Search Results (362)

Coronary artery disease (CAD) remains the leading cause of cardiovascular mortality worldwide. Accurate and non-invasive quantification of coronary hemodynamics, namely in the right coronary artery (RCA), is essential for clinical decision-making but remains challenging due to the complex interaction among vessel geometry, pulsatile flow, and blood rheology. This study presents and validates a transparent computational framework for non-invasive fractional flow reserve (FFR) estimation using patient-specific RCA geometries reconstructed from coronary computed tomography angiography (CCTA) using SimVascular 27-03-2023. The proposed workflow integrates realistic boundary conditions through a Womersley velocity profile and a three-element Windkessel outlet model, coupled with a viscoelastic blood rheology formulation (sPTT) implemented via user-defined functions (UDFs). This work integrates all clinically relevant conditions of invasive FFR assessment into a single patient-specific computational framework, while delivering results within a time frame compatible with clinical practice, representing a meaningful methodological advance. The methodology was applied to seven patient-specific cases, and the resulting non-invasive FFR values were compared with both invasive wire-based measurements and commercial HeartFlow^® outputs (Mountain View, CA, USA). Under hyperemic conditions, the computed FFR values showed strong agreement with invasive references, with a mean relative error of 8.4% ± 6.3%, showing diagnostic consistency similar to that of HeartFlow^® (8.3% ± 8.1%) for the selected dataset. These findings demonstrate the ability of the proposed CFD-based pipeline to accurately replicate physiological coronary behavior under hyperemia. This novel workflow provides a fully on-site, open-source, reproducible, and cost-effective framework. Ultimately, this study advances the clinical applicability of non-invasive CFD tools for the functional assessment of CAD, particularly in the RCA. Full article

Coronary artery disease (CAD) remains the leading cause of cardiovascular morbidity and mortality worldwide, with plaque composition and morphology being as key determinants of disease progression and clinical outcomes. Accurate plaque characterization is essential for risk stratification and therapeutic decision-making, yet conventional image interpretation is limited by inter-observer variability and time-intensive workflows. Artificial intelligence (AI) models have emerged as a transformative tool for automated coronary plaque analysis across multiple imaging modalities. AI-driven models demonstrate high diagnostic accuracy for plaque detection, segmentation, quantification, and vulnerability assessment. Integration of AI-derived imaging biomarkers with clinical risk scores can further enhance prediction of major adverse cardiovascular events and supports personalized management. These advances position AI-enhanced imaging as a powerful adjunct for both invasive and non-invasive evaluation of CAD. Despite its promise, important barriers to widespread clinical adoption remain, including data heterogeneity, algorithmic bias, limited model transparency, insufficient prospective validation, regulatory challenges, and incomplete integration into clinical workflows. Addressing these challenges will be essential to ensure safe, generalizable, and cost-effective implementation of AI in routine cardiovascular care. Full article

Automated assessment of coronary artery (CA) lesions via Coronary Computed Tomography Angiography (CCTA) is essential for the diagnosis of coronary artery disease (CAD). However, current deep learning approaches confront several challenges, primarily regarding the modeling of long-range anatomical dependencies, the effective decoupling of plaque texture from stenosis geometry, and the utilization of clinically prevalent mixed-grained annotations. To address these challenges, we propose a novel mixed-grained hierarchical geometric-semantic learning network (MG-HGLNet). Specifically, we introduce a topology-aware dual-stream encoding (TDE) module, which incorporates a bidirectional vessel Mamba (BiV-Mamba) encoder to capture global hemodynamic contexts and rectify spatial distortions inherent in curved planar reformation (CPR). Furthermore, a synergistic spectral–morphological decoupling (SSD) module is designed to disentangle task-specific features; it utilizes frequency-domain analysis to extract plaque spectral fingerprints while employing a texture-guided deformable attention mechanism to refine luminal boundary. To mitigate the scarcity of fine-grained labels, we implement a mixed-grained supervision optimization (MSO) strategy, utilizing anatomy-aware dynamic prototypes and logical consistency constraints to effectively leverage coarse branch-level labels. Extensive experiments on an in-house dataset demonstrate that MG-HGLNet achieves a stenosis grading accuracy of 92.4% and a plaque classification accuracy of 91.5%. The results suggest that our framework not only outperforms state-of-the-art methods but also maintains robust performance under weakly supervised settings, offering a promising solution for label-efficient CAD diagnosis. Full article

