Research Presentation Session: Cardiac

RPS 1603 - Biomarkers in cardiac imaging

March 1, 16:00 - 17:30 CET

7 min
A radiomic model to correlate the quality of pericoronary adipose tissue with significant coronary artery disease
Marco De Giorgi, Salerno / Italy
Author Block: M. De Giorgi1, S. Dell'Aversana2, A. Ponsiglione1, A. Paludi1, L. Pinto1, A. Annunziata1, E. Cavaglià2, R. Cuocolo1, M. Imbriaco1; 1Naples/IT, 2Pozzuoli/IT
Purpose: The study aimed to evaluate the correlation between pericoronary adipose tissue (PCAT) quality, assessed with radiomics features, and significant coronary artery stenoses (≥70%).
Methods or Background: Four operators retrospectively analysed the images of 100 coronary CT exams (50 patients with significant coronary artery disease [CAD] and 50 healthy controls). The course of the coronary artery on axial CT images was semi-automatically segmented, followed by automated expansion of the VOI. A threshold was then applied to include exclusively the PCAT. Feature extraction was done with the open source PyRadiomics package, and an Intraclass Correlation Coefficient Analysis (ICC) was performed based on segmentations by four different readers, to assess feature stability. To explore the potential clinical value of these stable radiomics features an exploratory supervised machine learning analysis was performed. The training set patients were balanced using synthetic oversampling, followed by information gain ranking feature selection. Finally, using the WEKA software platform, a simple logistic model’s performance was assessed.
Results or Findings: A total of 1,183 radiomics features from each VOI and other clinical values (age, gender hypertension, diabetes, dyslipidaemia, familiarity) were extracted. Of these, 1,068 were found to be stable at the ICC analysis (ICC lbound ≥0.75). After merging radiomics and clinical features, those with low variance were 108, while 777 proved to be highly intercorrelated. The model trained on the top five features based on information gain ranking achieved an AUC of 0.88 in the training data and 0.83 in the test set to identify significant stenoses.
Conclusion: PCAT radiomics paired with clinical data showed good discrimination between healthy and significantly stenotic coronary vessels, with a high degree of inter-reader reproducibility. Future studies are needed to create models predictive of prognosis or treatment response.
Limitations: This was a single-centre, retrospective study.
Funding for this study: No funding was received for this study.
Has your study been approved by an ethics committee? Yes
Ethics committee - additional information: This study was approved by local IRB, with a waiver for informed consent due to the retrospective, observational nature of the study.
7 min
Advancing pericoronary inflammation evaluation: dual-energy CT-derived fat fraction as a promising imaging biomarker for cardiovascular risk stratification
Sara Marziali, Milan / Italy
Author Block: S. Marziali, C. B. Monti, D. Capra, F. Rizzetto, G. Folco, F. Sardanelli, F. Secchi; Milan/IT
Purpose: The objective of this study is to assess the role of pericoronary fat fraction (FF) obtained via dual-energy CT as an innovative imaging biomarker to detect coronary inflammation, comparing it to conventional biomarkers such as pericoronary fat attenuation index (FAI) and the degree of coronary stenosis.
Methods or Background: In our retrospective study, we reviewed patients who had undergone cardiac CT scans at our institution using a dual-energy calcium scoring scan. We collected both demographic and clinical data for each patient, including factors like family history of CAD, smoking habits, type 2 diabetes, hypertension, and hypercholesterolaemia. Our main objective was to evaluate fat fraction (FF), defined as the ratio of adipose tissue within a designated area: Each patient's FF maps were processed using the Syngo.via software, and regions of interest (ROIs) were delineated around the coronary arteries, specifically the left anterior descending artery (LAD), circumflex artery (CX), and right coronary artery (RCA). Concurrently, fat tissue attenuation (FAI) values were recorded. Information regarding coronary stenoses was extracted from CT reports for comprehensive analysis.
Results or Findings: The study encompassed a sample of 99 patients, comprising 32% females with a median age of 66 years (IQR: 58-74 years). A significant negative correlation emerged between FF and FAI across coronary arteries: LAD at ρ=-0.617 (p<0.001), LCX at ρ=-0.493 (p<0.001), and RCA at ρ=−0.506 (p<0.001). Pericoronary FF displayed a weak negative correlation with coronary stenosis at the LAD (ρ=-0.220, p=0.035), correlations were not statistically significant for the LCX and the RCA (p=0.572).
Conclusion: Fat fraction, evaluated using dual-energy CT, presents promise as an additional imaging biomarker for coronary inflammation. It could yield potential for cardiovascular risk stratification, underscoring the need for further, comprehensive research.
Limitations: This was single centre, retrospective study.
Funding for this study: No funding was received for this study.
Has your study been approved by an ethics committee? Yes
Ethics committee - additional information: The local ethics committee (Ethics Committee of IRCCS Ospedale San Raffaele) approved this retrospective study (protocol code “CardioRetro”, number 122/int/2017; approved on 14th September 2017, and amended on 19th July 2022). Informed consent was waived due to the retrospective nature of the study.
