LASSNet: A Four Steps Deep Neural Network for Left Atrial Segmentation and Scar Quantification

Accurate quantification of left atrium (LA) scar in patients with atrial fibrillation is essential to guide successful ablation strategies. Prior to LA scar quantification, a proper LA cavity segmentation is required to ensure exact location of scar. Both tasks can be extremely time-consuming and are subject to inter-observer disagreements when done manually. We developed and validated a deep neural network to automatically segment the LA cavity and the LA scar. The global architecture uses a multi-network sequential approach in two stages which segment the LA cavity and the LA Scar. Each stage has two steps: a region of interest Neural Network and a refined segmentation network. We analysed the performances of our network according to different parameters and applied data triaging. 200+ late gadolinium enhancement magnetic resonance images were provided by the LAScarQS 2022 Challenge. Finally, we compared our performances for scar quantification to the literature and demonstrated improved performances.

Real-Time Prediction of Mortality, Cardiac Arrest, and Thromboembolic Complications in Hospitalized Patients With COVID-19

Background

COVID-19 infection carries significant morbidity and mortality. Current risk prediction for complications in COVID-19 is limited, and existing approaches fail to account for the dynamic course of the disease.

Objectives

The purpose of this study was to develop and validate the COVID-HEART predictor, a novel continuously updating risk-prediction technology to forecast adverse events in hospitalized patients with COVID-19.

Methods

Retrospective registry data from patients with severe acute respiratory syndrome coronavirus 2 infection admitted to 5 hospitals were used to train COVID-HEART to predict all-cause mortality/cardiac arrest (AM/CA) and imaging-confirmed thromboembolic events (TEs) (n = 2,550 and n = 1,854, respectively). To assess COVID-HEART's performance in the face of rapidly changing clinical treatment guidelines, an additional 1,100 and 796 patients, admitted after the completion of development data collection, were used for testing. Leave-hospital-out validation was performed.

Results

Over 20 iterations of temporally divided testing, the mean area under the receiver operating characteristic curve were 0.917 (95% confidence interval [CI]: 0.916-0.919) and 0.757 (95% CI: 0.751-0.763) for prediction of AM/CA and TE, respectively. The interquartile ranges of median early warning times were 14 to 21 hours for AM/CA and 12 to 60 hours for TE. The mean area under the receiver operating characteristic curve for the left-out hospitals were 0.956 (95% CI: 0.936-0.976) and 0.781 (95% CI: 0.642-0.919) for prediction of AM/CA and TE, respectively.

Conclusions

The continuously updating, fully interpretable COVID-HEART predictor accurately predicts AM/CA and TE within multiple time windows in hospitalized COVID-19 patients. In its current implementation, the predictor can facilitate practical, meaningful changes in patient triage and resource allocation by providing real-time risk scores for these outcomes. The potential utility of the predictor extends to COVID-19 patients after hospitalization and beyond COVID-19.

Arrhythmic sudden death survival prediction using deep learning analysis of scarring in the heart

Sudden cardiac death from arrhythmia is a major cause of mortality worldwide. Here, we develop a novel deep learning (DL) approach that blends neural networks and survival analysis to predict patient-specific survival curves from contrast-enhanced cardiac magnetic resonance images and clinical covariates for patients with ischemic heart disease. The DL-predicted survival curves offer accurate predictions at times up to 10 years and allow for estimation of uncertainty in predictions. The performance of this learning architecture was evaluated on multi-center internal validation data and tested on an independent test set, achieving concordance index of 0.83 and 0.74, and 10-year integrated Brier score of 0.12 and 0.14. We demonstrate that our DL approach with only raw cardiac images as input outperforms standard survival models constructed using clinical covariates. This technology has the potential to transform clinical decision-making by offering accurate and generalizable predictions of patient-specific survival probabilities of arrhythmic death over time.

Anatomically informed deep learning on contrast-enhanced cardiac magnetic resonance imaging for scar segmentation and clinical feature extraction

Background

Visualizing fibrosis on cardiac magnetic resonance (CMR) imaging with contrast enhancement (late gadolinium enhancement; LGE) is paramount in characterizing disease progression and identifying arrhythmia substrates. Segmentation and fibrosis quantification from LGE-CMR is intensive, manual, and prone to interobserver variability. There is an unmet need for automated LGE-CMR image segmentation that ensures anatomical accuracy and seamless extraction of clinical features.

Objective

This study aimed to develop a novel deep learning solution for analysis of contrast-enhanced CMR images that produces anatomically accurate myocardium and scar/fibrosis segmentations and uses these to calculate features of clinical interest.

Methods

Data sources were 155 2-dimensional LGE-CMR patient scans (1124 slices) and 246 synthetic “LGE-like” scans (1360 slices) obtained from cine CMR using a novel style-transfer algorithm. We trained and tested a 3-stage neural network that identified the left ventricle (LV) region of interest (ROI), segmented ROI into viable myocardium and regions of enhancement, and postprocessed the segmentation results to enforce conforming to anatomical constraints. The segmentations were used to directly compute clinical features, such as LV volume and scar burden.

Results

Predicted LV and scar segmentations achieved 96% and 75% balanced accuracy, respectively, and 0.93 and 0.57 Dice coefficient when compared to trained expert segmentations. The mean scar burden difference between manual and predicted segmentations was 2%.

Conclusion

We developed and validated a deep neural network for automatic, anatomically accurate expert-level LGE- CMR myocardium and scar/fibrosis segmentation, allowing direct calculation of clinical measures. Given the training set heterogeneity, our approach could be extended to multiple imaging modalities and patient pathologies.

