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Michael Hadley @hadleymd.bsky.social · 02/01/2026

🔹 CT bifurcation score + subtended mass stratify which branches need protection. 🔹 CT-fluoro overlay and AR/VR provide live guidance. 👉 Bottom line: Maximize PCI precision/efficiency by planning w/ CCTA; #IVUS/#OCT for optimization. www.ahajournals.org/doi/10.1161/... @uniofgalway 🇮🇪

ahajournals.org

Coronary CTA in Contemporary Percutaneous Coronary Intervention: From Diagnostic Modality to Decision-Making Toolkit | Circulation: Cardiovascular Imaging

Percutaneous coronary intervention outcomes rely heavily on accurate lesion assessment and procedural planning. Invasive tools, such as fractional flow reserve, nonhyperemic pressure ratios,…

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Michael Hadley @hadleymd.bsky.social · 02/01/2026

🔹 CT picks optimal views, predicts engagement, and helps right-size guides. 🔹 Length, vessel geometry, calcium map, high-risk plaque ➡️ smarter prep (lithotripsy/atherectomy) and cleaner landing zones. 🔹 CT-FFR and virtual stent planning predicts post-PCI FFR (P3 data).

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Michael Hadley @hadleymd.bsky.social · 02/01/2026

CCTA isn’t just for diagnosis, it’s a PCI playbook. Excellent new review details how #CCTA offers shorter cases, less contrast/radiation, fewer geographic misses, better stent sizing, and a reproducible workflow you can teach.

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Michael Hadley @hadleymd.bsky.social · 12/12/2025

❗ Coronary calcium scoring is a great way to risk stratify patients for the #1 cause of death, but many insurance plans still don't cover this test. 👏 Here's a new expert statement in @JACCJournals that calls on payers to provide coverage. The time is now for progress. buff.ly/UCWJZG5

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Michael Hadley @hadleymd.bsky.social · 12/12/2025

🤔 Young woman presents with chest pain. Diagnosis? 🚀 Incredible #CardiacCT imaging @NorthwellHealth #cardioSky

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Michael Hadley @hadleymd.bsky.social · 04/12/2025

💥 New review from @TheLancet on Dx of #CAD. 👉 Bottom line: The field continues to shift toward plaque-centric #CCTA, with functional tests layered on for ischemia, reflecting a more comprehensive approach to chronic CAD. www.thelancet.com/journals/lan... @drmarthagulati.bsky.social #CardioSky

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Michael Hadley @hadleymd.bsky.social · 21/11/2025

🔎 Incredible #CT images of #LVAD complications - just out in @JACCJournals. 👏 Thanks to the team at @inselgruppe.bsky.social for putting this together! www.jacc.org/doi/10.1016/... #cardiosky

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Michael Hadley @hadleymd.bsky.social · 19/11/2025

🔥 Hot off the press! 2025 CV Imaging Training Statement 🛣️ New "Advanced Imager" pathway with Level II-like competence in CT, MR, Echo, and Nuc 🚀 Nice emphasis on cross-modality integration for CAD, sarcoid, amyloid, HCM pericardium, masses, structural, and ACHD Link below👇

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Michael Hadley @hadleymd.bsky.social · 18/11/2025

What is the unifying diagnosis?🫀 Incredible cardiac imaging happening @NorthwellHealth 🚀 #cardioSky @SCMRorg SSFP, LGE, T1, T2

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Michael Hadley @hadleymd.bsky.social · 11/11/2025

🚨 New AHA statement on NOCA from @CardioMDPhD @lesleejshaw and others. 👉 AI plaque analysis improves risk discrimination and changes downstream management. 🚀 @NorthwellHealth will be studying this as we prepare to roll out Plaque Analysis! #CardioSky www.ahajournals.org/doi/10.1161/...

