Tao Chen

Coronary computed tomography angiography (CCTA) remains essential for diagnosing coronary artery disease, while the focus has moved from stenosis to plaque burden. Current workflows either need manual adjustments that limit consistency and efficiency, or they lack segment-specific precision. This study evaluated the effectiveness and reliability of a fully automated deep learning-based plaque quantification method using CCTA. DVPlaque workflow, a fully automated deep learning model, was developed to quantify segment-specific plaque volume. A total of 271 CCTA scans were included. Plaque quantification was performed by the expert and DVPlaque model, respectively. Reliability was measured through interclass correlation coefficient (ICC) analysis and Bland-Altman plots. DVPlaque workflow cost less time than expert measurement (p < 0.0001). Among these segments of major coronary arteries, proximal left ascending artery (LAD) had the highest prevalence of plaque (97.0%). Among these coronary arteries, the volumes of total plaque (TP), calcified plaque (CP), noncalcified plaque (NCP), and low-density NCP were the highest in LAD (all p-values < 0.05). On a per-patient level, the ICCs for TP, CP, and NCP volume were 0.962, 0.985, and 0.932. The corresponding biases and 95% limits of agreement were - 25.39 [ - 261.51, 210.73] mm³, 11.88 [ - 52.78, 76.55] mm³, and - 37.27 [ - 255.88, 181.33] mm³. For TP, CP, and NCP, per-vessel ICCs were all > 0.90, and per-segment ICCs were > 0.90 except for mid-LAD NCP (0.887). DVPlaque scheme was capable of quantifying plaque volume with excellent efficiency. The automated quantification of CP and NCP exhibited strong reliability even on a per-segment level, facilitating clinical application.

Qingsong Wang, Tao Chen, Jun Guo, Stefano Bordignon; Rapid Tissue Coverage of the Fluoropolymer-Coated Watchman FLX Pro: Insights from Automated Deep-Learn

Aim: Remnant cholesterol (RC) has been recognized as a modifiable risk factor for cardiovascular disease (CVD). However, the association between long-term changes in RC during follow-up and incident CVD remains underexplored, with most research focusing on baseline RC levels. Methods: Data for this prospective cohort study were derived from the China Health and Retirement Longitudinal Study (CHARLS). RC levels were calculated using the Friedewald equation. Changes in RC, cumulative RC, and the change in RC (ΔRC) were assessed by comparing RC levels at Waves 1 and 3. Cox proportional hazard models, adjusted for potential confounders, were used to evaluate the impact of baseline and dynamic RC levels on incident CVD risk. Results: Among 3,866 participants (46.23% male, mean age: 57.50 years) followed for 5.0 years, participants with initially high RC who decreased to low levels showed reduced CVD risk (HR 0.71, 95% CI 0.54-0.94). Those with low baseline RC escalating to high levels showed similar risk (HR 0.85, 95% CI 0.68-1.06) compared to consistently high RC levels. Highest tertile cumulative RC significantly increased CVD risk (HR 1.37, 95% CI 1.11–1.69). Among high baseline RC participants, those in the lowest ΔRC tertile had reduced CVD risk (HR 0.68, 95% CI 0.52–0.89). Conclusions: Longitudinal RC increases were associated with higher CVD risks, while RC reductions were associated with decreased risks. RC monitoring and management may contribute to CVD risk assessment and prevention, though further research with direct RC measurement and clinically validated outcomes is needed.

Background: Cardiovascular disease (CVD) is closely associated with the triglyceride glucose (TyG) index and its related indicators, particularly its combination with obesity indices. However, there is limited research on the relationship between changes in TyG-related indices and CVD, as most studies have focused on baseline TyG-related indices. Methods: The data for this prospective cohort study were obtained from the China Health and Retirement Longitudinal Study. The exposures were changes in TyG-related indices and cumulative TyG-related indices from 2012 to 2015. The K-means algorithm was used to classify changes in each TyG-related index into four classes (Class 1 to Class 4). Multivariate logistic regressions were used to evaluate the associations between the changes in TyG-related indices and the incidence of CVD. Results: In total, 3243 participants were included in this study, of whom 1761 (54.4%) were female, with a mean age of 57.62 years at baseline. Over a 5-year follow-up, 637 (19.6%) participants developed CVD. Fully adjusted logistic regression analyses revealed significant positive associations between changes in TyG-related indices, cumulative TyG-related indices and the incidence of CVD. Among these changes in TyG-related indices, changes in TyG-waist circumference (WC) showed the strongest association with incident CVD. Compared to the participants in Class 1 of changes in TyG-WC, the odds ratio (OR) for participants in Class 2 was 1.41 (95% confidence interval (CI) 1.08–1.84), the OR for participants in Class 3 was 1.54 (95% CI 1.15–2.07), and the OR for participants in Class 4 was 1.94 (95% CI 1.34–2.80). Moreover, cumulative TyG-WC exhibited the strongest association with incident CVD among cumulative TyG-related indices. Compared to the participants in Quartile 1 of cumulative TyG-WC, the OR for participants in Quartile 2 was 1.33 (95% CI 1.00–1.76), the OR for participants in Quartile 3 was 1.46 (95% CI 1.09–1.96), and the OR for participants in Quartile 4 was 1.79 (95% CI 1.30–2.47). Conclusions: Changes in TyG-related indices are independently associated with the risk of CVD. Changes in TyG-WC are expected to become more effective indicators for identifying individuals at a heightened risk of CVD.

OBJECTIVE To assess the feasibility and safety of the minimalistic approach to left atrial appendage occlusion (LAAO) guided by cardiac computed tomography angiography (CCTA). METHODS Ninety consecutive patients who underwent LAAO, with or without CCTA-guided, were matched (1:2). Each step of the LAAO procedure in the computed tomography (CT) guidance group (CT group) was directed by preprocedural CT planning. In the control group, LAAO was performed using the standard method. All patients were followed up for 12 months, and device surveillance was conducted using CCTA. RESULTS A total of 90 patients were included in the analysis, with 30 patients in the CT group and 60 matched patients in the control group. All patients were successfully implanted with Watchman devices. The mean ages for the CT group and the control group were 70.0 ± 9.4 years and 68.4 ± 11.9 years (P = 0.52), respectively. The procedure duration (45.6 ± 10.7 min vs. 58.8 ± 13.0 min, P < 0.001) and hospital stay (7.5 ± 2.4 day vs. 9.6 ± 2.8 day, P = 0.001) in the CT group was significantly shorter compared to the control group. However, the total radiation dose was higher in the CT group compared to the control group (904.9 ± 348.0 mGy vs. 711.9 ± 211.2 mGy, P = 0.002). There were no significant differences in periprocedural pericardial effusion (3.3% vs. 6.3%, P = 0.8) between the two groups. The rate of postprocedural adverse events (13.3% vs. 18.3%, P = 0.55) were comparable between both groups at 12 months follow-up. CONCLUSIONS CCTA is capable of detailed LAAO procedure planning. Minimalistic LAAO with preprocedural CCTA planning was feasible and safe, with shortened procedure time and acceptable increased radiation and contras consumption. For patients with contraindications to general anesthesia and/or transesophageal echocardiography, this promising method may be an alternative to conventional LAAO.