Aims of SMARTool

SMARTool aims at the development of a Cloud platform for enabling clinical decision support for prevention of coronary heart disease (CHD) and of major adverse cardiovascular events (MACE). This will be achieved through the standardization and integration of heterogeneous health data and existing patient/artery specific multiscale and multilevel predictive models. Specifically, the SMARTool models are based on the extension of the already available multiscale and multilevel ARTreat models for coronary plaque assessment and progression over time using non-invasive imaging by coronary computed tomography angiography (CCTA) and are extended with functional site-specific assessment (hemodynamically significant plaques by noninvasive FFR computation) and additional heterogeneous patient-specific non-imaging data (history, lifestyle, exposome, biohumoral data, phenotyping and genotyping). Additionally, the final CDSS will include a microfluidic device for on-chip blood analysis of cellular/molecular inflammatory markers.

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Objectives

Collect imaging/non-imaging information from subjects with suspected CAD at different time points (baseline and follow-up), into a patient-specific standardized repository. Historical data are available retrospectively through the EVINCI cohort, while current data from the same subjects will be collected prospectively at follow-up during the project.
Create a patient-specific non-imaging based predictive model for CAD stratification score (genomic/transcriptomics data, history/lifestyle/exposome information, circulating cellular and molecular markers).
Develop a microfluidic device for on-chip blood assay directly exploitable in SMARTool platform which will characterize the patient-specific cellular/molecular inflammatory phenotype.
Refine the existing site-specific multiscale-multilevel model of plaque progression, developed within the FP7 project ARTreat, with site specific imaging information from EVINCI retrospective/baseline and prospective/follow-up CCTA, plus patient-specific non-imaging information of OBJ1.
Implement the existing tools of 3D CCTA artery reconstruction, 3D CCTA plaque characterization and fractional flow reserve measurement with additional data for an integrated anatomo-functional tool.
Refine existing techniques for treatment and intervention support, providing decision support for medical therapy and virtual angioplasty.
Integrate the outcomes of the objectives 1-6 into a unified platform for CAD patient management, enhanced with a POCT based on a key enabling technology for blood assay, highly visual data representation and human computer interaction techniques. Part of this objective is the consideration of state of the art security protocols, as well as the evaluation of the functionalities and the assessement for usability in 4 clinical sites.
Apply the platform in retrospective (baseline) data and validate them by using the prospective (follow-up) data towards improved diagnosis (more accurate 3D artery reconstruction, 3D plaque composition, virtual FFR assessment), severity stratification (high, medium and low CAD score), prediction (more accurate plaque progression simulation), and treatment (medical therapy options and stenting simulation). Additionally, to quantify the uncertainties pertaining to each source of data towards the decisions (diagnosis, prognosis, treatment), through the implementation of error propagation studies and to identify the limits of the corresponding decisions.
Assess the exploitation potential and cost effectiveness of the SMARTool platform.
Assess and analyse the behavioral, ethical, legal, regulatory and social implications and impacts of the novel platform for CAD patient management versus current practice and use of evidence-based communication for disseminating the project.