| Title: | Incremental predictive value of CMR phenotyping for major adverse cardiovascular events: an interpretable machine learning study from UK Biobank |
| Journal: | Frontiers in Medicine |
| Published: | 31 Jul 2026 |
| Pubmed: | https://pubmed.ncbi.nlm.nih.gov/42601981/ |
| DOI: | https://doi.org/10.3389/fmed.2026.1852547 |
| URL: | https://www.frontiersin.org/journals/medicine/articles/10.3389/fmed.2026.1852547/pdf |
Publication 21259
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Abstract
Aims: To characterize cardiac magnetic resonance (CMR)-derived phenotypes in a population-based cohort and to evaluate their incremental prognostic value for major adverse cardiovascular events (MACE) beyond traditional risk factors.</p>
Methods: Participants from the UK Biobank imaging cohort without prior cardiovascular diseases were included. Unsupervised k-means clustering and Kaplan-Meier analyses identified distinct CMR-derived phenotypes. Sequential XGBoost models were developed to evaluate the incremental predictive value of CMR features over conventional risk factors, with SHAP used for interpretation. Cross-modality transportability was assessed in an independent Asian cohort using echocardiographic data as a surrogate for CMR-derived variables.</p>
Results: Among 27,254 participants, 785 (2.88%) experienced MACE over a median follow-up of approximately 5 years. Two phenotypes were identified, with the higher-risk phenotype characterized by increased cardiac volumes, impaired cardiac function, a tendency toward myocardial hypertrophy, and reduced myocardial strain. The CMR-enhanced model improved MACE prediction compared with traditional risk factors alone (AUC: 0.76, 95% CI: 0.73-0.79; vs. AUC: 0.61, 95% CI: 0.58-0.64, P < 0.001), with strong performance for heart failure (AUC: 0.90, 95% CI: 0.86-0.94). In the cross-modality validation cohort, the simplified model yielded an AUC of 0.69 (95% CI: 0.56-0.83). Higher age, left ventricular mass index, global wall thickness, and lower levels of high-density lipoprotein cholesterol, left atrial ejection fraction, right atrial stroke volume were the key contributors to increased MACE risk.</p>
Conclusion: CMR-derived phenotypes provide incremental prognostic value beyond traditional risk factors and may improve early identification of individuals at elevated cardiovascular risk.</p>
9 Authors
- Peiqi Liu
- Chang Liu
- Yao Ma
- Zhi Lv
- Kexin Li
- Zi Kou
- Pei Wang
- Fuxian Ren
- Dengfeng Gao
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