We report the case of an 80 yo female patient with cardiovascular risk factors and previous diagnosis of Tako-Tsubo syndrome, who was referred to our institution one year after a previous diagnosis, due to symptoms suggestive of acute coronary syndrome (SCA) after severe emotional stress. After ruling out suspected CAD by cardiac computed tomography (CCT) and subsequent invasive coronary angiography (ICA) confirming no significant stenosis but presence of vulnerable plaque, the patient underwent further investigation by cardiac magnetic resonance (CMR) that confirmed a clinical picture compatible with recurrence of Tako-Tsubo syndrome. Our case underlines the importance of multimodality imaging to guide diagnosis and treatment in this specific clinical scenario. Full article

Background and Objectives: Whole Blood Viscosity (WBV), estimated using the De Simone formula, is a key hemodynamic parameter linked to endothelial dysfunction and atherosclerosis. Its association with significant coronary calcification, defined as a high Coronary Artery Calcium Score (CACS ≥ 100), remains unclear. This study investigated whether calculated WBV predicts high CACS. Materials and Methods: In this single-center, retrospective, cross-sectional study, 403 patients undergoing coronary computed tomography angiography for suspected stable coronary artery disease were included. Participants were stratified into CACS < 100 (n = 258) and CACS ≥ 100 (n = 145). WBV was calculated at High Shear Rate (HSR) and Low Shear Rate (LSR) using the De Simone formula. Multivariate binomial logistic regression adjusted for conventional cardiovascular risk factors was used to identify independent predictors of high CACS. Results: Patients with CACS ≥ 100 were older, more frequently male, and had a higher prevalence of diabetes and hypertension (all p < 0.01). Mean WBV did not differ significantly between groups: WBV-HSR, 4.3 ± 0.5 cP vs. 4.4 ± 0.5 cP (p = 0.456); WBV-LSR, 29.9 ± 8.0 cP vs. 30.4 ± 8.6 cP (p = 0.505). In multivariate models, neither WBV-HSR (OR: 0.489; p = 0.462) nor WBV-LSR (OR: 0.987; p = 0.520) independently predicted high CACS. Age and sex were the strongest independent predictors (p < 0.001). Conclusions: No independent association was found between calculated WBV and high CACS in this cross-sectional study. Full article

Background: The impact of diabetes on the management and outcomes of patients with borderline CT-derived fractional flow reserve (FFR_CT) remains unclear. Methods: This multicenter study enrolled symptomatic patients with suspected coronary artery disease who underwent Coronary computed tomography angiography (CCTA) between June 2021 and May 2023, yielding FFR_CT values between 0.70 and 0.80. Revascularization occurring within 90 days after CCTA was documented. The endpoint was major adverse cardiovascular events (MACE), as a composite of all-cause death, nonfatal myocardial infarction, and unplanned revascularization. Outcomes were analyzed using Cox proportional hazards models, while the relationship between FFR_CT and MACE was examined using restricted cubic spline analysis (RCS). Results: This analysis included 1515 patients with borderline FFR_CT values, comprising 503 (33.2%) with diabetes. Over a median follow-up of 985 days, 117 MACE occurred. Multivariate analysis showed that revascularization was independently associated with a reduced risk of the endpoint, a protective effect consistent in both non-diabetic (adjusted HR [aHR] 0.53, 95% CI 0.29–0.96; p = 0.036) and diabetic patients (aHR 0.25, 95% CI 0.09–0.71; p = 0.009). RCS revealed a significant non-linear relationship between FFR_CT and MACE in non-diabetic patients (p = 0.002). Conclusions: In patients with borderline FFR_CT, revascularization was linked to a lower incidence of MACE, and this association was consistent regardless of diabetes status. Full article

