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Prognostic Value of AI-Based Quantitative Coronary CTA vs Human Reader-Based Visual Assessment 基于人工智能的定量冠状动脉CTA与基于人类阅读器的视觉评估的预后价值:来自CONFIRM2注册表的结果
IF 15.2 1区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2026-03-01 Epub Date: 2025-12-01 DOI: 10.1016/j.jcmg.2025.09.021
Alexander van Rosendael MD, PhD , Rine Nakanishi MD, PhD , Jeroen J. Bax MD, PhD , Gianluca Pontone MD, PhD , Saima Mushtaq MD , Ronny R. Buechel MD , Christoph Gräni MD, PhD , Gudrun Feuchtner MD , Pietro G. Lacaita MD , Amit R. Patel MD , Cristiane C. Singulane MD , Andrew D. Choi MD , Mouaz Al-Mallah MD, MSc , Daniele Andreini MD, PhD , Ronald P. Karlsberg MD , Geoffrey W. Cho MD , Carlos E. Rochitte MD , Mirvat Alasnag MD , Ashraf Hamdan MD , Filippo Cademartiri MD, PhD , Ibrahim Danad MD, PhD
<div><h3>Background</h3><div>The severity and extent of whole heart coronary plaque volume and stenosis can be reliably measured by artificial intelligence–guided quantitative coronary computed tomography angiography (AI-QCT). Limited data are available on the potential incremental prognostic value compared with currently recommended qualitative coronary computed tomography angiography (CTA) reads and the coronary artery calcium score (CACS).</div></div><div><h3>Objectives</h3><div>The aim of this study was to evaluate the prognostic value of AI-QCT compared with human coronary CTA reads, including the CAD-RADS (Coronary Artery Disease–Reporting and Data System), CACS, and the modified Duke Index.</div></div><div><h3>Methods</h3><div>CONFIRM2 (Quantitative COroNary CT Angiography Evaluation For Evaluation of Clinical Outcomes: An InteRnational, Multicenter Registry) is a multicenter, international, observational cohort study of patients undergoing clinically indicated coronary CTA with follow-up for major adverse cardiac events (MACE). Asymptomatic patients and those with cardiac history were excluded. Coronary artery disease presence, extent, and composition were quantified by AI-QCT across the coronary tree, yielding 24 patient-, vessel-, and plaque-level variables. On the basis of prior analyses, noncalcified plaque burden and diameter stenosis were identified as the strongest predictors and combined for statistical modeling as “AI-QCT.” Comparator computed tomography scores included CAD-RADS, CACS, and the modified Duke Index, whereas clinical predictors were summarized in the risk factor–weighted clinical likelihood score. Area under the curve (AUC) and continuous net reclassification index (NRI) were calculated to assess the incremental value. The primary endpoint was MACE (death, myocardial infarction [MI], stroke, heart failure, late revascularization, or hospital stay for unstable angina), and the secondary endpoint was death or MI.</div></div><div><h3>Results</h3><div>In 1,916 patients with all risk scores available, 87 (4.5%) MACE and 27 (1.4%) death/MI events occurred during 3 years of follow-up. There was a stepwise risk increase with higher coronary artery disease classifications with CAD-RADS and CACS. The addition of AI-QCT significantly improved risk stratification for MACE compared with CAD-RADS (AUC: 0.81 vs 0.79; <em>P</em> < 0.001 and NRI: 0.47; <em>P</em> < 0.001), CACS (AUC: 0.79 vs 0.70; <em>P</em> < 0.001 and NRI 0.61; <em>P</em> < 0.001), the modified Duke Index (AUC: 0.81 vs 0.76; <em>P</em> < 0.001 and NRI: 0.52; <em>P</em> < 0.001), and CAD-RADS + CACS model (AUC: 0.81 vs 0.79; <em>P</em> = 0.004 and NRI: 0.54; <em>P</em> < 0.001). AI-QCT also improved discrimination when results were adjusted for the risk factor–weighted clinical likelihood and for the prediction of death/MI. Excluding 195 patients with severe stenosis (≥70%), in a multivariable model of CAD-RADS and AI-QCT, only AI-QCT was signi
