AI-enabled cardiac chambers volumetry in coronary calcium scans (AI-CAC) predicts heart failure and outperforms NT-proBNP: The Multi-Ethnic Study of Atherosclerosis

Abstract Introduction Coronary artery calcium (CAC) scans contain useful information beyond the Agatston CAC score that is not currently reported. We recently reported that artificial intelligence (AI)-enabled cardiac chambers volumetry in CAC scans (AI-CAC) predicted incident atrial fibrillation in the Multi-Ethnic Study of Atherosclerosis (MESA). In this study, we investigated the performance of AI-CAC for prediction of incident heart failure (HF) and compared it with 10 known clinical risk factors, NT-proBNP, and the Agatston CAC score. Methods We applied AI-CAC to 5750 CAC scans of asymptomatic individuals (52% women, White 40%, Black 26%, Hispanic 22% Chinese 12%) free of known cardiovascular disease at the MESA baseline examination (2000-2002). We used the 15-year outcomes data and compared the time-dependent area under the curve (AUC) of AI-CAC versus NT-proBNP, Agatston score, and 10 known clinical risk factors (age, gender, diabetes, current smoking, hypertension medication, systolic and diastolic blood pressure, LDL, HDL, total cholesterol, and hs-CRP) for predicting incident HF over 15 years. Results Over 15 years of follow-up, 256 HF events accrued. The AUC for predicting HF with AI-CAC (0.826) was significantly higher than NT-proBNP (0.742) and Agatston score (0.712) (p<.0001), and comparable to clinical risk factors (0.818, p=0.4141). AI-CAC category-free Net Reclassification Index (NRI) significantly improved on clinical risk factors (0.32), NT-proBNP (0.46), and Agatston score (0.71) for HF prediction at 15 years (p<0.0001). Conclusion AI-CAC significantly outperformed NT-proBNP and the Agatston CAC score, and significantly improved the AUC and category-free NRI of clinical risk factors for incident HF prediction.