All Publications
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Radiomics for the Detection and Prediction of Cancer Therapy-Related Cardiotoxicity.
JACC. Advances
2026; 5 (8): 102942
Abstract
Modern cancer therapies have improved survival but unmasked the growing challenge of cancer therapy-related cardiotoxicity, a leading cause of morbidity and mortality in cancer survivors. Current surveillance strategies, relying on serial echocardiography and cardiac biomarkers, are reactive, detecting cardiac injury only after clinical symptoms emerge. Identifying fundamental, imaging-based biomarkers enables timely recognition of subclinical cardiotoxicity. Radiomics, the high-throughput extraction of quantitative features from routine medical images, provides a noninvasive method to characterize tissue pathophysiology beyond the limits of human visual perception. This review explores the emerging evidence of radiomics for the real-time detection and prediction of cardiotoxicity. We identify distinct radiomic signatures across imaging modalities and examine the challenge of personalized risk stratification utilizing radiomics, which show significant promise. This review concludes that although this novel field is currently limited by small studies lacking external validation, radiomics is poised to enable a paradigm shift in the field of cardio-oncology.
View details for DOI 10.1016/j.jacadv.2026.102942
View details for PubMedID 42385320
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Multiple Endotypes and Angina Burden in Patients With Nonobstructive Coronary Arteries.
JAMA cardiology
2026
Abstract
Coronary function testing (CFT) can be used to delineate the underlying mechanisms of chest pain in angina with nonobstructive coronary arteries (ANOCA). However, the association between overlapping ANOCA endotypes and angina burden remains poorly defined.To investigate the impact of multiple ANOCA endotypes on angina burden.This cross-sectional study included patients with suspected ANOCA who underwent acetylcholine provocation testing for endothelium-dependent abnormalities, adenosine-mediated physiology testing for endothelium-independent abnormalities, and intravascular ultrasound with hemodynamic testing for a functionally significant myocardial bridge between August 2007 and February 2025 at Stanford Hospital. Data were analyzed from March 2025 through May 2025.The primary outcome was the association between the number of ANOCA endotypes and angina burden. The Seattle Angina Questionnaire (SAQ) was used to evaluate overall angina burden.Patients undergoing comprehensive CFT for ANOCA.A total of 485 patients (mean [SD] age, 52 [14] years; 352 female patients [73%]) were included. There were 36 patients (7%) with no abnormalities, 150 patients (31%) with 1 endotype, 215 patients (44%) with 2 endotypes, and 84 patients (17%) with 3 endotypes identified on CFT. Mean (SD) SAQ summary scores were comparable among patients with an endothelium-dependent abnormality (50.5 [18.3]), an endothelium-independent abnormality (49.3 [19.9]), and myocardial bridging (49.8 [19.2]), and worsened with an increasing number of endotypes identified at CFT (normal CFT finding: 55.9 [17.6]; 1 endotype: 53.8 [17.7]; 2 endotypes: 51.2 [18.3]; and 3 endotypes: 45.7 [20.0]; P = .003). After multivariable adjustment, each additional endotype identified on CFT was associated with a lower SAQ summary score (B = -3.55; 95% CI, -5.56 to -1.54; P < .001).In this observational cross-sectional study, multiple endotypes frequently coexisted in patients with ANOCA, and a greater number of endotypes identified on CFT was associated with worse angina.
View details for DOI 10.1001/jamacardio.2026.1234
View details for PubMedID 42201701
View details for PubMedCentralID PMC13217240
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Cardiac Rehabilitation for Coronary Artery Disease: Gaps, Digital Models, and the Future of Personalized Prevention.
The American journal of cardiology
2025
Abstract
Cardiovascular disease is the leading cause of global morbidity and mortality, with coronary artery disease representing the primary driver of premature death. Cardiac rehabilitation (CR) is a cornerstone of secondary prevention that integrates exercise, risk factor modification, and education. CR reduces all-cause mortality, recurrent ischemic events, and improves quality of life. Yet, participation remains suboptimal, and CR is underutilized by women, older adults, minorities, and socioeconomically disadvantaged groups. We examine the modalities of CR including traditional center-based CR (CBCR), home-based CR and hybrid models. By leveraging telemedicine, mobile health, and wearable biosensors remote delivery of CR has shown comparable efficacy to traditional CBCR. The integration of artificial intelligence offers opportunities to personalize CR through continuous physiological monitoring and exercise prescriptions. In conclusion, CR remains cost-effective from a health-system perspective, but patient-level affordability and equitable access require targeted policy, financial, and culturally adapted interventions to ensure personalized and equitable delivery of secondary prevention.
View details for DOI 10.1016/j.amjcard.2025.12.013
View details for PubMedID 41468986
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Comparison of International Expert Working Group Algorithms for Diagnosing Angina With Nonobstructive Coronary Arteries.
JACC. Cardiovascular interventions
2025; 18 (24): 2995-3005
Abstract
Coronary function testing (CFT) protocols in patients with angina with nonobstructive coronary arteries (ANOCA) differ among expert working groups. The European Association of Percutaneous Cardiovascular Interventions (EAPCI) endorses testing for coronary artery spasm and microvascular dysfunction, while the Microvascular Network (MVN) recommends additional assessment for myocardial bridging and endothelial dysfunction.The aim of this study was to compare the diagnostic yield between the EAPCI and MVN algorithms in a large cohort of patients with ANOCA.Fractional flow reserve, coronary flow reserve, index of microcirculatory resistance, intravascular ultrasound, acetylcholine provocation, and myocardial bridging assessment were performed in patients referred for clinically suspected ANOCA.Among 516 patients, the prevalence of ANOCA, obstructive coronary artery disease, and noncardiac chest pain was 53.5%, 20.9%, and 25.6%, respectively, according to the EAPCI algorithm, compared with 88.2%, 3.3%, and 8.5% according to the MVN algorithm (P < 0.001 for overall difference). Of 132 patients classified as noncardiac chest pain by the EAPCI algorithm, 66.7% were reclassified into an ANOCA endotype using the MVN algorithm. Similarly, 84.3% of 108 patients diagnosed with obstructive coronary artery disease using the EAPCI algorithm were reclassified into an ANOCA endotype by the MVN algorithm. The mean Seattle Angina Questionnaire summary score was significantly lower in patients with cardiac chest pain compared with those with noncardiac chest pain (51.0 vs 56.1; P = 0.030) as defined by the MVN algorithm.The MVN algorithm results in a higher diagnostic yield for ANOCA endotypes compared with the EAPCI algorithm. Routine testing for myocardial bridging and endothelial dysfunction should be considered in patients with suspected ANOCA.
View details for DOI 10.1016/j.jcin.2025.09.049
View details for PubMedID 41443782
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Optimising primary care management of patients following acute coronary syndrome.
The British journal of general practice : the journal of the Royal College of General Practitioners
2025; 75 (760): 531-534
View details for DOI 10.3399/BJGP.2025.0403
View details for PubMedID 41167956