IntelFAT

Cercetare

Țesutul adipos epicardic, inflamația locală și vulnerabilitatea plăcilor ateromatoase-studiu imagistic computațional bazat pe inteligență artificială – IntelFAT

Proposal Registration Code

PN-III-P4-ID-PCE-2020-2861

Project Registration Code

PCE 206/2021

Project Acronym

IntelFAT

Purpose and project planning

Purpose: To study the role of epicardial fat-mediated inflammation in the complex process of atheromatous plaque vulnerabilisation, using an innovative solution for quantification of the local inflammation at the site of the epicardial fat surrounding coronary arteries, based on advanced techniques of CCTA, artificial intelligence and cloud computing.

Project planning:

WP1: Data extraction from the image bank (M1-M12)

WP2: Development of the AI solution and radiomics integration (M13-M18)

WP3: Biomarker study (M25-M36)

WP4: Dissemination (M13-M36)

WP5: Project management (M1-M36)

Project Start Date

02 March 2021

Project End Date

31 Dec 2023

Project Duration

36 months

Total budget value

1.198.032 lei

Funding

Ministry of Research and Innovation, CNCS-UEFISCDI

Main objectives

1) To demonstrate the role of regional epicardial fat, surrounding coronary segments with atheromatous plaques, in the complex process of plaque vulnerabilisation

2) To demonstrate the correlation between the amount of global and regional epicardial fat and serum biomarkers of systemic inflammation

3) To test new computational imaging solutions, including the ones based on radiomics approach, for characterization of CT vulnerability features and epicardial fat inflammation

4) To develop and test AI-based algorithms for predicting the risk associated with increased inflammation at the level of epicardial fat and with vulnerability features, to validate their role as new imaging markers of CV risk.

Team:

Name

Role

Prof. Benedek Theodora

Project director

Prof. Benedek Imre

Experienced researcher

 

Dr. Boldisor Cristian

Experienced researcher

 

Dr. Coman Simona

Experienced researcher

 

Dr. Rat Nora

Postdoc

 

Dr. Opincariu Diana

Postdoc

 

Dr. Hodas Roxana

PhD student

 

Dr. Rodean Ioana

PhD student

 

Dr. Matyas Botond

PhD student

Results

1. New algorithm for image postprocessing and characterisation of epicardial fat inflammation

2. New algorithm for assessment of vulnerable atheromatous plaques

3. New risk prediction tool, to predict the risk of major cardiovascular events, based on analysis of epicardial fat inflammation

4. Biomarker study to validate the prediction tool.

Host institution

George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures

Rezultatele obținute:

Proiectul a dus la dezvoltarea și implementarea unor noi tehnologii imagistice bazate pe inteligență artificială pentru evaluarea riscului asociat plăcilor ateromatoase coronariene, integrând în algoritmul de evaluare a riscului și inflamația de la nivelul țesutului epicardic din jurul arterelor coronare. Astfel, proiectul a generat următoarele rezultate:

  • un nou algoritm de postprocesare imagistică și caracterizare a inflamației din țesutul epicardic bazat pe inteligență artificială
  • un nou algoritm pentru evaluarea plăcilor ateromatoase vulnerabile bazat pe inteligență artificială
  • un nou instrument de predicție pentru prezicerea riscului de evenimente cardiovasculare majore, bazat pe analiza inflamației de la nivelul țesutului epicardic prin inteligență artificială
  • validarea predicției prin studiul de biomarkeri

 

Principalul rezultat al proiectului, cu un puternic impact asupra serviciilor medicale de înaltă performanță, îl constituie introducerea, testarea și validarea unei noi metodologii de evaluare a riscului cardiovascular, bazate pe imagistică neinvazivă și care integrează inflamația coronariană în algoritmul de predicție. Superioritatea acesteia față de celelalte metodologii utilizate existente în prezent este dată în primul rând de integrarea în noua soluție rezultată din proiect a inflamației de la nivelul țesutului epicardic, cu potential crescut de destabilizare a plăcilor ateromatoase coronariene, dar și de algoritmul bazat pe inteligență artificială de determinare a fenotipului CT al plăcilor coronariene.

