Geometric deep learning-based coronary wall shear stress estimation from real-world patients.

Cardiac allograft vasculopathy (CAV) is a leading cause of graft failure following pediatric heart transplantation (HT). Early detection could improve long-term outcomes, but conventional coronary angiography often misses early-stage disease. Optical coherence tomography (OCT), a high-resolution intravascular imaging modality, may enable earlier and more sensitive CAV detection. This retrospective study analyzed pediatric HT recipients who underwent OCT between 2012 and 2024. OCT-derived maximal intima thickness (MIT) and cross-sectional area ratios were correlated with coronary angiography findings, hemodynamic data, CAV risk factors, and immunosuppressive regimens. Longitudinal analysis was performed in patients with serial OCT. In 214 examinations (386 vessels) from 67 patients (median age 3.1years, IQR 1.8-8.2, 49% female, median 5.1years post-HT, IQR 2.6-9.4), OCT-detected CAV (MIT≥0.3mm) was present in 31.9% of vessels versus 8.0% detected by angiography. MIT correlated with recipient and donor age, donor-recipient age difference, episodes of antibody-mediated rejection and was higher in adult donor grafts. Everolimus therapy was associated with significant lower MIT (p<0.001). Over time, 73% of grafts showed OCT-CAV with earlier onset (p=0.037) and higher incidence (p=0.005) in vessels from adult donors. Presence of CAV by angiography or OCT was associated with increased graft loss or dysfunction (log rank p=0.044, HR 4.21, 95%CI 1.16-15.28). OCT detects early-stage CAV in pediatric heart transplant recipients with substantially greater sensitivity than angiography. Everolimus may mitigate early CAV progression. OCT offers significant potential for early detection and risk stratification.

Coronary artery black-blood imaging via T2-prepared phase-sensitive inversion-recovery steady-state free precession in Kawasaki disease.

A 68-year-old man with a history of abdominal aortic aneurysm presented with incidental coronary artery thickening on coronary CT angiography (CCTA). Eight years later, increased thickening was noted on CCTA and cardiac MRI, with PET/CT showing FDG avidity. Serology revealed elevated IgG4 and ESR. High-dose prednisone led to decreased wall thickening and FDG avidity; rituximab was initiated following relapse. This case highlights the challenges of diagnosing IgG4-related coronary arteritis and underscores the essential role of advanced imaging in guiding surveillance and therapy, especially in asymptomatic patients.

Coronary computed tomography angiography (CCTA) enables a non-invasive, comprehensive assessment of coronary artery disease, and artificial intelligence (AI) offers the potential to improve CCTA image interpretation. This study aimed to evaluate the performance of an AI-powered method for automatic plaque quantification from CCTA, with optical coherence tomography (OCT) as reference standard. Patients who underwent CCTA within 6 months prior to OCT were retrospectively enrolled. AI-assisted automatic plaque quantification was performed on CCTA with specific plaque composition classification based on adaptive Hounsfield unit thresholds. Qualitative high-risk plaque features were also assessed. Automated co-registration of CCTA and OCT was performed with the link of invasive coronary angiography. A total of 91 patients with 153 co-registered lesions were evaluated. The AI-assisted automatic CCTA analysis showed significant correlations with OCT for quantifying plaque volume/burden and different plaque compositions (all P values <0.001); of which, the correlation coefficient for plaque volume was 0.84. Vulnerable plaque, defined as lipid-to-cap ratio >0.33 on OCT, was identified in 39 (25.5%) lesions. CCTA-derived plaque volume >82.5 mm3 [odds ratio (OR), 9.39], maximal plaque burden >76.4% (OR, 3.70), lipidic tissue volume >16.3 mm³ (OR, 4.42), all P < 0.001, and high-risk plaque features ≥2 (OR, 2.70, P = 0.009) were independent predictors of OCT-derived vulnerable plaques. The average time for automatic CCTA plaque quantification was 1.8 min per patient. The novel AI-powered method facilitated fully automatic plaque quantification and correlated well with co-registered OCT.