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Michael Hadley @hadleymd.bsky.social · 07/11/2025

👧 Family: ECG+echo (CMR if equivocal); echo q1–2y, CMR q2–5y 🧩 Phenocopies: Amyloid (EF/GLS >4.1, high T1), Fabry (low T1, basal IL LGE), Athlete (balanced dilation, no LGE) 🤖 Future: AI, indexed wall thickness, DTI/FAPI doi.org/10.1093/ehjc... #CardioSky

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Michael Hadley @hadleymd.bsky.social · 07/11/2025

🚦 Obstruction is dynamic: LVOTO >30 rest, >50 provoked ⏳ Mid-cavity HCM = hourglass LV & apical aneurysm; doppler underestimates pressures 🌫️ Ischemia w/o CAD is common: check CMR/PET for microvascular dysfunction 💊 Therapy monitoring: CMIs: start for EF ≥55–60%; hold <50%

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Michael Hadley @hadleymd.bsky.social · 07/11/2025

🧭 Diagnosis ≠ MWT ≥15 mm alone: use phenotype, function, tissue characterization 🔥 LGE matters: ~65% have LGE; ≥15% LV mass can up-class ICD risk 🎯 EF can mislead: track GLS for systolic dysfunction 🫁 Diastolic assessment: EACVI/ASE 4-criteria + LA strain; exercise echo

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Michael Hadley @hadleymd.bsky.social · 07/11/2025

🚀 New #EACVI consensus statement on multimodality imaging for #HCM from @s_e_petersen @cardim_nuno. #Echo, #CMR, #CCT, and #PET each add unique value across diagnosis, symptoms, prognosis, screening, and treatment monitoring. Key points👇

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Michael Hadley @hadleymd.bsky.social · 04/11/2025

🚀 CT perfusion can provide volumetric MBF maps that pair seamlessly with #CCTA for a single comprehensive exam. ?Could this offer a one-stop shop? doi.org/10.1016/j.jc... #cardiacimaging #cardioSky

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Michael Hadley @hadleymd.bsky.social · 04/11/2025

🧱 Historically, there has been limited access to PET scans needed to quantify MBF. But this is changing. 👏 As described in this expert review, CT & MRI are now validated to deliver comprehensive/actionable reporting on MBF, bringing greater precision to the chest pain pathway.

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Michael Hadley @hadleymd.bsky.social · 04/11/2025

💥 Myocardial Blood Flow (#MBF) isn't just a #PET thing anymore. #CCT and #CMR are in the game. 🚦 Angina isn't always explained by epicardial stenoses. Quantification of MBF can detect other causes (#ANOCA), like microvascular disease, HCM, or transplant vasculopathy.

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Michael Hadley @hadleymd.bsky.social · 30/10/2025

🚀 If we start reporting even 3 of these opportunistic metrics (e.g. RV function, membranous septum length, frailty marker), we move CT-TAVR from procedural planning → phenotyping platform. #TAVR #StructuralHeart #cardioSky @danilorenzatti @CardioMDPhD

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Michael Hadley @hadleymd.bsky.social · 30/10/2025

🔹 Frailty on CT: psoas/skeletal muscle index + vertebral HU → osteosarcopenia → worse 1-year outcomes. 🔹 CAD beyond “is there calcium?”: better CCTA (PCCT) + CT-FFR can reduce the number of patients we send for invasive angio.

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Michael Hadley @hadleymd.bsky.social · 30/10/2025

🔹 Amyloid signal: CT-ECV (esp. with dual/spectral or photon-counting) → separates AS remodeling from coexisting ATTR, which is not rare in this population. 🔹 Fat: EAT / peri-coronary fat volume + attenuation → inflammatory signature that tracks with MACE after TAVR.

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Michael Hadley @hadleymd.bsky.social · 30/10/2025

🔹 Conduction risk: membranous septum length, LVOT/root/mitral annular calcium → helps predict who’s heading for a PPM. 🔹 Myocardial phenotype: full-cycle CT → RV function (often missed on echo), CT-GLS, “cardiac damage” staging → all tied to mortality after TAVR.

