{
  "abstract": "Aim To assess the prognostic value of AI-derived cardiothoracic structures and coronary artery calcification volumetric measurements in pulmonary hypertension (PH) using non-gated, non-contrast CT.Methods Two validated deep learning models were used to segment and measure the volumes of cardiothoracic structures and coronary artery calcifications on non-contrast CT scans. The prognostic value of AI-derived cardiothoracic structures and coronary artery calcification volumetric measurements was assessed using univariable and multivariable Cox regression adjusted for demographics and PH subgroups and REVEAL scores.Results 620 patients were included, with a mean age of 64±13 years, 62% female, and 472 patients with PH. Calcifications were present in the right coronary artery (RCA), mainstem and left anterior descending artery (LAD), and left circumflex artery (LCX) in 45%, 67%, and 35% of patients, respectively. Among these, 388 patients died. In multivariable Cox regression analysis adjusted for age, sex, and PH subgroup, right atrial (RA) volume was independently associated with mortality (HR 1.024, 95% CI 1.009–1.039, p = 0.001), as were coronary artery calcifications in the RCA (HR 1.378, 95% CI 1.113–1.705, p = 0.003), mainstem and LAD (HR 1.868, 95% CI 1.441–2.421, p < 0.001), and LCX (HR 1.342, 95% CI 1.084–1.660, p = 0.007). After further adjustment for the REVEAL risk score, these associations remained significant (RA volume HR 1.026, RCA calcification HR 1.604, mainstem and LAD calcification HR 2.339, LCX calcification HR 1.576; all p < 0.001) (table 1, figures 1 and 2).Conclusion AI-derived RA volume and coronary artery calcifications are independently associated with increased mortality in PH patients. Which cardiovascular structure volume is independently associated with increased mortality in PH patients?LAAscending aortaDescending aortaRAAbstract 18 Figure 2Kaplan–Meier survival curves according to AI-derived cardiac structure volumes of right atrium volume and mainstem and left anterior descending artery calcification volumeAbstract 18 Table 1Univariable and multivariable Cox regression analysis of AI-derived structure volumes and mortality in pulmonary hypertension (PH)StructureUnivariable analysisMultivariable analysis **Multivariable analysis ***HR+95% CIp-valueSigHR+95% CIp-valueSigHR+95% CIp-valueSigVentricles1.0020.996 – 1.0090.5081.0010.994 – 1.0090.7070.9950.988 – 1.0020.152LA1.0451.022 – 1.068< 0.001*1.0030.979 – 1.0280.7881.0241.001 – 1.0470.043*RA1.0411.027 – 1.055< 0.001*1.0241.009 – 1.0390.001*1.0261.012 – 1.041< 0.001*AAo1.0241.001 – 1.0470.040*0.9870.962 – 1.0120.3130.9990.976 – 1.0230.931PA1.0251.007 – 1.0430.008*1.0100.989 – 1.0320.3401.0050.985 – 1.0250.655DAo1.0431.016 – 1.0700.002*0.9990.968 – 1.0310.9411.0100.982 – 1.0380.493PA/AAo > 11.1990.980 – 1.4670.0771.3561.090 – 1.6860.006*1.1530.942 – 1.4110.166RCA calcification1.7881.462 – 2.184< 0.001*1.3781.113 – 1.7050.003*1.6041.311 – 1.964< 0.001*Mainstem + LAD calcification2.4981.959 – 3.182< 0.001*1.8681.441 – 2.421< 0.001*2.3391.834 – 2.983< 0.001*LCX calcification1.8031.472 – 2.206< 0.001*1.3421.084 – 1.6600.007*1.5761.285 – 1.933< 0.001*Calcification in any coronary artery2.4151.865 – 3.127< 0.001*2.1911.670 – 2.874< 0.001*2.2991.775 – 2.979< 0.001*Calcification in all coronary arteries1.8821.524 – 2.324< 0.001*1.6731.347 – 2.077< 0.001*1.6611.342 – 2.055< 0.001*LA: Left atrium, RA: Right atrium, AAo: Ascending aorta, PA: Pulmonary artery, DAo: Descending aorta, RCA: Right Coronary Artery, LAD: Left Anterior Descending Artery, LCX: Left Circumflex Artery, HR: Hazard ratio, CI: Confidence Interval. *Significant. ** Multivariable Cox regression models adjusted for age, sex, and PH subgroups. *** Multivariable Cox regression models adjusted for REVEAL 2.0 as exploratory analysis. + Hazard ratios indicate hazard per 10-mL increase in AI-derived volume from non-contrast CT.Abstract 18 Figure 1Flow chart of the study design. PH: Pulmonary Hypertension, PAH: Pulmonary arterial hypertension, LHD: Left Heart Disease, CTEPH: Chronic thromboembolic pulmonary hypertension, RCA: Right Coronary Artery, LAD: Left Anterior Descending Artery, LCX: Left Circumflex ArteryPA",
  "authors": [
    {
      "affiliations": [
        "School of Medicine and Population Health, The University of Sheffield, Sheffield, United Kingdom",
        "Radiological Sciences Department, College of Applied Medical Science, King Saud bin Abdulaziz University for Health Science, Riyadh, Saudi Arabia",
        "King Abdullah International Medical Research Centre (KAIMRC), Riyadh, Saudi Arabia"
      ],
      "name": "Turki Nasser Alnasser"
    },
    {
      "affiliations": [
        "School of Medicine and Population Health, The University of Sheffield, Sheffield, United Kingdom",
        "Insigneo Institute, Faculty of Engineering, The University of Sheffield, Sheffield, United Kingdom"
      ],
      "name": "Alireza Hokmabadi"
    },
    {
      "affiliations": [
        "School of Medicine and Population Health, The University of Sheffield, Sheffield, United Kingdom"
      ],
      "name": "Michael Sharkey"
    },
    {
      "affiliations": [
        "School of Medicine and Population Health, The University of Sheffield, Sheffield, United Kingdom",
        "Insigneo Institute, Faculty of Engineering, The University of Sheffield, Sheffield, United Kingdom",
        "National Institute for Health and Care Research, Sheffield Biomedical Research Centre, Sheffield, United Kingdom",
        "Sheffield Pulmonary Vascular Disease Unit, Sheffield Teaching Hospitals NHS Trust, Sheffield, United Kingdom"
      ],
      "name": "David G Kiely"
    },
    {
      "affiliations": [
        "School of Medicine and Population Health, The University of Sheffield, Sheffield, United Kingdom",
        "Insigneo Institute, Faculty of Engineering, The University of Sheffield, Sheffield, United Kingdom",
        "National Institute for Health and Care Research, Sheffield Biomedical Research Centre, Sheffield, United Kingdom",
        "Department of Clinical Radiology, Sheffield Teaching Hospitals, Sheffield, United Kingdom"
      ],
      "name": "Samer Alabed"
    },
    {
      "affiliations": [
        "School of Medicine and Population Health, The University of Sheffield, Sheffield, United Kingdom",
        "Insigneo Institute, Faculty of Engineering, The University of Sheffield, Sheffield, United Kingdom",
        "National Institute for Health and Care Research, Sheffield Biomedical Research Centre, Sheffield, United Kingdom",
        "Department of Clinical Radiology, Sheffield Teaching Hospitals, Sheffield, United Kingdom"
      ],
      "name": "Andrew J Swift"
    }
  ],
  "title": "18 AI-derived cardiothoracic structures and coronary artery calcification volumes on non-contrast CT as predictors of mortality in pulmonary hypertension",
  "uid": "785a4377-8878-5334-876e-cde6dd8526c6"
}