Coronary artery disease (CAD) remains a major global health burden. Accurate identification of the culprit vessel and assessment of stenosis severity are essential for guiding individualized therapy. Although coronary CT angiography (CCTA) is the first-line non-invasive modality for CAD diagnosis, its dependence on high-end equipment, radiation exposure, and strict patient cooperation limits large-scale use. With advances in artificial intelligence (AI) and the widespread availability of electrocardiography (ECG), AI-ECG offers a promising alternative for CAD screening. In this study, we developed an interpretable AI-ECG model to predict severe or complete stenosis of the four major coronary arteries on CCTA. On the internal validation set, the model's AUCs for the right coronary artery (RCA), left main coronary artery (LM), left anterior descending artery (LAD), and left circumflex artery (LCX) were 0.794, 0.818, 0.744, and 0.755, respectively; on the external validation set, the AUCs reached 0.749, 0.971, 0.667, and 0.727, respectively. Performance remained stable in a clinically normal-ECG subset, indicating robustness beyond overt ECG abnormalities. Subgroup analyses across demographic and acquisition-time strata further confirmed model stability. Risk stratification based on vessel-specific incidence thresholds showed consistent separation on calibration and cumulative event curves. Interpretability analyses revealed distinct waveform differences between high- and low-risk groups, highlighting key electrophysiological regions contributing to model decisions and offering new insights into the ECG correlates of coronary stenosis.

Despite coronary artery calcium scoring being considered a largely solved problem within the realm of medical artificial intelligence, this paper argues that significant improvements can still be made. By shifting the focus from pathology detection to a deeper understanding of anatomy, the novel algorithm proposed in the paper both achieves high accuracy in coronary artery calcium scoring and offers enhanced interpretability of the results. This approach not only aids in the precise quantification of calcifications in coronary arteries, but also provides valuable insights into the underlying anatomical structures. Through this anatomically-informed methodology, the paper shows how a nuanced understanding of the heart's anatomy can lead to more accurate and interpretable results in the field of cardiovascular health. We demonstrate the superior accuracy of the proposed method by evaluating it on an open-source multi-vendor dataset, where we obtain results at the inter-observer level, surpassing the current state of the art. Finally, the qualitative analyses show the practical value of the algorithm in such tasks as labeling coronary artery calcifications, identifying aortic calcifications, and filtering out false positive detections due to noise.

Coronary artery disease stands as one of the primary contributors to global mortality rates. The automated identification of coronary artery stenosis from X-ray images plays a critical role in the diagnostic process for coronary heart disease. This task is challenging due to the complex structure of coronary arteries, intrinsic noise in X-ray images, and the fact that stenotic coronary arteries appear narrow and blurred in X-ray angiographies. This study employs five different variants of the Mamba-based model and one variant of the Swin Transformer-based model, primarily based on the U-Net architecture, for the localization of stenosis in Coronary artery disease. Our best results showed an F1 score of 68.79% for the U-Mamba BOT model, representing an 11.8% improvement over the semi-supervised approach.

Cardiovascular hemodynamic fields provide valuable medical decision markers for coronary artery disease. Computational fluid dynamics (CFD) is the gold standard for accurate, non-invasive evaluation of these quantities in vivo. In this work, we propose a time-efficient surrogate model, powered by machine learning, for the estimation of pulsatile hemodynamics based on steady-state priors. We introduce deep vectorised operators, a modelling framework for discretisation independent learning on infinite-dimensional function spaces. The underlying neural architecture is a neural field conditioned on hemodynamic boundary conditions. Importantly, we show how relaxing the requirement of point-wise action to permutation-equivariance leads to a family of models that can be parametrised by message passing and self-attention layers. We evaluate our approach on a dataset of 74 stenotic coronary arteries extracted from coronary computed tomography angiography (CCTA) with patient-specific pulsatile CFD simulations as ground truth. We show that our model produces accurate estimates of the pulsatile velocity and pressure while being agnostic to re-sampling of the source domain (discretisation independence). This shows that deep vectorised operators are a powerful modelling tool for cardiovascular hemodynamics estimation in coronary arteries and beyond.

Precise localization of coronary arteries in Computed Tomography (CT) scans is critical from the perspective of medical assessment of coronary artery disease. Although various methods exist that offer high-quality segmentation of coronary arteries in cardiac contrast-enhanced CT scans, the potential of less invasive, non-contrast CT in this area is still not fully exploited. Since such fine anatomical structures are hardly visible in this type of medical images, the existing methods are characterized by high recall and low precision, and are used mainly for filtering of atherosclerotic plaques in the context of calcium scoring. In this paper, we address this research gap and introduce a deep learning algorithm for segmenting coronary arteries in multi-vendor ECG-gated non-contrast cardiac CT images which benefits from a novel framework for semi-automatic generation of Ground Truth (GT) via image registration. We hypothesize that the proposed GT generation process is much more efficient in this case than manual segmentation, since it allows for a fast generation of large volumes of diverse data, which leads to well-generalizing models. To investigate and thoroughly evaluate the segmentation quality based on such an approach, we propose a novel method for manual mesh-to-image registration, which is used to create our test-GT. The experimental study shows that the trained model has significantly higher accuracy than the GT used for training, and leads to the Dice and clDice metrics close to the interrater variability.

