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Kouri N, Frankenhauser I, Peng Z, Labuzan SA, Boon BDC, Moloney CM, Pottier C, Wickland DP, Caetano-Anolles K, Corriveau-Lecavalier N, Tranovich JF, Wood AC, Hinkle KM, Lincoln SJ, Spychalla AJ, Senjem ML, Przybelski SA, Engelberg-Cook E, Schwarz CG, Kwan RS, Lesser ER, Crook JE, Carter RE, Ross OA, Lachner C, Ertekin-Taner N, Ferman TJ, Fields JA, Machulda MM, Ramanan VK, Nguyen AT, Reichard RR, Jones DT, Graff-Radford J, Boeve BF, Knopman DS, Petersen RC, Jack CR, Kantarci K, Day GS, Duara R, Graff-Radford NR, Dickson DW, Lowe VJ, Vemuri P, Murray ME. Clinicopathologic Heterogeneity and Glial Activation Patterns in Alzheimer Disease. JAMA Neurol 2024:2817289. [PMID: 38619853 PMCID: PMC11019448 DOI: 10.1001/jamaneurol.2024.0784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 01/05/2024] [Indexed: 04/16/2024]
Abstract
Importance Factors associated with clinical heterogeneity in Alzheimer disease (AD) lay along a continuum hypothesized to associate with tangle distribution and are relevant for understanding glial activation considerations in therapeutic advancement. Objectives To examine clinicopathologic and neuroimaging characteristics of disease heterogeneity in AD along a quantitative continuum using the corticolimbic index (CLix) to account for individuality of spatially distributed tangles found at autopsy. Design, Setting, and Participants This cross-sectional study was a retrospective medical record review performed on the Florida Autopsied Multiethnic (FLAME) cohort accessioned from 1991 to 2020. Data were analyzed from December 2022 to December 2023. Structural magnetic resonance imaging (MRI) and tau positron emission tomography (PET) were evaluated in an independent neuroimaging group. The FLAME cohort includes 2809 autopsied individuals; included in this study were neuropathologically diagnosed AD cases (FLAME-AD). A digital pathology subgroup of FLAME-AD cases was derived for glial activation analyses. Main Outcomes and Measures Clinicopathologic factors of heterogeneity that inform patient history and neuropathologic evaluation of AD; CLix score (lower, relative cortical predominance/hippocampal sparing vs higher, relative cortical sparing/limbic predominant cases); neuroimaging measures (ie, structural MRI and tau-PET). Results Of the 2809 autopsied individuals in the FLAME cohort, 1361 neuropathologically diagnosed AD cases were evaluated. A digital pathology subgroup included 60 FLAME-AD cases. The independent neuroimaging group included 93 cases. Among the 1361 FLAME-AD cases, 633 were male (47%; median [range] age at death, 81 [54-96] years) and 728 were female (53%; median [range] age at death, 81 [53-102] years). A younger symptomatic onset (Spearman ρ = 0.39, P < .001) and faster decline on the Mini-Mental State Examination (Spearman ρ = 0.27; P < .001) correlated with a lower CLix score in FLAME-AD series. Cases with a nonamnestic syndrome had lower CLix scores (median [IQR], 13 [9-18]) vs not (median [IQR], 21 [15-27]; P < .001). Hippocampal MRI volume (Spearman ρ = -0.45; P < .001) and flortaucipir tau-PET uptake in posterior cingulate and precuneus cortex (Spearman ρ = -0.74; P < .001) inversely correlated with CLix score. Although AD cases with a CLix score less than 10 had higher cortical tangle count, we found lower percentage of CD68-activated microglia/macrophage burden (median [IQR], 0.46% [0.32%-0.75%]) compared with cases with a CLix score of 10 to 30 (median [IQR], 0.75% [0.51%-0.98%]) and on par with a CLix score of 30 or greater (median [IQR], 0.40% [0.32%-0.57%]; P = .02). Conclusions and Relevance Findings show that AD heterogeneity exists along a continuum of corticolimbic tangle distribution. Reduced CD68 burden may signify an underappreciated association between tau accumulation and microglia/macrophages activation that should be considered in personalized therapy for immune dysregulation.
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Affiliation(s)
- Naomi Kouri
- Department of Neuroscience, Mayo Clinic, Jacksonville, Florida
| | - Isabelle Frankenhauser
- Department of Neuroscience, Mayo Clinic, Jacksonville, Florida
- Paracelsus Medical Private University, Salzburg, Austria
| | - Zhongwei Peng
- Department of Quantitative Health Sciences, Mayo Clinic, Jacksonville, Florida
| | | | | | | | - Cyril Pottier
- Department of Neuroscience, Mayo Clinic, Jacksonville, Florida
| | - Daniel P. Wickland
- Department of Quantitative Health Sciences, Mayo Clinic, Jacksonville, Florida
| | | | - Nick Corriveau-Lecavalier
- Department of Radiology, Mayo Clinic, Rochester, Minnesota
- Department of Neurology, Mayo Clinic, Rochester, Minnesota
| | | | - Ashley C. Wood
- Department of Neuroscience, Mayo Clinic, Jacksonville, Florida
| | - Kelly M. Hinkle
- Department of Neuroscience, Mayo Clinic, Jacksonville, Florida
| | | | | | | | - Scott A. Przybelski
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota
| | | | | | - Rain S. Kwan
- Department of Quantitative Health Sciences, Mayo Clinic, Jacksonville, Florida
| | - Elizabeth R. Lesser
- Department of Quantitative Health Sciences, Mayo Clinic, Jacksonville, Florida
| | - Julia E. Crook
- Department of Quantitative Health Sciences, Mayo Clinic, Jacksonville, Florida
| | - Rickey E. Carter
- Department of Quantitative Health Sciences, Mayo Clinic, Jacksonville, Florida
| | - Owen A. Ross
- Department of Neuroscience, Mayo Clinic, Jacksonville, Florida
| | - Christian Lachner
- Department of Psychiatry and Psychology, Mayo Clinic, Jacksonville, Florida
| | - Nilüfer Ertekin-Taner
- Department of Neuroscience, Mayo Clinic, Jacksonville, Florida
- Department of Neurology, Mayo Clinic, Jacksonville, Florida
| | - Tanis J. Ferman
- Department of Psychiatry and Psychology, Mayo Clinic, Jacksonville, Florida
| | - Julie A. Fields
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota
| | - Mary M. Machulda
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota
| | | | - Aivi T. Nguyen
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota
| | - R. Ross Reichard
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota
| | - David T. Jones
- Department of Radiology, Mayo Clinic, Rochester, Minnesota
- Department of Neurology, Mayo Clinic, Rochester, Minnesota
| | | | | | | | | | | | - Kejal Kantarci
- Department of Radiology, Mayo Clinic, Rochester, Minnesota
| | - Gregory S. Day
- Department of Neurology, Mayo Clinic, Jacksonville, Florida
| | - Ranjan Duara
- Wien Center for Alzheimer’s Disease and Memory Disorders, Mount Sinai Medical Center, Miami Beach, Florida
| | | | | | - Val J. Lowe
- Department of Radiology, Mayo Clinic, Rochester, Minnesota
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Nakai H, Nagayama H, Takahashi H, Froemming AT, Kawashima A, Bolan CW, Adamo DA, Carter RE, Fazzio RT, Tsuji S, Lomas DJ, Mynderse LA, Humphreys MR, Dora C, Takahashi N. Cancer Detection Rate and Abnormal Interpretation Rate of Prostate MRI in Patients With Low-Grade Cancer. J Am Coll Radiol 2024; 21:387-397. [PMID: 37838189 DOI: 10.1016/j.jacr.2023.07.030] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 07/21/2023] [Accepted: 07/27/2023] [Indexed: 10/16/2023]
Abstract
PURPOSE The aim of this study was to evaluate the utility of cancer detection rate (CDR) and abnormal interpretation rate (AIR) in prostate MRI for patients with low-grade prostate cancer (PCa). METHODS This three-center retrospective study included patients who underwent prostate MRI from 2017 to 2021 with known low-grade PCa (Gleason score 6) without prior treatment. Patient-level highest Prostate Imaging Reporting & Data System (PI-RADS®) score and pathologic diagnosis within 1 year after MRI were used to evaluate the diagnostic performance of prostate MRI in detecting clinically significant PCa (csPCa; Gleason score ≥ 7). The metrics AIR, CDR, and CDR adjusted for pathologic confirmation rate were calculated. Radiologist-level AIR-CDR plots were shown. Simulation AIR-CDR lines were created to assess the effects of different diagnostic performances of prostate MRI and the prevalence of csPCa. RESULTS A total of 3,207 examinations were interpreted by 33 radiologists. Overall AIR, CDR, and CDR adjusted for pathologic confirmation rate at PI-RADS 3 to 5 (PI-RADS 4 and 5) were 51.7% (36.5%), 22.1% (18.8%), and 30.7% (24.6%), respectively. Radiologist-level AIR and CDR at PI-RADS 3 to 5 (PI-RADS 4 and 5) were in the 36.8% to 75.6% (21.9%-57.5%) range and the 16.3%-28.7% (10.9%-26.5%) range, respectively. In the simulation, changing parameters of diagnostic performance or csPCa prevalence shifted the AIR-CDR line. CONCLUSIONS The authors propose CDR and AIR as performance metrics in prostate MRI and report reference performance values in patients with known low-grade PCa. There was variability in radiologist-level AIR and CDR. Combined use of AIR and CDR could provide meaningful feedback for radiologists to improve their performance by showing relative performance to other radiologists.
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Affiliation(s)
| | - Hiroki Nagayama
- Department of Radiology, Mayo Clinic, Rochester, Minnesota; Department of Radiology, Nagasaki University School of Medicine, Nagasaki, Japan
| | | | - Adam T Froemming
- Division Chair of Abdominal Imaging, Department of Radiology, Mayo Clinic, Rochester, Minnesota
| | | | - Candice W Bolan
- Chief, Department of Radiology, Mayo Clinic, Jacksonville, Florida
| | - Daniel A Adamo
- Department of Radiology, Mayo Clinic, Rochester, Minnesota
| | - Rickey E Carter
- Vice Chair, Department of Quantitative Health Sciences, Mayo Clinic, Jacksonville, Florida
| | - Robert T Fazzio
- Division Chair of Breast Imaging, Department of Radiology, Mayo Clinic, Rochester, Minnesota
| | | | - Derek J Lomas
- Department of Urology, Mayo Clinic, Rochester, Minnesota
| | | | | | - Chandler Dora
- Department of Urology, Mayo Clinic, Jacksonville, Florida
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Ouyang D, Carter RE, Pellikka PA. Machine Learning in Imaging: What is JASE Looking For? J Am Soc Echocardiogr 2024; 37:273-275. [PMID: 38432849 DOI: 10.1016/j.echo.2024.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/05/2024]
Affiliation(s)
- David Ouyang
- Department of Cardiology, Cedars-Sinai Medical Center
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Nagayama H, Nakai H, Takahashi H, Froemming AT, Kawashima A, Bolan CW, Adamo DA, Carter RE, Fazzio RT, Tsuji S, Lomas DJ, Mynderse LA, Humphreys MR, Dora C, Takahashi N. Cancer Detection Rate and Abnormal Interpretation Rate of Prostate MRI Performed for Clinical Suspicion of Prostate Cancer. J Am Coll Radiol 2024; 21:398-408. [PMID: 37820833 DOI: 10.1016/j.jacr.2023.07.031] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 07/21/2023] [Accepted: 07/27/2023] [Indexed: 10/13/2023]
Abstract
PURPOSE To report cancer detection rate (CDR) and abnormal interpretation rate (AIR) in prostate MRI performed for clinical suspicion of prostate cancer (PCa). MATERIALS AND METHODS This retrospective single-institution, three-center study included patients who underwent MRI for clinical suspicion of PCa between 2017 and 2021. Patients with known PCa were excluded. Patient-level Prostate Imaging-Reporting and Data System (PI-RADS) score was extracted from the radiology report. AIR was defined as number of abnormal MRI (PI-RADS score 3-5) / total number of MRIs. CDR was defined as number of clinically significant PCa (csPCa: Gleason score ≥7) detected at abnormal MRI / total number of MRI. AIR, CDR, and CDR adjusted for pathology confirmation rate were calculated for each of three centers and pre-MRI biopsy status (biopsy-naive and previous negative biopsy). RESULTS A total of 9,686 examinations (8,643 unique patients) were included. AIR, CDR, and CDR adjusted for pathology confirmation rate were 45.4%, 23.8%, and 27.6% for center I; 47.2%, 20.0%, and 22.8% for center II; and 42.3%, 27.2%, and 30.1% for center III, respectively. Pathology confirmation rate ranged from 81.6% to 88.0% across three centers. AIR and CDR for biopsy-naive patients were 45.5% to 52.6% and 24.2% to 33.5% across three centers, respectively, and those for previous negative biopsy were 27.2% to 39.8% and 11.7% to 14.2% across three centers, respectively. CONCLUSION We reported CDR and AIR in prostate MRI for clinical suspicion of PCa. CDR needs to be adjusted for pathology confirmation rate and pre-MRI biopsy status for interfacility comparison.
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Affiliation(s)
- Hiroki Nagayama
- Department of Radiology, Mayo Clinic, Rochester, Minnesota; Department of Radiology, Nagasaki University School of Medicine, Nagasaki, Japan
| | | | | | - Adam T Froemming
- Division Chair of the Abdominal Imaging in Minnesota, Department of Radiology, Mayo Clinic, Rochester, Minnesota
| | | | - Candice W Bolan
- Chief, Department of Radiology, Mayo Clinic, Jacksonville, Florida
| | - Daniel A Adamo
- Department of Radiology, Mayo Clinic, Rochester, Minnesota
| | - Rickey E Carter
- Vice Chair, Department of Quantitative Health Sciences, Mayo Clinic, Jacksonville, Florida
| | - Robert T Fazzio
- Division Chair of the Breast Imaging, Department of Radiology, Mayo Clinic, Rochester, Minnesota
| | | | - Derek J Lomas
- Department of Urology, Mayo Clinic, Rochester, Minnesota
| | | | | | - Chandler Dora
- Department of Urology, Mayo Clinic, Jacksonville, Florida
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McCollough CH, Winfree TN, Melka EF, Rajendran K, Carter RE, Leng S. Photon-Counting Detector Computed Tomography Versus Energy-Integrating Detector Computed Tomography for Coronary Artery Calcium Quantitation. J Comput Assist Tomogr 2024; 48:212-216. [PMID: 37801651 PMCID: PMC10939985 DOI: 10.1097/rct.0000000000001554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/08/2023]
Abstract
OBJECTIVES Photon-counting detector (PCD) computed tomography (CT) offers improved spatial and contrast resolution, which can impact quantitative measurements. This work aims to determine in human subjects the effect of dual-source PCD-CT on the quantitation of coronary artery calcification (CAC) compared with dual-source energy-integrating detector (EID) CT in both 1- and 3-mm images. METHODS This prospective study enrolled patients receiving a clinical EID-CT CAC examination to undergo a research PCD-CT CAC examination. Axial images were reconstructed with a 512 × 512 matrix, 200-mm field of view, 3-mm section thickness/1.5-mm interval using a quantitative kernel (Qr36). Sharper kernels (Qr56/QIR strength 4 for PCD and Qr49/ADMIRE strength 5 for EID) were used to reconstruct images with 1-mm section thickness/0.5-mm interval. Pooled analysis was performed for all calcifications with nonzero values, and volume and Agatston scores were compared between EID-CT and PCD-CT. A Wilcoxon signed-rank test was performed with P < 0.05 considered statistically significant. RESULTS In 21 subjects (median age, 58 years; range, 50-75 years; 13 male [62%]) with a total of 42 calcified arteries detected at 3 mm and 46 calcified arteries at 1-mm images, EID-CT CAC volume and Agatston scores were significantly lower than those of PCD-CT ( P ≤ 0.001). At 3-mm thickness, the mean (standard deviation) volume and Agatston score for EID-CT were 55.5 (63.4) mm 3 and 63.8 (76.9), respectively, and 61.5 (69.4) mm 3 and 70.4 (85.3) for PCD-CT ( P = 0.0001 and P = 0.0013). At 1-mm thickness, the mean (standard deviation) volume and score for EID-CT were 50.0 (56.3) mm 3 and 61.1 (69.3), respectively, and 59.5 (63.9) mm 3 and 72.5 (79.9) for PCD-CT ( P < 0.0001 for both). The applied radiation dose (volume CT dose index) for the PCD-CT scan was 2.1 ± 0.6 mGy, which was 13% lower than for the EID-CT scan (2.4 ± 0.7 mGy, P < 0.001). CONCLUSIONS Relative to EID-CT, PCD-CT demonstrated a small but significant increase in coronary artery calcium volume and Agatston score.
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Affiliation(s)
| | - Tim N Winfree
- From the Department of Radiology, Mayo Clinic, Rochester, MN
| | - Elnata F Melka
- From the Department of Radiology, Mayo Clinic, Rochester, MN
| | | | - Rickey E Carter
- Department of Health Science Research, Mayo Clinic, Jacksonville, FL
| | - Shuai Leng
- From the Department of Radiology, Mayo Clinic, Rochester, MN
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Bornhorst J, Rokke D, Day P, Erdahl S, Wieczorek MA, Carter RE, Jannetto PJ. Assessment of Sigma Error Metrics Associated with Manual Secondary Result Review and Subsequent Artificial Intelligence-Driven Quality Assurance Review-Application to Kidney Stone Analysis. Clin Chem 2024; 70:453-455. [PMID: 38006322 DOI: 10.1093/clinchem/hvad195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2023]
Affiliation(s)
- Joshua Bornhorst
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, United States
| | - Denise Rokke
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, United States
| | - Patrick Day
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, United States
| | - Sarah Erdahl
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, United States
| | - Mikolaj A Wieczorek
- Digital Innovation Laboratory, Mayo Clinic, Florida, Jacksonville, FL, United States
| | - Rickey E Carter
- Department of Qualitative Health Sciences, Mayo Clinic, Florida, Jacksonville, FL, United States
| | - Paul J Jannetto
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, United States
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Borlaug BA, Koepp KE, Reddy YNV, Obokata M, Sorimachi H, Freund M, Haberman D, Sweere K, Weber KL, Overholt EA, Safe BA, Omote K, Omar M, Popovic D, Acker NG, Gladwin MT, Olson TP, Carter RE. Inorganic Nitrite to Amplify the Benefits and Tolerability of Exercise Training in Heart Failure With Preserved Ejection Fraction: The INABLE-Training Trial. Mayo Clin Proc 2024; 99:206-217. [PMID: 38127015 PMCID: PMC10872737 DOI: 10.1016/j.mayocp.2023.08.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 08/22/2023] [Accepted: 08/29/2023] [Indexed: 12/23/2023]
Abstract
OBJECTIVE To determine whether nitrite can enhance exercise training (ET) effects in heart failure with preserved ejection fraction (HFpEF). METHODS In this multicenter, double-blind, placebo-controlled, randomized trial conducted at 1 urban and 9 rural outreach centers between November 22, 2016, and December 9, 2021, patients with HFpEF underwent ET along with inorganic nitrite 40 mg or placebo 3 times daily. The primary end point was peak oxygen consumption (VO2). Secondary end points included Kansas City Cardiomyopathy Questionnaire overall summary score (KCCQ-OSS, range 0 to 100; higher scores reflect better health status), 6-minute walk distance, and actigraphy. RESULTS Of 92 patients randomized, 73 completed the trial because of protocol modifications necessitated by loss of drug availability. Most patients were older than 65 years (80%), were obese (75%), and lived in rural settings (63%). At baseline, median peak VO2 (14.1 mL·kg-1·min-1) and KCCQ-OSS (63.7) were severely reduced. Exercise training improved peak VO2 (+0.8 mL·kg-1·min-1; 95% CI, 0.3 to 1.2; P<.001) and KCCQ-OSS (+5.5; 95% CI, 2.5 to 8.6; P<.001). Nitrite was well tolerated, but treatment with nitrite did not affect the change in peak VO2 with ET (nitrite effect, -0.13; 95% CI, -1.03 to 0.76; P=.77) or KCCQ-OSS (-1.2; 95% CI, -7.2 to 4.9; P=.71). This pattern was consistent across other secondary outcomes. CONCLUSION For patients with HFpEF, ET administered for 12 weeks in a predominantly rural setting improved exercise capacity and health status, but compared with placebo, treatment with inorganic nitrite did not enhance the benefit from ET. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT02713126.