人工智能引导的定量冠状动脉计算机断层造影(AI-QCT)可以可靠地测量全心冠状动脉斑块体积和狭窄的严重程度和程度。与目前推荐的定性冠状动脉ct血管造影(CTA)读数和冠状动脉钙评分(CACS)相比,关于潜在的增量预后价值的数据有限。目的本研究的目的是评估AI-QCT与人类冠状动脉CTA读数的预后价值,包括CAD-RADS(冠状动脉疾病报告和数据系统)、CACS和改良的Duke指数。方法confirm2(定量冠状动脉CT血管造影评估用于评估临床结果:一项国际多中心注册研究)是一项多中心国际观察性队列研究,研究对象是接受临床指征冠状动脉CTA并随访主要心脏不良事件(MACE)的患者。排除无症状患者和有心脏病史的患者。通过AI-QCT对冠状动脉病变的存在、程度和组成进行量化,得出24个患者、血管和斑块水平变量。在先前分析的基础上,非钙化斑块负担和直径狭窄被确定为最强的预测因子,并将其合并为“AI-QCT”统计模型。比较计算机断层扫描评分包括CAD-RADS、CACS和改进的Duke指数,而临床预测指标则总结为危险因素加权临床似然评分。计算曲线下面积(Area under the curve, AUC)和连续净重分类指数(continuous net reclassification index, NRI)来评估增量值。主要终点为MACE(死亡、心肌梗死[MI]、卒中、心力衰竭、晚期血运重建术或因不稳定心绞痛住院),次要终点为死亡或心肌梗死。结果在获得所有风险评分的1916例患者中,3年随访期间发生了87例(4.5%)MACE和27例(1.4%)死亡/心肌梗死事件。CAD-RADS和CACS的冠状动脉疾病分类越高,风险越高。与CAD-RADS (AUC: 0.81 vs 0.79, P < 0.001, NRI: 0.47, P < 0.001)、CACS (AUC: 0.79 vs 0.70, P < 0.001, NRI 0.61, P < 0.001)、改良杜克指数(AUC: 0.81 vs 0.76, P < 0.001, NRI: 0.52, P < 0.001)和CAD-RADS + CACS模型(AUC: 0.81 vs 0.79, P = 0.004, NRI: 0.54, P < 0.001)相比,AI-QCT的加入显著改善了MACE的风险分层。当对危险因素加权的临床可能性和死亡/心肌梗死的预测结果进行调整时,AI-QCT也提高了识别能力。除195例严重狭窄患者(≥70%)外,在CAD-RADS和AI-QCT的多变量模型中,只有AI-QCT与MACE和死亡/MI显著相关,与CAD-RADS相比,AI-QCT显著改善了MACE (AUC: 0.77 vs 0.72; P < 0.001, NRI: 0.54; P < 0.001)和死亡/MI (AUC: 0.81 vs 0.73; P = 0.011, NRI: 0.69; P = 0.001)的风险分层。结论与CAD-RADS 2.0、CACS和改进的Duke指数相比,sai - qct在预测MACE以及死亡或非致死性心肌梗死的次要终点方面提供了更多的预后信息。
{"title":"Prognostic Value of AI-Based Quantitative Coronary CTA vs Human Reader-Based Visual Assessment","authors":"Alexander van Rosendael MD, PhD ,&nbsp;Rine Nakanishi MD, PhD ,&nbsp;Jeroen J. Bax MD, PhD ,&nbsp;Gianluca Pontone MD, PhD ,&nbsp;Saima Mushtaq MD ,&nbsp;Ronny R. Buechel MD ,&nbsp;Christoph Gräni MD, PhD ,&nbsp;Gudrun Feuchtner MD ,&nbsp;Pietro G. Lacaita MD ,&nbsp;Amit R. Patel MD ,&nbsp;Cristiane C. Singulane MD ,&nbsp;Andrew D. Choi MD ,&nbsp;Mouaz Al-Mallah MD, MSc ,&nbsp;Daniele Andreini MD, PhD ,&nbsp;Ronald P. Karlsberg MD ,&nbsp;Geoffrey W. Cho MD ,&nbsp;Carlos E. Rochitte MD ,&nbsp;Mirvat Alasnag MD ,&nbsp;Ashraf Hamdan MD ,&nbsp;Filippo Cademartiri MD, PhD ,&nbsp;Ibrahim Danad MD, PhD","doi":"10.1016/j.jcmg.2025.09.021","DOIUrl":"10.1016/j.jcmg.2025.09.021","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Background&lt;/h3&gt;&lt;div&gt;The severity and extent of whole heart coronary plaque volume and stenosis can be reliably measured by artificial intelligence–guided quantitative coronary computed tomography angiography (AI-QCT). Limited data are available on the potential incremental prognostic value compared with currently recommended qualitative coronary computed tomography angiography (CTA) reads and the coronary artery calcium score (CACS).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Objectives&lt;/h3&gt;&lt;div&gt;The aim of this study was to evaluate the prognostic value of AI-QCT compared with human coronary CTA reads, including the CAD-RADS (Coronary Artery Disease–Reporting and Data System), CACS, and the modified Duke Index.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;div&gt;CONFIRM2 (Quantitative COroNary CT Angiography Evaluation For Evaluation of Clinical Outcomes: An InteRnational, Multicenter Registry) is a multicenter, international, observational cohort study of patients undergoing clinically indicated coronary CTA with follow-up for major adverse cardiac events (MACE). Asymptomatic patients and those with cardiac history were excluded. Coronary artery disease presence, extent, and composition were quantified by AI-QCT across the coronary tree, yielding 24 patient-, vessel-, and plaque-level variables. On the basis of prior analyses, noncalcified plaque burden and diameter stenosis were identified as the strongest predictors and combined for statistical modeling as “AI-QCT.” Comparator computed tomography scores included CAD-RADS, CACS, and the modified Duke Index, whereas clinical predictors were summarized in the risk factor–weighted clinical likelihood score. Area under the curve (AUC) and continuous net reclassification index (NRI) were calculated to assess the incremental value. The primary endpoint was MACE (death, myocardial infarction [MI], stroke, heart failure, late revascularization, or hospital stay for unstable angina), and the secondary endpoint was death or MI.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;In 1,916 patients with all risk scores available, 87 (4.5%) MACE and 27 (1.4%) death/MI events occurred during 3 years of follow-up. There was a stepwise risk increase with higher coronary artery disease classifications with CAD-RADS and CACS. The addition of AI-QCT significantly improved risk stratification for MACE compared with CAD-RADS (AUC: 0.81 vs 0.79; &lt;em&gt;P&lt;/em&gt; &lt; 0.001 and NRI: 0.47; &lt;em&gt;P&lt;/em&gt; &lt; 0.001), CACS (AUC: 0.79 vs 0.70; &lt;em&gt;P&lt;/em&gt; &lt; 0.001 and NRI 0.61; &lt;em&gt;P&lt;/em&gt; &lt; 0.001), the modified Duke Index (AUC: 0.81 vs 0.76; &lt;em&gt;P&lt;/em&gt; &lt; 0.001 and NRI: 0.52; &lt;em&gt;P&lt;/em&gt; &lt; 0.001), and CAD-RADS + CACS model (AUC: 0.81 vs 0.79; &lt;em&gt;P&lt;/em&gt; = 