Enhancing cardiovascular risk prediction through AI-enabled calcium-omics

• URL: http://arxiv.org/abs/2308.12224v1
• Date: Wed, 23 Aug 2023 16:05:14 GMT
• Title: Enhancing cardiovascular risk prediction through AI-enabled calcium-omics
• Authors: Ammar Hoori, Sadeer Al-Kindi, Tao Hu, Yingnan Song, Hao Wu, Juhwan Lee, Nour Tashtish, Pingfu Fu, Robert Gilkeson, Sanjay Rajagopalan, David L. Wilson
• Abstract summary: Coronary artery calcium (CAC) is a powerful predictor of major adverse cardiovascular events (MACE) To determine if AI methods using detailed calcification features (i.e., calcium-omics) can improve MACE prediction. Our findings suggest the utility of calcium-omics in improved prediction of risk.
• Score: 4.035300372916709
• License: http://creativecommons.org/licenses/by-nc-nd/4.0/
• Abstract: Background. Coronary artery calcium (CAC) is a powerful predictor of major adverse cardiovascular events (MACE). Traditional Agatston score simply sums the calcium, albeit in a non-linear way, leaving room for improved calcification assessments that will more fully capture the extent of disease. Objective. To determine if AI methods using detailed calcification features (i.e., calcium-omics) can improve MACE prediction. Methods. We investigated additional features of calcification including assessment of mass, volume, density, spatial distribution, territory, etc. We used a Cox model with elastic-net regularization on 2457 CT calcium score (CTCS) enriched for MACE events obtained from a large no-cost CLARIFY program (ClinicalTri-als.gov Identifier: NCT04075162). We employed sampling techniques to enhance model training. We also investigated Cox models with selected features to identify explainable high-risk characteristics. Results. Our proposed calcium-omics model with modified synthetic down sampling and up sampling gave C-index (80.5%/71.6%) and two-year AUC (82.4%/74.8%) for (80:20, training/testing), respectively (sampling was applied to the training set only). Results compared favorably to Agatston which gave C-index (71.3%/70.3%) and AUC (71.8%/68.8%), respectively. Among calcium-omics features, numbers of calcifications, LAD mass, and diffusivity (a measure of spatial distribution) were important determinants of increased risk, with dense calcification (>1000HU) associated with lower risk. The calcium-omics model reclassified 63% of MACE patients to the high risk group in a held-out test. The categorical net-reclassification index was NRI=0.153. Conclusions. AI analysis of coronary calcification can lead to improved results as compared to Agatston scoring. Our findings suggest the utility of calcium-omics in improved prediction of risk.

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