 

Țesutul adipos epicardic, inflamația locală și vulnerabilitatea plăcilor ateromatoase-studiu imagistic computațional bazat pe inteligență artificială – IntelFAT

 

UEFISCDI PCE 206/2021

REZUMAT EXECUTIV

Obiectivul general al proiectului IntelFat a constat în cercetarea rolului inflamației mediate de țesutul adipos epicardic în cadrul procesului complex de vulnerabilizare a plăcii ateromatoase. Cercetarea a avut la bază utilizarea unei soluții inovative pentru cuantificarea inflamației locale de la nivelul țesutului adipos epicardic din jurul arterelor coronare, bazată pe post-procesarea imaginilor obținute prin tehnici imagistice avansate de Angio CT coronarian. Pentru realizarea acestui obiectiv, s-au efectuat:

  • extragerea datelor din banca de date imagistică avută la dispoziția proiectului
  • dezvoltarea unor algoritmi de selecție și extragere a caracteristicilor imagistice prin AI
  • dezvoltarea de algoritmi de inteligență artificială pentru evaluarea inflamației din țesutul adipos
  • studiu de biomarkeri în corelație cu caracteristicile CT de vulnerabilitate a plăcii coronariene la 158 pacienți cu inflamație accentuată la nivelul țesutului adipos
  • testarea și validarea algoritmilor de predicție a riscului de sindrom coronarian acut

În total, tehnologia de detectare a inflamației țesutului adipos a fost testată la un număr de 760 artere coronare ale 261 de pacienți, a căror imagini au fost extrase din baza de date și procesate, iar rezultatele au arătat rolul inflamației de la nivelul țesutului epicardic în vulnerabilizarea plăcilor ateromatoase. Astfel, am demonstrat că o creștere a inflamației poate identifica sediul viitoarei rupturi a plăcii ateromatoase (Benedek T et al, Congresul EuroPCR, Paris, mai 2023). La pacienții post COVID s-a arătat o vulnerabilizare mai crescută și o inflamație mai accentuată la nivelul coronarei drepte (Benedek T et al, Congresul Colegiului American de Cardiologie, New Orleans, martie 2023, rezumat publicat în JACC 2023), și valori mai mari ale scorului FAI de inflamație pericoronariană (Matyas B et al, rezumat publicat în Eur. Heart J. Cardiovasc. Imaging, 2023).  Totodată, inflamația epicardică înainte de ablație a fost asociată cu un risc crescut de recidivă a fibrilației atriale la 12 luni (Bordi L et al, JCE 2023), iar indicele de inflamație epicardică FAI s-a corelat semnificativ cu markerii de vulnerabilitate CT (Parajko et al, rezumat publicat în Eur. Heart J. Cardiovasc. Imaging, 2023). De asemenea, pacienții cu un scor de calciu ridicat au prezentat diferențe regionale în distribuția inflamației coronariene, (Rosca A et al, rezumat publicat în Eur. Heart J. Cardiovasc. Imaging, 2023), iar plăcile cu risc ridicat s-au constatat chiar și la pacienții cu un scor de calciu zero (Matyas B et al, JCE 2023). Studiul de biomarkeri a arătat că I-CAM și MMP-9 sunt predictorii cei mai puternici pentru evenimentele adverse majore legate de vulnerabilizarea unei plăci coronariene.

În paralel, activitățile de diseminare au constat în redactarea a 12 publicații in extenso (6 publicate în reviste ISI cu factor de impact iar 6 under review), 7 comunicări la congrese internaționale indexate ISI, precum și organizarea de evenimente de diseminare cu ocazia conferințelor organizate sau susținute de membrii echipei de proiect, atât online cât și fizic.

Epicardial Fat, local Inflammation and Atheromatous Plaque Vulnerabilisation – a Computational Imaging Study based on Artificial Intelligence – IntelFAT

UEFISCDI PCE 206/2021

EXECUTIVE SUMMARY

The main objective of the project was to study the role of epicardial fat-mediated inflammation in the complex process of atheromatous plaque vulnerabilisation, using an innovative solution for quantification of the local inflammation at the site of the epicardial fat surrounding coronary arteries, based on advanced techniques of CCTA, artificial intelligence and cloud computing.

For achievement of this objective, the following activities were performing during the execution of the project:

-extraction of image data from the image bank available for the project.

-development of a new algorithm for selection and extraction of imaging characteristics using AI

-development of AI algorithms for assessment of inflammation at the level of epicardial adipose tissue

-biomarker study to correlate the CT characteristics of plaque vulnerability in 158 patients with high inflammation in the epicardial fat

-algorithm testing and validation for risk prediction, to assess their power to detect the risk of an acute coronary syndrome.

