1
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Chao CJ, Jeong J, Arsanjani R, Kim K, Tsai YL, Yu WC, Farina JM, Mahmoud AK, Ayoub C, Grogan M, Kane GC, Banerjee I, Oh JK. Echocardiography-Based Deep Learning Model to Differentiate Constrictive Pericarditis and Restrictive Cardiomyopathy. JACC Cardiovasc Imaging 2024; 17:349-360. [PMID: 37943236 DOI: 10.1016/j.jcmg.2023.09.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 09/07/2023] [Accepted: 09/25/2023] [Indexed: 11/10/2023]
Abstract
BACKGROUND Constrictive pericarditis (CP) is an uncommon but reversible cause of diastolic heart failure if appropriately identified and treated. However, its diagnosis remains a challenge for clinicians. Artificial intelligence may enhance the identification of CP. OBJECTIVES The authors proposed a deep learning approach based on transthoracic echocardiography to differentiate CP from restrictive cardiomyopathy. METHODS Patients with a confirmed diagnosis of CP and cardiac amyloidosis (CA) (as the representative disease of restrictive cardiomyopathy) at Mayo Clinic Rochester from January 2003 to December 2021 were identified to extract baseline demographics. The apical 4-chamber view from transthoracic echocardiography studies was used as input data. The patients were split into a 60:20:20 ratio for training, validation, and held-out test sets of the ResNet50 deep learning model. The model performance (differentiating CP and CA) was evaluated in the test set with the area under the curve. GradCAM was used for model interpretation. RESULTS A total of 381 patients were identified, including 184 (48.3%) CP, and 197 (51.7%) CA cases. The mean age was 68.7 ± 11.4 years, and 72.8% were male. ResNet50 had a performance with an area under the curve of 0.97 to differentiate the 2-class classification task (CP vs CA). The GradCAM heatmap showed activation around the ventricular septal area. CONCLUSIONS With a standard apical 4-chamber view, our artificial intelligence model provides a platform to facilitate the detection of CP, allowing for improved workflow efficiency and prompt referral for more advanced evaluation and intervention of CP.
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Affiliation(s)
- Chieh-Ju Chao
- Mayo Clinic Rochester, Rochester, Minnesota, USA; Mayo Clinic Arizona, Scottsdale, Arizona, USA
| | - Jiwoong Jeong
- Mayo Clinic Arizona, Scottsdale, Arizona, USA; Arizona State University, Tempe, Arizona, USA
| | | | - Kihong Kim
- Mayo Clinic Rochester, Rochester, Minnesota, USA
| | - Yi-Lin Tsai
- Taipei Veterans General Hospital, Taipei, Taiwan
| | - Wen-Chung Yu
- Taipei Veterans General Hospital, Taipei, Taiwan
| | | | | | - Chadi Ayoub
- Mayo Clinic Arizona, Scottsdale, Arizona, USA
| | | | | | - Imon Banerjee
- Mayo Clinic Arizona, Scottsdale, Arizona, USA; Arizona State University, Tempe, Arizona, USA
| | - Jae K Oh
- Mayo Clinic Rochester, Rochester, Minnesota, USA.
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Lloyd JW, Anavekar NS, Oh JK, Miranda WR. Multimodality Imaging in Differentiating Constrictive Pericarditis From Restrictive Cardiomyopathy: A Comprehensive Overview for Clinicians and Imagers. J Am Soc Echocardiogr 2023; 36:1254-1265. [PMID: 37619909 DOI: 10.1016/j.echo.2023.08.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2023] [Revised: 07/27/2023] [Accepted: 08/14/2023] [Indexed: 08/26/2023]
Abstract
In the evaluation of heart failure, 2 differential diagnostic considerations include constrictive pericarditis and restrictive cardiomyopathy. The often outwardly similar clinical presentation of these 2 pathologic entities routinely renders their clinical distinction difficult. Consequently, initial assessment requires a keen understanding of their separate pathophysiology, epidemiology, and hemodynamic effects. Following a detailed clinical evaluation, further assessment initially rests on comprehensive echocardiographic investigation, including detailed Doppler evaluation. With the combination of mitral inflow characterization, tissue Doppler assessment, and hepatic vein interrogation, initial differentiation of constrictive pericarditis and restrictive cardiomyopathy is often possible with high sensitivity and specificity. In conjunction with a compatible clinical presentation, successful differentiation enables both an accurate diagnosis and subsequent targeted management. In certain cases, however, the diagnosis remains unclear despite echocardiographic assessment, and additional evaluation is required. With advances in noninvasive tools, such evaluation can often continue in a stepwise, algorithmic fashion noninvasively, including both cross-sectional and nuclear imaging. Should this additional evaluation itself prove insufficient, invasive assessment with appropriate expertise may ultimately be necessary.
