PMID- 37052568 OWN - NLM STAT- MEDLINE DCOM- 20231023 LR - 20231026 IS - 1876-7591 (Electronic) IS - 1876-7591 (Linking) VI - 16 IP - 10 DP - 2023 Oct TI - AI-Based Fully Automated Left Atrioventricular Coupling Index as a Prognostic Marker in Patients Undergoing Stress CMR. PG - 1288-1302 LID - S1936-878X(23)00112-2 [pii] LID - 10.1016/j.jcmg.2023.02.015 [doi] AB - 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. CI - Copyright (c) 2023 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved. FAU - Pezel, Theo AU - Pezel T AD - Institut Cardiovasculaire Paris Sud, Cardiovascular Magnetic Resonance Laboratory, Hopital Prive Jacques Cartier, Ramsay Sante, Massy, France; Inserm UMRS 942, Service de Cardiologie, Hopital Lariboisiere, Assistance Publique-Hopitaux de Paris, Universite Paris Cite, Paris, France. FAU - Garot, Philippe AU - Garot P AD - Institut Cardiovasculaire Paris Sud, Cardiovascular Magnetic Resonance Laboratory, Hopital Prive Jacques Cartier, Ramsay Sante, Massy, France. FAU - Toupin, Solenn AU - Toupin S AD - Scientific Partnerships, Siemens Healthcare France, Saint-Denis, France. FAU - Sanguineti, Francesca AU - Sanguineti F AD - Institut Cardiovasculaire Paris Sud, Cardiovascular Magnetic Resonance Laboratory, Hopital Prive Jacques Cartier, Ramsay Sante, Massy, France. FAU - Hovasse, Thomas AU - Hovasse T AD - Institut Cardiovasculaire Paris Sud, Cardiovascular Magnetic Resonance Laboratory, Hopital Prive Jacques Cartier, Ramsay Sante, Massy, France. FAU - Unterseeh, Thierry AU - Unterseeh T AD - Institut Cardiovasculaire Paris Sud, Cardiovascular Magnetic Resonance Laboratory, Hopital Prive Jacques Cartier, Ramsay Sante, Massy, France. FAU - Champagne, Stephane AU - Champagne S AD - Institut Cardiovasculaire Paris Sud, Cardiovascular Magnetic Resonance Laboratory, Hopital Prive Jacques Cartier, Ramsay Sante, Massy, France. FAU - Morisset, Stephane AU - Morisset S AD - Independent Biostatistician, Assistance Publique-Hopitaux de Paris, Universite Paris Cite, Paris, France. FAU - Chitiboi, Teodora AU - Chitiboi T AD - Siemens Healthcare GmbH, Hamburg, Germany. FAU - Jacob, Athira J AU - Jacob AJ AD - Digital Technologies and Innovation, Siemens Healthineers, Princeton, New Jersey, USA. FAU - Sharma, Puneet AU - Sharma P AD - Digital Technologies and Innovation, Siemens Healthineers, Princeton, New Jersey, USA. FAU - Venkatesh, Bharath Ambale AU - Venkatesh BA AD - Division of Cardiology, Department of Medicine, Johns Hopkins Hospital, Johns Hopkins University School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA; Department of Radiology, Johns Hopkins Hospital, Johns Hopkins University School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA. FAU - Lima, Joao A C AU - Lima JAC AD - Division of Cardiology, Department of Medicine, Johns Hopkins Hospital, Johns Hopkins University School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA; Department of Radiology, Johns Hopkins Hospital, Johns Hopkins University School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA. FAU - Garot, Jerome AU - Garot J AD - Institut Cardiovasculaire Paris Sud, Cardiovascular Magnetic Resonance Laboratory, Hopital Prive Jacques Cartier, Ramsay Sante, Massy, France. Electronic address: jgarot@angio-icps.com. LA - eng PT - Journal Article DEP - 20230412 PL - United States TA - JACC Cardiovasc Imaging JT - JACC. Cardiovascular imaging JID - 101467978 RN - 0 (Contrast Media) RN - AU0V1LM3JT (Gadolinium) SB - IM CIN - JACC Cardiovasc Imaging. 2023 Oct;16(10):1303-1305. PMID: 37204385 MH - Male MH - Humans MH - Female MH - *Cardiovascular Diseases MH - Prognosis MH - Longitudinal Studies MH - Contrast Media MH - Gadolinium MH - Artificial Intelligence MH - Magnetic Resonance Imaging, Cine MH - Predictive Value of Tests MH - Risk Factors MH - *Heart Failure/diagnostic imaging/therapy MH - Heart Atria MH - Magnetic Resonance Spectroscopy MH - Ischemia MH - Stroke Volume OTO - NOTNLM OT - cardiac magnetic resonance OT - cardiovascular death OT - coupling OT - heart failure OT - left atrioventricular coupling index OT - myocardial ischemia OT - stress testing COIS- Funding Support and Author Disclosures Drs Toupin, Dr Chitiboi, Ms Jacob, and Dr Sharma are employees of Siemens Healthcare. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose. EDAT- 2023/04/14 06:00 MHDA- 2023/10/23 12:46 CRDT- 2023/04/13 10:27 PHST- 2023/01/11 00:00 [received] PHST- 2023/02/08 00:00 [accepted] PHST- 2023/10/23 12:46 [medline] PHST- 2023/04/14 06:00 [pubmed] PHST- 2023/04/13 10:27 [entrez] AID - S1936-878X(23)00112-2 [pii] AID - 10.1016/j.jcmg.2023.02.015 [doi] PST - ppublish SO - JACC Cardiovasc Imaging. 2023 Oct;16(10):1288-1302. doi: 10.1016/j.jcmg.2023.02.015. Epub 2023 Apr 12.