Clinical Outcomes and Prognosis

1348647 - AI-based Fully Automated Left Atrioventricular Coupling Index as a Prognostic Marker in Patients Undergoing Stress-CMR

Thursday, January 26, 2023

4:30 PM – 5:10 PM

Location: Pacific Jewel

Presenting Author(s)

Theo Pezel, MD

Head of the Cardiovascular Imaging department
Lariboisiere University Hospital, APHP, Paris, France
Paris, Ile-de-France, France

Primary Author(s)

Theo Pezel, MD

Head of the Cardiovascular Imaging department
Lariboisiere University Hospital, APHP, Paris, France
Paris, Ile-de-France, France

Co-Author(s)

PG

Philippe Garot, MD

Cardiologist
Institut Cardiovasculaire Paris Sud (ICPS), Cardiovascular Magnetic Resonance Laboratory, Hôpital Privé Jacques CARTIER, Massy, France
ST

Solenn Toupin, PhD

Clinical scientist
Siemens Healthcare France, Scientific partnerships, Saint-Denis
Bordeaux, Aquitaine, France
FS

Francesca Sanguineti, MD

Cardiologist
Institut Cardiovasculaire Paris Sud (ICPS), Cardiovascular Magnetic Resonance Laboratory, Hôpital Privé Jacques CARTIER, Massy, France
TH

Thomas Hovasse, MD

Cardiologist
Institut Cardiovasculaire Paris Sud (ICPS), Cardiovascular Magnetic Resonance Laboratory, Hôpital Privé Jacques CARTIER, Massy, France
TU

Thierry Unterseeh, MD

Cardiologist
Institut Cardiovasculaire Paris Sud (ICPS), Cardiovascular Magnetic Resonance Laboratory, Hôpital Privé Jacques CARTIER, Massy, France
SC

Stéphane Champagne, MD

Cardiologist
Institut Cardiovasculaire Paris Sud (ICPS), Cardiovascular Magnetic Resonance Laboratory, Hôpital Privé Jacques CARTIER, Massy, France
TC

Teodora Chitiboi, PhD

Research Scientist
Siemens Healthcare GmbH, Hamburg, Germany
Hamburg, Germany
AJ

Athira J. Jacob, MSc

Research Scientist
Siemens Medical Solutions USA, Inc., Princeton, NJ, United States
Plainsboro, New Jersey, United States
PS

Puneet Sharma, PhD

Research & Technology Manager
Siemens Medical Solutions USA, Inc., Princeton, NJ, United States
Princeton, New Jersey, United States
Bharath Ambale-Venkatesh, PhD

Physicist
The John Hopkins Hospital
Baltimore, Maryland, United States
Joao A. C Lima, MD

MD
The John Hopkins Hospital
Baltimore, Maryland, United States
Jerome Garot, PhD

Head
ICPS - Massy
Massy, Ile-de-France, France

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. The aim of the study was to determine in patients undergoing stress CMR whether fully automated artificial intelligence-based LACI can provide incremental prognostic value to predict HF.

Methods:

Between 2016 and 2018, we conducted a longitudinal study including all consecutive patients with abnormal (inducible ischemia or late gadolinium enhancement (LGE)) vasodilator stress CMR. Control subjects with normal stress CMR were selected using propensity score-matching. LACI was defined as the ratio of LA to LV end-diastolic volumes. Notably, on random subsets of 60 patients for the LV and 378 patients for the LA, the average dice score was 89.4 ± 5.7 for the LV and 87.9 ± 12.7 for the LA. 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 2,662 patients [65±12 years, 68% men, 1:1 matched patients (1,331 with normal and 1,331 with abnormal CMR)], LACI was positively associated with the primary outcome (median follow-up 5.2 (4.8-5.5) years) before and after adjustment for risk factors in the overall propensity-matched population (adjusted hazard ratio [HR], 5.94 [95%CI, 3.74-9.45] per 0.1% increment), patients with abnormal (adjusted HR, 6.38 [95%CI, 3.77-10.8] per 0.1% increment), and normal CMR (adjusted HR, 6.15 [95%CI, 2.97-12.7] per 0.1% increment; 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-statistic improvement: 0.15; NRI=0.705; IDI=0.398, all p< 0.001; LR-test p< 0.001).

Conclusion:

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 LGE.