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Affiliation(s)
- Barry A Borlaug
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN.
| | - Katlyn E Koepp
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
| | - Yogesh N V Reddy
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
| | - Masaru Obokata
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
| | - Hidemi Sorimachi
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
| | - Monique Freund
- Mayo Clinic Community Cardiology Southwest Wisconsin, La Crosse
| | - Doug Haberman
- Mayo Clinic Community Cardiology Southwest Wisconsin, La Crosse
| | - Kara Sweere
- Mayo Clinic Community Cardiology Southeast Minnesota, Albert Lea
| | - Kari L Weber
- Mayo Clinic Community Cardiology Southeast Minnesota, Austin
| | | | - Bethany A Safe
- Mayo Clinic Community Cardiology Southeast Minnesota, Red Wing
| | - Kazunori Omote
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
| | - Massar Omar
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
| | - Dejana Popovic
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
| | - Nancy G Acker
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
| | - Mark T Gladwin
- Department of Medicine, Maryland School of Medicine, Baltimore
| | - Thomas P Olson
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
| | - Rickey E Carter
- Department of Quantitative Health Sciences, Mayo Clinic, Jacksonville, FL
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Hsieh SS, Inoue A, Yalon M, Cook DA, Gong H, Sudhir Pillai P, Johnson MP, Fidler JL, Leng S, Yu L, Carter RE, Holmes DR, McCollough CH, Fletcher JG. Targeted Training Reduces Search Errors but Not Classification Errors for Hepatic Metastasis Detection at Contrast-Enhanced CT. Acad Radiol 2024; 31:448-456. [PMID: 37567818 PMCID: PMC10853479 DOI: 10.1016/j.acra.2023.06.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 06/15/2023] [Accepted: 06/20/2023] [Indexed: 08/13/2023]
Abstract
RATIONALE AND OBJECTIVES Methods are needed to improve the detection of hepatic metastases. Errors occur in both lesion detection (search) and decisions of benign versus malignant (classification). Our purpose was to evaluate a training program to reduce search errors and classification errors in the detection of hepatic metastases in contrast-enhanced abdominal computed tomography (CT). MATERIALS AND METHODS After Institutional Review Board approval, we conducted a single-group prospective pretest-posttest study. Pretest and posttest were identical and consisted of interpreting 40 contrast-enhanced abdominal CT exams containing 91 liver metastases under eye tracking. Between pretest and posttest, readers completed search training with eye-tracker feedback and coaching to increase interpretation time, use liver windows, and use coronal reformations. They also completed classification training with part-task practice, rating lesions as benign or malignant. The primary outcome was metastases missed due to search errors (<2 seconds gaze under eye tracker) and classification errors (>2 seconds). Jackknife free-response receiver operator characteristic (JAFROC) analysis was also conducted. RESULTS A total of 31 radiologist readers (8 abdominal subspecialists, 8 nonabdominal subspecialists, 15 senior residents/fellows) participated. Search errors were reduced (pretest 11%, posttest 8%, difference 3% [95% confidence interval, 0.3%-5.1%], P = .01), but there was no difference in classification errors (difference 0%, P = .97) or in JAFROC figure of merit (difference -0.01, P = .36). In subgroup analysis, abdominal subspecialists demonstrated no evidence of change. CONCLUSION Targeted training reduced search errors but not classification errors for the detection of hepatic metastases at contrast-enhanced abdominal CT. Improvements were not seen in all subgroups.
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Affiliation(s)
- Scott S Hsieh
- Department of Radiology, Mayo Clinic, 200 First St. SW, Rochester, MN 55905 (S.S.H., A.I., M.Y., H.G., P.S.P., J.L.F., S.L., L.Y., C.H.McC., J.G.F.); Department of General Internal Medicine, Mayo Clinic, 200 First St. SW, Rochester, MN 55905 (S.S.H.).
| | - Akitoshi Inoue
- Department of Radiology, Mayo Clinic, 200 First St. SW, Rochester, MN 55905 (S.S.H., A.I., M.Y., H.G., P.S.P., J.L.F., S.L., L.Y., C.H.McC., J.G.F.)
| | - Mariana Yalon
- Department of Radiology, Mayo Clinic, 200 First St. SW, Rochester, MN 55905 (S.S.H., A.I., M.Y., H.G., P.S.P., J.L.F., S.L., L.Y., C.H.McC., J.G.F.)
| | - David A Cook
- Quantitative Health Services - Clinical Trials and Biostatistics, Mayo Clinic, 200 First St. SW, Rochester, MN 55905 (D.A.C.)
| | - Hao Gong
- Department of Radiology, Mayo Clinic, 200 First St. SW, Rochester, MN 55905 (S.S.H., A.I., M.Y., H.G., P.S.P., J.L.F., S.L., L.Y., C.H.McC., J.G.F.)
| | - Parvathy Sudhir Pillai
- Department of Radiology, Mayo Clinic, 200 First St. SW, Rochester, MN 55905 (S.S.H., A.I., M.Y., H.G., P.S.P., J.L.F., S.L., L.Y., C.H.McC., J.G.F.)
| | - Matthew P Johnson
- Department of Physiology Biomedical Engineering, Mayo Clinic, 200 First St. SW, Rochester, MN 55905 (M.P.J., R.E.C.)
| | - Jeff L Fidler
- Department of Radiology, Mayo Clinic, 200 First St. SW, Rochester, MN 55905 (S.S.H., A.I., M.Y., H.G., P.S.P., J.L.F., S.L., L.Y., C.H.McC., J.G.F.)
| | - Shuai Leng
- Department of Radiology, Mayo Clinic, 200 First St. SW, Rochester, MN 55905 (S.S.H., A.I., M.Y., H.G., P.S.P., J.L.F., S.L., L.Y., C.H.McC., J.G.F.)
| | - Lifeng Yu
- Department of Radiology, Mayo Clinic, 200 First St. SW, Rochester, MN 55905 (S.S.H., A.I., M.Y., H.G., P.S.P., J.L.F., S.L., L.Y., C.H.McC., J.G.F.)
| | - Rickey E Carter
- Department of Physiology Biomedical Engineering, Mayo Clinic, 200 First St. SW, Rochester, MN 55905 (M.P.J., R.E.C.)
| | - David R Holmes
- Quantitative Health Services - Clinical Trials and Biostatistics, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL 32224 (D.R.H. III)
| | - Cynthia H McCollough
- Department of Radiology, Mayo Clinic, 200 First St. SW, Rochester, MN 55905 (S.S.H., A.I., M.Y., H.G., P.S.P., J.L.F., S.L., L.Y., C.H.McC., J.G.F.)
| | - Joel G Fletcher
- Department of Radiology, Mayo Clinic, 200 First St. SW, Rochester, MN 55905 (S.S.H., A.I., M.Y., H.G., P.S.P., J.L.F., S.L., L.Y., C.H.McC., J.G.F.)
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Anand V, Weston AD, Scott CG, Kane GC, Pellikka PA, Carter RE. Machine Learning for Diagnosis of Pulmonary Hypertension by Echocardiography. Mayo Clin Proc 2024; 99:260-270. [PMID: 38309937 DOI: 10.1016/j.mayocp.2023.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 03/23/2023] [Accepted: 05/02/2023] [Indexed: 02/05/2024]
Abstract
OBJECTIVE To evaluate a machine learning (ML)-based model for pulmonary hypertension (PH) prediction using measurements and impressions made during echocardiography. METHODS A total of 7853 consecutive patients with right-sided heart catheterization and transthoracic echocardiography performed within 1 week from January 1, 2012, through December 31, 2019, were included. The data were split into training (n=5024 [64%]), validation (n=1275 [16%]), and testing (n=1554 [20%]). A gradient boosting machine with enumerated grid search for optimization was selected to allow missing data in the boosted trees without imputation. The training target was PH, defined by right-sided heart catheterization as mean pulmonary artery pressure above 20 mm Hg; model performance was maximized relative to area under the receiver operating characteristic curve using 5-fold cross-validation. RESULTS Cohort age was 64±14 years; 3467 (44%) were female, and 81% (6323/7853) had PH. The final trained model included 19 characteristics, measurements, or impressions derived from the echocardiogram. In the testing data, the model had high discrimination for the detection of PH (area under the receiver operating characteristic curve, 0.83; 95% CI, 0.80 to 0.85). The model's accuracy, sensitivity, positive predictive value, and negative predictive value were 82% (1267/1554), 88% (1098/1242), 89% (1098/1241), and 54% (169/313), respectively. CONCLUSION By use of ML, PH could be predicted on the basis of clinical and echocardiographic variables, without tricuspid regurgitation velocity. Machine learning methods appear promising for identifying patients with low likelihood of PH.
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Affiliation(s)
- Vidhu Anand
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
| | - Alexander D Weston
- Department of Quantitative Health Sciences, Mayo Clinic, Jacksonville, FL; Digital Innovation Lab, Mayo Clinic, Jacksonville, FL
| | | | - Garvan C Kane
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
| | | | - Rickey E Carter
- Department of Quantitative Health Sciences, Mayo Clinic, Jacksonville, FL; Digital Innovation Lab, Mayo Clinic, Jacksonville, FL
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10
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Lee E, Ito S, Miranda WR, Lopez-Jimenez F, Kane GC, Asirvatham SJ, Noseworthy PA, Friedman PA, Carter RE, Borlaug BA, Attia ZI, Oh JK. Artificial intelligence-enabled ECG for left ventricular diastolic function and filling pressure. NPJ Digit Med 2024; 7:4. [PMID: 38182738 PMCID: PMC10770308 DOI: 10.1038/s41746-023-00993-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 12/11/2023] [Indexed: 01/07/2024] Open
Abstract
Assessment of left ventricular diastolic function plays a major role in the diagnosis and prognosis of cardiac diseases, including heart failure with preserved ejection fraction. We aimed to develop an artificial intelligence (AI)-enabled electrocardiogram (ECG) model to identify echocardiographically determined diastolic dysfunction and increased filling pressure. We trained, validated, and tested an AI-enabled ECG in 98,736, 21,963, and 98,763 patients, respectively, who had an ECG and echocardiographic diastolic function assessment within 14 days with no exclusion criteria. It was also tested in 55,248 patients with indeterminate diastolic function by echocardiography. The model was evaluated using the area under the curve (AUC) of the receiver operating characteristic curve, and its prognostic performance was compared to echocardiography. The AUC for detecting increased filling pressure was 0.911. The AUCs to identify diastolic dysfunction grades ≥1, ≥2, and 3 were 0.847, 0.911, and 0.943, respectively. During a median follow-up of 5.9 years, 20,223 (20.5%) died. Patients with increased filling pressure predicted by AI-ECG had higher mortality than those with normal filling pressure, after adjusting for age, sex, and comorbidities in the test group (hazard ratio (HR) 1.7, 95% CI 1.645-1.757) similar to echocardiography and in the indeterminate group (HR 1.34, 95% CI 1.298-1.383). An AI-enabled ECG identifies increased filling pressure and diastolic function grades with a good prognostic value similar to echocardiography. AI-ECG is a simple and promising tool to enhance the detection of diseases associated with diastolic dysfunction and increased diastolic filling pressure.
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Affiliation(s)
- Eunjung Lee
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | - Saki Ito
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | - William R Miranda
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | | | - Garvan C Kane
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | | | | | - Paul A Friedman
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | - Rickey E Carter
- Health Sciences Research, Mayo Clinic, Jacksonville, FL, USA
| | - Barry A Borlaug
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | - Zachi I Attia
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | - Jae K Oh
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA.
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11
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Schulte PJ, Goldberg JD, Oster RA, Ambrosius WT, Bonner LB, Cabral H, Carter RE, Chen Y, Desai M, Li D, Lindsell CJ, Pomann GM, Slade E, Tosteson TD, Yu F, Spratt H. Peer review of clinical and translational research manuscripts: Perspectives from statistical collaborators. J Clin Transl Sci 2024; 8:e20. [PMID: 38384899 PMCID: PMC10879991 DOI: 10.1017/cts.2023.707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 11/29/2023] [Accepted: 12/19/2023] [Indexed: 02/23/2024] Open
Abstract
Research articles in the clinical and translational science literature commonly use quantitative data to inform evaluation of interventions, learn about the etiology of disease, or develop methods for diagnostic testing or risk prediction of future events. The peer review process must evaluate the methodology used therein, including use of quantitative statistical methods. In this manuscript, we provide guidance for peer reviewers tasked with assessing quantitative methodology, intended to complement guidelines and recommendations that exist for manuscript authors. We describe components of clinical and translational science research manuscripts that require assessment including study design and hypothesis evaluation, sampling and data acquisition, interventions (for studies that include an intervention), measurement of data, statistical analysis methods, presentation of the study results, and interpretation of the study results. For each component, we describe what reviewers should look for and assess; how reviewers should provide helpful comments for fixable errors or omissions; and how reviewers should communicate uncorrectable and irreparable errors. We then discuss the critical concepts of transparency and acceptance/revision guidelines when communicating with responsible journal editors.
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Affiliation(s)
- Phillip J. Schulte
- Division of Clinical Trials and Biostatistics, Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA
| | - Judith D. Goldberg
- Division of Biostatistics, Department of Population Health, New York University Grossman School of Medicine, New York, NY, USA
| | - Robert A. Oster
- Department of Medicine, Division of Preventive Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Walter T. Ambrosius
- Department of Biostatistics and Data Science, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Lauren Balmert Bonner
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Howard Cabral
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA
| | - Rickey E. Carter
- Department of Quantitative Health Sciences, Mayo Clinic, Jacksonville, FL, USA
| | - Ye Chen
- Biostatistics, Epidemiology and Research Design (BERD), Tufts Clinical and Translational Science Institute (CTSI), Boston, MA, USA
| | - Manisha Desai
- Quantitative Sciences Unit, Departments of Medicine, Biomedical Data Science, and Epidemiology and Population Health, Stanford University, Stanford, CA, USA
| | - Dongmei Li
- Department of Clinical and Translational Research, Obstetrics and Gynecology and Public Health Sciences, University of Rochester Medical Center, Rochester, NY, USA
| | | | - Gina-Maria Pomann
- Department of Biostatistics and Bioinformatics, Duke University, Durham, NC, USA
| | - Emily Slade
- Department of Biostatistics, University of Kentucky, Lexington, KY, USA
| | - Tor D. Tosteson
- Department of Biomedical Data Science, Geisel School of Medicine, Dartmouth College, Hanover, NH, USA
| | - Fang Yu
- Department of Biostatistics, University of Nebraska Medical Center, Omaha, NE, USA
| | - Heidi Spratt
- Department of Biostatistics and Data Science, School of Public and Population Health, University of Texas Medical Branch, Galveston, TX, USA
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12
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McCollough CH, Rajiah P, Bois JP, Winfree TN, Carter RE, Rajendran K, Williamson EE, Thorne JE, Leng S. Comparison of Photon-counting Detector and Energy-integrating Detector CT for Visual Estimation of Coronary Percent Luminal Stenosis. Radiology 2023; 309:e230853. [PMID: 38051190 PMCID: PMC10741385 DOI: 10.1148/radiol.230853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 09/20/2023] [Accepted: 10/20/2023] [Indexed: 12/07/2023]
Abstract
Background Compared with energy-integrating detector (EID) CT, the improved resolution of photon-counting detector (PCD) CT coupled with high-energy virtual monoenergetic images (VMIs) has been shown to decrease calcium blooming on images in phantoms and cadaveric specimens. Purpose To determine the impact of dual-source PCD CT on visual and quantitative estimation of percent diameter luminal stenosis compared with dual-source EID CT in patients. Materials and Methods This prospective study recruited consecutive adult patients from an outpatient facility between January and March 2022. Study participants underwent clinical dual-source EID coronary CT angiography followed by a research dual-source PCD CT examination. For PCD CT, multienergy data were used to create VMIs at 50 and 100 keV. Two readers independently reviewed EID CT images followed by PCD CT images after a washout period. Readers visually graded the most severe stenosis in terms of percent diameter luminal stenosis for the left main, left anterior descending, right, and circumflex coronary arteries, unblinded to scanner type. Quantitative measures of percent stenosis were made using commercial software. Visual and quantitative estimates of percent stenosis were compared between EID CT and PCD CT using the Wilcoxon signed-rank test. Results A total of 25 participants (median age, 59 years [range, 18-78 years]; 16 male participants) were enrolled. On EID CT images, readers 1 and 2 identified 39 and 32 luminal stenoses, respectively, with a percent diameter luminal stenosis greater than 0%. Visual estimates of percent stenosis were lower on PCD CT images than EID CT images (reader 1: median 20.6% [IQR, 8.8%-61.2%] vs 31.8% [IQR, 12.9%-69.7%], P < .001; reader 2: 6.5% [IQR, 0.4%-54.1%] vs 22.9% [IQR, 1.8%-67.4%], P = .002). No difference was observed between EID CT and PCD CT for quantitative measures of percent stenosis (median difference, -1.5% [95% CI: -3.0%, 2.5%]; P = .51). Conclusion Relative to using EID CT, using PCD CT led to decreases in visual estimates of percent stenosis. © RSNA, 2023 See also the editorial by Murphy and Donnelly in this issue.
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Affiliation(s)
- Cynthia H. McCollough
- From the Department of Radiology, Mayo Clinic, 200 First St SW, Rochester, MN 55905 (C.H.M., P.R., J.P.B., T.N.W., K.R., E.E.W., J.E.T., S.L.); and Department of Health Science Research, Mayo Clinic, Jacksonville, Fla (R.E.C.)
| | - Prabhakar Rajiah
- From the Department of Radiology, Mayo Clinic, 200 First St SW, Rochester, MN 55905 (C.H.M., P.R., J.P.B., T.N.W., K.R., E.E.W., J.E.T., S.L.); and Department of Health Science Research, Mayo Clinic, Jacksonville, Fla (R.E.C.)
| | - John P. Bois
- From the Department of Radiology, Mayo Clinic, 200 First St SW, Rochester, MN 55905 (C.H.M., P.R., J.P.B., T.N.W., K.R., E.E.W., J.E.T., S.L.); and Department of Health Science Research, Mayo Clinic, Jacksonville, Fla (R.E.C.)
| | - Tim N. Winfree
- From the Department of Radiology, Mayo Clinic, 200 First St SW, Rochester, MN 55905 (C.H.M., P.R., J.P.B., T.N.W., K.R., E.E.W., J.E.T., S.L.); and Department of Health Science Research, Mayo Clinic, Jacksonville, Fla (R.E.C.)
| | - Rickey E. Carter
- From the Department of Radiology, Mayo Clinic, 200 First St SW, Rochester, MN 55905 (C.H.M., P.R., J.P.B., T.N.W., K.R., E.E.W., J.E.T., S.L.); and Department of Health Science Research, Mayo Clinic, Jacksonville, Fla (R.E.C.)
| | - Kishore Rajendran
- From the Department of Radiology, Mayo Clinic, 200 First St SW, Rochester, MN 55905 (C.H.M., P.R., J.P.B., T.N.W., K.R., E.E.W., J.E.T., S.L.); and Department of Health Science Research, Mayo Clinic, Jacksonville, Fla (R.E.C.)
| | - Eric E. Williamson
- From the Department of Radiology, Mayo Clinic, 200 First St SW, Rochester, MN 55905 (C.H.M., P.R., J.P.B., T.N.W., K.R., E.E.W., J.E.T., S.L.); and Department of Health Science Research, Mayo Clinic, Jacksonville, Fla (R.E.C.)
| | - Jamison E. Thorne
- From the Department of Radiology, Mayo Clinic, 200 First St SW, Rochester, MN 55905 (C.H.M., P.R., J.P.B., T.N.W., K.R., E.E.W., J.E.T., S.L.); and Department of Health Science Research, Mayo Clinic, Jacksonville, Fla (R.E.C.)
| | - Shuai Leng
- From the Department of Radiology, Mayo Clinic, 200 First St SW, Rochester, MN 55905 (C.H.M., P.R., J.P.B., T.N.W., K.R., E.E.W., J.E.T., S.L.); and Department of Health Science Research, Mayo Clinic, Jacksonville, Fla (R.E.C.)
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13
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Pataky MW, Dasari S, Michie KL, Sevits KJ, Kumar AA, Klaus KA, Heppelmann CJ, Robinson MM, Carter RE, Lanza IR, Nair KS. Impact of biological sex and sex hormones on molecular signatures of skeletal muscle at rest and in response to distinct exercise training modes. Cell Metab 2023; 35:1996-2010.e6. [PMID: 37939659 PMCID: PMC10659143 DOI: 10.1016/j.cmet.2023.10.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 05/09/2023] [Accepted: 10/13/2023] [Indexed: 11/10/2023]
Abstract
Substantial divergence in cardio-metabolic risk, muscle size, and performance exists between men and women. Considering the pivotal role of skeletal muscle in human physiology, we investigated and found, based on RNA sequencing (RNA-seq), that differences in the muscle transcriptome between men and women are largely related to testosterone and estradiol and much less related to genes located on the Y chromosome. We demonstrate inherent unique, sex-dependent differences in muscle transcriptional responses to aerobic, resistance, and combined exercise training in young and older cohorts. The hormonal changes with age likely explain age-related differential expression of transcripts. Furthermore, in primary human myotubes we demonstrate the profound but distinct effects of testosterone and estradiol on amino acid incorporation to multiple individual proteins with specific functions. These results clearly highlight the potential of designing exercise programs tailored specifically to men and women and have implications for people who change gender by altering their hormone profile.
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Affiliation(s)
- Mark W Pataky
- Division of Endocrinology and Metabolism, Mayo Clinic, Rochester, MN, USA
| | - Surendra Dasari
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA
| | - Kelly L Michie
- Division of Endocrinology and Metabolism, Mayo Clinic, Rochester, MN, USA
| | - Kyle J Sevits
- Division of Endocrinology and Metabolism, Mayo Clinic, Rochester, MN, USA
| | - A Aneesh Kumar
- Division of Endocrinology and Metabolism, Mayo Clinic, Rochester, MN, USA
| | - Katherine A Klaus
- Division of Endocrinology and Metabolism, Mayo Clinic, Rochester, MN, USA
| | | | - Matthew M Robinson
- School of Biological and Population Health Sciences, College of Public Health and Human Sciences, Oregon State University, Corvallis, OR, USA
| | - Rickey E Carter
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, USA
| | - Ian R Lanza
- Division of Endocrinology and Metabolism, Mayo Clinic, Rochester, MN, USA
| | - K Sreekumaran Nair
- Division of Endocrinology and Metabolism, Mayo Clinic, Rochester, MN, USA.
