{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T15:03:41Z","timestamp":1790175821697,"version":"4.1.0"},"reference-count":29,"publisher":"MDPI AG","issue":"19","license":[{"start":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T00:00:00Z","timestamp":1790121600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J. Clin. Med.","JCM"],"abstract":"<jats:p>Background: Despite high procedural success of transcatheter mitral valve replacement (TMVR), mortality remains substantial, and conventional risk scores inadequately reflect the specific risk profile of this high-risk population. Artificial intelligence (AI)-derived analysis may enable TMVR-specific risk assessment using routinely acquired computed tomography (CT). Methods: In a retrospective European multicenter registry, AI-based segmentation of harmonized real-world pre-procedural cardiac CT with variable thoracic and upper-abdominal coverage was applied in patients undergoing TMVR with the TendyneTM system (134 patients; 346 CT-derived variables retained for high-dimensional screening). One-year cardiovascular mortality was assessed using Cox proportional hazards models with Benjamini\u2013Hochberg false discovery rate correction. STS- and EuroSCORE II-adjusted analyses and a targeted coronary-ventricular coupling analysis were performed. Results: In the STS-adjusted Cox analysis, nine AI-derived CT parameters met the 10% FDR discovery threshold for cardiovascular mortality, spanning skeletal (n = 3), muscular (n = 1), and cardiopulmonary phenotypes (n = 5), whereas three parameters met this threshold in CT-only analyses. Coronary\u2013ventricular coupling, defined as coronary artery volume relative to left ventricular end-diastolic volume, was significantly associated with lower 1-year cardiovascular mortality in the CT-only analysis (HR per IQR 0.47, 95% CI 0.22\u20131.00; p = 0.049) and after EuroSCORE II adjustment (HR 0.47, 95% CI 0.22\u20130.99; p = 0.046), while the STS-adjusted estimate remained directionally consistent but did not reach statistical significance (HR 0.49, 95% CI 0.23\u20131.05; p = 0.067). Conclusions: AI-based CT phenotyping identifies imaging-derived markers associated with cardiovascular mortality beyond information captured by conventional surgical risk scores in TMVR patients. Coronary-ventricular coupling emerges as a promising automated CT-derived imaging marker with a biologically plausible pathophysiological basis, linking coronary arterial volume to ventricular size in mitral valve disease.<\/jats:p>","DOI":"10.3390\/jcm15197400","type":"journal-article","created":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T14:03:26Z","timestamp":1790172206000},"page":"7400","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Artificial Intelligence-Derived Computed Tomography Phenotyping for Cardiovascular Risk Stratification in Transcatheter Mitral Valve Replacement"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0009-0007-0184-7421","authenticated-orcid":false,"given":"Liliane","family":"Zillner","sequence":"first","affiliation":[{"name":"Department of Cardiac and Thoracic Aortic Surgery, Medical University of Vienna, 1090 Vienna, Austria"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"visualization","vocabulary":"credit"},{"role":"investigation","vocabulary":"credit"},{"role":"conceptualization","vocabulary":"credit"},{"role":"methodology","vocabulary":"credit"},{"role":"resources","vocabulary":"credit"},{"role":"supervision","vocabulary":"credit"},{"role":"software","vocabulary":"credit"},{"role":"data-curation","vocabulary":"credit"},{"role":"project-administration","vocabulary":"credit"},{"role":"writing-original-draft","vocabulary":"credit"},{"role":"validation","vocabulary":"credit"},{"role":"formal-analysis","vocabulary":"credit"},{"role":"writing-review-editing","vocabulary":"credit"}]},{"given":"Tillmann","family":"Kerbel","sequence":"additional","affiliation":[{"name":"Department of Cardiac and Thoracic Aortic Surgery, Medical University of Vienna, 1090 Vienna, Austria"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"data-curation","vocabulary":"credit"},{"role":"writing-review-editing","vocabulary":"credit"},{"role":"formal-analysis","vocabulary":"credit"}]},{"given":"Paul","family":"Sautner","sequence":"additional","affiliation":[{"name":"Department of Cardiac and Thoracic Aortic Surgery, Medical University of Vienna, 1090 Vienna, Austria"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"software","vocabulary":"credit"},{"role":"writing-review-editing","vocabulary":"credit"},{"role":"formal-analysis","vocabulary":"credit"},{"role":"data-curation","vocabulary":"credit"}]},{"given":"Mirjam G.","family":"Wild","sequence":"additional","affiliation":[{"name":"Medizinische Klinik I, LMU University Hospital, 81377 Munich, Germany"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"resources","vocabulary":"credit"},{"role":"writing-review-editing","vocabulary":"credit"},{"role":"data-curation","vocabulary":"credit"}]},{"given":"Michaela M.","family":"Hell","sequence":"additional","affiliation":[{"name":"Department of Cardiology, University Medical Center Mainz, 55131 Mainz, Germany"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"methodology","vocabulary":"credit"},{"role":"validation","vocabulary":"credit"},{"role":"writing-review-editing","vocabulary":"credit"}]},{"given":"Elmar W.","family":"Kuhn","sequence":"additional","affiliation":[{"name":"Department of Cardiothoracic Surgery, Heart Center, University Hospital Cologne, 50937 Cologne, Germany"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"project-administration","vocabulary":"credit"},{"role":"resources","vocabulary":"credit"},{"role":"writing-review-editing","vocabulary":"credit"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8839-7476","authenticated-orcid":false,"given":"Tanja K.","family":"Rudolph","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Heart and Diabetes Center North Rhine-Westphalia, Ruhr University Bochum, 44801 Bad Oeynhausen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"resources","vocabulary":"credit"},{"role":"writing-review-editing","vocabulary":"credit"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2892-8949","authenticated-orcid":false,"given":"Thomas","family":"Walther","sequence":"additional","affiliation":[{"name":"Department of Cardiac Surgery, University Hospital Frankfurt, 60590 Frankfurt, Germany"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"resources","vocabulary":"credit"},{"role":"formal-analysis","vocabulary":"credit"},{"role":"writing-review-editing","vocabulary":"credit"}]},{"given":"Lenard","family":"Conradi","sequence":"additional","affiliation":[{"name":"Department of Cardiac Surgery, Heart Center, University Hospital Cologne, 50937 Cologne, Germany"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"data-curation","vocabulary":"credit"},{"role":"writing-review-editing","vocabulary":"credit"},{"role":"resources","vocabulary":"credit"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9842-587X","authenticated-orcid":false,"given":"Andreas","family":"Zierer","sequence":"additional","affiliation":[{"name":"Department for Cardiac, Vascular and Thoracic Surgery, Kepler University Hospital Linz, 4020 Linz, Austria"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"resources","vocabulary":"credit"},{"role":"writing-review-editing","vocabulary":"credit"},{"role":"formal-analysis","vocabulary":"credit"}]},{"given":"Francesco","family":"Maisano","sequence":"additional","affiliation":[{"name":"Valve Center, IRCCS Ospedale San Raffaele, University Vita-Salute San Raffaele, 20132 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"data-curation","vocabulary":"credit"},{"role":"writing-review-editing","vocabulary":"credit"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9843-2925","authenticated-orcid":false,"given":"Marco","family":"Russo","sequence":"additional","affiliation":[{"name":"Department of Cardiac Surgery and Heart Transplantation, Azienda Ospedaliera San Camillo Forlanini, 00152 Rome, 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