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Affiliation(s)
- James W Lloyd
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Nandan S Anavekar
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Jae K Oh
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - William R Miranda
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota.
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Barriales-Revilla L, Benites-Yshpilco L, Baltodano-Arellano R, Falcón-Quispe L, Cupe-Chacalcaje K, Cachicatari-Beltrán A, Lévano-Pachas G. [Imagen multimodal de la pericarditis constrictiva: reporte de un caso de cirrosis cardiaca]. ARCHIVOS PERUANOS DE CARDIOLOGIA Y CIRUGIA CARDIOVASCULAR 2023; 4:109-113. [PMID: 38046233 PMCID: PMC10688404 DOI: 10.47487/apcyccv.v4i3.294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/02/2023] [Accepted: 09/04/2023] [Indexed: 12/05/2023]
Abstract
Constrictive pericarditis is a rare cause of ascites and cardiac cirrhosis. We present the case of a 36-year-old male patient with a history of cirrhosis of unknown etiology, who consulted for refractory ascites, dyspnea, and lower limb swelling. Echocardiography determined constrictive pericarditis, which was corroborated by the findings of computed tomography. The clinical and hemodynamic worsening of the patient led to an emergency pericardiectomy with satisfactory recovery. This report shows a severe clinical consequence of constrictive pericarditis, cardiac cirrhosis, which was reversible with pericardial extirpation. Multimodal imaging was essential in the diagnosis of constrictive pericarditis.
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Affiliation(s)
- Lucía Barriales-Revilla
- Servicio de Cardiología, Hospital Guillermo Almenara Irigoyen, EsSalud, Lima, Peru. Servicio de Cardiología Hospital Guillermo Almenara Irigoyen, EsSalud Lima Peru
| | - Lindsay Benites-Yshpilco
- Servicio de Cardiología, Hospital Guillermo Almenara Irigoyen, EsSalud, Lima, Peru. Servicio de Cardiología Hospital Guillermo Almenara Irigoyen, EsSalud Lima Peru
| | - Roberto Baltodano-Arellano
- Facultad de Medicina, Universidad Nacional Mayor de San Marcos, Lima, Peru. Universidad Nacional Mayor de San Marcos Facultad de Medicina Universidad Nacional Mayor de San Marcos Lima Peru
- Unidad de Imágenes Cardiacas, Servicio de Cardiología, Hospital Guillermo Almenara Irigoyen, EsSalud, Lima, Peru Unidad de Imágenes Cardiacas, Servicio de Cardiología Hospital Guillermo Almenara Irigoyen, EsSalud Lima Peru
| | - Luis Falcón-Quispe
- Unidad de Imágenes Cardiacas, Servicio de Cardiología, Hospital Guillermo Almenara Irigoyen, EsSalud, Lima, Peru Unidad de Imágenes Cardiacas, Servicio de Cardiología Hospital Guillermo Almenara Irigoyen, EsSalud Lima Peru
| | - Kelly Cupe-Chacalcaje
- Unidad de Imágenes Cardiacas, Servicio de Cardiología, Hospital Guillermo Almenara Irigoyen, EsSalud, Lima, Peru Unidad de Imágenes Cardiacas, Servicio de Cardiología Hospital Guillermo Almenara Irigoyen, EsSalud Lima Peru
| | - Angela Cachicatari-Beltrán
- Unidad de Imágenes Cardiacas, Servicio de Cardiología, Hospital Guillermo Almenara Irigoyen, EsSalud, Lima, Peru Unidad de Imágenes Cardiacas, Servicio de Cardiología Hospital Guillermo Almenara Irigoyen, EsSalud Lima Peru
| | - Gerald Lévano-Pachas
- Servicio de Cardiología, Hospital Guillermo Almenara Irigoyen, EsSalud, Lima, Peru. Servicio de Cardiología Hospital Guillermo Almenara Irigoyen, EsSalud Lima Peru
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Grewal HK, Bansal M. Echocardiographic Differentiation of Pericardial Constriction and Left Ventricular Restriction. Curr Cardiol Rep 2022; 24:1599-1610. [PMID: 36040551 DOI: 10.1007/s11886-022-01774-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/12/2022] [Indexed: 01/11/2023]
Abstract
PURPOSE OF REVIEW Overlapping hemodynamics in constrictive pericarditis (CP) and restrictive cardiomyopathy (RCM) often pose difficulties in establishing accurate diagnosis. Echocardiography is the first-line imaging modality used for this purpose, but no single echocardiographic parameter is sufficiently robust for distinguishing between the two conditions. The newer developments may improve the diagnostic accuracy of echocardiography in this setting. RECENT FINDINGS Recent studies have validated multiparametric algorithms, based on conventional echocardiographic parameters, which enable high sensitivity and specificity for distinguishing between CP and RCM. In addition, myocardial deformation analysis using speckle-tracking echocardiography