0.004 and NRI: 0.54; &lt;em&gt;P&lt;/em&gt; &lt; 0.001). AI-QCT also improved discrimination when results were adjusted for the risk factor–weighted clinical likelihood and for the prediction of death/MI. Excluding 195 patients with severe stenosis (≥70%), in a multivariable model of CAD-RADS and AI-QCT, only AI-QCT was signi","PeriodicalId":14767,"journal":{"name":"JACC. Cardiovascular imaging","volume":"19 3","pages":"Pages 345-359"},"PeriodicalIF":15.2,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145644904","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Rebound Effect in Left Ventricular Structure, Tissue Characteristics, and Function in HOCM After Mavacamten Discontinuation 马伐卡坦停药后左室结构、组织特征和功能的反弹效应。
IF 15.2 1区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2026-03-01 Epub Date: 2025-10-23 DOI: 10.1016/j.jcmg.2025.09.007
Yinzhu Chen MD , Xinyi Luo MD , Yuelong Yang MD, Jiehao Ou MBBS, Liqi Cao MD, Xiahui Tian MD, Ying Ying Bao MD, Liwen Li MD, Shuang Xia MD, Hui Liu MD
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引用次数: 0
Myocardial Blood Flow Assessment and Reporting for Ischemic Heart Disease 缺血性心脏病的心肌血流评估和报告:心脏PET、MR、CT和超声心动图。
IF 15.2 1区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2026-03-01 Epub Date: 2025-10-28 DOI: 10.1016/j.jcmg.2025.08.022
Thomas H. Schindler MD, PhD , Andrew E. Arai MD , Colin Berry MD, PhD , Robert Sykes MD , Koen Nieman MD , Kakuya Kitagawa MD , Y. Chandrashekhar MD , Shouqiang Li MD , Feng Xie MD , Thomas R. Porter MD , Sharmila Dorbala MD , Vasken Dilsizian MD
Positron emission tomographic myocardial perfusion imaging in conjunction with tracer-kinetic modeling affords the concurrent assessment of myocardial blood flow (MBF) in mL/min/g of tissue. Cardiac magnetic resonance, computed tomography, and echocardiography are emerging technologies capable of MBF quantification. The noninvasive evaluation and quantification of MBF during hyperemia and at rest and corresponding myocardial flow reserve expand the realm of conventional myocardial perfusion imaging from detection of the most advanced, and flow-limiting, epicardial lesions in multivessel coronary artery disease (CAD) to less severe intermediate epicardial lesions, accurate delineation of the extent and severity of ischemic burden in multivessel CAD, detection of diffuse ischemia attributable to CAD or at coronary arteriolar level such as in hypertrophic cardiomyopathy, transplantation vasculopathy, and coronary microvascular dysfunction in its classical and/or endogen forms. Apart from improving the diagnostic scope in ischemic heart disease, the additional quantitation of MBF also affords the contingency to follow-up on treatment success of therapeutic interventions, risk factor modifications, and/or lifestyle changes likely to improve long-term cardiovascular outcomes. Standardized algorithms for each imaging modality in the diagnosis and reporting of ischemia heart disease appear critical for optimized diagnosis and treatment decisions in such patients. In this respect, the convened expert panel strives to provide a concise overview of the pathophysiology of ischemic heart disease and its noninvasive assessment with different imaging modalities that may be pivotal for the diagnosis of various pattern types of ischemic heart disease, as well as individualized and image-guided patient care likely to further optimize cardiovascular outcome.
正电子发射层析心肌灌注成像结合示踪动力学建模,可同时评估组织的mL/min/g心肌血流量(MBF)。心脏磁共振、计算机断层扫描和超声心动图是能够量化MBF的新兴技术。充血和静息时MBF的无创评估和量化以及相应的心肌血流储备,将传统心肌灌注成像的领域从检测多支冠状动脉疾病(CAD)中最晚期、最限流的心外膜病变扩展到较轻的中间心外膜病变,准确描绘多支冠心病缺血性负担的程度和严重程度。冠心病或冠状动脉水平弥漫性缺血的检测,如肥厚性心肌病、移植血管病和冠状动脉微血管功能障碍的经典和/或内源性形式。除了提高缺血性心脏病的诊断范围外,MBF的额外定量也为治疗干预措施的治疗成功、风险因素的改变和/或生活方式的改变提供了可能改善长期心血管结果的随访。在诊断和报告缺血性心脏病时,每种成像模式的标准化算法对于优化此类患者的诊断和治疗决策至关重要。在这方面,召集的专家小组努力提供缺血性心脏病的病理生理学的简明概述及其不同成像方式的无创评估,这可能对各种类型的缺血性心脏病的诊断至关重要,以及个性化和图像引导的患者护理可能进一步优化心血管结果。
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引用次数: 0
The Prognostic Value of 18F-FAPI PET/CT Imaging in Pulmonary Arterial Hypertension 18F-FAPI PET/CT对肺动脉高压的预后价值
IF 15.2 1区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2026-03-01 Epub Date: 2026-01-05 DOI: 10.1016/j.jcmg.2025.11.010
Hai-Ming Chen MD , Peng Hou MM , Si-Hao Liang MM , Wen-Liang Guo MM , Ting-Ting Sun MM , Shao-Nan Zhong MM , Kai-Xiang Zhong MM , Rui-Yue Zhao MD , Yi-Min Fu BS , Hui-Zhen Zhong BS , Nan-Shan Zhong MD , Cheng Hong MD , Xin-Lu Wang MD

