Search Results (138)

Coronary computed tomography angiography (CCTA) has emerged as the leading noninvasive imaging modality for the assessment of coronary artery disease (CAD), offering high-resolution visualization of the coronary anatomy and plaque characterization. The development of fractional flow reserve derived from CCTA (FFR-CT) has further transformed the diagnostic landscape by enabling the simultaneous evaluation of both anatomical stenosis and lesion-specific ischemia. FFR-CT has demonstrated diagnostic accuracy comparable to invasive FFR. The combined use of CCTA and FFR-CT is now pivotal in a broad range of clinical scenarios, including the evaluation of stable and acute chest pain, assessment of high-risk and complex plaque features, and preoperative planning. As evidence continues to mount, CCTA and FFR-CT are positioned to become the primary gatekeepers to the cardiac catheterization laboratory, potentially reducing the number of unnecessary invasive procedures. This review highlights the growing clinical utility of FFR-CT, its integration with advanced plaque imaging, and the future potential of these technologies in redefining the management of CAD, while also acknowledging current limitations, including image quality requirements, cost, and access. Full article

Coronary plaque vulnerability, more than luminal stenosis, drives acute coronary syndromes. Optical coherence tomography (OCT), intravascular ultrasound (IVUS), and coronary computed tomography angiography (CCTA) visualize plaque morphology in vivo, but manual interpretation is time-consuming and operator-dependent. We performed a narrative literature survey of artificial intelligence (AI) applications—focusing on machine learning (ML) architectures—for automated coronary plaque segmentation and risk characterization across OCT, IVUS, and CCTA. Recent ML models achieve expert-level lumen and plaque segmentation, reliably detecting features linked to vulnerability such as a lipid-rich necrotic core, calcification, positive remodelling, and a napkin-ring sign. Integrative radiomic and multimodal frameworks further improve prognostic stratification for major adverse cardiac events. Nonetheless, progress is constrained by small, single-centre datasets, heterogeneous validation metrics, and limited model interpretability. AI-enhanced plaque assessment offers rapid, reproducible, and comprehensive coronary imaging analysis. Future work should prioritize large multicentre repositories, explainable architectures, and prospective outcome-oriented validation to enable routine clinical adoption. Full article

Coronary chronic total occlusions (CTOs) are diagnosed in a significant portion of patients undergoing coronary angiography and represent one of the most complex scenarios in contemporary percutaneous coronary interventions (PCI). This review systematically examines how adjunctive imaging modalities’—intravascular ultrasound (IVUS), optical coherence tomography (OCT), and coronary computed tomography angiography (CCTA)—co-registration enhances the precision and success rates of CTO-PCI during the procedure. The strategic integration of these technologies enables the development of patient-specific intervention strategies tailored to individual vascular architecture and lesion characteristics. This personalized approach marks a transition from standardized protocols to precision interventional cardiology, potentially optimizing procedural success rates while minimizing complications. Full article

Objectives: This study evaluates the economic impact of digital health interventions (DHIs) developed under the HosmartAI EU-funded program, focusing on obstetrics, cardiology, and gastroenterology. Methods: A Cost Consequence Analysis (CCA) was chosen in order to be able to examine the costs and consequences of AI technologies in early diagnosis of preterm births, echocardiography, coronary computed tomography angiography (CCTA), and capsule endoscopy (CE). Results: The results show that in obstetrics and CCTA, the AI technologies are cost-saving, with the AI-based preterm birth detection leading to savings of 99,840 EUR due to reduced severity of prematurity. In the echocardiography scenario, the new AI technology slightly increased costs (9409 vs. 2116 EUR), but offered benefits in diagnostic accuracy and shorter interpretation duration, particularly for less experienced physicians. Similarly, the capsule endoscopy AI technology raised annual costs by 6626 EUR but improved productivity, accuracy, and user satisfaction. Conclusions: The findings emphasize the need for standardized frameworks to guide economic evaluations of DHIs, ensuring informed healthcare investment and reimbursement decisions in the future. Full article

