Liver radiomics on routine cardiac CT identifies hepatic stress states that predict heart failure.
Authors
Affiliations (5)
Affiliations (5)
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Health Sciences Research Building II, 1750 Haygood Drive, Suite N647, Atlanta, GA 30322, USA.
- Atlanta Veterans Affairs Medical Center, Atlanta, GA, USA.
- Computer Science and Informatics, Emory University, Atlanta, GA, USA.
- Harrington Heart and Vascular Institute, University Hospitals/Case Western Reserve University, Cleveland, OH, USA.
- DeBakey Heart and Vascular Center, Houston Methodist, Houston, TX, USA.
Abstract
Heart failure (HF) prevention remains limited because early multisystem cardiometabolic dysfunction is not captured by conventional risk tools. We evaluated whether liver radiomic phenotypes derived opportunistically from coronary artery calcium computed tomography (CAC-CT) identify imaging-defined hepatic stress states associated with incident HF. We analysed 59 237 individuals undergoing CAC-CT (CLARIFY: 46 028; Houston Methodist: 13 209). Liver regions were segmented and radiomic features extracted to derive a Liver Radiomics Score (LRS). The model was trained in a CLARIFY derivation cohort (Dtr, n = 9205), validated in a hold-out cohort (Dts, n = 36 823), and externally evaluated in Houston Methodist (Dext, n = 13 209). The mean follow-up was 1411 days (SD 760.1) in the pooled Dtr and Dts cohorts (1144 HF events) and 470 days (SD 596) in Dext (212 HF events). Continuous LRS was associated with incident HF [Dts: hazard ratio (HR) 1.63, 95% confidence interval (CI) 1.52-1.74; P < 0.001; Dext: HR 1.04, 95% CI 1.01-1.07; P = 0.004] and remained significant after multivariable adjustment in Dts. Increasing LRS quartiles showed progressively adverse hepatic, haemodynamic, and cardiometabolic profiles and higher HF risk. Among 17 806 Dts participants with PREVENT data, adding LRS modestly improved discrimination across CAC- and PREVENT-based models (P < 0.001) and improved reclassification metrics (7-year net reclassification improvement up to 0.25; including integrated discrimination improvement up to 0.015). High LRS identified elevated risk in low-risk groups: among participants with CAC=0, high LRS conferred ∼2.5-fold higher 5-year HF incidence, and ∼2.9-fold in PREVENT-low individuals. In this large multicentre cohort, liver radiomics from CAC-CT captured hepatic stress states linked to HF risk and modestly improved risk stratification beyond CAC and PREVENT scores.