A Machine Learning Model Using Cardiac CT and MRI Data Predicts Cardiovascular Events in Obstructive Coronary Artery Disease.

Journal: Radiology
PMID: 39807980

Abstract

Background Multimodality imaging is essential for personalized prognostic stratification in suspected coronary artery disease (CAD). Machine learning (ML) methods can help address this complexity by incorporating a broader spectrum of variables. Purpose To investigate the performance of an ML model that uses both stress cardiac MRI and coronary CT angiography (CCTA) data to predict major adverse cardiovascular events (MACE) in patients with newly diagnosed CAD. Materials and Methods This retrospective study included consecutive symptomatic patients without known CAD referred for CCTA between December 2008 and January 2020. Patients with obstructive CAD (at least one ≥50% stenosis at CCTA) underwent stress cardiac MRI for functional assessment. Eighteen clinical, two electrocardiogram, nine CCTA, and 12 cardiac MRI parameters were evaluated as inputs for the ML model, which involved automated feature selection with the least absolute shrinkage and selection operator algorithm and model building with an XGBoost algorithm. The primary outcome was MACE, defined as a composite of cardiovascular death and nonfatal myocardial infarction. External testing was performed using two independent datasets. Performance was compared between the ML model and existing scores and other approaches using the area under the receiver operating characteristic curve (AUC). Results Of 2210 patients who completed cardiac MRI, 2038 (mean age, 70 years ± 12 [SD]; 1091 [53.5%] female participants) completed follow-up (median duration, 7 years [IQR, 6-9 years]); 281 experienced MACE (13.8%). The ML model exhibited a higher AUC (0.86) for MACE prediction than the European Society of Cardiology score (0.55), QRISK3 score (0.60), Framingham Risk Score (0.50), segment involvement score (0.71), CCTA data alone (0.76), or stress cardiac MRI data alone (0.83) ( value range, <.001 to .004). The ML model also exhibited good performance in the two external validation datasets (AUC, 0.84 and 0.92). Conclusion An ML model including both CCTA and stress cardiac MRI data demonstrated better performance in predicting MACE than traditional methods and existing scores in patients with newly diagnosed CAD. © RSNA, 2025

Authors

  • Théo Pezel
    Department of Cardiology, University Hospital of Lariboisiere, Université Paris-Cité, (Assistance Publique des Hôpitaux de Paris, AP-HP), Paris, France.
  • Solenn Toupin
    Siemens Healthcare France, Scientific Partnerships, Saint-Denis, France.
  • Valérie Bousson
    Université de Paris, 85 boulevard Saint-Germain, Paris 75006, France; Radiology Department, Hopital Lariboisiére - AP-HP.Nord Université de Paris, 2 Rue Ambroise Paré, Paris 75010, France.
  • Kenza Hamzi
    MIRACL.ai Laboratory, Multimodality Imaging for Research and Analysis Core Laboratory and Artificial Intelligence, University Hospital of Lariboisiere (AP-HP), Paris, France.
  • Thomas Hovasse
    Cardiovascular Magnetic Resonance Laboratory, Institut Cardiovasculaire Paris Sud (ICPS), Hôpital Privé Jacques Cartier, Ramsay Santé, Massy, France.
  • Thierry Lefevre
    From the Department of Cardiology (T.P., K.H., T.G., A.L., E.G., A.U., J.G.D., P.H.), MIRACL.ai (Multimodality Imaging for Research and Analysis Core Laboratory: and Artificial Intelligence) (T.P., S.T., K.H., T.G., A.L., E.G., A.U., J.G.D., P.H.), Inserm MASCOT-UMRS 942 (T.P., K.H., T.A.S., T.G., A.L., E.G., A.U., J.G.D., P.H.), and Department of Radiology (T.P., V.B., L.H., T.G.), Université Paris Cité, University Hospital of Lariboisière, Assistance Publique-Hôpitaux de Paris, Paris, France; Cardiovascular Magnetic Resonance Laboratory (T.P., T.H., T.U., F.S., S.C., P.G., J.G.) and Cardiac Computed Tomography Laboratory (T.P., T.H., T.L., B.C., T.U., F.S., S.C., H.B., A.N., M.A., P.G., J.G.), Hôpital Privé Jacques Cartier, Institut Cardiovasculaire Paris Sud, Ramsay Santé, 6 Avenue du Noyer Lambert, 91300 Massy, France; Scientific Partnerships, Siemens Healthcare France, Saint-Denis, France (S.T.); Department of Cardiology, Hôpital Universitaire de Bruxelles-Hôpital Erasme, Brussels, Belgium (A.U.); and Department of Cardiovascular Imaging, American Hospital of Paris, Neuilly, France (O.V., M.S.).