7 min
Prognostic value of changes in epicardial adipose tissue volume and density on lung cancer screening CT
Isabel Luisa Langenbach, Erzhausen / Germany
Author Block: I. L. Langenbach1, I. Hadzic1, R. Zeleznik1, M. C. Langenbach1, D. Maintz2, T. Mayrhofer1, M. T. Lu1, H. Aerts1, B. Foldyna1; 1Boston/US, 2Münster/DE
Purpose: To investigate how longitudinal changes in epicardial adipose tissue (EAT) volume and density relate to all-cause, cardiovascular (CV), and lung cancer mortality in participants undergoing low-dose computed tomography (LDCT) for lung cancer screening.
Methods or Background: EAT volume and density, known as potential risk factors for CV disease, were measured using a validated automated deep-learning algorithm on serial, non-ECG-synchronised, non-contrast chest LDCT in heavy smokers enrolled in the National Lung Screening Trial (NLST). EAT volumes were indexed to body surface area (cm3/m2). EAT volume and density changes over two years (EAT; t2-years–tbaseline) were categorised into increase, no-change, and decrease categories (no-change: volume: -7 to +11%; density: -3 to +2%). EAT was associated with all-cause, CV, and lung cancer mortality (10-year follow-up) in multivariable Cox regression models, adjusted for baseline EAT values, traditional CV risk factors, BMI, history of CV disease, and coronary artery calcium (CAC) score.
Results or Findings: Of 20,661 people (59% men; age: 61±5 years), 3,483/20,661 (16.9%) died over a median follow-up of 10.4 (9.9–10.8) years (CV death: 816/3,483 [23.4%]; lung cancer death: 705/3,483 [20.2%]). In general, EAT volume increased, while density slightly decreased over time (+2.5±11.0 cm3/m2 and -0.5±3.0 HU). In fully adjusted analysis, EAT volume decrease was related to all-cause and CV mortality (HR=1.34; 95%CI: 1.23–1.46; p<0.001, HR=1.27; 95%CI: 1.06–1.51; p=0.009, respectively), while EAT volume increase was associated with higher hazard of all-cause mortality (HR=1.15; 95%CI: 1.06–1.25; p<0.001). EAT density increase was associated with a higher risk for all-cause (HR=1.32; 95%CI: 1.22–1.44; p<0.001), CV (HR=1.30; 95%CI: 1.09–1.55; p=0.004), and lung cancer mortality (HR=1.34; 95%CI: 1.11–1.62; p=0.002).
Conclusion: Patients eligible for lung cancer screening with changes in EAT volume and density have higher mortality risks and a need for better risk stratification.
Limitations: Identified limitations were (1) that this was a retrospective study, and (2) that a high-risk population of heavy smokers was used.
Funding for this study: No funding was received for this study.
Has your study been approved by an ethics committee? Not applicable
Ethics committee - additional information: No information provided by the submitter.
7 min
Foetal epicardial fat thickness: can it serve as a marker for gestational diabetic mellitus?
Amandeep Singh, Amritsar / India
Author Block: A. Singh; Amritsar/IN
Purpose: To evaluate the role of foetal epicardial fat thickness as a marker to screen for GDM.
Methods or Background: The study included pregnant patients at 24 + 0/6 to 28 + 0/6 weeks of gestation scheduled for a 75 g oral glucose tolerance test from December 2020 to March 2022. Antenatal ultrasound was performed on a Voluson E8 Expert BT12 (Wipro GE) ultrasound machine. Out of 180 patients, 60 patients were selected, that is, 30 patients with raised 75 g OGTT results (cases of GDM) and 30 patients with normal 75 g OGTT results. The collected data were transformed into variables, coded, and entered into Microsoft Excel. Data were analysed using the Shapiro–Wilk normality test, student's t-test or Mann–Whitney U test, chi-square test, or Fisher's exact test and statistically evaluated using the SPSS-PC-25 version.
Results or Findings: Foetal EFT was found to be significantly more in the GDM group in comparison to controls without GDM, and the increased foetal EFT was positively associated with 2-hour OGTT serum glucose values. The mean foetal epicardial fat thickness (EFT) in mothers with GDM was significantly larger, i.e., 0.17 ± 0.02 cm than in mothers without GDM, i.e., 0.12 ± 0.01 cm (p < 0.001). The receiver operating characteristic (ROC) curve plotted from values calculated from our results shows high sensitivity (i.e., 96.67%) and specificity (i.e., 90%) of foetal EFT as a predictor for GDM with an AUROC value of 0.96 and 95% confidence interval of 0.92 to 1.0.
Conclusion: EFT was significantly higher in foetuses of diabetic versus nondiabetic mothers, therefore concluding that epicardial fat thickness measurement in foetuses can serve as a novel marker in GDM.
