Search Results (625)

Monitoring cardiovascular health enables continuous and real-time risk assessment. This study utilized the Framingham Heart Study dataset to develop and evaluate machine-learning models for predicting mortality risk based on key cardiovascular parameters. Some machine-learning algorithms were applied to multiple machine-learning models. Among these, XGBoost achieved the highest predictive performance, each with an area under the curve (AUC) value of 0.83. Feature importance analysis revealed that coronary artery disease, glucose levels, and diastolic blood pressure (DIABP) were the most significant risk factors associated with mortality. The primary contribution of this research lies in its implications for public health and preventive medicine. By identifying key risk factors, it becomes possible to calculate individual and population-level risk scores and to design targeted early intervention strategies aimed at reducing cardiovascular-related mortality. Full article

A healthy vasculature with well-regulated perfusion and pulsatility is essential for the brain. One vascular structure that has received little attention is the carotid siphon. The proximal portion of the siphon is stiff due to the narrow location in the skull base, whilst the distal portion is highly flexible. This flexible part in combination with the specific curves lead to lower pulsatility at the cost of energy deposition in the arterial wall. This deposited energy contributes to damage and calcification. Severe siphon calcification stiffens the distal part of the siphon, leading to less damping of the pulsatility. Increased blood flow pulsatility is a possible cause of stroke and cognitive disorders. In this review, based on comprehensive multimodality imaging, we first describe the anatomy and physiology of the carotid siphon. Subsequently, we review the in vivo imaging data, which indeed suggest that the siphon attenuates pulsatility. Finally, the data as available in the literature are shown to provide convincing evidence that severe siphon calcifications and the calcification pattern are linked to incident stroke and dementia. Interventional studies are required to test whether this association is causal and how an assessment of pulsatility and the siphon calcification pattern can improve personalized medicine, working to prevent and treat brain disease. Full article

Background/Objectives: This study aimed to identify the risk factors for respiratory failure in patients with intracerebral hemorrhage (ICH) accompanied by intraventricular hemorrhage (IVH) extension. Methods: We retrospectively included 208 patients with ICH accompanied by IVH extension. Respiratory failure was defined as carbon dioxide levels > 45 mmHg with a pH < 7.35 in arterial blood gas analysis (ABGA) or the application of a ventilator due to respiratory dysfunction. We measured the severity of IVH extension using the Graeb scale, and ICH volume was assessed for each patient. Results: Of the 208 included patients, 83 had respiratory failure. There were no significant differences in age, sex ratio, or Graeb scale score between patients with and without respiratory failure (p > 0.05). However, ICH volume was significantly larger in patients with respiratory failure (42.0 ± 42.5 mL) than in those without (26.4 ± 25.7 mL) (p = 0.003). In the receiver operating characteristic (ROC) curve analysis, the area under the ROC curve for ICH volume predicting respiratory failure was 0.612. The optimal threshold for detecting respiration failure in patients with ICH and IVH dilatation, based on the Youden index, was >63.2 mL, with a sensitivity of 30.12% and a specificity of 89.60%. Approximately 40% of patients experienced respiratory failure following ICH accompanied by IVH extension. Conclusions: A large ICH volume was associated with the occurrence of respiratory failure. Therefore, caution is required in patients with an ICH volume > 63.2 mL. Full article

