Background
Cardiovascular magnetic resonance imaging is considered gold standard for assessment of cardiac morphology and function. Furthermore, it has demonstrated prognostic utility in patients undergoing transcatheter aortic valve replacement (TAVR). Novel artificial intelligence enabled fully automated analyses may facilitate data acquisition by reduction of time-consuming post-processing but have not yet been compared against conventional manual data acquisition in patients with severe aortic stenosis (AS).

Methods
Fully automated and manual biventricular assessments were performed in 139 prospectively recruited AS patients scheduled for TAVR. Commercially available software solutions (suiteHEART®, Neosoft, USA; QMass®, Medis Medical Imaging Systems, Netherlands) were used for biventricular volumetric assessments, which included left ventricular (LV) mass, LV and right ventricular (RV) end-diastolic and end-systolic volume, LV and RV stroke volume as well as LV and RV ejection fraction (EF). Results of fully automated, and manual analyses were compared and regression analyses and receiver operator characteristics (ROC) including area under the curve (AUC) calculation for prediction of cardiovascular (CV) death were performed.

Results
Both, fully automated and manual assessment of LVEF, revealed similar prediction of CV mortality in univariable (manual: hazard ratio [HR] 0.970 [95% CI 0.943–0.997] p=0.032; automated: HR 0.967 [95% CI 0.939–0.995] p=0.022) and multivariable analyses models (model 1: [including significant univariable parameters] manual: HR 0.968 [95% CI 0.938–0.999] p=0.043; automated: HR 0.963 [95% CI 0.933–0.995] p=0.024 ; model 2: [including classical CV risk factors] manual: HR 0.962 [95% CI0.920–0.996] p=0.027; automated: HR 0.954 [95% CI 0.920–0.989] p=0.011). There were no differences in AUC (LVEF AUC fully automated 0.686; AUC manual 0.661; p=0.214). Fully automated quantification resulted in a substantial average time saving of 10 minutes per patient.

Conclusion
Fully automated biventricular volumetric assessments enable efficient and equal risk prediction compared to conventional manual approaches. In addition to significant time savings this may provide the tools for optimized clinical management and stratification of patients with severe AS undergoing TAVR.