NMR-based metabolic measures of chronic stable angina and myocardial infarction in patients with diabetes mellitus.

The association between oils and fats consumption and the risk of premature coronary artery disease in a multi-centric case-control study: Iran premature coronary artery (IPAD).

Impact of using the 2024 ESC guideline-recommended method to estimate the likelihood of obstructive coronary disease - a cardiac CT study.

Aim. To assess the relationship between epicardial fat thickness (EFT) and metabolic-associated fatty liver disease (MAFLD), including hepatic steatosis (HS) and steatohepatitis, in myocardial infarction (MI), as well as to analyze the changes of transaminase levels in patients with a combination of ST-elevation MI (STEMI) and MAFLD to accurately identify liver disease. Material and methods. A total of 163 patients with ST-elevation myocardial infarction (STEMI) (n=144) and non-ST-elevation myocardial infarction (NSTEMI) (n=19) with metabolic syndrome (MetS) were admitted for primary coronary angiography and percutaneous intervention (PCI). Eighty-two patients had concomitant MAFLD (55 with steatosis and 27 with steatosis). Liver elastometry, EFT measurement, cardiac troponin I levels, alanine and aspartate aminotransferase (ALT and AST) levels, and cytokeratin-18 fragment concentrations were measured. Results. MAFLD in patients with MI compared to patients without liver pathology is associated with higher EFT (p&lt;0,01). According to two-way analysis of variance, a stable increase in blood AST and ALT levels was established for the combination of MI and MAFLD (p&lt;0,05, generalized η² effect size ≥0,11 for both aminotransferases). In STEMI combined with steatohepatitis, compared to HS and STEMI without MAFLD (control), a significantly higher EFT (p&lt;0,01), AST (p&lt;0,05) and ALT (p&lt;0,001) levels were noted. Conclusion. MAFLD in patients with MI is associated with an increase in EFT. For the combination of STEMI-steatohepatitis, compared to STEMI-HS and STEMI without MAFLD, a higher EFT was observed. This may indicate not only the role of EFT in acute coronary pathology but also the relationship of this indicator with MAFLD severity. In uncomplicated STEMI, analysis and interpretation of transaminase activity in assessing MAFLD are recommended no earlier than 10 days.

Effects of Transradial Catheterisation on Radial Artery Bypass Graft Patency: A Systematic Review and Meta-Analysis.

For individuals with suspected chronic coronary syndrome, the 2024 ESC guidelines recommend use of a structured estimate of the probability of obstructive coronary artery disease (CAD). This 'risk factor-weighted clinical likelihood' (RF-CL) model is recommended as the initial step after history taking and combines age, sex, symptom characteristics, and five clinical risk factors, with coronary calcification data, if available. The resulting numerical estimate indicates an initial 'pre-test probability' of obstructive CAD, that has been calibrated to provide improved accuracy compared with previous models. It can help triage patients for appropriate testing and identify individuals with a very low likelihood of obstructive CAD, for whom deferral of further diagnostic tests should be considered. Designed to assess the likelihood of obstructive CAD, the RF-CL model is not designed to predict ischaemia, which may occur in the absence of obstructive coronary disease and could account for patient symptoms. The score is easy and quick to use, with extensive external validation in contemporary populations including European, North American, and Asian cohorts. However, some have questioned the practical application of the RF-CL tool, citing challenges with the specificity and clarity of patient symptoms, definition and weighting of risk factors, as well as the other 'enrichment factors' that can enhance the likelihood. The RF-CL model is quantitative up to 45% and then becomes semi-quantitative/qualitative. For patients considered very high likelihood, with an estimated score > 85%, invasive coronary angiography is recommended, although how this score may be reached is not entirely clear. The RF-CL model undoubtedly improves the prediction of obstructive CAD and can 'de-risk' a significant number of symptomatic patients safely, reducing unnecessary testing. In the development and application of such a probability estimate, there is a need to strike a good balance between simplicity and usefulness, vs increased sensitivity at the expense of greater complexity. Here, the two sides of this Great Debate are presented, to help the reader better evaluate the practical usefulness of the new RF-CL assessment in predicting the probability of obstructive CAD.

