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Fu K, Dong Y, Wang Z, Teng J, Cheng C, Su C, Ji X, Lu H. The role of body composition in left ventricular remodeling, reverse remodeling, and clinical outcomes for heart failure with mildly reduced ejection fraction: more knowledge to the "obesity paradox". Cardiovasc Diabetol 2024; 23:334. [PMID: 39261931 PMCID: PMC11391770 DOI: 10.1186/s12933-024-02430-9] [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: 08/16/2024] [Accepted: 09/03/2024] [Indexed: 09/13/2024] Open
Abstract
BACKGROUND Although the "obesity paradox" is comprehensively elucidated in heart failure (HF) with reduced ejection fraction (HFrEF) and HF with preserved ejection fraction (HFpEF), the role of body composition in left ventricular (LV) remodeling, LV reverse remodeling (LVRR), and clinical outcomes is still unclear for HF with mildly reduced ejection fraction (HFmrEF). METHODS Our study is a single-centre, prospective, and echocardiography-based study. Consecutive HFmrEF patients, defined as HF patients with a left ventricular ejection fraction (LVEF) between 40 and 49%, between January 2016 to December 2021 were included. Echocardiography was re-examined at 3-, 6-, and 12-month follow-up to assess the LVRR dynamically. Body mass index (BMI), fat mass, fat-free mass, percent body fat (PBF), CUN-BAE index, and lean mass index (LMI) were adopted as anthropometric parameters in our study to assess body composition. The primary outcome was LVRR, defined as: (1) a reduction higher than 10% in LV end-diastolic diameter index (LVEDDI), or a LVEDDI < 33 mm/m2, (2) an absolute increase of LVEF higher than 10 points compared with baseline echocardiogram, or a follow-up LVEF ≥50%. The secondary outcome was a composite of re-hospitalization for HF or cardiovascular death. RESULTS A total of 240 HFmrEF patients were enrolled in our formal analysis. After 1-year follow-up based on echocardiography, 113 (47.1%) patients developed LVRR. Patients with LVRR had higher fat mass (21.7 kg vs. 19.3 kg, P = 0.034) and PBF (28.7% vs. 26.6%, P = 0.047) compared with those without. The negative correlation between anthropometric parameters and baseline LVEDDI was significant (all P < 0.05). HFmrEF patients with higher BMI, fat mass, PBF, CUN-BAE index, and LMI had more pronounced and persistent increase of LVEF and decline in LV mass index (LVMI). Univariable Cox regression analysis revealed that higher BMI (HR 1.042, 95% CI 1.002-1.083, P = 0.037) and fat mass (HR 1.019, 95% CI 1.002-1.036, P = 0.026) were each significantly associated with higher cumulative incidence of LVRR for HFmrEF patients, while this relationship vanished in the adjusted model. Mediation analysis indicated that the association between BMI and fat mass with LVRR was fully mediated by baseline LV dilation. Furthermore, higher fat mass (aHR 0.957, 95% CI 0.917-0.999, P = 0.049) and PBF (aHR 0.963, 95% CI 0.924-0.976, P = 0.043) was independently associated with lower risk of adverse clinical events. CONCLUSIONS Body composition played an important role in the LVRR and clinical outcomes for HFmrEF. For HFmrEF patients, BMI and fat mass was positively associated with the cumulative incidence of LVRR, while higher fat mass and PBF predicted lower risk of adverse clinical events but not LMI.
