What if a CAC score of zero isn’t truly zero?

ESC 2026 · 10 Scientific Presentations · Oral & Poster · 4/10

HeartLung's AI-CAC can detect small and semi-calcified plaques invisible to human eyes.Same scan. A more refined “zero.”

Organised by: European Society of Cardiology (ESC) visual

For decades, a coronary artery calcium (CAC) score of zero has been one of the most reassuring findings in cardiovascular prevention.

However, a small portion of individuals with CAC=0 experience an adverse coronary cardiovascular event.    

At ESC Congress 2026, HeartLung.AI presented Agatston-2.0 - a next-generation AI-based approach designed to detect clinically meaningful coronary calcification that may be missed by conventional Agatston scoring.

Roughly 1 in 5 “zeros” was not actually zero.

Among 3,965 participants from MESA and the Framingham Heart Study - all with a conventional Agatston score of zero:

21.7% had detectable AI-CAC with Agatston-2.0.

Those with AI-CAC > 0 had:

• 73% higher adjusted risk of myocardial infarction

• 85% higher risk of hard CHD

• 71% higher risk of all CHD

• Greater progression to conventional CAC > 0 at 10 years: 66.3% vs. 43.4%

  
  
  
  

  Agatston-2.0 · See What Conventional CAC Scoring May Miss

  Agatston-2.0 uses deep-learning coronary segmentation, intensity calibration, continuous voxel-level weighting, and spatial filtering - all from the same non-contrast CT scan.

Same scan. No extra radiation. A more precise understanding of cardiovascular risk.

Download the full ESC Congress 2026 presentation to explore the Agatston-2.0 methodology, clinical outcomes, subgroup analyses, and future directions.

Agatston-2_0_Part-I_ESC-Congress-2026_v6.pptx

Download PPTX • 9.39MB