Incremental predictive utility of a radiomics signature in a nomogram for the recurrence of atrial fibrillation

Dongyan Zheng; Yueli Zhang; Dong Huang; Man Wang; Ning Guo; Shu Zhu; Juanjuan Zhang; Tao Ying

doi:10.3389/fcvm.2023.1203009

Incremental predictive utility of a radiomics signature in a nomogram for the recurrence of atrial fibrillation

Front Cardiovasc Med. 2023 Aug 11:10:1203009. doi: 10.3389/fcvm.2023.1203009. eCollection 2023.

Authors

Dongyan Zheng¹, Yueli Zhang¹, Dong Huang², Man Wang¹, Ning Guo¹, Shu Zhu¹, Juanjuan Zhang², Tao Ying¹

Affiliations

¹ Department of Ultrasound, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China.
² Department of Cardiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China.

Abstract

Background: Recurrence of atrial fibrillation (AF) after catheter ablation (CA) remains a challenge today. Although it is believed that evaluating the structural and functional remodeling of the left atrium (LA) may be helpful in predicting AF recurrence, there is a lack of consensus on prediction accuracy. Ultrasound-based radiomics is currently receiving increasing attention because it might aid in the diagnosis and prognosis prediction of AF recurrence. However, research on LA ultrasound radiomics is limited.

Objective: We aim to investigate the incremental predictive utility of LA radiomics and construct a radiomics nomogram to preoperatively predict AF recurrence following CA.

Methods: A training cohort of 232 AF patients was designed for nomogram construction, while a validation cohort (n = 100) served as the model performance test. AF recurrence during a follow-up period of 3-12 months was defined as the endpoint. The radiomics features related to AF recurrence were extracted and selected to create the radiomics score (rad score). These rad scores, along with other morphological and functional indicators for AF recurrence, were included in the multivariate Cox analysis to establish a nomogram for the prediction of the likelihood of AF recurrence within 1 year following CA.

Results: In the training and validation cohorts, AF recurrence rates accounted for 32.3% (75/232) and 25.0% (25/100), respectively. We extracted seven types of radiomics features associated with AF recurrence from apical four-chamber view echocardiography images and established a rad score for each patient. The radiomics nomogram was built with the rad score, AF type, left atrial appendage emptying flow velocity, and peak atrial longitudinal strain. It outperformed the nomogram building without the rad score in terms of the predictive efficacy of CA outcome and showed favorable performance in both cohorts.

Conclusion: We revealed the incremental utility of a radiomics signature in the prediction of AF recurrence and preliminarily developed and validated a radiomics nomogram for identifying patients who were at high risk of post-CA recurrence, which contributed to an appropriate management strategy for AF.

Keywords: atrial fibrillation; catheter ablation; nomogram; radiomics; recurrence; speckle-tracking echocardiography.

Grants and funding

This work was supported by the Retrospective Study Project of Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine (ynhg202106) and Shanghai Key Clinical Disciplines Fund (Grant No. shslczdzk03203).