C. Michael Gibson, MD

Sunny San Diego had me smiling through my interviews at SCCT last Friday. Maybe I was also smiling because I got to talk to my friend, Bob Pelberg, MD about his insights into why carotid plaque is important to quantify and I made a new friend in Chris, Maroules, MD while learning more about his experience with plaque analysis software.

Check out the show and enjoy today’s issue.

Vik

Cardiac Imaging

Zero CAC And The Cost of CCTA-QPA

The power of a zero CAC score is facing fresh scrutiny after new plaque analysis data presented at SCCT 2026 shows just how much noncalcified plaque confers its own cardiovascular risk, despite the software’s financial barriers.

• Current U.S. dyslipidemia guidelines stratify risk using CAC scoring and total plaque volume, but they don’t address the zero-CAC score group.
• Unfortunately, young symptomatic patients with a zero calcium score still go on to have heart attacks, potentially missed by the reassurance zero CAC provides.

To test whether quantitative plaque assessment can address this, researchers analyzed 3.7k PROMISE patients who were evaluated with CCTA and Cleerly’s qualitative plaque analysis (QPA) software, 40% of whom had a CAC score of zero.

• Among zero-CAC patients, the 12% with noncalcified plaque were slightly older, more often male, and more often non-white than those without plaque.
• The rate of significant stenosis (≥50%) was far higher in patients with noncalcified plaque, at 22% versus 9%, regardless of CAC status.

Extending these results into risk stratification yielded some shocking trends.

• MACE rates were similar for patients with noncalcified plaque regardless of CAC status (4.5% vs 3.9%). 
• Meanwhile MACE fell to just 0.8% for those with neither CAC nor plaque.
• Zero-CAC patients with noncalcified plaque were nearly six times more likely to experience MACE than those without (HR: 5.93).
• Noncalcified plaque volume predicted MACE about as well as total plaque volume.

That’s a big win for proponents of CCTA and plaque analysis, but it’s not likely to convince everyone, especially with a separate SCCT presentation questioning PROMISE’s economics of QPA vs. CAC.

• Per an analysis by Dr. Khurram Nasir, CCTA costs roughly 3.83x more ($24.5k) than CAC scoring to find one patient who will experience a CV event.
• Beyond that, adding QPA (about $1,000 on top of $400 for CCTA) theoretically pushes the cost of detecting a single MACE-bound patient to $280k.

The Takeaway

PROMISE’s results re-ignite the question of what to do with patients who have zero CAC. While CCTA paired with QPA is the current best clinical option, it’s clear that financial hurdles are what prevent us from using plaque analysis instead of CAC as the go-to diagnostic modality.

Merge Cardio 12.5 is Officially Available!

From AI-generated echo measurements to upgraded UI and reports, Merge Cardio 12.5 brings a long list of new innovations to the table. Find out more about how Merge Cardio’s latest version streamlines workflows to make your cardiovascular service line more cost-effective and patient-centered.

The Power of AI in Cardiovascular Imaging

Cardiac labs are under more pressure than ever to deliver more with greater speed and precision. Hear from Tony Gallagher, Director of Noninvasive Cardiology at Baptist Health Lexington about how Siemens Healthineers’ ACUSON Origin is reshaping daily practice and transforming the future of echocardiography.

Beyond the Calcium Score with Circle CVI

The coronary artery calcium score has been the non-invasive gold standard for a quick look at heart disease risk, but it only tells part of the story. Learn more about how Circle Cardiovascular Imaging is using AI-enabled coronary plaque analysis to redefine heart risk beyond what a CAC score can tell us.

The Wire

• Neko Health Raises $700M: Preventive health company Neko Health notched a $700M Series C round to advance its boutique screening mission. The Swedish company will use the funds to fuel an aggressive U.S. expansion this year, with its first clinics opening in New York and other cities. The company calls its flagship offering Neko Health Scan, which uses blood pressure, ECG, and a basket of other diagnostic technologies to “capture millions of health data points.” 