Background: Midaortic Syndrome (MAS) is a rare vascular condition characterized by segmental narrowing of the thoracic and abdominal aorta, often involving ostial narrowing of the renal or visceral arteries. While open surgical repair has been the standard treatment, it carries significant morbidity, especially in high-risk patients. Endovascular techniques, including the Chimney approach, provide a minimally invasive alternative to preserve and reestablish both aortic and branch vessel perfusion. This study evaluates the feasibility, safety, and early and midterm outcomes of the Chimney technique used in a cohort of patients with MAS. Methods: Between 2019 and 2025, 9 patients with MAS and branch vessel involvement underwent endovascular repair using the Chimney technique at Brüderklinikum Julia Lanz Hospital in the Mannheim Teaching Hospital of Heidelberg University. Pre-procedural planning was based on computed tomography angiography. Technical success, peri-procedural complications, changes in blood pressure, renal function, and target-vessel stent patency were monitored. Patients were followed over a median of 3 years (range, 0.08–6 years). Results: Nine patients (mean age 77.2 ± 8.7 years; 66.6% female) underwent endovascular repair for midaortic syndrome. All patients were unfit for open surgery. Comorbidities included hypertension (100%), coronary artery disease (100%), and chronic kidney disease (77.7%). Technical success and target-vessel patency were 100%, with no intraoperative deaths, impairment of renal function, or 30-day mortality. One patient (11.1%) developed an access-site hematoma, which was managed conservatively. Median hospital stay was 6 days. During a median 3-year follow-up (range 1 month–6 years), all chimney stents remained patent, patients experienced durable symptom relief, blood pressure improvement, and freedom from reintervention. Conclusions: The Chimney technique offers a safe and effective endovascular option for high-risk patients with Midaortic Syndrome, achieving high technical success, preserved branch-vessel patency, and improvement of symptoms. Larger studies with longer follow-up are warranted to confirm durability and optimize patient selection for this technique. Full article

Coronary artery bypass grafting (CABG) remains a cornerstone of treatment for patients with advanced or complex coronary artery disease, yet long-term success is influenced by graft patency, progression of native disease, and ventricular remodeling. Optimizing the follow-up of these patients requires a structured approach in which multimodality cardiovascular imaging plays a central role. Echocardiography remains the first-line modality, providing readily available assessment of ventricular function, valvular competence, and wall motion, while advanced techniques, such as strain imaging and myocardial work, enhance sensitivity for subclinical dysfunction. Coronary computed tomography angiography (CCTA) offers excellent diagnostic accuracy for graft patency and native coronary anatomy, with emerging applications of CT perfusion and fractional flow reserve derived from CT (FFR-CT) expanding its ability to assess lesion-specific ischemia. Cardiovascular magnetic resonance (CMR) provides comprehensive tissue characterization, quantifying scar burden, viability, and inducible ischemia, and stress CMR protocols have demonstrated both safety and independent prognostic value in post-CABG cohorts. Nuclear imaging with single-photon emission computed tomography (SPECT) and positron emission tomography (PET) remains essential for quantifying perfusion, viability, and absolute myocardial blood flow, with hybrid PET/CT approaches offering further refinement in patients with recurrent symptoms. In patients after CABG, multimodality imaging is tailored to the patient’s characteristics, symptoms, and pre-test probability of disease progression. In asymptomatic patients, imaging focuses on surveillance, risk stratification, and the early detection of subclinical abnormalities, whereas in symptomatic individuals, it focuses on establishing the diagnosis, defining prognosis, and guiding therapeutic interventions. Therefore, the aim of our review is to propose updated and comprehensive guidance on the crucial role of multimodality cardiovascular imaging in the evaluation and management of post-CABG patients and to provide a practical, evidence-based framework for optimizing outcomes. Full article