Background

Emerging evidence demonstrates increased fluorine-18–fibroblast activation protein inhibitor (18F-FAPI) accumulation in the right ventricular (RV) and pulmonary arteries (PAs) of patients with pulmonary arterial hypertension (PAH). However, the data regarding the prognostic utility of this molecular imaging biomarker remain limited.

Objectives

This study evaluated the prognostic value of 18F-FAPI uptake by positron emission tomography/computed tomography (PET/CT) in PAH patients.

Methods

Forty-six consecutive PAH patients underwent 18F-FAPI PET/CT between August 2022 and June 2024. The patients were stratified into the low-, intermediate- and high-risk groups using a 3-strata risk model. The primary endpoint was defined as clinical worsening events. 18F-FAPI uptake was quantified as target-to-background ratio (TBR) for both RV and PAs. The relationships between the PET/CT parameters and clinical worsening were determined using Cox regression and Kaplan-Meier analyses.

Results

Over a median follow-up period of 17.0 months, 22 patients (47.8%) experienced clinical worsening events. The TBR in the RV and PAs progressively increased with higher risk strata (all P < 0.05). Significantly higher TBR in the RV and PAs were observed in clinical worsening vs non–clinical worsening patients (all P < 0.05). Multivariable Cox regression analysis identified the TBR of RV free wall (TBRRVFW) as an independent predictor of clinical worsening (HR: 1.699 [95% CI: 1.153-2.415]; P = 0.007). TBRRVFW predicted clinical worsening (area under the curve [AUC]: 0.75; 95% CI: 0.60-0.87), and AUC was further improved based on a combination of TBRRVFW, World Health Organization functional class, and RV fractional area change (0.83; 95% CI: 0.69-0.93). Kaplan-Meier curves indicated that patients with TBRRVFW > 2.1 had a poorer prognosis (log-rank P = 0.005).

