There is rising interest in the role of coronary inflammation in the creation process for unstable plaques that lead to heart attacks. Cardiology has long concentrated on lipid control and plaques, but plaques do not destabilize and become vulnerable to rupture unless there are influenced by inflammation. A study presented at ACC.24, the annual meeting of the American College of Cardiology (ACC), used artificial intelligence (AI) to visualize inflammation on cardiac computed tomography (CT) scans and track the impact of the new anti-inflammatory drug, orticumab.[1]
Nehal Mehta, MD, director of inflammatory risk and preventive cardiology with the Hospital of the University of Pennsylvania, presented the study. Overall, the AI assessment showed that the new drug was able to reduce coronary inflammation by 50%.
The team's analysis used the CaRi-Heart AI technology developed by Caristo Diagnostics, which shows the perivascular fat attenuation (PFI) surrounding vessels and can serve as a biomarker for coronary inflammation. The AI assesses this using a fat attenuation index (FAI) score, which is then used to color code the fat based on the level of inflammation, and offers a comprehensive report showing heart attack risk. The study randomized 77 patients.
"In the entire population following treatment with orticumab, there was a reduction across all coronary artery inflammation. In particular, when you looked at the high inflammation subgroup, ... there was a statistically significant reduction across the right coronary artery and the LAD," Mehta explained.
This research was conducted after the success of a 2017-2019 study of patients with psoriasis using CaRi-Heart AI. This is a population at high risk for coronary disease. Results demonstrated a correlation between psoriasis severity and increased coronary inflammation, which was mitigated by anti-inflammatory biologic therapy. Mehta said the same was observed in this new study.
"When you look at the prognostic device that Caristo has put together, there was a reduction of six points in this score following treatment with orticumab. These findings suggest that coronary inflammation can be effectively and safely treated, and orticumab and oxidized LDL antibody can be used to treat coronary inflammation. If this is a prognostic marker of future cardiovascular events and we're able to reduce that marker to avoid future events, there's just so many exciting opportunities ahead," Mehta said.
Mehta and his colleagues believe this technology will change the screening practices for cardiac patients in the future. The AI is able to clearly show patients who are at high risk for myocardial infarction, but may have low, soft plaque burden and a calcium score of zero. This can be used in a preventive screening CT scan and later follow-up scans can be used to later to assess the impact of drug treatment.
Dave Fornell has covered healthcare for more than 17 years, with a focus in cardiology and radiology. Fornell is a 5-time winner of a Jesse H. Neal Award, the most prestigious editorial honors in the field of specialized journalism. The wins included best technical content, best use of social media and best COVID-19 coverage. Fornell was also a three-time Neal finalist for best range of work by a single author. He produces more than 100 editorial videos each year, most of them interviews with key opinion leaders in medicine. He also writes technical articles, covers key trends, conducts video hospital site visits, and is very involved with social media. E-mail: dfornell@innovatehealthcare.com