title: Non-invasive volumetric assessment of aortic atheroma: a core laboratory validation using computed tomography angiography.
abstract: Aortic atherosclerosis has been linked with worse peri- and post-procedural outcomes following a range of aortic procedures. Yet, there are currently no standardized methods for non-invasive volumetric pan-aortic plaque assessment. We propose a novel means of more accurately assessing plaque volume across whole aortic segments using computed tomography angiography (CTA) imaging. Sixty patients who underwent CTA prior to trans-catheter aortic valve implantation were included in this analysis. Specialized software analysis (3mensio Vascular™, Pie Medical, Maastricht, Netherlands) was used to reconstruct images using a centerline approach, thus creating true cross-sectional aortic images, akin to those images produced with intravascular ultrasonography. Following aortic segmentation (from the aortic valve to the renal artery origin), atheroma areas were measured across multiple contiguous evenly spaced (10 mm) cross-sections. Percent atheroma volume (PAV), total atheroma volume (TAV) and calcium score were calculated. In our populations (age 79.9 ± 8.5 years, male 52 %, diabetes 27 %, CAD 84 %, PVD 20 %), mean ± SD number of cross sections measured for each patient was 35.1 ± 3.5 sections. Mean aortic PAV and TAV were 33.2 ± 2.51 % and 83,509 ± 17,078 mm(3), respectively. Median (IQR) calcium score was 1.5 (0.7-2.5). Mean (SD) inter-observer coefficient of variation and agreement for plaque area among 4 different analysts was 14.1 (5.4), and the mean (95 % CI) Lin's concordance correlation coefficient was 0.79 (0.62-0.89), effectively simulating a Core Laboratory scenario. We provide an initial validation of cross-sectional volumetric aortic atheroma assessment using CTA. This proposed methodology highlights the potential for utilizing non-invasive aortic plaque imaging for risk prediction across a range of clinical scenarios.
authors.affiliation: Department of Internal Medicine, Cleveland Clinic Foundation, Cleveland, OH, USA. muh_hammadah@hotmail.com.
authors.forename: Muhammad
authors.identifier: http://orcid.org/0000-0002-1596-4836
authors.initials: M
authors.lastname: Hammadah
authors.affiliation: Department of Internal Medicine, Cleveland Clinic Foundation, Cleveland, OH, USA.
authors.forename: Mohammed
authors.initials: M
authors.lastname: Qintar
authors.affiliation: Atherosclerosis Imaging Core Laboratory, Cleveland Clinic Coordinating Center for Clinical Research (C5R), Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH, 44195, USA.|Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, OH, USA.
authors.forename: Steven E
authors.initials: SE
authors.lastname: Nissen
authors.affiliation: Atherosclerosis Imaging Core Laboratory, Cleveland Clinic Coordinating Center for Clinical Research (C5R), Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH, 44195, USA.
authors.forename: Julie St
authors.initials: JS
authors.lastname: John
authors.affiliation: Department of Internal Medicine, Cleveland Clinic Foundation, Cleveland, OH, USA.
authors.forename: Saqer
authors.initials: S
authors.lastname: Alkharabsheh
authors.affiliation: Lerner College of Medicine, Cleveland Clinic, Cleveland, OH, USA.
authors.forename: Motunrayo
authors.initials: M
authors.lastname: Mobolaji-Lawal
authors.affiliation: Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, OH, USA.
authors.forename: Femi
authors.initials: F
authors.lastname: Philip
authors.affiliation: Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, OH, USA.
authors.forename: Kiyoko
authors.initials: K
authors.lastname: Uno
authors.affiliation: South Australian Health and Medical Research Institute, Adelaide, Australia.
authors.forename: Yu
authors.initials: Y
authors.lastname: Kataoka
authors.affiliation: Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, OH, USA.
authors.forename: Brett
authors.initials: B
authors.lastname: Babb
authors.affiliation: Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, OH, USA.
authors.forename: Roman
authors.initials: R
authors.lastname: Poliszczuk
authors.affiliation: Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, OH, USA.
authors.forename: Samir R
authors.initials: SR
authors.lastname: Kapadia
authors.affiliation: Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, OH, USA.
authors.forename: E Murat
authors.initials: EM
authors.lastname: Tuzcu
authors.affiliation: Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, OH, USA.
authors.forename: Paul
authors.initials: P
authors.lastname: Schoenhagen
authors.affiliation: South Australian Health and Medical Research Institute, Adelaide, Australia.|University of Adelaide, Adelaide, Australia.
authors.forename: Stephen J
authors.initials: SJ
authors.lastname: Nicholls
authors.affiliation: Atherosclerosis Imaging Core Laboratory, Cleveland Clinic Coordinating Center for Clinical Research (C5R), Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH, 44195, USA. purir@ccf.org.|Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, OH, USA. purir@ccf.org.|University of Adelaide, Adelaide, Australia. purir@ccf.org.
authors.forename: Rishi
authors.initials: R
authors.lastname: Puri
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001018:Aortic Diseases / Q000000981:diagnostic imaging*; D001027:Aortography / Q000379:methods*; D050197:Atherosclerosis / Q000000981:diagnostic imaging*; D005260:Female; D006801:Humans; D008297:Male; D061330:Multidetector Computed Tomography; D015588:Observer Variation; D058226:Plaque, Atherosclerotic; D011237:Predictive Value of Tests; D011379:Prognosis; D011857:Radiographic Image Interpretation, Computer-Assisted; D015203:Reproducibility of Results; D012984:Software
keywords: Aortic atheroma; CT angiogram; CTA; Plaque volume