Deep Convolutional Neural Networks to Predict Cardiovascular Risk from Computed Tomography

Overview

Journal Nat Commun

Specialty Biology

Date 2021 Jan 30

PMID 33514711

Citations 64

Authors

Roman Zeleznik

Borek Foldyna

Parastou Eslami

Jakob Weiss

Ivanov Alexander

Jana Taron

Chintan Parmar

Raza M Alvi

Dahlia Banerji

Mio Uno

Yasuka Kikuchi

Julia Karady

Lili Zhang

Jan-Erik Scholtz

Thomas Mayrhofer

Asya Lyass

Taylor F Mahoney

Joseph M Massaro

Ramachandran S Vasan

Pamela S Douglas

Udo Hoffmann

Michael T Lu

Hugo J W L Aerts

Affiliations

Soon will be listed here.

Abstract

Coronary artery calcium is an accurate predictor of cardiovascular events. While it is visible on all computed tomography (CT) scans of the chest, this information is not routinely quantified as it requires expertise, time, and specialized equipment. Here, we show a robust and time-efficient deep learning system to automatically quantify coronary calcium on routine cardiac-gated and non-gated CT. As we evaluate in 20,084 individuals from distinct asymptomatic (Framingham Heart Study, NLST) and stable and acute chest pain (PROMISE, ROMICAT-II) cohorts, the automated score is a strong predictor of cardiovascular events, independent of risk factors (multivariable-adjusted hazard ratios up to 4.3), shows high correlation with manual quantification, and robust test-retest reliability. Our results demonstrate the clinical value of a deep learning system for the automated prediction of cardiovascular events. Implementation into clinical practice would address the unmet need of automating proven imaging biomarkers to guide management and improve population health.

Citing Articles

Applications of Artificial Intelligence for the Prediction and Diagnosis of Cancer Therapy-Related Cardiac Dysfunction in Oncology Patients.

Scalia I, Pathangey G, Abdelnabi M, Ibrahim O, Abdelfattah F, Pereyra Pietri M Cancers (Basel). 2025; 17(4).

PMID: 40002200 PMC: 11852369. DOI: 10.3390/cancers17040605.

OPPORTUNISTIC ASSESSMENT OF CARDIOVASCULAR RISK USING AI-DERIVED STRUCTURAL AORTIC AND CARDIAC PHENOTYPES FROM NON-CONTRAST CHEST COMPUTED TOMOGRAPHY.

Oo D, Sturniolo A, Jung M, Langenbach M, Foldyna B, Kiel D medRxiv. 2025; .

PMID: 39974056 PMC: 11839003. DOI: 10.1101/2025.01.28.25321302.

Association of Epicardial Adipose Tissue Changes on Serial Chest CT Scans with Mortality: Insights from the National Lung Screening Trial.

Langenbach I, Hadzic I, Zeleznik R, Langenbach M, Maintz D, Mayrhofer T Radiology. 2025; 314(2):e240473.

PMID: 39964263 PMC: 11868846. DOI: 10.1148/radiol.240473.

Medical multimodal multitask foundation model for lung cancer screening.

Niu C, Lyu Q, Carothers C, Kaviani P, Tan J, Yan P Nat Commun. 2025; 16(1):1523.

PMID: 39934138 PMC: 11814333. DOI: 10.1038/s41467-025-56822-w.

Opportunistic assessment of steatotic liver disease in lung cancer screening eligible individuals.

Weiss J, Bernatz S, Johnson J, Thiriveedhi V, Mak R, Fedorov A J Intern Med. 2025; 297(3):276-288.

PMID: 39868889 PMC: 11846076. DOI: 10.1111/joim.20053.

References

Lu M, Onuma O, Massaro J, DAgostino Sr R, ODonnell C, Hoffmann U . Lung Cancer Screening Eligibility in the Community: Cardiovascular Risk Factors, Coronary Artery Calcification, and Cardiovascular Events. Circulation. 2016; 134(12):897-9. PMC: 5031246. DOI: 10.1161/CIRCULATIONAHA.116.023957. View

Huang Y, Wu F, Wang Y, Ju Y, Mar G, Chuo C . Reliable categorisation of visual scoring of coronary artery calcification on low-dose CT for lung cancer screening: validation with the standard Agatston score. Eur Radiol. 2012; 23(5):1226-33. DOI: 10.1007/s00330-012-2726-5. View

Douglas P, Hoffmann U, Lee K, Mark D, Al-Khalidi H, Anstrom K . PROspective Multicenter Imaging Study for Evaluation of chest pain: rationale and design of the PROMISE trial. Am Heart J. 2014; 167(6):796-803.e1. PMC: 4044617. DOI: 10.1016/j.ahj.2014.03.003. View

Qazi S, Massaro J, Chuang M, DAgostino Sr R, Hoffmann U, ODonnell C . Increased Aortic Diameters on Multidetector Computed Tomographic Scan Are Independent Predictors of Incident Adverse Cardiovascular Events: The Framingham Heart Study. Circ Cardiovasc Imaging. 2017; 10(12). PMC: 5728667. DOI: 10.1161/CIRCIMAGING.117.006776. View

