基于人工智能的全自动左房室耦合指数作为压力- cmr患者的预后指标

T. Pezel , P. Garot , S. Toupin , F. Sanguineti , T. Hovasse , T. Unterseeh , S. Champagne , T. Chitiboi , B. Ambale Venkatesh , J.A.C. Lima , J. Garot
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引用次数: 0

摘要

引言在没有临床心血管疾病的个体中,左房室耦合指数(LACI)是心力衰竭(HF)的一个强大而独立的预测指标。为了确定在接受应激性CMR的患者中,基于全自动人工智能的LACI是否可以为预测HF提供增加的预后价值。方法在2016年至2018年间,我们进行了一项研究,包括所有连续出现异常血管舒张应激性CMR[诱导性缺血或晚期钆增强(LGE)]的患者。使用倾向评分匹配选择CMR正常的对照受试者。LACI定义为左心房与左心室舒张末期容积的比值。主要结果包括使用Cox回归法因急性心衰或心血管死亡住院治疗。结果在2662名患者[65±12岁,68%的男性,1:1匹配的患者(1331名CMR正常,1331名异常)]中,LACI与总体倾向匹配人群中风险因素调整前后的主要结果[中位随访5.2(4.8–5.5)年]呈正相关[调整后的危险比(HR),5.94(95%CI,3.74–9.45)/0.1%增量],具有异常[调整后的HR,6.38(95%CI,3.77-10.8)/0.1%增量]和正常CMR[调整后HR,6.15(95%CI)/0.1%递增;所有P<;0.001]的患者。调整后,LACI≥25%表明,与传统的危险因素和压力CMR结果相比,模型识别和重新分类的改善最大(C统计学改善:0.15;NRI=0.705;IDI=0.398,所有P<0.001;LR检验P<0.001)CMR,与包括诱导性缺血和LGE在内的传统风险因素相比具有增加的预后价值(图1)。
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AI-based fully automated left atrioventricular coupling index as a prognostic marker in patients undergoing stress-CMR

Introduction

The left atrioventricular coupling index (LACI) is a strong and independent predictor of heart failure (HF) in individuals without clinical cardiovascular disease. To determine in patients undergoing stress CMR whether fully automated artificial intelligence-based LACI can provide incremental prognostic value to predict HF.

Method

Between 2016 and 2018, we conducted a study including all consecutive patients with abnormal vasodilator stress CMR [inducible ischemia or late gadolinium enhancement (LGE)]. Control subjects with normal CMR were selected using propensity score-matching. LACI was defined as the ratio of LA to LV end-diastolic volumes. The primary outcome included hospitalization for acute HF or cardiovascular death using Cox regression.

Results

In 2662 patients [65 ± 12 years, 68% men, 1:1 matched patients (1331 with normal and 1331 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 (Fig. 1).

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来源期刊
Archives of Cardiovascular Diseases Supplements
Archives of Cardiovascular Diseases Supplements CARDIAC & CARDIOVASCULAR SYSTEMS-
自引率
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发文量
508
期刊介绍: Archives of Cardiovascular Diseases Supplements is the official journal of the French Society of Cardiology. The journal publishes original peer-reviewed clinical and research articles, epidemiological studies, new methodological clinical approaches, review articles, editorials, and Images in cardiovascular medicine. The topics covered include coronary artery and valve diseases, interventional and pediatric cardiology, cardiovascular surgery, cardiomyopathy and heart failure, arrhythmias and stimulation, cardiovascular imaging, vascular medicine and hypertension, epidemiology and risk factors, and large multicenter studies. Additionally, Archives of Cardiovascular Diseases also publishes abstracts of papers presented at the annual sessions of the Journées Européennes de la Société Française de Cardiologie and the guidelines edited by the French Society of Cardiology.
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