Topological Data Analysis of Coronary Plaques Demonstrates the Natural History of Coronary Atherosclerosis

Doyeon Hwang; Haneol J Kim; Seung-Pyo Lee; Seonhee Lim; Bon-Kwon Koo; Yong-Jin Kim; Woong Kook; Daniele Andreini; Mouaz H Al-Mallah; Matthew J Budoff; Filippo Cademartiri; Kavitha Chinnaiyan; Jung Hyun Choi; Edoardo Conte; Hugo Marques; Pedro de Araújo Gonçalves; Ilan Gottlieb; Martin Hadamitzky; Jonathon A Leipsic; Erica Maffei; Gianluca Pontone; Gilbert L Raff; Sanghoon Shin; Byoung Kwon Lee; Eun Ju Chun; Ji Min Sung; Sang-Eun Lee; Daniel S Berman; Fay Y Lin; Renu Virmani; Habib Samady; Peter H Stone; Jagat Narula; Jeroen J Bax; Leslee J Shaw; James K Min; Hyuk-Jae Chang

doi:10.1016/j.jcmg.2020.11.009

Topological Data Analysis of Coronary Plaques Demonstrates the Natural History of Coronary Atherosclerosis

JACC Cardiovasc Imaging. 2021 Jul;14(7):1410-1421. doi: 10.1016/j.jcmg.2020.11.009. Epub 2021 Jan 13.

Authors

Doyeon Hwang¹, Haneol J Kim², Seung-Pyo Lee³, Seonhee Lim⁴, Bon-Kwon Koo¹, Yong-Jin Kim¹, Woong Kook², Daniele Andreini⁵, Mouaz H Al-Mallah⁶, Matthew J Budoff⁷, Filippo Cademartiri⁸, Kavitha Chinnaiyan⁹, Jung Hyun Choi¹⁰, Edoardo Conte⁵, Hugo Marques¹¹, Pedro de Araújo Gonçalves¹¹, Ilan Gottlieb¹², Martin Hadamitzky¹³, Jonathon A Leipsic¹⁴, Erica Maffei¹⁵, Gianluca Pontone⁵, Gilbert L Raff⁹, Sanghoon Shin¹⁶, Byoung Kwon Lee¹⁷, Eun Ju Chun¹⁸, Ji Min Sung¹⁹, Sang-Eun Lee²⁰, Daniel S Berman²¹, Fay Y Lin²², Renu Virmani²³, Habib Samady²⁴, Peter H Stone²⁵, Jagat Narula²⁶, Jeroen J Bax²⁷, Leslee J Shaw²², James K Min²², Hyuk-Jae Chang¹⁹

Affiliations

¹ Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, South Korea.
² Department of Mathematical Science, Seoul National University, Seoul, South Korea.
³ Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, South Korea. Electronic address: sproll1@snu.ac.kr.
⁴ Department of Mathematical Science, Seoul National University, Seoul, South Korea. Electronic address: slim@snu.ac.kr.
⁵ Department of Medicine, Centro Cardiologico Monzino, IRCCS Milano, Milan, Italy.
⁶ Department of Cardiology, Houston Methodist DeBakey Heart and Vascular Center, Houston Methodist Hospital, Houston, Texas, USA.
⁷ Department of Medicine, Los Angeles Biomedical Research Institute, Torrance, California, USA.
⁸ Cardiovascular Imaging Center, SDN IRCCS, Naples, Italy.
⁹ Department of Cardiology, William Beaumont Hospital, Royal Oak, Michigan, USA.
¹⁰ Division of Cardiology, Department of Internal Medicine, Pusan University Hospital, Busan, South Korea.
¹¹ Department of Radiology, UNICA, Unit of Cardiovascular Imaging, Hospital da Luz, Nova Medical School, Lisboa, Portugal.
¹² Department of Radiology, Casa de Saude São Jose, Rio de Janeiro, Brazil.
¹³ Department of Radiology and Nuclear Medicine, German Heart Center Munich, Munich, Germany.
¹⁴ Department of Medicine and Radiology, University of British Columbia, Vancouver, British Columbia, Canada.
¹⁵ Department of Radiology, Area Vasta 1/ASUR Marche, Urbino, Italy.
¹⁶ Division of Cardiology, Department of Internal Medicine, Ewha Womans University Seoul Hospital, Ewha Womans University College of Medicine, Seoul, South Korea.
¹⁷ Division of Cardiology, Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea.
¹⁸ Department of Radiology, Seoul National University Bundang Hospital, Seongnam, South Korea.
¹⁹ Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Yonsei University Health System, Seoul, South Korea; Yonsei-Cedars-Sinai Integrative Cardiovascular Imaging Research Center, Yonsei University College of Medicine, Yonsei University Health System, Seoul, South Korea.
²⁰ Division of Cardiology, Department of Internal Medicine, Ewha Womans University Seoul Hospital, Ewha Womans University College of Medicine, Seoul, South Korea; Yonsei-Cedars-Sinai Integrative Cardiovascular Imaging Research Center, Yonsei University College of Medicine, Yonsei University Health System, Seoul, South Korea.
²¹ Department of Imaging, Cedars Sinai Medical Center, Los Angeles, California, USA; Department of Medicine, Cedars Sinai Medical Center, Los Angeles, California, USA.
²² Department of Radiology, Dalio Institute of Cardiovascular Imaging, New York-Presbyterian Hospital and Weill Cornell Medicine, New York, New York, USA.
²³ Department of Pathology, CVPath Institute, Gaithersburg, Maryland, USA.
²⁴ Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia, USA.
²⁵ Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
²⁶ Zena and Michael A. Wiener Cardiovascular Institute, Mount Sinai Heart, Icahn School of Medicine at Mount Sinai, New York, New York, USA; Marie-Josée and Henry R. Kravis Center for Cardiovascular Health, Mount Sinai Heart, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
²⁷ Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands.

