Whether coronary plaque response to proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibition differs by sex remains uncertain. We assessed sex-related differences in serial intravascular imaging and transcriptomic responses to evolocumab. This post hoc analysis of the YELLOW III trial included 110 patients with chronic coronary disease (CCD) receiving maximally tolerated statin therapy who had lipid-rich, non-obstructive coronary lesions on optical coherence tomography (OCT). All received evolocumab 140 mg every 2 weeks for 26 weeks. Serial OCT, near-infrared spectroscopy, and intravascular ultrasound were performed at baseline and follow-up. Peripheral blood mononuclear cells underwent RNA sequencing. Among 110 patients, 29 were women and 81 were men. Absolute low-density lipoprotein cholesterol reduction did not differ significantly between women and men (-56.6 ± 35.9 vs. -58.1 ± 26.4 mg/dL; p = 0.830). Plaque response did not differ significantly by sex for minimum fibrous cap thickness (+ 27.9 ± 26.5 vs. + 26.4 ± 20.7 μm; p = 0.755), maximum lipid core burden index within a 4-mm segment (-86.8 ± 158.6 vs. -96.2 ± 134.4; p = 0.756), and percent atheroma volume (-1.2 ± 1.1 vs. -1.5 ± 1.6
Accurate assessment of left main coronary artery (LMCA) disease is essential for guiding revascularization. Intravascular ultrasound (IVUS) is the reference standard for anatomical evaluation of intermediate LMCA stenosis, whereas quantitative flow ratio (QFR) is an angiography-derived, wire-free physiological index. Data comparing these modalities in LMCA disease remain limited. This prospective single-center study included 135 patients with LMCA lesions undergoing coronary angiography and IVUS between January 2024 and June 2025. Offline QFR was calculated using QAngio XA 3D. Significant LMCA disease was defined as IVUS-derived minimum lumen area (MLA) < 6 mm² or QFR < 0.80. Agreement, correlation, and diagnostic performance of QFR were evaluated against IVUS. The mean age was 63.4 ± 9.7 years, and 88.1
Intramyocardial hemorrhage (IMH), a severe reperfusion injury, is optimally detected by T2* mapping, which remains limited by sensitivity to artifacts and relatively long acquisition times. We aimed to evaluate the prognostic value of IMH identified by conventional T2-weighted (T2W) imaging in patients with ST-elevation myocardial infarction (STEMI). In this single-center retrospective study, 453 STEMI patients underwent CMR at a median of 5 days post-reperfusion. IMH was identified quantitatively as a hypointense core within edema on T2W imaging and expressed as a percentage of left ventricular mass. The primary endpoint was a composite of all-cause death and heart failure hospitalization. IMH was present in 167 patients (36.9
CT-derived fractional flow reserve (CT-FFR) enables noninvasive physiological assessment from coronary CT angiography. This study aimed to evaluate its diagnostic performance across six prespecified anatomical and calcification-related factors to clarify lesion-specific clinical applications. In this prospective multicenter trial, 317 patients with 366 target vessels underwent coronary CT angiography and invasive fractional flow reserve (FFR) within 7 days. CT-FFR performance was evaluated according to target vessel, lesion location, lesion length, bifurcation involvement, target-lesion calcification, and per-patient coronary calcium burden. These factors were selected a priori to address distinct anatomical or pathophysiological hypotheses. Subgroup analyses were exploratory, and nominal P values are reported. Overall vessel-level accuracy, sensitivity, specificity, positive predictive value, negative predictive value (NPV), and area under the receiver operating characteristic curve were 87.2
As patients increasingly access their own electronic health records, the dense technical language of cardiac magnetic resonance (CMR) reports has become a barrier both to patient comprehension and to decision-making by non-imaging physicians. We evaluated whether ChatGPT-4o can enhance the accessibility of CMR reports and generate clinical recommendations, and we quantified the accuracy, safety, and patient reception of these outputs. We prospectively enrolled 75 consecutive outpatients undergoing CMR at two Italian tertiary centres. Each physician-dictated report was processed with ChatGPT-4o through the web interface to produce a simplified patient-facing explanation and tailored clinical recommendations. Two expert cardiologists rated the correctness and completeness of the simplified reports on 5-point Likert scales, with inter-rater reliability by ICC(2,1). Three additional cardiologists rated the AI-generated recommendations for correctness, completeness, and potential harm after a calibration session using a shared written rubric. Patients completed paired questionnaires comparing the standard and AI-enhanced reports across six domains, analysed with the Wilcoxon signed-rank test. Expert-rated correctness of the simplified reports was 4.63 ± 0.88 and completeness 4.42 ± 1.06, with excellent agreement (ICC 0.95–0.99). Patients rated AI-enhanced reports significantly higher than standard reports across every domain (all p < 0.001), including overall satisfaction (8.87 ± 1.11 vs. 6.56 ± 2.22 on a 10-point scale; +35
