CT Attenuation Map Derived Body Composition Is Associated with Cardiorespiratory Fitness in Multicenter External Validation
Journal:
medRxiv
Published Date:
May 8, 2026
Abstract
Aim: Exercise capacity is a powerful predictor of cardiovascular risk. In patients unable to exercise, body composition analysis can potentially be used to estimate cardiorespiratory fitness. We developed a body composition fitness score, then validated its utility in two external populations. Methods and Results: We included patients from four sites undergoing single photon emission computed tomography (SPECT) and twelve sites undergoing positron emission tomography (PET). We quantified body composition using deep learning. We evaluated associations between body composition and good exercise capacity (defined as completing [≥]7 minutes on a Bruce protocol) then developed a body composition fitness score. We then assessed the associations of fitness score with exercise capacity and all-cause mortality in external populations. In total, 36471 patients were included with median age 67 (interquartile range 58 - 74). Median skeletal muscle density was higher among patients with good exercise capacity. In the external SPECT population, the body composition fitness score had higher prediction performance for good exercise capacity (AUC 0.771, 95% CI 0.752 - 0.789) than age (AUC 0.717, p<0.01). In the external PET population, high body composition fitness score was associated with lower cardiovascular death (adjusted hazard ratio 0.70, 95% CI 0.62 - 0.79, p<0.001). Conclusions: We demonstrated that a comprehensive body composition fitness score could identify patients with good cardiorespiratory fitness. This approach transforms routinely acquired CT data into a surrogate marker of fitness which can be applied in patients undergoing PET, or other CT imaging, where exercise testing is not performed.
