Heart failure & cardiomyopathiesCohort study
AI-derived left-to-right cardiac chamber volume ratios in coronary artery calcium scans strongly predict heart failure
- prospective cohorts
- external validation
Authors' conclusion
In these two prospective cohorts, AI-derived LV/RV ratio from CAC scans strongly predicted HF. New clinical trials guided by these imaging biomarkers are warranted to establish their clinical utility.
Study context
- Population
- Asymptomatic Multi-Ethnic Study of Atherosclerosis (MESA) participants with coronary artery calcium (CAC) scans; external validation in Framingham Heart Study Offspring (FHS-O) cohortMESA participants, external validation N = 1,052 (FHS-O) · MESA 5,732 · FHS-O 1,052
- Participants
- 5,732 participants
- Exposure
- Left-to-right ventricular (LV/RV), atrial (LA/RA), and left atrial-to-right ventricular (LA/RV) volume ratios were evaluated using multivariable Cox models and feature selection techniques
- MESAn = 5,732
- FHS-On = 1,052
Main finding
As reported in the abstract
Incident HF in MESA · median follow-up of 17.7 years
participants developed heart failure (HF)
369 participants (6.3%)
Observational data: associations, not effects.
Further findings
Incident HF by elevated ratios (≥95th percentile), MESA
| Comparison | HR (95% CI) | |
|---|---|---|
| LV/RV ≥95th percentile | 4.04 (2.89–5.65) | |
| LA/RA ≥95th percentile | 2.90 (2.07–4.06) | |
| LA/RV ≥95th percentile | 2.61 (1.87–3.46) | |
| 0.20.5125Hazard ratio (log scale) |
Incident HF among participants with normal LV sizes (interquartile-range)
| Comparison | HR (95% CI) | |
|---|---|---|
| LV/RV ≥95th | 2.34 (1.29–4.25) | |
| 0.20.5125Hazard ratio (log scale) |
Incident HF in FHS-O · median follow-up 14.4 years
| Comparison | HR (95% CI) | |
|---|---|---|
| LV/RV ≥75th percentile | 2.23 (1.16–4.30) | |
| LA/RA · not significant | 1.22 (0.65–2.29) | |
| 0.20.5125Hazard ratio (log scale) |
- Incident HF in FHS-O — HF events
- 56 HF events (5.3%)
Feature selection
- Feature selection techniques identified LV/RV as the strongest predictor
Original publication
AI-derived left-to-right cardiac chamber volume ratios in coronary artery calcium scans strongly predict heart failure. Eur Heart J Cardiovasc Imaging. Published 27 January 2026. doi:10.1093/ehjci/jeag027
Summarised from the published abstract; every number is checked against it