Background/Objectives: Interstitial lung disease (ILD) is frequently complicated by pulmonary hypertension (PH), which is associated with reduced exercise capacity and poor prognosis. Early and accurate non-invasive detection of PH remains a clinical challenge. This study evaluated whether combining quantitative CT analysis of lung fibrosis with cardiac MRI-derived measures of right ventricular (RV) function improves the diagnostic accuracy of PH in patients with ILD. Methods: We retrospectively analyzed 72 ILD patients who underwent chest CT, cardiac MRI, and right heart catheterization (RHC). Lung fibrosis was quantified using a Gaussian Histogram Normalized Correlation (GHNC) software that computed the proportions of diseased lung, ground-glass opacity (GGO), honeycombing, reticulation, consolidation, and emphysema. MRI was used to assess RV end-systolic volume (RVESV), ejection fraction, and RV longitudinal strain. PH was defined as a mean pulmonary arterial pressure (mPAP) ≥ 20 mmHg and pulmonary vascular resistance ≥ 3 Wood units on RHC. Results: Compared to patients without PH, those with PH (n = 21) showed significantly reduced RV strain (−13.4 ± 5.1% vs. −16.4 ± 5.2%, p = 0.026) and elevated RVESV (74.2 ± 18.3 mL vs. 59.5 ± 14.2 mL, p = 0.003). CT-derived indices also differed significantly: diseased lung area (56.4 ± 17.2% vs. 38.4 ± 12.5%, p < 0.001), GGO (11.8 ± 3.6% vs. 8.65 ± 4.3%, p = 0.005), and honeycombing (17.7 ± 4.9% vs. 12.8 ± 6.4%, p = 0.0027) were all more prominent in the PH group. In receiver operating characteristic curve analysis, diseased lung area demonstrated an area under the curve of 0.778 for detecting PH. This increased to 0.847 with the addition of RVESV, and further to 0.854 when RV strain was included. Combined models showed significant improvement in risk reclassification: net reclassification improvement was 0.700 (p = 0.002) with RVESV and 0.684 (p = 0.004) with RV strain; corresponding IDI values were 0.0887 (p = 0.03) and 0.1222 (p = 0.01), respectively. Conclusions: Combining CT-based fibrosis quantification with cardiac MRI-derived RV functional assessment enhances the non-invasive diagnosis of PH in ILD patients. This integrated imaging approach significantly improves diagnostic precision and may facilitate earlier, more targeted interventions in the management of ILD-associated PH. Full article

Background/Objectives: Peripheral artery disease (PAD) impacts more than 200 million individuals globally and leads to mortality and morbidity secondary to progressive limb dysfunction and amputation. However, clinical management of PAD remains suboptimal, in part because of the lack of standardized biomarkers to predict patient outcomes. Growth differentiation factor 15 (GDF15) is a stress-responsive cytokine that has been studied extensively in cardiovascular disease, but its investigation in PAD remains limited. This study aimed to use explainable statistical and machine learning methods to assess the prognostic value of GDF15 for limb outcomes in patients with PAD. Methods: This prognostic investigation was carried out using a prospectively enrolled cohort comprising 454 patients diagnosed with PAD. At baseline, plasma GDF15 levels were measured using a validated multiplex immunoassay. Participants were monitored over a two-year period to assess the occurrence of major adverse limb events (MALE), a composite outcome encompassing major lower extremity amputation, need for open/endovascular revascularization, or acute limb ischemia. An Extreme Gradient Boosting (XGBoost) model was trained to predict 2-year MALE using 10-fold cross-validation, incorporating GDF15 levels along with baseline variables. Model performance was primarily evaluated using the area under the receiver operating characteristic curve (AUROC). Secondary model evaluation metrics were accuracy, sensitivity, specificity, negative predictive value (NPV), and positive predictive value (PPV). Prediction histogram plots were generated to assess the ability of the model to discriminate between patients who develop vs. do not develop 2-year MALE. For model interpretability, SHapley Additive exPlanations (SHAP) analysis was performed to evaluate the relative contribution of each predictor to model outputs. Results: The mean age of the cohort was 71 (SD 10) years, with 31% (n = 139) being female. Over the two-year follow-up period, 157 patients (34.6%) experienced MALE. The XGBoost model incorporating plasma GDF15 levels and demographic/clinical features achieved excellent performance for predicting 2-year MALE in PAD patients: AUROC 0.84, accuracy 83.5%, sensitivity 83.6%, specificity 83.7%, PPV 87.3%, and NPV 86.2%. The prediction probability histogram for the XGBoost model demonstrated clear separation for patients who developed vs. did not develop 2-year MALE, indicating strong discrimination ability. SHAP analysis showed that GDF15 was the strongest predictive feature for 2-year MALE, followed by age, smoking status, and other cardiovascular comorbidities, highlighting its clinical relevance. Conclusions: Using explainable statistical and machine learning methods, we demonstrated that plasma GDF15 levels have important prognostic value for 2-year MALE in patients with PAD. By integrating clinical variables with GDF15 levels, our machine learning model can support early identification of PAD patients at elevated risk for adverse limb events, facilitating timely referral to vascular specialists and aiding in decisions regarding the aggressiveness of medical/surgical treatment. This precision medicine approach based on a biomarker-guided prognostication algorithm offers a promising strategy for improving limb outcomes in individuals with PAD. Full article

