AI-derived automated quantification of cardiac chambers and myocardium from non-contrast CT: Prediction of major adverse cardiovascular events in asymptomatic subjects

• Published in: Atherosclerosis Vol. 401; p. 119098
• Main Authors: Razipour, Aryabod, Grodecki, Kajetan, Manral, Nipun, Geers, Jolien, Gransar, Heidi, Shanbhag, Aakash, Miller, Robert J.H., Rozanski, Alan, Berman, Daniel S., Slomka, Piotr J., Dey, Damini
• Format: Journal Article
• Language: English
• Published: Ireland Elsevier B.V 01.02.2025
• Subjects: Aged; Artificial Intelligence; Asymptomatic Diseases; Cardiac chambers; Coronary Angiography - methods; Coronary Artery Disease - diagnostic imaging; Coronary Artery Disease - mortality; Deep Learning; Female; Heart Ventricles - diagnostic imaging; Heart Ventricles - physiopathology; Humans; Left ventricle; Major adverse cardiovascular events; Male; Middle Aged; Myocardium; Predictive Value of Tests; Prognosis; Radiographic Image Interpretation, Computer-Assisted - methods; Risk Assessment; Tomography, X-Ray Computed; Vascular Calcification - diagnostic imaging; Myocardium; Major adverse cardiovascular events; Artificial intelligence; Cardiac chambers; Left ventricle
• ISSN: 0021-9150; 1879-1484; 1879-1484
• DOI: 10.1016/j.atherosclerosis.2024.119098

The significance of left ventricular mass and chamber volumes from non-contrast computed tomography (CT) for predicting major adverse cardiovascular events (MACE) has not been studied. Our objective was to evaluate the role of artificial intelligence-enabled multi-chamber cardiac volumetry from non-contrast CT for long-term risk stratification in asymptomatic subjects without known coronary artery disease. Our study included 2022 asymptomatic individuals (55.6 ± 9.0 years; 59.2 % male) from the EISNER (Early Identification of Subclinical Atherosclerosis by Noninvasive Imaging Research) trial. Multi-chamber cardiac volumetry was performed using deep-learning algorithms from routine non-contrast CT scans for coronary artery calcium scoring. MACE was defined as cardiac death, acute coronary syndrome, and late (>180 days) revascularization. A total of 215 individuals (11 %) suffered MACE at a mean follow-up of 13.9 ± 3 years. Individuals with MACE had higher left ventricular mass (115.1g vs. 105.2g, p < 0.001). In a multivariable analysis adjusted for cardiovascular risk factors and medications, left ventricular mass (HR 2.76, p<0.001) and coronary artery calcium score (HR 1.34, p<0.001) were independent predictors of long-term MACE. Adding left ventricular mass to the coronary calcium score improved the Receiver Operating Characteristic Area Under the Curve (AUC 0.753 vs 0.767, p=0.031) with continuous net reclassification index of 18 % (p=0.011). Left ventricular mass (HR 3.89, p<0.001), but not the coronary artery calcium score predicted cardiovascular death. Left ventricular mass quantified automatically by AI from routine non-contrast CT independently predicted long-term MACE over and above the coronary calcium score in asymptomatic participants without known coronary artery disease. [Display omitted] •Multivariable analysis adjusted for cardiovascular risk factors and medications revealed that LV mass (HR 2.76, p < 0.001) and coronary artery calcium score (HR 1.34, p < 0.001) are both independent predictors of MACE.•Multivariable analysis adjusted for cardiovascular risk factors and medications showed that LV mass (HR 3.89, p = 0.004), but not coronary calcium score, independently predicts cardiovascular deaths.•Coronary artery calcium scores predictive performance for MACE improved after adding LV mass (AUC 0.753 vs. 0.767, p = 0.031).