On August 31st, 2013 ARTreat project (ICT-2007, FP7-224297), entitled “Multi-level patient-specific artery and atherogenesis model for outcome prediction, decision support treatment, and virtual hand-on training” successfully ended, at month 60 for the project. ARTreat is an integrated project coordinated by the National Council of Research (CNR) of Italy, managing 20 EU partners selected to provide a multidisciplinary approach (IT, biological, medical, bioengineering) to the project objectives.
An interview with the Coordinator, Prof Oberdan Parodi, will talk us through the project.
Atherosclerosis is a disease of the arterial blood vessels (arteries), in which the walls of the blood vessels become thickened and hardened by "plaques." The plaques are composed of cholesterol and other lipids, inflammatory cells, and calcium deposits. The plaques can slow the flow of blood through the arteries, and if the plaques rupture, the blood flow can become completely obstructed. Atherosclerosis can be easily confused with arteriosclerosis. Arteriosclerosis is a general term describing any hardening (and loss of elasticity) of medium or large arteries, while atherosclerosis is a hardening of an artery specifically due to an atheromatous plaque.
ARTreat aimed to develop a multiscale and predictive model, which integrates:
Around this three-level multiscale model, a treatment decision support system and training services have been also developed.
The early detection and prediction of the progression of atherosclerosis are the crucial requirements towards improved treatment, and reduction in mortality and morbidity. Despite the many advances in imaging and functional measurements, determining optimal treatment strategies for patient with cardiovascular disease remained problematic.
In ARTreat, the integration of multiple types of anatomical and functional patient data produced from different technologies into a consistent framework helps in managing the complex care process of cardiovascular diseases (CVD), and provides support in prescribing the optimal patient treatment. ARTreat produced tools to assist doctors in making decisions and developing solutions act to minimize future therapy costs, by providing personalized treatment support.
From the technical point of view, compared to previous products for ATS diagnosis and prediction of progression, ARTreat has been able to provide an integrated platform offering several functionalities in terms of:
The most innovative output of ARTreat platform lies in the development and validation of a patient-specific predictive tool of atherosclerotic plaque formation and progression, based on integration of systemic features with local features, namely artery anatomy, blood flow and particle dynamics. Local parameters were assessed by advanced imaging modalities (CT angiography, MRI), Computational Flow Dynamics and newly developed mass transfer computations. Compared to previous studies, new features were included in the specific risk prediction model, including markers of systemic inflammation (monocyte activation, circulating levels of adhesion molecules) and HDL circulating levels. Another relevant achievement beyond the state of the art was to develop a tool for clinical decision support. In the diagnostic workflow, no previous platforms integrated clinical information (risk scores, results of functional tests) with tools capable of predicting plaque progression from three level models. The development of such tools presents the ability to capture the complex and multi-factorial relationships that link underlying pathophysiologic mechanisms.
The major achievement of dissemination on how ARTreat can improve the current clinical practice has been represented by the organization of the International Workshop on the ARTreat results (Cape Sounio, Greece, May 2013), whereas all Consortium participated to the dissemination event by providing results on the project clinical and scientific outputs. The project results were presented to an audience of cardiologists, neurologists, biologists and bio-engineers involved in atherosclerosis research.
Although in a limited population, this predictive tool was tested against the most reliable end-point, namely a prolonged clinical and imaging follow-up of the atherosclerotic process. By this approach, ARTreat platform not only is focusing on features correlated with plaque progression (systemic and local), but also infers on formation of de-novo plaques in apparently normal vascular territories at baseline evaluation. The role of adhesion molecules, diabetes, low HDL and local wall shear stress in formation and progression of atherosclerotic plaques has been assessed in two groups of patients with coronary or carotid atherosclerotic disease, and used for modeling plaque growth in human beings, creating a tool for treatment decision support.
The application in patient-specific context makes ARTreat a promising system for application of the developed models to the clinical arena. Key steps needed to transform ARTreat prototypes into industrial products to be leaded in the Healthcare IT market of standalone medical devices software include two different phases after the project conclusion: