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

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 MaffeiGianluca 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

Department of Internal Medicine

Research output: Contribution to journal › Article › peer-review

12 Citations (Scopus)

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.

Original language	English
Pages (from-to)	1410-1421
Number of pages	12
Journal	JACC: Cardiovascular Imaging
Volume	14
Issue number	7
DOIs	https://doi.org/10.1016/j.jcmg.2020.11.009
Publication status	Published - 2021 Jul

Bibliographical note

Funding Information:
This work was supported by a grant from Seoul National University Hospital research fund (Grant No. 0320200430), the Leading Foreign Research Institute Recruitment Program through the National Research Foundation of Korea funded by the Ministry of Science and ICT (Grant No. 2012027176) (to Dr. Chang), and the National Research Foundation of Korea funded by the Ministry of Science and ICT (Grant No. 2017R1E1A1A03070779 and 2019R1A2C2084099). The study was also funded in part by a generous gift from the Dalio Institute of Cardiovascular Imaging and the Michael Wolk Foundation. The funders of the study had no role in study design, data collection, data analysis, data interpretation, or writing of the report. Dr. Koo has received institutional research grant support from St. Jude Medical (Abbott Vascular) and Philips Volcano. Dr. Samady has served on the scientific advisory board of Philips; has an equity interest in Covanos Inc.; and has received research grant support from Medtronic. Dr. Min has received funding from the Dalio Foundation, the National Institutes of Health, and GE Healthcare; has served on the scientific advisory board of Arineta and GE Healthcare; and has an equity interest in Cleerly. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.

Publisher Copyright:
© 2021 American College of Cardiology Foundation

All Science Journal Classification (ASJC) codes

Radiology Nuclear Medicine and imaging
Cardiology and Cardiovascular Medicine

Access to Document

10.1016/j.jcmg.2020.11.009

Cite this

Hwang, D., Kim, H. J., Lee, S. P., Lim, S., Koo, B. K., Kim, Y. J., Kook, W., Andreini, D., Al-Mallah, M. H., Budoff, M. J., Cademartiri, F., Chinnaiyan, K., Choi, J. H., Conte, E., Marques, H., de Araújo Gonçalves, P., Gottlieb, I., Hadamitzky, M., Leipsic, J. A., ... Chang, H. J. (2021). Topological Data Analysis of Coronary Plaques Demonstrates the Natural History of Coronary Atherosclerosis. JACC: Cardiovascular Imaging, 14(7), 1410-1421. https://doi.org/10.1016/j.jcmg.2020.11.009

@article{bd134ca8410740ff9841c9337b98496e,

title = "Topological Data Analysis of Coronary Plaques Demonstrates the Natural History of Coronary Atherosclerosis",

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{\textquoteright} 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.",

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

note = "Funding Information: This work was supported by a grant from Seoul National University Hospital research fund (Grant No. 0320200430), the Leading Foreign Research Institute Recruitment Program through the National Research Foundation of Korea funded by the Ministry of Science and ICT (Grant No. 2012027176) (to Dr. Chang), and the National Research Foundation of Korea funded by the Ministry of Science and ICT (Grant No. 2017R1E1A1A03070779 and 2019R1A2C2084099). The study was also funded in part by a generous gift from the Dalio Institute of Cardiovascular Imaging and the Michael Wolk Foundation. The funders of the study had no role in study design, data collection, data analysis, data interpretation, or writing of the report. Dr. Koo has received institutional research grant support from St. Jude Medical (Abbott Vascular) and Philips Volcano. Dr. Samady has served on the scientific advisory board of Philips; has an equity interest in Covanos Inc.; and has received research grant support from Medtronic. Dr. Min has received funding from the Dalio Foundation, the National Institutes of Health, and GE Healthcare; has served on the scientific advisory board of Arineta and GE Healthcare; and has an equity interest in Cleerly. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose. Publisher Copyright: {\textcopyright} 2021 American College of Cardiology Foundation",

