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Cine Images Derived-Radiomic for the Prediction of Event Free Survival in Patients With ST-Segment Elevation
Xin A1, Ying Zhang2, Lei Zhao3
17th Department of Health Cadre, the Second Medical Center, Chinese PLA General Hospital, Beijing, China (X.A.); Department of Cardiology, the first Medical Center, Chinese PLA General Hospital, Beijing, China (X.A., Y.Z., Y.C.G.Q.); Senior Department of Cardiology, the Sixth Medical Center, Chinese PLA General Hospital, Beijing, China (X.A., Y.Z., L.Z., Y.C., S.Z., G.Q.).
Insights
Radiomic features from contrast-free cine cardiac magnetic resonance (CMR) offer valuable prognostic insights for ST-segment elevation myocardial infarction (STEMI) patients. This approach provides independent and incremental risk prediction, comparable to contrast-enhanced methods.
Area of Science:
- Cardiology
- Medical Imaging
- Radiology
Background:
- ST-segment elevation myocardial infarction (STEMI) is a critical condition requiring accurate prognostic assessment.
- Cardiac magnetic resonance (CMR) is a key imaging modality in cardiovascular disease evaluation.
- Contrast-free imaging techniques are desirable for patient safety and efficiency.
Purpose of the Study:
- To assess the prognostic capability of radiomic features extracted from contrast-free cine CMR.
- To determine if these features offer incremental value in predicting major adverse cardiovascular events (MACE) post-STEMI.
- To compare the performance of contrast-free radiomics with traditional contrast-enhanced CMR methods.
Main Methods:
- Retrospective analysis of 440 STEMI patients undergoing cine CMR one week post-percutaneous coronary intervention.
- Radiomic features were extracted from cine images.
- A radiomics-based risk score (RAD score) was developed using random survival forest and LASSO-Cox regression for feature selection.
Main Results:
- The RAD score demonstrated incremental prognostic value over clinical models in both internal and external validation cohorts.
- Predictive performance of the RAD score was comparable to cardiac magnetic resonance with late gadolinium enhancement (LGE-CMR).
- High risk defined by the RAD score was independently associated with MACE after adjusting for established risk factors.
Conclusions:
- Contrast-free cine-CMR radiomics provides significant independent and incremental prognostic information in STEMI patients.
- This approach achieves predictive performance comparable to LGE-CMR.
- Contrast-free radiomics supports individualized risk stratification for STEMI patients.
Rationale And Objectives:
To evaluate the prognostic value of radiomic features derived from contrast-free cine cardiac magnetic resonance (CMR) in patients with ST-segment elevation myocardial infarction (STEMI).
Materials And Methods:
We retrospectively included 440 patients with acute STEMI (86.6% males, 56.9 ± 10.6 years of age), who underwent CMR one week after percutaneous coronary intervention. Patients were assigned by centers into a development cohort (n = 359) and a validation cohort (n = 81). Radiomic features were extracted from cine images. Feature selection was performed using random survival forest and least absolute shrinkage and selection operator (LASSO)-Cox regression to generate a radiomics-based risk score (RAD score). Discrimination was evaluated using logistic and Cox regression analysis.
Results:
During the median follow-up period of 2.9 years, 88 patients experienced major adverse cardiovascular events (MACE). The RAD score provided incremental prognostic value over the clinical model in the internal (C-index 0.86 [0.79-0.92] vs 0.65 [0.55-0.78]; p < 0.001) and external cohort (C-index 0.80 [0.70-0.91] vs 0.63 [0.48-0.78]; p = 0.014), comparable to the clinical + LGE-CMR model (C-index 0.80 [0.70-0.91] vs 0.77 [0.65-0.89]; p = 0.547). Receiver operating characteristic analyses were consistent with C-index findings. After adjusting for established risk factors, RAD score-defined high risk remained independently associated with MACE (HR 11.30, 95% CI 4.96-21.44; p < 0.001).
Conclusion:
Cine-CMR radiomics provides independent and incremental prognostic information after STEMI and attains predictive performance comparable to parameters from cardiac magnetic resonance with late gadolinium enhancement, supporting contrast-free, individualized risk stratification.
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