Arterial hypertension (AH) and type 2 diabetes mellitus (T2DM) predispose to left atrial (LA) dysfunction and atrial myopathy. We assessed the ability of peak atrial longitudinal strain (PALS) to predict major adverse cardiovascular events (MACEs) in AH and/or T2DM. We retrospectively enrolled patients > 40 years, in sinus rhythm, with AH and/or T2DM. Standard and advanced echocardiographic indices were collected; patients with previous MACEs, cardiac surgery, pacemakers, or moderate-to-severe valvular disease were excluded. The composite endpoint included atrial fibrillation, heart failure hospitalization, transient ischemic attack, stroke, myocardial infarction/coronary revascularization, and cardiovascular/all-cause mortality. Study population: 292 patients (63.0 ± 9.6 years, 50
The ramus intermedius (RI) is a variant artery arising from the trifurcation of the left main (LM) coronary artery. While prior work from our group has demonstrated that RI is associated with greater atherosclerotic plaque burden in the LM, whether this anatomical variant is associated with increased overall coronary plaque burden across the entire coronary tree remains unknown. This study aimed to evaluate the relationship between RI presence and total coronary plaque, stenosis, and segment involvement. A large retrospective single-center study was conducted among 11,497 adults who underwent coronary computed tomography angiography (CCTA) between October 2006 and December 2022 in Los Angeles, California. The total plaque score (TPS), total stenosis score (TSS), and segment involvement score (SIS) were quantified for each participant. Differences between individuals with and without an RI were assessed using the Wilcoxon rank-sum test. Negative binomial regression models were constructed with TPS, TSS, and SIS as dependent variables and RI presence as the independent variable, adjusting for traditional cardiovascular risk factors. Among 11,497 subjects (mean age 62.0 ± 12.4 years, 64
This study aimed to validate the agreement and clinical utility of an artificial intelligence-based CT-SYNTAX score (AI-CT-SS) against the invasive angiography-based reference standard (ICA-SS) and manual CT-SS in patients with complex coronary artery disease (CAD). This retrospective study was conducted at The First Affiliated Hospital of Soochow University. Patients with complex CAD who underwent both CCTA and ICA within 30 days between June 2016 and October 2024 were included. SYNTAX scores were calculated using ICA (ICA-SS), manual CCTA interpretation (manual CT-SS), and AI (AI-CT-SS). Agreement was evaluated using Cohen’s kappa, Bland-Altman plots, and paired t-tests. Among 411 patients (mean age 62.5 ± 12.6 years; 75.4
The purpose of this study was to evaluate whether a misalignment correction algorithm reduces artifacts from breathing in patients undergoing computed tomography angiography (CTA) early after coronary artery bypass graft (CABG) surgery. In this retrospective study, consecutive patients undergoing CTA early after CABG surgery between November 2023 and March 2025 were screened. Patients exhibiting relevant breathing artifacts on standard reconstructions were included for the evaluation. CTA was acquired in the ECG-gated sequential mode on a dual-source CT. For each patient, standard reconstructions were compared with those using a misalignment correction algorithm designed to resolve discontinuities between adjacent image stacks (ZeeFree). Two blinded readers assessed artifacts across six anatomical regions (bypass grafts, coronary arteries, thoracic aorta, pulmonary trunk, lung/trachea, and sternum) using a 4-point visual analogue scale. Among 680 patients scanned at a median of 4 days (IQR 2–8 days) after CABG surgery, 75 patients (11
To determine whether higher Hounsfield unit (HU) thresholds for computed tomography-derived aortic valve calcium (CT-AVC) scoring provide additional hemodynamic or discriminatory value beyond conventional 130-HU Agatston scoring in classical high-flow/high-gradient severe aortic stenosis (AS). This single-center retrospective cohort included 63 consecutive pre-TAVI patients with trileaflet, classical high-flow/high-gradient severe AS. CT-AVC was quantified on non-contrast ECG-gated CT at 130, 200, 500, 800, and 1000 HU within a manually defined leaflet/annulus region of interest, excluding left ventricular outflow tract and mitral annular calcification. Associations with peak gradient, mean gradient, and aortic valve area were assessed using correlation and multivariable linear regression.Exploratory ROC analysis assessed discrimination of very severe hemodynamic burden, defined as a mean gradient ≥ 60 mmHg, within the established severe-AS cohort, with ROC areas compared using DeLong testing. CT-AVC at all HU thresholds was independently associated with higher peak gradient (β, 0.010 at 130 HU to 0.144 at 1000 HU; all P ≤ 0.005) and higher mean gradient (β, 0.0059 at 130 HU to 0.073 at 1000 HU; all P ≤ 0.024). Associations with aortic valve area were not statistically significant. Within-cohort discrimination of very severe hemodynamic burden was modest and comparable across thresholds (AUC 0.65–0.67), with no statistically significant difference by DeLong testing (P = 0.68). In classical high-flow/high-gradient severe AS, CT-AVC demonstrated consistent associations with transvalvular gradients across HU thresholds. Higher HU thresholds did not outperform conventional 130-HU scoring and showed only modest, comparable performance for within-severity hemodynamic stratification. These thresholds should be interpreted as complementary densitometric analyses rather than alternative diagnostic cut-offs.