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14
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Boon BDC, Labuzan SA, Peng Z, Matchett BJ, Kouri N, Hinkle KM, Lachner C, Ross OA, Ertekin-Taner N, Carter RE, Ferman TJ, Duara R, Dickson DW, Graff-Radford NR, Murray ME. Retrospective Evaluation of Neuropathologic Proxies of the Minimal Atrophy Subtype Compared With Corticolimbic Alzheimer Disease Subtypes. Neurology 2023; 101:e1412-e1423. [PMID: 37580158 PMCID: PMC10573142 DOI: 10.1212/wnl.0000000000207685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Accepted: 06/07/2023] [Indexed: 08/16/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Alzheimer disease (AD) is neuropathologically classified into 3 corticolimbic subtypes based on the neurofibrillary tangle distribution throughout the hippocampus and association cortices: limbic predominant, typical, and hippocampal sparing. In vivo, a fourth subtype, dubbed "minimal atrophy," was identified using structural MRI. The objective of this study was to identify a neuropathologic proxy for the neuroimaging-defined minimal atrophy subtype. METHODS We applied 2 strategies in the Florida Autopsied Multi-Ethnic (FLAME) cohort to evaluate a neuropathologic proxy for the minimal atrophy subtype. In the first strategy, we selected AD cases with a Braak tangle stage IV (Braak IV) because of the relative paucity of neocortical tangle involvement compared with Braak >IV. Braak IV cases were compared with the 3 AD subtypes. In the alternative strategy, typical AD was stratified by brain weight and cases having a relatively high brain weight (>75th percentile) were defined as minimal atrophy. RESULTS Braak IV cases (n = 37) differed from AD subtypes (limbic predominant [n = 174], typical [n = 986], and hippocampal sparing [n = 187] AD) in having the least years of education (median 12 years, group-wise p < 0.001) and the highest brain weight (median 1,140 g, p = 0.002). Braak IV cases most resembled the limbic predominant cases owing to their high proportion of APOE ε4 carriers (75%, p < 0.001), an amnestic syndrome (100%, p < 0.001), as well as older age of cognitive symptom onset and death (median 79 and 85 years, respectively, p < 0.001). Only 5% of Braak IV cases had amygdala-predominant Lewy bodies (the lowest frequency observed, p = 0.017), whereas 32% had coexisting pathology of Lewy body disease, which was greater than the other subtypes (p = 0.005). Nearly half (47%) of the Braak IV samples had coexisting limbic predominant age-related TAR DNA-binding protein 43 encephalopathy neuropathologic change. Cases with a high brain weight (n = 201) were less likely to have amygdala-predominant Lewy bodies (14%, p = 0.006) and most likely to have Lewy body disease (31%, p = 0.042) compared with those with middle (n = 455) and low (n = 203) brain weight. DISCUSSION The frequency of Lewy body disease was increased in both neuropathologic proxies of the minimal atrophy subtype. We hypothesize that Lewy body disease may underlie cognitive decline observed in minimal atrophy cases.
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Affiliation(s)
- Baayla D C Boon
- From the Department of Neuroscience (B.D.C.B., S.A.L., B.J.M., N.K., K.M.H., O.A.R., N.E.-T., D.W.D., M.E.M.), Department of Quantitative Health Sciences (Z.P., R.E.C.), Department of Neurology (C.L., N.E.-T., N.R.G.-R.), and Department of Psychiatry & Psychology (C.L., T.J.F.), Mayo Clinic, Jacksonville; and Wien Center for Alzheimer's Disease and Memory Disorders (R.D.), Mount Sinai Medical Center, Miami Beach, FL
| | - Sydney A Labuzan
- From the Department of Neuroscience (B.D.C.B., S.A.L., B.J.M., N.K., K.M.H., O.A.R., N.E.-T., D.W.D., M.E.M.), Department of Quantitative Health Sciences (Z.P., R.E.C.), Department of Neurology (C.L., N.E.-T., N.R.G.-R.), and Department of Psychiatry & Psychology (C.L., T.J.F.), Mayo Clinic, Jacksonville; and Wien Center for Alzheimer's Disease and Memory Disorders (R.D.), Mount Sinai Medical Center, Miami Beach, FL
| | - Zhongwei Peng
- From the Department of Neuroscience (B.D.C.B., S.A.L., B.J.M., N.K., K.M.H., O.A.R., N.E.-T., D.W.D., M.E.M.), Department of Quantitative Health Sciences (Z.P., R.E.C.), Department of Neurology (C.L., N.E.-T., N.R.G.-R.), and Department of Psychiatry & Psychology (C.L., T.J.F.), Mayo Clinic, Jacksonville; and Wien Center for Alzheimer's Disease and Memory Disorders (R.D.), Mount Sinai Medical Center, Miami Beach, FL
| | - Billie J Matchett
- From the Department of Neuroscience (B.D.C.B., S.A.L., B.J.M., N.K., K.M.H., O.A.R., N.E.-T., D.W.D., M.E.M.), Department of Quantitative Health Sciences (Z.P., R.E.C.), Department of Neurology (C.L., N.E.-T., N.R.G.-R.), and Department of Psychiatry & Psychology (C.L., T.J.F.), Mayo Clinic, Jacksonville; and Wien Center for Alzheimer's Disease and Memory Disorders (R.D.), Mount Sinai Medical Center, Miami Beach, FL
| | - Naomi Kouri
- From the Department of Neuroscience (B.D.C.B., S.A.L., B.J.M., N.K., K.M.H., O.A.R., N.E.-T., D.W.D., M.E.M.), Department of Quantitative Health Sciences (Z.P., R.E.C.), Department of Neurology (C.L., N.E.-T., N.R.G.-R.), and Department of Psychiatry & Psychology (C.L., T.J.F.), Mayo Clinic, Jacksonville; and Wien Center for Alzheimer's Disease and Memory Disorders (R.D.), Mount Sinai Medical Center, Miami Beach, FL
| | - Kelly M Hinkle
- From the Department of Neuroscience (B.D.C.B., S.A.L., B.J.M., N.K., K.M.H., O.A.R., N.E.-T., D.W.D., M.E.M.), Department of Quantitative Health Sciences (Z.P., R.E.C.), Department of Neurology (C.L., N.E.-T., N.R.G.-R.), and Department of Psychiatry & Psychology (C.L., T.J.F.), Mayo Clinic, Jacksonville; and Wien Center for Alzheimer's Disease and Memory Disorders (R.D.), Mount Sinai Medical Center, Miami Beach, FL
| | - Christian Lachner
- From the Department of Neuroscience (B.D.C.B., S.A.L., B.J.M., N.K., K.M.H., O.A.R., N.E.-T., D.W.D., M.E.M.), Department of Quantitative Health Sciences (Z.P., R.E.C.), Department of Neurology (C.L., N.E.-T., N.R.G.-R.), and Department of Psychiatry & Psychology (C.L., T.J.F.), Mayo Clinic, Jacksonville; and Wien Center for Alzheimer's Disease and Memory Disorders (R.D.), Mount Sinai Medical Center, Miami Beach, FL
| | - Owen A Ross
- From the Department of Neuroscience (B.D.C.B., S.A.L., B.J.M., N.K., K.M.H., O.A.R., N.E.-T., D.W.D., M.E.M.), Department of Quantitative Health Sciences (Z.P., R.E.C.), Department of Neurology (C.L., N.E.-T., N.R.G.-R.), and Department of Psychiatry & Psychology (C.L., T.J.F.), Mayo Clinic, Jacksonville; and Wien Center for Alzheimer's Disease and Memory Disorders (R.D.), Mount Sinai Medical Center, Miami Beach, FL
| | - Nilufer Ertekin-Taner
- From the Department of Neuroscience (B.D.C.B., S.A.L., B.J.M., N.K., K.M.H., O.A.R., N.E.-T., D.W.D., M.E.M.), Department of Quantitative Health Sciences (Z.P., R.E.C.), Department of Neurology (C.L., N.E.-T., N.R.G.-R.), and Department of Psychiatry & Psychology (C.L., T.J.F.), Mayo Clinic, Jacksonville; and Wien Center for Alzheimer's Disease and Memory Disorders (R.D.), Mount Sinai Medical Center, Miami Beach, FL
| | - Rickey E Carter
- From the Department of Neuroscience (B.D.C.B., S.A.L., B.J.M., N.K., K.M.H., O.A.R., N.E.-T., D.W.D., M.E.M.), Department of Quantitative Health Sciences (Z.P., R.E.C.), Department of Neurology (C.L., N.E.-T., N.R.G.-R.), and Department of Psychiatry & Psychology (C.L., T.J.F.), Mayo Clinic, Jacksonville; and Wien Center for Alzheimer's Disease and Memory Disorders (R.D.), Mount Sinai Medical Center, Miami Beach, FL
| | - Tanis J Ferman
- From the Department of Neuroscience (B.D.C.B., S.A.L., B.J.M., N.K., K.M.H., O.A.R., N.E.-T., D.W.D., M.E.M.), Department of Quantitative Health Sciences (Z.P., R.E.C.), Department of Neurology (C.L., N.E.-T., N.R.G.-R.), and Department of Psychiatry & Psychology (C.L., T.J.F.), Mayo Clinic, Jacksonville; and Wien Center for Alzheimer's Disease and Memory Disorders (R.D.), Mount Sinai Medical Center, Miami Beach, FL
| | - Ranjan Duara
- From the Department of Neuroscience (B.D.C.B., S.A.L., B.J.M., N.K., K.M.H., O.A.R., N.E.-T., D.W.D., M.E.M.), Department of Quantitative Health Sciences (Z.P., R.E.C.), Department of Neurology (C.L., N.E.-T., N.R.G.-R.), and Department of Psychiatry & Psychology (C.L., T.J.F.), Mayo Clinic, Jacksonville; and Wien Center for Alzheimer's Disease and Memory Disorders (R.D.), Mount Sinai Medical Center, Miami Beach, FL
| | - Dennis W Dickson
- From the Department of Neuroscience (B.D.C.B., S.A.L., B.J.M., N.K., K.M.H., O.A.R., N.E.-T., D.W.D., M.E.M.), Department of Quantitative Health Sciences (Z.P., R.E.C.), Department of Neurology (C.L., N.E.-T., N.R.G.-R.), and Department of Psychiatry & Psychology (C.L., T.J.F.), Mayo Clinic, Jacksonville; and Wien Center for Alzheimer's Disease and Memory Disorders (R.D.), Mount Sinai Medical Center, Miami Beach, FL
| | - Neill R Graff-Radford
- From the Department of Neuroscience (B.D.C.B., S.A.L., B.J.M., N.K., K.M.H., O.A.R., N.E.-T., D.W.D., M.E.M.), Department of Quantitative Health Sciences (Z.P., R.E.C.), Department of Neurology (C.L., N.E.-T., N.R.G.-R.), and Department of Psychiatry & Psychology (C.L., T.J.F.), Mayo Clinic, Jacksonville; and Wien Center for Alzheimer's Disease and Memory Disorders (R.D.), Mount Sinai Medical Center, Miami Beach, FL
| | - Melissa E Murray
- From the Department of Neuroscience (B.D.C.B., S.A.L., B.J.M., N.K., K.M.H., O.A.R., N.E.-T., D.W.D., M.E.M.), Department of Quantitative Health Sciences (Z.P., R.E.C.), Department of Neurology (C.L., N.E.-T., N.R.G.-R.), and Department of Psychiatry & Psychology (C.L., T.J.F.), Mayo Clinic, Jacksonville; and Wien Center for Alzheimer's Disease and Memory Disorders (R.D.), Mount Sinai Medical Center, Miami Beach, FL.
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15
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Khosravi B, Weston AD, Nugen F, Mickley JP, Kremers HM, Wyles CC, Carter RE, Taunton MJ. Demystifying Statistics and Machine Learning in Analysis of Structured Tabular Data. J Arthroplasty 2023; 38:1943-1947. [PMID: 37598784 PMCID: PMC10947212 DOI: 10.1016/j.arth.2023.08.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 08/10/2023] [Accepted: 08/11/2023] [Indexed: 08/22/2023] Open
Abstract
Electronic health records have facilitated the extraction and analysis of a vast amount of data with many variables for clinical care and research. Conventional regression-based statistical methods may not capture all the complexities in high-dimensional data analysis. Therefore, researchers are increasingly using machine learning (ML)-based methods to better handle these more challenging datasets for the discovery of hidden patterns in patients' data and for classification and predictive purposes. This article describes commonly used ML methods in structured data analysis with examples in orthopedic surgery. We present practical considerations in starting an ML project and appraising published studies in this field.
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Affiliation(s)
- Bardia Khosravi
- Orthopedic Surgery Artificial Intelligence Laboratory (OSAIL), Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN
- Radiology Informatics Lab (RIL), Department of Radiology, Mayo Clinic, Rochester, MN
| | - Alexander D. Weston
- Orthopedic Surgery Artificial Intelligence Laboratory (OSAIL), Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN
- Digital Innovation Lab, Department of Quantitative Health Sciences, Mayo Clinic, Jacksonville, FL
| | - Fred Nugen
- Radiology Informatics Lab (RIL), Department of Radiology, Mayo Clinic, Rochester, MN
| | - John P. Mickley
- Orthopedic Surgery Artificial Intelligence Laboratory (OSAIL), Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN
| | - Hilal Maradit Kremers
- Orthopedic Surgery Artificial Intelligence Laboratory (OSAIL), Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN
| | - Cody C. Wyles
- Orthopedic Surgery Artificial Intelligence Laboratory (OSAIL), Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN
- Radiology Informatics Lab (RIL), Department of Radiology, Mayo Clinic, Rochester, MN
- Department of Clinical Anatomy, Mayo Clinic, Rochester, MN
| | - Rickey E. Carter
- Digital Innovation Lab, Department of Quantitative Health Sciences, Mayo Clinic, Jacksonville, FL
| | - Michael J. Taunton
- Orthopedic Surgery Artificial Intelligence Laboratory (OSAIL), Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN
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16
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Senefeld JW, Gorman EK, Johnson PW, Moir ME, Klassen SA, Carter RE, Paneth NS, Sullivan DJ, Morkeberg OH, Wright RS, Fairweather D, Bruno KA, Shoham S, Bloch EM, Focosi D, Henderson JP, Juskewitch JE, Pirofski LA, Grossman BJ, Tobian AA, Franchini M, Ganesh R, Hurt RT, Kay NE, Parikh SA, Baker SE, Buchholtz ZA, Buras MR, Clayburn AJ, Dennis JJ, Diaz Soto JC, Herasevich V, Klompas AM, Kunze KL, Larson KF, Mills JR, Regimbal RJ, Ripoll JG, Sexton MA, Shepherd JR, Stubbs JR, Theel ES, van Buskirk CM, van Helmond N, Vogt MN, Whelan ER, Wiggins CC, Winters JL, Casadevall A, Joyner MJ. Rates Among Hospitalized Patients With COVID-19 Treated With Convalescent Plasma: A Systematic Review and Meta-Analysis. Mayo Clin Proc Innov Qual Outcomes 2023; 7:499-513. [PMID: 37859995 PMCID: PMC10582279 DOI: 10.1016/j.mayocpiqo.2023.09.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2023] Open
Abstract
Objective To examine the association of COVID-19 convalescent plasma transfusion with mortality and the differences between subgroups in hospitalized patients with COVID-19. Patients and Methods On October 26, 2022, a systematic search was performed for clinical studies of COVID-19 convalescent plasma in the literature from January 1, 2020, to October 26, 2022. Randomized clinical trials and matched cohort studies investigating COVID-19 convalescent plasma transfusion compared with standard of care treatment or placebo among hospitalized patients with confirmed COVID-19 were included. The electronic search yielded 3841 unique records, of which 744 were considered for full-text screening. The selection process was performed independently by a panel of 5 reviewers. The study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Data were extracted by 5 independent reviewers in duplicate and pooled using an inverse-variance random effects model. The prespecified end point was all-cause mortality during hospitalization. Results Thirty-nine randomized clinical trials enrolling 21,529 participants and 70 matched cohort studies enrolling 50,160 participants were included in the systematic review. Separate meta-analyses reported that transfusion of COVID-19 convalescent plasma was associated with a decrease in mortality compared with the control cohort for both randomized clinical trials (odds ratio [OR], 0.87; 95% CI, 0.76-1.00) and matched cohort studies (OR, 0.76; 95% CI, 0.66-0.88). The meta-analysis of subgroups revealed 2 important findings. First, treatment with convalescent plasma containing high antibody levels was associated with a decrease in mortality compared with convalescent plasma containing low antibody levels (OR, 0.85; 95% CI, 0.73 to 0.99). Second, earlier treatment with COVID-19 convalescent plasma was associated with a decrease in mortality compared with the later treatment cohort (OR, 0.63; 95% CI, 0.48 to 0.82). Conclusion During COVID-19 convalescent plasma use was associated with a 13% reduced risk of mortality, implying a mortality benefit for hospitalized patients with COVID-19, particularly those treated with convalescent plasma containing high antibody levels treated earlier in the disease course.
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Affiliation(s)
- Jonathon W. Senefeld
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN
- Department of Kinesiology and Community Health, University of Illinois Urbana-Champaign, Urbana, IL
| | - Ellen K. Gorman
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN
| | - Patrick W. Johnson
- Department of Quantitative Health Sciences, Mayo Clinic, Jacksonville, FL
| | - M. Erin Moir
- Department of Kinesiology, University of Wisconsin-Madison, Madison
| | - Stephen A. Klassen
- Department of Kinesiology, Brock University, St. Catharines, Ontario, Canada
| | - Rickey E. Carter
- Department of Quantitative Health Sciences, Mayo Clinic, Jacksonville, FL
| | - Nigel S. Paneth
- Department of Epidemiology and Biostatistics and Department of Pediatrics and Human Development, Michigan State University, East Lansing
| | - David J. Sullivan
- Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Baltimore, ML
| | - Olaf H. Morkeberg
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN
| | - R. Scott Wright
- Human Research Protection Program, Mayo Clinic, Rochester, MN
| | | | - Katelyn A. Bruno
- Department of Cardiovascular Medicine, Mayo Clinic, Jacksonville, FL
- Division of Cardiovascular Medicine, University of Florida, Gainesville
| | - Shmuel Shoham
- Department of Medicine, Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Evan M. Bloch
- Department of Pathology Johns Hopkins University School of Medicine, Baltimore, ML
| | - Daniele Focosi
- North-Western Tuscany Blood Bank, Pisa University Hospital, Italy
| | - Jeffrey P. Henderson
- Division of Infectious Diseases, Department of Medicine, Washington University School of Medicine in St. Louis, MO
- Department of Molecular Microbiology, Washington University School of Medicine in St. Louis, MO
| | | | - Liise-Anne Pirofski
- Division of Infectious Diseases, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY
| | - Brenda J. Grossman
- Department of Pathology and Immunology, Washington University School of Medicine in St. Louis, MO
| | - Aaron A.R. Tobian
- Department of Pathology Johns Hopkins University School of Medicine, Baltimore, ML
| | - Massimo Franchini
- Division of Transfusion Medicine, Carlo Poma Hospital, Mantua, Italy
| | - Ravindra Ganesh
- Department of General Internal Medicine, Mayo Clinic, Rochester, MN
| | - Ryan T. Hurt
- Department of General Internal Medicine, Mayo Clinic, Rochester, MN
| | - Neil E. Kay
- Division of Hematology, Mayo Clinic, Rochester, MN
- Department of Immunology, Mayo Clinic, Rochester, MN
| | | | - Sarah E. Baker
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN
| | - Zachary A. Buchholtz
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN
| | - Matthew R. Buras
- Department of Quantitative Health Sciences, Mayo Clinic, Scottsdale, AZ
| | - Andrew J. Clayburn
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN
| | - Joshua J. Dennis
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN
| | - Juan C. Diaz Soto
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN
| | - Vitaly Herasevich
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN
| | - Allan M. Klompas
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN
| | - Katie L. Kunze
- Department of Quantitative Health Sciences, Mayo Clinic, Scottsdale, AZ
| | | | - John R. Mills
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN
| | - Riley J. Regimbal
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN
| | - Juan G. Ripoll
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN
| | - Matthew A. Sexton
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN
| | - John R.A. Shepherd
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN
| | - James R. Stubbs
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN
| | - Elitza S. Theel
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN
| | | | - Noud van Helmond
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN
| | - Matthew N.P. Vogt
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN
| | - Emily R. Whelan
- Department of Cardiovascular Medicine, Mayo Clinic, Jacksonville, FL
| | - Chad C. Wiggins
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN
| | - Jeffrey L. Winters
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN
| | - Arturo Casadevall
- Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Baltimore, ML
| | - Michael J. Joyner
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN
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Adedinsewo DA, Morales-Lara AC, Dugan J, Garzon-Siatoya WT, Yao X, Johnson PW, Douglass EJ, Attia ZI, Phillips SD, Yamani MH, Tobah YB, Rose CH, Sharpe EE, Lopez-Jimenez F, Friedman PA, Noseworthy PA, Carter RE. Screening for peripartum cardiomyopathies using artificial intelligence in Nigeria (SPEC-AI Nigeria): Clinical trial rationale and design. Am Heart J 2023; 261:64-74. [PMID: 36966922 DOI: 10.1016/j.ahj.2023.03.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 03/10/2023] [Accepted: 03/15/2023] [Indexed: 05/26/2023]
Abstract
BACKGROUND Artificial intelligence (AI), and more specifically deep learning, models have demonstrated the potential to augment physician diagnostic capabilities and improve cardiovascular health if incorporated into routine clinical practice. However, many of these tools are yet to be evaluated prospectively in the setting of a rigorous clinical trial-a critical step prior to implementing broadly in routine clinical practice. OBJECTIVES To describe the rationale and design of a proposed clinical trial aimed at evaluating an AI-enabled electrocardiogram (AI-ECG) for cardiomyopathy detection in an obstetric population in Nigeria. DESIGN The protocol will enroll 1,000 pregnant and postpartum women who reside in Nigeria in a prospective randomized clinical trial. Nigeria has the highest reported incidence of peripartum cardiomyopathy worldwide. Women aged 18 and older, seen for routine obstetric care at 6 sites (2 Northern and 4 Southern) in Nigeria will be included. Participants will be randomized to the study intervention or control arm in a 1:1 fashion. This study aims to enroll participants representative of the general obstetric population at each site. The primary outcome is a new diagnosis of cardiomyopathy, defined as left ventricular ejection fraction (LVEF) < 50% during pregnancy or within 12 months postpartum. Secondary outcomes will include the detection of impaired left ventricular function (at different LVEF cut-offs), and exploratory outcomes will include the effectiveness of AI-ECG tools for cardiomyopathy detection, new diagnosis of cardiovascular disease, and the development of composite adverse maternal cardiovascular outcomes. SUMMARY This clinical trial focuses on the emerging field of cardio-obstetrics and will serve as foundational data for the use of AI-ECG tools in an obstetric population in Nigeria. This study will gather essential data regarding the utility of the AI-ECG for cardiomyopathy detection in a predominantly Black population of women and pave the way for clinical implementation of these models in routine practice. TRIAL REGISTRATION Clinicaltrials.gov: NCT05438576.