(1) Background: Our aim was to evaluate the diagnostic performance of combined coronary computed tomography angiography (CCTA) and dynamic CT myocardial perfusion imaging (CT-MPI) for detecting hemodynamically significant coronary artery disease (CAD) in patients with intermediate pretest probability. (2) Methods: Patients with an intermediate pretest probability of CAD were retrospectively enrolled. All patients underwent CCTA and dynamic CT-MPI using a third-generation dual-source CT scanner prior to invasive coronary angiography (ICA). Anatomically significant stenosis was defined as ≥50% luminal narrowing on both CCTA and ICA. Fractional flow reserve (FFR) was performed during ICA in selected cases. Hemodynamically significant CAD was defined per vessel as FFR ≤ 0.80, angiographic stenosis ≥70%, or having undergone revascularization. The diagnostic performance of CCTA alone and CCTA combined with CT-MPI was compared against this reference standard. (3) Results: Seventy-four patients (mean age, 66.8 ± 11.1 years; 59 men) were included. The median coronary calcium score was 508.5 Agatston units (interquartile range: 147–1173). ICA and CCTA detected anatomically significant stenoses in 137 (61.7%) and 146 (65.8%) coronary vessels, respectively, and in 62 (83.8%) and 71 (95.9%) patients, respectively. Hemodynamically significant stenosis was present in 56 patients (76%) and 99 vessels (45%). On a per-vessel basis, CCTA alone yielded a sensitivity of 96.7%, specificity of 60.3%, positive predictive value (PPV) of 64.4%, and negative predictive value (NPV) of 96.1%. Combined CCTA and CT-MPI demonstrated a sensitivity of 90.1%, specificity of 84.3%, PPV of 82.7%, and NPV of 91.1%. The area under the receiver operating characteristic curve improved from 0.787 (95% confidence interval: 0.73–0.84) for CCTA to 0.872 (95% confidence interval: 0.82–0.91) for the combined approach (p < 0.05). The median total radiation dose for both CCTA and CT-MPI was 8.05 mSv (interquartile range: 6.71–11.0). (4) Conclusions: In patients with intermediate pretest probability of CAD, combining CCTA with dynamic CT-MPI significantly enhances the diagnostic performance for identifying hemodynamically significant coronary stenosis compared to CCTA alone. Full article

Objective: We aimed to evaluate the feasibility, added value, and radiation dose of coronary computed tomography angiography (CCTA) and stress dynamic CT myocardial perfusion imaging (MPI) in patients with coronary artery disease (CAD) in a real-world setting. Materials and Methods: This retrospective study included 65 patients (mean age: 51.2 ± 11.5 years; 21 female) with moderate CAD, selected from the Radiological Database of our hospital between May 2022 and December 2024. All patients underwent CCTA and stress dynamic CT-MPI using a third-generation dual-source CT scanner. The shuttle-mode acquisition technique was used for CT-MPI with 60 mL of contrast (iopamidol, 370 mg iodine/mL) administered at a flow rate of 6 mL/s. The mean myocardial blood flow (MBF) and other quantitative parameters were measured for both CAD and reference segments (RSs). A 17-segment-based analysis was employed (excluding the apex). The MBF ratio, defined as the mean MBF value of CAD segments divided by that of RS, was used with a cut-off value of 0.85 to distinguish hypoperfused from non-hypoperfused segments within CAD territories. Non-parametric statistical tests were applied. Results: A total of 1040 segments were evaluated. In 62 segments, the mean MBF of CAD territories was found to have decreased. The mean MBF and myocardial blood volume (MBV) in hypoperfused CAD segments were 65.1 ± 19.8 mL/100 mL/min and 14.5 ± 2.7 mL/100 mL, respectively, both significantly lower compared to non-hypoperfused CAD segments and RSs (p < 0.001). The mean effective dose of the protocol was 6.3 ± 1.4 mSv, corresponding to an estimated individual lifetime cancer risk of approximately 0.06% per test, based on BEIR VII Phase 2 modeling. This risk is cumulative, with repeat testing over a 10-year period potentially increasing lifetime cancer risk in proportion to total radiation exposure. The mean total examination time was 26 ± 4 min. Conclusion: The combined CCTA and dynamic CT-MPI protocol is feasible in real-world clinical practice and offers a comprehensive morphological and functional assessment of moderate CAD, with a manageable radiation dose and examination time. Full article

