CIRC Newsletter: October

Introduction

Dear Colleagues,
This month’s introduction focuses on CIRC’s machine learning program. Machine learning is a type of artificial intelligence, where a computer “learns” how to accomplish a task without direct human instruction. Deep learning is a type of machine learning that employs many-layered neural networks. Deep learning is particularly well-suited for image classification tasks. There has been substantial interest in applying deep learning to medical imaging.
In 2017 we founded our CIRC machine learning program, leveraging our strengths as the core lab for multicenter imaging trials, our background in epidemiology, and excitement about how this new technology can improve decision-making.
In just a few years we have made notable achievements. Our first paper using deep learning to predict long-term mortality from chest x-ray images was published in JAMA Open in 2019. This year Vineet Raghu and I published in Annals of Internal Medicine our work using chest x-rays and commonly available electronic medical record data (age, sex, whether currently smoking) to identify high-risk smokers who would benefit from lung cancer screening CT, with substantially better performance than Medicare’s lung cancer screening criteria, the current clinical standard. Vineet won the American Society of Clinical Oncology (ASCO) Conquer Cancer award for this work. He will present additional studies using chest x-rays to assess biological age and risk of post-operative mortality at the American Heart Association (AHA) and Radiological Society of North America meetings. Vineet’s work on biological age is a finalist for the 2020 US National Academy of Medicine Healthy Aging Catalyst grant. More recently, we received a grant from the AHA to use deep learning and chest x-rays to predict adverse cardiovascular events in COVID-19.
With the support of a grant from the AHA Precision Medicine Program and colleagues from the Brigham AI in Medicine (AIM) group, we have also applied machine learning to coronary artery calcium and chest CT. Parastou Eslami published a paper using radiomics to assess calcium in the Framingham Heart Study in Radiology: Cardiothoracic Imaging. Roman Zeleznik, a graduate student at AIM, presented work on our automated tool that quantifies coronary artery calcium from CTs in FHS, ROMICAT-II, PROMISE, and the National Lung Screening Trial (NLST) at AHA and RSNA.
Overall, the future is bright for CIRC and machine learning. I am excited to be part of this dynamic field. I am also hopeful that these techniques will help us better take care of our patients.

Best regards,
Michael

Michael T. Lu, MD, MPH
Director of AI, Cardiovascular Imaging Research Center

AWARDED GRANTS

GOLDILOX Trial

Study Chair: Dr. Udo Hoffmann
Study PIs Dr. Borek Foldyna and Dr. Michael Lu

A Phase IIB, Randomized, Double-blinded, Placebo-controlled, Parallel-design Study to Evaluate the Efficacy and Safety of MEDI6570 in Participants with a Prior Myocardial Infarction, Persistent Inflammation, and Elevated N-terminal Prohormone Brain Natriuretic Peptide sponsored by AstraZeneca. CIRC has been awarded the contract as the Coronary Computed Tomography Angiography Core Laboratory for this trial. This is one of the first large Phase IIB trials were non-calcified plaque volume is the primary endpoint and one of the largest CT trials to date with 780 patients expected to be enrolled across the world. Project Date: 02/28/20 - 02/27/25

Neuroimaging Measures of Psychosocial Stress as Predictors of Articular and Arterial Inflammation, Cardiometabolic Disease, and Treatment Response in Rheumatoid Arthritis

Dr. Ahmed Tawakol

NIAMS 1 R56 AR077187-01 (Bathon/ Tawakol)

Project Period: 09/01/2020 – 08/31/2021
The overall goal of the MPI project is to identify 1) whether psychological distress in RA blunts the ability of immunomodulating pharmacotherapies to reduce inflammatory burden in articular and arterial sites, 2) whether these associations are mediated through increased hematopoietic tissue activity, and 3) how functional connectivity of the amygdala with other brain regions potentiates tissue inflammation.

