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ORIGINAL RESEARCH article

Front. Artif. Intell.
Sec. Medicine and Public Health
Volume 7 - 2024 | doi: 10.3389/frai.2024.1446640
This article is part of the Research Topic Cross-Modal Learning in Medicine: Bridging Large Language Models with Medical Image Analysis View all 3 articles

Impact of Hypertension on Coronary Artery Plaques and FFR-CT in Type 2 Diabetes Mellitus Patients: Evaluation Utilizing Artificial Intelligence Processed Coronary Computed Tomography Angiography

Provisionally accepted
Yan XI Yan XI *Yi Xu Yi Xu *Zheng Shu Zheng Shu Deng X. FEI Deng X. FEI *
  • Shanghai TCM-Integrated Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China

The final, formatted version of the article will be published soon.

    Objective: This study utilized artificial intelligence (AI) to quantify coronary computed tomography angiography (CCTA) images, aiming to compare plaque characteristics and CTderived fractional flow reserve (FFR-CT) between patients with type 2 diabetes mellitus (T2DM) with or without hypertension (HTN). Methods: A retrospective analysis was conducted on 1151 patients with suspected coronary artery disease who underwent CCTA at a single center. Patients were grouped into T2DM (n = 133), HTN (n = 442), T2DM (HTN+) (n = 256), and control (n = 320). AI assessed various CCTA parameters, including plaque components, high-risk plaques (HRPs), FFR-CT, severity of coronary stenosis using Coronary Artery Disease Reporting and Data System 2.0 (CAD-RADS 2.0), segment involvement score (SIS), and segment stenosis score (SSS). Statistical analysis compared these parameters among groups. Results: The T2DM (HTN+) group had the highest plaque volume and length, SIS, SSS, and CAD-RADS 2.0 classification. In the T2DM group, 54.0% of the plaque volume was noncalcified and 46.0% was calcified, while in the HTN group, these values were 24.0% and 76.0%, respectively. The T2DM (HTN+) group had more calcified plaques (35.7% noncalcified, 64.3% calcified) than the T2DM group. The average necrotic core volume was 4.25 mm³ in the T2DM group and 5.23 mm³ in the T2DM (HTN+) group, with no significant difference (P > 0.05). HRPs were more prevalent in both T2DM and T2DM (HTN+) compared to HTN and control groups (P < 0.05). The T2DM (HTN+) group had a higher likelihood (26.1%) of FFR-CT ≤ 0.75 compared to the T2DM group (13.8%). FFR-CT ≤ 0.75 correlated with CAD-RADS 2.0 (OR = 7.986, 95%CI = 5.466-11.667, Cutoff = 3, P < 0.001) and noncalcified plaque volume (OR = 1.006, 95%CI = 1.003-1.009, Cutoff = 29.65 mm³, P < 0.001). HRPs were associated with HbA1c levels (OR = 1.631, 95%CI = 1.387-1.918). Conclusion: AI analysis of CCTA identifies patterns in quantitative plaque characteristics and FFR-CT values. Comorbid HTN exacerbates partially calcified plaques, leading to more severe coronary artery stenosis in patients with T2DM. T2DM is associated with partially noncalcified plaques, whereas HTN is linked to partially calcified plaques.

    Keywords: diabetes, Hypertension, Coronary computed tomography angiography, Coronary Artery Disease, artificial intelligence

    Received: 10 Jun 2024; Accepted: 07 Oct 2024.

    Copyright: © 2024 XI, Xu, Shu and FEI. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

    * Correspondence:
    Yan XI, Shanghai TCM-Integrated Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
    Yi Xu, Shanghai TCM-Integrated Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
    Deng X. FEI, Shanghai TCM-Integrated Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China

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