• FDA Clears Siemens Plaque Analysis: The FDA cleared Siemens Healthineers’ home grown, CT-based coronary plaque analysis software. Debuted at RSNA 2025, the syngo.CT Coronary Cockpit will become part of the syngo.via advanced visualization platform as an optional add-on for Siemens’ CT and C-arm workflows. Like other plaque analysis tools, the solution segments and labels the coronary arteries while quantifying plaque types to help plan stent measurements and placements. Siemens’ decision to offer its own plaque analysis software speaks volumes to how widespread the technology has become in the last two years.

• Standing for Fluoro Lab Radiation Safety: Four of cardiology’s most important medical groups are demanding stronger radiation safety in fluoroscopic labs. A new joint expert consensus statement backed by SCAI, ASE, HRS, and SVS says current technologies can virtually eliminate clinicians’ radiation exposure and end the need for heavy lead aprons, which are tied to orthopedic issues. The groups note that many cath labs still abide by older practices, putting them out of step with the federal government’s “as low as reasonably achievable” standard for radiation dose. 

• Radiation and Aging Fluoro Equipment: Speaking of radiation exposure, a recent paper in JSCAI revealed widespread use of aging fluoroscopy equipment in cath labs across California and Illinois that makes minimizing operator dose more difficult. Across 654 units, researchers found a median system age of 17 years, and equipment released before 2001 accounted for 22% of inventory. The article argues that legacy equipment unfairly tilts the onus of radiation safety toward clinicians and calls for requiring imaging infrastructure investments to reduce radiation risk.

• FFR Tech Shows Potential: MedHub-AI’s fractional flow reserve software, AutocathFFR, produced rapid and reliable readings of C-arm based coronary angiograms in a new JSCAI study, challenging the gold standard status of invasive FFR. Among 496 patients with stenosis, AutocathFFR achieved 93.8% overall diagnostic accuracy and 91.4% accuracy in challenging “gray zone” cases. Average computation time was 36.1 seconds. AutocathFFR is approved in the EU and Japan, and awaits an FDA decision.

• Rethinking the MINOCA Name: A new EHJ viewpoint argues the “I” in MINOCA should stand for injury, not infarction, since it’s a working diagnosis. The heart attack symptoms that accompany MINOCA can be caused by true myocardial infarction, but also infection, physical trauma, and other issues. Tweaking the terminology would emphasize the need for further testing toward a final diagnosis. The proposed change comes as clinicians await the Fifth Universal Definition of Myocardial Infarction.

• CV Drugs Carry Their Weight: Obesity may pose less CV risk than it once did in industrialized nations as medical therapy improves. That’s according to a new Lancet study that pooled health survey data for 978k people between 1990 and 2024. In the U.S. and four other countries, obese older adults reached average BP and non-HDL cholesterol levels roughly equal to — or better than — those with normal BMI. The trends accompanied rising use of antihypertensive and lipid-lowering drugs.

• Inadequate Action on CKM Risk Factors: A JACC study suggested that most individuals with cardiovascular-kidney-metabolic syndrome don’t receive sufficient treatment. Data from 6.3k CKM patients showed only half of those with hyperlipidemia or hypertension underwent care. Individuals with diabetes had higher treatment odds (83.4%), but even with intervention, blood pressure (44.7%), glycemia (47.3%), and cholesterol (68.2%) levels weren’t well controlled. Coming just a couple years after the AHA’s CKM Initiative launch, this data underscores how much work is left for addressing comorbidities.

• Nitroglycerin’s AS Safety Rebrand: News from SCCT 2026 supports AS patients’ use of nitroglycerin for pre-TAVI CT angiography. Data from 109 patients with severe AS who received sublingual nitroglycerin showed improved diagnostic accuracy (84.9% vs 67.6%) and 1.7x better signal-to-noise ratios compared to those who didn’t receive the medication. Nitroglycerin has long been inadvisable for AS patients due to concerns over plunging blood pressures, but the new data reinforces the drug’s safety and efficacy.   