has revealed distinct pattern of abnormalities in the two conditions. CP is characterized by impaired left ventricular apical rotation with relatively preserved longitudinal strain, esp. of ventricular and atrial septum. In contrast, RCM results in global and marked impairment of left ventricular longitudinal strain with initially preserved circumferential mechanics. Combining multiple echocardiographic parameters into step-wise algorithms and incorporation of myocardial deformation analysis help improve the diagnostic accuracy of echocardiography for distinguishing between CP and RCM. The use of machine-learning may allow easy integration of a wide range of echocardiographic and clinical parameters to permit accurate, automated diagnosis, with less dependence on the user expertise.
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Affiliation(s)
- Hardeep Kaur Grewal
- Medanta Heart Institute, Medanta - The Medicity, Gurgaon, Haryana, 122001, India
| | - Manish Bansal
- Medanta Heart Institute, Medanta - The Medicity, Gurgaon, Haryana, 122001, India.
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Xu Z, Yu F, Zhang B, Zhang Q. Intelligent diagnosis of left ventricular hypertrophy using transthoracic echocardiography videos. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2022; 226:107182. [PMID: 36257197 DOI: 10.1016/j.cmpb.2022.107182] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Revised: 09/14/2022] [Accepted: 10/08/2022] [Indexed: 06/16/2023]
Abstract
PURPOSE Left ventricular hypertrophy (LVH) is an independent risk factor for cardiovascular events and mortality. Pathological LVH can be caused by various diseases. In this study, we explored the possibility of using time and frequency domain analysis of myocardial radiomics features for patients with LVH in differentiating hypertrophic cardiomyopathy (HCM), hypertensive heart disease (HHD) and uremic cardiomyopathy (UCM) based on transthoracic echocardiography (TTE). This was the first study to explore TTE myocardial time and frequency domain analyses for multiple LVH etiology differentiation. MATERIALS AND METHODS We proposed an artificially intelligent diagnosis system based on radiomics techniques for differentiating HCM, HHD and UCM on TTE videos of the apical four-chamber view, which mainly included interventricular septum (IVS) segmentation, feature extraction and classification. We used two independent cohorts, one with 150 patients, including 50 HHD, 50 HCM and 50 UCM, for segmentation training and testing, and another with 149 patients (namely the main cohort), including 50 HHD, 46 HCM and 53 UCM, for classification training and testing after segmentation and feature extraction. Firstly, the U-Net, Residual U-Net (ResUNet) and nnU-Net were trained and tested to segment the IVS on TTE still images in the first cohort. Then the trained model with the best segmentation performance was further used for IVS prediction of ordered TTE images in video sequences in the main cohort. The post-processing was used to eliminate the noisy debris by selecting the maximum connected region and smoothing the edges of the predicted IVS region. Secondly, static radiomics features were extracted from the IVS of ordered TTE images in each video sequence, and subsequently the time and frequency domain features were further extracted from each time series of a static radiomics feature in the video sequence. Finally, the point-wise gated Boltzmann machine (PGBM) was used to learn and fuse the time and frequency domain features, and the support vector machine was used to classify the learned features for LVH diagnosis. The classification was performed with five-fold cross validation. RESULTS The ResUNet showed the best segmentation performance, with Dice coefficient, sensitivity, specificity and accuracy of 0.817, 76.3%, 99.6% and 98.6%, respectively. With post-processing, the Dice coefficient, sensitivity, specificity and accuracy of the ResUNet were further improved to 0.839, 77.0%, 99.8%, and 98.8%, respectively. The classification areas under the receiver operating characteristic curves (AUCs) were 0.838 ± 0.049 for HHD vs. HCM, 0.868 ± 0.042 for HCM vs. UCM and 0.701 ± 0.140 for HHD vs. UCM. CONCLUSION In this work, we proposed an intelligent identification system for LVH etiology classification based on routine TTE video images with good diagnostic performance. This deep learning method is feasible in automatic TTE images interpretation and expected to assist clinicians in detecting the primary cause of LVH.