Predicting risk of sudden cardiac death in patients with cardiac sarcoidosis using multimodality imaging and personalized heart modeling in a multivariable classifier

Cardiac sarcoidosis (CS), an inflammatory disease characterized by formation of granulomas in the heart, is associated with high risk of sudden cardiac death (SCD) from ventricular arrhythmias. Current "one-size-fits-all" guidelines for SCD risk assessment in CS result in insufficient appropriate primary prevention. Here, we present a two-step precision risk prediction technology for patients with CS. First, a patient's arrhythmogenic propensity arising from heterogeneous CS-induced ventricular remodeling is assessed using a novel personalized magnetic-resonance imaging and positron-emission tomography fusion mechanistic model. The resulting simulations of arrhythmogenesis are fed, together with a set of imaging and clinical biomarkers, into a supervised classifier. In a retrospective study of 45 patients, the technology achieved testing results of 60% sensitivity [95% confidence interval (CI): 57-63%], 72% specificity [95% CI: 70-74%], and 0.754 area under the receiver operating characteristic curve [95% CI: 0.710-0.797]. It outperformed clinical metrics, highlighting its potential to transform CS risk stratification.

Machine Learning in Arrhythmia and Electrophysiology

Machine learning (ML), a branch of artificial intelligence, where machines learn from big data, is at the crest of a technological wave of change sweeping society. Cardiovascular medicine is at the forefront of many ML applications, and there is a significant effort to bring them into mainstream clinical practice. In the field of cardiac electrophysiology, ML applications have also seen a rapid growth and popularity, particularly the use of ML in the automatic interpretation of ECGs, which has been extensively covered in the literature. Much lesser known are the other aspects of ML application in cardiac electrophysiology and arrhythmias, such as those in basic science research on arrhythmia mechanisms, both experimental and computational; in the development of better techniques for mapping of cardiac electrical function; and in translational research related to arrhythmia management. In the current review, we examine comprehensively such ML applications as they match the scope of this journal. The current review is organized in 3 parts. The first provides an overview of general ML principles and methodologies that will afford readers of the necessary information on the subject, serving as the foundation for inviting further ML applications in arrhythmia research. The basic information we provide can serve as a guide on how one might design and conduct an ML study. The second part is a review of arrhythmia and electrophysiology studies in which ML has been utilized, highlighting the broad potential of ML approaches. For each subject, we outline comprehensively the general topics, while reviewing some of the research advances utilizing ML under the subject. Finally, we discuss the main challenges and the perspectives for ML-driven cardiac electrophysiology and arrhythmia research.

Building the space elevator: lessons from biological design

One of the biggest perceived challenges in building megastructures, such as the space elevator, is the unavailability of materials with sufficient tensile strength. The presumed necessity of very strong materials stems from a design paradigm which requires structures to operate at a small fraction of their maximum tensile strength (usually, 50% or less). This criterion limits the probability of failure by giving structures sufficient leeway in handling stochastic components, such as variability in material strength and/or external forces. While reasonable for typical engineering structures, low working stress ratios-defined as operating stress as a fraction of ultimate tensile strength-in the case of megastructures are both too stringent and unable to adequately control the failure probability. We draw inspiration from natural biological structures, such as bones, tendons and ligaments, which are made up of smaller substructures and exhibit self-repair, and suggest a design that requires structures to operate at significantly higher stress ratios, while maintaining reliability through a continuous repair mechanism. We outline a mathematical framework for analysing the reliability of structures with components exhibiting probabilistic rupture and repair that depend on their time-in-use (age). Further, we predict time-to-failure distributions for the overall structure. We then apply this framework to the space elevator and find that a high degree of reliability is achievable using currently existing materials, provided it operates at sufficiently high working stress ratios, sustained through an autonomous repair mechanism, implemented via, e.g. robots.

Ergodicity, hidden bias and the growth rate gain

Many single-cell observables are highly heterogeneous. A part of this heterogeneity stems from age-related phenomena: the fact that there is a nonuniform distribution of cells with different ages. This has led to a renewed interest in analytic methodologies including use of the 'von Foerster equation' for predicting population growth and cell age distributions. Here we discuss how some of the most popular implementations of this machinery assume a strong condition on the ergodicity of the cell cycle duration ensemble. We show that one common definition for the term ergodicity, 'a single individual observed over many generations recapitulates the behavior of the entire ensemble' is implied by the other, 'the probability of observing any state is conserved across time and over all individuals' in an ensemble with a fixed number of individuals but that this is not true when the ensemble is growing. We further explore the impact of generational correlations between cell cycle durations on the population growth rate. Finally, we explore the 'growth rate gain'-the phenomenon that variations in the cell cycle duration leads to an improved population-level growth rate-in this context. We highlight that, fundamentally, this effect is due to asymmetric division.

A Kramers-Moyal approach to the analysis of third-order noise with applications in option valuation

We propose the use of the Kramers-Moyal expansion in the analysis of third-order noise. In particular, we show how the approach can be applied in the theoretical study of option valuation. Despite Pawula’s theorem, which states that a truncated model may exhibit poor statistical properties, we show that for a third-order Kramers-Moyal truncation model of an option’s and its underlier’s price, important properties emerge: (i) the option price can be written in a closed analytical form that involves the Airy function, (ii) the price is a positive function for positive skewness in the distribution, (iii) for negative skewness, the price becomes negative only for price values that are close to zero. Moreover, using third-order noise in option valuation reveals additional properties: (iv) the inconsistencies between two popular option pricing approaches (using a “delta-hedged” portfolio and using an option replicating portfolio) that are otherwise equivalent up to the second moment, (v) the ability to develop a measure R of how accurately an option can be replicated by a mixture of the underlying stocks and cash, (vi) further limitations of second-order models revealed by introducing third-order noise.