PMID: 33454260
DOI: 10.1016/j.jcmg.2020.11.009

Abstract

Objectives: This study sought to identify distinct patient groups and their association with outcome based on the patient similarity network using quantitative coronary plaque characteristics from coronary computed tomography angiography (CTA).

Background: Coronary CTA can noninvasively assess coronary plaques quantitatively.

Methods: Patients who underwent 2 coronary CTAs at a minimum of 24 months' interval were analyzed (n = 1,264). A similarity Mapper network of patients was built by topological data analysis (TDA) based on the whole-heart quantitative coronary plaque analysis on coronary CTA to identify distinct patient groups and their association with outcome.

Results: Three distinct patient groups were identified by TDA, and the patient similarity network by TDA showed a closed loop, demonstrating a continuous trend of coronary plaque progression. Group A had the least coronary plaque amount (median 12.4 mm³ [interquartile range (IQR): 0.0 to 39.6 mm³]) in the entire coronary tree. Group B had a moderate coronary plaque amount (31.7 mm³ [IQR: 0.0 to 127.4 mm³]) with relative enrichment of fibrofatty and necrotic core (32.6% [IQR: 16.7% to 46.2%] and 2.7% [IQR: 0.1% to 6.9%] of the total plaque, respectively) components. Group C had the largest coronary plaque amount (187.0 mm³ [IQR: 96.7 to 306.4 mm³]) and was enriched for dense calcium component (46.8% [IQR: 32.0% to 63.7%] of the total plaque). At follow-up, total plaque volume, fibrous, and dense calcium volumes increased in all groups, but the proportion of fibrofatty component decreased in groups B and C, whereas the necrotic core portion decreased in only group B (all p < 0.05). Group B showed a higher acute coronary syndrome incidence than other groups (0.3% vs. 2.6% vs. 0.6%; p = 0.009) but both group B and C had a higher revascularization incidence than group A (3.1% vs. 15.5% vs. 17.8%; p < 0.001). Incorporating group information from TDA demonstrated increase of model fitness for predicting acute coronary syndrome or revascularization compared with that incorporating clinical risk factors, percentage diameter stenosis, and high-risk plaque features.

Conclusions: The TDA of quantitative whole-heart coronary plaque characteristics on coronary CTA identified distinct patient groups with different plaque dynamics and clinical outcomes. (Progression of AtheRosclerotic PlAque DetermIned by Computed TomoGraphic Angiography Imaging [PARADIGM]; NCT02803411).

Keywords: coronary computed tomography angiography; coronary plaque; topological data analysis.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Coronary Artery Disease* / diagnostic imaging
Data Analysis
Exercise
Humans
Predictive Value of Tests

Associated data

ClinicalTrials.gov/NCT02803411