Background/Objectives: The similarities and differences from a rheological perspective between significant short focal and mild long coronary lesions warrant investigation to elucidate wall shear stress (WSS) angiographic discrepancies. Methods: Patients who underwent coronary computed tomography angiography (CCTA) between 1 January 2023 and 1 September 2024 were selected for computational fluid dynamics (CFD) analysis. The selection criteria included either a focal (≤20 mm) hemodynamically significant stenosis, defined as ≥75% lumen narrowing, or a long (30–40 mm) non-hemodynamically significant lesion showing ≤50% stenosis of the left anterior descending (LAD) artery. Patient-specific models were reconstructed from ECG-gated CCTA images. Wall shear stress (WSS, measured in Pascals) and residence time (RT) were evaluated for each patient. Results: The LAD arteries of 30 patients (mean age 54 years, 63.3% men) were evaluated: 16 with focal, hemodynamically significant coronary stenosis, while 14 with diffuse, long, non-hemodynamically significant coronary lesions. Both groups exhibited a lower mean WSS compared to the non-stenosed segment, with no significant difference in mean WSS between the two groups (p = 0.84). Conversely, both groups demonstrated a higher mean residence time (RT) compared to the non-stenosed segments (0.2 ± 0.06 vs. 0.60 ± 0.03, p < 0.001 and 0.2 ± 0.006 vs. 0.59 ± 0.02, p < 0.001, respectively), and no significant difference in mean RT (p = 0.82). Conclusions: Long, angiographically mild coronary stenoses show similar WSS and RT characteristics compared to short hemodynamically significant coronary stenosis. Full article

Background/Objectives: Cardiac allograft vasculopathy (CAV) is a major complication following orthotopic heart transplantation (OHT). Graft denervation results in silent ischemia, even when already established, requiring regular screening for early diagnosis. This study explores whether myocardial work (MW) can non-invasively identify OHT patients with obstructive coronary lesions (OCL). Methods: During regular follow-ups, 55 OHT recipients underwent paired, prospective coronary computed tomography angiography (CCTA) and transthoracic echocardiography (TTE) examinations. Additionally, 57 healthy volunteers (HV) provided reference TTE data. Classic echocardiographic parameters, such as left ventricle global longitudinal strain (LV-GLS) and MW indices, were obtained in all individuals. Data from three groups were analyzed: HV, OHT patients without coronary lesions or with <50% lesions on the CCTA (OHT-non-OCL), and OHT patients with ≥50% lesions on the CCTA (OHT-OCL). Results: CCTA identified seven OHT patients with OCL. Significant differences across the groups existed for LV-GLS (OHT-OCL −10.6% CI −14 to −6.8 vs. OHT-non-OCL −15.6% CI −16.5 to −13.4% vs. HV −18% CI −20 to −16, p < 0.01) and global work efficiency (GWE) (OHT-OCL 87% CI 86 to 92 vs. OHT-non-OCL 94% CI 91 to 95 vs. HV 96% CI 95 to 97, p < 0.01). The optimal cut-off values identified using the Youden Index were LV-GLS < −14.4% (AUC 0.80, sensitivity 0.86, specificity 0.71) and GWE < 89% (AUC 0.75, sensitivity 0.71, specificity 0.85). Multivariate analysis showed GWE as the best marker for detecting OCL. Conclusions: GWE is the echocardiographic parameter that best identifies OHT patients that have OCL on CCTA. If validated in larger studies, GWE could become a readily accessible tool for CAV detection. Full article

Cardiovascular diseases, including coronary artery disease, are the leading cause of mortality in the general population. The likelihood of significant coronary artery disease occurring in young women (<40 years of age) is very low. Diagnosis is challenging and often delayed, treatment tends to be suboptimal, and the long-term prognosis is poor. We present the case of a 38-year-old woman with typical anginal chest pain whose coronary computed tomography angiography (CCTA) revealed significant narrowing in the left anterior descending artery (LAD) despite a coronary artery calcium score (CACS) of zero. To assess the significance of the lesion, coronary angiography and intravascular ultrasound (IVUS) were performed, which revealed borderline narrowing. Conservative treatment was recommended. Full article

