Atherosclerosis risk classification with computed tomography angiography: A radiologic-pathologic validation study.

BACKGROUND AND AIMS: The application of machine learning to assess plaque risk phenotypes on cardiovascular CT angiography (CTA) is an area of active investigation. Studies using accepted histologic definitions of plaque risk as ground truth for machine learning models are uncommon. The aim was to evaluate the accuracy of a machine-learning software for determining plaque risk phenotype as compared to expert pathologists (histologic ground truth). METHODS: Sections of atherosclerotic plaques paired with CTA were prospectively collected from patients undergoing carotid endarterectomy at two centers. Specimens were annotated for lipid-rich necrotic core, calcification, matrix, and intraplaque hemorrhage at 2 mm spacing and classified as minimal disease, stable plaque, or unstable plaque according to a modified American Heart Association histological definition. Phenotype is determined in two steps: plaque morphology is delineated according to histological tissue definitions, followed by a machine learning classifier. The performance in derivation and validation cohorts for plaque risk categorization and stenosis was compared to histologic ground truth at each matched cross-section. RESULTS: A total of 496 and 408 vessel cross-sections in the derivation and validation cohorts (from 30 and 23 patients, respectively). The software demonstrated excellent agreement in the validation cohort with histological ground truth plaque risk phenotypes with weighted kappa of 0.82 [0.78-0.86] and area under the receiver operating curve for correct identification of plaque type was 0.97 [0.96, 0.98], 0.95 [0.94, 0.97], 0.99 [0.99, 1.0] for unstable plaque, stable plaque, and minimal disease, respectively. Diameter stenosis correlated poorly to histologically defined plaque type; weighted kappa 0.25 in the validation cohort. CONCLUSIONS: A machine-learning software trained on histological ground-truth tissue inputs demonstrated high accuracy for identifying plaque stability phenotypes as compared to expert pathologists.

Climate warming and summer monsoon breaks drive compound dry and hot extremes in India.

Considering the severe impacts of compound dry and hot extremes, we examine the primary drivers of CDHEs during the summer monsoon in India. Using ERA5 reanalysis, we show that most of the CDHEs in India occur during the droughts caused by the summer monsoon rainfall deficit. Despite a decline in the frequency of summer monsoon droughts in recent decades, increased CDHEs are mainly driven by warming and dry spells during the summer monsoon particularly in the Northeast, central northeast, and west central regions. A strong land-atmospheric coupling during droughts in the summer monsoon season leads to frequent CDHEs in the Northwest and southern peninsular regions. Furthermore, regional variations in land-atmospheric coupling cause substantial differences in the CDHE occurrence in different parts of the country. Summer monsoon rainfall variability and increased warming can pose a greater risk of compound dry and hot extremes with severe impacts on various sectors in India.