Attenuation artifacts on myocardial perfusion SPECT differ across camera geometries. This study evaluated whether CT attenuation correction (CTAC) improves per-vessel detection of obstructive coronary artery disease (CAD) on a stationary 19-pinhole CZT system. Rest–stress ⁹⁹ᵐTc-tetrofosmin CZT SPECT studies from 48 patients with angiographically confirmed CAD (185 vessels) were retrospectively reconstructed with and without CTAC. The reference standard was ≥ 70
After endovascular aneurysm repair, patients require lifelong CT follow-ups. Photon-counting detector CT (PCD-CT) may improve detection of tiny iodinated structures at low radiation dose. The aim of this experimental study was to find the lowest dose which still provides high detectability of small endoleaks using PCD-CT with 55 keV and 50 keV virtual monoenergetic images (VMIs). An abdominal aneurysm phantom mimicking medium and large patients was scanned at 100
Functional mitral regurgitation (FMR) in heart failure (HF) has evolved substantially with contemporary guideline-directed medical therapy (GDMT); given its prognostic impact, accurate quantification of FMR is critical for risk stratification. This study aims to compare pathophysiological correlates and prognostic role of different echocardiographic approaches to effective regurgitant orifice area (EROA) assessment. We prospectively enrolled consecutive chronic HF outpatients with left ventricular ejection fraction (LVEF) < 50
A 55-year-old male with history of prior LCx STEMI and remote chest external beam radiation underwent cardiac MRI(CMR) for aortic regurgitation. CMR demonstrated Nonischemic late gadolinium enhancement (LGE), valvular thickening, and pericardial effusion. Correlation with radiation treatment planning CT supported the diagnosis of radiation-induced myocardial fibrosis despite a history of prior STEMI.
Background Cardiac magnetic resonance (CMR) is the reference standard for diagnosing left ventricular (LV) noncompaction cardiomyopathy (NCCM). However, reported associations between CMR-derived structural parameters and major adverse cardiovascular and cerebrovascular events (MACCE) remain inconsistent. This study aimed to evaluate CMR characteristics in NCCM compared with controls and assess their associations with MACCE based on published case-control studies. Methods The Cochrane Collaboration methodological framework was followed. In the primary analysis, CMR-derived parameters were compared between NCCM patients and controls. In the secondary analysis, these parameters were compared between NCCM patients with and without MACCE. Results The pooled analysis using a random-effects model demonstrates that patients with NCCM exhibit a markedly reduced CMR-derived left ventricular ejection fraction (LVEF), feature tracking derived strain indices and higher LV volumes compared with controls. CMR parameters, including LVEF, ventricular volumes, and the extent of trabeculation showed modest or no association with adverse outcomes. In contrast, late gadolinium enhancement (LGE) was the imaging marker most consistently associated with MACCE (RR = 2.78; 95
Myocardial iron overload represents a major cause of cardiac morbidity in patients with thalassemia. Cardiovascular magnetic resonance (CMR) T2* is the current reference for noninvasive myocardial iron quantification; however, it may be limited in detecting early iron-related myocardial changes. Native T1 mapping emerged as a complementary technique that may overcome some of the T2* limitations. The aim of this review is to analyze the available evidence on the use of native T1 mapping in thalassemia patients and to evaluate its relationship with T2*. Literature search was performed in PubMed, Scopus, Embase, and Cochrane. Studies evaluating myocardial T1 mapping in thalassemia patients were included. Data extraction focused on study characteristics, technical aspects, T1 and T2* values, and associations between the two measures. Sixteen studies were included. Most investigations reported a good relationship between T1 and T2* values. The strength of this association was higher in iron-overloaded cohorts and weaker in patients with normal T2*. Several studies described a subset of patients with reduced T1 despite normal T2*. Considerable heterogeneity was observed across studies in acquisition protocols, region of interest strategies and native T1 reference values. In conclusion, T1 mapping shows a global, though heterogeneous, association with T2* in thalassemia patients and its systematic integration in acquisition protocols represents a valuable complementary tool to T2*. Native T1 mapping may improve detection of early myocardial iron-related changes and support individualized patient management. Prospective longitudinal studies incorporating clinical outcomes are required to define the prognostic value and clinical role of T1 mapping.