Background/Objectives: Myocardial infarction with non-obstructive coronary arteries (MINOCA) is a heterogenous clinical entity that differs in pathophysiology, treatment, and prognosis from myocardial infarction with obstructive coronary artery disease (MI-CAD) and MINOCA mimickers, such as myocarditis or Takotsubo syndrome. This study aimed to compare the clinical characteristics, imaging findings, management strategies, and long-term outcomes of patients with true MINOCA, MI-CAD, and MINOCA mimickers. Methods: This retrospective cohort study included 1596 patients hospitalized with acute myocardial infarction (AMI) between 2012 and 2024 at a tertiary university hospital. Patients were classified as having true MINOCA, MI-CAD, or MINOCA mimickers based on coronary angiography and advanced cardiac imaging. Data included clinical and laboratory variables, echocardiography, cardiac magnetic resonance (CMR), and coronary computed tomography angiography (CCTA). All-cause mortality was analyzed using Cox regression. Results: Of 1596 AMI patients, 111 (7.0%) had true MINOCA, 1359 (85.1%) had MI-CAD, and 127 (8.0%) had MINOCA mimickers. Mimicker patients were significantly younger and had fewer cardiovascular risk factors. True MINOCA was more frequent in females and associated with preserved left ventricular ejection fraction and lower high-sensitivity troponin T levels compared to MI-CAD. CMR and CCTA contributed to etiological clarification in over 70% of MINOCA and mimicker patients. High-risk plaque features were observed in 42.9% of CCTA scans, suggesting but not confirming an atherosclerotic mechanism. Long-term all-cause mortality in MINOCA was similar to MI-CAD (32.1% vs. 30.9%, p = 0.764) and significantly higher than in mimickers (5.9%, p < 0.001). Conclusions: True MINOCA is a distinct clinical entity with diagnostic and prognostic implications. Its comparable mortality to MI-CAD highlights the need for accurate diagnosis and targeted secondary prevention strategies. Full article

(1) Background: The SCORE2-Diabetes model has been developed as an effective tool to estimate the 10-year cardiovascular risk in patients with diabetes. Coronary computed tomography angiography (CCTA) and its derived Coronary Artery Calcium Score (CACS) are widely used non-invasive imaging tools for assessing coronary artery disease (CAD). This study aimed to evaluate the correlation between CACS and SCORE2-Diabetes in patients with T2DM. (2) Methods: A cross-sectional study was conducted from October 2023 to May 2024. We included patients aged 40 to 69 years with T2DM who underwent a coronary multislice CT scan due to atypical angina. The correlation between CACS and SCORE2-Diabetes was analyzed using Spearman’s rank correlation coefficient. (3) Results: A total of 100 patients met the inclusion criteria, including 71 males and 29 females, with a mean age of 61.9 ± 5.4 years. The differences in CACS and SCORE2-Diabetes among different degrees of coronary artery stenosis were statistically significant (p < 0.05). A statistically significant but weak positive correlation was observed between CACS and SCORE2-Diabetes across all risk categories, with Spearman’s rank correlation coefficients ranging from 0.27 to 0.28 (p < 0.01). (4) Conclusions: Despite the weak correlation between CACS and SCORE2-Diabetes, understanding their relationship and independent associations with disease severity is valuable. The combination of these two tools may warrant investigation in future studies to potentially enhance cardiovascular risk assessment in T2DM patients. Full article

Perioperative and long-term postoperative major adverse cardiovascular events (MACE) are a leading cause of morbidity and mortality in patients undergoing noncardiac surgery. In selected high-risk patients, when information about cardiovascular status may influence surgical decisions, preoperative risk stratification is reasonable, with stress imaging being the preferred method. Coronary computed angiography (CCTA) and coronary artery calcium score (CACS) offer direct anatomical assessment of atherosclerotic coronary arteries and help gauge the extent and severity of coronary artery disease. Strong evidence supports that CCTA and CACS, either alone or in combination, are reliable methods for assessing the risk of both perioperative and long-term postoperative MACE, often demonstrating equal or superior prognostic performance compared to traditional imaging tools. Moreover, integrating CCTA or CACS into standard preoperative imaging protocols further enhances perioperative risk prediction and improves the ability to accurately stratify patients. Future research is needed to better define the role of CCTA and CACS in preoperative cardiovascular risk evaluation of patients undergoing noncardiac surgery. Full article

