Top reads from the CHEST journal portfolio – January 2026

Journal CHEST^®

Artificial Intelligence-Based Echocardiography in Pulmonary Arterial Hypertension

By Bettia Celestin, MD, and colleagues

This study by Celestin and colleagues analyzed the use of deep learning (DL) in echocardiography to assess pulmonary hypertension (PH). The study provides compelling evidence that DL-based echocardiography workflow can deliver clinically reliable right-heart measurements, comparable to expert core laboratory interpretation. Peak tricuspid regurgitation velocity (TRV) and tricuspid annular plane systolic excursion—cornerstone parameters in current PH diagnostic and risk stratification algorithms—demonstrated minimal systematic bias and acceptable precision across a wide range of disease severity, endorsing TRV as a robust echocardiographic marker. In contrast, right ventricular fractional area change exhibited higher bias and variability, highlighting need for cautious clinical interpretation.

This work supports the integration of automated DL workflows into routine echocardiography to enhance efficiency, reduce inter-reader variability, and standardize PH screening and longitudinal assessment. Such approaches may ultimately facilitate earlier referral, more consistent monitoring, and broader access to PH evaluation across diverse clinical settings.

Commentary by Maidah Yaqoob, MD, Member of the CHEST Physician Editorial Board

CHEST^® Pulmonary

The Additional Accuracy Gained by Cone Beam CT in Shape-Sensing Robotic Bronchoscopy

By Alberto E. Revelo, MD, and colleagues

Revelo and colleagues provide a nice prospective pilot study of 110 consecutive patients with pulmonary lesions < 3 cm requiring diagnosis by robotic-assisted bronchoscopy (RAB). They assessed whether the addition of cone beam CT (CBCT) scans provided more accurate biopsy tool placement in the center of the lesion. The important takeaway is that CBCT scan, when added to RAB, significantly improves tool localization to the center of the lesion versus RAB alone.

Furthermore, when using RAB alone, only a small portion (26.5%) of lung lesions had the center of the lesion targeted correctly. The addition of CBCT greatly improved the accuracy of the needle to the center of the lesion in approximately 60% of lesions. These important findings of the beneficial diagnostic accuracy effect of CBCT to RAB provides further evidence that CBCT utilization should become more routine for health systems to deploy for the diagnosis of lung lesions as opposed to not utilizing it at all.

Commentary by Jeffrey Velotta, MD, Member of the CHEST Physician Editorial Board

CHEST^® Critical Care

Association of Peripheral Norepinephrine Protocol Implementation on Central Venous Catheter Placement in a Medical ICU

By Lara M. Groetzinger, PharmD, BCCCP, and colleagues

In this single-center retrospective cohort study, the authors found that initiating a peripheral norepinephrine protocol was associated with a statistically significant reduction in central venous catheter (CVC) use (59.5% vs 53.5%), without significant complications, in their medical ICU. Just over 50% of patients who initially started on peripheral norepinephrine ultimately needed a CVC. The protocol specified that low-concentration norepinephrine could be given at a maximal rate of 0.5 ug/kg/min for up to 48 hours, with careful nursing monitoring of the peripheral line and extensive education.

These may be numerically small differences but can translate to significant reductions in CVC utilization in busy ICUs. Clinicians’ decisions to use CVC are often driven by multiple factors, but this and other data should reassure them that a low to moderate dose of peripherally administered norepinephrine is safe, provided that it is given through good quality intravenous lines with close monitoring.^1–2

Commentary by Yuri Matusov, MD, Member of the CHEST Physician Editorial Board

References