Although lipoprotein(a) [Lp(a)] is an established independent risk factor for atherosclerotic cardiovascular disease (ASCVD) in primary prevention settings, it remains unclear whether Lp(a) contributes to an increased risk of adverse cardiovascular events in patients with established ASCVD. The current analysis combines the ATHEROREMO and IBIS-3 observational studies, which together enrolled 798 patients undergoing coronary angiography for stable angina pectoris or acute coronary syndrome. Intravascular ultrasound (IVUS) and near-infrared spectroscopy were performed to assess coronary plaque characteristics in a non-culprit study segment. Regression models were applied to relate Lp(a) to coronary plaque characteristics and long-term (up to 10 year) clinical outcomes. Lp(a) was analysed both as a continuous and categorical variable (using 75 nmol/L and 125 nmol/L as threshold). Mean age of the patients was 61.6 years (10.8); 75% were male; 19% had elevated Lp(a) levels (>125 nmol/L). Patients with Lp(a) > 125 nmol/L had a significantly higher prevalence of hypercholesterolemia and prior percutaneous coronary intervention. These patients demonstrated higher IVUS-derived plaque burden (40.7% (±11.5) vs. 38.6% (±10.7), p = 0.028), though no associations were found with other plaque characteristics, e.g. minimum lumen area, lipid core burden index and thin-cap fibroatheroroma. No association was found between Lp(a) and -5-year major adverse cardiac events (HR 1.06, 95% CI: 0.70-1.60, p = 0.78) and 10-year all-cause mortality (HR 0.63, 95% CI: 0.38-1.06, p = 0.78). Among patients with established ASCVD, Lp(a) was associated with plaque burden, supporting evidence that relates Lp(a) to atherosclerotic disease. However, Lp(a) was not associated with long-term mortality or cardiac adverse events in these patients.

Predictors of Obstructive Coronary Artery Disease in Positive Electrocardiogram, Negative Echocardiogram Stress Tests: A Single-Centre Retrospective Analysis.

Background and Objective: To evaluate the relationship between hemoglobin A1c (HbA1c) levels and angiographic atherosclerotic burden in non-diabetic individuals. Materials and methods: This retrospective study included adult patients who underwent coronary angiography (CAG) at İzmir Atatürk Training and Research Hospital between 2002 and 2006. All clinical, biochemical, and angiographic data were retrieved from archived hospital records. Individuals with a previous diagnosis of diabetes mellitus or with fasting plasma glucose ≥126 mg/dL were excluded. HbA1c levels, routine biochemical parameters, and classical cardiovascular risk factors were evaluated. The extent and severity of coronary artery disease (CAD) were quantified using the Gensini scoring system, which assigns stenosis-based severity points and multiplies them by segment-specific weighting factors to reflect anatomical importance. Patients were classified according to HbA1c categories and number of involved coronary vessels. Correlations between HbA1c, inflammatory markers, and angiographic severity were analyzed. Results: Higher HbA1c levels were associated with increased Gensini scores and greater angiographic atherosclerotic burden. Individuals with HbA1c ≥6.0% showed significantly elevated fibrinogen and C-reactive protein levels, suggesting an accompanying low-grade inflammatory process. Although overall group comparisons indicated a significant difference in HbA1c levels, post-hoc analyses did not reveal differences between specific vessel-involvement subgroups. HbA1c demonstrated a modest but meaningful relationship with subclinical coronary atherosclerosis, independent of lipid parameters. Conclusion: HbA1c may serve as an early, accessible marker of atherosclerotic risk even in individuals without diabetes. This study provides region-specific evidence supporting the integration of HbA1c into cardiovascular risk-stratification strategies for earlier detection and prevention. January 2026; Vol. 20(1):005. DOI: https://doi.org/10.55010/imcjms.20.005 *Correspondence: Savas Gokcek, Department of Medical Oncology, Necip Fazıl City Hospital Kahramanmaraş/Turkey, 46080.Email: gokceksavas35@gmail.com. © 2026 The Author(s). This is an open access article distributed under the terms of the Creative Commons Attribution License(CC BY 4.0).

