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AI-derived left-to-right cardiac chamber volume ratios in coronary artery calcium scans strongly predict heart failure.

Authors: Morteza Naghavi|||Seyed Reza Mirjalili|||Kyle Atlas|||Anthony P Reeves|||Chenyu Zhang|||Jakob Wasserthal|||Amir Azimi|||Ali Hashemi|||Mohammadhossein Mozafarybazargany|||Thomas Atlas|||Claudia I Henschke|||David F Yankelevitz|||Javier J Zulueta|||Jeffrey I Mechanick|||Andrea D Branch|||Rowena Yip|||Sion K Roy|||Khurram Nasir|||Zahi Fayad|||Michael V McConnell|||Ioannis A Kakadiaris|||Jamal S Rana|||Rozemarijn Vliegenthart|||David J Maron|||Jagat Narula|||Kim Williams|||Prediman K Shah|||Matthew J Budoff|||Daniel Levy|||Roxana Mehran|||Robert A Kloner|||Nathan D Wong

Journal: European heart journal. Cardiovascular Imaging

Publication Type: Journal Article

Date: 2026

DOI: PMC13021276

ID: 41591983

Affiliations:

Affiliations

    Artificial Intelligence Research Unit, HeartLung.AI, Houston, TX, USA.|||Artificial Intelligence Research Unit, HeartLung.AI, Houston, TX, USA.|||Artificial Intelligence Research Unit, HeartLung.AI, Houston, TX, USA.|||Department of Electrical and Computer Engineering, Cornell University, Ithaca, NY, USA.|||Artificial Intelligence Research Unit, HeartLung.AI, Houston, TX, USA.|||Clinic of Radiology and Nuclear Medicine, University Hospital Basel, , Basel, Switzerland.|||Artificial Intelligence Research Unit, HeartLung.AI, Houston, TX, USA.|||Artificial Intelligence Research Unit, HeartLung.AI, Houston, TX, USA.|||Artificial Intelligence Research Unit, HeartLung.AI, Houston, TX, USA.|||Department of Radiology, Tustin Teleradiology, Tustin, CA, USA.|||Department of Diagnostic, Molecular, and Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA.|||Department of Diagnostic, Molecular, and Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA.|||Pulmonary, Critical Care and Sleep Medicine, Mount Sinai Morningside Hospital, New York, NY, USA.|||Kravis Center for Clinical Cardiovascular Health, Mount Sinai Fuster Heart Hospital, New York, NY, USA.|||Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA.|||Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA.|||The Lundquist Institute at Harbor-UCLA, Torrance, CA, USA.|||Division of Cardiovascular Prevention and Wellness, Houston Methodist Hospital, Texas, USA.|||BioMedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA.|||Stanford Prevention Research Center, Stanford University School of Medicine, Stanford, CA, USA.|||Computational Biomedicine Laboratory, Department of Computer Science, University of Houston, Houston, TX, USA.|||Division of Cardiology, Kaiser Permanente Oakland Medical Center, California, USA.|||Department of Radiology, University Medical Center, Groningen, GZ, The Netherlands.|||Stanford Prevention Research Center, Stanford University School of Medicine, Stanford, CA, USA.|||Cardiovascular Research Institute, University of Texas Health-McGovern Medical School, Houston, TX, USA.|||Department of Medicine, University of Louisville, Louisville, KY, USA.|||Department of Cardiology, Atherosclerosis Research Center, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA.|||The Lundquist Institute at Harbor-UCLA, Torrance, CA, USA.|||Population Sciences Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA.|||Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA.|||Depatment of Cardiovascular Research, Huntington Medical Research Institutes, Pasadena, CA, USA.|||Heart Disease Prevention Program, Mary and Steve Wen Cardiovascular Division, University of California Irvine, Irvine, CA, USA.

Abstract

The AI-CVD initiative seeks to extract actionable insights from coronary artery calcium (CAC) scans beyond the traditional CAC score. We previously demonstrated that AI-derived cardiac chamber volumes from CAC scans predict incident heart failure (HF). We aimed to evaluate whether left-to-right cardiac chamber volume ratios outperform chamber volumes in predicting HF.


