Deep Learning-Derived Cardiac Chamber Volumes and Mass From PET/CT Attenuation Scans: Associations With Myocardial Flow Reserve and Heart Failure.
Authors
Affiliations (9)
Affiliations (9)
- Departments of Medicine (Division of Artificial Intelligence in Medicine), Imaging, and Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA (W.H., A.S., R.J.H.M., P.B.K., A.K., M.L., D.D., D.S.B., P.J.S.).
- Department of Electrical and Computer Engineering, University of Southern California, Los Angeles (A.S.).
- Department of Cardiac Sciences, University of Calgary, AB, Canada (R.J.H.M.).
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN (S.W., P.C.).
- Department of Medicine, University of Utah, Salt Lake City (S.K., V.T.L., S.M.).
- Department of Biomorphological and Functional Science, University of Naples Federico II | UNINA, Naples, Italy (W.A.).
- Nuclear Cardiology Department, Kansas University Medical Center, Brigham and Women's Hospital, Harvard Medical School, Boston, MA. (T.R.).
- Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA. (M.F.D.C.).
- Cardiovascular Imaging Program, Departments of Radiology and Medicine, and Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA. (M.F.D.C.).
Abstract
Computed tomography (CT) attenuation correction scans are an intrinsic part of positron emission tomography (PET) myocardial perfusion imaging using PET/CT, but anatomic information is rarely derived from these ultralow-dose CT scans. We aimed to assess the association between deep learning-derived cardiac chamber volumes (right atrial, right ventricular, left ventricular, and left atrial) and mass (left ventricular) from these scans with myocardial flow reserve and heart failure hospitalization. We included 18 079 patients with consecutive cardiac PET/CT from 6 sites. A deep learning model estimated cardiac chamber volumes and left ventricular mass from computed tomography attenuation correction imaging. Associations between deep learning-derived CT mass and volumes with heart failure hospitalization and reduced myocardial flow reserve were assessed in a multivariable analysis. During a median follow-up of 4.3 years, 1721 (9.5%) patients experienced heart failure hospitalization. Patients with 3 or 4 abnormal chamber volumes were 7× more likely to be hospitalized for heart failure compared with patients with normal volumes. In adjusted analyses, left atrial volume (hazard ratio [HR], 1.25 [95% CI, 1.19-1.30]), right atrial volume (HR, 1.29 [95% CI, 1.23-1.35]), right ventricular volume (HR, 1.25 [95% CI, 1.20-1.31]), left ventricular volume (HR, 1.27 [95% CI, 1.23-1.35]), and left ventricular mass (HR, 1.25 [95% CI, 1.18-1.32]) were independently associated with heart failure hospitalization. In multivariable analyses, left atrial volume (odds ratio, 1.14 [95% CI, 1.0-1.19]) and ventricular mass (odds ratio, 1.12 [95% CI, 1.6-1.17]) were independent predictors of reduced myocardial flow reserve. Deep learning-derived chamber volumes and left ventricular mass from computed tomography attenuation correction were predictive of heart failure hospitalization and reduced myocardial flow reserve in patients undergoing cardiac PET perfusion imaging. This anatomic data can be routinely reported along with other PET/CT parameters to improve risk prediction.