# CARDINAL Predicts Cardiovascular Risk From Non-contrast Cardiac CT

arXiv: https://arxiv.org/abs/2608.27690 · HTML: https://mlsanity.com/paper/2608.27690/

## Key facts

- No citing papers in the map yet (data through 14 Oct 2026).
- Builds on 4 of its 50 references that are in the map.
- First posted on arXiv 27 Aug 2026.

## Builds on (most cited first, 4 of 4)

- [A Survey on Deep Learning in Medical Image Analysis](https://mlsanity.com/paper/1702.05747/) (2017)
- [Video Swin Transformer](https://mlsanity.com/paper/2106.13230/) (2021)
- [TotalSegmentator: robust segmentation of 104 anatomical structures in CT images](https://mlsanity.com/paper/2208.05868/) (2022)
- [Image biomarker standardisation initiative](https://mlsanity.com/paper/1612.07003/) (2016)

## Abstract (arXiv)

Cardiovascular risk prediction remains limited by incomplete clinical data and imaging biomarkers that reduce computed tomography (CT) to a small number of handcrafted features. We developed CARDINAL (Cardiovascular Assessment via Representation learning from Deep Imaging with Nested Anatomical Latent embeddings), a clinically grounded framework that learns compact representations from routine non-contrast cardiac CT for major adverse cardiovascular event (MACE) prediction. In 17,659 patients, CARDINAL was evaluated for 1-, 3-, 5-, and 10-year MACE prediction against American Heart Association (AHA) pooled cohort equations (PCE), AHA predicting risk of cardiovascular disease events (PREVENT), coronary artery calcium (CAC), segmentation-derived CT biomarkers, and 70-feature structural radiomics. Gains were largest at longer horizons. At 10 years, CARDINAL (joint) achieved an area under the receiver operating characteristic curve (AUROC) of 0.866 ± 0.020 and an area under the precision-recall curve (AUPRC) of 0.890 ± 0.015, compared with an AUROC of 0.826 ± 0.023 and an AUPRC of 0.826 ± 0.022 for structural radiomics, the strongest baseline. CARDINAL also achieved the highest survival concordance index (C-index), 0.753 ± 0.015, and high-versus-low risk-tertile hazard ratio, 10.78 ± 3.16, with favorable reclassification and exploratory calibration. These findings suggest that non-contrast cardiac CT contains prognostic information beyond conventional risk equations, CAC scoring, and engineered imaging biomarkers.