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Observational Study
. 2020 Mar 3;9(5):e013958.
doi: 10.1161/JAHA.119.013958. Epub 2020 Feb 22.

Machine Learning Framework to Identify Individuals at Risk of Rapid Progression of Coronary Atherosclerosis: From the PARADIGM Registry

Donghee Han  1 , Kranthi K Kolli  2 , Subhi J Al'Aref  2 , Lohendran Baskaran  2 , Alexander R van Rosendael  2 , Heidi Gransar  3 , Daniele Andreini  4 , Matthew J Budoff  5 , Filippo Cademartiri  6 , Kavitha Chinnaiyan  7 , Jung Hyun Choi  8 , Edoardo Conte  4 , Hugo Marques  9 , Pedro de Araújo Gonçalves  9 , Ilan Gottlieb  10 , Martin Hadamitzky  11 , Jonathon A Leipsic  12 , Erica Maffei  13 , Gianluca Pontone  4 , Gilbert L Raff  7 , Sangshoon Shin  14 , Yong-Jin Kim  15 , Byoung Kwon Lee  16 , Eun Ju Chun  17 , Ji Min Sung  1 , Sang-Eun Lee  1 , Renu Virmani  18 , Habib Samady  19 , Peter Stone  20 , Jagat Narula  21 , Daniel S Berman  22 , Jeroen J Bax  23 , Leslee J Shaw  2 , Fay Y Lin  2 , James K Min  2 , Hyuk-Jae Chang  1
Affiliations
Observational Study

Machine Learning Framework to Identify Individuals at Risk of Rapid Progression of Coronary Atherosclerosis: From the PARADIGM Registry

Donghee Han et al. J Am Heart Assoc. .

Abstract

Background Rapid coronary plaque progression (RPP) is associated with incident cardiovascular events. To date, no method exists for the identification of individuals at risk of RPP at a single point in time. This study integrated coronary computed tomography angiography-determined qualitative and quantitative plaque features within a machine learning (ML) framework to determine its performance for predicting RPP. Methods and Results Qualitative and quantitative coronary computed tomography angiography plaque characterization was performed in 1083 patients who underwent serial coronary computed tomography angiography from the PARADIGM (Progression of Atherosclerotic Plaque Determined by Computed Tomographic Angiography Imaging) registry. RPP was defined as an annual progression of percentage atheroma volume ≥1.0%. We employed the following ML models: model 1, clinical variables; model 2, model 1 plus qualitative plaque features; model 3, model 2 plus quantitative plaque features. ML models were compared with the atherosclerotic cardiovascular disease risk score, Duke coronary artery disease score, and a logistic regression statistical model. 224 patients (21%) were identified as RPP. Feature selection in ML identifies that quantitative computed tomography variables were higher-ranking features, followed by qualitative computed tomography variables and clinical/laboratory variables. ML model 3 exhibited the highest discriminatory performance to identify individuals who would experience RPP when compared with atherosclerotic cardiovascular disease risk score, the other ML models, and the statistical model (area under the receiver operating characteristic curve in ML model 3, 0.83 [95% CI 0.78-0.89], versus atherosclerotic cardiovascular disease risk score, 0.60 [0.52-0.67]; Duke coronary artery disease score, 0.74 [0.68-0.79]; ML model 1, 0.62 [0.55-0.69]; ML model 2, 0.73 [0.67-0.80]; all P<0.001; statistical model, 0.81 [0.75-0.87], P=0.128). Conclusions Based on a ML framework, quantitative atherosclerosis characterization has been shown to be the most important feature when compared with clinical, laboratory, and qualitative measures in identifying patients at risk of RPP.

Keywords: coronary artery disease; coronary computed tomography angiography; machine learning; plaque progression; risk prediction.

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Figures

Figure 1
Figure 1
Importance of features by information‐gain method. The information gain method measured the entropy gain with respect to RPP for each variable and then ranks the attributes by their individual evaluations (from top to bottom).
Figure 2
Figure 2
Areas under the receiver operating characteristic curves for the prediction of rapid plaque progression in test set. ASCVD indicates 10‐year atherosclerotic cardiovascular disease risk; CAD, coronary artery disease; ML, machine learning.
Figure 3
Figure 3
Areas under the receiver operating characteristic curves for the prediction of rapid plaque progression stratified by (A) sex and (B) age for Model 3 (P value for differences: A, 0.588; B, 0.873).
See this image and copyright information in PMC

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