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Affiliation(s)
- Kang Fu
- State Key Laboratory for Innovation and Transformation of Luobing Theory, Jinan, China
- Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, Jinan, China
- Department of Cardiology, Cheeloo College of Medicine, Qilu Hospital of Shandong University, Shandong University, Jinan, China
| | - Youran Dong
- State Key Laboratory for Innovation and Transformation of Luobing Theory, Jinan, China
- Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, Jinan, China
- Department of Cardiology, Cheeloo College of Medicine, Qilu Hospital of Shandong University, Shandong University, Jinan, China
| | - Zhiyuan Wang
- State Key Laboratory for Innovation and Transformation of Luobing Theory, Jinan, China
- Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, Jinan, China
- Department of Cardiology, Cheeloo College of Medicine, Qilu Hospital of Shandong University, Shandong University, Jinan, China
| | - Junlin Teng
- State Key Laboratory for Innovation and Transformation of Luobing Theory, Jinan, China
- Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, Jinan, China
- Department of Cardiology, Cheeloo College of Medicine, Qilu Hospital of Shandong University, Shandong University, Jinan, China
| | - Congyi Cheng
- State Key Laboratory for Innovation and Transformation of Luobing Theory, Jinan, China
- Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, Jinan, China
- Department of Cardiology, Cheeloo College of Medicine, Qilu Hospital of Shandong University, Shandong University, Jinan, China
| | - Cong Su
- State Key Laboratory for Innovation and Transformation of Luobing Theory, Jinan, China
- Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, Jinan, China
- Department of Cardiology, Cheeloo College of Medicine, Qilu Hospital of Shandong University, Shandong University, Jinan, China
| | - Xiaoping Ji
- State Key Laboratory for Innovation and Transformation of Luobing Theory, Jinan, China.
- Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, Jinan, China.
- Department of Cardiology, Cheeloo College of Medicine, Qilu Hospital of Shandong University, Shandong University, Jinan, China.
| | - Huixia Lu
- State Key Laboratory for Innovation and Transformation of Luobing Theory, Jinan, China.
- Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, Jinan, China.
- Department of Cardiology, Cheeloo College of Medicine, Qilu Hospital of Shandong University, Shandong University, Jinan, China.
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5
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Chen X, Zhao Y, Court LE, Wang H, Pan T, Phan J, Wang X, Ding Y, Yang J. SC-GAN: Structure-completion generative adversarial network for synthetic CT generation from MR images with truncated anatomy. Comput Med Imaging Graph 2024; 113:102353. [PMID: 38387114 DOI: 10.1016/j.compmedimag.2024.102353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 12/14/2023] [Accepted: 02/04/2024] [Indexed: 02/24/2024]
Abstract
Creating synthetic CT (sCT) from magnetic resonance (MR) images enables MR-based treatment planning in radiation therapy. However, the MR images used for MR-guided adaptive planning are often truncated in the boundary regions due to the limited field of view and the need for sequence optimization. Consequently, the sCT generated from these truncated MR images lacks complete anatomic information, leading to dose calculation error for MR-based adaptive planning. We propose a novel structure-completion generative adversarial network (SC-GAN) to generate sCT with full anatomic details from the truncated MR images. To enable anatomy compensation, we expand input channels of the CT generator by including a body mask and introduce a truncation loss between sCT and real CT. The body mask for each patient was automatically created from the simulation CT scans and transformed to daily MR images by rigid registration as another input for our SC-GAN in addition to the MR images. The truncation loss was constructed by implementing either an auto-segmentor or an edge detector to penalize the difference in body outlines between sCT and real CT. The experimental results show that our SC-GAN achieved much improved accuracy of sCT generation in both truncated and untruncated regions compared to the original cycleGAN and conditional GAN methods.
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Affiliation(s)
- Xinru Chen
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA; The University of Texas MD Anderson Cancer Center UTHealth Houston Graduate School of Biomedical Sciences, Houston, TX 77030, USA.
| | - Yao Zhao
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA; The University of Texas MD Anderson Cancer Center UTHealth Houston Graduate School of Biomedical Sciences, Houston, TX 77030, USA.
| | - Laurence E Court
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA; The University of Texas MD Anderson Cancer Center UTHealth Houston Graduate School of Biomedical Sciences, Houston, TX 77030, USA
| | - He Wang
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA; The University of Texas MD Anderson Cancer Center UTHealth Houston Graduate School of Biomedical Sciences, Houston, TX 77030, USA
| | - Tinsu Pan
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA; The University of Texas MD Anderson Cancer Center UTHealth Houston Graduate School of Biomedical Sciences, Houston, TX 77030, USA
| | - Jack Phan
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Xin Wang
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA; The University of Texas MD Anderson Cancer Center UTHealth Houston Graduate School of Biomedical Sciences, Houston, TX 77030, USA
| | - Yao Ding
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Jinzhong Yang
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA; The University of Texas MD Anderson Cancer Center UTHealth Houston Graduate School of Biomedical Sciences, Houston, TX 77030, USA.