Cardiovascular disease (CVD) accounts for about half of non-communicable diseases. Vessel stenosis in the coronary artery is considered to be the major risk of CVD. Computed tomography angiography (CTA) is one of the widely used noninvasive imaging modalities in coronary artery diagnosis due to its superior image resolution. Clinically, segmentation of coronary arteries is essential for the diagnosis and quantification of coronary artery disease. Recently, a variety of works have been proposed to address this problem. However, on one hand, most works rely on in-house datasets, and only a few works published their datasets to the public which only contain tens of images. On the other hand, their source code have not been published, and most follow-up works have not made comparison with existing works, which makes it difficult to judge the effectiveness of the methods and hinders the further exploration of this challenging yet critical problem in the community. In this paper, we propose a large-scale dataset for coronary artery segmentation on CTA images. In addition, we have implemented a benchmark in which we have tried our best to implement several typical existing methods. Furthermore, we propose a strong baseline method which combines multi-scale patch fusion and two-stage processing to extract the details of vessels. Comprehensive experiments show that the proposed method achieves better performance than existing works on the proposed large-scale dataset. The benchmark and the dataset are published at https://github.com/XiaoweiXu/ImageCAS-A-Large-Scale-Dataset-and-Benchmark-for-Coronary-Artery-Segmentation-based-on-CT.

Coronary Artery Diseases although preventable are one of the leading cause of mortality worldwide. Due to the onerous nature of diagnosis, tackling CADs has proved challenging. This study addresses the automation of resource-intensive and time-consuming process of manually detecting stenotic lesions in coronary arteries in X-ray coronary angiography images. To overcome this challenge, we employ a specialized Convnext-V2 backbone based Mask RCNN model pre-trained for instance segmentation tasks. Our empirical findings affirm that the proposed model exhibits commendable performance in identifying stenotic lesions. Notably, our approach achieves a substantial F1 score of 0.5353 in this demanding task, underscoring its effectiveness in streamlining this intensive process.

Functionally significant coronary artery disease (CAD) is caused by plaque buildup in the coronary arteries, potentially leading to narrowing of the arterial lumen, i.e. coronary stenosis, that significantly obstructs blood flow to the myocardium. The current reference for establishing the presence of a functionally significant stenosis is invasive fractional flow reserve (FFR) measurement. To avoid invasive measurements, non-invasive prediction of FFR from coronary CT angiography (CCTA) has emerged. For this, machine learning approaches, characterized by fast inference, are increasingly developed. However, these methods predict a single FFR value per artery i.e. they don't provide information about the stenosis location or treatment strategy. We propose a deep learning-based method to predict the FFR along the artery from CCTA scans. This study includes CCTA images of 110 patients who underwent invasive FFR pullback measurement in 112 arteries. First, a multi planar reconstruction (MPR) of the artery is fed to a variational autoencoder to characterize the artery, i.e. through the lumen area and unsupervised artery encodings. Thereafter, a convolutional neural network (CNN) predicts the FFR along the artery. The CNN is supervised by multiple loss functions, notably a loss function inspired by the Earth Mover's Distance (EMD) to predict the correct location of FFR drops and a histogram-based loss to explicitly supervise the slope of the FFR curve. To train and evaluate our model, eight-fold cross-validation was performed. The resulting FFR curves show good agreement with the reference allowing the distinction between diffuse and focal CAD distributions in most cases. Quantitative evaluation yielded a mean absolute difference in the area under the FFR pullback curve (AUPC) of 1.7. The method may pave the way towards fast, accurate, automatic prediction of FFR along the artery from CCTA.

Hemodynamic velocity fields in coronary arteries could be the basis of valuable biomarkers for diagnosis, prognosis and treatment planning in cardiovascular disease. Velocity fields are typically obtained from patient-specific 3D artery models via computational fluid dynamics (CFD). However, CFD simulation requires meticulous setup by experts and is time-intensive, which hinders large-scale acceptance in clinical practice. To address this, we propose graph neural networks (GNN) as an efficient black-box surrogate method to estimate 3D velocity fields mapped to the vertices of tetrahedral meshes of the artery lumen. We train these GNNs on synthetic artery models and CFD-based ground truth velocity fields. Once the GNN is trained, velocity estimates in a new and unseen artery can be obtained with 36-fold speed-up compared to CFD. We demonstrate how to construct an SE(3)-equivariant GNN that is independent of the spatial orientation of the input mesh and show how this reduces the necessary amount of training data compared to a baseline neural network.

Corresponding author: Dr Joseph Jacob UCL Centre for Medical Image Computing 1st Floor, 90 High Holborn, London WC1V6LJ j.jacob@ucl.ac.uk Abstract Early detection and diagnosis of coronary artery disease (CAD) could save lives and reduce healthcare costs. In this study, we propose a 3D Resnet-50 deep learning model to directly classify normal subjects and CAD patients on computed tomography coronary angiography images. Our proposed method outperforms a 2D Resnet-50 model by 23.65%. Explainability is also provided by using a Grad-GAM. Furthermore, we link the 3D CAD classification to a 2D two-class semantic segmentation for improved explainability and accurate abnormality localisation. Introduction Coronary artery disease (CAD) is a common cause of death [1] in developed (i.e., UK, USA) and developing countries (i.e., India, Philippines). Early detection and diagnosis of CAD could save lives and costs [2]. Currently, computed tomography coronary angiography (CTCA) plays a central role in diagnosing or excluding CAD in patients with chest pain [3, 4].