ArticleStroke2026
AI-Derived LA Volume Index, LA/RA and LA/LV Volume Ratios From Coronary Artery Calcium Scans Predict Long-Term Atrial Fibrillation and Stroke.
Amir Azimi, Kyle Atlas, Anthony P Reeves, Chenyu Zhang, Jakob Wasserthal, Seyed Reza Mirjalili, Mohammadhossein Mozafarybazargany, Ali Hashemi, Thomas Atlas, Claudia I Henschke and 21 more
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In one paragraphArticle in Stroke, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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5 · Who and what moneyAuthors and funding
31 authors.
Anthony P ReevesDepartment of Electrical and Computer Engineering, Cornell University, Ithaca, NY (A.P.R.).ORCID 0000-0002-1451-3080 Jakob WasserthalClinic of Radiology and Nuclear Medicine, University Hospital Basel, Switzerland (J.W.).ORCID 0000-0002-9921-5698 Mohammadhossein MozafarybazarganyHeartLung.AI, Houston, TX (A.A., K.A., C.Z., S.R.M., M.M., A.H., M.N.).
Ali HashemiHeartLung.AI, Houston, TX (A.A., K.A., C.Z., S.R.M., M.M., A.H., M.N.).
Claudia I HenschkeDepartment of Diagnostic, Molecular, and Interventional Radiology (C.I.H., D.F.Y.), Icahn School of Medicine at Mount Sinai, NY.ORCID 0000-0001-7364-4294 David F YankelevitzDepartment of Diagnostic, Molecular, and Interventional Radiology (C.I.H., D.F.Y.), Icahn School of Medicine at Mount Sinai, NY.
Javier J ZuluetaPulmonary, Critical Care and Sleep Medicine, Mount Sinai Morningside Hospital, NY (J.J.Z.).ORCID 0000-0003-3182-3555 Andrea D BranchDepartment of Medicine (A.D.B., R.M.), Icahn School of Medicine at Mount Sinai, NY.
Sion K RoyThe Lundquist Institute, CA (S.K.R., M.J.B.).
Jamal S RanaDivision of Cardiology, Kaiser Permanente Oakland Medical Center, California (J.S.R.).
Zahi A FayadBioMedical Engineering and Imaging Institute. Icahn School of Medicine at Mount Sinai, NY (Z.A.F.).ORCID 0000-0002-3439-7347 Michael V McConnellStanford Prevention Research Center, Stanford University School of Medicine, CA (M.V.M.C., D.J.M.).ORCID 0000-0001-8743-0932 Rozemarijn VliegenthartDepartment of Radiology, University Medical Center Groningen, the Netherlands (R.V.).ORCID 0000-0002-7262-3376 David J MaronStanford Prevention Research Center, Stanford University School of Medicine, CA (M.V.M.C., D.J.M.).ORCID 0000-0002-4867-8588 Prediman K ShahCedars-Sinai Medical Center, Los Angeles, CA (P.K.S.).
Emelia J BenjaminBoston Medical Center and Boston University Chobanian & Avedisian School of Medicine and School of Public Health, MA (E.J.B.).ORCID 0000-0003-4076-2336 Nathan D WongHeart Disease Prevention Program, Mary and Steve Wen Cardiovascular Division, University of California, Irvine (N.D.W.).ORCID 0000-0003-1102-7324 Funding
Institute for Clinical and Translational ResearchUL1TR001079 · NCATS · JOHNS HOPKINS UNIVERSITY · PI FORD, DANIEL ERNEST · 2013 to 2017
$60.1MWake Forest Clinical and Translational Science AwardUL1TR001420 · NCATS · WAKE FOREST UNIVERSITY HEALTH SCIENCES · PI ARD, JAMY D, FOLEY, KRISTIE L · 2015 to 2023
$32.3MFRAMINGHAM HEART STUDY - YEAR 5 EXAM75N92019D00031 · NHLBI · BOSTON UNIVERSITY MEDICAL CAMPUS · PI RAMACHANDRAN, VASAN · 2019 to 2024
$29.8MClinical and Translational Science AwardUL1TR000040 · NCATS · COLUMBIA UNIVERSITY HEALTH SCIENCES · PI GINSBERG, HENRY N · 2012 to 2015
$26.2MIDENTIFICATION OF COMMON GENETIC VARIANTS FOR ATRIAL FIBRILLATION AND PR INTERVALR01HL092577 · NHLBI · MASSACHUSETTS GENERAL HOSPITAL · PI BENJAMIN, EMELIA J., ELLINOR, PATRICK THOMAS · 2009 to 2025
$20.6MTask Area A Core Study Operations.Task Area A shall encompass annual follow-up of cohort members, clinical endpoints ascertainment, study coordination activities, maintenance of the database and biosp75N92020D00001 · NHLBI · UNIVERSITY OF WASHINGTON · PI MCCLELLAND, ROBYN LEAGH · 2020 to 2025
$17.2MTask Area A shall encompass annual follow-up of cohort members, clinical events investigations, study operations, and data analysis and manuscript writing. If implemented, Task A.1 will provide fundin75N92020D00005 · NHLBI · UNIVERSITY OF CALIFORNIA LOS ANGELES · PI WATSON, KAROL E · 2020 to 2025
$5.1MTO EXERCISE OPTION PERIOD ONE (1) FOR TASK AREA A - MESA CORE OPERATIONS, FIELD CENTER.75N92020D00004 · NHLBI · NORTHWESTERN UNIVERSITY · PI SIEGEL, JONATHAN H · 2020 to 2025
$4.5MTask Area A shall encompass annual follow-up of cohort members, clinical events investigations, study operations, and data analysis and manuscript writing. If implemented, Task A.1 will provide fundin75N92020D00006 · NHLBI · UNIVERSITY OF MINNESOTA · PI PANKOW, JAMES S · 2020 to 2025