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7
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Xu K, Li TZ, Terry JG, Krishnan AR, Deppen SA, Huo Y, Maldonado F, Carr JJ, Landman BA, Sandler KL. Age-related Muscle Fat Infiltration in Lung Screening Participants: Impact of Smoking Cessation. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.12.05.23299258. [PMID: 38106099 PMCID: PMC10723505 DOI: 10.1101/2023.12.05.23299258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/19/2023]
Abstract
Rationale Skeletal muscle fat infiltration progresses with aging and is worsened among individuals with a history of cigarette smoking. Many negative impacts of smoking on muscles are likely reversible with smoking cessation. Objectives To determine if the progression of skeletal muscle fat infiltration with aging is altered by smoking cessation among lung cancer screening participants. Methods This was a secondary analysis based on the National Lung Screening Trial. Skeletal muscle attenuation in Hounsfield unit (HU) was derived from the baseline and follow-up low-dose CT scans using a previously validated artificial intelligence algorithm. Lower attenuation indicates greater fatty infiltration. Linear mixed-effects models were constructed to evaluate the associations between smoking status and the muscle attenuation trajectory. Measurements and Main Results Of 19,019 included participants (age: 61 years, 5 [SD]; 11,290 males), 8,971 (47.2%) were actively smoking cigarettes. Accounting for body mass index, pack-years, percent emphysema, and other confounding factors, actively smoking predicted a lower attenuation in both males (β0 =-0.88 HU, P<.001) and females (β0 =-0.69 HU, P<.001), and an accelerated muscle attenuation decline-rate in males (β1=-0.08 HU/y, P<.05). Age-stratified analyses indicated that the accelerated muscle attenuation decline associated with smoking likely occurred at younger age, especially in females. Conclusions Among lung cancer screening participants, active cigarette smoking was associated with greater skeletal muscle fat infiltration in both males and females, and accelerated muscle adipose accumulation rate in males. These findings support the important role of smoking cessation in preserving muscle health.
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Affiliation(s)
- Kaiwen Xu
- Department of Computer Science, Vanderbilt University, Nashville, Tennessee
| | - Thomas Z. Li
- Department of Biomedical Engineering, Vanderbilt University, Nashville, Tennessee
- School of Medicine, Vanderbilt University, Nashville, Tennessee
| | - James G. Terry
- Department of Radiology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Aravind R. Krishnan
- Department of Electrical and Computer Engineering, Vanderbilt University, Nashville, Tennessee
| | - Stephen A. Deppen
- Department of Thoracic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Yuankai Huo
- Department of Computer Science, Vanderbilt University, Nashville, Tennessee
- Department of Electrical and Computer Engineering, Vanderbilt University, Nashville, Tennessee
| | - Fabien Maldonado
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - J. Jeffrey Carr
- Department of Radiology, Vanderbilt University Medical Center, Nashville, Tennessee
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Bennett A. Landman
- Department of Computer Science, Vanderbilt University, Nashville, Tennessee
- Department of Biomedical Engineering, Vanderbilt University, Nashville, Tennessee
- Department of Electrical and Computer Engineering, Vanderbilt University, Nashville, Tennessee
