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AI-Based Fully Automated Left Atrioventricular Coupling Index as a Prognostic Marker in Patients Undergoing Stress
Théo Pezel1, Philippe Garot2, Solenn Toupin3
1Institut Cardiovasculaire Paris Sud, Cardiovascular Magnetic Resonance Laboratory, Hôpital Privé Jacques Cartier, Ramsay Santé, Massy, France; Inserm UMRS 942, Service de Cardiologie, Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, Université Paris Cité, Paris, France.
Insights
The left atrioventricular coupling index (LACI) predicts heart failure (HF) and cardiovascular death in patients undergoing stress cardiac magnetic resonance (CMR). This AI-derived index offers significant prognostic value beyond traditional risk factors.
Area of Science:
- Cardiology
- Medical Imaging
- Artificial Intelligence
Background:
- The left atrioventricular coupling index (LACI) is a known predictor of heart failure (HF) in healthy individuals.
- Its prognostic capability in patients with pre-existing cardiovascular disease is not well-established.
Purpose of the Study:
- To assess the incremental prognostic value of an AI-based LACI in predicting HF in patients undergoing stress cardiac magnetic resonance (CMR).
- To determine if LACI can identify patients at higher risk for adverse cardiovascular events.
Main Methods:
- A longitudinal study of 2,134 patients undergoing vasodilator stress CMR between 2016-2018.
- LACI, calculated as the ratio of left atrial to left ventricular end-diastolic volumes, was assessed using automated AI.
- The primary outcome was hospitalization for acute HF or cardiovascular death, analyzed using Cox regression.
Main Results:
- LACI was independently associated with the primary outcome in the overall, abnormal CMR, and normal CMR groups (adjusted HRs ranging from 1.12 to 1.22, P < 0.001).
- A LACI threshold of ≥25% significantly improved model discrimination and reclassification of risk (C-index improvement: 0.16, NRI: 0.388, IDI: 0.153, all P < 0.001).
Conclusions:
- The AI-derived LACI provides independent prognostic information for HF hospitalization and cardiovascular death in patients undergoing stress CMR.
- LACI offers incremental predictive value beyond traditional risk factors and CMR findings like inducible ischemia and late gadolinium enhancement.
Background:
The left atrioventricular coupling index (LACI) is a strong and independent predictor of heart failure (HF) in individuals without clinical cardiovascular disease. Its prognostic value is not established in patients with cardiovascular disease.
Objectives:
This study sought to determine in patients undergoing stress cardiac magnetic resonance (CMR) whether fully automated artificial intelligence-based LACI can provide incremental prognostic value to predict HF.
Methods:
Between 2016 and 2018, the authors conducted a longitudinal study including all consecutive patients with abnormal (inducible ischemia or late gadolinium enhancement) vasodilator stress CMR. Control subjects with normal stress CMR were selected using propensity score matching. LACI was defined as the ratio of left atrial to left ventricular end-diastolic volumes. The primary outcome included hospitalization for acute HF or cardiovascular death. Cox regression was used to evaluate the association of LACI with the primary outcome after adjustment for traditional risk factors.
Results:
In 2,134 patients (65 ± 12 years, 77% men, 1:1 matched patients [1,067 with normal and 1,067 with abnormal CMR]), LACI was positively associated with the primary outcome (median follow-up: 5.2 years [IQR: 4.8-5.5 years]) before and after adjustment for risk factors in the overall propensity-matched population (adjusted HR: 1.18 [95% CI: 1.13-1.24]), in patients with abnormal CMR (adjusted HR per 0.1% increment: 1.22 [95% CI: 1.14-1.30]), and in patients with normal CMR (adjusted HR per 0.1% increment: 1.12 [95% CI: 1.05-1.20]) (all P < 0.001). After adjustment, a higher LACI of ≥25% showed the greatest improvement in model discrimination and reclassification over and above traditional risk factors and stress CMR findings (C-index improvement: 0.16; net reclassification improvement = 0.388; integrative discrimination index = 0.153, all P < 0.001; likelihood ratio test P < 0.001).
Conclusions:
LACI is independently associated with hospitalization for HF and cardiovascular death in patients undergoing stress CMR, with an incremental prognostic value over traditional risk factors including inducible ischemia and late gadolinium enhancement.
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