title: Prediction of atherosclerotic disease progression using LDL transport modelling: a serial computed tomographic coronary angiographic study.
abstract: OBJECTIVE
  To investigate the efficacy of low-density lipoprotein (LDL) transport simulation in reconstructed arteries derived from computed tomography coronary angiography (CTCA) to predict coronary segments that are prone to progress.
  
  
  RESULTS
  Thirty-two patients admitted with an acute coronary event who underwent 64-slice CTCA after percutaneous coronary intervention and at 3-year follow-up were included in the analysis. The CTCA data were used to reconstruct the coronary anatomy of the untreated vessels at baseline and follow-up, and LDL transport simulation was performed in the baseline models. The computed endothelial shear stress (ESS), LDL concentration, and CTCA-derived plaque characteristics were used to identify predictors of substantial disease progression (defined as an increase in the plaque burden at follow-up higher than two standard deviations of the intra-observer variability of the expert who performed the analysis). Fifty-eight vessels were analysed. High LDL concentration [odds ratio (OR): 2.16; 95% confidence interval (CI): 1.64-2.84; P = 0.0054], plaque burden (OR: 1.40; 95% CI: 1.13-1.72; P = 0.0017), and plaque area (OR: 3.46; 95% CI: 2.20-5.44; P≤ 0.0001) were independent predictors of a substantial disease progression at follow-up. The ESS appears as a predictor of disease progression in univariate analysis but was not an independent predictor when the LDL concentration was entered into the multivariate model. The accuracy of the model that included the LDL concentration was higher than the accuracy of the model that included the ESS (65.1 vs. 62.5%).
  
  
  CONCLUSIONS
  LDL transport modelling appears a better predictor of atherosclerotic disease progression than the ESS, and combined with the atheroma characteristics provided by CTCA is able to detect with a moderate accuracy segments that will exhibit a significant plaque burden increase at mid-term follow-up.
authors.affiliation: Unit of Medical Technology and Intelligent Information Systems, Department of Materials Science and Engineering, University of Ioannina, Ioannina, Greece.
authors.forename: Antonis
authors.initials: A
authors.lastname: Sakellarios
authors.affiliation: Department of Cardiovascular Sciences, University College London, London, UK.|Department of Cardiology, Barts Health NHS Foundation Trust, London, UK.
authors.forename: Christos V
authors.initials: CV
authors.lastname: Bourantas
authors.affiliation: Division of Image Processing, Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: Stella-Lida
authors.initials: SL
authors.lastname: Papadopoulou
authors.affiliation: Unit of Medical Technology and Intelligent Information Systems, Department of Materials Science and Engineering, University of Ioannina, Ioannina, Greece.
authors.forename: Zeta
authors.initials: Z
authors.lastname: Tsirka
authors.affiliation: Department of Interventional Cardiology, Erasmus University Medical Centre, Thoraxcenter, z120 Dr Molerwaterplein 40, 3015 GD Rotterdam, The Netherlands.
authors.forename: Ton
authors.initials: T
authors.lastname: de Vries
authors.affiliation: Division of Image Processing, Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: Pieter H
authors.initials: PH
authors.lastname: Kitslaar
authors.affiliation: Department of Interventional Cardiology, Erasmus University Medical Centre, Thoraxcenter, z120 Dr Molerwaterplein 40, 3015 GD Rotterdam, The Netherlands.
authors.forename: Chrysafios
authors.initials: C
authors.lastname: Girasis
authors.affiliation: Department of Cardiology, Medical School, University of Ioannina, Ioannina, Greece.
authors.forename: Katerina K
authors.initials: KK
authors.lastname: Naka
authors.affiliation: Unit of Medical Technology and Intelligent Information Systems, Department of Materials Science and Engineering, University of Ioannina, Ioannina, Greece.
authors.forename: Dimitrios I
authors.initials: DI
authors.lastname: Fotiadis
authors.affiliation: Abbott Vascular, Diegem, Belgium.
authors.forename: Susan
authors.initials: S
authors.lastname: Veldhof
authors.affiliation: Columbia University Medical Center, New York, NY, USA.
authors.forename: Greg W
authors.initials: GW
authors.lastname: Stone
authors.affiliation: Division of Image Processing, Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: Johan H C
authors.initials: JH
authors.lastname: Reiber
authors.affiliation: Department of Cardiology, Medical School, University of Ioannina, Ioannina, Greece.
authors.forename: Lampros K
authors.initials: LK
authors.lastname: Michalis
authors.affiliation: Department of Interventional Cardiology, Erasmus University Medical Centre, Thoraxcenter, z120 Dr Molerwaterplein 40, 3015 GD Rotterdam, The Netherlands.
authors.forename: Patrick W
authors.initials: PW
authors.lastname: Serruys
authors.affiliation: Department of Interventional Cardiology, Erasmus University Medical Centre, Thoraxcenter, z120 Dr Molerwaterplein 40, 3015 GD Rotterdam, The Netherlands.
authors.forename: Pim J
authors.initials: PJ
authors.lastname: de Feyter
authors.affiliation: Department of Interventional Cardiology, Erasmus University Medical Centre, Thoraxcenter, z120 Dr Molerwaterplein 40, 3015 GD Rotterdam, The Netherlands hect2701@gmail.com.
authors.forename: Hector M
authors.initials: HM
authors.lastname: Garcia-Garcia
mesh_terms: D054058:Acute Coronary Syndrome / Q000000981:diagnostic imaging / Q000628:therapy; D000368:Aged; D000704:Analysis of Variance; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects / Q000379:methods*; D015331:Cohort Studies; D000072226:Computed Tomography Angiography / Q000379:methods*; D003198:Computer Simulation; D017023:Coronary Angiography / Q000379:methods*; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging* / Q000628:therapy; D018450:Disease Progression; D005260:Female; D006801:Humans; D007091:Image Processing, Computer-Assisted; D008077:Lipoproteins, LDL / Q000097:blood*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic / Q000379:methods; D061330:Multidetector Computed Tomography; D015999:Multivariate Analysis; D011237:Predictive Value of Tests; D012372:ROC Curve; D012189:Retrospective Studies; D012680:Sensitivity and Specificity
chemical_list: D008077:Lipoproteins, LDL
keywords: LDL transport; plaque growth; prediction of atherosclerosis