{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,6]],"date-time":"2026-11-06T17:26:06Z","timestamp":1793985966610,"version":"4.8.0"},"reference-count":29,"publisher":"Oxford University Press (OUP)","issue":"15","license":[{"start":{"date-parts":[[2026,9,19]],"date-time":"2026-09-19T00:00:00Z","timestamp":1789776000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000050","name":"National Heart, Lung, and Blood Institute of the National Institutes of Health","doi-asserted-by":"publisher","award":["R01EB034586"],"award-info":[{"award-number":["R01EB034586"]}],"id":[{"id":"10.13039\/100000050","id-type":"DOI","asserted-by":"publisher"}]},{"name":"National Institute of Biomedical Imaging and Bioengineering of the National Institutes of Health","id":[{"id":"https:\/\/ror.org\/00372qc85","id-type":"ROR","asserted-by":"crossref"}]},{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,11,6]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Aims<\/jats:title>\n                    <jats:p>Inadequate pharmacologic stress may limit the diagnostic and prognostic accuracy of myocardial perfusion imaging (MPI). The splenic ratio (SR), a measure of stress adequacy, has emerged as a potential imaging biomarker. We developed an artificial intelligence (AI) method to derive SR and evaluated the prognostic value in a large multicentre 82Rb-PET cohort undergoing regadenoson stress testing.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and results<\/jats:title>\n                    <jats:p>We retrospectively analysed 16 650 patients from six sites in the REFINE PET registry with clinically indicated MPI and linked clinical outcomes. SR was calculated using fully automated algorithms as the ratio of splenic uptake at stress vs. rest. Patients were stratified by SR into decile groups. The primary outcome was major adverse cardiovascular events (MACE). Survival analysis was conducted using Kaplan\u2013Meier and Cox proportional hazards models adjusted for clinical and imaging covariates, including myocardial flow reserve (MFR \u22652 vs. &amp;lt;2) and presence of ischaemia. The cohort had a median age of 69 years, with 59% male patients. Common risk factors included hypertension (81%), dyslipidaemia (77%), diabetes (35%), and prior coronary artery disease (31%). Median follow-up was 3.4 years. Patients with high SR in the testing cohort (n = 950) had an increased risk of MACE [hazard ratio (HR) 1.19, 95% confidence interval (CI) 1.06\u20131.34, P = 0.005]. Among testing patients with preserved MFR (\u22652; n = 8067), high SR remained independently associated with MACE (HR 1.43, 95% CI 1.20\u20131.70, P &amp;lt; 0.001). Even among patients with preserved MFR and no ischaemia in the testing cohort(MFR\u22652, SDS&amp;lt;2; n = 6508), high SR remained independently associated with MACE (HR 1.54 95% CI 1.26\u20131.88, P &amp;lt; 0.001).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Elevated AI-derived SR was independently associated with adverse cardiovascular outcomes, including among patients with preserved MFR. These findings support SR as a novel, automated imaging biomarker for risk stratification in 82Rb PET MPI.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/cvr\/cvag184","type":"journal-article","created":{"date-parts":[[2026,9,14]],"date-time":"2026-09-14T11:16:56Z","timestamp":1789384616000},"page":"2130-2140","source":"Crossref","is-referenced-by-count":0,"title":["Artificial intelligence\u2013derived splenic response in cardiac positron emission tomography is associated with major adverse cardiovascular events: a multi-site study"],"prefix":"10.1093","volume":"122","author":[{"given":"Giselle","family":"Ramirez","sequence":"first","affiliation":[{"name":"Artificial Intelligence in Medicine Research Center, Departments of Biomedical Sciences, Medicine, and Cardiology, Cedars-Sinai Medical Center , 6500 Wilshire Blvd, Los Angeles, CA 90048 ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Naga L","family":"Dharmavaram","sequence":"additional","affiliation":[{"name":"Artificial Intelligence in Medicine Research Center, Departments of Biomedical Sciences, Medicine, and Cardiology, Cedars-Sinai Medical Center , 6500 Wilshire Blvd, Los Angeles, CA 90048 ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aakash","family":"Shanbhag","sequence":"additional","affiliation":[{"name":"Artificial Intelligence in Medicine Research Center, Departments of Biomedical Sciences, Medicine, and Cardiology, Cedars-Sinai Medical Center , 6500 Wilshire Blvd, Los Angeles, CA 90048 ,","place":["USA"]},{"name":"Department of Electrical and Computer Engineering, University of Southern California , Los Angeles, CA ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert J H","family":"Miller","sequence":"additional","affiliation":[{"name":"Artificial Intelligence in Medicine Research Center, Departments of Biomedical Sciences, Medicine, and Cardiology, Cedars-Sinai Medical Center , 6500 Wilshire Blvd, Los Angeles, CA 90048 ,","place":["USA"]},{"name":"Department of Cardiac Sciences, University of Calgary , Calgary, Alberta ,","place":["Canada"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul B","family":"Kavanagh","sequence":"additional","affiliation":[{"name":"Artificial Intelligence in Medicine Research Center, Departments of Biomedical Sciences, Medicine, and Cardiology, Cedars-Sinai Medical Center , 6500 Wilshire Blvd, Los Angeles, CA 90048 ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jirong","family":"Yi","sequence":"additional","affiliation":[{"name":"Artificial Intelligence in Medicine Research Center, Departments of Biomedical Sciences, Medicine, and Cardiology, Cedars-Sinai Medical Center , 6500 Wilshire Blvd, Los Angeles, CA 90048 ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mark","family":"Lemley","sequence":"additional","affiliation":[{"name":"Artificial