Key result
Baseline right atrial volume index was associated with an increased risk of major adverse cardiac events following thoracic radiotherapy, with a 2% increased risk per unit increase (sHR 1.02).
Why the study?
Patients receiving thoracic radiotherapy face an increased risk of MACE posttreatment, motivating the use of machine learning to discover and externally validate novel predictors of MACE.
Do baseline right and left atrial volume indices (RAVI and LAVI) predict major adverse cardiac events in patients receiving thoracic radiotherapy for NSCLC or breast cancer?
Cohort (n=984)
Yes
Do baseline right and left atrial volume indices (RAVI and LAVI) predict major adverse cardiac events in patients receiving thoracic radiotherapy for NSCLC or breast cancer?
Hazard Ratio: 1.02 (95% CI 1–1.04)
p-value: p=0.03
CT-derived right and left atrial volume indices are novel radiographic predictors for increased risk of major adverse cardiac events following chest radiotherapy, offering a potential strategy for upfront cardiovascular risk profiling.
RAVI may aid pre-radiotherapy MACE risk stratification; hypothesis-generating and requires prospective validation.
Introduction Patients receiving thoracic radiotherapy (RT) have an increased risk of major adverse cardiac events (MACE) posttreatment. We utilized machine learning (ML) to discover novel predictors of MACE and validated them on an external cohort. Methods This multi-institutional retrospective study included 984 patients [ n = 803 non-small cell lung cancer (NSCLC), n = 181 breast cancer] treated with radiotherapy. Extreme gradient boosting was utilized to discover novel clinical, dosimetric, and anatomical features (CT-based cardiac substructure segmentations) associated with MACE in a cohort of locally advanced NSCLC patients. Fine–Gray regression was performed with non-cardiac death as a competing risk. External validation was performed utilizing independent cohorts of NSCLC or breast cancer patients. Results In the discovery dataset ( n = 701), 70 patients experienced MACE. ML modeling (training AUC, 0.68; testing AUC, 0.71) identified right and left atrial volume indices (RAVI and LAVI, respectively) as top predictors. After adjusting for baseline cardiovascular risk and known radiotherapy predictive factors, RAVI was associated with an increased risk of MACE [subdistribution hazard ratio (sHR) 1.02/unit, 95% confidence interval (CI): 1.00–1.04; p = 0.03]. In the validation cohorts ( n = 102 NSCLC; n = 181 breast cancer), RAVI was associated with an increased risk of MACE (NSCLC: sHR 1.05, 95% CI: 1.001–1.106, p = 0.04; breast cancer: sHR 1.06, 95% CI: 1.01–1.11, p = 0.03). Similar findings were found for LAVI. Discussion ML modeling identified right and left atrial enlargement as novel radiographic predictors for increased risk of MACE following chest radiotherapy, which was validated in independent breast and lung cancer datasets. Given that echocardiography studies have demonstrated the prognostic utility of atrial volume indices across cardiovascular risk groups, these findings warrant further study to identify additional strategies for upfront cardiovascular risk profiling.
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Qiao et al. (2025) conducted a cohort in Locally advanced non-small cell lung cancer or breast cancer (n=984). Baseline right atrial volume index (RAVI) vs. Lower RAVI was evaluated on Major adverse cardiac events (MACE) (sHR 1.02, 95% CI 1.00-1.04, p=0.03). Baseline right atrial volume index was associated with an increased risk of major adverse cardiac events following thoracic radiotherapy, with a 2% increased risk per unit increase (sHR 1.02).
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