In total, the novel technology for detection of epicardial fat inflammation was tested in a number of 760 coronary arteries of 261 subjects, whose images were extracted from the image bank and further processed. The results indicated  a relevant role of epicardial fat inflammation in the complex process of coronary atheromatous plaque vulnerabilisation.  We demonstrated that a high inflammation at this level may identify the site of a future plaque rupture  (Benedek T et al, EuroPCR, Paris, may 2023). In post-COVID we found a significantly higher vulnerability associated with an increased inflammation at the level of the right coronary artery (Benedek T et al, ACC congress, New Orleans, march 2023, abstract published in JACC 2023), and increased levels of the fat attenuation index (FAI) score reflecting pericoronary inflammation (Matyas B et al, abstract published in European Heart J. Cardiovasc. Imaging, 2023).  At the same time, epicardial fat inflammation was associated with an increased risk of 12-months recurrence following atrial fibrillation ablation (Bordi L et al, JCE 2023), and FAI was significantly associated with vulnerability markers at CT (Parajko et al, abstract published in Eur. Heart J. Cardiovasc. Imaging, 2023). Moreover, subjects with increased coronary calcium score presented ragional variation in the distribution of pericoronary inflammation  (Rosca A et al, abstract published in Eur. Heart J. Cardiovasc. Imaging, 2023), and high-risk coronary plaques weer noticed even in patients with zero calcium score but increased inflammation (Matyas B et al, JCE 2023). The biomarker study identified I-CAM și MMP-9 as the strongest predictors of major cardiovascular events caused by vulnerabilization of a coronary plaque.

Dissemination activities resulted in 12 manuscripts (6 published in ISI-quoted journal with impact factor and 6 under review), 7 presentations in international congresses ISI-indexed, and organization of various dissemination events, live or online.

Dissemination

 

Publication in extenso in ISI-quoted journals with impact factor, with acknowledgement

  1. Matyas BB, Gerculy R, Rat N, Blindu E, Stanescu GA, Rosca A, Buicu CF, Benedek I, Benedek T. Highly Inflamed Non-Calcified Coronary Plaques Sealed with Stents in Patients with Zero Calcium Score – a Case Series and Review of the Literature. Journal of Cardiovascular Emergencies. 2024;10(1), ahead of print, jce.ro,  https://doi.org/10.2478/jce-2023-0016, ISI cu IF 0.4
  2. Hatfaludi CA, Danu MD. Leonte HA, Popescu BA, Condrea F, Aldea GD, Sandu AE, Leordeanu M, Suciu C, Rodean IP. Applications of Artificial Intelligence in Cardiovascular Emergencies – Status Quo and Outlook. Journal of Cardiovascular Emergencies. 2023;9(4):83-102. https://doi.org/10.2478/jce-2023-0019, ISI cu IF 0.4
  3. Matyas BB, Benedek I, Blindu E, Parajko Zs, Mihaila T, Rat N, Benedek T. Assessing the Impact of Long-term High-Dose Statin Treatment on Pericoronary Inflammation and Plaque Distribution – a Comprehensive Coronary CTA Follow-up Study. European Radiology, under review, ISI cu IF 5.9
  4. Bordi L, Opincariu D, Benedek T, Kovács I, Parajkó Zs, Márton E, Gerculy R, Benedek I. Left Atrial Volume Quantified by MSCT Predicts Emergency Hospitalizations for AF and Arrhythmia Recurrence after Catheter Ablation. Journal of Cardiovascular Emergencies. 2023;9(2):24–31, jce.ro, https://doi.org/10.2478/jce-2023-0004, ISI cu IF 0.4
  5. Blindu E, Benedek I, Rodean IP, Halatiu VB, Rat N, Tolescu C, Mihaila T, Rosca A, Matyas BB, Szabo E, Gerculy R, Pasaroiu D, Buicu F, Benedek T. Regional Differences in the Level of Inflammation Between the Right and Left Coronary Arteries – a Coronary Computed Tomography Angiography Study of Epicardial Fat Attenuation Index in Four Scenarios of Cardiovascular Emergencies. Journal of Cardiovascular Emergencies. 2023;9(4):111–119, jce.ro, https://doi.org/10.2478/jce-2023-0014, ISI cu IF 0.4
  6. Halatiu VB, Benedek I, Rodean IP, Cojocariu LO, Mihaila T, Blindu E, Rosca A, Matyas BB, Gerculy R, Buicu F, Benedek T. Coronary Computed Tomography Angiography-derived modified Duke index is associated with peri-coronary Fat Attenuation Index and predicts severity of coronary inflammation in post COVID-19 patients. Medicine (Basel), under review, ISI cu IF 2.6
  7. Rat N, Matyas BB, Bajka B, Buicu CF, Benedek T. Highly inflamed coronary plaque detected by Angio-CT in a 28-year-old patient with STEMI and long COVID. IMAGING, under review, ISI cu IF 0.4
  8. Gerculy R, Cernica D, Rodean I, Rat N, Buicu F, Benedek I, Benedek T. 3D-printing of the Heart Based on Cardiac CT for Diagnosing a Rare Form of Postinfarction Ventricular Septal Rupture Mimicking Biventricular Free Wall Rupture. IMAGING, under review, ISI cu IF 0.4
  9. Halatiu VB, Rodean IP, Benedek T, Matyas BB, Blindu E, Buicu F, Benedek I. Serial CT for assessment of plaque progression in a young patient with repeated acute coronary syndromes and high familial risk. IMAGING, under review, ISI cu IF 0.4
  10. Matyas BB, Blindu E, Rat N, Kovacs I, Buicu CF, Benedek T. A Race Against Time: Coronary-CTA Discovers a Highly Inflamed Plaque in 49-Year-Old Right Before STEMI. Journal of Cardiovascular Emergencies. 2024;10(1), ahead of print, jce.ro,  https://doi.org/10.2478/jce-2023-0017, ISI cu IF 0.4
  11. Gerculy R, Benedek I, Kovacs I, Rat N, Halatiu VB, Rodean I, Bordi L, Blindu E, Rosca A, Matyas BB, Szabo E, Parajko Zs, Benedek T. Correlations between CT-assessed vascular inflammation at different levels of the coronary circulation and the risk of atrial fibrillation. Journal of Clinical Medicine, under review, ISI cu IF 3.9
  12. Blindu E, Matyas BB, Bajka B, Buicu CF, Chitu M, Benedek I. High Inflammation and Coronary Calcification in an Acute Coronary Syndrome Successfully Treated with Cutting Balloon. Journal of Cardiovascular Emergencies. 2024;10(1), ahead of print, jce.ro, https://doi.org/10.2478/jce-2023-0015, ISI cu IF 0.4