Multimodal imaging plays a central role in optimizing the evaluation and management of myocardial ischemia by leveraging the complementary strengths of echocardiography, cardiac magnetic resonance imaging (CMR), single photon emission computed tomography (SPECT), positron emission tomography (PET), and invasive coronary angiography (ICA). Noninvasive functional imaging is typically recommended for patients with intermediate to high pre-test probability of coronary artery disease, while coronary computed tomography angiography (CCTA) is preferred for low to intermediate risk. Stress echocardiography is valuable for detecting wall motion abnormalities and is particularly effective in multivessel or left main disease, where perfusion techniques may miss balanced ischemia. CMR offers high spatial resolution and quantitative assessment of myocardial blood flow (MBF), while SPECT and PET quantify ischemic burden, with PET providing superior accuracy for MBF and microvascular disease. ICA remains the gold standard for defining the presence, location, and severity of epicardial coronary stenosis. It is indicated when noninvasive imaging reveals high-risk features, when symptoms are refractory to medical therapy, or when noninvasive results are inconclusive. While ICA offers high spatial resolution, it alone cannot assess the hemodynamic significance of intermediate lesions, nor the coronary microvasculature. Adjunctive invasive hemodynamic and provocative coronary testing (e.g., Fractional Flow Reserve—FFR, invasive Coronary Flow Reserve—CFR, Index of Microcirculatory Resistance—IMR, acetylcholine test) provide essential insights, especially in ischemia with nonobstructive coronary arteries. Given its procedural risks, ICA should be reserved for cases where it will impact management. Intravascular imaging may be used to further characterize lesions. In summary, modality selection should be individualized based on patient characteristics, comorbidities, contraindications, and the need for anatomical versus physiological data. Integrating noninvasive and invasive modalities provides a comprehensive, patient-centered approach to ischemia evaluation. Full article

Background: Coronary computed tomography angiography (CCTA) is a non-invasive imaging tool used predominantly in suspected chronic coronary artery disease (CAD) patients, due to its high negative predictive value. However, increasing focus has been placed on CCTA to manage and risk stratify acute chest pain patients in emergency departments (ED). Objective: This scoping review summarizes the available evidence on the role of CCTA to exclude acute coronary syndrome (ACS) in low-risk acute chest pain patients, focusing on its diagnostic accuracy, safety, and application in the context of high sensitivity cardiac troponin assays (hs-cTn). Methods: Articles published between January 2015 and March 2025 investigating CCTA use in low-risk acute chest pain patients were retrieved from Medline, Embase, Emcare, and Web of Science databases. Results: 22 articles (13,617 patients) were retrieved. CCTA had strong diagnostic performance, with an excellent negative predictive value (99.8–100%) and sensitivity (94–100%) for ACS diagnosis and prediction of major adverse cardiovascular events. Specificity and positive predictive values were lower and less consistent. When combined with hs-cTn, the diagnostic accuracy of CCTA for ACS was improved significantly. CCTA was associated with low rates of ACS at follow-up (0–3.5%), which were lower than or comparable to the safety outcomes of standard care and stress testing. Full article

