Incremental Prognostic Value of Pericardial Adipose Tissue Radiomic Phenotype Based on Cardiac MRI in Patients With End-Stage Renal Disease.

While pericardial adipose tissue (PEAT) volume is linked to cardiac risk, the prognostic value of its radiomic features for major adverse cardiac events (MACE: a composite of cardiac death, myocardial infarction, heart failure hospitalization, or stroke) in end-stage renal disease (ESRD) patients is unknown. To evaluate the association of PEAT radiomics with MACE in patients with ESRD. Retrospective. Two hundred forty-eight ESRD patients (160 males) from three centers were included and divided into development (198 patients) and validation cohorts (50 patients) by centers. 3.0 T/cine imaging, T2 and T2* mappings, all gradient echo. A triple-stage Unet model (3SUnet) was used for the segmentation of PEAT in cine images. Myocardial T2 and T2* values were extracted from native T2 and T2* images. Demographic and laboratory data were collected within 1 week of the MRI scan. Participants were followed up from the MRI scanning every 2 weeks until July 2023 until MACE occurred. Principal component analysis (PCA) was used to reduce radiomic features to principal radiomics (PrPEAT-rads). Cox regression analyses were used to investigate the prognostic value of extracted PrPEAT-rads. p-value ≤ 0.05 was considered statistically significant. During a median follow-up time of 35.6 months, 63 patients (25.4% of 248; 15 in the external validation cohort) experienced MACE. The combined use of selected PrPEAT-rads with conventional MRI risk scores significantly improved risk stratification of MACE in both the internal (C-index: 0.715 vs. 0.768; integrated Brier score [IBS]: 0.095 vs. 0.090) and the external validation cohort (C-index: 0.737 vs. 0.774; IBS: 0.130 vs. 0.070). PrPEAT-rad1 was a significant independent factor associated with MACE after adjusting for both clinical (HR: 0.937) and MRI (HR: 0.916) covariates. The cardiac MRI cine-based PEAT radiomics features in ESRD patients demonstrated a stronger association with MACE compared to conventional clinical and MRI parameters. 3. Stage 2.