{
  "abstract": "To assess the prognostic value of AI-derived cardiothoracic structures and coronary artery calcification volumetric measurements in pulmonary hypertension (PH) using non-gated, non-contrast CT. Patients with suspected PH who underwent non-gated, non-contrast chest CT and right heart catheterisation within one month were retrospectively identified from the Assessing the Spectrum of PH Identified at a Referral Centre (ASPIRE) registry. Two validated deep learning models were used to segment and measure the volumes of cardiothoracic structures and coronary artery calcifications. The prognostic value of AI-derived cardiothoracic structures and coronary artery calcification volumetric measurements was assessed using univariable and multivariable Cox regression adjusted for demographics and PH subgroups and REVEAL scores. Six hundred twenty patients were included (mean age 64 ± 13 years; 62% female; 388 patients died during follow-up), comprising 202 patients with pulmonary arterial hypertension, 84 with PH-LHD, 112 with PH associated with lung disease, 65 with chronic thromboembolic PH, 9 with unclear PH, and 148 patients without PH. Calcifications were present in the right coronary artery (RCA), mainstem and left anterior descending artery (LAD), and left circumflex artery (LCX) in 45%, 67%, and 35% of patients, respectively. In multivariable Cox regression analysis adjusted for age, sex, and PH subgroup, right atrial (RA) volume was independently associated with mortality (HR 1.024, 95% CI: 1.009-1.039, p = 0.001), as were coronary artery calcifications in the RCA (HR 1.378, 95% CI: 1.113-1.705, p = 0.003), mainstem and LAD (HR 1.868, 95% CI: 1.441-2.421, p < 0.001), and LCX (HR 1.342, 95% CI: 1.084-1.660, p = 0.007). After further adjustment for the REVEAL risk score, these associations remained significant (RA volume HR 1.026, RCA calcification HR 1.604, mainstem and LAD calcification HR 2.339, LCX calcification HR 1.576; all p < 0.001). AI-derived RA volume and coronary artery calcifications are independently associated with increased mortality in PH patients. QuestionThe prognostic significance of AI-derived cardiothoracic volumes and coronary artery calcification measured on routine non-gated, non-contrast chest CT in patients with PH remains uncertain.FindingsAI-derived RA volume and coronary artery calcification volumes independently predicted mortality in PH patients, even after adjustment for demographics, PH subgroups, and REVEAL score.Relevance statementAutomated CT-based AI measurements can provide additional prognostic biomarkers to improve risk stratification in PH beyond established clinical scores.",
  "abstract_shown": true,
  "affiliations": [
    "School of Medicine and Population Health, The University of Sheffield, Sheffield, UK.",
    "Radiological Sciences Department, College of Applied Medical Science, King Saud bin Abdulaziz University for Health Science, Riyadh, Saudi Arabia.",
    "King Abdullah International Medical Research Centre (KAIMRC), Riyadh, Saudi Arabia.",
    "Insigneo Institute, Faculty of Engineering, The University of Sheffield, Sheffield, UK.",
    "National Institute for Health and Care Research, Sheffield Biomedical Research Centre, Sheffield, UK.",
    "Sheffield Pulmonary Vascular Disease Unit, Sheffield Teaching Hospitals NHS Trust, Sheffield, UK.",
    "Department of Clinical Radiology, Sheffield Teaching Hospitals, Sheffield, UK."
  ],
  "article_type": "research article",
  "arxiv": null,
  "author_total": 6,
  "authors": [
    {
      "affs": [
        0,
        1,
        2
      ],
      "name": "Turki Nasser Alnasser",
      "orcid": "0009-0004-8014-4924"
    },
    {
      "affs": [
        0,
        3
      ],
      "name": "Alireza Hokmabadi"
    },
    {
      "affs": [
        0
      ],
      "name": "Michael Sharkey"
    },
    {
      "affs": [
        0,
        3,
        4,
        5
      ],
      "name": "David G Kiely"
    },
    {
      "affs": [
        0,
        3,
        4,
        6
      ],
      "name": "Samer Alabed"
    },
    {
      "affs": [
        0,
        3,
        4,
        6
      ],
      "name": "Andrew J Swift"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/4pgez8nhc17ab.bib",
  "cited_by": 0,
  "doi": "10.1007/s44449-026-00005-2",
  "fulltext_url": "https://europepmc.org/articles/PMC13743566",
  "id": "4pgez8nhc17ab",
  "issns": [
    "3120-4732"
  ],
  "landing_url": "https://europepmc.org/article/MED/42999449",
  "language": "eng",
  "licence": "CC-BY",
  "licence_label": "CC BY",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "openalex",
      "2740|Pulmonary Hypertension Research and Treatments"
    ]
  ],
  "openalex": "W7225165957",
  "pdf_url": "https://europepmc.org/articles/PMC13743566?pdf=render",
  "pmcid": "PMC13743566",
  "pmid": "42999449",
  "published": "2026-11-04",
  "publisher": null,
  "ris": "https://research.draconitic.com/paper/4pgez8nhc17ab.ris",
  "sources": [
    {
      "first_seen": "2026-11-09T15:20:34Z",
      "native_id": "MED:42999449",
      "source": "europepmc",
      "url": "https://europepmc.org/article/MED/42999449"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "openalex:2740|Pulmonary Hypertension Research and Treatments",
      "subfield": "general"
    }
  ],
  "title": "AI-derived cardiothoracic structures and coronary artery calcification volumes on non-contrast CT as predictors of mortality in pulmonary hypertension.",
  "title_text": "AI-derived cardiothoracic structures and coronary artery calcification volumes on non-contrast CT as predictors of mortality in pulmonary hypertension.",
  "type": "peer-reviewed",
  "updated_at": "2026-11-09T15:20:34Z",
  "url": "https://research.draconitic.com/paper/4pgez8nhc17ab",
  "venue": "European radiology cardiovascular and thoracic",
  "versions": []
}