Background: Chronic obstructive pulmonary disease (COPD) is increasingly recognized as a disorder linked to increased cardiovascular risk, often coexisting with coronary artery disease (CAD), yet angiographic data on coronary involvement in COPD remain limited. This study aimed to evaluate whether COPD is associated with a distinct angiographic pattern of CAD, focusing on vessel distribution. Methods: We retrospectively enrolled 94 patients who underwent coronary angiography between 2023 and 2024 for suspected or known CAD. Clinical data, comorbidities, laboratory testing, pulmonary function, electrocardiography, echocardiography, and angiography were collected. Participants were stratified into two groups: COPD (n = 47) and non-COPD (n = 47). Coronary vessels were classified by number, location, and diameter. The normality of continuous variables was assessed using the Shapiro–Wilk test. Non-normally distributed variables were compared using the Mann–Whitney U test, while Fisher’s exact test was used for categorical comparisons. A multivariable logistic regression model was performed to identify independent predictors of left main coronary artery (LMCA) disease at the patient level. The primary endpoint was the association between COPD and CAD severity. Results: Baseline characteristics, including age, sex, BMI, and smoking history, were comparable between groups. The overall extent of CAD, expressed as the number of diseased vessels, did not differ significantly (p = 0.1436). However, vessel-based analysis revealed a distinct pattern: COPD patients showed a significantly higher prevalence of left main coronary artery (LMCA) disease compared to non-COPD patients (14% vs. 4.7%, p &lt; 0.001). At the patient level, LMCA disease was present in 15/47 (31.9%) COPD patients compared with 6/47 (12.8%) non-COPD patients (p = 0.046). Multivariable logistic regression confirmed that COPD was an independent predictor of LMCA disease (OR = 3.56, 95% CI: 1.12–11.29, p = 0.031) after adjustment for age, sex, smoking, diabetes, and chronic kidney disease. Intermediate-caliber vessels were most frequently affected in both groups, while small-caliber branches were less commonly involved in COPD patients. Conclusions: COPD is an independent predictor of LMCA disease despite a similar overall angiographic extent of CAD. These findings suggest a distinct, high-risk coronary phenotype in COPD and highlight the need for enhanced cardiovascular vigilance and integrated cardiopulmonary management in this population.

Guiding Preventive Care Strategies for Patients With Atherosclerotic Plaque on Coronary CTA: Primary Outcomes of the DECIDE Registry.

An early and accurate diagnosis of coronary artery disease (CAD) is essential for effective treatment. Although X-ray coronary angiography (XCA) is the clinical gold standard for CAD diagnosis, blurred vessel boundaries, low contrast, and minute stenotic regions can make pixel-level segmentation difficult. We propose Stenosis-YOLO, a YOLOv8-based segmentation framework that addresses these challenges. Its key contributions are as follows: (1) an edge enhancement stem (EES) that combines Laplacian edge extraction with spatial feature pooling to strengthen fine vascular and boundary representations; (2) a small-target-aware neck that uses space-to-depth convolution (SPD-Conv) on the P2 layer and a feature fusion module (FFM) to improve multiscale integration; and (3) a semisupervised pseudo-label self-training strategy that uses unlabeled data to improve performance. When evaluated on the ARCADE benchmark, Stenosis-YOLO significantly outperformed the state-of-the-art techniques for coronary stenosis segmentation and instance segmentation, achieving improvements of 6.4%, 4.9%, 5.7%, and 4.2% in terms of precision, recall, F1-score, and mean average precision (mAP), respectively, over the baseline YOLOv8 model. Stenosis-YOLO also performed exceptionally well in stenosis detection, achieving 0.976, 0.972, 0.974, and 0.983 for precision, recall, F1-score, and mAP, respectively. This represents enhancements of 1.6% and 0.7% in the F1-score and mAP, respectively, compared to the leading coronary stenosis detection model. These results demonstrate the effectiveness of combining edge enhancement, small-target modeling, and semisupervised learning for accurate coronary stenosis segmentation.