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Affiliation(s)
| | | | - Jennifer Dugan
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
| | | | - Xiaoxi Yao
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN; Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN
| | - Patrick W Johnson
- Department of Quantitative Health Sciences, Mayo Clinic, Jacksonville, FL
| | - Erika J Douglass
- Department of Cardiovascular Medicine, Mayo Clinic, Jacksonville, FL
| | - Zachi I Attia
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
| | | | - Mohamad H Yamani
- Department of Cardiovascular Medicine, Mayo Clinic, Jacksonville, FL
| | | | - Carl H Rose
- Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, MN
| | - Emily E Sharpe
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN
| | | | - Paul A Friedman
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
| | - Peter A Noseworthy
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN; Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN
| | - Rickey E Carter
- Department of Quantitative Health Sciences, Mayo Clinic, Jacksonville, FL
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18
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De Sario GD, Haider CR, Maita KC, Torres-Guzman RA, Emam OS, Avila FR, Garcia JP, Borna S, McLeod CJ, Bruce CJ, Carter RE, Forte AJ. Using AI to Detect Pain through Facial Expressions: A Review. Bioengineering (Basel) 2023; 10:bioengineering10050548. [PMID: 37237618 DOI: 10.3390/bioengineering10050548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 04/24/2023] [Accepted: 04/27/2023] [Indexed: 05/28/2023] Open
Abstract
Pain assessment is a complex task largely dependent on the patient's self-report. Artificial intelligence (AI) has emerged as a promising tool for automating and objectifying pain assessment through the identification of pain-related facial expressions. However, the capabilities and potential of AI in clinical settings are still largely unknown to many medical professionals. In this literature review, we present a conceptual understanding of the application of AI to detect pain through facial expressions. We provide an overview of the current state of the art as well as the technical foundations of AI/ML techniques used in pain detection. We highlight the ethical challenges and the limitations associated with the use of AI in pain detection, such as the scarcity of databases, confounding factors, and medical conditions that affect the shape and mobility of the face. The review also highlights the potential impact of AI on pain assessment in clinical practice and lays the groundwork for further study in this area.
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Affiliation(s)
| | - Clifton R Haider
- Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, MN 55902, USA
| | - Karla C Maita
- Division of Plastic Surgery, Mayo Clinic, Jacksonville, FL 32224, USA
| | | | - Omar S Emam
- Division of AI in Health Sciences, University of Louisville, Louisville, KY 40292, USA
| | - Francisco R Avila
- Division of Plastic Surgery, Mayo Clinic, Jacksonville, FL 32224, USA
| | - John P Garcia
- Division of Plastic Surgery, Mayo Clinic, Jacksonville, FL 32224, USA
| | - Sahar Borna
- Division of Plastic Surgery, Mayo Clinic, Jacksonville, FL 32224, USA
| | | | - Charles J Bruce
- Department of Cardiovascular Medicine, Mayo Clinic, Jacksonville, FL 32224, USA
| | - Rickey E Carter
- Department of Health Sciences Research, Mayo Clinic, Jacksonville, FL 32224, USA
| | - Antonio J Forte
- Division of Plastic Surgery, Mayo Clinic, Jacksonville, FL 32224, USA
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19
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Anand V, Hu H, Weston AD, Scott CG, Michelena HI, Pislaru SV, Carter RE, Pellikka PA. Machine learning-based risk stratification for mortality in patients with severe aortic regurgitation. Eur Heart J Digit Health 2023; 4:188-195. [PMID: 37265866 PMCID: PMC10232267 DOI: 10.1093/ehjdh/ztad006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 12/06/2022] [Indexed: 06/03/2023]
Abstract
Aims The current guidelines recommend aortic valve intervention in patients with severe aortic regurgitation (AR) with the onset of symptoms, left ventricular enlargement, or systolic dysfunction. Recent studies have suggested that we might be missing the window of early intervention in a significant number of patients by following the guidelines. Methods and results The overarching goal was to determine if machine learning (ML)-based algorithms could be trained to identify patients at risk for death from AR independent of aortic valve replacement (AVR). Models were trained with five-fold cross-validation on a dataset of 1035 patients, and performance was reported on an independent dataset of 207 patients. Optimal predictive performance was observed with a conditional random survival forest model. A subset of 19/41 variables was selected for inclusion in the final model. Variable selection was performed with 10-fold cross-validation using random survival forest model. The top variables included were age, body surface area, body mass index, diastolic blood pressure, New York Heart Association class, AVR, comorbidities, ejection fraction, end-diastolic volume, and end-systolic dimension, and the relative variable importance averaged across five splits of cross-validation in each repeat were evaluated. The concordance index for predicting survival of the best-performing model was 0.84 at 1 year, 0.86 at 2 years, and 0.87 overall, respectively. Conclusion Using common echocardiographic parameters and patient characteristics, we successfully trained multiple ML models to predict survival in patients with severe AR. This technique could be applied to identify high-risk patients who would benefit from early intervention, thereby improving patient outcomes.
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Affiliation(s)
- Vidhu Anand
- Corresponding author. Tel: +507 284 4441, Fax: +507 266 0228,
| | - Hanwen Hu
- Department of Quantitative Health Sciences Research, Mayo Clinic, Jacksonville, FL 32202, USA
| | - Alexander D Weston
- Department of Quantitative Health Sciences Research, Mayo Clinic, Jacksonville, FL 32202, USA
| | - Christopher G Scott
- Department of Quantitative Health Science, Mayo Clinic, Rochester, MN 55905, USA
| | - Hector I Michelena
- Department of Cardiovascular Medicine, Mayo Clinic Rochester Minnesota, 200 First Street SW, Rochester, MN 55905, USA
| | - Sorin V Pislaru
- Department of Cardiovascular Medicine, Mayo Clinic Rochester Minnesota, 200 First Street SW, Rochester, MN 55905, USA
| | - Rickey E Carter
- Department of Quantitative Health Sciences Research, Mayo Clinic, Jacksonville, FL 32202, USA
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20
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Borna S, Haider CR, Maita KC, Torres RA, Avila FR, Garcia JP, De Sario Velasquez GD, McLeod CJ, Bruce CJ, Carter RE, Forte AJ. A Review of Voice-Based Pain Detection in Adults Using Artificial Intelligence. Bioengineering (Basel) 2023; 10:bioengineering10040500. [PMID: 37106687 PMCID: PMC10135816 DOI: 10.3390/bioengineering10040500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 04/13/2023] [Accepted: 04/19/2023] [Indexed: 04/29/2023] Open
Abstract
Pain is a complex and subjective experience, and traditional methods of pain assessment can be limited by factors such as self-report bias and observer variability. Voice is frequently used to evaluate pain, occasionally in conjunction with other behaviors such as facial gestures. Compared to facial emotions, there is less available evidence linking pain with voice. This literature review synthesizes the current state of research on the use of voice recognition and voice analysis for pain detection in adults, with a specific focus on the role of artificial intelligence (AI) and machine learning (ML) techniques. We describe the previous works on pain recognition using voice and highlight the different approaches to voice as a tool for pain detection, such as a human effect or biosignal. Overall, studies have shown that AI-based voice analysis can be an effective tool for pain detection in adult patients with various types of pain, including chronic and acute pain. We highlight the high accuracy of the ML-based approaches used in studies and their limitations in terms of generalizability due to factors such as the nature of the pain and patient population characteristics. However, there are still potential challenges, such as the need for large datasets and the risk of bias in training models, which warrant further research.
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Affiliation(s)
- Sahar Borna
- Division of Plastic Surgery, Mayo Clinic, Jacksonville, FL 32224, USA
| | - Clifton R Haider
- Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, MN 55902, USA
| | - Karla C Maita
- Division of Plastic Surgery, Mayo Clinic, Jacksonville, FL 32224, USA
| | - Ricardo A Torres
- Division of Plastic Surgery, Mayo Clinic, Jacksonville, FL 32224, USA
| | - Francisco R Avila
- Division of Plastic Surgery, Mayo Clinic, Jacksonville, FL 32224, USA
| | - John P Garcia
- Division of Plastic Surgery, Mayo Clinic, Jacksonville, FL 32224, USA
| | | | | | - Charles J Bruce
- Department of Cardiovascular Medicine, Mayo Clinic, Jacksonville, FL 32224, USA
| | - Rickey E Carter
- Department of Health Sciences Research, Mayo Clinic, Jacksonville, FL 32224, USA
| | - Antonio J Forte
- Division of Plastic Surgery, Mayo Clinic, Jacksonville, FL 32224, USA
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21
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Hsieh SS, Inoue A, Yalon M, Cook DA, Fidler JL, Gong H, Pillai PS, Vercnocke AJ, Johnson MP, Leng S, Yu L, Holmes DR, Carter RE, McCollough CH, Fletcher JG. A training program to reduce reader search errors for liver metastasis detection in CT. Medical Imaging 2023: Image Perception, Observer Performance, and Technology Assessment 2023; 12467. [PMID: 37064083 PMCID: PMC10099580 DOI: 10.1117/12.2654007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/05/2023]
Abstract
Detection of low contrast liver metastases varies between radiologists. Training may improve performance for lower-performing readers and reduce inter-radiologist variability. We recruited 31 radiologists (15 trainees, 8 non-abdominal staff, and 8 abdominal staff) to participate in four separate reading sessions: pre-test, search training, classification training, and post-test. In the pre-test, each radiologist interpreted 40 liver CT exams containing 91 metastases, circumscribed suspected hepatic metastases while under eye tracker observation, and rated confidence. In search training, radiologists interpreted a separate set of 30 liver CT exams while receiving eye tracker feedback and after coaching to increase use of coronal reformations, interpretation time, and use of liver windows. In classification training, radiologists interpreted up to 100 liver CT image patches, most with benign or malignant lesions, and compared their annotations to ground truth. Post-test was identical to pre-test. Between pre- and post-test, sensitivity increased by 2.8% (p = 0.01) but AUC did not change significantly. Missed metastases were classified as search errors (<2 seconds gaze time) or classification errors (>2 seconds gaze time) using the eye tracker. Out of 2775 possible detections, search errors decreased (10.8% to 8.1%; p < 0.01) but classification errors were unchanged (5.7% vs 5.7%). When stratified by difficulty, easier metastases showed larger reductions in search errors: for metastases with average sensitivity of 0-50%, 50-90%, and 90-100%, reductions in search errors were 16%, 35%, and 58%, respectively. The training program studied here may be able to improve radiologist performance by reducing errors but not classification errors.
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Affiliation(s)
- Scott S Hsieh
- Dept. of Radiology, Mayo Clinic, Rochester, MN, USA 55902
| | - Akitoshi Inoue
- Dept. of Radiology, Mayo Clinic, Rochester, MN, USA 55902
| | - Mariana Yalon
- Dept. of Radiology, Mayo Clinic, Rochester, MN, USA 55902
| | - David A Cook
- Dept. of Internal Medicine, Mayo Clinic, Rochester, MN, USA 55902
| | - Jeff L Fidler
- Dept. of Radiology, Mayo Clinic, Rochester, MN, USA 55902
| | - Hao Gong
- Dept. of Radiology, Mayo Clinic, Rochester, MN, USA 55902
| | | | | | - Matthew P Johnson
- Dept. of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA 55902
| | - Shuai Leng
- Dept. of Radiology, Mayo Clinic, Rochester, MN, USA 55902
| | - Lifeng Yu
- Dept. of Radiology, Mayo Clinic, Rochester, MN, USA 55902
| | - David R Holmes
- Dept. of Radiology, Mayo Clinic, Rochester, MN, USA 55902
| | - Rickey E Carter
- Dept. of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA 55902
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22
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Avila FR, Carter RE, McLeod CJ, Bruce CJ, Guliyeva G, Torres-Guzman RA, Maita KC, Ho OA, TerKonda SP, Forte AJ. The Role of Telemedicine in Prehospital Traumatic Hand Injury Evaluation. Diagnostics (Basel) 2023; 13:diagnostics13061165. [PMID: 36980474 PMCID: PMC10047211 DOI: 10.3390/diagnostics13061165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 03/11/2023] [Accepted: 03/16/2023] [Indexed: 03/30/2023] Open
Abstract
Unnecessary ED visits and transfers to hand clinics raise treatment costs and patient burden at trauma centers. In the present COVID-19 pandemic, needless transfers can increase patients' risk of viral exposure. Therefore, this review analyzes different aspects of the remote diagnosis and triage of traumatic hand injuries. The most common file was photography, with the most common devices being cell phone cameras. Treatment, triage, diagnosis, cost, and time outcomes were assessed, showing concordance between teleconsultation and face-to-face patient evaluations. We conclude that photography and video consultations are feasible surrogates for ED visits in patients with traumatic hand injuries. These technologies should be leveraged to decrease treatment costs and potentially decrease the time to definitive treatment after initial evaluation.
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Affiliation(s)
- Francisco R Avila
- Division of Plastic Surgery, Mayo Clinic, 4500 San Pablo Rd., Jacksonville, FL 32224, USA
| | - Rickey E Carter
- Department of Quantitative Health Sciences, Mayo Clinic, 4500 San Pablo Rd., Jacksonville, FL 32224, USA
| | - Christopher J McLeod
- Department of Cardiovascular Medicine, Mayo Clinic, 4500 San Pablo Rd., Jacksonville, FL 32224, USA
| | - Charles J Bruce
- Department of Cardiovascular Medicine, Mayo Clinic, 4500 San Pablo Rd., Jacksonville, FL 32224, USA
| | - Gunel Guliyeva
- Department of Plastic and Reconstructive Surgery, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA
| | | | - Karla C Maita
- Division of Plastic Surgery, Mayo Clinic, 4500 San Pablo Rd., Jacksonville, FL 32224, USA
| | - Olivia A Ho
- Division of Plastic Surgery, Mayo Clinic, 4500 San Pablo Rd., Jacksonville, FL 32224, USA
| | - Sarvam P TerKonda
- Division of Plastic Surgery, Mayo Clinic, 4500 San Pablo Rd., Jacksonville, FL 32224, USA
| | - Antonio J Forte
- Division of Plastic Surgery, Mayo Clinic, 4500 San Pablo Rd., Jacksonville, FL 32224, USA
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Garzon-Siatoya WT, Lara ACM, Douglass E, Wight J, Olutola I, Johnson PW, Attia ZI, Friedman PA, Noseworthy P, Carter RE, Kinaszczuk A, Adedinsewo D. PROSPECTIVE VALIDATION OF A 12-LEAD ECG BASED ARTIFICIAL INTELLIGENCE MODEL FOR DETECTION OF LOW EJECTION FRACTION AMONG YOUNG WOMEN. J Am Coll Cardiol 2023. [DOI: 10.1016/s0735-1097(23)02729-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
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Lara ACM, Garzon-Siatoya WT, Douglass EJ, Wight J, Olutola I, Johnson PW, Attia ZI, Friedman PA, Noseworthy P, Carter RE, Kinaszczuk A, Adedinsewo D. EFFECTIVENESS OF AN ARTIFICIAL INTELLIGENCE-ENHANCED DIGITAL STETHOSCOPE TO SCREEN FOR CARDIOMYOPATHY AMONG YOUNG WOMEN: A PROSPECTIVE OBSERVATIONAL STUDY. J Am Coll Cardiol 2023. [DOI: 10.1016/s0735-1097(23)02593-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
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Adedinsewo D, Hardway HD, Morales-Lara AC, Wieczorek MA, Johnson PW, Douglass EJ, Dangott BJ, Nakhleh RE, Narula T, Patel PC, Goswami RM, Lyle MA, Heckman AJ, Leoni-Moreno JC, Steidley DE, Arsanjani R, Hardaway B, Abbas M, Behfar A, Attia ZI, Lopez-Jimenez F, Noseworthy PA, Friedman P, Carter RE, Yamani M. Non-invasive detection of cardiac allograft rejection among heart transplant recipients using an electrocardiogram based deep learning model. Eur Heart J Digit Health 2023; 4:71-80. [PMID: 36974261 PMCID: PMC10039431 DOI: 10.1093/ehjdh/ztad001] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 12/08/2022] [Indexed: 01/15/2023]
Abstract
Aims Current non-invasive screening methods for cardiac allograft rejection have shown limited discrimination and are yet to be broadly integrated into heart transplant care. Given electrocardiogram (ECG) changes have been reported with severe cardiac allograft rejection, this study aimed to develop a deep-learning model, a form of artificial intelligence, to detect allograft rejection using the 12-lead ECG (AI-ECG). Methods and results Heart transplant recipients were identified across three Mayo Clinic sites between 1998 and 2021. Twelve-lead digital ECG data and endomyocardial biopsy results were extracted from medical records. Allograft rejection was defined as moderate or severe acute cellular rejection (ACR) based on International Society for Heart and Lung Transplantation guidelines. The extracted data (7590 unique ECG-biopsy pairs, belonging to 1427 patients) was partitioned into training (80%), validation (10%), and test sets (10%) such that each patient was included in only one partition. Model performance metrics were based on the test set (n = 140 patients; 758 ECG-biopsy pairs). The AI-ECG detected ACR with an area under the receiver operating curve (AUC) of 0.84 [95% confidence interval (CI): 0.78-0.90] and 95% (19/20; 95% CI: 75-100%) sensitivity. A prospective proof-of-concept screening study (n = 56; 97 ECG-biopsy pairs) showed the AI-ECG detected ACR with AUC = 0.78 (95% CI: 0.61-0.96) and 100% (2/2; 95% CI: 16-100%) sensitivity. Conclusion An AI-ECG model is effective for detection of moderate-to-severe ACR in heart transplant recipients. Our findings could improve transplant care by providing a rapid, non-invasive, and potentially remote screening option for cardiac allograft function.
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Affiliation(s)
- Demilade Adedinsewo
- Department of Cardiovascular Medicine, Division of Cardiovascular Diseases, Mayo Clinic, 4500 San Pablo Rd, Jacksonville, FL 32224, USA
| | - Heather D Hardway
- Department of Quantitative Health Sciences, Mayo Clinic, Jacksonville, FL, USA
| | - Andrea Carolina Morales-Lara
- Department of Cardiovascular Medicine, Division of Cardiovascular Diseases, Mayo Clinic, 4500 San Pablo Rd, Jacksonville, FL 32224, USA
| | - Mikolaj A Wieczorek
- Department of Quantitative Health Sciences, Mayo Clinic, Jacksonville, FL, USA
| | - Patrick W Johnson
- Department of Quantitative Health Sciences, Mayo Clinic, Jacksonville, FL, USA
| | - Erika J Douglass
- Department of Cardiovascular Medicine, Division of Cardiovascular Diseases, Mayo Clinic, 4500 San Pablo Rd, Jacksonville, FL 32224, USA
| | - Bryan J Dangott
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Jacksonville, FL, USA
| | - Raouf E Nakhleh
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Jacksonville, FL, USA
| | - Tathagat Narula
- Department of Transplantation, Mayo Clinic, Jacksonville, FL, USA
| | - Parag C Patel
- Department of Transplantation, Mayo Clinic, Jacksonville, FL, USA
| | - Rohan M Goswami
- Department of Transplantation, Mayo Clinic, Jacksonville, FL, USA
| | - Melissa A Lyle
- Department of Transplantation, Mayo Clinic, Jacksonville, FL, USA
| | - Alexander J Heckman
- Department of Cardiovascular Medicine, Division of Cardiovascular Diseases, Mayo Clinic, 4500 San Pablo Rd, Jacksonville, FL 32224, USA
| | | | - D Eric Steidley
- Department of Cardiovascular Medicine, Mayo Clinic, Phoenix, AZ, USA
| | - Reza Arsanjani
- Department of Cardiovascular Medicine, Mayo Clinic, Phoenix, AZ, USA
| | - Brian Hardaway
- Department of Cardiovascular Medicine, Mayo Clinic, Phoenix, AZ, USA
| | - Mohsin Abbas
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | - Atta Behfar
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | - Zachi I Attia
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | | | | | - Paul Friedman
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | - Rickey E Carter
- Department of Quantitative Health Sciences, Mayo Clinic, Jacksonville, FL, USA
| | - Mohamad Yamani
- Department of Cardiovascular Medicine, Division of Cardiovascular Diseases, Mayo Clinic, 4500 San Pablo Rd, Jacksonville, FL 32224, USA
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Avila FR, Carter RE, McLeod CJ, Bruce CJ, Giardi D, Guliyeva G, Forte AJ. Accuracy of Wearable Sensor Technology in Hand Goniometry: A Systematic Review. Hand (N Y) 2023; 18:340-348. [PMID: 34032154 PMCID: PMC10035090 DOI: 10.1177/15589447211014606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Wearable devices and sensor technology provide objective, unbiased range of motion measurements that help health care professionals overcome the hindrances of protractor-based goniometry. This review aims to analyze the accuracy of existing wearable sensor technologies for hand range of motion measurement and identify the most accurate one. METHODS We performed a systematic review by searching PubMed, CINAHL, and Embase for studies evaluating wearable sensor technology in hand range of motion assessment. Keywords used for the inquiry were related to wearable devices and hand goniometry. RESULTS Of the 71 studies, 11 met the inclusion criteria. Ten studies evaluated gloves and 1 evaluated a wristband. The most common types of sensors used were bend sensors, followed by inertial sensors, Hall effect sensors, and magnetometers. Most studies compared wearable devices with manual goniometry, achieving optimal accuracy. Although most of the devices reached adequate levels of measurement error, accuracy evaluation in the reviewed studies might be subject to bias owing to the use of poorly reliable measurement techniques for comparison of the devices. CONCLUSION Gloves using inertial sensors were the most accurate. Future studies should use different comparison techniques, such as infrared camera-based goniometry or virtual motion tracking, to evaluate the performance of wearable devices.