Background/Objectives: Despite growing evidence on quantitative computed tomography (CT) analysis of coronary plaques and pericoronary adipose tissue (PCAT), their association with myocardial perfusion (MP) in patients with first acute myocardial infarction (AMI) with obstructive coronary artery disease (MICAD) and non-obstructive coronary arteries (MINOCA) remain unclear. The aim of this study was to assess the relationship between quantitative CT coronary plaque components and PCAT characteristics with MP, myocardial blood flow (MBF) and coronary flow reserve (CFR) obtained by dynamic single-photon emission computed tomography (SPECT) in patients with AMI. Methods: Patients with a first episode of AMI were included in the study. All patients underwent coronary CT angiography with quantitative assessment of plaque volume (PV) and burden (PB), as well as PCAT volume and attenuation. Dynamic SPECT was performed on cadmium–zinc–telluride gamma-camera for quantitative assessment of MP parameters, stress and rest MBF, and CFR. Results: A total of 31 patients (median age 62 [56–70] years) were analyzed, including MICAD (n = 21) and MINOCA (n = 10). MICAD patients had significantly higher total PV and PB, mainly due to non-calcified and fibrofatty components (p < 0.05), while low-attenuation (LAP) and calcified plaques (CP) did not differ between groups. PCAT volumes were higher in MICAD (p < 0.05), whereas PCAT attenuation showed no differences. Dynamic SPECT revealed lower stress MBF and CFR in MICAD (p < 0.05). Correlation analysis showed positive associations of PV and PB with MP summed stress and rest scores, except LAP or CP; PB was negatively associated with MBF. In addition, PCAT volume correlated negatively with stress and rest MBF and CFR, as well as PCAT attenuation correlated positively with stress-induced MP abnormalities. Conclusions: Patients with MICAD demonstrated a greater extent of atherosclerosis and larger PCAT volume compared with MINOCA. Moreover, PCAT volume demonstrated inverse associations with MBF and CFR, indicating a potential link between PCAT characteristics and microvascular dysfunction. Full article

Antiretroviral therapy (ART) controls HIV-1 replication in people with HIV-1 (PWH), but intestinal integrity impairment persists and fuels microbial translocation and chronic immune activation, thus heightening the cardiovascular disease (CVD) risk. Here, we sought to identify novel immunological correlates of the HIV and CVD status in ART-treated PWH (HIV⁺; n = 42) and uninfected participants (HIV⁻; n = 40) of the Canadian HIV and Aging Cohort Study (CHACS), with/without subclinical coronary atherosclerotic plaques, measured by Coronary Computed Tomography Angiography as total plaque volume (TPV, mm³). PBMCs were analyzed by flow cytometry for the expression of T-cell lineage (CD45, CD3, CD4, CD8αα, CD8αβ, TCRαβ, TCRγδ), epithelial cell (EpCAM/CD326), activation (HLA-DR), and gut-homing/residency markers (CD69, CD196/CCR6, CD199/CCR9, CD49d/Itgα4, CD103/ItgαE, Itgβ7). Alterations in the CD3⁺ T-cell pool, such as increased frequencies of CD8⁺TCRαβ⁺ and TCRγδ⁺ cells, to the detriment of CD4⁺TCRαβ⁺ subsets, were associated with the HIV status. Also, CD4⁺ T-cells with CD326⁺CD69⁺CCR6⁺ItgαE⁺ and CCR6⁺Itgβ7⁻ phenotypes were increased in frequency in HIV⁺ vs. HIV⁻ participants, together with a decreased frequency of CD8⁺ T-cells with an intraepithelial lymphocyte (IEL)-like CD3⁺CD4⁻TCRαβ⁺TCRγδ⁻CD8αα⁺CD8αβ⁻ phenotype. Finally, multivariate logistic regression identified the frequency of ItgαE⁺CD8⁺, ItgαE⁻CD8⁺, CCR6⁺CD4⁺, and CCR6⁺Itgβ7⁻CD4⁺ T-cells as strong positive correlates of HIV status and atherosclerotic plaque in ART-treated PWH. Full article

