Amyar Amine, Al-Deiri Danah, Sroubek Jakub, Kiang Alan, Ghanbari Fahime, Nakamori Shiro, Rodriguez Jennifer, Kramer Daniel B, Manning Warren J, Kwon Deborah, Nezafat Reza
Departments of Medicine (Cardiovascular Division), Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA.
Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA.
JACC Adv. 2025 Apr;4(4):101684. doi: 10.1016/j.jacadv.2025.101684. Epub 2025 Mar 23.
Risk stratification in patients with nonischemic dilated cardiomyopathy (DCM) remains challenging. Although late gadolinium enhancement (LGE) cardiovascular magnetic resonance is recognized as a major risk factor for ventricular tachycardia/ventricular fibrillation (VT/VF), the prognostic value of LGE radiomics is unknown.
The purpose of this study was to investigate if radiomic analysis of LGE images can improve arrhythmia risk stratification in patients with DCM beyond current clinical and imaging markers.
In a 2-center retrospective study, patients with DCM were identified among those who received primary prevention implantable cardioverter-defibrillators (ICDs) according to the clinical guidelines and had a cardiovascular magnetic resonance before ICD implantation. The study included patients with DCM from the Cleveland Clinic Foundation for model development and patients with DCM from Beth Israel Deaconess Medical Center for external validation. Left ventricular myocardial radiomic features were extracted from LGE images. The primary outcome was appropriate ICD intervention defined as shock or antitachycardia pacing for VT/VF. Consensus clustering and pairwise correlation were used to identify the radiomic signature. To assess the prognostic value of LGE radiomics, we built 2 logistic regression models using the development data: 1) model 1, including clinical risk factors and scar presence and 2) model 2, which combines model 1 and LGE radiomics.
In total, 270 patients with DCM (61% male, age 58 ± 13 years) in development data and 113 patients with DCM (71% male, age 55 ± 14 years) in external validation were included. VT/VF occurred in 40 (15%) patients in development and 16 (15%) in external validation cohorts over a median follow-up period of 4.0 (IQR: 2.5-6.1) and 2.6 (IQR: 1.2-4.1) years, respectively. Consensus clustering and pairwise correlation revealed 3 distinct radiomic features. Model 2 showed a higher C-statistic than model 1 (0.71 [95% CI: 0.62-0.80] vs 0.61 [95% CI: 0.53-0.71]; P = 0.028 in development and 0.70 [95% CI: 0.59-0.85] vs 0.61 [95% CI: 0.46-0.77]; P = 0.025 in external validation). This also significantly improved risk stratification with a continuous net reclassification index of 0.60 [95% CI: 0.29-0.91; P < 0.001] in development and of 0.29 [95% CI: 0.26-0.56; P = 0.03] in external validation. Additionally, 1 radiomic feature, namely the gray level co-occurrence matrix autocorrelation, was an independent predictor of VT/VF in both development (HR: 1.45 [95% CI: 1.10-1.91]; P = 0.01) and in external validation (HR: 2.38 [95% CI: 1.28-4.42]; P = 0.01).
In this proof-of-concept study, radiomic analysis of LGE images provides additional prognostic value beyond LGE presence in predicting arrhythmia in patients with DCM.
非缺血性扩张型心肌病（DCM）患者的风险分层仍然具有挑战性。尽管延迟钆增强（LGE）心血管磁共振被认为是室性心动过速/心室颤动（VT/VF）的主要危险因素，但LGE放射组学的预后价值尚不清楚。
本研究的目的是调查LGE图像的放射组学分析是否能在当前临床和影像学标志物之外，改善DCM患者的心律失常风险分层。
在一项2中心回顾性研究中，根据临床指南，在接受一级预防植入式心律转复除颤器（ICD）且在ICD植入前进行了心血管磁共振检查的患者中识别出DCM患者。该研究包括来自克利夫兰诊所基金会的DCM患者用于模型开发，以及来自贝斯以色列女执事医疗中心的DCM患者用于外部验证。从LGE图像中提取左心室心肌放射组学特征。主要结局是适当的ICD干预，定义为针对VT/VF的电击或抗心动过速起搏。使用共识聚类和成对相关性来识别放射组学特征。为了评估LGE放射组学的预后价值，我们使用开发数据建立了2个逻辑回归模型：1）模型1，包括临床危险因素和瘢痕存在情况；2）模型2，它结合了模型1和LGE放射组学。
总共纳入了270例开发数据中的DCM患者（61%为男性，年龄58±13岁）和113例外部验证中的DCM患者（71%为男性，年龄55±14岁）。在中位随访期分别为4.0（四分位间距：2.5 - 6.1）年和2.6（四分位间距：1.2 - 4.1）年的开发队列和外部验证队列中，分别有40例（15%）和16例（15%）患者发生VT/VF。共识聚类和成对相关性揭示了3种不同的放射组学特征。模型2显示出比模型1更高的C统计量（开发队列中分别为0.71 [95%置信区间：0.62 - 0.80] 对0.61 [95%置信区间：0.53 - 0.71]；P = 0.028，外部验证中分别为0.70 [95%置信区间：0.59 - 0.85] 对0.61 [95%置信区间：0.46 - 0.77]；P = 0.025）。这也显著改善了风险分层，开发队列中的连续净重新分类指数为0.60 [95%置信区间：0.29 - 0.91；P < 0.001]，外部验证中的为0.29 [95%置信区间：0.26 - 0.56；P = 0.03]。此外，1种放射组学特征，即灰度共生矩阵自相关，在开发队列（风险比：1.45 [95%置信区间：1.10 - 1.91]；P = 0.01）和外部验证队列（风险比：2.38 [95%置信区间：1.28 - 4.42]；P = 0.01）中都是VT/VF的独立预测因子。
在这项概念验证研究中，LGE图像的放射组学分析在预测DCM患者心律失常方面，除了LGE的存在外还提供了额外的预后价值。