Conclusions

18F-FAPI PET uptake in the RV free wall may be a noninvasive and promising prognostic indicator for PAH.
背景:越来越多的证据表明,肺动脉高压(PAH)患者的右心室(RV)和肺动脉(PAs)中氟-18成纤维细胞活化蛋白抑制剂(18F-FAPI)积累增加。然而,关于这种分子成像生物标志物的预后效用的数据仍然有限。目的评价正电子发射断层扫描/计算机断层扫描(PET/CT)对PAH患者18F-FAPI摄取的预后价值。方法对46例PAH患者于2022年8月至2024年6月连续行18F-FAPI PET/CT检查。采用三层风险模型将患者分为低、中、高危组。主要终点定义为临床恶化事件。18F-FAPI摄取被量化为RV和PAs的靶本比(TBR)。采用Cox回归和Kaplan-Meier分析确定PET/CT参数与临床恶化之间的关系。结果在17.0个月的中位随访期间,22例患者(47.8%)出现临床恶化事件。RV和PAs的TBR随着高危层的增加而逐渐增加(P < 0.05)。临床恶化的患者与非临床恶化的患者相比,RV和PAs的TBR明显更高(P < 0.05)。多变量Cox回归分析发现,RV游离壁TBR (TBRRVFW)是临床恶化的独立预测因子(HR: 1.699 [95% CI: 1.153-2.415]; P = 0.007)。TBRRVFW预测临床恶化(曲线下面积[AUC]: 0.75; 95% CI: 0.60-0.87),结合TBRRVFW、世界卫生组织功能分级和RV分数面积变化,AUC进一步改善(0.83;95% CI: 0.69-0.93)。Kaplan-Meier曲线显示,TBRRVFW >; 2.1的患者预后较差(log-rank P = 0.005)。结论右心室游离壁18f - fapi PET摄取可能是一种无创且有希望的PAH预后指标。
{"title":"The Prognostic Value of 18F-FAPI PET/CT Imaging in Pulmonary Arterial Hypertension","authors":"Hai-Ming Chen MD ,&nbsp;Peng Hou MM ,&nbsp;Si-Hao Liang MM ,&nbsp;Wen-Liang Guo MM ,&nbsp;Ting-Ting Sun MM ,&nbsp;Shao-Nan Zhong MM ,&nbsp;Kai-Xiang Zhong MM ,&nbsp;Rui-Yue Zhao MD ,&nbsp;Yi-Min Fu BS ,&nbsp;Hui-Zhen Zhong BS ,&nbsp;Nan-Shan Zhong MD ,&nbsp;Cheng Hong MD ,&nbsp;Xin-Lu Wang MD","doi":"10.1016/j.jcmg.2025.11.010","DOIUrl":"10.1016/j.jcmg.2025.11.010","url":null,"abstract":"<div><h3>Background</h3><div>Emerging evidence demonstrates increased fluorine-18–fibroblast activation protein inhibitor (<sup>18</sup>F-FAPI) accumulation in the right ventricular (RV) and pulmonary arteries (PAs) of patients with pulmonary arterial hypertension (PAH). However, the data regarding the prognostic utility of this molecular imaging biomarker remain limited.</div></div><div><h3>Objectives</h3><div>This study evaluated the prognostic value of <sup>18</sup>F-FAPI uptake by positron emission tomography/computed tomography (PET/CT) in PAH patients.</div></div><div><h3>Methods</h3><div>Forty-six consecutive PAH patients underwent <sup>18</sup>F-FAPI PET/CT between August 2022 and June 2024. The patients were stratified into the low-, intermediate- and high-risk groups using a 3-strata risk model. The primary endpoint was defined as clinical worsening events. <sup>18</sup>F-FAPI uptake was quantified as target-to-background ratio (TBR) for both RV and PAs. The relationships between the PET/CT parameters and clinical worsening were determined using Cox regression and Kaplan-Meier analyses.</div></div><div><h3>Results</h3><div>Over a median follow-up period of 17.0 months, 22 patients (47.8%) experienced clinical worsening events. The TBR in the RV and PAs progressively increased with higher risk strata (all <em>P &lt;</em> 0.05). Significantly higher TBR in the RV and PAs were observed in clinical worsening vs non–clinical worsening patients (all <em>P &lt;</em> 0.05). Multivariable Cox regression analysis identified the TBR of RV free wall (TBR<sub>RVFW</sub>) as an independent predictor of clinical worsening (HR: 1.699 [95% CI: 1.153-2.415]; <em>P =</em> 0.007). TBR<sub>RVFW</sub> predicted clinical worsening (area under the curve [AUC]: 0.75; 95% CI: 0.60-0.87), and AUC was further improved based on a combination of TBR<sub>RVFW</sub>, World Health Organization functional class, and RV fractional area change (0.83; 95% CI: 0.69-0.93). Kaplan-Meier curves indicated that patients with TBR<sub>RVFW</sub> &gt; 2.1 had a poorer prognosis (log-rank <em>P =</em> 0.005).</div></div><div><h3>Conclusions</h3><div><sup>18</sup>F-FAPI PET uptake in the RV free wall may be a noninvasive and promising prognostic indicator for PAH.</div></div>","PeriodicalId":14767,"journal":{"name":"JACC. Cardiovascular imaging","volume":"19 3","pages":"Pages 363-374"},"PeriodicalIF":15.2,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145902486","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Impaired Right Ventricular Function After Transcatheter Treatment of Tricuspid Regurgitation 经导管治疗三尖瓣反流后右室功能受损
IF 15.2 1区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2026-03-01 Epub Date: 2026-01-05 DOI: 10.1016/j.jcmg.2025.12.004
Paul A. Grayburn MD
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引用次数: 0
Quantitative Coronary CT Angiography and the Power of Numbers 定量冠状动脉CT血管造影与数字的力量。
IF 15.2 1区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2026-03-01 Epub Date: 2026-03-02 DOI: 10.1016/j.jcmg.2026.01.013
Koen Nieman MD, PhD (Associate Editor, JACC: Cardiovascular Imaging), Y. Chandrashekhar MD, DM (Editor-in-Chief, JACC: Cardiovascular Imaging)
{"title":"Quantitative Coronary CT Angiography and the Power of Numbers","authors":"Koen Nieman MD, PhD (Associate Editor, JACC: Cardiovascular Imaging),&nbsp;Y. Chandrashekhar MD, DM (Editor-in-Chief, JACC: Cardiovascular Imaging)","doi":"10.1016/j.jcmg.2026.01.013","DOIUrl":"10.1016/j.jcmg.2026.01.013","url":null,"abstract":"","PeriodicalId":14767,"journal":{"name":"JACC. Cardiovascular imaging","volume":"19 3","pages":"Pages 444-446"},"PeriodicalIF":15.2,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147350941","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Fully Automatic AI-Based Quantification of LV Mass in Echocardiography 超声心动图中基于人工智能的左室质量全自动量化
IF 15.2 1区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2026-03-01 Epub Date: 2025-10-29 DOI: 10.1016/j.jcmg.2025.09.014
Krunoslav Michael Sveric MD , Ivan Platzek MD , Stefanie Jellinghaus MD , Roxana Botan MD , Barış Cansız Dr-Ing , F. Niklas Schietzold Dipl-Ing , Stephan Haussig MD , Michael Kaliske Dr-Ing , Ralf-Thorsten Hoffmann PhD , Axel Linke PhD