 

Communications in international congress ISI-indexed, with acknowledgement 

  1. V B Halatiu, I Benedek, I P Rodean, L O Cojocariu, T Mihaila, E Blindu, A Rosca, B B Matyas, E Szabo, Z Parajko, R Gerculy, T Benedek – CT-derived modified Duke score is associated with pericoronary Fat Attenuation Index and predicts severity of coronary inflammation, European Heart Journal – Cardiovascular Imaging, Volume 24, Issue Suppl. 1, June 2023, jead119.221, https://doi.org/10.1093/ehjci/jead119.221
  2. Z S Parajko, I Benedek, I Kovacs, L Bordi, D Opincariu, N Rat, B Halatiu, I Rodean, E Blindu, A Rosca, B Matyas, R Gerculy, T Benedek – Association between coronary inflammation measured by FAT attenuation index and CT features of atheromatous plaque vulnerability, European Heart Journal – Cardiovascular Imaging, Volume 24, Issue Suppl. 1, June 2023, jead119.326, https://doi.org/10.1093/ehjci/jead119.326
  3. B Matyas, I Benedek, D Opincariu, E Blindu, A Rosca, L Bordi, B Benedek, T Benedek – Increased risk of coronary plaque vulnerabilization following COVID-19 infection, identified by elevated FAI index of pericoronary inflammation at coronary CT, European Heart Journal – Cardiovascular Imaging, Volume 24, Issue Suppl. 1, 2023, jead119.306,  https://doi.org/10.1093/ehjci/jead119.306
  4. A Rosca, I Benedek, M Neicu, B Matyas, E Blindu, I Rodean, V B Halatiu, N Rat, R Gerculy, T Benedek – Correlations between coronary calcium score, FAI index of epicardial fat inflammation and regional distribution of pericoronary inflammation – insights from the IntelFAT study, European Heart Journal – Cardiovascular Imaging, Volume 24, Issue Suppl. 1, June 2023, jead119.318, https://doi.org/10.1093/ehjci/jead119.318
  5. B Matyas, I Benedek, A Rosca, A Stanescu, E Blindu, R Gerculy, T Benedek – Reduction of perivascular inflammation following long-term statin treatment – a coronary CT follow-up study using Fat Attenuation Index, European Heart Journal, Volume 44, Issue Suppl. 2, November 2023, ehad655.153, https://doi.org/10.1093/eurheartj/ehad655.153
  6. T Benedek, B Mátyás, D Opincariu, R Hodas, I Benedek – Angio CT Assessment of Coronary Plaque Inflammation Indicates Increased Vulnerability of Right Coronary Plaques in post-COVID Patients – Journal of the American College of Cardiology – 2023 – Vol. 81, Issue 8, Supl. A – Pg. 1506 – ISSN: 0735-1097, eISSN: 1558-3597; https://doi.org/10.1016/S0735-1097(23)01950-2
  7. T Benedek, I Rodean, B. Matyas, E. Blindu, B. Halatiu, A. Rosca, N. Rat, I. Benedek. Progression of coronary inflammation identifies the location of a future culprit plaque. Congresul European EuroPCR, Paris, 16-19 mai 2023, abstract published in Eurintervention.