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Cardiac computed tomography (CT) scanning is an advanced cardiac imaging technique that utilizes CT technology, with or without intravenous (IV) contrast, to produce accurate cross-sectional virtual slices of specific areas of the heart, coronary circulation, and major blood vessels such as the aorta, pulmonary veins, and arteries. The computer processes these slices to generate three-dimensional images. Multidetector CT (MDCT) is a rapid form of CT scanning that captures multiple slices...
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Diagnosing acute coronary syndrome or ACS begins with a thorough patient history. Notable symptoms include central, crushing chest pain radiating to the left arm, neck, jaw, or back, along with shortness of breath, sweating (diaphoresis), nausea, vomiting, dizziness, and palpitations.It is crucial to note any history of cardiac illnesses and assess risk factors, including age, gender, smoking, hypertension, diabetes, hyperlipidemia, and a sedentary lifestyle.During physical examination, vital...
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A Pathophysiology-Oriented Imaging Phenotype Framework for Nonobstructive Coronary Artery Disease.

Hongqun Du1, Wenyue Chen1, Hao Tian1

  • 1Department of Medical Imaging, Affiliated Hospital of Jiangnan University, No. 1000 Hefeng Road, Wuxi 214122, China.

Journal of Cardiovascular Development and Disease
|April 27, 2026
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Nonobstructive coronary artery disease (NOCAD) has diverse causes. A new imaging phenotype framework shows functional and structural dominance predict major adverse cardiovascular events, guiding risk stratification.

Keywords:
CT-derived fractional flow reservecoronary computed tomography angiographyimaging phenotypenonobstructive coronary artery diseaseperivascular fat attenuation indexplaque burdenrisk stratification

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Area of Science:

  • Cardiology
  • Medical Imaging
  • Pathophysiology

Background:

  • Nonobstructive coronary artery disease (NOCAD) is a complex condition with varied underlying mechanisms, despite no flow-limiting blockages.
  • Current diagnostic approaches may not fully capture the prognostic implications of NOCAD's heterogeneity.

Purpose of the Study:

  • To develop and validate a rule-based imaging phenotype framework for NOCAD using multiparametric coronary computed tomography angiography (CCTA).
  • To integrate functional, structural, and inflammatory data to categorize NOCAD patients and assess prognostic significance.

Main Methods:

  • Retrospective analysis of 485 NOCAD patients.
  • Assessment of CT-derived fractional flow reserve (CT-FFR), plaque burden, high-risk plaque features, and perivascular fat attenuation index (FAI).
  • Categorization into function-, structure-, inflammation-dominant, or low-risk phenotypes based on hierarchical rules and percentile thresholds.

Main Results:

  • During a median 36-month follow-up, 11.5% of patients experienced major adverse cardiovascular events (MACE).
  • Function dominance was linked to the highest MACE risk (HR 4.054), followed by structure dominance (HR 3.129).
  • Isolated inflammation dominance did not show a significant independent association with MACE.

Conclusions:

  • A phenotype-oriented interpretation of CCTA metrics can reflect distinct biological pathways in coronary pathology.
  • The developed framework highlights a graded prognostic association across functional and structural abnormalities in NOCAD.
  • This approach supports improved risk stratification for patients with nonobstructive coronary artery disease.