- Department of Radiology, Vanderbilt University Medical Center, Nashville, Tennessee
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Kim L. Sandler
- Department of Radiology, Vanderbilt University Medical Center, Nashville, Tennessee
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Xu K, Khan MS, Li TZ, Gao R, Terry JG, Huo Y, Lasko TA, Carr JJ, Maldonado F, Landman BA, Sandler KL. AI Body Composition in Lung Cancer Screening: Added Value Beyond Lung Cancer Detection. Radiology 2023; 308:e222937. [PMID: 37489991 PMCID: PMC10374937 DOI: 10.1148/radiol.222937] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 05/25/2023] [Accepted: 05/26/2023] [Indexed: 07/26/2023]
Abstract
Background An artificial intelligence (AI) algorithm has been developed for fully automated body composition assessment of lung cancer screening noncontrast low-dose CT of the chest (LDCT) scans, but the utility of these measurements in disease risk prediction models has not been assessed. Purpose To evaluate the added value of CT-based AI-derived body composition measurements in risk prediction of lung cancer incidence, lung cancer death, cardiovascular disease (CVD) death, and all-cause mortality in the National Lung Screening Trial (NLST). Materials and Methods In this secondary analysis of the NLST, body composition measurements, including area and attenuation attributes of skeletal muscle and subcutaneous adipose tissue, were derived from baseline LDCT examinations by using a previously developed AI algorithm. The added value of these measurements was assessed with sex- and cause-specific Cox proportional hazards models with and without the AI-derived body composition measurements for predicting lung cancer incidence, lung cancer death, CVD death, and all-cause mortality. Models were adjusted for confounding variables including age; body mass index; quantitative emphysema; coronary artery calcification; history of diabetes, heart disease, hypertension, and stroke; and other PLCOM2012 lung cancer risk factors. Goodness-of-fit improvements were assessed with the likelihood ratio test. Results Among 20 768 included participants (median age, 61 years [IQR, 57-65 years]; 12 317 men), 865 were diagnosed with lung cancer and 4180 died during follow-up. Including the AI-derived body composition measurements improved risk prediction for lung cancer death (male participants: χ2 = 23.09, P < .001; female participants: χ2 = 15.04, P = .002), CVD death (males: χ2 = 69.94, P < .001; females: χ2 = 16.60, P < .001), and all-cause mortality (males: χ2 = 248.13, P < .001; females: χ2 = 94.54, P < .001), but not for lung cancer incidence (male participants: χ2 = 2.53, P = .11; female participants: χ2 = 1.73, P = .19). Conclusion The body composition measurements automatically derived from baseline low-dose CT examinations added predictive value for lung cancer death, CVD death, and all-cause death, but not for lung cancer incidence in the NLST. Clinical trial registration no. NCT00047385 © RSNA, 2023 Supplemental material is available for this article. See also the editorial by Fintelmann in this issue.
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Affiliation(s)
- Kaiwen Xu
- From the Department of Computer Science (K.X., Y.H., T.A.L., B.A.L.),
Department of Biomedical Engineering (T.Z.L., B.A.L.), School of Medicine
(T.Z.L.), and Department of Electrical and Computer Engineering (Y.H., B.A.L.),
Vanderbilt University, 2301 Vanderbilt Pl, Nashville, TN 37235; University of
Missouri–Kansas City, Kansas City, Mo (M.S.K.); Saint Luke’s Mid
