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Toupin S, Pezel T, Hovasse T, Sanguineti F, Champagne S, Unterseeh T, Duhamel S, Chitiboi T, Jacob AJ, Borgohain I, Sharma P, Gonçalves T, Martial PJ, Gall E, Florence J, Unger A, Garot P, Garot J. Artificial intelligence-based fully automated stress left ventricular ejection fraction as a prognostic marker in patients undergoing stress cardiovascular magnetic resonance. Eur Heart J Cardiovasc Imaging 2024; 25:1338-1348. [PMID: 38985691 DOI: 10.1093/ehjci/jeae168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2024] [Revised: 06/13/2024] [Accepted: 06/24/2024] [Indexed: 07/12/2024] Open
Abstract
AIMS This study aimed to determine in patients undergoing stress cardiovascular magnetic resonance (CMR) whether fully automated stress artificial intelligence (AI)-based left ventricular ejection fraction (LVEFAI) can provide incremental prognostic value to predict death above traditional prognosticators. METHODS AND RESULTS Between 2016 and 2018, we conducted a longitudinal study that included all consecutive patients referred for vasodilator stress CMR. LVEFAI was assessed using AI algorithm combines multiple deep learning networks for LV segmentation. The primary outcome was all-cause death assessed using the French National Registry of Death. Cox regression was used to evaluate the association of stress LVEFAI with death after adjustment for traditional risk factors and CMR findings. In 9712 patients (66 ± 15 years, 67% men), there was an excellent correlation between stress LVEFAI and LVEF measured by expert (LVEFexpert) (r = 0.94, P < 0.001). Stress LVEFAI was associated with death [median (interquartile range) follow-up 4.5 (3.7-5.2) years] before and after adjustment for risk factors [adjusted hazard ratio, 0.84 (95% confidence interval, 0.82-0.87) per 5% increment, P < 0.001]. Stress LVEFAI had similar significant association with death occurrence compared with LVEFexpert. After adjustment, stress LVEFAI value showed the greatest improvement in model discrimination and reclassification over and above traditional risk factors and stress CMR findings (C-statistic improvement: 0.11; net reclassification improvement = 0.250; integrative discrimination index = 0.049, all P < 0.001; likelihood-ratio test P < 0.001), with an incremental prognostic value over LVEFAI determined at rest. CONCLUSION AI-based fully automated LVEF measured at stress is independently associated with the occurrence of death in patients undergoing stress CMR, with an additional prognostic value above traditional risk factors, inducible ischaemia and late gadolinium enhancement.
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Affiliation(s)
- Solenn Toupin
- Department of Scientific Partnerships, Siemens Healthcare France, 93200 Saint-Denis, France
| | - Théo Pezel
- Department of Cardiology, Université Paris Cité, University Hospital of Lariboisiere, (Assistance Publique des Hôpitaux de Paris, AP-HP), 75010 Paris, France
- MIRACL.ai Laboratory, Multimodality Imaging for Research and Analysis Core Laboratory and Artificial Intelligence, University Hospital of Lariboisiere (AP-HP), 75010 Paris, France
- Inserm MASCOT - UMRS 942, University Hospital of Lariboisiere, 75010 Paris, France
- Department of Radiology, Université Paris Cité, University Hospital of Lariboisiere, (Assistance Publique des Hôpitaux de Paris, AP-HP), 75010 Paris, France
- Institut Cardiovasculaire Paris Sud (ICPS), Cardiovascular Magnetic Resonance Laboratory, Hôpital Privé Jacques CARTIER, Ramsay Santé, 6 Avenue du Noyer Lambert, 91300 Massy, France
| | - Thomas Hovasse
- Institut Cardiovasculaire Paris Sud (ICPS), Cardiovascular Magnetic Resonance Laboratory, Hôpital Privé Jacques CARTIER, Ramsay Santé, 6 Avenue du Noyer Lambert, 91300 Massy, France
| | - Francesca Sanguineti