This study aimed to investigate the severity of myocardial fibrosis in patients with coronary heart disease (CHD) combined with diabetes mellitus (DM) using cardiovascular magnetic resonance (CMR) T1 mapping technique. This study enrolled 146 patients with CHD who underwent CMR. 96 patients had CHD without DM [CHD(DM-)], and 50 patients had CHD with DM [CHD(DM+)] according to whether they had DM or not. CMR-related parameters were also measured, including left ventricular (LV) cardiac function, T1 mapping, global strain, and late gadolinium enhancement. Patients were further divided into four subgroups based on the presence or absence of heart failure (HF): CHD (DM+) with HF, CHD (DM+) without HF, CHD (DM-) with HF, and CHD (DM-) without HF. The determinants of myocardial fibrosis in patients with CHD and CHD(DM+) were determined by multivariate linear regression analysis. Both native T1 and extracellular volume fraction (ECV) were significantly higher in patients with CHD (DM+) compared with those with CHD (DM-) [native T1: 1263.52 ± 69.19 vs. 1237.62 ± 62.11 and ECV: 33.95 (31.49, 37.62) vs. 32.21 (28.63, 35.7), respectively, p < 0.05]. While LV functional parameters, global peak strain, and late gadolinium enhancement were not significantly different between CHD (DM+) and CHD (DM-) patients. DM is an independent determinant of elevated native T1 and ECV in patients with CHD. In CHD and CHD (DM+), native T1 and ECV were significantly correlated with N-terminal pro-brain natriuretic peptide and LV ejection fraction. Meanwhile, native T1 and ECV were higher in patients with CHD (DM+) with HF than in those with CHD (DM+) without HF (p < 0.05). Elevated CMR native T1 and ECV values indicate that DM acts as an independent determinant in exacerbating myocardial fibrosis among CHD patients. Moreover, in patients with CHD combined with DM who developed HF, native T1 and ECV values were further increased, suggesting that the combination of DM and HF further aggravates myocardial fibrosis severity in CHD patients.
Accurate, early identification of transthyretin cardiac amyloidosis (ATTR-CA) is challenging yet critical for effective treatment. In this work, the modeled endpoint is scan positivity on [^99mTc] Tc-PYP scintigraphy, defined by the semi-quantitative Perugini visual grade (Grade 2-3 versus Grade 0-1). Two multimodal deep-learning frameworks, including Late Fusion (LF) and Cross-Modal Fusion Network (CMF-Net), are proposed to combine [^99mTc] Tc-Pyrophosphate ([^99mTc] Tc-PYP) scintigraphy with clinical metadata for automated detection. On a curated cohort of 109 patients (62 positive, 47 negative), fusion models consistently outperformed image-only convolutional neural networks (CNNs): CMF-Net raised average accuracy by 6.9 percentage points and LF by 5.4. EfficientNet CMF-Net achieved peak accuracy 90.9 [^99mTc] Tc-PYP scan positivity and may streamline scan interpretation.
We aimed to develop and assess the performance of a Machine learning (ML) model integrating common clinical features to predict arrhythmic events in patients with Hypertrophic Cardiomyopathy (HCM). Post-hoc analysis of an international multicenter registry of 531 HCM patients (49 years (IQR 35–61), 57