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Affiliation(s)
- Zhou Xu
- The SMART (Smart Medicine and AI-Based Radiology Technology) Lab, Shanghai Institute for Advanced Communication and Data Science, Shanghai University, Shanghai, China; School of Communication and Information Engineering, Shanghai University, Shanghai, China
| | - Fei Yu
- Department of Ultrasound in Medicine, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China; Department of Ultrasound in Medicine, Ningbo First Hospital, Ningbo, China
| | - Bo Zhang
- Department of Ultrasound in Medicine, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China.
| | - Qi Zhang
- The SMART (Smart Medicine and AI-Based Radiology Technology) Lab, Shanghai Institute for Advanced Communication and Data Science, Shanghai University, Shanghai, China; School of Communication and Information Engineering, Shanghai University, Shanghai, China.
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Montisci A, Palmieri V, Vietri MT, Sala S, Maiello C, Donatelli F, Napoli C. Big Data in cardiac surgery: real world and perspectives. J Cardiothorac Surg 2022; 17:277. [PMID: 36309702 PMCID: PMC9617748 DOI: 10.1186/s13019-022-02025-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Accepted: 10/14/2022] [Indexed: 11/10/2022] Open
Abstract
Big Data, and the derived analysis techniques, such as artificial intelligence and machine learning, have been considered a revolution in the modern practice of medicine. Big Data comes from multiple sources, encompassing electronic health records, clinical studies, imaging data, registries, administrative databases, patient-reported outcomes and OMICS profiles. The main objective of such analyses is to unveil hidden associations and patterns. In cardiac surgery, the main targets for the use of Big Data are the construction of predictive models to recognize patterns or associations better representing the individual risk or prognosis compared to classical surgical risk scores. The results of these studies contributed to kindle the interest for personalized medicine and contributed to recognize the limitations of randomized controlled trials in representing the real world. However, the main sources of evidence for guidelines and recommendations remain RCTs and meta-analysis. The extent of the revolution of Big Data and new analytical models in cardiac surgery is yet to be determined.
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7
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Guidelines for Echocardiographic Diagnosis of Cardiomyopathy: Recommendations from Echocardiography Group of Ultrasound Medicine Branch in Chinese Medical Association, Echocardiography Committee of Cardiovascular Branch in Chinese Medical Association. ADVANCED ULTRASOUND IN DIAGNOSIS AND THERAPY 2022. [DOI: 10.37015/audt.2022.210021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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8
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Taylor AM. The role of artificial intelligence in paediatric cardiovascular magnetic resonance imaging. Pediatr Radiol 2022; 52:2131-2138. [PMID: 34936019 PMCID: PMC9537201 DOI: 10.1007/s00247-021-05218-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 08/13/2021] [Accepted: 10/05/2021] [Indexed: 11/24/2022]
Abstract
Artificial intelligence (AI) offers the potential to change many aspects of paediatric cardiac imaging. At present, there are only a few clinically validated examples of AI applications in this field. This review focuses on the use of AI in paediatric cardiovascular MRI, using examples from paediatric cardiovascular MRI, adult cardiovascular MRI and other radiologic experience.