Background

Accurate assessment of left ventricular (LV) myocardial mass is critical for guiding treatment decisions. Measurements based on echocardiography are limited by operator variability. Artificial intelligence (AI)–based methods promise improved precision and reproducibility, but they require validation against high-resolution reference standards such as computed tomography (CT).

Objectives

The aim of this study is to compare the accuracy of AI-based vs expert manual echocardiography LV mass measurements using CT as the reference and to evaluate real-world test-retest reliability.

Methods

In 218 patients undergoing echocardiography and CT, the authors analyzed LV mass, interventricular septal diameter (IVSD), end-diastolic diameter, posterior wall diameter (PWD), and end-diastolic volume. LV mass was assessed by the conventional linear method as well as a novel hybrid method combining end-diastolic tracings with mean wall thickness. AI- and expert-based (Expert) echocardiographic measurements were compared with CT using intraclass correlation coefficient (ICC) and mean absolute percentage error (MAPE). Increased relative wall thickness (RWT >0.42;+) and abnormal LV mass was evaluated using receiver-operating characteristic analysis (area under the curve [AUC]). Test-retest reliability was assessed in a bedside cohort (n = 40) using coefficient of variation.

Results

AI echocardiography showed strongest agreement with CT for LV mass assessment using the hybrid method (ICC: 0.76; MAPE: 0.16) and lower agreement for the linear method (ICC: 0.49; MAPE: 0.44). Nevertheless, compared with Expert echocardiography, AI reduced measurement error by ∼20%, mainly due to more consistent IVSD and PWD measurements, and reclassified 34% of RWT+ cases. Diagnostic accuracy for detecting increased LV mass was higher with AI echocardiography than with Expert echocardiography (AUC: 0.78 vs 0.71 for linear; 0.84 vs 0.77 for hybrid). Test-retest reliability was highest with AI echocardiography for both mass methods (coefficient of variation: 7.8% and 8.1%), and reproducibility of manual assessment varied with operator skills.

Conclusions

AI echocardiography provides superior accuracy, diagnostic performance, and reproducibility for LV mass assessment compared with expert evaluation, supporting its clinical integration to improve standardization in cardiac imaging.
背景准确评估左心室(LV)心肌质量对指导治疗决策至关重要。基于超声心动图的测量受到操作者可变性的限制。基于人工智能(AI)的方法有望提高精度和可重复性,但它们需要针对高分辨率参考标准(如计算机断层扫描(CT))进行验证。目的比较人工智能超声心动图与专家手工超声心动图以CT为参考测量左室质量的准确性,并评估真实世界的重测可靠性。方法218例患者行超声心动图和CT检查,分析左室质量、室间隔内径(IVSD)、舒张末期内径、后壁内径(PWD)和舒张末期容积。左室质量的评估采用传统的线性方法以及将舒张末期示踪与平均壁厚相结合的新型混合方法。采用类内相关系数(ICC)和平均绝对百分比误差(MAPE)对人工智能和专家超声心动图(Expert)测量结果进行比较。使用受体工作特征分析(曲线下面积[AUC])评估相对壁厚增加(RWT >0.42;+)和左室异常质量。在床边队列(n = 40)中使用变异系数评估重测信度。结果超声心动图与CT对左室质量评价的混合方法一致性最强(ICC: 0.76; MAPE: 0.16),线性方法一致性较低(ICC: 0.49; MAPE: 0.44)。然而,与Expert超声心动图相比,AI将测量误差降低了约20%,主要是由于IVSD和PWD测量更加一致,并对34%的RWT+病例进行了重新分类。AI超声心动图检测左室肿块增加的诊断准确性高于Expert超声心动图(线性超声心动图AUC: 0.78 vs 0.71;混合超声心动图AUC: 0.84 vs 0.77)。人工智能超声心动图两种质量方法的重测信度最高(变异系数:7.8%和8.1%),人工评估的再现性因操作人员技能而异。结论与专家评估相比,超声心动图在左室质量评估中具有更高的准确性、诊断性能和可重复性,支持其临床整合,以提高心脏成像的标准化。
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引用次数: 0
Stress Cardiac Magnetic Resonance Ischemia Burden and Cardiovascular Events 心脏磁共振缺血负荷和心血管事件:缺血试验的事后分析。
IF 15.2 1区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2026-03-01 Epub Date: 2025-12-05 DOI: 10.1016/j.jcmg.2025.10.015
Raymond Y. Kwong MD, MPH , Bobby Heydari MD , Siddique Abbasi MD, MSc , Francois-Pierre Mongeon MD , Francois Marcotte MD , Matthias Friedrich MD , Leslee J. Shaw PhD , Yifan Xu MPH , Rebecca Anthopolos DrPH , Raffi Bekeredjian MD , Lorenzo Monti MD , Joseph Selvanayagam MBBS, DPhil , Maciej Lesiak MD, PhD , Michael H. Picard MD , Daniel S. Berman MD , Sripal Bangalore MD, MHA , John A. Spertus MD, MPH , Gregg W. Stone MD , William E. Boden MD , James Min MD , Harmony R. Reynolds MD