Impact of Treating Asymptomatic CMV Replication on Cardiovascular Risk in Treated HIV Infection

Dr. Ahmed Tawakol

NIH R01HL152957-01A1 (Hunt/Hsue/Tawakol)

Project Period: 08/20/2020 – 07/31/2024
The major goals of this project are: Specific Aim 1: To determine whether 48 weeks of letermovir-mediated suppression of asymptomatic CMV replication reduces aortic vascular inflammation by FDG-PET/CT in ART-suppressed PLWH. Specific Aim 2: To determine whether 48 weeks of letermovir-mediated CMV suppression reduces soluble markers of endothelial dysfunction in ART-suppressed PLWH. Specific Aim 3: To determine the plasma proteomic signatures of letermovir-mediated CMV suppression in ART-suppressed PLWH and their correlation with changes in surrogate markers of vascular disease.

Reducing Arterial Inflammation and Improving Metabolic Health by Dual CCR2 and CCR5 Antagonism in People Living with HIV

Dr. Ahmed Tawakol

NIH 1R01HL149516-01A1 (Lo/Tawakol)

Project Period: 09/01/2020 - 08/31/2025
Specific Aim 1: To determine the impact of dual CCR2/CCR5 antagonism with CVC on arterial inflammation and circulating soluble and cellular markers of inflammation and immune activation
Specific Aim 2: To determine the impact of dual CCR2/CCR5 antagonism with CVC on insulin resistance, adipose tissue depots, and adipose tissue inflammation and gene expression.

Deep Learning to Predict Biological Age and Longevity from Chest Radiographs

Dr. Vineet Raghu

THE HEALTHY LONGEVITY GLOBAL COMPETITION CATALYST AWARD

Sponsor: National Academy of Sciences

Project Date: 10/15/2020 – 10/14/2021
The goal of the project is to develop a pragmatic measure of biological age based on a chest x-ray image using a convolutional neural network (CNN), a type of artificial intelligence. The aims are to 1) create a CNN to quantify biological age from a chest x-ray image and 2) demonstrate that this chest x-ray age predicts longevity better than chronological age.

Cardiac Clinical CT 2020

Dr. Brian Ghoshhajra

Sponsor: Siemens Medical Solutions USA, Inc.

Project date: 9/1/2020 – 8/31/2021
This project will investigate the ability of DSCT to acquire both anatomical (i.e. presence of coronary stenosis) and functional (i.e. hemodynamic significance) information by performing a single cardiac CT scan under pharmacologic stress conditions. Superior temporal resolution of DSCT should be sufficient to achieve diagnostic image quality under stress in spite of increased heart rate. Such an approach will allow to complement the benefits of CCTA (high negative predictive value but weak specificity) by the incremental benefits of myocardial perfusion imaging (via increased specificity), using a single CT scan. The incremental benefit of CT-FFR analysis of the CCTA data will also be evaluated.

Welcome New Members!

Dr. Marton Kolossvary is a new NIH-T32 fellow joining Dr. Udo Hoffmann’s group.
His fellowship training will focus on the application of artificial intelligence techniques to better understand pathophysiology of coronary artery disease using cardiovascular imaging. Using radiomics and deep learning we can precision phenotype atherosclerosis in-vivo and gain new insights into the development and progression of the disease, and how risk factors potentially alter the course of the disease.

Marton is from Budapest, Hungary where he received his MD diploma from Semmelweis University in July of 2016 and his PhD in May of 2020 under the supervision of Pál Maurovich-Horvat. In his PhD research work he was the first to use radiomics in the cardiovascular imaging domain, showing the superiority of this technique compared to conventional quantitative image analytics.

Megan McCloud is a new Clinical Research Coordinator II working on the GOLDILOX and MEDI6012 trials. She completed her BS in Behavioral Neuroscience with a minor in English at Northeastern University in May 2019 and is currently obtaining an MS in Biotechnology with a concentration in Enterprise at Northeastern.

CIRC in upcoming Conferences

NOVEMBER 14-16

Dr. Andreas Kammerlander
ABSTRACT POSTER SESSION - November 13, 9:00 am - 10:00am

Rising Prevalance of Obesity in the US: National Health and Nutrition Examination Survey (NHANES) 2003-2018
Sex Differences in the Associations of Visceral Adipose Tissue and Cardiometabolic and Cardiovascular Disease Risk: The Framingham Heart Study

Dr. Parastou Eslami

Endothelial Shear Stress Assessment in Coronary Arteries: Comparison Between 3D Reconstructions Based on Invasive and Noninvasive Imaging (Awarded for the Melvin Judkins Early Career Investigator)

