Evidence-grounded essays for the cardio-oncology community.
Long-form scientific writing from HIER Institute investigators on imaging biomarkers, artificial intelligence, radiomics, survivorship, equity, and the policy landscape of precision cardiovascular oncology. Every essay is grounded in high-impact peer-reviewed literature and written for clinicians, scientists, and policymakers who need to make decisions this quarter.
A Multimodal Cardiovascular Risk Model for Radiation-Treated Cancer Survivors
How planning CT phenotypes, ECG signal, and routinely collected clinical data combine into a single interpretable predictor of MACE for patients on radiation oncology — and why the comparator matters as much as the model.
MACE Endpoints and Adjudication in Radiation Oncology Cohorts
How to specify, adjudicate, and analyze cardiovascular death, MI, stroke, heart failure hospitalization, and coronary revascularization in cancer survivors — with the time windows, data sources, and competing-risk rules that make cardio-oncology outcome studies reproducible.
Coronary Artery Calcium on Radiation Planning CT
Every non-contrast planning CT contains a coronary calcium score hiding in plain sight. A synthesis of MESA, NLST, CLARIFY, and modern deep-learning validation for why opportunistic CAC scoring belongs in every cardio-oncology survivorship pathway.
Cardiac Substructure Dose in Thoracic Radiotherapy
Mean heart dose is a summary statistic, not a mechanism. Why the LAD, left atrium, and conduction tissue deserve their own dose constraints in every thoracic and breast plan.
Deep Inspiration Breath Hold in Breast Radiotherapy
DIBH remains the single largest intervention available to lower cardiac dose in left-sided breast radiotherapy — and access to it remains inequitable in ways that are measurable and addressable.
Fusing ECG, Echo, and Cardiovascular Imaging with Planning CT Biomarkers
Four new specific aims for the HIER Institute program: paired ECG + CT transformers, echo–CT structural reconciliation, geriatric multimodal risk stratification, and a federated cardio-oncology foundation model — grounded in the 2025–2026 Red Journal, IJROBP, JACC CardioOncology, IEEE, and geriatric oncology literature.
Epicardial and Pericardial Adipose Distribution on Planning CT
How a fat depot invisible to routine oncologic reads becomes a decades-long predictor of cardiovascular death — and why every radiation planning CT is a missed opportunity to measure it.
Left Atrial Dose and Radiation-Associated Atrial Fibrillation
Atrial fibrillation is the most under-reported cardiovascular endpoint in thoracic radiotherapy. A synthesis of the LA dose-response literature, the mechanistic case for pulmonary vein exposure, and the substructure constraints radiation oncology should be tracking today.
Thoracic Aortic Calcium on Planning CT
Aortic calcium is a stroke- and cardiovascular-mortality predictor independent of coronary calcium — and it is visible on every planning CT that already contains the coronaries. Why every cardio-oncology imaging read should include it.
Anthracyclines and Thoracic Radiation: The Multiplicative Cardiotoxicity Problem
Anthracycline dose and thoracic radiation dose are the two largest modifiable cardiotoxicity exposures in oncology — and they compound rather than add. A synthesis of the childhood-cancer survivor and adult-lymphoma evidence, and what it means for prevention today.
Immune Checkpoint Inhibitor Myocarditis: Detection, Adjudication, and Radiation Overlap
ICI-associated myocarditis is rare but frequently fatal, and it disproportionately affects patients also receiving thoracic radiation. A structured framework for baseline screening, on-treatment surveillance, and endpoint adjudication in cardio-oncology cohorts.
Cardiac MRI T1 and T2 Mapping in Cancer Survivors
Quantitative cardiac MRI mapping detects diffuse fibrosis and oedema years before ejection fraction drops. Where T1, T2, and extracellular volume fit into the cardio-oncology survivorship pathway — and what a defensible surveillance protocol looks like.
GLP-1 and SGLT2 Agents in Cardio-Oncology Prevention
GLP-1 receptor agonists and SGLT2 inhibitors reduce major cardiovascular events, epicardial fat, and heart failure hospitalizations across the populations that also make up cardio-oncology survivorship clinics. A synthesis of the trial evidence and where these agents fit into a modern prevention pathway.