$4.4MTask Area A shall encompass annual follow-up of cohort members, clinical events investigations, study operations, and data analysis and manuscript writing. If implemented, Task A.1 will provide fundin75N92020D00003 · NHLBI · JOHNS HOPKINS UNIVERSITY · PI POST, WENDY S · 2020 to 2025
$3.8MTask Area A shall encompass annual follow-up of cohort members, clinical events investigations, study operations, and data analysis and manuscript writing. If implemented, Task A.1 will provide fundin75N92020D00007 · NHLBI · WAKE FOREST UNIVERSITY HEALTH SCIENCES · PI BERTONI, ALAIN GERALD · 2020 to 2025
$3.5MTask Area A shall encompass annual follow-up of cohort members, clinical events investigations, study operations, and data analysis and manuscript writing. If implemented, Task A.1 will provide fundin75N92020D00002 · NHLBI · COLUMBIA UNIVERSITY HEALTH SCIENCES · PI SHEA, STEVEN J · 2020 to 2025
$3.4MNCATS NIH HHS UL1 TR000040NCATS NIH HHS UL1 TR001079NCATS NIH HHS UL1 TR001420NHLBI NIH HHS 75N92019D00031NHLBI NIH HHS 75N92020D00001NHLBI NIH HHS 75N92020D00002NHLBI NIH HHS 75N92020D00003NHLBI NIH HHS 75N92020D00004NHLBI NIH HHS 75N92020D00005NHLBI NIH HHS 75N92020D00006NHLBI NIH HHS 75N92020D00007NHLBI NIH HHS HHSN268201500001CNHLBI NIH HHS HHSN268201500001INHLBI NIH HHS HHSN268201500003CNHLBI NIH HHS HHSN268201500003INHLBI NIH HHS N01 HC025195NHLBI NIH HHS N01 HC095159NHLBI NIH HHS N01 HC095160NHLBI NIH HHS N01 HC095161NHLBI NIH HHS N01 HC095162NHLBI NIH HHS N01 HC095163NHLBI NIH HHS N01 HC095164NHLBI NIH HHS N01 HC095165NHLBI NIH HHS N01 HC095166NHLBI NIH HHS N01 HC095167NHLBI NIH HHS N01 HC095168NHLBI NIH HHS N01 HC095169NHLBI NIH HHS R01 HL092577NHLBI NIH HHS R43 HL174376
6 · The paper itselfAbstract
backgroundThe AI-CVD initiative aims to extract actionable insights from coronary artery calcium (CAC) scans beyond the traditional CAC score. Although AI-derived cardiac chamber volumes predict atrial fibrillation (AF) and stroke, the long-term prognostic value of chamber ratios is less established. We evaluated the predictive value of AI-derived left atrial volume index and related chamber ratios (left atrial [LA]/right atrial [RA], LA/left ventricular) from routine CAC scans for incident AF and stroke, and their incremental value beyond established risk scores.
methodsPooled participant-level data from 2 prospective cohorts, the MESA (Multi-Ethnic Study of Atherosclerosis, 2000-2002, n=5670) and the FHS (Framingham Heart Study Offspring cohort, 1998-2001, n=1142), were analyzed. Primary outcomes were incident AF and incident stroke. AI-enabled volumetry (AutoChamber, AI-CVD platform) quantified cardiac chamber metrics from noncontrast CAC scans. Cox proportional hazards models, net reclassification improvement, time-dependent area under the curve, calibration metrics, and least absolute shrinkage and selection operator regression were applied to evaluate predictive performance.
resultsOver a median 17-year follow-up, 1302 participants developed AF, and 365 experienced stroke events. Individuals in the ≥95th percentile of chamber metrics had a significantly increased risk. Adjusted hazard ratios for AF were 2.66 (95% CI, 2.23-3.17) for left atrial volume index, 2.04 (95% CI, 1.71-2.45) for LA/left ventricular (LV) ratio, and 1.87 (95% CI, 1.55-2.26) for LA/RA ratio. For stroke, corresponding hazard ratios were 1.96 (95% CI, 1.38-2.77), 1.64 (95% CI, 1.15-2.33), and 1.83 (95% CI, 1.29-2.59), respectively. AI-derived metrics improved reclassification beyond Cohorts for Heart and Aging Research in Genomic Epidemiology Atrial Fibrillation risk score and Framingham Stroke Risk Profile, with greatest improvements for AF from left atrial volume index (net reclassification improvement, 0.48) and stroke from LA/RA ratio (net reclassification improvement, 0.39), driven mainly by nonevent classification. Although discrimination improvements (area under the curve ) were modest, chamber measurements substantially improved Framingham Stroke Risk Profile calibration (slope, 0.448 to 0.834-0.902). Among all chamber metrics (including volumes and ratios), the least absolute shrinkage and selection operator identified left atrial volume index as the strongest predictor for AF, and LA/RA ratio as the strongest for stroke.
conclusionsAI-enabled left atrial volumetric and ratio-based metrics derived opportunistically from CAC scans provide incremental predictive value for AF and stroke prediction.
Indexed as
Atrial FibrillationCoronary VesselsHeart AtriaHeart VentriclesStrokeAgedAged, 80 and overCalciumCohort StudiesFemaleHumansMaleMiddle AgedPredictive Value of TestsProspective StudiesCalciumartificial intelligenceatrial fibrillationcalibrationglobal healthprevalence
Identifiers
PMID41948813
PMCPMC13078722
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