Intelligence in Medicine Research Center, Departments of Biomedical Sciences, Medicine, and Cardiology, Cedars-Sinai Medical Center , 6500 Wilshire Blvd, Los Angeles, CA 90048 ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Valerie","family":"Builoff","sequence":"additional","affiliation":[{"name":"Artificial Intelligence in Medicine Research Center, Departments of Biomedical Sciences, Medicine, and Cardiology, Cedars-Sinai Medical Center , 6500 Wilshire Blvd, Los Angeles, CA 90048 ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anna","family":"Marcinkiewicz","sequence":"additional","affiliation":[{"name":"Artificial Intelligence in Medicine Research Center, Departments of Biomedical Sciences, Medicine, and Cardiology, Cedars-Sinai Medical Center , 6500 Wilshire Blvd, Los Angeles, CA 90048 ,","place":["USA"]},{"name":"Center of Radiological Diagnostics, National Medical Institute of the Ministry of the Interior and Administration , Warsaw ,","place":["Poland"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2236-6970","authenticated-orcid":false,"given":"Damini","family":"Dey","sequence":"additional","affiliation":[{"name":"Artificial Intelligence in Medicine Research Center, Departments of Biomedical Sciences, Medicine, and Cardiology, Cedars-Sinai Medical Center , 6500 Wilshire Blvd, Los Angeles, CA 90048 ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0572-912X","authenticated-orcid":false,"given":"Jon","family":"Hainer","sequence":"additional","affiliation":[{"name":"Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women\u2019s Hospital, Harvard Medical School , Boston, MA ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Samuel","family":"Wopperer","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine, Mayo Clinic , Rochester, MN ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stacey","family":"Knight","sequence":"additional","affiliation":[{"name":"Intermountain Medical Center Heart Institute, Intermountain Healthcare , Murray, UT ,","place":["USA"]},{"name":"Department of Internal Medicine, University of Utah , Salt Lake City, UT ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6659-5332","authenticated-orcid":false,"given":"Viet T","family":"Le","sequence":"additional","affiliation":[{"name":"Intermountain Medical Center Heart Institute, Intermountain Healthcare , Murray, UT ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Steve","family":"Mason","sequence":"additional","affiliation":[{"name":"Intermountain Medical Center Heart Institute, Intermountain Healthcare , Murray, UT ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Erick","family":"Alexanderson","sequence":"additional","affiliation":[{"name":"Department of Nuclear Cardiology, Ignacio Chavez National Institute of Cardiology , Mexico City ,","place":["Mexico"]},{"name":"Faculty of Medicine, National Autonomous University of Mexico PET\/CT Unit, , Mexico City ,","place":["Mexico"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Isabel","family":"Carvajal-Juarez","sequence":"additional","affiliation":[{"name":"Department of Nuclear Cardiology, Ignacio Chavez National Institute of Cardiology , Mexico City ,","place":["Mexico"]},{"name":"Faculty of Medicine, National Autonomous University of Mexico PET\/CT Unit, , Mexico City ,","place":["Mexico"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ren\u00e9 R S","family":"Packard","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Department of Medicine, David Geffen School of Medicine, University of California , Los Angeles, CA , ; Ronald Reagan UCLA Medical Center, Los Angeles, California; West Los Angeles Veterans Affairs Medical Center, Los Angeles, California","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas L","family":"Rosamond","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine, The University of Kansas Medical Center , Kansas City, KS ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mouaz H","family":"Al-Mallah","sequence":"additional","affiliation":[{"name":"Houston Methodist Academic Institute, Houston Methodist DeBakey Heart and Vascular Center Department of Cardiology, , Houston, TX ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Leandro","family":"Slipczuk","sequence":"additional","affiliation":[{"name":"Cardiology Division, Montefiore Health Systemr\/Albert Einstein College of Medicine , New York, NY ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mark I","family":"Travin","sequence":"additional","affiliation":[{"name":"Department of Radiology, Montefiore Medical Center and the Albert Einstein College of Medicine , Bronx, NY ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2187-4076","authenticated-orcid":false,"given":"Wanda","family":"Acampa","sequence":"additional","affiliation":[{"name":"Department of Advanced Biomedical Sciences, University of Naples Federico II , Naples ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew J","family":"Einstein","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Department of Medicine, and Department of Radiology, Columbia University Irving Medical Center and New York-Presbyterian Hospital , New York, NY ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Panithaya","family":"Chareonthaitawee","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine, Mayo Clinic , Rochester, MN ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel S","family":"Berman","sequence":"additional","affiliation":[{"name":"Artificial Intelligence in Medicine Research Center, Departments of Biomedical Sciences, Medicine, and Cardiology, Cedars-Sinai Medical Center , 6500 Wilshire Blvd, Los Angeles, CA 90048 ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marcelo F","family":"Di Carli","sequence":"additional","affiliation":[{"name":"Division of 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