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Optical Coherence Tomography Based Biomechanical Fluid-Structure Interaction Analysis of Coronary Atherosclerosis Progression
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Coronary artery stenosis, plaque burden, and severity of myocardial ischemia

Tanja Kero1,2,3, Juhani Knuuti3,4,5, Sarah Bär3,6

  • 1Nuclear Medicine and PET, Department of Surgical Sciences, Uppsala University, Uppsala, Sweden.

European Heart Journal. Imaging Methods and Practice
|December 15, 2025
PubMed

Insights

Artificial intelligence (AI) analysis of coronary computed tomography angiography shows plaque burden and stenosis correlate with myocardial ischaemia severity. However, anatomical imaging alone may not fully assess coronary artery disease (CAD).

Area of Science:

  • Cardiovascular Imaging
  • Artificial Intelligence in Medicine
  • Coronary Artery Disease

Background:

  • The link between coronary atherosclerosis extent/composition and myocardial ischaemia severity is not fully understood.
  • Accurate assessment of coronary artery disease (CAD) is crucial for patient management.

Purpose of the Study:

  • To evaluate if AI-guided coronary computed tomography angiography (CCTA) plaque burden and composition correlate with myocardial ischaemia severity.

Main Methods:

  • 837 symptomatic patients underwent CCTA and 15O-water PET myocardial perfusion imaging.
  • AI quantified plaque features (stenosis, PAV, NCPV, CPV) per patient and artery.
  • Ischaemia severity was categorized by myocardial blood flow.

Main Results:

  • Increasing ischaemia severity correlated with higher stenosis and plaque burden (PAV, NCPV, CPV) across all major coronary arteries (P < 0.001).
  • Diameter stenosis and non-calcified plaque volume (NCPV) predicted ischaemia severity.
  • Calcified plaque volume (CPV) predicted ischaemia severity in LAD and RCA.

Conclusions:

  • AI-derived CCTA plaque burden and stenosis are associated with myocardial ischaemia severity.
  • Anatomical imaging alone may be insufficient for precise CAD phenotyping.
  • Integrating functional imaging with quantitative plaque analysis is recommended for comprehensive CAD evaluation.
Abstract

Keywords:
artificial intelligencecoronary computed tomography angiographycoronary plaqueischaemiapositron emission tomography

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