  • Bernard Chevalier
    From the Department of Cardiology (T.P., K.H., T.G., A.L., E.G., A.U., J.G.D., P.H.), MIRACL.ai (Multimodality Imaging for Research and Analysis Core Laboratory: and Artificial Intelligence) (T.P., S.T., K.H., T.G., A.L., E.G., A.U., J.G.D., P.H.), Inserm MASCOT-UMRS 942 (T.P., K.H., T.A.S., T.G., A.L., E.G., A.U., J.G.D., P.H.), and Department of Radiology (T.P., V.B., L.H., T.G.), Université Paris Cité, University Hospital of Lariboisière, Assistance Publique-Hôpitaux de Paris, Paris, France; Cardiovascular Magnetic Resonance Laboratory (T.P., T.H., T.U., F.S., S.C., P.G., J.G.) and Cardiac Computed Tomography Laboratory (T.P., T.H., T.L., B.C., T.U., F.S., S.C., H.B., A.N., M.A., P.G., J.G.), Hôpital Privé Jacques Cartier, Institut Cardiovasculaire Paris Sud, Ramsay Santé, 6 Avenue du Noyer Lambert, 91300 Massy, France; Scientific Partnerships, Siemens Healthcare France, Saint-Denis, France (S.T.); Department of Cardiology, Hôpital Universitaire de Bruxelles-Hôpital Erasme, Brussels, Belgium (A.U.); and Department of Cardiovascular Imaging, American Hospital of Paris, Neuilly, France (O.V., M.S.).
  • Thierry Unterseeh
    Cardiovascular Magnetic Resonance Laboratory, Institut Cardiovasculaire Paris Sud (ICPS), Hôpital Privé Jacques Cartier, Ramsay Santé, Massy, France.
  • Francesca Sanguineti
    Cardiovascular Magnetic Resonance Laboratory, Institut Cardiovasculaire Paris Sud (ICPS), Hôpital Privé Jacques Cartier, Ramsay Santé, Massy, France.
  • Stéphane Champagne
    Cardiovascular Magnetic Resonance Laboratory, Institut Cardiovasculaire Paris Sud (ICPS), Hôpital Privé Jacques Cartier, Ramsay Santé, Massy, France.
  • Hakim Benamer
    From the Department of Cardiology (T.P., K.H., T.G., A.L., E.G., A.U., J.G.D., P.H.), MIRACL.ai (Multimodality Imaging for Research and Analysis Core Laboratory: and Artificial Intelligence) (T.P., S.T., K.H., T.G., A.L., E.G., A.U., J.G.D., P.H.), Inserm MASCOT-UMRS 942 (T.P., K.H., T.A.S., T.G., A.L., E.G., A.U., J.G.D., P.H.), and Department of Radiology (T.P., V.B., L.H., T.G.), Université Paris Cité, University Hospital of Lariboisière, Assistance Publique-Hôpitaux de Paris, Paris, France; Cardiovascular Magnetic Resonance Laboratory (T.P., T.H., T.U., F.S., S.C., P.G., J.G.) and Cardiac Computed Tomography Laboratory (T.P., T.H., T.L., B.C., T.U., F.S., S.C., H.B., A.N., M.A., P.G., J.G.), Hôpital Privé Jacques Cartier, Institut Cardiovasculaire Paris Sud, Ramsay Santé, 6 Avenue du Noyer Lambert, 91300 Massy, France; Scientific Partnerships, Siemens Healthcare France, Saint-Denis, France (S.T.); Department of Cardiology, Hôpital Universitaire de Bruxelles-Hôpital Erasme, Brussels, Belgium (A.U.); and Department of Cardiovascular Imaging, American Hospital of Paris, Neuilly, France (O.V., M.S.).