Reference List

    Savarese  G, Becher  PM, Lund  LH, Seferovic  P, Rosano  GMC, Coats  AJS. Global burden of heart failure: a comprehensive and updated review of epidemiology. Cardiovasc Res  2022;118:3272–87.|||Wei  C, Heidenreich  PA, Sandhu  AT. The economics of heart failure care. Prog Cardiovasc Dis  2024;82:90–101.|||McDonagh  TA, Metra  M, Adamo  M, Gardner  RS, Baumbach  A, Böhm  M  et al.  2023 Focused Update of the 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J  2023;44:3627–39.|||McCracken  C, Szabo  L, Abdulelah  ZA, Condurache  D-G, Vago  H, Nichols  TE  et al.  Ventricular volume asymmetry as a novel imaging biomarker for disease discrimination and outcome prediction. Eur Heart J Open  2024;4:oeae059. doi: 10.1093/ehjopen/oeae059.|||Ndumele  CE, Rangaswami  J, Chow  SL, Neeland  IJ, Tuttle  KR, Khan  SS  et al.  Cardiovascular-kidney-metabolic health: a presidential advisory from the American Heart Association. Circulation  2023;148:1606–35.|||Naghavi  M, Reeves  A, Budoff  M, Li  D, Atlas  K, Zhang  C  et al.  AI-enabled cardiac chambers volumetry in coronary artery calcium scans (AI-CAC(TM)) predicts heart failure and outperforms NT-proBNP: the multi-ethnic study of atherosclerosis. J Cardiovasc Comput Tomogr  2024;18:392–400.|||Naghavi  M, Mirjalili  R, Atlas  K, Zhang  C, Reeves  A, Atlas  T  et al.  AI-enabled Cardiac chambers volumetry interactions with diabetes for incident heart failure: an AI-CVD study. J Cardiovasc Comput Tomogr  2025;19:S52.|||Naghavi  M, Reeves  AP, Atlas  K, Zhang  C, Atlas  T, Henschke  CI  et al.  Artificial intelligence applied to coronary artery calcium scans (AI-CAC) significantly improves cardiovascular events prediction. NPJ Digit Med  2024;7:309.|||Naghavi  M, Reeves Anthony  P, Atlas Kyle  C, Zhang  C, Li  D, Atlas  T  et al.  AI-Enabled CT cardiac chamber volumetry predicts atrial fibrillation and stroke comparable to MRI. JACC Adv  2024;3:101300.|||Naghavi  M, Yankelevitz  D, Reeves  AP, Budoff  MJ, Li  D, Atlas  K  et al.  AI-enabled left atrial volumetry in coronary artery calcium scans (AI-CAC(TM)) predicts atrial fibrillation as early as one year, improves CHARGE-AF, and outperforms NT-proBNP: the multi-ethnic study of atherosclerosis. J Cardiovasc Comput Tomogr  2024;18:383–91.|||Razipour  A, Grodecki  K, Manral  N, Geers  J, Gransar  H, Shanbhag  A  et al.  AI-derived automated quantification of cardiac chambers and myocardium from non-contrast CT: prediction of major adverse cardiovascular events in asymptomatic subjects. Atherosclerosis  2025;401:119098.|||Miller  RJH, Killekar  A, Shanbhag  A, Bednarski  B, Michalowska  AM, Ruddy  TD  et al.  Predicting mortality from AI cardiac volumes mass and coronary calcium on chest computed tomography. Nat Commun  2024;15:2747.|||Hoballah  M, Chehab  O, Abdollahi  A, Wu Colin  O, Scarpa  B, Post Wendy  S  et al.  Left-to-right cardiac chamber volume ratios as predictors of cardiovascular events: the multi-ethnic study of atherosclerosis (MESA). JACC  2025;85:2109.|||von Knobelsdorff-Brenkenhoff  F, Pilz  G, Schulz-Menger  J. Representation of cardiovascular magnetic resonance in the AHA/ACC guidelines. J Cardiovasc Magn Reson  2017;19:70.|||Naghavi  M, Reeves  A, Atlas  K, Zhang  C, Roy  S, Budoff  M  et al.  Automated left ventricular volumetry using artificial intelligence in coronary calcium scans (AI-CAC) predicts heart failure comparably to cardiac MRI and outperforms NT-proBNP: the multi-ethnic study of atherosclerosis (MESA). J Cardiovasc Comput Tomogr  2024;18:S16–7.|||Naghavi  M, Atlas  K, Zhang  C, Reeves  A, Jaalouk  E, Henschke  C  et al.  AI-enabled Cardiac chambers volumetry in non-contrast cardiac CT scans (AI-CAC) detects HFrEF vs. HFpEF. Circulation  2024;150:A4144057–A.