America Heart Institute, Kansas City, Mo (M.S.K.); Siemens Healthineers,
Princeton, NJ (R.G.); Department of Radiology (J.G.T., J.J.C., B.A.L., K.L.S.),
Department of Biomedical Informatics (T.A.L., J.J.C., B.A.L.), Division of
Cardiovascular Medicine (J.J.C.), Division of Allergy, Pulmonary and Critical
Care Medicine (F.M.), Vanderbilt University Institute of Imaging Science
(B.A.L.), Vanderbilt Brain Institute (B.A.L.), Department of Psychiatry and
Behavioral Sciences (B.A.L.), Department of Neurology (B.A.L.), and Vanderbilt
Memory & Alzheimer’s Center (B.A.L.), Vanderbilt University
Medical Center, Nashville, Tenn
| | - Mirza S. Khan
- From the Department of Computer Science (K.X., Y.H., T.A.L., B.A.L.),
Department of Biomedical Engineering (T.Z.L., B.A.L.), School of Medicine
(T.Z.L.), and Department of Electrical and Computer Engineering (Y.H., B.A.L.),
Vanderbilt University, 2301 Vanderbilt Pl, Nashville, TN 37235; University of
Missouri–Kansas City, Kansas City, Mo (M.S.K.); Saint Luke’s Mid
America Heart Institute, Kansas City, Mo (M.S.K.); Siemens Healthineers,
Princeton, NJ (R.G.); Department of Radiology (J.G.T., J.J.C., B.A.L., K.L.S.),
Department of Biomedical Informatics (T.A.L., J.J.C., B.A.L.), Division of
Cardiovascular Medicine (J.J.C.), Division of Allergy, Pulmonary and Critical
Care Medicine (F.M.), Vanderbilt University Institute of Imaging Science
(B.A.L.), Vanderbilt Brain Institute (B.A.L.), Department of Psychiatry and
Behavioral Sciences (B.A.L.), Department of Neurology (B.A.L.), and Vanderbilt
Memory & Alzheimer’s Center (B.A.L.), Vanderbilt University
Medical Center, Nashville, Tenn
| | - Thomas Z. Li
- From the Department of Computer Science (K.X., Y.H., T.A.L., B.A.L.),
Department of Biomedical Engineering (T.Z.L., B.A.L.), School of Medicine
(T.Z.L.), and Department of Electrical and Computer Engineering (Y.H., B.A.L.),
Vanderbilt University, 2301 Vanderbilt Pl, Nashville, TN 37235; University of
Missouri–Kansas City, Kansas City, Mo (M.S.K.); Saint Luke’s Mid
America Heart Institute, Kansas City, Mo (M.S.K.); Siemens Healthineers,
Princeton, NJ (R.G.); Department of Radiology (J.G.T., J.J.C., B.A.L., K.L.S.),
Department of Biomedical Informatics (T.A.L., J.J.C., B.A.L.), Division of
Cardiovascular Medicine (J.J.C.), Division of Allergy, Pulmonary and Critical
Care Medicine (F.M.), Vanderbilt University Institute of Imaging Science
(B.A.L.), Vanderbilt Brain Institute (B.A.L.), Department of Psychiatry and
Behavioral Sciences (B.A.L.), Department of Neurology (B.A.L.), and Vanderbilt
Memory & Alzheimer’s Center (B.A.L.), Vanderbilt University
Medical Center, Nashville, Tenn
| | - Riqiang Gao
- From the Department of Computer Science (K.X., Y.H., T.A.L., B.A.L.),
Department of Biomedical Engineering (T.Z.L., B.A.L.), School of Medicine
(T.Z.L.), and Department of Electrical and Computer Engineering (Y.H., B.A.L.),
Vanderbilt University, 2301 Vanderbilt Pl, Nashville, TN 37235; University of
Missouri–Kansas City, Kansas City, Mo (M.S.K.); Saint Luke’s Mid
America Heart Institute, Kansas City, Mo (M.S.K.); Siemens Healthineers,
Princeton, NJ (R.G.); Department of Radiology (J.G.T., J.J.C., B.A.L., K.L.S.),
Department of Biomedical Informatics (T.A.L., J.J.C., B.A.L.), Division of
Cardiovascular Medicine (J.J.C.), Division of Allergy, Pulmonary and Critical
Care Medicine (F.M.), Vanderbilt University Institute of Imaging Science
(B.A.L.), Vanderbilt Brain Institute (B.A.L.), Department of Psychiatry and
Behavioral Sciences (B.A.L.), Department of Neurology (B.A.L.), and Vanderbilt
Memory & Alzheimer’s Center (B.A.L.), Vanderbilt University