• Are Cannabis and CVD linked? A new Trends in Cardiovascular Medicine paper hinted that the answer may be yes, to some degree. Data from 2014 to 2015 suggests that marijuana could have associations with heart attacks, stroke, and arrhythmias, with atrial arrhythmias detected in 12.5% of cannabis users compared to 2.7% of nonusers. Still, the jury is out on how consumption and types of cannabinoids may affect heart health, and if certain groups are more vulnerable than others.

• Withings Enters Clinical Care: Withings branched out from health monitoring to launch Withings Medical, a telemedicine service for Medicare beneficiaries with cardiovascular-kidney-metabolic syndrome. By managing medications and promoting lifestyle changes, Withings clinicians will work in tandem with PCPs to alter disease trajectories. Withings is one of nearly 200 organizations participating in the new CMS ACCESS Model, which ties payments to patient outcomes rather than service volume.

State-of-the-Art Cardiac Monitoring at Scale

Cleared for 13 different heart rhythm interpretations, AccurKardia’s AccurECG 2.0 shortens the time from an arrhythmia incident to clinical intervention. Watch here to find out how AccurKardia and Specialized Medical are teaming up to bring the AccurECG 2.0 technology to clinicians across the U.S.

How Automated MRI Software Transformed Radiology Regional

Radiology Regional recently integrated automated MRI scanning software into their imaging practice imaging. Hear from their team how automating CMR scans streamlined their practice and enhanced patient care.

The Resource Wire

• Merge & Us2.ai for Accessible Cardiac AI: AI isn’t the future anymore, it’s an irreplaceable feature for cardiac imaging. Dive deeper into how Merge & Us2.ai are integrating FDA-cleared algorithms with advanced imaging systems to help clinicians focus on what matters most – their patients.

• Heart Failure Hospitalization Doubles Risk of Cardiovascular Death: 21% of patients with symptomatic heart failure escalate to hospitalization for heart failure or cardiovascular death, and 25% of those who experience hospitalization are readmitted due to heart failure within one year of discharge. Watch Bayer’s Dr. Alanna Morris-Simon discuss heart failure hospitalizations and when to assess care plans

• Making the Leap to Outsource Post-Processing: Interested in how to outsource cardiac image post-processing, but not sure where to start? PIA walks you through how to assess and compare vendors, understand pricing models and payment options, and outline your requirements to identify vendors who meet your clinical needs.

• Telemedicine Isn’t About Technology. It’s About People. With temporary telehealth rules expiring, millions of Medicare patients may lose their ability to see their doctors remotely. Read why Monebo and the Alliance for Connected Care are urging Congress to make telemedicine a permanent part of the healthcare system.

• Staying ALERT with Tempus: Undertreatment and time to treatment of valvular heart disease are among the biggest challenges health systems face today, but Tempus’ AI-driven EHR notifications can change that. Read the results of Medtronic and Tempus’ ALERT trial which found that delivering data directly to providers resulted in a 40% relative increase in life-saving valve procedures. 

• Earlier Detection, Better Outcomes: When it comes to heart disease, early detection is crucial to a patient’s long-term health. Learn more about how Fujifilm helps clinicians achieve that with the Lisendo 880 cardiovascular ultrasound system’s unique solutions that detect early abnormalities seen in heart failure, while offering insight into cardiac functions and groundbreaking hemodynamic analysis.

The Industry Wire

1. OpenAI’s health chief says AI models will get better. 
2. Anthropic moves into healthcare with Claude tie-ups. 
3. FDA’s CBER seeks stability with “normal” leadership.
4. Medicare proposal could devastate remote-monitoring industry. 
5. Why are employees at large companies on Medicaid?  
6. CDC says cyclosporiasis outbreaks in four states may be linked. 
7. Insurers file suit against CMS over Medicare Advantage scores. 
8. Which medical specialities are getting happier? 
9. HHS watchdog targets fraud in Medicare, Medicaid. 
10. HCA cuts 2026 forecast as people drop ACA plans.