CARDINAL：基于非对比心脏CT预测心血管风险
CARDINAL Predicts Cardiovascular Risk From Non-contrast Cardiac CT
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中文总结 AI 辅助
本研究开发了基于临床依据的CARDINAL框架，从非对比心脏CT学习表征预测主要不良心血管事件，在17659名患者中，其10年预测性能优于多种基线方法，证明非对比心脏CT蕴含额外预后信息。
中文摘要 AI 辅助
心血管风险预测目前受限于不完整的临床数据以及将计算机断层扫描（CT）简化为少量手工特征的成像生物标志物，存在局限性。我们开发了CARDINAL（全称：Cardiovascular Assessment via Representation learning from Deep Imaging with Nested Anatomical Latent embeddings，即基于嵌套解剖潜在嵌入的深度成像表征学习的心血管评估），这是一个基于临床依据的框架，可从常规非对比心脏CT中学习紧凑表征，用于主要不良心血管事件（MACE）的预测。我们在17659名患者中，针对1年、3年、5年和10年的MACE预测，将CARDINAL与美国心脏协会（AHA）汇总队列方程（PCE）、AHA心血管疾病事件预测（PREVENT）、冠状动脉钙化（CAC）、分割衍生的CT生物标志物以及70特征结构放射组学进行了评估。在更长的时间范围内，性能提升最为显著。在10年时，CARDINAL（联合模型）的受试者工作特征曲线下面积（AUROC）为0.866±0.020，精确召回曲线下面积（AUPRC）为0.890±0.015；而最强的基线方法结构放射组学的AUROC为0.826±0.023，AUPRC为0.826±0.022。CARDINAL还获得了最高的生存一致性指数（C-index，0.753±0.015），以及高低风险三分位数的风险比（10.78±3.16），同时具备良好的重新分类能力和探索性校准。这些发现表明，非对比心脏CT包含超出传统风险方程、CAC评分和工程化成像生物标志物之外的预后信息。
英文摘要
Cardiovascular risk prediction remains limited by incomplete clinical data and imaging biomarkers that reduce computed tomography (CT) to a small number of handcrafted features. We developed CARDINAL (Cardiovascular Assessment via Representation learning from Deep Imaging with Nested Anatomical Latent embeddings), a clinically grounded framework that learns compact representations from routine non-contrast cardiac CT for major adverse cardiovascular event (MACE) prediction. In 17,659 patients, CARDINAL was evaluated for 1-, 3-, 5-, and 10-year MACE prediction against American Heart Association (AHA) pooled cohort equations (PCE), AHA predicting risk of cardiovascular disease events (PREVENT), coronary artery calcium (CAC), segmentation-derived CT biomarkers, and 70-feature structural radiomics. Gains were largest at longer horizons. At 10 years, CARDINAL (joint) achieved an area under the receiver operating characteristic curve (AUROC) of 0.866 $\pm$ 0.020 and an area under the precision-recall curve (AUPRC) of 0.890 $\pm$ 0.015, compared with an AUROC of 0.826 $\pm$ 0.023 and an AUPRC of 0.826 $\pm$ 0.022 for structural radiomics, the strongest baseline. CARDINAL also achieved the highest survival concordance index (C-index), 0.753 $\pm$ 0.015, and high-versus-low risk-tertile hazard ratio, 10.78 $\pm$ 3.16, with favorable reclassification and exploratory calibration. These findings suggest that non-contrast cardiac CT contains prognostic information beyond conventional risk equations, CAC scoring, and engineered imaging biomarkers.