  • Antoinette Neylon
    From the Department of Cardiology (T.P., K.H., T.G., A.L., E.G., A.U., J.G.D., P.H.), MIRACL.ai (Multimodality Imaging for Research and Analysis Core Laboratory: and Artificial Intelligence) (T.P., S.T., K.H., T.G., A.L., E.G., A.U., J.G.D., P.H.), Inserm MASCOT-UMRS 942 (T.P., K.H., T.A.S., T.G., A.L., E.G., A.U., J.G.D., P.H.), and Department of Radiology (T.P., V.B., L.H., T.G.), Université Paris Cité, University Hospital of Lariboisière, Assistance Publique-Hôpitaux de Paris, Paris, France; Cardiovascular Magnetic Resonance Laboratory (T.P., T.H., T.U., F.S., S.C., P.G., J.G.) and Cardiac Computed Tomography Laboratory (T.P., T.H., T.L., B.C., T.U., F.S., S.C., H.B., A.N., M.A., P.G., J.G.), Hôpital Privé Jacques Cartier, Institut Cardiovasculaire Paris Sud, Ramsay Santé, 6 Avenue du Noyer Lambert, 91300 Massy, France; Scientific Partnerships, Siemens Healthcare France, Saint-Denis, France (S.T.); Department of Cardiology, Hôpital Universitaire de Bruxelles-Hôpital Erasme, Brussels, Belgium (A.U.); and Department of Cardiovascular Imaging, American Hospital of Paris, Neuilly, France (O.V., M.S.).
  • Mariama Akodad
    From the Department of Cardiology (T.P., K.H., T.G., A.L., E.G., A.U., J.G.D., P.H.), MIRACL.ai (Multimodality Imaging for Research and Analysis Core Laboratory: and Artificial Intelligence) (T.P., S.T., K.H., T.G., A.L., E.G., A.U., J.G.D., P.H.), Inserm MASCOT-UMRS 942 (T.P., K.H., T.A.S., T.G., A.L., E.G., A.U., J.G.D., P.H.), and Department of Radiology (T.P., V.B., L.H., T.G.), Université Paris Cité, University Hospital of Lariboisière, Assistance Publique-Hôpitaux de Paris, Paris, France; Cardiovascular Magnetic Resonance Laboratory (T.P., T.H., T.U., F.S., S.C., P.G., J.G.) and Cardiac Computed Tomography Laboratory (T.P., T.H., T.L., B.C., T.U., F.S., S.C., H.B., A.N., M.A., P.G., J.G.), Hôpital Privé Jacques Cartier, Institut Cardiovasculaire Paris Sud, Ramsay Santé, 6 Avenue du Noyer Lambert, 91300 Massy, France; Scientific Partnerships, Siemens Healthcare France, Saint-Denis, France (S.T.); Department of Cardiology, Hôpital Universitaire de Bruxelles-Hôpital Erasme, Brussels, Belgium (A.U.); and Department of Cardiovascular Imaging, American Hospital of Paris, Neuilly, France (O.V., M.S.).
  • Tania Ah-Sing
    From the Department of Cardiology (T.P., K.H., T.G., A.L., E.G., A.U., J.G.D., P.H.), MIRACL.ai (Multimodality Imaging for Research and Analysis Core Laboratory: and Artificial Intelligence) (T.P., S.T., K.H., T.G., A.L., E.G., A.U., J.G.D., P.H.), Inserm MASCOT-UMRS 942 (T.P., K.H., T.A.S., T.G., A.L., E.G., A.U., J.G.D., P.H.), and Department of Radiology (T.P., V.B., L.H., T.G.), Université Paris Cité, University Hospital of Lariboisière, Assistance Publique-Hôpitaux de Paris, Paris, France; Cardiovascular Magnetic Resonance Laboratory (T.P., T.H., T.U., F.S., S.C., P.G., J.G.) and Cardiac Computed Tomography Laboratory (T.P., T.H., T.L., B.C., T.U., F.S., S.C., H.B., A.N., M.A., P.G., J.G.), Hôpital Privé Jacques Cartier, Institut Cardiovasculaire Paris Sud, Ramsay Santé, 6 Avenue du Noyer Lambert, 91300 Massy, France; Scientific Partnerships, Siemens Healthcare France, Saint-Denis, France (S.T.); Department of Cardiology, Hôpital Universitaire de Bruxelles-Hôpital Erasme, Brussels, Belgium (A.U.); and Department of Cardiovascular Imaging, American Hospital of Paris, Neuilly, France (O.V., M.S.).
  • Lounis Hamzi
    Radiology Department, Lariboisière's Hospital, AP-HP.Nord-Université de Paris, 2 rue Ambroise Paré, 75010, Paris, France (V.B., G.A., N.B., L.P., L.H.).
  • Trecy Gonçalves
    Department of Cardiology, Université Paris Cité, University Hospital of Lariboisiere, (Assistance Publique des Hôpitaux de Paris, AP-HP), 75010 Paris, France.