Medical Center, Nashville, Tenn
| | - James G. Terry
- From the Department of Computer Science (K.X., Y.H., T.A.L., B.A.L.),
Department of Biomedical Engineering (T.Z.L., B.A.L.), School of Medicine
(T.Z.L.), and Department of Electrical and Computer Engineering (Y.H., B.A.L.),
Vanderbilt University, 2301 Vanderbilt Pl, Nashville, TN 37235; University of
Missouri–Kansas City, Kansas City, Mo (M.S.K.); Saint Luke’s Mid
America Heart Institute, Kansas City, Mo (M.S.K.); Siemens Healthineers,
Princeton, NJ (R.G.); Department of Radiology (J.G.T., J.J.C., B.A.L., K.L.S.),
Department of Biomedical Informatics (T.A.L., J.J.C., B.A.L.), Division of
Cardiovascular Medicine (J.J.C.), Division of Allergy, Pulmonary and Critical
Care Medicine (F.M.), Vanderbilt University Institute of Imaging Science
(B.A.L.), Vanderbilt Brain Institute (B.A.L.), Department of Psychiatry and
Behavioral Sciences (B.A.L.), Department of Neurology (B.A.L.), and Vanderbilt
Memory & Alzheimer’s Center (B.A.L.), Vanderbilt University
Medical Center, Nashville, Tenn
| | - Yuankai Huo
- From the Department of Computer Science (K.X., Y.H., T.A.L., B.A.L.),
Department of Biomedical Engineering (T.Z.L., B.A.L.), School of Medicine
(T.Z.L.), and Department of Electrical and Computer Engineering (Y.H., B.A.L.),
Vanderbilt University, 2301 Vanderbilt Pl, Nashville, TN 37235; University of
Missouri–Kansas City, Kansas City, Mo (M.S.K.); Saint Luke’s Mid
America Heart Institute, Kansas City, Mo (M.S.K.); Siemens Healthineers,
Princeton, NJ (R.G.); Department of Radiology (J.G.T., J.J.C., B.A.L., K.L.S.),
Department of Biomedical Informatics (T.A.L., J.J.C., B.A.L.), Division of
Cardiovascular Medicine (J.J.C.), Division of Allergy, Pulmonary and Critical
Care Medicine (F.M.), Vanderbilt University Institute of Imaging Science
(B.A.L.), Vanderbilt Brain Institute (B.A.L.), Department of Psychiatry and
Behavioral Sciences (B.A.L.), Department of Neurology (B.A.L.), and Vanderbilt
Memory & Alzheimer’s Center (B.A.L.), Vanderbilt University
Medical Center, Nashville, Tenn
| | - Thomas A. Lasko
- From the Department of Computer Science (K.X., Y.H., T.A.L., B.A.L.),
Department of Biomedical Engineering (T.Z.L., B.A.L.), School of Medicine
(T.Z.L.), and Department of Electrical and Computer Engineering (Y.H., B.A.L.),
Vanderbilt University, 2301 Vanderbilt Pl, Nashville, TN 37235; University of
Missouri–Kansas City, Kansas City, Mo (M.S.K.); Saint Luke’s Mid
America Heart Institute, Kansas City, Mo (M.S.K.); Siemens Healthineers,
Princeton, NJ (R.G.); Department of Radiology (J.G.T., J.J.C., B.A.L., K.L.S.),
Department of Biomedical Informatics (T.A.L., J.J.C., B.A.L.), Division of
Cardiovascular Medicine (J.J.C.), Division of Allergy, Pulmonary and Critical
Care Medicine (F.M.), Vanderbilt University Institute of Imaging Science
(B.A.L.), Vanderbilt Brain Institute (B.A.L.), Department of Psychiatry and
Behavioral Sciences (B.A.L.), Department of Neurology (B.A.L.), and Vanderbilt
Memory & Alzheimer’s Center (B.A.L.), Vanderbilt University
Medical Center, Nashville, Tenn
| | - John Jeffrey Carr
- From the Department of Computer Science (K.X., Y.H., T.A.L., B.A.L.),
Department of Biomedical Engineering (T.Z.L., B.A.L.), School of Medicine
(T.Z.L.), and Department of Electrical and Computer Engineering (Y.H., B.A.L.),
Vanderbilt University, 2301 Vanderbilt Pl, Nashville, TN 37235; University of
Missouri–Kansas City, Kansas City, Mo (M.S.K.); Saint Luke’s Mid
America Heart Institute, Kansas City, Mo (M.S.K.); Siemens Healthineers,
Princeton, NJ (R.G.); Department of Radiology (J.G.T., J.J.C., B.A.L., K.L.S.),