Coronary Artery Disease (CAD), mainly due to the progressive development of atherosclerotic plaques, is one of the world’s leading causes of mortality and morbidity. A significant percentage of initial events (around 30%) remain fatal to this day despite significant advances in the diagnosis and treatment of cardiovascular diseases (CVDs). Early detection and risk stratification are therefore essential. In this study, we adopted a multi-omics approach integrating transcriptomic (RNA-seq) and epigenomic (ATAC-seq) profiling of peripheral blood mononuclear cells (PBMCs) from a cohort of individuals undergoing clinically indicated cardiac computed tomography angiography (CCTA) to uncover potential novel molecular markers of CAD. We identified 39 genes consistently dysregulated across all CAD subtypes. ATAC-seq analysis revealed distinct chromatin accessibility patterns at CAD-associated loci, with a predominance of quiescent and transcriptionally active states. Validation in an independent cohort confirmed the expression patterns of key Differentially Expressed Genes (DEGs), such as Claudin 18 (CLDN18), supporting the robustness of our findings. Consequently, the integration of multi-omics data allowed us to identify a core gene signature and regulatory patterns associated with disease severity, offering potential biomarkers for clinical risk stratification in patients with CAD. Full article

Background: There have been 20.5 million deaths due to cardiovascular diseases (CVDs), including atherosclerotic coronary artery disease (CAD) and stroke, so far in 2025. Atherosclerosis, which begins in newborns, may be influenced by preconception factors and continues to develop in adults, requiring a proper assessment of the burden of atherosclerotic plaque, as it is the direct cause of CAD. This review aims to emphasize the role of a staging system proposed by the Lancet Commission for the quantification of atherosclerotic coronary artery disease (ACAD) with an emphasis on preconception risk factors and protective factors, based on coronary computed tomography angiography (CCTA). Methods: It is suggested that the use of CCTA scanning makes it possible to quantify the atherosclerotic plaque burden into four stages. Results: CCTA enables us to see how much plaque has built up, as well as the type of plaque, but not the biochemistry of the plaque, to determine its vulnerability. However, if the plaque is a non-calcified fatty plaque, it is considered to be a strong predictor of the risk of myocardial infarction (MI), whereas a more stable calcified plaque is known to be protective against MI. There are several risk factors and protective factors which may influence the process of the rupture or vulnerability of the plaque. A randomized trial revealed that, after a median follow-up of 10·0 years, deaths due to CAD or non-fatal MI were less frequent in the CCTA group compared with a control group. Conclusions: Despite a few gaps in knowledge about the value of a staging system of ACAD, the available evidence indicates that it is helpful in decreasing morbidity and mortality with available therapies. Full article

Background/Objectives: Coronary artery disease (CAD) remains the leading global cause of mortality, underscoring the need for functional assessments that extend beyond anatomical evaluation. The Hyperemic Stenosis Resistance (HSR) index combines invasive pressure and flow parameters to assess stenosis severity but faces limitations due to methodological and standardization challenges. This study aimed to introduce and validate a novel non-invasive computational equivalent of HSR (cHSR), derived from coronary computed tomography angiography (CCTA), and to compare its diagnostic performance with fractional flow reserve derived from computational fluid dynamics (FFR_CFD) and quantitative flow ratio (QFR). Methods: A retrospective analysis was conducted on 64 patients (106 coronary lesions) with suspected chronic coronary syndrome (CCS) who underwent both CCTA and invasive coronary angiography (ICA). Computational simulations incorporated patient-specific boundary conditions based on CCTA-derived left ventricular and aortic flow data. Diagnostic accuracy for predicting revascularization was compared among cHSR, FFR_CFD, and QFR. Results: FFR_CFD showed a strong correlation with invasive FFR (r = 0.87, p < 0.0001). The cHSR index achieved the highest diagnostic accuracy (96.2%) at an optimal cut-off of 0.75 mmHg/cm·s⁻¹, outperforming both FFR_CFD and QFR. No significant correlation was found between cHSR and shear stress parameters, including the Oscillatory Shear Index (OSI) and Time-Averaged Wall Shear Stress (TAWSS), indicating complex hemodynamic interactions beyond simple flow–pressure relationships. Conclusions: The computational hyperemic stenosis resistance (cHSR) index represents a promising non-invasive tool for the functional assessment of CAD, demonstrating superior diagnostic performance compared with existing imaging-based indices. Prospective multicenter studies with larger populations are warranted to confirm its clinical applicability and prognostic value in chronic coronary syndrome management. Full article