AI prediction of cardiovascular events using opportunistic epicardial adipose tissue assessments from CT calcium score

Department of Radiology, Case Western Reserve University, Cleveland, OH, 44106, USA Abstract Background: Recent studies have used basic epicardial adipose tissue (EAT) assessments (e.g., volume and mean HU) to predict risk of atherosclerosis-related, major adverse cardiovascular events (MACE). Objectives: Create novel, hand-crafted EAT features, "fat-omics", to capture the pathophysiology of EAT and improve MACE prediction. We extracted 148 radiomic features (morphological, spatial, and intensity) and used Cox elastic-net for feature reduction and prediction of MACE. Results: Traditional fat features gave marginal prediction (EAT-volume/EAT-mean-HU/ BMI gave C-index 0.53/0.55/0.57, Significant improvement was obtained with 15 fat-omics features (C-index=0.69, Other high-risk features include kurtosis-of-EAT-thickness, reflecting the heterogeneity of thicknesses, and EATvolume-in-the-top-25%-of-the-heart, emphasizing adipose near the proximal coronary arteries. Kaplan-Meyer plots of Cox-identified, high-and low-risk patients were well separated with the median of the fat-omics risk, while high-risk group having HR 2.4 times that of the low-risk group (P<0.001). Conclusion: Preliminary findings indicate an opportunity to use more finely tuned, explainable assessments on EAT for improved cardiovascular risk prediction. Introduction Cardiovascular disease is a major cause of morbidity and mortality worldwide (1), leading to 17.9 million deaths globally each year (2). Numerous risk score methodologies have been developed to predict risks from cardiovascular disease, but these methods often lack sufficient discrimination (3). Accurate explainable risk prediction models will provide useful information to patients and physicians for more personalized medications and interventions. Previous studies have determined the usefulness of coronary calcification Agatston score as obtained from CT calcium score (CTCS) images for cardiovascular risk prediction.