Patel M, Calhoon J, Dehmer G, Grantham J, Maddox T, Maron D . Correction to: ACC/AATS/AHA/ASE/ASNC/SCAI/SCCT/STS 2017 Appropriate Use Criteria for Coronary Revascularization in Patients With Stable Ischemic Heart Disease. J Nucl Cardiol. 2018; 25(6):2191-2192. DOI: 10.1007/s12350-018-1292-x. View

Blaha M, Cainzos-Achirica M, Greenland P, McEvoy J, Blankstein R, Budoff M . Role of Coronary Artery Calcium Score of Zero and Other Negative Risk Markers for Cardiovascular Disease: The Multi-Ethnic Study of Atherosclerosis (MESA). Circulation. 2016; 133(9):849-58. PMC: 4775391. DOI: 10.1161/CIRCULATIONAHA.115.018524. View

Grundy S, Stone N, Bailey A, Beam C, Birtcher K, Blumenthal R . 2018 AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA Guideline on the Management of Blood Cholesterol: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. J Am Coll Cardiol. 2018; 73(24):3168-3209. DOI: 10.1016/j.jacc.2018.11.002. View

Tsao C, Vasan R . Cohort Profile: The Framingham Heart Study (FHS): overview of milestones in cardiovascular epidemiology. Int J Epidemiol. 2015; 44(6):1800-13. PMC: 5156338. DOI: 10.1093/ije/dyv337. View

Timmis A, Townsend N, Gale C, Grobbee R, Maniadakis N, Flather M . European Society of Cardiology: Cardiovascular Disease Statistics 2017. Eur Heart J. 2017; 39(7):508-579. DOI: 10.1093/eurheartj/ehx628. View

10.

Kannel W, Feinleib M, MCNAMARA P, Garrison R, CASTELLI W . An investigation of coronary heart disease in families. The Framingham offspring study. Am J Epidemiol. 1979; 110(3):281-90. DOI: 10.1093/oxfordjournals.aje.a112813. View

11.

Aberle D, Adams A, Berg C, Black W, Clapp J, Fagerstrom R . Reduced lung-cancer mortality with low-dose computed tomographic screening. N Engl J Med. 2011; 365(5):395-409. PMC: 4356534. DOI: 10.1056/NEJMoa1102873. View

12.

van Velzen S, Lessmann N, Velthuis B, Bank I, van den Bongard D, Leiner T . Deep Learning for Automatic Calcium Scoring in CT: Validation Using Multiple Cardiac CT and Chest CT Protocols. Radiology. 2020; 295(1):66-79. PMC: 7106943. DOI: 10.1148/radiol.2020191621. View

13.

DAgostino Sr R, Vasan R, Pencina M, Wolf P, Cobain M, Massaro J . General cardiovascular risk profile for use in primary care: the Framingham Heart Study. Circulation. 2008; 117(6):743-53. DOI: 10.1161/CIRCULATIONAHA.107.699579. View

14.

Nihiser A, Lee S, Wechsler H, McKenna M, Odom E, Reinold C . Body mass index measurement in schools. J Sch Health. 2007; 77(10):651-71. DOI: 10.1111/j.1746-1561.2007.00249.x. View

15.

Budoff M, Young R, Burke G, Carr J, Detrano R, Folsom A . Ten-year association of coronary artery calcium with atherosclerotic cardiovascular disease (ASCVD) events: the multi-ethnic study of atherosclerosis (MESA). Eur Heart J. 2018; 39(25):2401-2408. PMC: 6030975. DOI: 10.1093/eurheartj/ehy217. View

16.

Chiles C, Duan F, Gladish G, Ravenel J, Baginski S, Snyder B . Association of Coronary Artery Calcification and Mortality in the National Lung Screening Trial: A Comparison of Three Scoring Methods. Radiology. 2015; 276(1):82-90. PMC: 5137795. DOI: 10.1148/radiol.15142062. View

17.

Raff G, Chinnaiyan K, Cury R, Garcia M, Hecht H, Hollander J . SCCT guidelines on the use of coronary computed tomographic angiography for patients presenting with acute chest pain to the emergency department: a report of the Society of Cardiovascular Computed Tomography Guidelines Committee. J Cardiovasc Comput Tomogr. 2014; 8(4):254-71. DOI: 10.1016/j.jcct.2014.06.002. View

18.

Huo Y, Terry J, Wang J, Nath V, Bermudez C, Bao S . Coronary Calcium Detection using 3D Attention Identical Dual Deep Network Based on Weakly Supervised Learning. Proc SPIE Int Soc Opt Eng. 2019; 10949. PMC: 6874228. DOI: 10.1117/12.2512541. View

19.

Hoffmann U, Truong Q, Fleg J, Goehler A, Gazelle S, Wiviott S . Design of the Rule Out Myocardial Ischemia/Infarction Using Computer Assisted Tomography: a multicenter randomized comparative effectiveness trial of cardiac computed tomography versus alternative triage strategies in patients with acute chest pain.... Am Heart J. 2012; 163(3):330-8, 338.e1. PMC: 3736358. DOI: 10.1016/j.ahj.2012.01.028. View

20.

Detrano R, Guerci A, Carr J, Bild D, Burke G, Folsom A . Coronary calcium as a predictor of coronary events in four racial or ethnic groups. N Engl J Med. 2008; 358(13):1336-45. DOI: 10.1056/NEJMoa072100. View