Background

Research comparing the prognostic value of stress cardiac magnetic resonance (CMR) to other stress modalities in patients with coronary disease is limited.

Objectives

The authors compared the prognostic value of stress CMR vs alternative testing by either single-photon emission computed tomography or stress echocardiography (SPECT/echo) in the ISCHEMIA (International Study of Comparative Health Effectiveness with Medical and Invasive Approaches) trial.

Methods

CMR vs SPECT/echo was compared in 3,909 patients randomized in ISCHEMIA after sites’ interpretation of moderate to severe ischemia. Ischemia and infarct extent, measured by either CMR or SPECT/echo, were each associated with the trial’s primary outcome of cardiovascular death, nonfatal myocardial infarction (MI), or hospitalization for unstable angina, heart failure, or resuscitated cardiac arrest, at a median follow-up of 3.37 years (Q1-Q3: 2.20-4.56 years).

Results

Compared with SPECT/echo (n = 5,627), CMR participants (n = 313) were not different in key demographic factors but were more likely to have severe ischemia (57% vs 38%; P < 0.001) and to be randomized (n = 257, 82%, vs n = 3,652, 65%; P < 0.001). Ischemia severity (no/mild, moderate, severe) by CMR core laboratory was associated with cumulative 4-year event rates of all trial-specific endpoints, including the primary outcome (P = 0.042), cardiovascular death/MI (P = 0.041), and nonfatal MI (P = 0.03), but SPECT/echo ischemia severity was not. No/mild, moderate, and severe ischemia by CMR were associated with 0%, 14%, and 23% 4-year primary outcome rates, respectively, compared with 18%, 15%, and 16%, by SPECT/echo. After adjustment for age, estimated glomerular filtration rate, and diabetes, the association between ischemia extent and the primary endpoint differed by imaging modality, with each additional ischemic segment on CMR associated with a 13% increase in hazard (interaction P = 0.02). In participants assigned to initial conservative management who had no/mild ischemia on imaging, 4-year rates of invasive referral and coronary revascularization were lower in the CMR than SPECT/echo group (16.7% and 0%, respectively, for CMR; and 31% and 13.3%, respectively, for SPECT/echo).

