Decoding the Heart Through Computed Tomography: Early Cardiomyopathy Detection Using Ensemble-Based Segmentation and...

Diagnosis of cardiomyopathies often depends on overt phenotypic manifestations, delaying patient management. This underscores the need for population-level opportunistic screening tools using clinically indicated CT scans to detect subclinical myocardial disease. This study developed an Ensemble Machine Learning (ML) model to automatically segment the left ventricular myocardium from CT data and estimate the probability of underlying myocardial disease using radiomic feature analysis. A total of 60 CT scans (~12,000 images) were used to train ML models for left ventricular myocardium segmentation, including scans from both healthy individuals and patients with myocardial disease. A novel Ensemble model was developed and externally validated on 10 independent CT scans. Subsequently, 100 unseen CT scans were segmented manually and automatically for radiomic feature analysis. After removing highly correlated features through intra-class variation and correlation filtering, the refined dataset was used for model training and testing. Key predictive features were identified, and model performance was evaluated. The four best-performing models (Unet++, ED w/ASC, FPN, and TresUNET) were combined to form an Ensemble model, achieving a final DICE score of 0.882 after hyperparameter optimization. External validation yielded a DICE score of 0.907. Radiomic feature analysis identified 15 key predictors of myocardial disease in both manual and automatic segmentation datasets. The model demonstrated strong performance in detecting underlying myocardial disease, with AUCs of 0.85 and 0.8, respectively. This study presents a fully automated CT-based framework for LV myocardial segmentation and radiomic phenotyping that accurately estimates the probability of underlying myocardial disease. The model demonstrates strong generalizability across different CT protocols and highlights the potential role of AI-driven CT analysis for early, non-invasive cardiomyopathy screening at a population level.