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Affiliation(s)
| | - Rickey E. Carter
- Department of Health Sciences Research, Mayo Clinic, Jacksonville, FL, USA
| | | | - Charles J. Bruce
- Department of Cardiovascular Medicine, Mayo Clinic, Jacksonville, FL, USA
| | - Davide Giardi
- Department of Cardiovascular Medicine, Mayo Clinic, Jacksonville, FL, USA
| | - Gunel Guliyeva
- Division of Plastic Surgery, Mayo Clinic, Jacksonville, FL, USA
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Davies JL, Lodermeier KA, Klein DM, Carter RE, Dyck PJB, Litchy WJ, Dyck PJ. Composite nerve conduction scores and signs for diagnosis and somatic staging of diabetic polyneuropathy: Mid North American ethnic cohort survey. Muscle Nerve 2023. [PMID: 36734298 DOI: 10.1002/mus.27793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 01/25/2023] [Accepted: 01/29/2023] [Indexed: 02/04/2023]
Abstract
INTRODUCTION/AIMS In the Diabetes Control and Complications Trial (DCCT), the minimal nerve conduction (NC) criterion for diabetic sensorimotor polyneuropathy (DSPN) was abnormality of NC in more than one peripheral nerve without specifying the attributes of NCs to be evaluated. In the present study, we assess individual and composite scores of NCs meeting the DCCT criterion and signs for improved diagnosis and assessment of DSPN severity. METHODS Evaluated were 13 attributes and 6 composite NC scores and signs and symptoms in 395 healthy subjects (HS) and 388 persons with diabetes (DM). RESULTS Percent abnormality between subjects with DM and HS was remarkably different among individual attributes and the six composite NC scores. For diagnosis of DSPN using the DCCT criterion, assessment of conduction velocities (CVs) and distal latencies (DLs) provided sensitive diagnoses of DSPN. NC amplitudes provided stronger measures of severity. In studied cohorts, DSPN was staged: N0, no NC abnormality using NC score 2 (CVs and DLs), 60.0%; N1, NC abnormality only, 18.4%; N2, NC abnormality and signs of feet or legs, 16.3%; and N3, NC abnormality and signs of thighs, 5.3%. DISCUSSION For sensitive and standard diagnosis of DSPN using the DCCT NC criterion, specifically defined composite scores of CVs and DLs, e.g., score 2, is recommended. A composite score of amplitudes, e.g., score 4, provides a stronger measure of neuropathy severity. Also, provided are HS reference values of evaluated attributes of NCs and estimates of staged severity of DSPN of mid North American DM cohorts.
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Affiliation(s)
- Jenny L Davies
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Diane M Klein
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
| | - Rickey E Carter
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
| | - P James B Dyck
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Peter J Dyck
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
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Hsieh SS, Cook DA, Inoue A, Gong H, Sudhir Pillai P, Johnson MP, Leng S, Yu L, Fidler JL, Holmes DR, Carter RE, McCollough CH, Fletcher JG. Understanding Reader Variability: A 25-Radiologist Study on Liver Metastasis Detection at CT. Radiology 2023; 306:e220266. [PMID: 36194112 PMCID: PMC9870852 DOI: 10.1148/radiol.220266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 07/07/2022] [Accepted: 08/17/2022] [Indexed: 01/26/2023]
Abstract
Background Substantial interreader variability exists for common tasks in CT imaging, such as detection of hepatic metastases. This variability can undermine patient care by leading to misdiagnosis. Purpose To determine the impact of interreader variability associated with (a) reader experience, (b) image navigation patterns (eg, eye movements, workstation interactions), and (c) eye gaze time at missed liver metastases on contrast-enhanced abdominal CT images. Materials and Methods In a single-center prospective observational trial at an academic institution between December 2020 and February 2021, readers were recruited to examine 40 contrast-enhanced abdominal CT studies (eight normal, 32 containing 91 liver metastases). Readers circumscribed hepatic metastases and reported confidence. The workstation tracked image navigation and eye movements. Performance was quantified by using the area under the jackknife alternative free-response receiver operator characteristic (JAFROC-1) curve and per-metastasis sensitivity and was associated with reader experience and image navigation variables. Differences in area under JAFROC curve were assessed with the Kruskal-Wallis test followed by the Dunn test, and effects of image navigation were assessed by using the Wilcoxon signed-rank test. Results Twenty-five readers (median age, 38 years; IQR, 31-45 years; 19 men) were recruited and included nine subspecialized abdominal radiologists, five nonabdominal staff radiologists, and 11 senior residents or fellows. Reader experience explained differences in area under the JAFROC curve, with abdominal radiologists demonstrating greater area under the JAFROC curve (mean, 0.77; 95% CI: 0.75, 0.79) than trainees (mean, 0.71; 95% CI: 0.69, 0.73) (P = .02) or nonabdominal subspecialists (mean, 0.69; 95% CI: 0.60, 0.78) (P = .03). Sensitivity was similar within the reader experience groups (P = .96). Image navigation variables that were associated with higher sensitivity included longer interpretation time (P = .003) and greater use of coronal images (P < .001). The eye gaze time was at least 0.5 and 2.0 seconds for 71% (266 of 377) and 40% (149 of 377) of missed metastases, respectively. Conclusion Abdominal radiologists demonstrated better discrimination for the detection of liver metastases on abdominal contrast-enhanced CT images. Missed metastases frequently received at least a brief eye gaze. Higher sensitivity was associated with longer interpretation time and greater use of liver display windows and coronal images. © RSNA, 2022 Online supplemental material is available for this article.
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Affiliation(s)
- Scott S. Hsieh
- From the Departments of Radiology (S.S.H., A.I., H.G., P.S.P., S.L.,
L.Y., J.L.F., C.H.M., J.G.F.), General Internal Medicine (D.A.C.), Quantitative
Health Services–Clinical Trials and Biostatistics (M.P.J.), and
Physiology and Biomedical Engineering (D.R.H.), Mayo Clinic Rochester, 200 First
St SW, Rochester, MN 55905; and Department of Quantitative Health
Services–Clinical Trials and Biostatistics, Mayo Clinic, Jacksonville,
Fla (R.E.C.)
| | - David A. Cook
- From the Departments of Radiology (S.S.H., A.I., H.G., P.S.P., S.L.,
L.Y., J.L.F., C.H.M., J.G.F.), General Internal Medicine (D.A.C.), Quantitative
Health Services–Clinical Trials and Biostatistics (M.P.J.), and
Physiology and Biomedical Engineering (D.R.H.), Mayo Clinic Rochester, 200 First
St SW, Rochester, MN 55905; and Department of Quantitative Health
Services–Clinical Trials and Biostatistics, Mayo Clinic, Jacksonville,
Fla (R.E.C.)
| | - Akitoshi Inoue
- From the Departments of Radiology (S.S.H., A.I., H.G., P.S.P., S.L.,
L.Y., J.L.F., C.H.M., J.G.F.), General Internal Medicine (D.A.C.), Quantitative
Health Services–Clinical Trials and Biostatistics (M.P.J.), and
Physiology and Biomedical Engineering (D.R.H.), Mayo Clinic Rochester, 200 First
St SW, Rochester, MN 55905; and Department of Quantitative Health
Services–Clinical Trials and Biostatistics, Mayo Clinic, Jacksonville,
Fla (R.E.C.)
| | - Hao Gong
- From the Departments of Radiology (S.S.H., A.I., H.G., P.S.P., S.L.,
L.Y., J.L.F., C.H.M., J.G.F.), General Internal Medicine (D.A.C.), Quantitative
Health Services–Clinical Trials and Biostatistics (M.P.J.), and
Physiology and Biomedical Engineering (D.R.H.), Mayo Clinic Rochester, 200 First
St SW, Rochester, MN 55905; and Department of Quantitative Health
Services–Clinical Trials and Biostatistics, Mayo Clinic, Jacksonville,
Fla (R.E.C.)
| | - Parvathy Sudhir Pillai
- From the Departments of Radiology (S.S.H., A.I., H.G., P.S.P., S.L.,
L.Y., J.L.F., C.H.M., J.G.F.), General Internal Medicine (D.A.C.), Quantitative
Health Services–Clinical Trials and Biostatistics (M.P.J.), and
Physiology and Biomedical Engineering (D.R.H.), Mayo Clinic Rochester, 200 First
St SW, Rochester, MN 55905; and Department of Quantitative Health
Services–Clinical Trials and Biostatistics, Mayo Clinic, Jacksonville,
Fla (R.E.C.)
| | - Matthew P. Johnson
- From the Departments of Radiology (S.S.H., A.I., H.G., P.S.P., S.L.,
L.Y., J.L.F., C.H.M., J.G.F.), General Internal Medicine (D.A.C.), Quantitative
Health Services–Clinical Trials and Biostatistics (M.P.J.), and
Physiology and Biomedical Engineering (D.R.H.), Mayo Clinic Rochester, 200 First
St SW, Rochester, MN 55905; and Department of Quantitative Health
Services–Clinical Trials and Biostatistics, Mayo Clinic, Jacksonville,
Fla (R.E.C.)
| | - Shuai Leng
- From the Departments of Radiology (S.S.H., A.I., H.G., P.S.P., S.L.,
L.Y., J.L.F., C.H.M., J.G.F.), General Internal Medicine (D.A.C.), Quantitative
Health Services–Clinical Trials and Biostatistics (M.P.J.), and
Physiology and Biomedical Engineering (D.R.H.), Mayo Clinic Rochester, 200 First
St SW, Rochester, MN 55905; and Department of Quantitative Health
Services–Clinical Trials and Biostatistics, Mayo Clinic, Jacksonville,
Fla (R.E.C.)
| | - Lifeng Yu
- From the Departments of Radiology (S.S.H., A.I., H.G., P.S.P., S.L.,
L.Y., J.L.F., C.H.M., J.G.F.), General Internal Medicine (D.A.C.), Quantitative
Health Services–Clinical Trials and Biostatistics (M.P.J.), and
Physiology and Biomedical Engineering (D.R.H.), Mayo Clinic Rochester, 200 First
St SW, Rochester, MN 55905; and Department of Quantitative Health
Services–Clinical Trials and Biostatistics, Mayo Clinic, Jacksonville,
Fla (R.E.C.)
| | - Jeff L. Fidler
- From the Departments of Radiology (S.S.H., A.I., H.G., P.S.P., S.L.,
L.Y., J.L.F., C.H.M., J.G.F.), General Internal Medicine (D.A.C.), Quantitative
Health Services–Clinical Trials and Biostatistics (M.P.J.), and
Physiology and Biomedical Engineering (D.R.H.), Mayo Clinic Rochester, 200 First
St SW, Rochester, MN 55905; and Department of Quantitative Health
Services–Clinical Trials and Biostatistics, Mayo Clinic, Jacksonville,
Fla (R.E.C.)
| | - David R. Holmes
- From the Departments of Radiology (S.S.H., A.I., H.G., P.S.P., S.L.,
L.Y., J.L.F., C.H.M., J.G.F.), General Internal Medicine (D.A.C.), Quantitative
Health Services–Clinical Trials and Biostatistics (M.P.J.), and
Physiology and Biomedical Engineering (D.R.H.), Mayo Clinic Rochester, 200 First
St SW, Rochester, MN 55905; and Department of Quantitative Health
Services–Clinical Trials and Biostatistics, Mayo Clinic, Jacksonville,
Fla (R.E.C.)
| | - Rickey E. Carter
- From the Departments of Radiology (S.S.H., A.I., H.G., P.S.P., S.L.,
L.Y., J.L.F., C.H.M., J.G.F.), General Internal Medicine (D.A.C.), Quantitative
Health Services–Clinical Trials and Biostatistics (M.P.J.), and
Physiology and Biomedical Engineering (D.R.H.), Mayo Clinic Rochester, 200 First
St SW, Rochester, MN 55905; and Department of Quantitative Health
Services–Clinical Trials and Biostatistics, Mayo Clinic, Jacksonville,
Fla (R.E.C.)
| | - Cynthia H. McCollough
- From the Departments of Radiology (S.S.H., A.I., H.G., P.S.P., S.L.,
L.Y., J.L.F., C.H.M., J.G.F.), General Internal Medicine (D.A.C.), Quantitative
Health Services–Clinical Trials and Biostatistics (M.P.J.), and
Physiology and Biomedical Engineering (D.R.H.), Mayo Clinic Rochester, 200 First
St SW, Rochester, MN 55905; and Department of Quantitative Health
Services–Clinical Trials and Biostatistics, Mayo Clinic, Jacksonville,
Fla (R.E.C.)
| | - Joel G. Fletcher
- From the Departments of Radiology (S.S.H., A.I., H.G., P.S.P., S.L.,
L.Y., J.L.F., C.H.M., J.G.F.), General Internal Medicine (D.A.C.), Quantitative
Health Services–Clinical Trials and Biostatistics (M.P.J.), and
Physiology and Biomedical Engineering (D.R.H.), Mayo Clinic Rochester, 200 First
St SW, Rochester, MN 55905; and Department of Quantitative Health
Services–Clinical Trials and Biostatistics, Mayo Clinic, Jacksonville,
Fla (R.E.C.)
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Avila FR, Torres-Guzman RA, Maita KC, Garcia JP, Haider CR, Ho OA, Carter RE, McLeod CJ, Bruce CJ, Forte AJ. Perceived Age as a Mortality and Comorbidity Predictor: A Systematic Review. Aesthetic Plast Surg 2023; 47:442-454. [PMID: 35650301 DOI: 10.1007/s00266-022-02932-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 05/01/2022] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Perceived age is defined as how old a person looks to external evaluators. It reflects the underlying biological age, which is a measure based on physical and physiological parameters reflecting a person's aging process more accurately than chronological age. People with a higher biological age have shorter lives compared to those with a lower biological age with the same chronological age. Our review aims to find whether increased perceived age is a risk factor for overall mortality risk or comorbidities. METHODS A literature search of three databases was conducted following the PRISMA guidelines for studies analyzing perceived age or isolated facial characteristics of old age and their relationship to mortality risk or comorbidity outcomes. Data on the number of patients, type and characteristics of evaluation methods, evaluator characteristics, mean chronologic age, facial characteristics studied, measured outcomes, and study results were collected. RESULTS Out of 977 studies, 15 fulfilled the inclusion criteria. These studies found an increase in mortality risk of 6-51% in older-looking people compared to controls (HR 1.06-1.51, p < 0.05). In addition, perceived age and some facial characteristics of old age were also associated with cardiovascular risk and myocardial infarction, cognitive function, bone mineral density, and chronic obstructive pulmonary disease (COPD). CONCLUSION Perceived age promises to be a clinically useful predictor of overall mortality and cardiovascular, pulmonary, cognitive, and osseous comorbidities. LEVEL OF EVIDENCE III This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Affiliation(s)
- Francisco R Avila
- Division of Plastic Surgery, Mayo Clinic, 4500 San Pablo Rd, Jacksonville, FL, 32224, USA
| | | | - Karla C Maita
- Division of Plastic Surgery, Mayo Clinic, 4500 San Pablo Rd, Jacksonville, FL, 32224, USA
| | - John P Garcia
- Division of Plastic Surgery, Mayo Clinic, 4500 San Pablo Rd, Jacksonville, FL, 32224, USA
| | - Clifton R Haider
- Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, MN, USA
| | - Olivia A Ho
- Division of Plastic Surgery, Mayo Clinic, 4500 San Pablo Rd, Jacksonville, FL, 32224, USA
| | - Rickey E Carter
- Department of Quantitative Health Sciences, Mayo Clinic, Jacksonville, FL, USA
| | | | - Charles J Bruce
- Department of Cardiovascular Medicine, Mayo Clinic, Jacksonville, FL, USA
| | - Antonio J Forte
- Division of Plastic Surgery, Mayo Clinic, 4500 San Pablo Rd, Jacksonville, FL, 32224, USA.
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30
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De Biase G, Carter RE, Otamendi-Lopez A, Garcia D, Chen S, Bojaxhi E, Quinones-Hinojosa A, Abode-Iyamah K. Assessment of surgeons' attitude towards awake spine surgery under spinal anesthesia. J Clin Neurosci 2023; 107:48-53. [PMID: 36502781 DOI: 10.1016/j.jocn.2022.12.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Accepted: 12/02/2022] [Indexed: 12/13/2022]
Abstract
BACKGROUND General anesthesia (GA) and spinal anesthesia (SA) have been adopted for lumbar spine surgery (LSS), but GA is used far more widely. We conducted a survey of spine surgeons to explore their attitudes and preferences regarding awake spine surgery under SA. METHODS A survey was emailed to 150 spine surgeons. Exposure and attitudes towards spine surgery under SA were elicited. A five-point Likert scale of agreement examined perceptions of SA, while attitudes towards SA were recorded by categorizing free text into themes. RESULTS Seventy-five surgeons completed the survey, 50 % response rate. Only 27 % said they perform LSS under SA. Most surgeons, 83 %, would recommend GA to a healthy patient undergoing lumbar laminectomy. Only 41 % believes SA to be as safe as GA, and only 30 % believes SA is associated with better postoperative pain control. The most common reasons why SA is not favored was lack of proven benefits over GA (65 %). When asked if a randomized trial finds SA to lead to less postoperative fatigue, 50 % said they would be more likely to offer SA, a significant increase from the baseline response of 27 % (p = 0.002). CONCLUSIONS Our survey indicates that the low adoption of SA for LSS is due to lack of surgeons' belief in the benefits of SA over GA, and that a randomized patient-centered trial has the potential of changing surgeons' perspective and increasing adoption of SA for LSS.
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Affiliation(s)
| | - Rickey E Carter
- Department of Quantitative Health Sciences, Mayo Clinic, Jacksonville, FL, USA
| | | | - Diogo Garcia
- Department of Neurosurgery, Mayo Clinic, Jacksonville, FL, USA
| | - Selby Chen
- Department of Neurosurgery, Mayo Clinic, Jacksonville, FL, USA
| | - Elird Bojaxhi
- Department of Anesthesiology, Mayo Clinic, Jacksonville, FL, USA
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31
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Avila FR, Carter RE, McLeod CJ, Bruce CJ, Giardi D, Guliyeva G, Torres-Guzman RA, Maita KC, Forte AJ. Perceived Age in Patients Exposed to Distinct UV Indexes: A Systematic Review. Indian J Plast Surg 2022; 56:103-111. [PMID: 37153341 PMCID: PMC10159705 DOI: 10.1055/s-0042-1759696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
AbstractPhotodamage is caused by chronic sun exposure and ultraviolet radiation and presents as wrinkles, sagging, and pigmented spots. An increase in the ultraviolet index can increase a person's perceived age by worsening skin photodamage. However, since the ultraviolet index varies considerably between geographical regions, perceived age might vary substantially among them. This review aims to describe the differences in chronological and perceived age in regions of the world with different ultraviolet indexes. A literature search of three databases was conducted for studies analyzing perceived age and its relationship to sun exposure. Ultraviolet indexes from the included studies were retrieved from the National Weather Service and the Tropospheric Emission Monitoring Internet Service. Out of 104 studies, seven fulfilled the inclusion criteria. Overall, 3,352 patients were evaluated for perceived age. All studies found that patients with the highest daily sun exposures had the highest perceived ages for their chronological age (p < 0.05). People with high sun exposure behaviors living in regions with high ultraviolet indexes will look significantly older than same-aged peers living in lower ultraviolet index regions.