- Institut Cardiovasculaire Paris Sud (ICPS), Cardiovascular Magnetic Resonance Laboratory, Hôpital Privé Jacques CARTIER, Ramsay Santé, 6 Avenue du Noyer Lambert, 91300 Massy, France
| | - Stéphane Champagne
- Institut Cardiovasculaire Paris Sud (ICPS), Cardiovascular Magnetic Resonance Laboratory, Hôpital Privé Jacques CARTIER, Ramsay Santé, 6 Avenue du Noyer Lambert, 91300 Massy, France
| | - Thierry Unterseeh
- Institut Cardiovasculaire Paris Sud (ICPS), Cardiovascular Magnetic Resonance Laboratory, Hôpital Privé Jacques CARTIER, Ramsay Santé, 6 Avenue du Noyer Lambert, 91300 Massy, France
| | - Suzanne Duhamel
- Institut Cardiovasculaire Paris Sud (ICPS), Cardiovascular Magnetic Resonance Laboratory, Hôpital Privé Jacques CARTIER, Ramsay Santé, 6 Avenue du Noyer Lambert, 91300 Massy, France
| | - Teodora Chitiboi
- Department of Engineering, Siemens Healthcare GmbH, Lindenplatz 2, 20099 Hamburg, Deutschland
| | - Athira J Jacob
- Digital Technologies and Innovation, Siemens Healthineers, 755 College Road East, Princeton, NJ 08540, USA
| | - Indraneel Borgohain
- Digital Technologies and Innovation, Siemens Healthineers, 755 College Road East, Princeton, NJ 08540, USA
| | - Puneet Sharma
- Digital Technologies and Innovation, Siemens Healthineers, 755 College Road East, Princeton, NJ 08540, USA
| | - Trecy Gonçalves
- Department of Cardiology, Université Paris Cité, University Hospital of Lariboisiere, (Assistance Publique des Hôpitaux de Paris, AP-HP), 75010 Paris, France
- MIRACL.ai Laboratory, Multimodality Imaging for Research and Analysis Core Laboratory and Artificial Intelligence, University Hospital of Lariboisiere (AP-HP), 75010 Paris, France
- Inserm MASCOT - UMRS 942, University Hospital of Lariboisiere, 75010 Paris, France
- Department of Radiology, Université Paris Cité, University Hospital of Lariboisiere, (Assistance Publique des Hôpitaux de Paris, AP-HP), 75010 Paris, France
- Institut Cardiovasculaire Paris Sud (ICPS), Cardiovascular Magnetic Resonance Laboratory, Hôpital Privé Jacques CARTIER, Ramsay Santé, 6 Avenue du Noyer Lambert, 91300 Massy, France
| | - Paul-Jun Martial
- Department of Cardiology, Université Paris Cité, University Hospital of Lariboisiere, (Assistance Publique des Hôpitaux de Paris, AP-HP), 75010 Paris, France
- MIRACL.ai Laboratory, Multimodality Imaging for Research and Analysis Core Laboratory and Artificial Intelligence, University Hospital of Lariboisiere (AP-HP), 75010 Paris, France
- Inserm MASCOT - UMRS 942, University Hospital of Lariboisiere, 75010 Paris, France
- Department of Radiology, Université Paris Cité, University Hospital of Lariboisiere, (Assistance Publique des Hôpitaux de Paris, AP-HP), 75010 Paris, France
- Institut Cardiovasculaire Paris Sud (ICPS), Cardiovascular Magnetic Resonance Laboratory, Hôpital Privé Jacques CARTIER, Ramsay Santé, 6 Avenue du Noyer Lambert, 91300 Massy, France
| | - Emmanuel Gall
- Department of Cardiology, Université Paris Cité, University Hospital of Lariboisiere, (Assistance Publique des Hôpitaux de Paris, AP-HP), 75010 Paris, France
- MIRACL.ai Laboratory, Multimodality Imaging for Research and Analysis Core Laboratory and Artificial Intelligence, University Hospital of Lariboisiere (AP-HP), 75010 Paris, France
- Inserm MASCOT - UMRS 942, University Hospital of Lariboisiere, 75010 Paris, France
- Institut Cardiovasculaire Paris Sud (ICPS), Cardiovascular Magnetic Resonance Laboratory, Hôpital Privé Jacques CARTIER, Ramsay Santé, 6 Avenue du Noyer Lambert, 91300 Massy, France
| | - Jeremy Florence
- Department of Cardiology, Université Paris Cité, University Hospital of Lariboisiere, (Assistance Publique des Hôpitaux de Paris, AP-HP), 75010 Paris, France
- MIRACL.ai Laboratory, Multimodality Imaging for Research and Analysis Core Laboratory and Artificial Intelligence, University Hospital of Lariboisiere (AP-HP), 75010 Paris, France