Limitations: Study can be extended to a larger sample population.
Funding for this study: No funding was received for this study.
Has your study been approved by an ethics committee? Yes
Ethics committee - additional information: Due clearance was obtained from the institutional research and ethics committee.
7 min
Is familial combined hypolipidemia (FHBL2) due to loss of function mutation in the Angiopoietin-like3 (ANGPTL3) gene protective for CAD?"
Serena Paciulli, Rome / Italy
Author Block: S. Paciulli1, G. C. Pambianchi1, L. Marchitelli1, M. Giannetti1, M. Francone2, C. Catalano1, N. Galea1; 1Rome/IT, 2Milan/IT
Purpose: The purpose of this study was to compare the prevalence and severity of coronary atherosclerotic disease (CAD) and the density and volume of epicardial fat (EpF) between a group of patients with FHBL2 and an age- and gender-matched control group and to analyse the correlation between EpF and stenosis degree.
Methods or Background: A group of 111 FHBL2 subjects were prospectively recruited and underwent coronary CT (CCTA). 46 normolipidemic asymptomatic age- and gender-matched subjects, who underwent CCTA according to current guidelines, were enrolled as a control group. CAD-RADS were used to determine stenosis severity and to divide patients into four classes (N= 0-1; L= 2; M= 3; S= 4-5). The density and volume of epicardial fat (EpF) were evaluated on CCTA images.
Results or Findings: According to CCTA images, FHLBL2 patients were classified as follows: 74 subjects were classed N (67%), 22 L (20%), 7 M (6%) and 8 S (7%); among the controls 17 subjects were classed N (37%), 16 L (35%), 8 M (17%) and 5 S (11%). In FHLBL2 subjects there was a higher prevalence of minimal or no stenosis (N: 67% vs 37%; P =0.001), and a lower prevalence of mild stenosis (L: 20% vs 35%; p <0.05), while there were no significant differences in the development of severe coronary atheromasia (S: 7% vs 11%; P =0.553). There were no significant differences in terms of EpF density or volume between the two groups (P >0.060 for both) but a correlation was observed between EpF density and volume and the degree of stenosis (Rho: - 0.563; P =0.023 and Rho: 0.565; P =0.019).
Conclusion: FHBL2 is associated with a lower prevalence and severity of CAD. An association between EpF density and volume and the severity of stenosis was also found.
Limitations: This was a single centre study.
Funding for this study: No funding was received for this study.
Has your study been approved by an ethics committee? Yes
Ethics committee - additional information: This study was approved by an ethics committee.
7 min
Combined use of MRI and PET imaging enhances diagnostic accuracy in cardiac sarcoidosis
Knut Haakon Stensaeth, Trondheim / Norway
Author Block: K. H. Stensaeth, H. Johansen, A. C. Dale; Trondheim/NO
Purpose: Diagnosing cardiac sarcoidosis (CS) often presents challenges. This study sought to assess the efficacy of integrating cardiac MR (CMR) with positron emission tomography (PET)-MR for diagnosing CS and guiding patient management.
Methods or Background: We conducted a retrospective review of 46 patients at St Olav's Hospital, Trondheim, Norway, between February 2017 and October 2021. Patients underwent CS evaluation using both CMR and PET-MR. Post-CMR, an experienced radiologist identified all patients as possibly having CS. A seasoned nuclear medicine physician then classified PET results as normal, unspecific, or positive. The final diagnosis combined imaging and clinical findings.
Results or Findings: Participants averaged 58±11 years of age; 24% were female. 28% had a previous biopsy confirming sarcoidosis. Predominant symptoms included dyspnea (26%), angina (15%), and syncope (13%), with 26% reporting arrhythmia history. Late gadolinium enhancement (LGE) prominently appeared in basal segments 2-6. Abnormal F18-FDG uptake occurred in 12 (26%) patients, with 10 patients deemed positive and two unspecific. During the inclusion period, mortality stood at 9%, exclusively among patients with positive FDG uptake. 43% exhibited compromised left ventricle (LV) function, 39% had hypertrophic cardiomyopathy, and 17% had a dilated LV. Alternative diagnoses comprised amyloidosis, giant cell myocarditis, systemic lupus erythematosus, Fabry's disease, arrhythmic right ventricle cardiomyopathy, and endocarditis. Additionally, 26% received an ICD or pacemaker.
Conclusion: In patients with potential CS, the combined use of CMR and PET imaging significantly aids diagnosis and management decisions. Integrating these modalities with clinical data can notably enhance diagnostic accuracy, especially when CMR results are ambiguous.
Limitations: This was a retrospective single centre study.
Funding for this study: No funding was received for this study.
Has your study been approved by an ethics committee? Yes
Ethics committee - additional information: This study was approved by an ethics committee; REK 6701 South-East C Norway.

This session will not be streamed, nor will it be available on-demand!