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Affiliation(s)
- Francisco R. Avila
- Division of Plastic Surgery, Mayo Clinic, Jacksonville, Florida, United States
| | - Rickey E. Carter
- Department of Health Sciences Research, Mayo Clinic, Jacksonville, Florida, United States
| | - Christopher J. McLeod
- Department of Cardiovascular Medicine, Mayo Clinic, Jacksonville, Florida, United States
| | - Charles J. Bruce
- Department of Cardiovascular Medicine, Mayo Clinic, Jacksonville, Florida, United States
| | - Davide Giardi
- Department of Cardiovascular Medicine, Mayo Clinic, Jacksonville, Florida, United States
| | - Gunel Guliyeva
- Division of Plastic Surgery, Mayo Clinic, Jacksonville, Florida, United States
| | | | - Karla C. Maita
- Division of Plastic Surgery, Mayo Clinic, Jacksonville, Florida, United States
| | - Antonio J. Forte
- Division of Plastic Surgery, Mayo Clinic, Jacksonville, Florida, United States
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Vachon CM, Norman AD, Prasad K, Jensen D, Schaeferle GM, Vierling KL, Sherden M, Majerus MR, Bews KA, Heinzen EP, Hebl A, Yost KJ, Kennedy RB, Theel ES, Ghosh A, Fries M, Wi CI, Juhn YJ, Sampathkumar P, Morice WG, Rocca WA, Tande AJ, Cerhan JR, Limper AH, Ting HH, Farrugia G, Carter RE, Finney Rutten LJ, Jacobson RM, St. Sauver J. Rates of Asymptomatic COVID-19 Infection and Associated Factors in Olmsted County, Minnesota, in the Prevaccination Era. Mayo Clin Proc Innov Qual Outcomes 2022; 6:605-617. [PMID: 36277251 PMCID: PMC9578336 DOI: 10.1016/j.mayocpiqo.2022.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Objective To estimate rates and identify factors associated with asymptomatic COVID-19 in the population of Olmsted County during the prevaccination era. Patients and Methods We screened first responders (n=191) and Olmsted County employees (n=564) for antibodies to SARS-CoV-2 from November 1, 2020 to February 28, 2021 to estimate seroprevalence and asymptomatic infection. Second, we retrieved all polymerase chain reaction (PCR)-confirmed COVID-19 diagnoses in Olmsted County from March 2020 through January 2021, abstracted symptom information, estimated rates of asymptomatic infection and examined related factors. Results Twenty (10.5%; 95% CI, 6.9%-15.6%) first responders and 38 (6.7%; 95% CI, 5.0%-9.1%) county employees had positive antibodies; an additional 5 (2.6%) and 10 (1.8%) had prior positive PCR tests per self-report or medical record, but no antibodies detected. Of persons with symptom information, 4 of 20 (20%; 95% CI, 3.0%-37.0%) first responders and 10 of 39 (26%; 95% CI, 12.6%-40.0%) county employees were asymptomatic. Of 6020 positive PCR tests in Olmsted County with symptom information between March 1, 2020, and January 31, 2021, 6% (n=385; 95% CI, 5.8%-7.1%) were asymptomatic. Factors associated with asymptomatic disease included age (0-18 years [odds ratio {OR}, 2.3; 95% CI, 1.7-3.1] and >65 years [OR, 1.40; 95% CI, 1.0-2.0] compared with ages 19-44 years), body mass index (overweight [OR, 0.58; 95% CI, 0.44-0.77] or obese [OR, 0.48; 95% CI, 0.57-0.62] compared with normal or underweight) and tests after November 20, 2020 ([OR, 1.35; 95% CI, 1.13-1.71] compared with prior dates). Conclusion Asymptomatic rates in Olmsted County before COVID-19 vaccine rollout ranged from 6% to 25%, and younger age, normal weight, and later tests dates were associated with asymptomatic infection.
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Affiliation(s)
- Celine M. Vachon
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN
| | - Aaron D. Norman
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN
| | - Kavita Prasad
- Integrative Medicine, Zumbro Valley Health Center, Mayo Clinic, Rochester, MN
| | - Dan Jensen
- Department of Health, Housing and Human Services Administration, Olmsted County Public Health, Mayo Clinic, Rochester, MN
| | - Gavin M. Schaeferle
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN
| | - Kristy L. Vierling
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN
| | - Meaghan Sherden
- Department of Epidemiology, Surveillance and Preparedness Team, Olmsted County Public Health, Mayo Clinic, Rochester, MN
| | | | - Katherine A. Bews
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN
| | - Ethan P. Heinzen
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN
| | - Amy Hebl
- Department of Human Resources, Olmsted County, Mayo Clinic, Rochester, MN
| | - Kathleen J. Yost
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN
| | - Richard B. Kennedy
- Vaccine Research Group, Division of General Internal Medicine, Mayo Clinic, Rochester, MN
| | - Elitza S. Theel
- Department of Laboratory Medicine and Pathology, Division of Clinical Microbiology, Mayo Clinic, Rochester, MN
| | - Aditya Ghosh
- Department of Internal Medicine, Northeast Georgia Medical Center, Gainesville, GA
| | | | - Chung-Il Wi
- Department of Precision Population Science Lab, Mayo Clinic, Rochester, MN
| | - Young J. Juhn
- Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN
| | - Priya Sampathkumar
- Division of Infectious Diseases, Department of Medicine, Mayo Clinic, Rochester, MN
| | - William G. Morice
- Department of Laboratory Medicine & Pathology, Mayo Clinic, Rochester, MN
| | - Walter A. Rocca
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN
- Department of Neurology and Women’s Health Research Center, Mayo Clinic, Rochester, MN
| | - Aaron J. Tande
- Division of Public Health, Infectious Diseases, and Occupational Medicine, Mayo Clinic, Rochester, MN
| | - James R. Cerhan
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN
| | - Andrew H. Limper
- Department of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN
| | - Henry H. Ting
- Department of Cardiology, Emory University, Atlanta, GA
| | - Gianrico Farrugia
- Division of Gastroenterology & Hepatology, Department of Medicine, Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, MN
| | - Rickey E. Carter
- Department of Quantitative Health Sciences, Mayo Clinic, Jacksonville, FL
| | | | - Robert M. Jacobson
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN
- Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN
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Murphree DH, Puri P, Shamim H, Bezalel SA, Drage LA, Wang M, Pittelkow MR, Carter RE, Davis MDP, Bridges AG, Mangold AR, Yiannias JA, Tollefson MM, Lehman JS, Meves A, Otley CC, Sokumbi O, Hall MR, Comfere N. Deep learning for dermatologists: Part I. Fundamental concepts. J Am Acad Dermatol 2022; 87:1343-1351. [PMID: 32434009 PMCID: PMC7669702 DOI: 10.1016/j.jaad.2020.05.056] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 04/16/2020] [Accepted: 05/12/2020] [Indexed: 12/31/2022]
Abstract
Artificial intelligence is generating substantial interest in the field of medicine. One form of artificial intelligence, deep learning, has led to rapid advances in automated image analysis. In 2017, an algorithm demonstrated the ability to diagnose certain skin cancers from clinical photographs with the accuracy of an expert dermatologist. Subsequently, deep learning has been applied to a range of dermatology applications. Although experts will never be replaced by artificial intelligence, it will certainly affect the specialty of dermatology. In this first article of a 2-part series, the basic concepts of deep learning will be reviewed with the goal of laying the groundwork for effective communication between clinicians and technical colleagues. In part 2 of the series, the clinical applications of deep learning in dermatology will be reviewed and limitations and opportunities will be considered.
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Affiliation(s)
- Dennis H Murphree
- Department of Health Sciences Research, Division of Digital Health Sciences, Mayo Clinic, Rochester, Minnesota; Mayo Clinic Office of Artificial Intelligence in Dermatology.
| | - Pranav Puri
- Mayo Clinic Office of Artificial Intelligence in Dermatology; Mayo Clinic Alix School of Medicine, Scottsdale, Arizona
| | - Huma Shamim
- Mayo Clinic Office of Artificial Intelligence in Dermatology; Department of Dermatology, Mayo Clinic, Rochester, Minnesota
| | - Spencer A Bezalel
- Mayo Clinic Office of Artificial Intelligence in Dermatology; Department of Dermatology, Mayo Clinic, Rochester, Minnesota
| | - Lisa A Drage
- Mayo Clinic Office of Artificial Intelligence in Dermatology; Department of Dermatology, Mayo Clinic, Rochester, Minnesota
| | - Michael Wang
- Department of Dermatology, University of California San Francisco, San Francisco, California
| | - Mark R Pittelkow
- Mayo Clinic Office of Artificial Intelligence in Dermatology; Department of Dermatology, Mayo Clinic, Scottsdale, Arizona
| | - Rickey E Carter
- Department of Health Sciences Research, Division of Biomedical Statistics and Informatics, Mayo Clinic, Jacksonville, Florida
| | - Mark D P Davis
- Mayo Clinic Office of Artificial Intelligence in Dermatology; Department of Dermatology, Mayo Clinic, Rochester, Minnesota
| | - Alina G Bridges
- Mayo Clinic Office of Artificial Intelligence in Dermatology; Department of Dermatology, Mayo Clinic, Rochester, Minnesota; Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota
| | - Aaron R Mangold
- Mayo Clinic Office of Artificial Intelligence in Dermatology; Department of Dermatology, Mayo Clinic, Scottsdale, Arizona
| | | | - Megha M Tollefson
- Mayo Clinic Office of Artificial Intelligence in Dermatology; Department of Dermatology, Mayo Clinic, Rochester, Minnesota
| | - Julia S Lehman
- Mayo Clinic Office of Artificial Intelligence in Dermatology; Department of Dermatology, Mayo Clinic, Rochester, Minnesota; Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota
| | - Alexander Meves
- Mayo Clinic Office of Artificial Intelligence in Dermatology; Department of Dermatology, Mayo Clinic, Rochester, Minnesota
| | - Clark C Otley
- Mayo Clinic Office of Artificial Intelligence in Dermatology; Department of Dermatology, Mayo Clinic, Rochester, Minnesota
| | - Olayemi Sokumbi
- Mayo Clinic Office of Artificial Intelligence in Dermatology; Department of Dermatology, Mayo Clinic, Jacksonville, Florida; Department of Laboratory Medicine and Pathology, Mayo Clinic, Jacksonville, Florida
| | - Matthew R Hall
- Mayo Clinic Office of Artificial Intelligence in Dermatology; Department of Dermatology, Mayo Clinic, Jacksonville, Florida
| | - Nneka Comfere
- Mayo Clinic Office of Artificial Intelligence in Dermatology; Department of Dermatology, Mayo Clinic, Rochester, Minnesota; Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota
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Sirmans TNH, Kouri N, Tamvaka N, Labuzan SA, Matchett BJ, Lincoln SJ, Hinkle KM, Moloney CM, Peng Z, Carter RE, Ross OA, Ertekin‐Taner N, Duara R, Graff‐Radford NR, Dickson DW, Murray ME. Digital Pathology Investigation of SERPINA5‐Tau Protein Interaction in Alzheimer’s Disease and Primary Tauopathies. Alzheimers Dement 2022. [DOI: 10.1002/alz.060316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | - Ranjan Duara
- Wien Center for Alzheimer’s Disease Research Center Miami Beach FL USA
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Puri P, Comfere N, Drage LA, Shamim H, Bezalel SA, Pittelkow MR, Davis MDP, Wang M, Mangold AR, Tollefson MM, Lehman JS, Meves A, Yiannias JA, Otley CC, Carter RE, Sokumbi O, Hall MR, Bridges AG, Murphree DH. Deep learning for dermatologists: Part II. Current applications. J Am Acad Dermatol 2022; 87:1352-1360. [PMID: 32428608 PMCID: PMC7669658 DOI: 10.1016/j.jaad.2020.05.053] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2020] [Revised: 05/07/2020] [Accepted: 05/08/2020] [Indexed: 01/14/2023]
Abstract
Because of a convergence of the availability of large data sets, graphics-specific computer hardware, and important theoretical advancements, artificial intelligence has recently contributed to dramatic progress in medicine. One type of artificial intelligence known as deep learning has been particularly impactful for medical image analysis. Deep learning applications have shown promising results in dermatology and other specialties, including radiology, cardiology, and ophthalmology. The modern clinician will benefit from an understanding of the basic features of deep learning to effectively use new applications and to better gauge their utility and limitations. In this second article of a 2-part series, we review the existing and emerging clinical applications of deep learning in dermatology and discuss future opportunities and limitations. Part 1 of this series offered an introduction to the basic concepts of deep learning to facilitate effective communication between clinicians and technical experts.
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Affiliation(s)
- Pranav Puri
- Mayo Clinic Alix School of Medicine, Scottsdale, Arizona; Mayo Clinic Office of Artificial Intelligence in Dermatology, Rochester, Minnesota
| | - Nneka Comfere
- Mayo Clinic Office of Artificial Intelligence in Dermatology, Rochester, Minnesota; Department of Dermatology, Mayo Clinic, Rochester, Minnesota; Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota.
| | - Lisa A Drage
- Mayo Clinic Office of Artificial Intelligence in Dermatology, Rochester, Minnesota; Department of Dermatology, Mayo Clinic, Rochester, Minnesota
| | - Huma Shamim
- Mayo Clinic Office of Artificial Intelligence in Dermatology, Rochester, Minnesota; Department of Dermatology, Mayo Clinic, Rochester, Minnesota
| | - Spencer A Bezalel
- Mayo Clinic Office of Artificial Intelligence in Dermatology, Rochester, Minnesota; Department of Dermatology, Mayo Clinic, Rochester, Minnesota
| | - Mark R Pittelkow
- Mayo Clinic Office of Artificial Intelligence in Dermatology, Rochester, Minnesota; Department of Dermatology, Mayo Clinic, Scottsdale, Arizona
| | - Mark D P Davis
- Mayo Clinic Office of Artificial Intelligence in Dermatology, Rochester, Minnesota; Department of Dermatology, Mayo Clinic, Rochester, Minnesota
| | - Michael Wang
- Department of Dermatology, University of California San Francisco, San Francisco, California
| | - Aaron R Mangold
- Mayo Clinic Office of Artificial Intelligence in Dermatology, Rochester, Minnesota; Department of Dermatology, Mayo Clinic, Scottsdale, Arizona
| | - Megha M Tollefson
- Mayo Clinic Office of Artificial Intelligence in Dermatology, Rochester, Minnesota; Department of Dermatology, Mayo Clinic, Rochester, Minnesota
| | - Julia S Lehman
- Mayo Clinic Office of Artificial Intelligence in Dermatology, Rochester, Minnesota; Department of Dermatology, Mayo Clinic, Rochester, Minnesota; Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota
| | - Alexander Meves
- Mayo Clinic Office of Artificial Intelligence in Dermatology, Rochester, Minnesota; Department of Dermatology, Mayo Clinic, Rochester, Minnesota
| | | | - Clark C Otley
- Mayo Clinic Office of Artificial Intelligence in Dermatology, Rochester, Minnesota; Department of Dermatology, Mayo Clinic, Rochester, Minnesota
| | - Rickey E Carter
- Department of Health Sciences Research, Division of Biomedical Statistics and Informatics, Mayo Clinic, Jacksonville, Florida
| | - Olayemi Sokumbi
- Mayo Clinic Office of Artificial Intelligence in Dermatology, Rochester, Minnesota; Department of Dermatology, Mayo Clinic, Jacksonville, Florida; Department of Laboratory Medicine and Pathology, Mayo Clinic, Jacksonville, Florida
| | - Matthew R Hall
- Mayo Clinic Office of Artificial Intelligence in Dermatology, Rochester, Minnesota; Department of Dermatology, Mayo Clinic, Jacksonville, Florida
| | - Alina G Bridges
- Mayo Clinic Office of Artificial Intelligence in Dermatology, Rochester, Minnesota; Department of Dermatology, Mayo Clinic, Rochester, Minnesota; Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota
| | - Dennis H Murphree
- Mayo Clinic Office of Artificial Intelligence in Dermatology, Rochester, Minnesota; Department of Health Sciences Research, Division of Digital Health Sciences, Mayo Clinic, Rochester, Minnesota
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Attia ZI, Harmon DM, Dugan J, Manka L, Lopez-Jimenez F, Lerman A, Siontis KC, Noseworthy PA, Yao X, Klavetter EW, Halamka JD, Asirvatham SJ, Khan R, Carter RE, Leibovich BC, Friedman PA. Prospective evaluation of smartwatch-enabled detection of left ventricular dysfunction. Nat Med 2022; 28:2497-2503. [PMID: 36376461 PMCID: PMC9805528 DOI: 10.1038/s41591-022-02053-1] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 09/23/2022] [Indexed: 11/16/2022]
Abstract
Although artificial intelligence (AI) algorithms have been shown to be capable of identifying cardiac dysfunction, defined as ejection fraction (EF) ≤ 40%, from 12-lead electrocardiograms (ECGs), identification of cardiac dysfunction using the single-lead ECG of a smartwatch has yet to be tested. In the present study, a prospective study in which patients of Mayo Clinic were invited by email to download a Mayo Clinic iPhone application that sends watch ECGs to a secure data platform, we examined patient engagement with the study app and the diagnostic utility of the ECGs. We digitally enrolled 2,454 unique patients (mean age 53 ± 15 years, 56% female) from 46 US states and 11 countries, who sent 125,610 ECGs to the data platform between August 2021 and February 2022; 421 participants had at least one watch-classified sinus rhythm ECG within 30 d of an echocardiogram, of whom 16 (3.8%) had an EF ≤ 40%. The AI algorithm detected patients with low EF with an area under the curve of 0.885 (95% confidence interval 0.823-0.946) and 0.881 (0.815-0.947), using the mean prediction within a 30-d window or the closest ECG relative to the echocardiogram that determined the EF, respectively. These findings indicate that consumer watch ECGs, acquired in nonclinical environments, can be used to identify patients with cardiac dysfunction, a potentially life-threatening and often asymptomatic condition.
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Affiliation(s)
- Zachi I. Attia
- Department of Cardiovascular Medicine, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - David M. Harmon
- Department of Cardiovascular Medicine, Mayo Clinic College of Medicine, Rochester, MN, USA.,Department of Internal Medicine, Mayo Clinic School of Graduate Medical Education, Rochester, MN, USA
| | - Jennifer Dugan
- Department of Cardiovascular Medicine, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - Lukas Manka
- Center for Digital Health, Mayo Clinic, Rochester, MN, USA
| | | | - Amir Lerman
- Department of Cardiovascular Medicine, Mayo Clinic College of Medicine, Rochester, MN, USA
| | | | - Peter A. Noseworthy
- Department of Cardiovascular Medicine, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - Xiaoxi Yao
- Department of Cardiovascular Medicine, Mayo Clinic College of Medicine, Rochester, MN, USA.,Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA
| | - Eric W. Klavetter
- Department of Cardiovascular Medicine, Mayo Clinic College of Medicine, Rochester, MN, USA
| | | | - Samuel J. Asirvatham
- Department of Cardiovascular Medicine, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - Rita Khan
- Center for Digital Health, Mayo Clinic, Rochester, MN, USA
| | - Rickey E. Carter
- Department of Quantitative Health Sciences, Jacksonville, FL, USA
| | - Bradley C. Leibovich
- Center for Digital Health, Mayo Clinic, Rochester, MN, USA.,Department of Urology, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - Paul A. Friedman
- Department of Cardiovascular Medicine, Mayo Clinic College of Medicine, Rochester, MN, USA.,Correspondence and requests for materials should be addressed to Paul A. Friedman.,
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Inoue A, Johnson TF, White D, Cox CW, Hartman TE, Thorne JE, Shanblatt ER, Johnson MP, Carter RE, Lee YS, Rajendran K, Leng S, McCollough CH, Fletcher JG. Estimating the Clinical Impact of Photon-Counting-Detector CT in Diagnosing Usual Interstitial Pneumonia. Invest Radiol 2022; 57:734-741. [PMID: 35703439 DOI: 10.1097/rli.0000000000000888] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The aim of this study was to evaluate the clinical impact of a higher spatial resolution, full field-of-view investigational photon-counting detector computed tomography (PCD-CT) on radiologist confidence in imaging findings and diagnosis of usual interstitial pneumonia (UIP) compared with conventional energy-integrating detector CT (EID-CT). MATERIALS AND METHODS Patients suspected of interstitial lung disease were scanned on a PCD-CT system after informed consent and a clinically indicated EID-CT. In 2 sessions, 3 thoracic radiologists blinded to clinical history and scanner type evaluated CT images of the right and left lungs separately on EID- or PCD-CT, reviewing each lung once/session, rating confidence in imaging findings of reticulation, traction bronchiectasis, honeycombing, ground-glass opacities (GGOs), mosaic pattern, and lower lobe predominance (100-point scale: 0-33, likely absent; 34-66, indeterminate; 67-100, likely present). Radiologists also rated confidence for the probability of UIP (0-20, normal; 21-40, inconsistent with UIP; 41-60, indeterminate UIP; 61-81; probable UIP; 81-100, definite UIP) and graded image quality. Because a confidence scale of 50 represented completely equivocal findings, magnitude score (the absolute value of confidence scores from 50) was used for analysis (higher scores were more confident). Image noise was measured for each modality. The magnitude score was compared using linear mixed effects regression. The consistency of findings and diagnosis between 2 scanners were evaluated using McNemar test and weighted κ statistics, respectively. RESULTS A total of 30 patients (mean age, 68.8 ± 11.0 years; M:F = 18:12) underwent conventional EID-CT (median CTDI vol , 7.88 mGy) and research PCD-CT (median CTDI vol , 6.49 mGy). The magnitude scores in PCD-CT were significantly higher than EID-CT for imaging findings of reticulation (40.7 vs 38.3; P = 0.023), GGO (34.4 vs 31.7; P = 0.019), and mosaic pattern (38.6 vs 35.9; P = 0.013), but not for other imaging findings ( P ≥ 0.130) or confidence in UIP (34.1 vs 22.2; P < 0.059). Magnitude score of probability of UIP in PCD-CT was significantly higher than EID-CT in one reader (26.0 vs 21.5; P = 0.009). Photon-counting detector CT demonstrated a decreased number of indeterminate GGO (17 vs 26), an increased number of unlikely GGO (74 vs 50), and an increased number of likely reticulations (140 vs 130) relative to EID-CT. Interobserver agreements among 3 readers for imaging findings and probability of UIP were similar between PCD-CT and EID-CT (intraclass coefficient: 0.507-0.818 vs 0.601-0.848). Photon-counting detector CT had higher scores in overall image quality (4.84 ± 0.38) than those in EID-CT (4.02 ± 0.40; P < 0.001) despite increased image noise (mean 85.5 vs 36.1 HU). CONCLUSIONS Photon-counting detector CT provided better image quality and improved the reader confidence for presence or absence of imaging findings of reticulation, GGO, and mosaic pattern with idiosyncratic improvement in confidence in UIP presence.
