AUTHOR=Zheng Dongyan , Zhang Yueli , Huang Dong , Wang Man , Guo Ning , Zhu Shu , Zhang Juanjuan , Ying Tao 

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

JOURNAL=Frontiers in Cardiovascular Medicine

VOLUME=Volume 10 - 2023

YEAR=2023

URL=https://www.frontiersin.org/journals/cardiovascular-medicine/articles/10.3389/fcvm.2023.1203009

DOI=10.3389/fcvm.2023.1203009

ISSN=2297-055X

ABSTRACT=Background Recurrence of atrial fibrillation (AF) after catheter ablation (CA) remains a challenge today. Although it is believed that evaluating 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 has received increasing attention currently because it may add in the diagnosis and prognosis prediction. However, the exploration of LA ultrasound radiomics is limited. Objective We aimed to investigate the incremental predictive utility of LA radiomics and construct a radiomics nomogram to preoperatively predicting 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 one year following CA. Results In the training and validation cohorts, AF recurrence 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 radiomics signature in the prediction of AF recurrence, and preliminary developed and validated a radiomics nomogram for identifying patients who were at high risk of post-CA recurrence, which contributed to appropriate AF management strategy.