AI-derived cardiothoracic structures and coronary artery calcification volumes on non-contrast CT as predictors of mortality in pulmonary hypertension.

@article{alnasser2026aiderived,
  title = {{AI-derived cardiothoracic structures and coronary artery calcification volumes on non-contrast CT as predictors of mortality in pulmonary hypertension.}},
  author = {Turki Nasser Alnasser and Alireza Hokmabadi and Michael Sharkey and David G Kiely and Samer Alabed and Andrew J Swift},
  journal = {European radiology cardiovascular and thoracic},
  year = {2026},
  month = nov,
  doi = {10.1007/s44449-026-00005-2},
  url = {https://europepmc.org/article/MED/42999449},
  note = {CC BY},
}

TY  - JOUR
TI  - AI-derived cardiothoracic structures and coronary artery calcification volumes on non-contrast CT as predictors of mortality in pulmonary hypertension.
AU  - Turki Nasser Alnasser
AU  - Alireza Hokmabadi
AU  - Michael Sharkey
AU  - David G Kiely
AU  - Samer Alabed
AU  - Andrew J Swift
PY  - 2026
DA  - 2026/11/04
JO  - European radiology cardiovascular and thoracic
DO  - 10.1007/s44449-026-00005-2
UR  - https://europepmc.org/article/MED/42999449
AB  - 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.
SN  - 3120-4732
ER  -