Department of Biomedical Informatics (T.A.L., J.J.C., B.A.L.), Division of
Cardiovascular Medicine (J.J.C.), Division of Allergy, Pulmonary and Critical
Care Medicine (F.M.), Vanderbilt University Institute of Imaging Science
(B.A.L.), Vanderbilt Brain Institute (B.A.L.), Department of Psychiatry and
Behavioral Sciences (B.A.L.), Department of Neurology (B.A.L.), and Vanderbilt
Memory & Alzheimer’s Center (B.A.L.), Vanderbilt University
Medical Center, Nashville, Tenn
| | - Fabien Maldonado
- From the Department of Computer Science (K.X., Y.H., T.A.L., B.A.L.),
Department of Biomedical Engineering (T.Z.L., B.A.L.), School of Medicine
(T.Z.L.), and Department of Electrical and Computer Engineering (Y.H., B.A.L.),
Vanderbilt University, 2301 Vanderbilt Pl, Nashville, TN 37235; University of
Missouri–Kansas City, Kansas City, Mo (M.S.K.); Saint Luke’s Mid
America Heart Institute, Kansas City, Mo (M.S.K.); Siemens Healthineers,
Princeton, NJ (R.G.); Department of Radiology (J.G.T., J.J.C., B.A.L., K.L.S.),
Department of Biomedical Informatics (T.A.L., J.J.C., B.A.L.), Division of
Cardiovascular Medicine (J.J.C.), Division of Allergy, Pulmonary and Critical
Care Medicine (F.M.), Vanderbilt University Institute of Imaging Science
(B.A.L.), Vanderbilt Brain Institute (B.A.L.), Department of Psychiatry and
Behavioral Sciences (B.A.L.), Department of Neurology (B.A.L.), and Vanderbilt
Memory & Alzheimer’s Center (B.A.L.), Vanderbilt University
Medical Center, Nashville, Tenn
| | - Bennett A. Landman
- From the Department of Computer Science (K.X., Y.H., T.A.L., B.A.L.),
Department of Biomedical Engineering (T.Z.L., B.A.L.), School of Medicine
(T.Z.L.), and Department of Electrical and Computer Engineering (Y.H., B.A.L.),
Vanderbilt University, 2301 Vanderbilt Pl, Nashville, TN 37235; University of
Missouri–Kansas City, Kansas City, Mo (M.S.K.); Saint Luke’s Mid
America Heart Institute, Kansas City, Mo (M.S.K.); Siemens Healthineers,
Princeton, NJ (R.G.); Department of Radiology (J.G.T., J.J.C., B.A.L., K.L.S.),
Department of Biomedical Informatics (T.A.L., J.J.C., B.A.L.), Division of
Cardiovascular Medicine (J.J.C.), Division of Allergy, Pulmonary and Critical
Care Medicine (F.M.), Vanderbilt University Institute of Imaging Science
(B.A.L.), Vanderbilt Brain Institute (B.A.L.), Department of Psychiatry and
Behavioral Sciences (B.A.L.), Department of Neurology (B.A.L.), and Vanderbilt
Memory & Alzheimer’s Center (B.A.L.), Vanderbilt University
Medical Center, Nashville, Tenn
| | - Kim L. Sandler
- From the Department of Computer Science (K.X., Y.H., T.A.L., B.A.L.),
Department of Biomedical Engineering (T.Z.L., B.A.L.), School of Medicine
(T.Z.L.), and Department of Electrical and Computer Engineering (Y.H., B.A.L.),
Vanderbilt University, 2301 Vanderbilt Pl, Nashville, TN 37235; University of
Missouri–Kansas City, Kansas City, Mo (M.S.K.); Saint Luke’s Mid
America Heart Institute, Kansas City, Mo (M.S.K.); Siemens Healthineers,
Princeton, NJ (R.G.); Department of Radiology (J.G.T., J.J.C., B.A.L., K.L.S.),
Department of Biomedical Informatics (T.A.L., J.J.C., B.A.L.), Division of
Cardiovascular Medicine (J.J.C.), Division of Allergy, Pulmonary and Critical
Care Medicine (F.M.), Vanderbilt University Institute of Imaging Science
(B.A.L.), Vanderbilt Brain Institute (B.A.L.), Department of Psychiatry and
Behavioral Sciences (B.A.L.), Department of Neurology (B.A.L.), and Vanderbilt
Memory & Alzheimer’s Center (B.A.L.), Vanderbilt University
Medical Center, Nashville, Tenn
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