- Inserm MASCOT - UMRS 942, University Hospital of Lariboisiere, 75010 Paris, France
- Institut Cardiovasculaire Paris Sud (ICPS), Cardiovascular Magnetic Resonance Laboratory, Hôpital Privé Jacques CARTIER, Ramsay Santé, 6 Avenue du Noyer Lambert, 91300 Massy, France
| | - Alexandre Unger
- Department of Cardiology, Université Paris Cité, University Hospital of Lariboisiere, (Assistance Publique des Hôpitaux de Paris, AP-HP), 75010 Paris, France
- MIRACL.ai Laboratory, Multimodality Imaging for Research and Analysis Core Laboratory and Artificial Intelligence, University Hospital of Lariboisiere (AP-HP), 75010 Paris, France
- Inserm MASCOT - UMRS 942, University Hospital of Lariboisiere, 75010 Paris, France
- Institut Cardiovasculaire Paris Sud (ICPS), Cardiovascular Magnetic Resonance Laboratory, Hôpital Privé Jacques CARTIER, Ramsay Santé, 6 Avenue du Noyer Lambert, 91300 Massy, France
| | - Philippe Garot
- Institut Cardiovasculaire Paris Sud (ICPS), Cardiovascular Magnetic Resonance Laboratory, Hôpital Privé Jacques CARTIER, Ramsay Santé, 6 Avenue du Noyer Lambert, 91300 Massy, France
| | - Jérôme Garot
- Institut Cardiovasculaire Paris Sud (ICPS), Cardiovascular Magnetic Resonance Laboratory, Hôpital Privé Jacques CARTIER, Ramsay Santé, 6 Avenue du Noyer Lambert, 91300 Massy, France
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Miller RJH, Huang C, Liang JX, Slomka PJ. Artificial intelligence for disease diagnosis and risk prediction in nuclear cardiology. J Nucl Cardiol 2022; 29:1754-1762. [PMID: 35508795 DOI: 10.1007/s12350-022-02977-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 03/29/2022] [Indexed: 10/18/2022]
Abstract
Artificial intelligence (AI) techniques have emerged as a highly efficient approach to accurately and rapidly interpret diagnostic imaging and may play a vital role in nuclear cardiology. In nuclear cardiology, there are many clinical, stress, and imaging variables potentially available, which need to be optimally integrated to predict the presence of obstructive coronary artery disease (CAD) or predict the risk of cardiovascular events. In spite of clinical awareness of a large number of potential variables, it is difficult for physicians to integrate multiple features consistently and objectively. Machine learning (ML) is particularly well suited to integrating this vast array of information to provide patient-specific predictions. Deep learning (DL), a branch of ML characterized by a multi-layered convolutional model architecture, can extract information directly from images and identify latent image features associated with a specific prediction. This review will discuss the latest AI applications to disease diagnosis and risk prediction in nuclear cardiology with a focus on potential clinical applications.
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Affiliation(s)
- Robert J H Miller
- Division of Artificial Intelligence in Medicine, Departments of Medicine, Imaging and Biomedical Sciences, Cedars-Sinai Medical Center, 8700 Beverly Blvd, Suite Metro 203, Los Angeles, CA, 90048, USA
- Department of Cardiac Sciences, University of Calgary and Libin Cardiovascular Institute, Calgary, AB, Canada
| | - Cathleen Huang
- Division of Artificial Intelligence in Medicine, Departments of Medicine, Imaging and Biomedical Sciences, Cedars-Sinai Medical Center, 8700 Beverly Blvd, Suite Metro 203, Los Angeles, CA, 90048, USA
| | - Joanna X Liang
- Division of Artificial Intelligence in Medicine, Departments of Medicine, Imaging and Biomedical Sciences, Cedars-Sinai Medical Center, 8700 Beverly Blvd, Suite Metro 203, Los Angeles, CA, 90048, USA
| | - Piotr J Slomka
- Division of Artificial Intelligence in Medicine, Departments of Medicine, Imaging and Biomedical Sciences, Cedars-Sinai Medical Center, 8700 Beverly Blvd, Suite Metro 203, Los Angeles, CA, 90048, USA.