To evaluate a new deep learning (DL) motion correction (MC) software based on partial angle reconstruction (PAR) to reduce motion artifacts in patients with increased heart rate (HR) in coronary CT angiography (CCTA). This retrospective single-center study included consecutive patients with HR > 70bpm who underwent single-beat wide-area-detector CCTA over a 6-month period. A DL PAR-based MC software was applied to each image, and corrected and uncorrected reconstructions were scored by two blinded independent cardiothoracic radiologists for coronary motion artifact severity. Scores were obtained on a per-vessel and on a per-patient level using a 5-point Likert scale (1 = non-interpretable, 2 = severe, 3 = moderate, 4 = mild, 5 = no artifacts). Scoring differences were analyzed with Chi-Squared test and interrater agreement with Gwet agreement coefficients. 62 patients (35 female) with (mean ± std.dev.) BMI 29.4 ± 6.8kg/m2 and HR 81.9 ± 13.1bpm were included. Without MC, the number of cases scored 3 or higher on a per-patient level were 40/62 (64.5%) and 43/62 (69.4%), respectively for reader 1 and 2. With MC, they improved to 50/62 (80.6%) and 55/62 (88.7%), respectively for reader 1 and 2. Improvements in scoring were significant for both readers (p < 0.02). Per-vessel scores followed a similar trend, but showed significance for both readers only for the right coronary artery (p < 0.001). The fraction of diagnostically-interpretable cases (score ≥ 2) were 91.9% (uncorrected) and 98.4% (motion-corrected) (reader 1), and 93.5% (uncorrected) and 96.8% (motion-corrected) (reader 2). Interrater agreement was between (0.67-0.78). The MC software significantly improved image quality by reducing coronary motion artifacts in CCTA patients with increased HR.

Correction: Transient cortical blindness following coronary angiography: a case report

Background: The relationship between testosterone and coronary artery disease (CAD) remains a subject of debate. Most studies suggest an inverse association-lower testosterone, higher risk. However, data from Central European populations undergoing coronary angiography are limited. Objectives: To investigate the association between serum testosterone levels and angiographically confirmed coronary artery stenosis in a Slovak population. Methods: This cross-sectional study included 129 consecutive stable patients (84 men, 45 women; mean age 64.3 ± 9.7 years) undergoing elective coronary angiography for suspected stable coronary artery disease. Significant coronary stenosis was defined as ≥50% luminal narrowing in any major epicardial vessel. Serum testosterone, lipid profile, and traditional risk factors were assessed. Univariate and multivariate logistic regression models were constructed to evaluate independent associations of coronary stenosis. Results: Coronary stenosis ≥ 50% was present in 74 patients (57.4%). Notably, patients with stenosis had significantly higher testosterone levels (6.62 ± 2.79 vs. 4.85 ± 3.50 ng/mL, p = 0.002). In univariate analysis, testosterone showed a significant association (OR 1.197 per ng/mL, OR 1.784 per SD, p = 0.003). In multivariate analysis adjusted for age, sex, diabetes mellitus, and LDL (low-density lipoprotein) cholesterol, testosterone remained independently associated (adjusted OR 2.043 per SD, 95% CI 1.221-3.420, p = 0.007), as did diabetes mellitus (OR 2.60, p = 0.032). Conclusions: Elevated serum testosterone is paradoxically associated with increased prevalence of coronary stenosis in our cohort. These findings from stable, chronic CAD patients may work fundamentally differently from what is observed in acute coronary syndromes, where stress-induced testosterone suppression may confound observed associations.