Background: Symptomatic patients with unilateral obstructive coronary artery disease (CAD) identified by coronary computed tomography angiography (CCTA), involving either the right or left coronary artery, typically undergo per-protocol bilateral coronary visualization during invasive coronary angiography (ICA). However, a selective visualization approach may be sufficient. Objectives: The objectives of this study were to assess the accuracy of CCTA in excluding hemodynamically significant coronary stenosis in patients with unilateral CAD and to evaluate whether a CCTA-guided selective ICA strategy can reduce procedure time and contrast agent use. Methods: In this cross-sectional cohort study, 454 patients with clinically suspected stable CAD who underwent CCTA prior to ICA were included. The study population consisted of 190 patients with unilateral obstructive CAD, defined as ≥50% diameter stenosis on CCTA, and an absence of obstructive CAD on the contralateral side. ICA with invasive functional assessment was used as the reference standard. Results: CCTA demonstrated a high accuracy, 97.4% (95% CI: 94–99%), in excluding hemodynamically significant disease in the contralateral arteries without obstructive CAD. Compared to the conventional ICA approach, a CCTA-guided selective visualization strategy resulted in significant reductions in procedure time and contrast agent usage: procedure time and contrast agent usage were reduced by 27% (95% CI: 12.1–47.5%) and 46.8% (95% CI: 27.5–67.0%), respectively. Conclusions: In patients with unilateral obstructive CAD identified by CCTA, a CCTA-guided selective ICA visualization strategy is highly accurate in ruling out hemodynamically significant CAD on the contralateral side. Additionally, this unilateral ICA approach has the potential to reduce both contrast agent usage and procedure time compared to the conventional bilateral visualization strategy. Full article

Introduction: Ischemic heart disease represents one of the main causes of mortality and morbidity, requiring accurate, noninvasive imaging. Coronary Computed Tomography Angiography (CCTA) offers a detailed coronary assessment but can be labor-intensive and operator-dependent. Methods: We developed a bounding box-based object detection method using deep learning to identify the right coronary artery (RCA), left anterior descending artery (LCA-LAD), and left circumflex artery (LCA-CX) in the CCTA cross-sections. A total of 19,047 images, which were recorded from 52 patients, underwent a five-fold cross-validation. The evaluation metrics included Average Precision (AP), Intersection over Union (IoU), Dice Similarity Coefficient (DSC), and Mean Absolute Error (MAE) to achieve both detection accuracy and spatial localization precision. Results: The mean AP scores for RCA, LCA-LAD, and LCA-CX were 0.71, 0.70, and 0.61, respectively. IoU and DSC indicated a better overlap for LCA-LAD, whereas LCA-CX was more challenging to detect. The MAE analysis showed the largest centroid deviation in RCA, highlighting variable performance across the artery classes. Discussion: These findings demonstrate the feasibility of automated coronary artery detection, potentially reducing observer variability and expediting CCTA analysis. They also highlight the need to refine the approach for complex anatomical variants or calcified plaques. Conclusion: A bounding box-based approach can thereby streamline clinical workflows by localizing major coronary arteries. Future research with diverse datasets and advanced visualization techniques may further enhance diagnostic accuracy and efficiency. Full article

Objectives: Our study aims to investigate the correlation between epicardial adipose tissue (EAT) volume assessed with non-contrast cardiac CT (NCCCT) and sex, age, coronary artery disease reporting and data system (CAD-RADS 2.0) categories, and coronary artery calcification (CAC) extent. The secondary aim is to establish the average values of EAT in a population considered healthy for coronary artery disease (CAD). Materials and Methods: We retrospectively analyzed patients who underwent coronary computed tomography angiography (CCTA) at our institution from January 2023 to August 2024. The CAD-RADS 2.0 scoring system was applied to assess the extent of CAD; CAC extent was quantified according to the Agatston score. EAT was segmented semi-automatically in NCCCT images, and its volume was subsequently measured. Correlation analyses between EAT volume, sex, patient age, CAC, and CAD-RADS categories were conducted. Results: A total of 489 consecutive patients met the inclusion criteria (63.96 ± 12.18 years; 214 females). The mean EAT volume ± SD in those categorized as CAD-RADS 0 (57.25 ± 15.45 years, 120 patients) was 117.43 ± 50.30 cm³: values were higher in men (121.07 ± 53.31 cm³) than in women (114.54 ± 47.98 cm³). EAT volumes positively correlated with age, male sex, CAD severity, and CAC scores. Conclusions: According to our results, males in all CAD-RADS categories have a greater amount of EAT than females. A positive correlation between the volume of EAT and factors such as age (p = 0.003), CAD-RADS categories (p: 0.004), and coronary calcium score (p = 0.0001) with a strong influence exerted by sex was demonstrated. Our results reinforce the observation that higher EAT volumes are associated with a more severe coronary artery disease. Full article