Hearts, Volume 7, Issue 3 (September 2026) – 4 articles

Background/Objectives: Myocardial bridging is a common anatomic variant in which an epicardial coronary artery takes an intramyocardial course. A true intracameral, or intracavitary, coronary course is rare. On coronary CT angiography (CTA), multiplanar and curved planar reformations answer most of these questions, but some cases stay equivocal because of partial-volume effects, cardiac motion, and loss of depth cues. A vessel next to a thin or fat-infiltrated wall can also mimic an intracameral course. Cinematic rendering (CR) is a photorealistic three-dimensional post-processing method that uses Monte Carlo path tracing with global illumination to reproduce natural depth and soft-tissue shading. Methods: In this retrospective, single-center, four-patient case series, we describe patients in whom CR was used alongside standard two-dimensional and reformatted CTA after the planar reconstructions had been read as equivocal. The cases were purposively selected as illustrative examples rather than consecutively enrolled, and the report is intended to be hypothesis-generating. Results: In two patients with left anterior descending (LAD) myocardial bridging, CR showed the tunneled segment with depth and was useful for discussion with referring clinicians and for teaching. In two patients whose coronary segment looked intracameral on planar images, CR showed intact overlying myocardium, which favored an intramyocardial course over chamber entry. Conclusions: In these selected patients, CR did not add anatomic information that was unavailable on expert reformations. It appeared to improve perceived depth and reader confidence in these equivocal cases and was useful for communication and teaching; no quantitative image analysis or formal reader study was performed. Because this is a small, retrospective case series without a comparison group, these observations are illustrative and hypothesis-generating and cannot be extrapolated to coronary CTA in general; prospective comparative studies are needed to determine whether CR adds diagnostic value over standard reconstructions. Full article

Background: Pericoronary adipose tissue (PCAT) radiomics on coronary computed tomography angiography (CCTA) may capture inflammatory and structural information beyond conventional attenuation measures. We assessed whether PCAT radiomics predicts future coronary events or quantifies plaque progression. Methods: PubMed/MEDLINE, Embase, and Web of Science were searched from inception to 29 August 2025. Eligible studies included adults undergoing CCTA with quantitative PCAT, or anatomically equivalent coronary perivascular adipose tissue (PVAT), radiomics, and longitudinal clinical or serial-CCTA outcomes. Findings were synthesised narratively because no common estimand supported meta-analysis. Methodological quality was assessed using QUADAS-2 and the Radiomics Quality Score (RQS). Results: Eleven full-text studies, representing at least 6307 participants were included; one study also analysed 127 plaques in 97 patients, and one reported a separate 202-person model-development sample whose overlap with its 1575-person cohort evaluation was not quantified. Eight studies evaluated coronary clinical events, and three evaluated plaque progression. Seven clinical-event studies reported better discrimination for radiomics-based or integrated models than at least one conventional comparator, although calibration and clinical-utility reporting were inconsistent. Two studies included clearly independent external validation. QUADAS-2 identified high patient-selection risk in 4/11 studies; RQSs ranged from 10/36 to 15/36 (mean: 12.5/36). Conclusions: PCAT radiomics shows preliminary prognostic potential, but confidence in the evidence is low because of retrospective designs, heterogeneous outcomes and workflows, restricted geographic sampling, and limited independent external validation. Current evidence is insufficient for routine clinical decision-making. Prospective multicentre validation with standardised acquisition, analysis, reporting, and clinically consistent endpoints is required. Full article

Semaglutide, a recombinant DNA-derived long-acting GLP-1 receptor agonist, has emerged as a key player for patients with or without T2DM and obesity. It exerts pleiotropic effects by modulating glycemic regulation and energy homeostasis. Mechanistically, it stimulates glucose-dependent insulin secretion and suppresses glucagon while enhancing satiety through POMC/NPY modulation in the arcuate nucleus and delaying gastric emptying. Beyond its metabolic utility, semaglutide is cardioprotective, leveraging the PI3K/Akt and eNOS pathways to improve vasodilation, reduce reactive oxygen species (ROS), and stabilize atherosclerotic plaques by inhibiting pro-inflammatory cytokines like TNF-α. While it improves cardiac output via PKA-mediated inotropy, potential cardiotoxicity, including resting tachycardia and autonomic-driven arrhythmias, requires clinical vigilance, particularly regarding electrolyte imbalances in heart failure patients. Ultimately, its robust vasculoprotective profile reinforces its potential as a cornerstone in cardiovascular pharmacotherapy. Further research is needed to better understand the effects of semaglutide on cardiac function and pathologies as it advances as a cardiac drug. This review discusses multiple molecular targets of semaglutide on the heart. Full article

Background: The ‘obesity paradox’, whereby obese patients demonstrate better clinical outcomes compared to normal-weight patients, has been reported in acute myocardial infarction, including ST-segment elevation myocardial infarction (STEMI). However, potential sex differences in this association remain largely unexplored. Methods: Using a prospective registry-based multicenter cohort of consecutive STEMI presentations, we evaluated the association between body mass index (BMI) and mortality in patients with STEMI. Patients were divided into three groups based on BMI: normal weight (18.5–24.9 kg/m²), overweight (25–29.9 kg/m²), and obese (≥30.0 kg/m²). We studied the odds of in-hospital, hospital discharge-to-5-year, and presentation to 5-year all-cause mortality by BMI groups in the overall cohort and in sex-stratified analyses. Results: Among 4682 consecutive STEMI patients, 30.1% were female, and 22.2% were normal weight, 36.2% overweight, and 41.6% obese. In the overall cohort, compared to normal-weight patients, the odds of in-hospital mortality were higher in obese patients (aOR 1.73, 95% CI 1.08–2.8) and the risk of discharge-to-5-year mortality was lower in overweight (aHR 0.69, 95% CI 0.57–0.85) and obese (aHR 0.66, 95% CI 0.53–0.82) patients. In sex-stratified analysis, compared to normal-weight males, obese males had higher odds of in-hospital mortality (aOR 2.25, 95% CI 1.18–4.51). Overweight and obese males (aHR 0.63, 95% CI 0.49–0.82, aHR 0.64, 95% CI 0.48–0.85) and obese females (aHR 0.68, 95% CI 0.49–0.94) had a lower discharge-to-5-year mortality risk. Conclusions: In this large STEMI cohort, obesity was associated with higher odds of in-hospital mortality but lower risk of discharge-to-5-year mortality. Sex-stratified analyses demonstrated that obese males were at high odds of in-hospital mortality and both obese males and females were at lower risk of discharge-to-5-year mortality. Full article