Dr. Vineet Raghu
ABSTRACT POSTER SESSION - November 13, 9:00 am - 10:00am

Deep Learning to Assess Cardiovascular Age from Chest Radiographs

Dr. Sandeep Hedgire
PRESENTATION - November 13, 9:00 am - 10:00 am

Cardiovascular Seminar: Post TEVAR Complications

NOVEMBER 29 - DECEMBER 5

Dr. Vineet Raghu
POSTER

Deep learning to predict post-operative mortality after cardiothoracic surgery using pre-operative chest radiographs

Dr. Parasou Eslami
POSTER

Endothelial Shear Stress Calculation in Human Coronary Arteries: Comparison Between 3D Reconstructions Based on Invasive and Noninvasive Imaging

Dr. Sandeep Hedgire
POSTER

CTA Characteristics of Bicuspid Aortic Valves and Predictive Value of Ascending Aortic Length on Aortic Diameter Growth: Preliminary Results

EDUCATIONAL EXHIBIT

Hunt for the Shunt with a Cardiac CT: A Quiz-based Review of Intracardiac Shunts for Trainees
Vice of the Device: Pearls and Pitfalls of Imaging Vascular Devices

CIRC Program Meeting

Mondays, 12-1pm

at 175 Cambridge St. 2nd Floor Conference Room; https://partners.zoom.us/j/96956151479

October 19
Dr. Jingyi Gong - Immune Checkpoint Inhibitors for Cancer Are Associated With Increased Venous Thromboembolism Events
Kris Zhai - Journal Scan

October 26
Tamara Babenko - Journal Scan
Nagendra Gudipati - Journal Scan

November 2
Dr. Andreas Kammerlander - Single Slice CT body composition in FHS: Time to redefine obesity?

November 9
Dr. Carlos Gongora - Updated mechanisms of effect and use of SGLT2 Inhibitors

November 23
Dr. Hadil Zureigat - Journal Scan
Dr. Amna Zafar - Tocilizumab to Prevent Cardiac Injury and Dysfunction in COVID-19

August, September 2020
Publications

Toribio M, Awadalla M, Cetlin M, et al. Brief Report: Vascular Dysfunction and Monocyte Activation Among Women With HIV. J Acquir Immune Defic Syndr. 2020

Foldyna B, Zeleznik R, Eslami P, et al. Epicardial Adipose Tissue in Patients With Stable Chest Pain: Insights From the PROMISE Trial. JACC Cardiovasc Imaging. August 2020

Barth S, Hautmann MB, Arvaniti E, et al. Mid-term hemodynamic and functional results after transcatheter mitral valve leaflet repair with the new PASCAL device. Clin Res Cardiol. August 2020

Campbell CM, Guha A, Haque T, Neilan TG, Addison D. Repurposing Immunomodulatory Therapies against Coronavirus Disease 2019 (COVID-19) in the Era of Cardiac Vigilance: A Systematic Review. J Clin Med. 2020

Lenihan D, Carver J, Porter C, et al. Cardio-oncology care in the era of the coronavirus disease 2019 (COVID-19) pandemic: An International Cardio-Oncology Society (ICOS) statement. CA Cancer J Clin. 2020

Lu MT, Raghu VK, Mayrhofer T, Aerts HJWL, Hoffmann U. Deep Learning Using Chest Radiographs to Identify High-Risk Smokers for Lung Cancer Screening Computed Tomography: Development and Validation of a Prediction Model. Ann Intern Med. September 2020

Abdelrahman KM, Chen MY, Dey AK, et al. Coronary Computed Tomography Angiography From Clinical Uses to Emerging Technologies: JACC State-of-the-Art Review. J Am Coll Cardiol. 2020

Kuo AH, Srivastava SD, Harrington SG, Hedgire SS. Not hepatic infarction: Cold quadrate sign. Clin Imaging. 2020

Osborne MT, Abbasi TA, Albaghdadi MS. Narrowing in on a PET tracer that characterizes coronary atheroma: (18)F-NaF uptake is increased in stenotic coronary artery disease. J Nucl Cardiol Off Publ Am Soc Nucl Cardiol. July 2020

Zanni M V, Currier JS, Kantor A, et al. Correlates and Timing of Reproductive Aging Transitions in a Global Cohort of Midlife Women With Human Immunodeficiency Virus: Insights From the REPRIEVE Trial. J Infect Dis. 2020

