R01HL167199

Pericoronary Fat: MACE Risk from Non-Contrast CT and the Role of Iodine Perfusion in Contrast CT - 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 disease, 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 advanced image processing and AI to better understand pericoronary fat appearance and to predict major adverse 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, inexpensive CTCS assessment of pericoronary fat suitable for screening.

As the principal pericoronary fat inflammation 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 disease. 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 calcifications, giving credence to the "outside-in" theory. The CTCS exam is inexpensive ($99) at many institutions.

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 multiple future studies on health disparities, genes, cardiometabolic risk, co-morbidities (e.g., diabetes and psoriasis), and cardio-oncology.

To accomplish goals, we have assembled a world-class team of biomedical engineers and physician scientists at University Hospitals/CWRU with deep knowledge of cardiovascular CT imaging 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 therapies.

Case Western Reserve University

NOT APPLICABLE

93.837 - Cardiovascular Diseases Research

National Heart Lung and Blood Institute (NHLBI) [HHS - NIH]

Cleveland, Ohio 44106 United States

Single Zip Code

NIH Research Project Grant (Parent R01 Clinical Trial Not Allowed) (PA-20-185)

Amendment Since initial award the total obligations have increased 290% from $786,146 to $3,063,177.