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Affiliation(s)
- Andrew M. Taylor
- Great Ormond Street Hospital for Children, Zayed Centre for Research, 20 Guildford St., Room 3.7, London, WC1N 1DZ UK ,Cardiovascular Imaging, UCL Institute of Cardiovascular Science, London, UK
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9
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Al'Aref SJ, Anchouche K, Singh G, Slomka PJ, Kolli KK, Kumar A, Pandey M, Maliakal G, van Rosendael AR, Beecy AN, Berman DS, Leipsic J, Nieman K, Andreini D, Pontone G, Schoepf UJ, Shaw LJ, Chang HJ, Narula J, Bax JJ, Guan Y, Min JK. Clinical applications of machine learning in cardiovascular disease and its relevance to cardiac imaging. Eur Heart J 2020; 40:1975-1986. [PMID: 30060039 DOI: 10.1093/eurheartj/ehy404] [Citation(s) in RCA: 233] [Impact Index Per Article: 58.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Revised: 05/29/2018] [Accepted: 07/06/2018] [Indexed: 12/19/2022] Open
Abstract
Artificial intelligence (AI) has transformed key aspects of human life. Machine learning (ML), which is a subset of AI wherein machines autonomously acquire information by extracting patterns from large databases, has been increasingly used within the medical community, and specifically within the domain of cardiovascular diseases. In this review, we present a brief overview of ML methodologies that are used for the construction of inferential and predictive data-driven models. We highlight several domains of ML application such as echocardiography, electrocardiography, and recently developed non-invasive imaging modalities such as coronary artery calcium scoring and coronary computed tomography angiography. We conclude by reviewing the limitations associated with contemporary application of ML algorithms within the cardiovascular disease field.
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Affiliation(s)
- Subhi J Al'Aref
- Department of Radiology, NewYork-Presbyterian Hospital and Weill Cornell Medicine, New York, NY, USA
| | - Khalil Anchouche
- Department of Radiology, NewYork-Presbyterian Hospital and Weill Cornell Medicine, New York, NY, USA
| | - Gurpreet Singh
- Department of Radiology, NewYork-Presbyterian Hospital and Weill Cornell Medicine, New York, NY, USA
| | - Piotr J Slomka
- Departments of Imaging and Medicine and Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Kranthi K Kolli
- Department of Radiology, NewYork-Presbyterian Hospital and Weill Cornell Medicine, New York, NY, USA
| | - Amit Kumar
- Department of Radiology, NewYork-Presbyterian Hospital and Weill Cornell Medicine, New York, NY, USA
| | - Mohit Pandey
- Department of Radiology, NewYork-Presbyterian Hospital and Weill Cornell Medicine, New York, NY, USA
| | - Gabriel Maliakal
- Department of Radiology, NewYork-Presbyterian Hospital and Weill Cornell Medicine, New York, NY, USA
| | - Alexander R van Rosendael
- Department of Radiology, NewYork-Presbyterian Hospital and Weill Cornell Medicine, New York, NY, USA
| | - Ashley N Beecy
- Department of Radiology, NewYork-Presbyterian Hospital and Weill Cornell Medicine, New York, NY, USA
| | - Daniel S Berman
- Departments of Imaging and Medicine and Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Jonathan Leipsic
- Departments of Medicine and Radiology, University of British Columbia, Vancouver, BC, Canada
| | - Koen Nieman
- Departments of Cardiology and Radiology, Stanford University School of Medicine and Cardiovascular Institute, Stanford, CA, USA
| | | | | | - U Joseph Schoepf
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science and Division of Cardiology, Department of Medicine, Medical University of South Carolina, Charleston, SC, USA
| | - Leslee J Shaw
- Department of Radiology, NewYork-Presbyterian Hospital and Weill Cornell Medicine, New York, NY, USA
| | - Hyuk-Jae Chang
- Division of Cardiology, Severance Cardiovascular Hospital and Severance Biomedical Science Institute, Yonsei University College of Medicine, Yonsei University Health System, Seoul, South Korea
| | - Jagat Narula
- Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Jeroen J Bax
- Department of Cardiology, Heart Lung Center, Leiden University Medical Center, Leiden, The Netherlands
| | - Yuanfang Guan
- Department of Computational Medicine and Bioinformatics, University of Michigan, Ann Arbor, MI, USA
| | - James K Min
- Department of Radiology, NewYork-Presbyterian Hospital and Weill Cornell Medicine, New York, NY, USA
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Gaffar S, Gearhart AS, Chang AC. The Next Frontier in Pediatric Cardiology: Artificial Intelligence. Pediatr Clin North Am 2020; 67:995-1009. [PMID: 32888694 DOI: 10.1016/j.pcl.2020.06.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Artificial intelligence (AI) in the last decade centered primarily around digitizing and incorporating the large volumes of patient data from electronic health records. AI is now poised to make the next step in health care integration, with precision medicine, imaging support, and development of individual health trends with the popularization of wearable devices. Future clinical pediatric cardiologists will use AI as an adjunct in delivering optimum patient care, with the help of accurate predictive risk calculators, continual health monitoring from wearables, and precision medicine. Physicians must also protect their patients' health information from monetization or exploitation.