Objectives: To assess the long-term survival outcomes of patients undergoing no-touch aorta, total arterial off-pump coronary artery bypass grafting (OPCAB) using a left internal mammary artery (LIMA)–radial artery (RA) Y-graft configuration. This approach was applied uniformly to all-comers undergoing isolated CABG between 2004 and 2021, irrespective of preoperative risk profile. Methods: We included all patients treated with total arterial OPCAB using the LIMA–RA Y-graft without additional concomitant procedures. Patients were stratified into five age groups (<50, 50–59, 60–69, 70–79, and >80 years). Survival at 5 years was analyzed using Kaplan–Meier curves and Cox regression analysis. Results: A total of 2174 patients were analyzed, with a median follow-up of 3266 days. In-hospital mortality was 0.6%, whereas postoperative stroke was 0.3% without residual trauma and 0.2% with residual trauma, respectively, without differences between age groups. The mean number of grafts per patient was 3.7, with no significant variation between age groups (p = 0.09). Overall, 5-year survival was 90% (n = 1767), ranging from 98% in the youngest group to 65% in the oldest (log-rank p < 0.0001). Conclusions: No-touch aorta, total arterial OPCAB using the LIMA–RA Y-graft is a safe and effective revascularization strategy for a broad spectrum of patients, including those with advanced age and comorbidities. Full article

Introduction: Sepsis has a high mortality rate, especially in low-income countries. Improving outcomes depends on the early recognition of patients at risk of death. Therefore, rapid and applicable prediction scores are needed in emergency triage. Objective: This study assessed the effectiveness of the qSOFA, NEWS, and IEWS scales in predicting in-hospital mortality during emergency triage. Additionally, we analyzed the efficacy of the IEWS_L, which integrates the IEWS with arterial lactate levels measured upon admission to the emergency department. Method: This retrospective study included patients who consulted the emergency department with suspected sepsis, where various scoring systems were evaluated for their effectiveness. We evaluated the diagnostic capacity of the tests by measuring the specificity, sensitivity, positive and negative predictive values, as well as the areas under the curve (AUC) of each score to predict mortality. Results: The study included 383 patients who had visited the emergency department. The overall mortality rate was 20.6%, and the mortality rate, precisely due to septic shock, was 35.2%. The AUC values for predicting in-hospital deaths due to sepsis were as follows: qSOFA: 0.68 (95% CI: 0.62–0.74); NEWS: 0.71 (95% CI: 0.64–0.77); IEWS: 0.74 (95% CI: 0.68–0.80); IEWS_L: 0.81 (95% CI: 0.76–0.86). Conclusions: In the emergency department, the IEWS scale demonstrated the best ability to accurately predict in-hospital mortality from sepsis when compared to the qSOFA and NEWS scale. Additionally, incorporating the serum lactate level into the IEWS scale significantly enhances its capacity to predict mortality. 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

Background/Objectives: The infraorbital canal (IOC) is a critical anatomical structure that passes through the anterior surface of the maxilla and opens at the infraorbital foramen, containing the infraorbital nerve, artery, and vein. Accurate localization of this canal in maxillofacial, dental implant, and orbital surgeries is of great importance to preventing nerve damage, reducing complications, and enabling successful surgical planning. The aim of this study is to perform automatic segmentation of the infraorbital canal in cone-beam computed tomography (CBCT) images using an artificial intelligence (AI)-based model. Methods: A total of 220 CBCT images of the IOC from 110 patients were labeled using the 3D Slicer software (version 4.10.2; MIT, Cambridge, MA, USA). The dataset was split into training, validation, and test sets at a ratio of 8:1:1. The nnU-Net v2 architecture was applied to the training and test datasets to predict and generate appropriate algorithm weight factors. The confusion matrix was used to check the accuracy and performance of the model. As a result of the test, the Dice Coefficient (DC), Intersection over the Union (IoU), F1-score, and 95% Hausdorff distance (95% HD) metrics were calculated. Results: By testing the model, the DC, IoU, F1-score, and 95% HD metric values were found to be 0.7792, 0.6402, 0.787, and 0.7661, respectively. According to the data obtained, the receiver operating characteristic (ROC) curve was drawn, and the AUC value under the curve was determined to be 0.91. Conclusions: Accurate identification and preservation of the IOC during surgical procedures are of critical importance to maintaining a patient’s functional and sensory integrity. The findings of this study demonstrated that the IOC can be detected with high precision and accuracy using an AI-based automatic segmentation method in CBCT images. This approach has significant potential to reduce surgical risks and to enhance the safety of critical anatomical structures. Full article

