively detect at-risk patients so that they can be placed on evidence-based thera- pies.