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Affiliation(s)
- Sharib Gaffar
- UC Irvine Pediatrics Residency Program, Choc Children's Hospital of Orange County, 757 Westwood Plaza, Ste 5235, Los Angeles, CA 90095-8358, USA
| | - Addison S Gearhart
- Boston Children's Hospital Heart Center, 300 Longwood Avenue, Boston, MA 02115, USA
| | - Anthony C Chang
- The Sharon Disney Lund Medical Intelligence and Innovation Institute (MI3), Children's Hospital of Orange County, 1120 W La Veta Ave, STE 860, Orange, CA 92868, USA.
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Rocon C, Tabassian M, Tavares de Melo MD, de Araujo Filho JA, Grupi CJ, Parga Filho JR, Bocchi EA, D'hooge J, Salemi VMC. Biventricular imaging markers to predict outcomes in non-compaction cardiomyopathy: a machine learning study. ESC Heart Fail 2020; 7:2431-2439. [PMID: 32608172 PMCID: PMC7524220 DOI: 10.1002/ehf2.12795] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Revised: 04/27/2020] [Accepted: 05/13/2020] [Indexed: 12/28/2022] Open
Abstract
Aims Left ventricular non‐compaction cardiomyopathy (LVNC) is a genetic heart disease, with heart failure, arrhythmias, and embolic events as main clinical manifestations. The goal of this study was to analyse a large set of echocardiographic (echo) and cardiac magnetic resonance imaging (CMRI) parameters using machine learning (ML) techniques to find imaging predictors of clinical outcomes in a long‐term follow‐up of LVNC patients. Methods and results Patients with echo and/or CMRI criteria of LVNC, followed from January 2011 to December 2017 in the heart failure section of a tertiary referral cardiologic hospital, were enrolled in a retrospective study. Two‐dimensional colour Doppler echocardiography and subsequent CMRI were carried out. Twenty‐four hour Holter monitoring was also performed in all patients. Death, cardiac transplantation, heart failure hospitalization, aborted sudden cardiac death, complex ventricular arrhythmias (sustained and non‐sustained ventricular tachycardia), and embolisms (i.e. stroke, pulmonary thromboembolism and/or peripheral arterial embolism) were registered and were referred to as major adverse cardiovascular events (MACEs) in this study. Recruited for the study were 108 LVNC patients, aged 38.3 ± 15.5 years, 48.1% men, diagnosed by echo and CMRI criteria. They were followed for 5.8 ± 3.9 years, and MACEs were registered. CMRI and echo parameters were analysed via a supervised ML methodology. Forty‐seven (43.5%) patients had at least one MACE. The best performance of imaging variables was achieved by combining four parameters: left ventricular (LV) ejection fraction (by CMRI), right ventricular (RV) end‐systolic volume (by CMRI), RV systolic dysfunction (by echo), and RV lower diameter (by CMRI) with accuracy, sensitivity, and specificity rates of 75.5%, 77%, 75%, respectively. Conclusions Our findings show the importance of biventricular assessment to detect the severity of this cardiomyopathy and to plan for early clinical intervention. In addition, this study shows that even patients with normal LV function and negative late gadolinium enhancement had MACE. ML is a promising tool for analysing a large set of parameters to stratify and predict prognosis in LVNC patients.