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Michael Hadley @hadleymd.bsky.social · 30/10/2025

We’re doing CT before most TAVRs, but we’re only cashing in on the “planning” part. This review argues we should be squeezing the rest of the dataset for prognosis and longitudinal care. www.journalofcardiovascularct.com/article/S193... What else is sitting on those scans? 👇

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Michael Hadley @hadleymd.bsky.social · 29/10/2025

💥 Masterful review of the literature on CT-FFR in @journalCCT www.journalofcardiovascularct.com/article/S193... #CCTA + #CTFFR = anatomy + physiology in one stop 🚀 Growing evidence to look at the translesional ΔFFR, not just the distal FFR value 🔺 @PRodriguezMD #cardioSky #CAD #SCCT

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Michael Hadley @hadleymd.bsky.social · 27/10/2025

🤔 Thought-provoking piece in @CircAHA from Kole & Joshi 🫀 A growing group of patients with subclinical atherosclerosis falls in between traditional "primary" and "secondary" prevention. I've heard of "prevention 1.5" or "plaque-informed prevention." How about the following classification system?👇

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Michael Hadley @hadleymd.bsky.social · 24/10/2025

🌈 Spectral data paves the way for plaque phenotyping, perfusion mapping, myocardial characterization - a possible "one-stop" exam? 🤔 Still need: larger prospective clinical validation and cost-effectiveness data 📖 www.jacc.org/doi/10.1016/... @ArthurShiyovich @RonBlankstein #cardioSky #CCTA

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Michael Hadley @hadleymd.bsky.social · 24/10/2025

💥 Just out in #JACC CVI: State-of-the-Art on Photon-Counting CT 👇 Why this technology is a game-changer: ☢️ Better for patients: ⬇️ radiation and ⬇️ contrast 😅 Better for readers: spatial rez of 0.1mm + ⬇️ blooming = stents and calcified plaques are clearer than ever before

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Michael Hadley @hadleymd.bsky.social · 21/10/2025

✨ Beautiful #CMR pictures. Young patient with new chest pain. SSFP, T2W, and LGE. #NorthwellHealth #cardiosky

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Michael Hadley @hadleymd.bsky.social · 15/10/2025

🪦 Ischemic heart disease remains the #1 cause of death worldwide 💥 That's 8.9M premature deaths or 136M years of life lost in 2023 alone 💊 We need a better strategy to detect and prevent ischemic heart disease 👏 Thanks to GBD for another incredible report: www.thelancet.com/journals/lan... #CCTA

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Michael Hadley @hadleymd.bsky.social · 14/10/2025

👉 Key strategies include: prospective gating, reduced field of view, BMI-tailored kVp, elimination of redundant phases, and hands-on training for techs. 🔬 Here, Chazal et al describe how a multicenter CCTA program used these strategies to lower mean radiation dose by 23%! doi.org/10.1016/j.ja...

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Michael Hadley @hadleymd.bsky.social · 14/10/2025

💥 As coronary CTA volumes increase, we must keep radiation exposures as low as reasonably achievable. ☢️ AHA/ACC/SCCT recommend a goal of median CCTA dose ≤4 mSv, which has been achieved in multicenter trials without compromising quality.

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Michael Hadley @hadleymd.bsky.social · 10/10/2025

❗ Impressively, only 1% of scans were indeterminate, and there was good diagnostic performance regardless of stent diameter. @DoosupShin @ziadalinyc @OKhaliqueMD #cardiotwitter #CCTA eurointervention.pcronline.com/article/phot...

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Michael Hadley @hadleymd.bsky.social · 10/10/2025

💥 Photon-counting detector CT offers good diagnostic accuracy for detecting ISR, overcoming artifacts that have plagued prior generations of scanners. 🔬 In a blinded study of 283 stented lesions, PCD-CT, as compared to cath, demonstrated NPV of 96.4% and accuracy of 88.9% for ISR ≥50%.