|||Bild  DE, Bluemke  DA, Burke  GL, Detrano  R, Roux  D, Folsom  AV  et al.  Multi-ethnic study of atherosclerosis: objectives and design. Am J Epidemiol  2002;156:871–81.|||Bittencourt  MS, Blankstein  R, Mao  S, Rivera  JJ, Bertoni  AG, Shaw  LJ  et al.  Left ventricular area on non-contrast cardiac computed tomography as a predictor of incident heart failure—the Multi-Ethnic Study of Atherosclerosis. J Cardiovasc Comput Tomogr  2016;10:500–6.|||Kannel  WB, Feinleib  M, Mcnamara  PM, Garrison  RJ, Castelli  WP. An investigation of coronary heart disease in families: the framingham offspring study. Am J Epidemiol  1979;110:281–90.|||Liu  CT, Broe  KE, Zhou  Y, Boyd  SK, Cupples  LA, Hannan  MT  et al.  Visceral adipose tissue is associated with bone microarchitecture in the framingham osteoporosis study. J Bone Miner Res  2017;32:143–50.|||McKee  PA, Castelli  WP, McNamara  PM, Kannel  WB. The natural history of congestive heart failure: the framingham study. N Engl J Med  1971;285:1441–6.|||Khan  SS, Matsushita  K, Sang  Y, Ballew  SH, Grams  ME, Surapaneni  A  et al.  Development and validation of the American Heart Association’s PREVENT equations. Circulation  2024;149:430–49.|||Khan  SS, Coresh  J, Pencina  MJ, Ndumele  CE, Rangaswami  J, Chow  SL  et al.  Novel prediction equations for absolute risk assessment of total cardiovascular disease incorporating cardiovascular-kidney-metabolic health: a scientific statement from the American Heart Association. Circulation  2023;148:1982–2004.|||Drowatzky  KL, Durstine  JL, Irwin  ML, Moore  CG, Davis  PG, Hand  GA  et al.  The association between physical activity, cardiorespiratory fitness, and lipoprotein(a) concentrations in a tri-ethnic sample of women: the Cross-Cultural Activity Participation Study. Vasc Med  2001;6:15–21.|||Ekelund  U, Steene-Johannessen  J, Brown  WJ, Fagerland  MW, Owen  N, Powell  KE  et al.  Does physical activity attenuate, or even eliminate, the detrimental association of sitting time with mortality? A harmonised meta-analysis of data from more than 1 million men and women. Lancet  2016;388:1302–10.|||Ozemek  C, Bonikowske  A, Christle  J, Gallo  P. ACSM's Guidelines for Exercise Testing and Prescription. Philadelphia: Lippincott Williams & Wilkins; 2025.|||Asch  FM, Miyoshi  T, Addetia  K, Citro  R, Daimon  M, Desale  S  et al.  Similarities and differences in left ventricular size and function among races and nationalities: results of the world alliance societies of echocardiography normal values study. J Am Soc Echocardiogr  2019;32:1396–406.e2.|||Yates  T, Razieh  C, Henson  J, Rowlands  AV, Goldney  J, Gulsin  GS  et al.  Device-measured physical activity and cardiac structure by magnetic resonance. Eur Heart J  2024;46:176–86.|||Galderisi  M, Cardim  N, D'Andrea  A, Bruder  O, Cosyns  B, Davin  L  et al.  The multi-modality cardiac imaging approach to the Athlete's heart: an expert consensus of the European Association of Cardiovascular Imaging. Eur Heart J Cardiovasc Imaging  2015;16:353.|||Flanagan  H, Cooper  R, George  KP, Augustine  DX, Malhotra  A, Paton  MF  et al.  The athlete’s heart: insights from echocardiography. Echo Res Pract  2023;10:15.|||Dong  T, Wang  TKM. Nuances in defining normal ranges for chamber quantification with cardiovascular magnetic resonance. Circ Cardiovasc Imaging  2024;17:e016488.|||Arbab-Zadeh  A, Dijk  E, Prasad  A, Fu  Q, Torres  P, Zhang  R  et al.  Effect of aging and physical activity on left ventricular compliance. Circulation  2004;110:1799–805.|||Diaz-Canestro  C, Montero  D. The impact of sex on left ventricular cardiac adaptations to endurance training: a systematic review and meta-analysis. Sports Med  2020;50:1501–13.