Background/Objectives: According to the guidelines established by the European Society of Vascular Surgery (ESVS), a minimum 2 mm diameter is advised for both the radial artery (RA) and cephalic vein (CV) to perform a radio-cephalic arteriovenous fistula (RC-AVF). However, studies have suggested that larger vein diameters, over 2.5 or 3 mm, or even smaller vessel diameters, above 1.6 mm, can yield satisfactory outcomes in both the medium and long term. This study aims to analyze how preoperative vascular mapping influences the long-term RC-AVF failure, considering adherence to guidelines. Methods: This retrospective, monocentric, and observational study enrolled 110 patients with ESKD who were admitted, between 2018 and 2024, to the Vascular Surgery Department at the Emergency County Hospital of Târgu Mureș for the creation of an RC-AVF. Demographic characteristics, comorbidities, preoperative vascular mapping data, and laboratory data were meticulously collected from the hospital’s electronic databases. Patients enrolled in the current study were categorized into two groups based on their adherence to guideline recommendations. Results: Patients whose RC-AVF was created outside guideline recommendations demonstrated smaller arterial (p < 0.001) and venous (p < 0.001) diameters. Additionally, a higher percentage of these patients were on hemodialysis via CVC at the time of RC-AVF creation (p = 0.041), as well as a higher incidence of 6-week AVF maturation failure (p = 0.012) and long-term AVF failure (p = 0.016). In ROC Curve analysis, a threshold of 2.75 mm was established for the RA (AUC: 0.647, p = 0.005) and 2.52 mm for the CV (AUC: 0.677, p = 0.001). Additionally, patients whose RC-AVF procedures adhered to guideline recommendations had a significantly lower risk of long-term RC-AVF failure (HR: 0.44, p = 0.012). This association lost significance after adjusting for cardiovascular risk factors and the presence of CVC at admission (HR: 0.69, p = 0.328). After full adjustment, only the CV remained an independent predictor of long-term successful RC-AVF (HR: 0.68, p = 0.026). In contrast, RA lost significance after adjusting for cardiovascular risk factors and the presence of CVC at admission (HR: 0.71, p = 0.086). Conclusions: In conclusion, this study reveals that only the diameter of the CV is correlated with the long-term failure of RC-AVF, independent of age, gender, diabetes, hypertension, active smoking, and the presence of a CVC at the time of AVF creation. Therefore, while adhering to the threshold diameters of the AR and CV, as recommended by the ESVS guidelines, facilitates the creation of a functional RC-AVF, we assert that additional cofactors, such as demographic data, usual cardiovascular risk factors, or CVC presence, must also be considered to achieve optimal long-term AVF. Full article