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Michael Hadley @hadleymd.bsky.social · 09/10/2025

🧲 #CMR can identify cardiac allograft vasculopathy effectively and non-invasively. 🔬 In this study of 110 patients s/p heart transplant, quant myocardial perfusion reserve <2.2 had NPV 100% and AUC 0.88 for significant CAV, as compared to cath. doi.org/10.1093/ehjc... @SCMR @EHJ #CardioSky

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Michael Hadley @hadleymd.bsky.social · 08/10/2025

💫 #CMR is useful for predicting SCD in NICM. 📊 DERIVATE 2.0 provides better risk classification, incorporating gender, LVEF, and amount/location of #LGE. 👉 Let's look beyond LVEF alone to determine which NICM patients get ICD. Full text: doi.org/10.1093/ehjc... #CMR @SCMR #cardiosky

doi.org

Redefining the risk of major arrhythmic events in non-ischaemic cardiomyopathy: insights from the DERIVATE-NICM study

AbstractAims. Selection of the patients for implantable cardioverter defibrillator primary prevention therapy in non-ischaemic cardiomyopathy (NICM) needs

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Michael Hadley @hadleymd.bsky.social · 07/10/2025

⭐ What this means: --Traditional screening tools miss many at-risk people --Even when risks are recognized, preventive therapies often aren't started --We need a better strategy to identify disease earlier @DLBHATTMD #cardiotwitter #CAD #CCTA @SCCT doi.org/10.1093/eurh...

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Michael Hadley @hadleymd.bsky.social · 07/10/2025

🚨 Preventing first heart attacks may need a rethink. 🔬 In this massive study of 4.6 million people with their first heart attack: --18% had no standard modifiable risk factors --51% had no warning symptoms beforehand --63% weren't on preventive meds (only 22% on statin)

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Michael Hadley @hadleymd.bsky.social · 07/10/2025

💊 If positive, guidelines could rec #CCTA for asymptomatic adults, allowing us to detect and treat #CAD earlier to prevent more heart attacks. 🫀 To prepare, we need to model what a positive trial could mean for patient volumes and what it would take to meet that need. 🏴󠁧󠁢󠁳󠁣󠁴󠁿 #cardiosky

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Michael Hadley @hadleymd.bsky.social · 07/10/2025

💥 The SCOT-HEART 2 trail could transform how we identify those at risk of heart attacks. 🔬 Trial randomizes asymptomatic patients ages 40-70 with ≥1 risk factors to either #CoronaryCTA or standard care, with appropriate therapies, looking for primary outcome of heart attack.

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Michael Hadley @hadleymd.bsky.social · 06/10/2025

Superb article summarizing the knowns and unknowns of broken heart syndrome (Takotsubo syndrome).💔 Yes, emotions can stun the heart. A fascinating tale of mind–heart biology. Full text here: www.nature.com/articles/s41... @elmir1omerovic #cardiotwitter

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Michael Hadley @hadleymd.bsky.social · 03/10/2025

🚨Late-presenting ostial LAD STEMI, imaged 7-days later with #CMR. Here's the #LGE. ❓Would you call thrombus? Microvascular obstruction? Intramyocardial hemorrhage? Or a combination of these? @NorthwellHealth @LenoxHill #cardiotwitter

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Michael Hadley @hadleymd.bsky.social · 03/10/2025

❓As Plaque Analysis roles out nationwide for #CCTA, providers are asking "How will this change clinical management?" ✔️The DECIDE registry provides one framework: Total Plaque Volume determines level of therapy. 🔬More research is needed to show impact on hard outcomes. #cardiotwitter @NorthwellHealth

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Michael Hadley @hadleymd.bsky.social · 03/10/2025

This #CMR shows anteroapical intramyocardial enhancement. Taking the image as a whole, what's one potential explanation? #cardiotwitter #CardiacImaging

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Michael Hadley @hadleymd.bsky.social · 01/10/2025

Important multicenter study in #EHJ #CMR outperforms societal recs for ICD placement in cardiac sarcoidosis 📈AUC=0.86 for 5-yr risk of fatal/life-threatening arrhythmias ⚡Highest risk = abnl LVEF + LGE that is multifocal, septal, subepicardial, or involves RV freewall buff.ly/Nc2upbU #cardiotwitter

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Michael Hadley @hadleymd.bsky.social · 30/09/2025

Nice review in #EHJ on LGE and SCD by @DrMarchlinski et al. buff.ly/GeU589P 🫀Good reminder that in CAD: LGE predicts SCD better than LVEF; absence of LGE has a high NPV for SCD 🔭Looking ahead, digital twins made from CMR data undergo virtual inductions to uncover arrhythmia risk #cardiotwitter

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