Radiomics-based machine learning models in STEMI: a promising tool for the prediction of major adverse cardiac events

To evaluate the potential value of the machine learning (ML) models using radiomic features of late gadolinium enhancement (LGE) and cine images on magnetic resonance imaging (MRI) along with relevant clinical information and conventional MRI parameters for the prediction of major adverse cardiac events (MACE) in ST-segment elevation myocardial infarction (STEMI) patients.

This retrospective study included 60 patients with the first STEMI. MACE consisted of new-onset congestive heart failure, ventricular arrhythmia, and cardiac death. Radiomic features were extracted from cine and LGE images. Inter-class correlation coefficients (ICCs) were calculated to assess inter-observer reproducibility. LASSO (least absolute shrinkage and selection operator) method was used for radiomic feature selection. Seven separate models using a different combination of the available information were investigated. Classifications with repeat random sampling were done using adaptive boosting, k-nearest neighbor, naive Bayes, neural network, random forest, stochastic gradient descent, and support vector machine algorithms.

Of the 1748 extracted radiomic features, 1393 showed good inter-observer agreement. With LASSO, 25 features were selected. Among the ML algorithms, the neural network showed the highest predictive performance on average (area under the curve (AUC) 0.822 ± 0.181). Of the best-calculated model, the one using clinical parameters, CMRI parameters, and selected radiomic features (model 7), the diagnostic performance was as follows: 0.965 AUC, 0.894 classification accuracy, 0.906 sensitivity, 0.883 specificity, 0.875 positive predictive value (PPV), and 0.912 negative predictive value (NPV).

The radiomics-based ML models incorporating clinical and conventional MRI parameters are promising for predicting MACE occurrence in STEMI patients in the follow-up period.

• Acute coronary occlusion results in variable changes at the cellular level ranging from myocyte swelling to myonecrosis depending on the duration of the ischemia and the metabolic state of the heart, which causes subtle heterogeneous signal changes that are imperceptible to the human eye with cardiac MRI. • Radiomics-based machine learning analysis of cardiac MR images is promising for risk prediction. • Combining MRI-derived parameters and clinical variables increases the accuracy of predictive models.