Background/Objectives: Patients with peripheral artery disease (PAD) have a heightened risk of major adverse cardiovascular events (MACE), including myocardial infarction, stroke, and death. Despite this, limited progress has been made in identifying reliable biomarkers to prognosticate such outcomes. Circulating growth factors, known to influence endothelial function and the progression of atherosclerosis, may hold prognostic value in this context. The objective of this research was to evaluate a broad range of blood-based growth factors to investigate their potential as predictors of MACE in patients diagnosed with PAD. Methods: A total of 465 patients with PAD were enrolled in a prospective cohort study. Baseline plasma levels of five different growth factors were measured, and participants were monitored over a two-year period. The primary outcome was the occurrence of MACE within those two years. Comparative analysis of protein levels between patients who did and did not experience MACE was performed using the Mann–Whitney U test. To assess the individual prognostic significance of each protein for predicting MACE within two years, Cox proportional hazards regression was performed, adjusting for clinical and demographic factors including a history of coronary and cerebrovascular disease. Subgroup analysis was performed to assess the prognostic value of these proteins in females, who may be at higher risk of PAD-related adverse events. Net reclassification improvement (NRI), integrated discrimination improvement (IDI), and area under the receiver operating characteristic curve (AUROC) were calculated to assess the added value of significant biomarkers to model performance for predicting 2-year MACE when compared to using demographic/clinical features alone. Kaplan–Meier curves stratified by IGFBP-1 tertiles compared using log-rank tests and Cox proportional hazards analysis were used to assess 2-year MACE risk trajectory based on plasma protein levels. Results: The average participant age was 71 years (SD 10); 31.1% were female and 47.2% had diabetes. By the end of the two-year follow-up, 18.1% (n = 84) had experienced MACE. Of all proteins studied, only insulin-like growth factor-binding protein 1 (IGFBP-1) showed a significant elevation among patients who suffered MACE versus those who remained event-free (20.66 [SD 3.91] vs. 13.94 [SD 3.80] pg/mL; p = 0.012). IGFBP-1 remained a significant independent predictor of 2-year MACE occurrence in the multivariable Cox analysis (adjusted hazard ratio [HR] 1.57, 95% CI 1.21–1.97; p = 0.012). Subgroup analyses revealed that IGFBP-1 was significantly associated with 2-year MACE occurrence in both females (adjusted HR 1.52, 95% CI 1.16–1.97; p = 0.015) and males (adjusted HR 1.04, 95% CI 1.02–1.22; p = 0.045). Incorporating IGFBP-1 into the clinical risk prediction model significantly enhanced its predictive performance, with an increase in the AUROC from 0.73 (95% CI 0.71–0.75) to 0.79 (95% CI 0.77–0.81; p = 0.01), an NRI of 0.21 (95% CI 0.07–0.36; p = 0.014), and an IDI of 0.041 (95% CI 0.015–0.066; p = 0.008), highlighting the prognostic value of IGFBP-1. Kaplan–Meier analysis showed an increase in the cumulative incidence of 2-year MACE across IGFBP-1 tertiles. Patients in the highest IGFBP-1 tertile experienced a significantly higher event rate compared to those in the lowest tertile (log-rank p = 0.008). In the Cox proportional hazards analysis, the highest tertile of IGFBP-1 was associated with increased 2-year MACE risk compared to the lowest tertile (adjusted HR 1.81; 95% CI: 1.31–2.65; p = 0.001). Conclusions: Among the growth factors analyzed, IGFBP-1 emerged as the sole biomarker independently linked to the development of MACE over a two-year span in both female and male PAD patients. The addition of IGFBP-1 to clinical features significantly improved model predictive performance for 2-year MACE. Measuring IGFBP-1 levels may enhance risk stratification and guide the intensity of therapeutic interventions and referrals to cardiovascular specialists, ultimately supporting more personalized and effective management strategies for patients with PAD to reduce systemic vascular risk. Full article

Background and Objectives: Sclerostin and dickkopf-1 (DKK1), which are Wnt inhibitors, are involved in vascular calcification and atherosclerosis. Atherosclerotic peripheral artery disease (PAD) is highly prevalent, particularly in patients with hypertension. This study aimed to explore the association between serum concentrations of Wnt pathway inhibitors and PAD in patients with hypertension. Materials and Methods: This cross-sectional trial recruited 92 patients with hypertension. PAD was defined as an ankle-brachial index < 0.9. The levels of sclerostin, DKK1, C-reactive protein (CRP), and other biochemical markers were assessed using fasting blood samples. Univariate and multivariate logistic regression and receiver operating characteristic curve analyses were conducted. Results: Patients with PAD (15.2%) had significantly higher serum sclerostin (p < 0.001) and CRP (p = 0.001) levels than those without PAD. However, the two groups did not significantly differ in terms of the DKK1 levels. Based on the multivariate analysis, sclerostin was an independent predictor of PAD (odds ratio: 1.054 per 1 pmol/L increase, 95% confidence interval: 1.019–1.090, p = 0.002) after adjusting for body mass index, fasting glucose levels, diabetes, smoking, and CRP levels. Sclerostin had a strong discriminatory power for diagnosing PAD according to the receiver operating characteristic curve analysis (area under the curve: 0.806, p < 0.001), with the best cutoff value of 71.5 pmol/L (sensitivity: 71.4%, specificity: 78.2%). Further, sclerostin was negatively associated with the ankle-brachial index, renal function, and dyslipidemia markers. Conclusions: Serum sclerostin levels are independently related to an increased risk for PAD in patients with hypertension. Therefore, it can be a potential biomarker for risk stratification and early diagnosis. Full article