Brigham KS, Peer MJ, Ghoshhajra BB, Co JPT. Increasing Vaginal Chlamydia Trachomatis Testing in Adolescent and Young Adults. Pediatrics. 2020

Farooqi KM, Ghoshhajra BB, Shah AM, et al. Recommendations for risk stratified use of cardiac computed tomography for congenital heart disease during the COVID-19 pandemic. J Cardiovasc Comput Tomogr. 2020

Foldyna B, Sandri M, Luecke C, et al. Quantitative coronary computed tomography angiography for the detection of cardiac allograft vasculopathy. Eur Radiol. 2020

Abboud A, Zamalloa JR, Sellars M, et al. A Heart Murmur Is Discovered on an Oncology Ward: Extramedullary Acute Myeloid Leukemia. Am J Med. 2020

Verdini D, Hedgire S, Auchincloss H, Isselbacher E, Sundt T, Ghoshhajra B. Giant coronary artery aneurysm: Cardiac gated CT as optimal exam. J Cardiovasc Comput Tomogr. 2020

Alvi RM, Zanni M V, Neilan AM, et al. Amino-terminal Pro-B-Type Natriuretic Peptide Among Patients Living With Both Human Immunodeficiency Virus and Heart Failure. Clin Infect Dis an Off Publ Infect Dis Soc Am. 2020

Dua A, Thondapu V, Rosovsky R, et al. Deep vein thrombosis protocol optimization to minimize healthcare worker exposure in coronavirus disease-2019. J Vasc surgery Venous Lymphat Disord. August 2020

Dar T, Osborne MT, Abohashem S, et al. Greater Neurobiological Resilience to Chronic Socioeconomic or Environmental Stressors Associates With Lower Risk for Cardiovascular Disease Events. Circ Cardiovasc Imaging. 2020

Eslami P, Thondapu V, Karady J, et al. Physiology and coronary artery disease: emerging insights from computed tomography imaging based computational modeling. Int J Cardiovasc Imaging. August 2020

Osborne MT, Shin LM, Mehta NN, Pitman RK, Fayad ZA, Tawakol A. Disentangling the Links Between Psychosocial Stress and Cardiovascular Disease. Circ Cardiovasc Imaging. 2020

Karády J, Taron J, Kammerlander AA, Hoffmann U. Outcomes of anatomical vs. functional testing for coronary artery disease: Lessons from the major trials. Herz. 2020

Lateef SS, Al Najafi M, Dey AK, et al. Relationship between chronic stress-related neural activity, physiological dysregulation and coronary artery disease in psoriasis: Findings from a longitudinal observational cohort study. Atherosclerosis. 2020

Kuo AH, Sakhuja RA, Hedgire SS. A Woman in Her 70s With Mitral Stenosis, Mitral Regurgitation, and Abnormal Morphology of the Mitral Valve. JAMA Cardiol. July 2020

O’Shea A, Parakh A, Hedgire S, Lee SI. Multisystem assessment of the imaging manifestations of coagulopathy in hospitalized patients with COVID-19. AJR Am J Roentgenol. July 2020

Neilan TG, Nguyen K-L, Zaha VG, et al. Myocardial Steatosis Among Antiretroviral Therapy-Treated People With Human Immunodeficiency Virus Participating in the REPRIEVE Trial. J Infect Dis. 2020

O’Shea A, Kilcoyne A, Hedgire SS, Harisinghani MG. Pelvic lymph nodes and pathways of disease spread in male pelvic malignancies. Abdom Radiol (New York). 2020

Klassen SL, Picard MH, Hill L, et al. Impact of Agreement and Discrepancies in Interpretations of Stress Echocardiography: Insights From the PROMISE Trial. JACC Cardiovasc Imaging. 2020

Strohbehn IA, Lee M, Seethapathy H, et al. Safety and Efficacy of Immune Checkpoint Inhibitors in Patients on Dialysis: A Retrospective Case Series. Am J kidney Dis Off J Natl Kidney Found. 2020

Ganatra S, Dani SS, Shah S, et al. Management of Cardiovascular Disease During Coronavirus Disease (COVID-19) Pandemic. Trends Cardiovasc Med. 2020

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