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Affiliation(s)
- Camila Rocon
- Heart Institute (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Av. Dr. Enéas de Carvalho Aguiar, 44, São Paulo, 05403-000, Brazil
| | - Mahdi Tabassian
- Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
| | - Marcelo Dantas Tavares de Melo
- Heart Institute (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Av. Dr. Enéas de Carvalho Aguiar, 44, São Paulo, 05403-000, Brazil
| | - Jose Arimateia de Araujo Filho
- Heart Institute (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Av. Dr. Enéas de Carvalho Aguiar, 44, São Paulo, 05403-000, Brazil
| | - Cesar José Grupi
- Heart Institute (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Av. Dr. Enéas de Carvalho Aguiar, 44, São Paulo, 05403-000, Brazil
| | - Jose Rodrigues Parga Filho
- Heart Institute (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Av. Dr. Enéas de Carvalho Aguiar, 44, São Paulo, 05403-000, Brazil
| | - Edimar Alcides Bocchi
- Heart Institute (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Av. Dr. Enéas de Carvalho Aguiar, 44, São Paulo, 05403-000, Brazil
| | - Jan D'hooge
- Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
| | - Vera Maria Cury Salemi
- Heart Institute (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Av. Dr. Enéas de Carvalho Aguiar, 44, São Paulo, 05403-000, Brazil
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12
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De Roeck F, Prihadi EA, Vermeersch P, De Greef Y. Constrictive pericarditis as late complication of cryoballoon pulmonary vein isolation. HeartRhythm Case Rep 2019; 6:34-39. [PMID: 31956500 PMCID: PMC6962741 DOI: 10.1016/j.hrcr.2019.10.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Revised: 09/27/2019] [Accepted: 10/22/2019] [Indexed: 12/23/2022] Open
Affiliation(s)
- Frederic De Roeck
- Department of Cardiology, ZiekenhuisNetwerk Antwerpen (ZNA) - Middelheim Hospital, Antwerp, Belgium
| | - Edgard A Prihadi
- Department of Cardiology, ZiekenhuisNetwerk Antwerpen (ZNA) - Middelheim Hospital, Antwerp, Belgium
| | - Paul Vermeersch
- Department of Cardiology, ZiekenhuisNetwerk Antwerpen (ZNA) - Middelheim Hospital, Antwerp, Belgium
| | - Yves De Greef
- Department of Cardiology, ZiekenhuisNetwerk Antwerpen (ZNA) - Middelheim Hospital, Antwerp, Belgium.,Postgraduate Program in Cardiac Electrophysiology and Pacing, Heart Rhythm Management Center, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, Brussels, Belgium
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Fava AM, Meredith D, Desai MY. Clinical Applications of Echo Strain Imaging: a Current Appraisal. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2019; 21:50. [PMID: 31473859 DOI: 10.1007/s11936-019-0761-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
PURPOSE OF REVIEW This article reviews recent advances in echocardiographic strain imaging, particularly in its ability to prognosticate in cardiovascular outcomes and impact clinical decision making. RECENT FINDINGS Strain has been proposed as a sensitive tool in detecting early ventricular dysfunction. Left ventricular global longitudinal strain (LV-GLS) detects subtle changes in myocardial function, often not quantifiable by ejection fraction alone. Thus, LV-GLS provides the opportunity for early decision-making, and the implementation of more effective treatments, improving outcomes in a variety of diseases such as valvular heart diseases, cardio-oncology, ischemic heart disease, cardiomyopathies, heart transplantation, and pericardial diseases and cardiomyopathies. Strain is a promising tool for the early detection of myocardial dysfunction in patients with preserved left ventricular ejection fraction and can prognosticate long-term outcomes.
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Affiliation(s)
- Agostina M Fava
- Heart and Vascular Institute, Cleveland Clinic, 9500 Euclid Avenue, Desk J1-5, Cleveland, OH, 44195, USA
| | - Dane Meredith
- Heart and Vascular Institute, Cleveland Clinic, 9500 Euclid Avenue, Desk J1-5, Cleveland, OH, 44195, USA
| | - Milind Y Desai
- Heart and Vascular Institute, Cleveland Clinic, 9500 Euclid Avenue, Desk J1-5, Cleveland, OH, 44195, USA.
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Leeson P. (Deep) Learning Your Left From Your Right. JACC Cardiovasc Imaging 2019; 13:382-384. [PMID: 31103576 DOI: 10.1016/j.jcmg.2019.03.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Accepted: 03/25/2019] [Indexed: 12/17/2022]
Affiliation(s)
- Paul Leeson
- Radcliffe Department of Medicine, Division of Cardiovascular Medicine, Oxford Cardiovascular Clinical Research Facility, John Radcliffe Hospital, University of Oxford, Oxford, United Kingdom.