Conclusions

Ischemia severity by CMR had a stronger association with all ISCHEMIA trial endpoints compared with SPECT/echo. (International Study of Comparative Health Effectiveness with Medical and Invasive Approaches [ISCHEMIA]; NCT01471522)
背景:比较应激性心脏磁共振(CMR)与其他应激方式对冠心病患者预后价值的研究是有限的。目的在缺血试验中,作者比较应激CMR与单光子发射计算机断层扫描或应激超声心动图(SPECT/echo)替代检测的预后价值(医学和侵入性方法的比较健康有效性国际研究)。方法对3909例局部缺血患者进行scmr与SPECT/echo对比分析。CMR或SPECT/echo测量的缺血和梗死程度均与试验的主要结局相关,心血管死亡、非致死性心肌梗死(MI)或因不稳定型心绞痛、心力衰竭或复苏性心脏骤停住院,中位随访时间为3.37年(一季度至第三季度:2.20-4.56年)。结果与SPECT/echo (n = 5,627)相比,CMR参与者(n = 313)在关键人口统计学因素上没有差异,但更有可能发生严重缺血(57% vs 38%; P < 0.001)和随机化(n = 257, 82% vs n = 3,652, 65%; P < 0.001)。CMR核心实验室检测的缺血严重程度(无/轻度、中度、重度)与所有试验特定终点的累积4年事件发生率相关,包括主要终点(P = 0.042)、心血管死亡/心肌梗死(P = 0.041)和非致死性心肌梗死(P = 0.03),但SPECT/回声缺血严重程度与此无关。CMR无/轻度、中度和重度缺血的4年主要转归率分别为0%、14%和23%,而SPECT/echo的4年主要转归率分别为18%、15%和16%。在调整了年龄、肾小球滤过率和糖尿病等因素后,缺血程度和主要终点之间的关系因成像方式而异,CMR上每增加一个缺血段,风险增加13%(相互作用P = 0.02)。在被分配到初始保守治疗的、在影像学上没有或轻微缺血的参与者中,CMR组的4年有创转诊和冠状动脉血运重建率低于SPECT/echo组(CMR组分别为16.7%和0%;SPECT/echo组分别为31%和13.3%)。结论与SPECT/echo相比,CMR测量的缺血严重程度与所有缺血试验终点的相关性更强。
{"title":"Stress Cardiac Magnetic Resonance Ischemia Burden and Cardiovascular Events","authors":"Raymond Y. Kwong MD, MPH ,&nbsp;Bobby Heydari MD ,&nbsp;Siddique Abbasi MD, MSc ,&nbsp;Francois-Pierre Mongeon MD ,&nbsp;Francois Marcotte MD ,&nbsp;Matthias Friedrich MD ,&nbsp;Leslee J. Shaw PhD ,&nbsp;Yifan Xu MPH ,&nbsp;Rebecca Anthopolos DrPH ,&nbsp;Raffi Bekeredjian MD ,&nbsp;Lorenzo Monti MD ,&nbsp;Joseph Selvanayagam MBBS, DPhil ,&nbsp;Maciej Lesiak MD, PhD ,&nbsp;Michael H. Picard MD ,&nbsp;Daniel S. Berman MD ,&nbsp;Sripal Bangalore MD, MHA ,&nbsp;John A. Spertus MD, MPH ,&nbsp;Gregg W. Stone MD ,&nbsp;William E. Boden MD ,&nbsp;James Min MD ,&nbsp;Harmony R. Reynolds MD","doi":"10.1016/j.jcmg.2025.10.015","DOIUrl":"10.1016/j.jcmg.2025.10.015","url":null,"abstract":"<div><h3>Background</h3><div>Research comparing the prognostic value of stress cardiac magnetic resonance (CMR) to other stress modalities in patients with coronary disease is limited.</div></div><div><h3>Objectives</h3><div>The authors compared the prognostic value of stress CMR vs alternative testing by either single-photon emission computed tomography or stress echocardiography (SPECT/echo) in the ISCHEMIA (International Study of Comparative Health Effectiveness with Medical and Invasive Approaches) trial.</div></div><div><h3>Methods</h3><div>CMR vs SPECT/echo was compared in 3,909 patients randomized in ISCHEMIA after sites’ interpretation of moderate to severe ischemia. Ischemia and infarct extent, measured by either CMR or SPECT/echo, were each associated with the trial’s primary outcome of cardiovascular death, nonfatal myocardial infarction (MI), or hospitalization for unstable angina, heart failure, or resuscitated cardiac arrest, at a median follow-up of 3.37 years (Q1-Q3: 2.20-4.56 years).</div></div><div><h3>Results</h3><div>Compared with SPECT/echo (n = 5,627), CMR participants (n = 313) were not different in key demographic factors but were more likely to have severe ischemia (57% vs 38%; <em>P</em> &lt; 0.001) and to be randomized (n = 257, 82%, vs n = 3,652, 65%; <em>P</em> &lt; 0.001). Ischemia severity (no/mild, moderate, severe) by CMR core laboratory was associated with cumulative 4-year event rates of all trial-specific endpoints, including the primary outcome (<em>P =</em> 0.042), cardiovascular death/MI (<em>P =</em> 0.041), and nonfatal MI (<em>P =</em> 0.03), but SPECT/echo ischemia severity was not. No/mild, moderate, and severe ischemia by CMR were associated with 0%, 14%, and 23% 4-year primary outcome rates, respectively, compared with 18%, 15%, and 16%, by SPECT/echo. After adjustment for age, estimated glomerular filtration rate, and diabetes, the association between ischemia extent and the primary endpoint differed by imaging modality, with each additional ischemic segment on CMR associated with a 13% increase in hazard (interaction <em>P =</em> 0.02). In participants assigned to initial conservative management who had no/mild ischemia on imaging, 4-year rates of invasive referral and coronary revascularization were lower in the CMR than SPECT/echo group (16.7% and 0%, respectively, for CMR; and 31% and 13.3%, respectively, for SPECT/echo).</div></div><div><h3>Conclusions</h3><div>Ischemia severity by CMR had a stronger association with all ISCHEMIA trial endpoints compared with SPECT/echo. (International Study of Comparative Health Effectiveness with Medical and Invasive Approaches [ISCHEMIA]; <span><span>NCT01471522</span><svg><path></path></svg></span>)</div></div>","PeriodicalId":14767,"journal":{"name":"JACC. Cardiovascular imaging","volume":"19 3","pages":"Pages 326-341"},"PeriodicalIF":15.2,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145680574","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Could Artificial Intelligence Change Our View on Left Ventricular Mass Measured by Echocardiography? 人工智能会改变我们对超声心动图测量左心室质量的看法吗?
IF 15.2 1区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2026-03-01 Epub Date: 2025-12-09 DOI: 10.1016/j.jcmg.2025.11.007
Paul Leeson MB, PhD , Sadie Bennett MClinRes
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引用次数: 0
Importance of Direct Visualization Fibroblast Activation Protein in Pulmonary Artery Hypertension 直接可视化成纤维细胞激活蛋白在肺动脉高压中的重要性。
IF 15.2 1区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2026-03-01 Epub Date: 2026-03-02 DOI: 10.1016/j.jcmg.2026.01.003
Stephanie L. Thorn PhD , Albert J. Sinusas MD
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引用次数: 0
期刊
JACC. Cardiovascular imaging
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