Background: Cirrhosis is responsible for a large proportion of mortality worldwide. Despite having multiple scoring systems, organ allocation for end-stage liver disease remains a major problem. Since anthropometric indices play important roles in predicting the prognosis of patients with cirrhosis, these variables were used in establishment of a novel scoring system. Methods: In order to evaluate a machine learning approach for predicting the probability of three-month mortality in cirrhotic patients awaiting liver transplantation, the clinical and anthropometric information of 64 patients referred to Abu-Ali-Sina Transplantation Center were collected and followed for three months. A LASSO logistic regression model was used to devise and validate a new machine learning approach and compare it to the Model for End-Stage Liver Disease (MELD) regarding the three-month mortality of cirrhotic patients. Hand grip, skeletal muscle mass index, average mean arterial pressure, serum sodium, and total bilirubin were assessed with this new machine learning approach to predict the prognosis of patients with cirrhosis, which we named the Sina score. Results: Sixty-four patients were enrolled, with a mean age of 46.50 ± 12.871 years. Like the MELD score, the Sina score is a precise prognostic tool for predicting the three-month mortality probability in cirrhotic patients [area under the curve (AUC) = 0.753 and p = 0.005 vs. AUC = 0.607 and p = 0.238]. Our machine learning approach, the Sina score, was shown to be a precise prognostic tool, like the MELD, for the prediction of the three-month mortality probability of cirrhotic patients awaiting liver transplantation. Conclusions: The Sina score, given that its level of precision is on par with the MELD, can be recommended for the prediction of three-month mortality in cirrhotic patients awaiting liver transplantation. Full article

Background: Pulmonary hypertension (PHT) is a rare but serious condition in children, requiring early diagnosis to prevent right ventricular failure. Non-invasive imaging modalities such as computed tomography angiography (CTA) have gained importance in assessing vascular changes, including main pulmonary artery (MPA) dilatation, increased vessel stiffness, and elevated pulmonary vascular resistance, which are characteristic of pulmonary hypertension (PHT). Objective: This study aimed to evaluate the diagnostic value of the main pulmonary artery-to-ascending aorta (MPA/AA) and main pulmonary artery-to-descending aorta (MPA/DA) ratios on CTA in pediatric patients with confirmed PHT. Methods: In this retrospective cohort study, 76 pediatric patients who underwent both cardiac catheterization and thoracic CTA were included. Patients were divided into PHT (mean pulmonary artery pressure ≥ 25 mmHg) and non-PHT groups. Vascular measurements were obtained from CTA, and MPA/AA and MPA/DA ratios were calculated. Statistical analyses included Mann–Whitney U tests and ROC curve analysis. Results: The MPA diameter and MPA/AA and MPA/DA ratios were significantly higher in the PHT group compared to controls (p < 0.05). ROC analysis showed strong diagnostic performance for both ratios. The MPA/DA ratio had an AUC of 0.927 with 78.5% sensitivity and 94% specificity at a cut-off value of 1.85. The MPA/AA ratio had an AUC of 0.896 with 76.5% sensitivity and 95% specificity at a cut-off value of 1.25. Conclusions: Both MPA/AA and MPA/DA ratios are reliable non-invasive indicators of pediatric PHT, with the MPA/DA ratio demonstrating slightly higher diagnostic accuracy. These findings support the use of CTA-derived vascular ratios, especially MPA/DA, as effective screening tools in clinical practice. Full article

Background: Synchronous computation of coronary angiography-derived fractional flow reserve (CAG-FFR) and coronary angiography-derived index of microcirculatory resistance (CAG-IMR) is a novel coronary angiography-based method for on-site assessment of suspected myocardial ischemia in patients with coronary artery disease (CAD). Methods: This trial is a prospective, multicenter, controlled study designed to assess the diagnostic performance of CAG-FFR and CAG-IMR in patients with suspected myocardial ischemia using wire-based FFR and IMR as reference standards. The functional parameters were calculated using a reduced order computational fluid dynamics solver that incorporates thrombolysis in myocardial infarction (TIMI) frame count and aortic pressure recorded by a disposable invasive pressure sensor. Results: CAG-FFR was computed in 325 patients, demonstrating a patient-level diagnostic accuracy of 95.4%, sensitivity of 95.9%, and specificity of 95.1%. The area under the receiver operating characteristic curve (AUC) of CAG-FFR was 0.977. Patient-specific aortic pressure adoption significantly improved the accuracy of CAG-FFR in the “gray zone” compared to fixed-pressure models. In addition, CAG-IMR was successfully computed in 180 patients, showing a patient-level diagnostic accuracy of 95.5%, sensitivity of 96.4%, and specificity of 95.2%. The AUC of CAG-IMR in diagnosing abnormal coronary microcirculatory dysfunction was 0.973. Conclusions: Synchronous computation of CAG-FFR and CAG-IMR demonstrated higher feasibility and excellent diagnostic accuracy compared to wire-based FFR and IMR, highlighting its clinical potential for CAD evaluation. Full article