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Alsharqi M, Woodward WJ, Mumith JA, Markham DC, Upton R, Leeson P. Artificial intelligence and echocardiography. Echo Res Pract 2018; 5:R115-R125. [PMID: 30400053 PMCID: PMC6280250 DOI: 10.1530/erp-18-0056] [Citation(s) in RCA: 91] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Accepted: 10/29/2018] [Indexed: 12/27/2022] Open
Abstract
Echocardiography plays a crucial role in the diagnosis and management of cardiovascular disease. However, interpretation remains largely reliant on the subjective expertise of the operator. As a result inter-operator variability and experience can lead to incorrect diagnoses. Artificial intelligence (AI) technologies provide new possibilities for echocardiography to generate accurate, consistent and automated interpretation of echocardiograms, thus potentially reducing the risk of human error. In this review, we discuss a subfield of AI relevant to image interpretation, called machine learning, and its potential to enhance the diagnostic performance of echocardiography. We discuss recent applications of these methods and future directions for AI-assisted interpretation of echocardiograms. The research suggests it is feasible to apply machine learning models to provide rapid, highly accurate and consistent assessment of echocardiograms, comparable to clinicians. These algorithms are capable of accurately quantifying a wide range of features, such as the severity of valvular heart disease or the ischaemic burden in patients with coronary artery disease. However, the applications and their use are still in their infancy within the field of echocardiography. Research to refine methods and validate their use for automation, quantification and diagnosis are in progress. Widespread adoption of robust AI tools in clinical echocardiography practice should follow and have the potential to deliver significant benefits for patient outcome.
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Affiliation(s)
- M Alsharqi
- Oxford Cardiovascular Clinical Research Facility, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - W J Woodward
- Oxford Cardiovascular Clinical Research Facility, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - J A Mumith
- Ultromics Ltd, Magdalen Centre, Robert Robinson Ave, Oxford, United Kingdom
| | - D C Markham
- Ultromics Ltd, Magdalen Centre, Robert Robinson Ave, Oxford, United Kingdom
| | - R Upton
- Ultromics Ltd, Magdalen Centre, Robert Robinson Ave, Oxford, United Kingdom
| | - P Leeson
- Oxford Cardiovascular Clinical Research Facility, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
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Alajaji W, Xu B, Sripariwuth A, Menon V, Kumar A, Schleicher M, Isma’eel H, Cremer PC, Bolen MA, Klein AL. Noninvasive Multimodality Imaging for the Diagnosis of Constrictive Pericarditis. Circ Cardiovasc Imaging 2018; 11:e007878. [DOI: 10.1161/circimaging.118.007878] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Wissam Alajaji
- Department of Cardiovascular Medicine, Summa Health Heart and Vascular Institute, Akron, OH (W.A.)
| | - Bo Xu
- Center for the Diagnosis and Treatment of Pericardial Diseases, Heart and Vascular Institute (B.X., V.M., A.K., P.C.C., A.L.K.), Cleveland Clinic, OH
| | | | - Vivek Menon
- Center for the Diagnosis and Treatment of Pericardial Diseases, Heart and Vascular Institute (B.X., V.M., A.K., P.C.C., A.L.K.), Cleveland Clinic, OH
| | - Arnav Kumar
- Center for the Diagnosis and Treatment of Pericardial Diseases, Heart and Vascular Institute (B.X., V.M., A.K., P.C.C., A.L.K.), Cleveland Clinic, OH
| | - Mary Schleicher
- Cleveland Clinic Alumni Library (M.S.), Cleveland Clinic, OH
| | | | - Paul C. Cremer
- Center for the Diagnosis and Treatment of Pericardial Diseases, Heart and Vascular Institute (B.X., V.M., A.K., P.C.C., A.L.K.), Cleveland Clinic, OH
| | - Michael A. Bolen
- Cardiovascular Section, Imaging Institute (A.S., M.A.B.), Cleveland Clinic, OH
| | - Allan L. Klein
- Center for the Diagnosis and Treatment of Pericardial Diseases, Heart and Vascular Institute (B.X., V.M., A.K., P.C.C., A.L.K.), Cleveland Clinic, OH
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Alsharqi M, Upton R, Mumith A, Leeson P. Artificial intelligence: a new clinical support tool for stress echocardiography. Expert Rev Med Devices 2018; 15:513-515. [PMID: 29992841 DOI: 10.1080/17434440.2018.1497482] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Maryam Alsharqi
- a Oxford Cardiovascular Clinical Research Facility, Division of Cardiovascular Medicine, Radcliffe Department of Medicine , University of Oxford , Oxford , UK
| | | | | | - Paul Leeson
- a Oxford Cardiovascular Clinical Research Facility, Division of Cardiovascular Medicine, Radcliffe Department of Medicine , University of Oxford , Oxford , UK
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