{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,27]],"date-time":"2026-04-27T20:43:23Z","timestamp":1777322603143,"version":"3.51.4"},"reference-count":30,"publisher":"MDPI AG","issue":"9","license":[{"start":{"date-parts":[[2026,4,26]],"date-time":"2026-04-26T00:00:00Z","timestamp":1777161600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>Background\/Objectives: Coronary artery disease (CAD) remains the leading cause of death worldwide. Traditional cardiovascular risk assessment is based on chronological age and other clinical factors, with inherent limitations and poor accuracy. Objective was to estimate the artificial intelligence (AI)-enhanced biological cardiovascular age calculation derived from coronary computed tomography angiography (CTA) reports using a large language model (LLM), in predicting major adverse cardiovascular events (MACE). Methods: Coronary CTA reports were analyzed using a LLM (ChatGPT-4.0v, OpenAI), from symptomatic patients with suspected CAD who underwent coronary CTA for clinical indications. Patients in which the LLM successfully analyzed the key metrics (1) coronary artery calcium (CAC) score and (2) coronary CTA reports (coronary stenosis severity (CAD-RADS), high-risk anatomy, non-calcified plaque, cardiac function (LVEF and others) were included. Results: 386 CTA reports were uploaded, and 346 (89.6%) included. The mean biological age (bioAGE) was 57.2 \u00b1 10.9 and the chronological 58.5 \u00b1 10.8 years. 137 (39.6%) were women. The intra-individual deviation in bioAGE was high (median: 8.8; IQR 9.98). BioAGE exceeded chronological age in 45.4% patient and was lower or equal in 54.6%) MACE rate was 8.7% comprising 2 deaths, 5 myocardial infarctions, and 22 late revascularizations. The accuracy for prediction of MACE was higher for bioAGE (c = 0.768; 95% CI: 0.681\u20130.855, p &lt; 0.001) compared to chronological age (c = 0.590; 95% CI: 0.492\u20130.689, p = 0.102) Conclusions: Biological age calculation from coronary CTA reports using LLM is feasible, yet intra-individual deviations are high. The accuracy for prediction of MACE is improved by bioAGE compared to chronological.<\/jats:p>","DOI":"10.3390\/diagnostics16091298","type":"journal-article","created":{"date-parts":[[2026,4,27]],"date-time":"2026-04-27T19:24:51Z","timestamp":1777317891000},"page":"1298","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Biological Cardiovascular Age Derived from Coronary CTA Reports Using a Large Language Model: A Novel Predictor of Major Adverse Cardiovascular Events?"],"prefix":"10.3390","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6755-4399","authenticated-orcid":false,"given":"Gudrun M.","family":"Feuchtner","sequence":"first","affiliation":[{"name":"Department of Radiology, Innsbruck Medical University, 6020 Innsbruck, Austria"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yannick","family":"Scharll","sequence":"additional","affiliation":[{"name":"Department of Radiology, Innsbruck Medical University, 6020 Innsbruck, Austria"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5139-4287","authenticated-orcid":false,"given":"Johannes","family":"Deeg","sequence":"additional","affiliation":[{"name":"Department of Radiology, Innsbruck Medical University, 6020 Innsbruck, Austria"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-4889-2177","authenticated-orcid":false,"given":"Valentin","family":"Bilgeri","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine III, Cardiology & Angiology, Innsbruck Medical University, 6020 Innsbruck, Austria"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5908-2923","authenticated-orcid":false,"given":"Philipp","family":"Spitaler","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine III, Cardiology & Angiology, Innsbruck Medical University, 6020 Innsbruck, Austria"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6577-0784","authenticated-orcid":false,"given":"Malik","family":"Galijasevic","sequence":"additional","affiliation":[{"name":"Department of Radiology, Innsbruck Medical University, 6020 Innsbruck, Austria"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-9626-8065","authenticated-orcid":false,"given":"Michael","family":"Swoboda","sequence":"additional","affiliation":[{"name":"Department of Radiology, Innsbruck Medical University, 6020 Innsbruck, Austria"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Leonhard","family":"Gruber","sequence":"additional","affiliation":[{"name":"Department of Radiology, Innsbruck Medical University, 6020 Innsbruck, Austria"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7255-0672","authenticated-orcid":false,"given":"Gerlig","family":"Widmann","sequence":"additional","affiliation":[{"name":"Department of Radiology, Innsbruck Medical University, 6020 Innsbruck, Austria"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-4049-4494","authenticated-orcid":false,"given":"Pietro G.","family":"Lacaita","sequence":"additional","affiliation":[{"name":"Department of Radiology, Innsbruck Medical University, 6020 Innsbruck, Austria"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2026,4,26]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"e93","DOI":"10.1161\/CIR.0000000000001123","article-title":"Heart disease and stroke statistics\u20132023 update: A report from the American Heart Association","volume":"147","author":"Tsao","year":"2023","journal-title":"Circulation"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"579","DOI":"10.1001\/jamainternmed.2021.0171","article-title":"Declining Accuracy of the Traditional Diamond-Forrester Estimates of Pretest Probability of Coronary Artery Disease: Time for New Methods","volume":"181","author":"Gibbons","year":"2021","journal-title":"JAMA Intern. 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