  • Antoine Lequipar
    Inserm MASCOT - UMRS 942, Department of Cardiology, University Hospital of Lariboisière, Université Paris-Cité, AP-HP, 75010 Paris, France; Multimodality Imaging Research for Analysis Core Laboratory: Artificial Intelligence (MIRACL.ai), Department of Data Science, Machine Learning and Artificial Intelligence in Health, University Hospital of Lariboisière, AP-HP, 75010 Paris, France.
  • Emmanuel Gall
    Department of Cardiology, Université Paris Cité, University Hospital of Lariboisiere, (Assistance Publique des Hôpitaux de Paris, AP-HP), 75010 Paris, France.
  • Alexandre Unger
    Department of Cardiology, Université Paris Cité, University Hospital of Lariboisiere, (Assistance Publique des Hôpitaux de Paris, AP-HP), 75010 Paris, France.
  • Jean Guillaume Dillinger
    Cardiology Department, Lariboisière Hospital, Assistance Publique Hôpitaux de Paris, Université Paris VII Denis Diderot, Paris, France.
  • Patrick Henry
    Cardiology Department, Lariboisière Hospital, Assistance Publique Hôpitaux de Paris, Université Paris VII Denis Diderot, Paris, France.
  • Olivier Vignaux
    From the Department of Cardiology (T.P., K.H., T.G., A.L., E.G., A.U., J.G.D., P.H.), MIRACL.ai (Multimodality Imaging for Research and Analysis Core Laboratory: and Artificial Intelligence) (T.P., S.T., K.H., T.G., A.L., E.G., A.U., J.G.D., P.H.), Inserm MASCOT-UMRS 942 (T.P., K.H., T.A.S., T.G., A.L., E.G., A.U., J.G.D., P.H.), and Department of Radiology (T.P., V.B., L.H., T.G.), Université Paris Cité, University Hospital of Lariboisière, Assistance Publique-Hôpitaux de Paris, Paris, France; Cardiovascular Magnetic Resonance Laboratory (T.P., T.H., T.U., F.S., S.C., P.G., J.G.) and Cardiac Computed Tomography Laboratory (T.P., T.H., T.L., B.C., T.U., F.S., S.C., H.B., A.N., M.A., P.G., J.G.), Hôpital Privé Jacques Cartier, Institut Cardiovasculaire Paris Sud, Ramsay Santé, 6 Avenue du Noyer Lambert, 91300 Massy, France; Scientific Partnerships, Siemens Healthcare France, Saint-Denis, France (S.T.); Department of Cardiology, Hôpital Universitaire de Bruxelles-Hôpital Erasme, Brussels, Belgium (A.U.); and Department of Cardiovascular Imaging, American Hospital of Paris, Neuilly, France (O.V., M.S.).
  • Marc Sirol
    From the Department of Cardiology (T.P., K.H., T.G., A.L., E.G., A.U., J.G.D., P.H.), MIRACL.ai (Multimodality Imaging for Research and Analysis Core Laboratory: and Artificial Intelligence) (T.P., S.T., K.H., T.G., A.L., E.G., A.U., J.G.D., P.H.), Inserm MASCOT-UMRS 942 (T.P., K.H., T.A.S., T.G., A.L., E.G., A.U., J.G.D., P.H.), and Department of Radiology (T.P., V.B., L.H., T.G.), Université Paris Cité, University Hospital of Lariboisière, Assistance Publique-Hôpitaux de Paris, Paris, France; Cardiovascular Magnetic Resonance Laboratory (T.P., T.H., T.U., F.S., S.C., P.G., J.G.) and Cardiac Computed Tomography Laboratory (T.P., T.H., T.L., B.C., T.U., F.S., S.C., H.B., A.N., M.A., P.G., J.G.), Hôpital Privé Jacques Cartier, Institut Cardiovasculaire Paris Sud, Ramsay Santé, 6 Avenue du Noyer Lambert, 91300 Massy, France; Scientific Partnerships, Siemens Healthcare France, Saint-Denis, France (S.T.); Department of Cardiology, Hôpital Universitaire de Bruxelles-Hôpital Erasme, Brussels, Belgium (A.U.); and Department of Cardiovascular Imaging, American Hospital of Paris, Neuilly, France (O.V., M.S.).
  • Philippe Garot
    Cardiovascular Magnetic Resonance Laboratory, Institut Cardiovasculaire Paris Sud (ICPS), Hôpital Privé Jacques Cartier, Ramsay Santé, Massy, France.
  • Jérôme Garot
    Cardiovascular Magnetic Resonance Laboratory, Institut Cardiovasculaire Paris Sud (ICPS), Hôpital Privé Jacques Cartier, Ramsay Santé, Massy, France.

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