AI-derived left atrial volumes on calcium-scoring CT correlate strongly with echo but run systematically higher

AI-derived left atrial volume from noncontrast coronary artery calcium CT correlates strongly with echocardiography (r=0.82) but is systematically larger (mean 45.7 vs 32.2 mL/m2; bias 13.5 mL/m2). Agreement was robust across sex, BMI, cardiac phase.

• Retrospective cohort of 220 patients who underwent both echocardiography and CAC CT within one year; AI used a deep learning autoencoder to derive chamber volumes.
• AI CAC CT volumes agreed with echo clinical severity (Cohen's kappa 0.70) and remained correlated in patients with heart failure (r=0.83, ICC=0.66) and without (r=0.77, ICC=0.62).
• CAC CT systematically overestimated left atrial volume relative to 2D echo (bias 13.5 mL/m2, 95% CI 12.3–14.7), so absolute values are not interchangeable.

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