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Affiliation(s)
- Akitoshi Inoue
- From the Department of Radiology, Mayo Clinic, Rochester, MN
| | | | - Darin White
- From the Department of Radiology, Mayo Clinic, Rochester, MN
| | - Christian W Cox
- From the Department of Radiology, Mayo Clinic, Rochester, MN
| | | | | | | | - Matthew P Johnson
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN
| | | | - Yong S Lee
- From the Department of Radiology, Mayo Clinic, Rochester, MN
| | | | - Shuai Leng
- From the Department of Radiology, Mayo Clinic, Rochester, MN
| | | | - Joel G Fletcher
- From the Department of Radiology, Mayo Clinic, Rochester, MN
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Inoue A, Johnson TF, White D, Cox CW, Hartman TE, Thorne JE, Shanblatt ER, Johnson MP, Carter RE, Lee YS, Rajendran K, Leng S, McCollough CH, Fletcher JG. Estimating the Clinical Impact of Photon-Counting-Detector CT in Diagnosing Usual Interstitial Pneumonia. Invest Radiol 2022. [PMID: 35703439 DOI: 10.1097/rli.0000000000000888:10.1097/rli.0000000000000888] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/07/2023]
Abstract
OBJECTIVE The aim of this study was to evaluate the clinical impact of a higher spatial resolution, full field-of-view investigational photon-counting detector computed tomography (PCD-CT) on radiologist confidence in imaging findings and diagnosis of usual interstitial pneumonia (UIP) compared with conventional energy-integrating detector CT (EID-CT). MATERIALS AND METHODS Patients suspected of interstitial lung disease were scanned on a PCD-CT system after informed consent and a clinically indicated EID-CT. In 2 sessions, 3 thoracic radiologists blinded to clinical history and scanner type evaluated CT images of the right and left lungs separately on EID- or PCD-CT, reviewing each lung once/session, rating confidence in imaging findings of reticulation, traction bronchiectasis, honeycombing, ground-glass opacities (GGOs), mosaic pattern, and lower lobe predominance (100-point scale: 0-33, likely absent; 34-66, indeterminate; 67-100, likely present). Radiologists also rated confidence for the probability of UIP (0-20, normal; 21-40, inconsistent with UIP; 41-60, indeterminate UIP; 61-81; probable UIP; 81-100, definite UIP) and graded image quality. Because a confidence scale of 50 represented completely equivocal findings, magnitude score (the absolute value of confidence scores from 50) was used for analysis (higher scores were more confident). Image noise was measured for each modality. The magnitude score was compared using linear mixed effects regression. The consistency of findings and diagnosis between 2 scanners were evaluated using McNemar test and weighted κ statistics, respectively. RESULTS A total of 30 patients (mean age, 68.8 ± 11.0 years; M:F = 18:12) underwent conventional EID-CT (median CTDI vol , 7.88 mGy) and research PCD-CT (median CTDI vol , 6.49 mGy). The magnitude scores in PCD-CT were significantly higher than EID-CT for imaging findings of reticulation (40.7 vs 38.3; P = 0.023), GGO (34.4 vs 31.7; P = 0.019), and mosaic pattern (38.6 vs 35.9; P = 0.013), but not for other imaging findings ( P ≥ 0.130) or confidence in UIP (34.1 vs 22.2; P < 0.059). Magnitude score of probability of UIP in PCD-CT was significantly higher than EID-CT in one reader (26.0 vs 21.5; P = 0.009). Photon-counting detector CT demonstrated a decreased number of indeterminate GGO (17 vs 26), an increased number of unlikely GGO (74 vs 50), and an increased number of likely reticulations (140 vs 130) relative to EID-CT. Interobserver agreements among 3 readers for imaging findings and probability of UIP were similar between PCD-CT and EID-CT (intraclass coefficient: 0.507-0.818 vs 0.601-0.848). Photon-counting detector CT had higher scores in overall image quality (4.84 ± 0.38) than those in EID-CT (4.02 ± 0.40; P < 0.001) despite increased image noise (mean 85.5 vs 36.1 HU). CONCLUSIONS Photon-counting detector CT provided better image quality and improved the reader confidence for presence or absence of imaging findings of reticulation, GGO, and mosaic pattern with idiosyncratic improvement in confidence in UIP presence.
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Affiliation(s)
- Akitoshi Inoue
- From the Department of Radiology, Mayo Clinic, Rochester, MN
| | | | - Darin White
- From the Department of Radiology, Mayo Clinic, Rochester, MN
| | - Christian W Cox
- From the Department of Radiology, Mayo Clinic, Rochester, MN
| | | | | | | | - Matthew P Johnson
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN
| | | | - Yong S Lee
- From the Department of Radiology, Mayo Clinic, Rochester, MN
| | | | - Shuai Leng
- From the Department of Radiology, Mayo Clinic, Rochester, MN
| | | | - Joel G Fletcher
- From the Department of Radiology, Mayo Clinic, Rochester, MN
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Senefeld JW, Paneth NS, Carter RE, Wright RS, Fairweather D, Bruno KA, Joyner MJ. Late Treatment for COVID-19 With Convalescent Plasma. Chest 2022; 162:e283-e284. [PMID: 36344142 PMCID: PMC9634046 DOI: 10.1016/j.chest.2022.07.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 07/19/2022] [Indexed: 11/06/2022] Open
Affiliation(s)
- Jonathon W Senefeld
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN
| | - Nigel S Paneth
- Departments of Epidemiology and Biostatistics and Pediatrics and Human Development, College of Human Medicine, Michigan State University, East Lansing, MI
| | - Rickey E Carter
- Department of Quantitative Health Sciences, Mayo Clinic, Jacksonville, FL
| | - R Scott Wright
- Departments of Cardiovascular Medicine and Human Research Protection Program, Mayo Clinic, Rochester, MN
| | | | - Katelyn A Bruno
- Department of Cardiovascular Medicine, Mayo Clinic, Jacksonville, FL
| | - Michael J Joyner
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN.
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Morales-Lara AC, Johnson PW, Douglass EJ, O'Sullivan S, Yamani MH, Noseworthy PA, Carter RE, Adedinsewo DA. Artificial intelligence-based risk stratification of atrial fibrillation among women with peripartum cardiomyopathy compared to other cardiomyopathies. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Atrial fibrillation (AF) is diagnosed in up to 50% of patients with heart failure. However, the prevalence of AF among patients with peripartum cardiomyopathy (PPCM) ranges from only 2–10%, with the lowest rates in Black women. An artificial intelligence enhanced electrocardiogram (AI-ECG) has previously been shown to be effective in detecting AF while in sinus rhythm, and for AF risk prediction in a population-based study.
Purpose
Our objective was to evaluate the use of an AI-ECG for AF risk stratification among women of reproductive age (18 to 49 years) with PPCM compared to other forms of cardiomyopathy.
Methods
We identified 59 reproductive age women with a diagnosis of PPCM between January 2007, and October 2018 and included matched controls in a 3:1 fashion. Matching was performed based on sex, age, race, and left ventricular ejection fraction. We excluded patients with a diagnosis of AF prior to cardiomyopathy diagnosis date. AI-ECG prediction probabilities were generated for ECGs performed within a 30-day window prior to the patient's first cardiomyopathy diagnosis date for the entire study cohort.
Results
A total of 236 patients were included in the final analysis (59 cases, 177 controls). Overall, the median age at cardiomyopathy diagnosis was 31.7 years (IQR: 18.5, 49.4), 76.3% were White, 8.5% were Black, and 15.3% represented other or unknown race. Over the period studied, 3.4% of women with PPCM developed AF compared to 5.6% of women with other cardiomyopathies. The frequency of positive AI-ECG predictions for AF was more common among women with other cardiomyopathies (40.7%) compared to women with PPCM (20.3%). The predicted odds ratio for AF development following a cardiomyopathy diagnosis based on AI-ECG results was 0.37 (95% CI: 0.18, 0.73) for PPCM compared to other cardiomyopathies (p=0.006).
Conclusion
We demonstrated that an AI-ECG model for AF prediction may play a potential role in arrhythmia risk stratification/prediction among young women with PPCM who have a demonstrable lower risk for AF compared to women with other cardiomyopathies. Mechanisms for lower AF risk among patients with PPCM remain unknown. Further studies evaluating mechanistic pathways will be essential.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- A C Morales-Lara
- Mayo Clinic, Cardiovascular Medicine , Jacksonville , United States of America
| | - P W Johnson
- Mayo Clinic, Quantitative Health Sciences , Jacksonville , United States of America
| | - E J Douglass
- Mayo Clinic, Cardiovascular Medicine , Jacksonville , United States of America
| | - S O'Sullivan
- Mayo Clinic, Cardiovascular Medicine , Jacksonville , United States of America
| | - M H Yamani
- Mayo Clinic, Cardiovascular Medicine , Jacksonville , United States of America
| | - P A Noseworthy
- Mayo Clinic, Cardiovascular Medicine , Rochester , United States of America
| | - R E Carter
- Mayo Clinic, Quantitative Health Sciences , Jacksonville , United States of America
| | - D A Adedinsewo
- Mayo Clinic, Cardiovascular Medicine , Jacksonville , United States of America
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Joyner MJ, Carter RE, Fairweather D, Wright RS. Convalescent plasma and COVID-19: Time for a second-second look? Transfus Med 2022; 33:16-20. [PMID: 36089562 PMCID: PMC9538409 DOI: 10.1111/tme.12915] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Revised: 08/10/2022] [Accepted: 08/19/2022] [Indexed: 11/29/2022]
Abstract
In this short narrative, we highlight some of our experiences leading the US Convalescent Plasma Program at the beginning of the pandemic in the spring and summer of 2020. This includes a brief summary of how the program emerged and high-level lessons we learned. We also share our impressions about why convalescent plasma was used at scale in the United States, early in the pandemic and share ideas that might inform the use of convalescent plasma in future outbreaks of novel infectious diseases.
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Affiliation(s)
- Michael J. Joyner
- Department of Anesthesiology & Perioperative MedicineMayo ClinicRochesterMinnesotaUSA
| | - Rickey E. Carter
- Department of Quantitative Health Sciences, Division of Clinical Trials & BiostatisticsMayo ClinicJacksonvilleFloridaUSA
| | | | - R. Scott Wright
- Department of Cardiovascular DiseasesMayo ClinicRochesterMinnesotaUSA
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Patel PP, El Sabbagh A, Johnson PW, Suliman R, Salwa N, Morales-Lara AC, Pollak P, Yamani M, Parikh P, Sonavane SK, Landolfo C, Alkhouli MA, Eleid MF, Guerrero M, Fortuin FD, Sweeney J, Noseworthy PA, Carter RE, Adedinsewo D. Sex Differences in the Impact of Aortic Valve Calcium Score on Mortality After Transcatheter Aortic Valve Replacement. Circ Cardiovasc Imaging 2022; 15:e014034. [PMID: 35920157 PMCID: PMC9397521 DOI: 10.1161/circimaging.122.014034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND Transcatheter aortic valve replacement (TAVR) is now an approved alternative to surgical aortic valve replacement for the treatment of severe aortic stenosis. As the clinical adoption of TAVR expands, it remains important to identify predictors of mortality after TAVR. We aimed to evaluate the impact of sex differences in aortic valve calcium score (AVCS) on long-term mortality following TAVR in a large patient sample. METHODS We included consecutive patients who successfully underwent TAVR for treatment of severe native aortic valve stenosis from June 2010 to May 2021 across all US Mayo Clinic sites with follow-up through July 2021. AVCS values were obtained from preoperative computed tomography of the chest. Additional clinical data were abstracted from medical records. Kaplan-Meier curves and Cox-proportional hazard regression models were employed to evaluate the effect of AVCS on long-term mortality. RESULTS A total of 2543 patients were evaluated in the final analysis. Forty-one percent were women, median age was 82 years (Q1: 76, Q3: 86), 18.4% received a permanent pacemaker following TAVR, and 88.5% received a balloon expandable valve. We demonstrate an increase in mortality risk with higher AVCS after multivariable adjustment (P<0.001). When stratified by sex, every 500-unit increase in AVCS was associated with a 7% increase in mortality risk among women (adjusted hazard ratio, 1.07 [95% CI, 1.02-1.12]) but not in men. CONCLUSIONS We demonstrate a notable sex difference in the association between AVCS and long-term mortality in a large TAVR patient sample. This study highlights the potential value of AVCS in preprocedural risk stratification, specifically among women undergoing TAVR. Additional studies are needed to validate this finding.
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Affiliation(s)
| | | | - Patrick W. Johnson
- Department of Quantitative Health Sciences, Mayo Clinic, Jacksonville, FL
| | - Rayan Suliman
- Division of Cardiovascular Medicine, Mayo Clinic, Jacksonville, FL
| | - Najiyah Salwa
- Division of Cardiovascular Medicine, Mayo Clinic, Jacksonville, FL
| | | | - Peter Pollak
- Division of Cardiovascular Medicine, Mayo Clinic, Jacksonville, FL
| | - Mohamad Yamani
- Division of Cardiovascular Medicine, Mayo Clinic, Jacksonville, FL
| | - Pragnesh Parikh
- Division of Cardiovascular Medicine, Mayo Clinic, Jacksonville, FL
| | | | - Carolyn Landolfo
- Division of Cardiovascular Medicine, Mayo Clinic, Jacksonville, FL
| | | | | | - Mayra Guerrero
- Division of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
| | | | - John Sweeney
- Division of Cardiovascular Medicine, Mayo Clinic, Phoenix, AZ
| | | | - Rickey E. Carter
- Department of Quantitative Health Sciences, Mayo Clinic, Jacksonville, FL
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43
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Reddy YNV, Kaye DM, Handoko ML, van de Bovenkamp AA, Tedford RJ, Keck C, Andersen MJ, Sharma K, Trivedi RK, Carter RE, Obokata M, Verbrugge FH, Redfield MM, Borlaug BA. Diagnosis of Heart Failure With Preserved Ejection Fraction Among Patients With Unexplained Dyspnea. JAMA Cardiol 2022; 7:891-899. [PMID: 35830183 DOI: 10.1001/jamacardio.2022.1916] [Citation(s) in RCA: 33] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Importance Diagnosis of heart failure with preserved ejection fraction (HFpEF) among dyspneic patients without overt congestion is challenging. Multiple diagnostic approaches have been proposed but are not well validated against the independent gold standard for HFpEF diagnosis of an elevated pulmonary capillary wedge pressure (PCWP) during exercise. Objective To evaluate H2FPEF and HFA-PEFF scores and a PCWP/cardiac output (CO) slope of more than 2 mm Hg/L/min to diagnose HFpEF. Design, Setting, and Participants This retrospective case-control study included patients with unexplained dyspnea from 6 centers in the US, the Netherlands, Denmark, and Australia from March 2016 to October 2020. Diagnosis of HFpEF (cases) was definitively ascertained by the presence of elevated PCWP during exertion; control individuals were those with normal rest and exercise hemodynamics. Main Outcomes and Measures Logistic regression was used to evaluate the accuracy of HFA-PEFF and H2FPEF scores to discriminate patients with HFpEF from controls. Results Among 736 patients, 563 (76%) were diagnosed with HFpEF (mean [SD] age, 69 [11] years; 334 [59%] female) and 173 (24%) represented controls (mean [SD] age, 60 [15] years; 109 [63%] female). H2FPEF and HFA-PEFF scores discriminated patients with HFpEF from controls, but the H2FPEF score had greater area under the curve (0.845; 95% CI, 0.810-0.875) compared with the HFA-PEFF score (0.710; 95% CI, 0.659-0.756) (difference, -0.134; 95% CI, -0.177 to -0.094; P < .001). Specificity was robust for both scores, but sensitivity was poorer for HFA-PEFF, with a false-negative rate of 55% for low-probability scores compared with 25% using the H2FPEF score. Use of the PCWP/CO slope to redefine HFpEF rather than exercise PCWP reclassified 20% (117 of 583) of patients, but patients reclassified from HFpEF to control by this metric had clinical, echocardiographic, and hemodynamic features typical of HFpEF, including elevated resting PCWP in 66% (46 of 70) of reclassified patients. Conclusions and Relevance In this case-control study, despite requiring fewer data, the H2FPEF score had superior diagnostic performance compared with the HFA-PEFF score and PCWP/CO slope in the evaluation of unexplained dyspnea and HFpEF in the outpatient setting.
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Affiliation(s)
- Yogesh N V Reddy
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - David M Kaye
- Department of Cardiology, Alfred Hospital, Melbourne, Victoria, Australia
| | - M Louis Handoko
- Department of Cardiology, Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, the Netherlands
| | - Arno A van de Bovenkamp
- Department of Cardiology, Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, the Netherlands
| | - Ryan J Tedford
- Division of Cardiology, Department of Medicine, Medical University of South Carolina, Charleston
| | - Carson Keck
- Division of Cardiology, Department of Medicine, Medical University of South Carolina, Charleston
| | - Mads J Andersen
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - Kavita Sharma
- Division of Cardiology, Department of Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Rishi K Trivedi
- Division of Cardiology, Department of Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Rickey E Carter
- Department of Health Sciences Research, Mayo Clinic, Jacksonville, Florida
| | - Masaru Obokata
- Department of Cardiovascular Medicine, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Frederik H Verbrugge
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota.,Biomedical Research Institute, Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium.,Centre for Cardiovascular Diseases, University Hospital Brussels, Jette, Belgium
| | | | - Barry A Borlaug
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
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Cortes MP, Schultz CS, Isha S, Sinclair JE, Bhakta S, Kunze KL, Johnson PW, Cowart JB, Carter RE, Franco PM, Sanghavi DK, Roy A. The Pitfalls of Mining for QuantiFERON Gold in Severely Ill COVID-19 Patients. Mayo Clin Proc Innov Qual Outcomes 2022; 6:409-419. [PMID: 35818352 PMCID: PMC9259470 DOI: 10.1016/j.mayocpiqo.2022.06.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Accepted: 06/30/2022] [Indexed: 12/15/2022] Open
Abstract
Objective To assess the proportion of indeterminate QFT-Plus results in patients admitted with severe COVID-19 pneumonia and to evaluate the factors associated with indeterminate QFT-Plus results. Study design Retrospective cohort study. Material & Methods Data of COVID-19 admissions at Mayo Clinic Florida were extracted between October 13, 2020 and September 20, 2021, and from a pre-pandemic cohort between October 13, 2018 and September 20, 2019. Secondary analysis of the COVID-19 cohort was performed using gradient boosting modeling to generate variable importance and SHAP plots. Results Our findings demonstrated more indeterminate QFT-Plus test results among hospitalized patients with severe COVID-19 infection compared to non-COVID patients (139 of 495, 28.1%). Factors associated with indeterminate QFT-Plus tests included elevated C-reactive protein (CRP), ferritin, lactate dehydrogenase (LDH), and interleukin-6 (IL 6), as well as low leukocytes, lymphocytes, and platelets. Conclusions Patients with severe COVID-19 had a higher likelihood of indeterminate QFT-Plus results which were associated with elevated inflammatory markers consistent with severe infection. IGRA screening tests are likely confounded by COVID-19 infection itself, limiting the screening ability for LTBI reactivation. Indeterminate QFT-Plus results may also require follow-up QFT-Plus testing, after patient recovery from COVID-19, increasing cost and complexity of medical decision making and management. Additional risk assessments may be needed in this patient population for LTBI screening in severe COVID-19 infected patients.
