Behind the Science: Why Photon-Counting CT Changes Coronary Calcium Imaging | JACC

Can targeting inflammation change the future of cardiovascular care? In this episode of Behind the Science, Dr. Kausik K. Ray discusses groundbreaking findings from the JACC study examining ruvonoflast, an oral NLRP3 inhibitor, in individuals at elevated cardiovascular risk. Learn how this Phase 1b trial demonstrated reductions in key inflammatory biomarkers, including hsCRP and IL-6, and why these results could signal a new approach to cardiovascular disease prevention and treatment. Read the full study: https://www.jacc.org/doi/10.1016/j.jacc.2026.05.014

How much of the coronary calcium seen on CT is real, and how much is image artifact? In this episode of Behind the Science, Adith Arun sits down with Dr. Doosup Shin to discuss their JACC study, "Photon-Counting Detector CT Reduces Calcium Overestimation Compared with Energy-Integrating Detector CT: Micro-CT Validation in Cadaveric Arteries." Using cadaveric coronary arteries and high-resolution micro-CT as the ground truth, the investigators compared next-generation photon-counting CT (PCCT) with conventional energy-integrating detector CT (EID-CT). Their findings show that PCCT substantially reduces calcium blooming artifact and decreases calcium overestimation, providing a more accurate representation of coronary calcification morphology. This conversation highlights how photon-counting CT may transform the evaluation of coronary artery disease by delivering sharper images, more accurate plaque characterization, and improved clinical decision-making. #PhotonCountingCT #CardiacCT #CoronaryCalciumImaging #CCTA #CoronaryArteryDisease #CalciumScoring #CardiovascularImaging #JACC

How much cardiovascular risk is hidden in the scans we already perform every day? In this episode of Behind the Science, we explore groundbreaking research on imaging-derived sarcopenic obesity and its relationship to heart failure, cardiovascular death, and overall mortality. The discussion highlights how routine cardiac MRI can provide novel insights into muscle health, risk stratification, and the biological pathways linking obesity, aging, and cardiovascular disease. Join us as we examine how imaging, genomics, and transcriptomics come together to identify individuals at higher cardiovascular risk, uncover shared mechanisms between muscle loss and heart failure, and reveal new opportunities for precision cardiology.

In this episode of Behind the Science, Dr. Yogesh Reddy joins to explore how sotatercept improves outcomes in pulmonary arterial hypertension (PAH) and why its effects go beyond traditional vasodilation. Using detailed invasive hemodynamic testing, exercise protocols, and skeletal muscle assessment, the study highlights key mechanisms, including reductions in pulmonary vascular resistance, improved right ventricular efficiency, increased hemoglobin, and enhanced oxygen extraction at the muscle level. These findings provide new insight into sotatercept's multi-system effects and help explain the significant improvements in exercise capacity seen in clinical trials—offering important implications for future PAH therapies. #Cardiology #PulmonaryHypertension #PAH #Sotatercept #ACC #JACC #MedicalResearch #HeartHealth

In this episode of Behind the Science, we sit down with Dr Yao to discuss the recent JACC publication, "The Prognostic Value of Serum Interleukin-6 Concentrations for 9 Cardiovascular and Mortality Outcomes: The Cross Cohort Collaboration (CCC)." The discussion explores the growing role of interleukin-6 (IL-6) as a key inflammatory biomarker in cardiovascular disease and its potential value beyond traditional markers such as high-sensitivity C-reactive protein (hsCRP). Drawing on data from more than 320,000 participants across multiple community-based cohorts, the study examined associations between IL-6 and nine major cardiovascular and mortality outcomes, including myocardial infarction, stroke, atrial fibrillation, heart failure, cardiovascular mortality, and all-cause mortality. #JACC #Cardiology #IL6 #Inflammation #CardiovascularDisease #HeartFailure #Prevention #Biomarkers #ClinicalResearch #BehindTheScience

In this episode of Behind the Science, Adith Arun is joined by Drs. Rahul Mahajan and Shaan Khurshid to discuss their recent JACC study on using artificial intelligence–enabled electrocardiograms (ECGs) to predict long-term stroke risk. Drawing on data from over 200,000 patients, the team demonstrates how a single 12‑lead ECG can be leveraged to stratify stroke risk over 1-, 5-, and 10-year time horizons, achieving performance comparable to established clinical risk scores such as the Framingham Risk Score. The conversation explores key findings, including the model's association with cardioembolic stroke, insights from ECG signal interpretation (notably P‑wave features), and the potential role of ECG-based AI as both a scalable clinical tool and a novel biomarker for atrial cardiomyopathy. Tune in to learn how emerging AI technologies may transform stroke prevention, risk stratification, and future cardiovascular research. #Cardiology #StrokePrevention #ECG #ArtificialIntelligence #MedicalResearch #ACC #JACC

In this episode of Behind the Science, host Adith Arun sits down with Dr. Evangelos Oikonomou to discuss groundbreaking research published in JACC: "Early Prediction of Heart Failure from Routine Cardiac CT Using Radiomic Phenotyping of Epicardial Fat." Dr. Oikonomou walks us through how AI-powered radiomic analysis of epicardial adipose tissue, the fat layer directly surrounding the heart, can serve as an early biomarker for heart failure risk, even in patients with no prior diagnosis. The study draws on over 60,000 coronary CT angiography cases from nine UK sites (the ORFNI consortium) to build and validate a fully automated risk scoring model. Topics covered: Why BMI falls short as a cardiovascular risk measure What epicardial fat reveals about myocardial disease How radiomics extracts hidden phenotypic features from CT images Model training, validation, and multi-site generalizability How the FRP (Fat Radiomic Profile) score is orthogonal to existing tools like PREVENT Implications for GLP-1 therapies and obesity-directed treatment eligibility The future of longitudinal monitoring and prospective enrichment studies This research represents a major step toward extracting untapped prognostic value from CT scans already being performed in clinical practice.

In this episode of Behind the Science, we explore how coronary artery calcium scoring improves cardiovascular risk assessment in patients with elevated lipoprotein(a). This multicohort study highlights how Lp(a) and CAC serve as independent predictors of ASCVD and how combining both tools enhances risk stratification in clinical practice. Learn how calcium scoring can help identify higher risk individuals, guide preventive cardiology decisions, and support personalized treatment strategies. This discussion is essential for clinicians focused on heart disease prevention, lipid disorders, and advanced cardiovascular imaging.

Listen in to JACC's perspective on our newest research, published on June 19 and featuring co-authors Adith Arun, BS, Clyde W. Yancy, MD, MSc. We present readers with another update in our Data Report Series, evaluating trends in excess cardiovascular mortality among Black Americans compared with White Americans from 2000 to 2024 and persistent disparities in outcomes. While modest improvements were observed in 2024 after pandemic-related increases, progress remains uneven, with heart failure mortality continuing to rise—especially among women. The overall burden remains high, with more than one million excess years of potential life lost annually and hypertension as the leading contributor. Long-term patterns show that earlier gains in reducing disparities have stalled, with current gaps resembling those seen in the mid-2010s. The findings emphasize that advances in cardiovascular care have not translated into equitable outcomes and call for sustained structural and policy interventions. #jacc #jaccjournals #jaccdatareport

Dr. Aaysha Cader, Social Media editor for JACC Interventions and Dr. Chao Gao discuss the pre-specified subgroup analysis of the REC-CAGEFREE I trial: Drug-Coated Balloon Angioplasty vs Drug-Eluting Stents in Noncomplex Coronary Bifurcation Lesions.