year = "2021",

month = jul,

doi = "10.1016/j.jcmg.2020.11.009",

language = "English",

volume = "14",

pages = "1410--1421",

journal = "JACC: Cardiovascular Imaging",

issn = "1936-878X",

publisher = "Elsevier Inc.",

number = "7",

}

Hwang, D, Kim, HJ, Lee, SP, Lim, S, Koo, BK, Kim, YJ, Kook, W, Andreini, D, Al-Mallah, MH, Budoff, MJ, Cademartiri, F, Chinnaiyan, K, Choi, JH, Conte, E, Marques, H, de Araújo Gonçalves, P, Gottlieb, I, Hadamitzky, M, Leipsic, JA, Maffei, E, Pontone, G, Raff, GL, Shin, S, Lee, BK, Chun, EJ, Sung, JM, Lee, SE, Berman, DS, Lin, FY, Virmani, R, Samady, H, Stone, PH, Narula, J, Bax, JJ, Shaw, LJ, Min, JK & Chang, HJ 2021, 'Topological Data Analysis of Coronary Plaques Demonstrates the Natural History of Coronary Atherosclerosis', JACC: Cardiovascular Imaging, vol. 14, no. 7, pp. 1410-1421. https://doi.org/10.1016/j.jcmg.2020.11.009

TY - JOUR

T1 - Topological Data Analysis of Coronary Plaques Demonstrates the Natural History of Coronary Atherosclerosis

AU - Hwang, Doyeon

AU - Kim, Haneol J.

AU - Lee, Seung Pyo

AU - Lim, Seonhee

AU - Koo, Bon Kwon

AU - Kim, Yong Jin

AU - Kook, Woong

AU - Andreini, Daniele

AU - Al-Mallah, Mouaz H.

AU - Budoff, Matthew J.

AU - Cademartiri, Filippo

AU - Chinnaiyan, Kavitha

AU - Choi, Jung Hyun

AU - Conte, Edoardo

AU - Marques, Hugo

AU - de Araújo Gonçalves, Pedro

AU - Gottlieb, Ilan

AU - Hadamitzky, Martin

AU - Leipsic, Jonathon A.

AU - Maffei, Erica

AU - Pontone, Gianluca

AU - Raff, Gilbert L.

AU - Shin, Sanghoon

AU - Lee, Byoung Kwon

AU - Chun, Eun Ju

AU - Sung, Ji Min

AU - Lee, Sang Eun

AU - Berman, Daniel S.

AU - Lin, Fay Y.

AU - Virmani, Renu

AU - Samady, Habib

AU - Stone, Peter H.

AU - Narula, Jagat

AU - Bax, Jeroen J.

AU - Shaw, Leslee J.

AU - Min, James K.

AU - Chang, Hyuk Jae

N1 - Funding Information: This work was supported by a grant from Seoul National University Hospital research fund (Grant No. 0320200430), the Leading Foreign Research Institute Recruitment Program through the National Research Foundation of Korea funded by the Ministry of Science and ICT (Grant No. 2012027176) (to Dr. Chang), and the National Research Foundation of Korea funded by the Ministry of Science and ICT (Grant No. 2017R1E1A1A03070779 and 2019R1A2C2084099). The study was also funded in part by a generous gift from the Dalio Institute of Cardiovascular Imaging and the Michael Wolk Foundation. The funders of the study had no role in study design, data collection, data analysis, data interpretation, or writing of the report. Dr. Koo has received institutional research grant support from St. Jude Medical (Abbott Vascular) and Philips Volcano. Dr. Samady has served on the scientific advisory board of Philips; has an equity interest in Covanos Inc.; and has received research grant support from Medtronic. Dr. Min has received funding from the Dalio Foundation, the National Institutes of Health, and GE Healthcare; has served on the scientific advisory board of Arineta and GE Healthcare; and has an equity interest in Cleerly. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose. Publisher Copyright: © 2021 American College of Cardiology Foundation

PY - 2021/7

Y1 - 2021/7

N2 - 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.

AB - 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.

UR - http://www.scopus.com/inward/record.url?scp=85100027359&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85100027359&partnerID=8YFLogxK

U2 - 10.1016/j.jcmg.2020.11.009

DO - 10.1016/j.jcmg.2020.11.009

M3 - Article

C2 - 33454260

AN - SCOPUS:85100027359

SN - 1936-878X

VL - 14

SP - 1410

EP - 1421

JO - JACC: Cardiovascular Imaging

JF - JACC: Cardiovascular Imaging

IS - 7

ER -

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

Abstract

Bibliographical note

All Science Journal Classification (ASJC) codes

Access to Document

Other files and links

Fingerprint

Cite this