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Miller RJH, Sharir T, Otaki Y, Gransar H, Liang JX, Einstein AJ, Fish MB, Ruddy TD, Kaufmann PA, Sinusas AJ, Miller EJ, Bateman TM, Dorbala S, Di Carli M, Tamarappoo BK, Dey D, Berman DS, Slomka PJ. Quantitation of Poststress Change in Ventricular Morphology Improves Risk Stratification. J Nucl Med 2021; 62:1582-1590. [PMID: 33712535 PMCID: PMC8612345 DOI: 10.2967/jnumed.120.260141] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 02/11/2021] [Indexed: 11/16/2022] Open
Abstract
Shape index and eccentricity index are measures of left ventricular morphology. Although both measures can be quantified with any stress imaging modality, they are not routinely evaluated during clinical interpretation. We assessed their independent associations with major adverse cardiovascular events (MACE), including measures of poststress change in shape index and eccentricity index. Methods: Patients undergoing SPECT myocardial perfusion imaging between 2009 and 2014 from the Registry of Fast Myocardial Perfusion Imaging with Next-Generation SPECT (REFINE SPECT) were studied. Shape index (ratio between the maximum left ventricular diameter in short axis and ventricular length) and eccentricity index (calculated from orthogonal diameters in short axis and length) were calculated in end-diastole at stress and rest. Multivariable analysis was performed to assess independent associations with MACE (death, nonfatal myocardial infarction, unstable angina, or late revascularization). Results: In total, 14,016 patients with a mean age of 64.3 ± 12.2 y (8,469 [60.4%] male were included. MACE occurred in 2,120 patients during a median follow-up of 4.3 y (interquartile range, 3.4-5.7). Rest, stress, and poststress change in shape and eccentricity indices were associated with MACE in unadjusted analyses (all P < 0.001). However, in multivariable models, only poststress change in shape index (adjusted hazard ratio, 1.38; P < 0.001) and eccentricity index (adjusted hazard ratio, 0.80; P = 0.033) remained associated with MACE. Conclusion: Two novel measures, poststress change in shape index and eccentricity index, were independently associated with MACE and improved risk estimation. Changes in ventricular morphology have important prognostic utility and should be included in patient risk estimation after SPECT myocardial perfusion imaging.
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Affiliation(s)
- Robert J H Miller
- Department of Cardiac Sciences, University of Calgary, Calgary, Alberta, Canada
- Department of Imaging, Medicine, and Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, California
| | - Tali Sharir
- Department of Nuclear Cardiology, Assuta Medical Center, Tel Aviv, Israel
| | - Yuka Otaki
- Department of Imaging, Medicine, and Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, California
| | - Heidi Gransar
- Department of Imaging, Medicine, and Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, California
| | - Joanna X Liang
- Department of Imaging, Medicine, and Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, California
| | - Andrew J Einstein
- Division of Cardiology, Department of Medicine, and Department of Radiology, Columbia University Irving Medical Center, New York, New York
| | - Mathews B Fish
- Oregon Heart and Vascular Institute, Sacred Heart Medical Center, Springfield, Oregon
| | - Terrence D Ruddy
- Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Philipp A Kaufmann
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Zurich, Switzerland
| | - Albert J Sinusas
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University, New Haven, Connecticut
| | - Edward J Miller
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University, New Haven, Connecticut
| | | | - Sharmila Dorbala
- Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Marcelo Di Carli
- Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Balaji K Tamarappoo
- Department of Imaging, Medicine, and Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, California
| | - Damini Dey
- Department of Imaging, Medicine, and Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, California
| | - Daniel S Berman
- Department of Imaging, Medicine, and Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, California
| | - Piotr J Slomka
- Department of Imaging, Medicine, and Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, California;
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