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Key Words
- AUC, Area under the curve
- CDC, Centers for Disease Control and Prevention
- CKD, Chronic kidney disease
- COVID-19, Coronavirus disease 2019
- CRP, C-reactive protein
- GBM, Gradient boosting machine
- IFN, Interferon
- IFN-γ, Interferon gamma release assay
- IL-6, Interleukin-6
- IRGAs, Interferon-gamma release assays
- LDH, Lactate dehydrogenase
- LTBI, Latent tuberculosis infection
- QFT-Plus, QuantiFERON-TB Gold Plus
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Affiliation(s)
- Melissa P Cortes
- Division of Hospital Internal Medicine, Mayo Clinic, Jacksonville, FL, USA
| | - Carrie S Schultz
- Division of Hospital Internal Medicine, Mayo Clinic, Jacksonville, FL, USA
| | - Shahin Isha
- Department of Critical Care, Mayo Clinic, Jacksonville, FL, USA
| | | | - Shivang Bhakta
- Department of Critical Care, Mayo Clinic, Jacksonville, FL, USA
| | - Katie L Kunze
- Department of Quantitative Health Sciences, Mayo Clinic, Scottsdale, AZ, USA
| | - Patrick W Johnson
- Department of Quantitative Health Sciences, Mayo Clinic, Jacksonville, FL, USA
| | - Jennifer B Cowart
- Division of Hospital Internal Medicine, Mayo Clinic, Jacksonville, FL, USA
| | - Rickey E Carter
- Department of Quantitative Health Sciences, Mayo Clinic, Jacksonville, FL, USA
| | - Pablo Moreno Franco
- Department of Critical Care, Mayo Clinic, Jacksonville, FL, USA.,Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Jacksonville, FL, USA.,Department of Transplantation, Mayo Clinic, Jacksonville, FL, USA
| | | | - Archana Roy
- Division of Hospital Internal Medicine, Mayo Clinic, Jacksonville, FL, USA
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Harmon DM, Carter RE, Cohen-Shelly M, Svatikova A, Adedinsewo DA, Noseworthy PA, Kapa S, Lopez-Jimenez F, Friedman PA, Attia ZI. Real-world performance, long-term efficacy, and absence of bias in the artificial intelligence enhanced electrocardiogram to detect left ventricular systolic dysfunction. European Heart Journal - Digital Health 2022; 3:238-244. [PMID: 36247412 PMCID: PMC9558265 DOI: 10.1093/ehjdh/ztac028] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
Aims Some artificial intelligence models applied in medical practice require ongoing retraining, introduce unintended racial bias, or have variable performance among different subgroups of patients. We assessed the real-world performance of the artificial intelligence-enhanced electrocardiogram to detect left ventricular systolic dysfunction with respect to multiple patient and electrocardiogram variables to determine the algorithm’s long-term efficacy and potential bias in the absence of retraining. Methods and results Electrocardiograms acquired in 2019 at Mayo Clinic in Minnesota, Arizona, and Florida with an echocardiogram performed within 14 days were analyzed (n = 44 986 unique patients). The area under the curve (AUC) was calculated to evaluate performance of the algorithm among age groups, racial and ethnic groups, patient encounter location, electrocardiogram features, and over time. The artificial intelligence-enhanced electrocardiogram to detect left ventricular systolic dysfunction had an AUC of 0.903 for the total cohort. Time series analysis of the model validated its temporal stability. Areas under the curve were similar for all racial and ethnic groups (0.90–0.92) with minimal performance difference between sexes. Patients with a ‘normal sinus rhythm’ electrocardiogram (n = 37 047) exhibited an AUC of 0.91. All other electrocardiogram features had areas under the curve between 0.79 and 0.91, with the lowest performance occurring in the left bundle branch block group (0.79). Conclusion The artificial intelligence-enhanced electrocardiogram to detect left ventricular systolic dysfunction is stable over time in the absence of retraining and robust with respect to multiple variables including time, patient race, and electrocardiogram features.
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Affiliation(s)
- David M Harmon
- Department of Internal Medicine, Mayo Clinic School of Graduate Medical Education , Rochester, MN
| | - Rickey E Carter
- Department of Quantitative Health Sciences, Mayo Clinic College of Medicine , Jacksonville, FL
| | - Michal Cohen-Shelly
- Department of Cardiovascular Medicine, Mayo Clinic College of Medicine , Rochester, MN
| | - Anna Svatikova
- Department of Cardiovascular Medicine, Mayo Clinic College of Medicine , Scottsdale, AZ
| | - Demilade A Adedinsewo
- Department of Cardiovascular Medicine, Mayo Clinic College of Medicine , Jacksonville, FL
| | - Peter A Noseworthy
- Department of Cardiovascular Medicine, Mayo Clinic College of Medicine , Rochester, MN
| | - Suraj Kapa
- Department of Cardiovascular Medicine, Mayo Clinic College of Medicine , Rochester, MN
| | | | - Paul A Friedman
- Department of Cardiovascular Medicine, Mayo Clinic College of Medicine , Rochester, MN
| | - Zachi I Attia
- Department of Cardiovascular Medicine, Mayo Clinic College of Medicine , Rochester, MN
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Sanghavi DK, Bhakta S, Wadei HM, Bosch W, Cowart JB, Carter RE, Shah SZ, Pollock BD, Neville MR, Oman SP, Speicher L, Siegel J, Scindia AD, Libertin CR, Kunze KL, Johnson PW, Matson MW, Franco PM. Low antispike antibody levels correlate with poor outcomes in COVID-19 breakthrough hospitalizations. J Intern Med 2022; 292:127-135. [PMID: 35194861 PMCID: PMC9115098 DOI: 10.1111/joim.13471] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND While COVID-19 immunization programs attempted to reach targeted rates, cases rose significantly since the emergence of the delta variant. This retrospective cohort study describes the correlation between antispike antibodies and outcomes of hospitalized, breakthrough cases during the delta variant surge. METHODS All patients with positive SARS-CoV-2 polymerase chain reaction hospitalized at Mayo Clinic Florida from 19 June 2021 to 11 November 2021 were considered for analysis. Cases were analyzed by vaccination status. Breakthrough cases were then analyzed by low and high antibody titers against SARS-CoV-2 spike protein, with a cut-off value of ≥132 U/ml. Outcomes included hospital length of stay (LOS), need for intensive care unit (ICU), mechanical ventilation, and mortality. We used 1:1 nearest neighbor propensity score matching without replacement to assess for confounders. RESULTS Among 627 hospitalized patients with COVID-19, vaccine breakthrough cases were older with more comorbidities compared to unvaccinated. After propensity score matching, the unvaccinated patients had higher mortality (27 [28.4%] vs. 12 [12.6%], p = 0.002) and LOS (7 [1.0-57.0] vs. 5 [1.0-31.0] days, p = 0.011). In breakthrough cases, low-titer patients were more likely to be solid organ transplant recipients (16 [34.0%] vs. 9 [12.3%], p = 0.006), with higher need for ICU care (24 [51.1%] vs. 22 [11.0%], p = 0.034), longer hospital LOS (median 6 vs. 5 days, p = 0.013), and higher mortality (10 [21.3%] vs. 5 [6.8%], p = 0.025) than high-titer patients. CONCLUSIONS Hospitalized breakthrough cases were more likely to have underlying risk factors than unvaccinated patients. Low-spike antibody titers may serve as an indicator for poor prognosis in breakthrough cases admitted to the hospital.
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Affiliation(s)
- Devang K Sanghavi
- Department of Critical Care Medicine, Mayo Clinic, Jacksonville, Florida, USA
| | - Shivang Bhakta
- Department of Critical Care Medicine, Mayo Clinic, Jacksonville, Florida, USA
| | - Hani M Wadei
- Department of Transplantation, Mayo Clinic, Jacksonville, Florida, USA
| | - Wendelyn Bosch
- Division of Infectious Diseases, Mayo Clinic, Jacksonville, Florida, USA
| | - Jennifer B Cowart
- Division of Hospital Internal Medicine, Mayo Clinic, Jacksonville, Florida, USA
| | - Rickey E Carter
- Department of Quantitative Health Sciences, Mayo Clinic, Jacksonville, Florida, USA
| | - Sadia Z Shah
- Department of Transplantation, Mayo Clinic, Jacksonville, Florida, USA
| | - Benjamin D Pollock
- Kern Center for the Science of Health Care Delivery, Mayo Clinic, Jacksonville, Florida, USA
| | - Matthew R Neville
- Kern Center for the Science of Health Care Delivery, Mayo Clinic, Jacksonville, Florida, USA
| | - Sven P Oman
- Division of Hospital Internal Medicine, Mayo Clinic, Jacksonville, Florida, USA
| | - Leigh Speicher
- Division of General Internal Medicine, Mayo Clinic, Jacksonville, Florida, USA
| | - Jason Siegel
- Department of Critical Care Medicine, Mayo Clinic, Jacksonville, Florida, USA.,Department of Neurology, Mayo Clinic, Jacksonville, Florida, USA
| | - Ameya D Scindia
- Department of Critical Care Medicine, Mayo Clinic, Jacksonville, Florida, USA
| | - Claudia R Libertin
- Division of Infectious Diseases, Mayo Clinic, Jacksonville, Florida, USA
| | - Katie L Kunze
- Department of Quantitative Health Sciences, Mayo Clinic, Scottsdale, Arizona, USA
| | - Patrick W Johnson
- Department of Quantitative Health Sciences, Mayo Clinic, Jacksonville, Florida, USA
| | - Mark W Matson
- Center for Digital Health-Data & Analytics, Mayo Clinic, Rochester, Minnesota, USA
| | - Pablo Moreno Franco
- Department of Critical Care Medicine, Mayo Clinic, Jacksonville, Florida, USA.,Department of Transplantation, Mayo Clinic, Jacksonville, Florida, USA.,Kern Center for the Science of Health Care Delivery, Mayo Clinic, Jacksonville, Florida, USA
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47
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Belov A, Huang Y, Villa CH, Whitaker BI, Forshee R, Anderson SA, Eder A, Verdun N, Joyner MJ, Wright SR, Carter RE, Hung DT, Homer M, Hoffman C, Lauer M, Marks P. Early administration of COVID-19 convalescent plasma with high titer antibody content by live viral neutralization assay is associated with modest clinical efficacy. Am J Hematol 2022; 97:770-779. [PMID: 35303377 PMCID: PMC9082011 DOI: 10.1002/ajh.26531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Revised: 03/09/2022] [Accepted: 03/11/2022] [Indexed: 11/21/2022]
Abstract
The efficacy of COVID‐19 convalescent plasma (CCP) as a treatment for hospitalized patients with COVID‐19 remains somewhat controversial; however, many studies have not evaluated CCP documented to have high neutralizing antibody titer by a highly accurate assay. To evaluate the correlation of the administration of CCP with titer determined by a live viral neutralization assay with 7‐ and 28‐day death rates during hospitalization, a total of 23 118 patients receiving a single unit of CCP were stratified into two groups: those receiving high titer CCP (>250 50% inhibitory dilution, ID50; n = 13 636) or low titer CCP (≤250 ID50; n = 9482). Multivariable Cox regression was performed to assess risk factors. Non‐intubated patients who were transfused with high titer CCP showed 1.1% and 1.7% absolute reductions in overall 7‐ and 28‐day death rates, respectively, compared to those non‐intubated patients receiving low titer CCP. No benefit of CCP was observed in intubated patients. The relative benefit of high titer CCP was confirmed in multivariable Cox regression. Administration of CCP with high titer antibody content determined by live viral neutralization assay to non‐intubated patients is associated with modest clinical efficacy. Although shown to be only of modest clinical benefit, CCP may play a role in the future should viral variants develop that are not neutralized by other available therapeutics.
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Affiliation(s)
- Artur Belov
- Center for Biologics Evaluation and Research US FDA Silver Spring Maryland USA
| | - Yin Huang
- Center for Biologics Evaluation and Research US FDA Silver Spring Maryland USA
| | - Carlos H. Villa
- Center for Biologics Evaluation and Research US FDA Silver Spring Maryland USA
| | - Barbee I. Whitaker
- Center for Biologics Evaluation and Research US FDA Silver Spring Maryland USA
| | - Richard Forshee
- Center for Biologics Evaluation and Research US FDA Silver Spring Maryland USA
| | - Steven A. Anderson
- Center for Biologics Evaluation and Research US FDA Silver Spring Maryland USA
| | - Anne Eder
- Center for Biologics Evaluation and Research US FDA Silver Spring Maryland USA
| | - Nicole Verdun
- Center for Biologics Evaluation and Research US FDA Silver Spring Maryland USA
| | - Michael J. Joyner
- Department of Anesthesiology and Perioperative Medicine Mayo Clinic Rochester Minnesota USA
| | - Scott R. Wright
- Department of Cardiology and the Human Research Protection Program Mayo Clinic Rochester Minnesota USA
| | - Rickey E. Carter
- Department of Quantitative Health Sciences Mayo Clinic Jacksonville Florida USA
| | - Deborah T. Hung
- Infectious Disease and Microbiome Program Broad Institute Cambridge Massachusetts USA
| | - Mary Homer
- Biomedical Advanced Research and Development Authority (BARDA) District of Columbia Washington USA
| | - Corey Hoffman
- Biomedical Advanced Research and Development Authority (BARDA) District of Columbia Washington USA
| | - Michael Lauer
- Office of the Director National Institutes of Health Bethesda Maryland USA
| | - Peter Marks
- Center for Biologics Evaluation and Research US FDA Silver Spring Maryland USA
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Christopoulos G, Attia ZI, Van Houten HK, Yao X, Carter RE, Lopez-Jimenez F, Kapa S, Noseworthy PA, Friedman PA. Artificial intelligence-electrocardiography to detect atrial fibrillation: trend of probability before and after the first episode. Eur Heart J Digit Health 2022; 3:228-235. [PMID: 36713006 PMCID: PMC9707931 DOI: 10.1093/ehjdh/ztac023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 03/09/2022] [Indexed: 02/01/2023]
Abstract
Aims Artificial intelligence (AI) enabled electrocardiography (ECG) can detect latent atrial fibrillation (AF) in patients with sinus rhythm (SR). However, the change of AI-ECG probability before and after the first AF episode is not well characterized. We sought to characterize the temporal trend of AI-ECG AF probability around the first episode of AF. Methods and results We retrospectively studied adults who had at least one ECG in SR prior to an ECG that documented AF. An AI network calculated the AF probability from ECGs during SR (positive defined >8.7%, based on optimal sensitivity and specificity). The AI-ECG probability was reported prior to and after the first episode of AF and stratified by age and CHA2DS2-VASc score. Mixed effect models were used to assess the rate of change between time points. A total of 59 212 patients with 544 330 ECGs prior to AF and 413 486 ECGs after AF were included. The mean time between the first positive AI-ECG and first AF was 5.4 ± 5.7 years. The mean AI-ECG probability was 19.8% 2-5 years prior to AF, 23.6% 1-2 years prior to AF, 34.0% 0-3 months prior to AF, 40.9% 0-3 months after AF, 35.2% 1-2 years after AF, and 42.2% 2-5 years after AF (P < 0.001). The rate of increase prior to AF was higher for age >50 years CHA2DS2-VASc score ≥4. Conclusion The AI-ECG probability progressively increases with time prior to the first AF episode, transiently decreases 1-2 years following AF and continues to increase thereafter.
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Affiliation(s)
| | - Zachi I Attia
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN 55905, USA
| | - Holly K Van Houten
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Rochester, MN, USA
| | - Xiaoxi Yao
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Rochester, MN, USA
- Division of Health Care Delivery Research, Mayo Clinic, Rochester, MN, USA
| | - Rickey E Carter
- Department of Health Sciences Research, Mayo Clinic, Jacksonville, FL, USA
| | | | - Suraj Kapa
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN 55905, USA
| | - Peter A Noseworthy
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN 55905, USA
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Bhakta S, Sanghavi DK, Johnson PW, Kunze KL, Neville MR, Wadei HM, Bosch W, Carter RE, Shah SZ, Pollock BD, Oman SP, Speicher L, Siegel J, Libertin CR, Matson MW, Franco PM, Cowart JB. Clinical and Laboratory Profiles of SARS-CoV-2 Delta Variant Compared to Pre-Delta Variants. Int J Infect Dis 2022; 120:88-95. [PMID: 35487339 PMCID: PMC9040426 DOI: 10.1016/j.ijid.2022.04.050] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Revised: 04/20/2022] [Accepted: 04/21/2022] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND The emergence of SARS-CoV-2 variants of concern has led to significant phenotypical changes in transmissibility, virulence, and public health measures. Our study used clinical data to compare characteristics between a Delta variant wave and a pre-Delta variant wave of hospitalized patients. METHODS This single-center retrospective study defined a wave as an increasing number of COVID-19 hospitalizations, which peaked and later decreased. Data from the United States Department of Health and Human Services was used to identify the waves' primary variant. Wave 1 (08/08/20-04/01/21) was characterized by heterogeneous variants, while Wave 2 (06/26/21-10/18/21) was predominantly Delta variant. Descriptive statistics, regression techniques, and machine learning approaches supported the comparisons between waves. RESULTS From the cohort(n=1318), Wave 2 patients(n=665) were more likely to be younger, have fewer comorbidities, require more ICU care, and show an inflammatory profile with higher C-reactive protein, lactate dehydrogenase, ferritin, fibrinogen, prothrombin time, activated thromboplastin time, and INR compared to Wave 1. The gradient boosting model showed an area under the ROC curve of 0.854(sensitivity 86.4%;specificity 61.5%;positive predictive value 73.8%; negative predictive value 78.3%). CONCLUSIONS Clinical and laboratory characteristics can be used to estimate the COVID-19 variant regardless of genomic testing availability. This finding has implications for variant-driven treatment protocols and further research.
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Affiliation(s)
- Shivang Bhakta
- Department of Critical Care Medicine, Mayo Clinic, Jacksonville, Florida, USA.
| | - Devang K Sanghavi
- Department of Critical Care Medicine, Mayo Clinic, Jacksonville, Florida, USA
| | - Patrick W Johnson
- Department of Quantitative Health Sciences, Mayo Clinic, Jacksonville, Florida, USA
| | - Katie L Kunze
- Department of Quantitative Health Sciences, Mayo Clinic, Scottsdale, Arizona, USA
| | - Matthew R Neville
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Jacksonville, Florida, USA
| | - Hani M Wadei
- Department of Transplantation, Mayo Clinic, Jacksonville, Florida, USA
| | - Wendelyn Bosch
- Division of Infectious Diseases, Mayo Clinic, Jacksonville, Florida, USA
| | - Rickey E Carter
- Department of Quantitative Health Sciences, Mayo Clinic, Jacksonville, Florida, USA
| | - Sadia Z Shah
- Department of Transplantation, Mayo Clinic, Jacksonville, Florida, USA
| | - Benjamin D Pollock
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Jacksonville, Florida, USA
| | - Sven P Oman
- Division of Hospital Internal Medicine, Mayo Clinic, Jacksonville, Florida, USA
| | - Leigh Speicher
- Division of General Internal Medicine, Mayo Clinic, Jacksonville, Florida, USA
| | - Jason Siegel
- Department of Critical Care Medicine, Mayo Clinic, Jacksonville, Florida, USA; Department of Neurology, Mayo Clinic, Jacksonville, Florida, USA
| | - Claudia R Libertin
- Division of Infectious Diseases, Mayo Clinic, Jacksonville, Florida, USA
| | - Mark W Matson
- Center for Digital Health - Data & Analytics, Mayo Clinic, Rochester, Minnesota, USA
| | - Pablo Moreno Franco
- Department of Critical Care Medicine, Mayo Clinic, Jacksonville, Florida, USA; Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Jacksonville, Florida, USA; Department of Transplantation, Mayo Clinic, Jacksonville, Florida, USA
| | - Jennifer B Cowart
- Division of Hospital Internal Medicine, Mayo Clinic, Jacksonville, Florida, USA.
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Kashou AH, Mulpuru SK, Deshmukh AJ, Ko WY, Attia ZI, Carter RE, Friedman PA, Noseworthy PA. An artificial intelligence-enabled ECG algorithm for comprehensive ECG interpretation: Can it pass the 'Turing test'? Cardiovasc Digit Health J 2022; 2:164-170. [PMID: 35265905 PMCID: PMC8890338 DOI: 10.1016/j.cvdhj.2021.04.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Objective To develop an artificial intelligence (AI)–enabled electrocardiogram (ECG) algorithm capable of comprehensive, human-like ECG interpretation and compare its diagnostic performance against conventional ECG interpretation methods. Methods We developed a novel AI-enabled ECG (AI-ECG) algorithm capable of complete 12-lead ECG interpretation. It was trained on nearly 2.5 million standard 12-lead ECGs from over 720,000 adult patients obtained at the Mayo Clinic ECG laboratory between 2007 and 2017. We then compared the need for human over-reading edits of the reports generated by the Marquette 12SL automated computer program, AI-ECG algorithm, and final clinical interpretations on 500 randomly selected ECGs from 500 patients. In a blinded fashion, 3 cardiac electrophysiologists adjudicated each interpretation as (1) ideal (ie, no changes needed), (2) acceptable (ie, minor edits needed), or (3) unacceptable (ie, major edits needed). Results Cardiologists determined that on average 202 (13.5%), 123 (8.2%), and 90 (6.0%) of the interpretations required major edits from the computer program, AI-ECG algorithm, and final clinical interpretations, respectively. They considered 958 (63.9%), 1058 (70.5%), and 1118 (74.5%) interpretations as ideal from the computer program, AI-ECG algorithm, and final clinical interpretations, respectively. They considered 340 (22.7%), 319 (21.3%), and 292 (19.5%) interpretations as acceptable from the computer program, AI-ECG algorithm, and final clinical interpretations, respectively. Conclusion An AI-ECG algorithm outperforms an existing standard automated computer program and better approximates expert over-read for comprehensive 12-lead ECG interpretation.
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Affiliation(s)
- Anthony H. Kashou
- Department of Medicine, Mayo Clinic, Rochester, Minnesota
- Address reprint requests and correspondence: Dr Anthony H. Kashou, Department of Medicine, Mayo Clinic, 200 First St SW, Rochester, MN 55905.
| | - Siva K. Mulpuru
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | | | - Wei-Yin Ko
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Zachi I. Attia
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Rickey E. Carter
- Department of Health Sciences Research, Mayo Clinic, Jacksonville, Florida
| | - Paul A. Friedman
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
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