1
|
Onnis C, van Assen M, Muscogiuri E, Muscogiuri G, Gershon G, Saba L, De Cecco CN. The Role of Artificial Intelligence in Cardiac Imaging. Radiol Clin North Am 2024; 62:473-488. [PMID: 38553181 DOI: 10.1016/j.rcl.2024.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/02/2024]
Abstract
Artificial intelligence (AI) is having a significant impact in medical imaging, advancing almost every aspect of the field, from image acquisition and postprocessing to automated image analysis with outreach toward supporting decision making. Noninvasive cardiac imaging is one of the main and most exciting fields for AI development. The aim of this review is to describe the main applications of AI in cardiac imaging, including CT and MR imaging, and provide an overview of recent advancements and available clinical applications that can improve clinical workflow, disease detection, and prognostication in cardiac disease.
Collapse
Affiliation(s)
- Carlotta Onnis
- Translational Laboratory for Cardiothoracic Imaging and Artificial Intelligence, Department of Radiology and Imaging Sciences, Emory University, 100 Woodruff Circle, Atlanta, GA 30322, USA; Department of Radiology, Azienda Ospedaliero Universitaria (A.O.U.), di Cagliari-Polo di Monserrato, SS 554 km 4,500 Monserrato, Cagliari 09042, Italy. https://twitter.com/CarlottaOnnis
| | - Marly van Assen
- Translational Laboratory for Cardiothoracic Imaging and Artificial Intelligence, Department of Radiology and Imaging Sciences, Emory University, 100 Woodruff Circle, Atlanta, GA 30322, USA. https://twitter.com/marly_van_assen
| | - Emanuele Muscogiuri
- Translational Laboratory for Cardiothoracic Imaging and Artificial Intelligence, Department of Radiology and Imaging Sciences, Emory University, 100 Woodruff Circle, Atlanta, GA 30322, USA; Division of Thoracic Imaging, Department of Radiology, University Hospitals Leuven, Herestraat 49, Leuven 3000, Belgium
| | - Giuseppe Muscogiuri
- Department of Diagnostic and Interventional Radiology, Papa Giovanni XXIII Hospital, Piazza OMS, 1, Bergamo BG 24127, Italy. https://twitter.com/GiuseppeMuscog
| | - Gabrielle Gershon
- Translational Laboratory for Cardiothoracic Imaging and Artificial Intelligence, Department of Radiology and Imaging Sciences, Emory University, 100 Woodruff Circle, Atlanta, GA 30322, USA. https://twitter.com/gabbygershon
| | - Luca Saba
- Department of Radiology, Azienda Ospedaliero Universitaria (A.O.U.), di Cagliari-Polo di Monserrato, SS 554 km 4,500 Monserrato, Cagliari 09042, Italy. https://twitter.com/lucasabaITA
| | - Carlo N De Cecco
- Translational Laboratory for Cardiothoracic Imaging and Artificial Intelligence, Department of Radiology and Imaging Sciences, Emory University, 100 Woodruff Circle, Atlanta, GA 30322, USA; Division of Cardiothoracic Imaging, Department of Radiology and Imaging Sciences, Emory University, Emory University Hospital, 1365 Clifton Road Northeast, Suite AT503, Atlanta, GA 30322, USA.
| |
Collapse
|
2
|
Argentiero A, Carella MC, Mandunzio D, Greco G, Mushtaq S, Baggiano A, Fazzari F, Fusini L, Muscogiuri G, Basile P, Siena P, Soldato N, Napoli G, Santobuono VE, Forleo C, Garrido EC, Di Marco A, Pontone G, Guaricci AI. Cardiac Magnetic Resonance as Risk Stratification Tool in Non-Ischemic Dilated Cardiomyopathy Referred for Implantable Cardioverter Defibrillator Therapy-State of Art and Perspectives. J Clin Med 2023; 12:7752. [PMID: 38137821 PMCID: PMC10743710 DOI: 10.3390/jcm12247752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 12/12/2023] [Accepted: 12/15/2023] [Indexed: 12/24/2023] Open
Abstract
Non-ischemic dilated cardiomyopathy (DCM) is a disease characterized by left ventricular dilation and systolic dysfunction. Patients with DCM are at higher risk for ventricular arrhythmias and sudden cardiac death (SCD). According to current international guidelines, left ventricular ejection fraction (LVEF) ≤ 35% represents the main indication for prophylactic implantable cardioverter defibrillator (ICD) implantation in patients with DCM. However, LVEF lacks sensitivity and specificity as a risk marker for SCD. It has been seen that the majority of patients with DCM do not actually benefit from the ICD implantation and, on the contrary, that many patients at risk of SCD are not identified as they have preserved or mildly depressed LVEF. Therefore, the use of LVEF as unique decision parameter does not maximize the benefit of ICD therapy. Multiple risk factors used in combination could likely predict SCD risk better than any single risk parameter. Several predictors have been proposed including genetic variants, electric indexes, and volumetric parameters of LV. Cardiac magnetic resonance (CMR) can improve risk stratification thanks to tissue characterization sequences such as LGE sequence, parametric mapping, and feature tracking. This review evaluates the role of CMR as a risk stratification tool in DCM patients referred for ICD.
Collapse
Affiliation(s)
- Adriana Argentiero
- University Cardiology Unit, Interdisciplinary Department of Medicine, University of Bari Aldo Moro, 70121 Bari, Italy; (A.A.); (M.C.C.); (D.M.); (G.G.); (P.B.); (P.S.); (N.S.); (G.N.); (V.E.S.); (C.F.)
| | - Maria Cristina Carella
- University Cardiology Unit, Interdisciplinary Department of Medicine, University of Bari Aldo Moro, 70121 Bari, Italy; (A.A.); (M.C.C.); (D.M.); (G.G.); (P.B.); (P.S.); (N.S.); (G.N.); (V.E.S.); (C.F.)
| | - Donato Mandunzio
- University Cardiology Unit, Interdisciplinary Department of Medicine, University of Bari Aldo Moro, 70121 Bari, Italy; (A.A.); (M.C.C.); (D.M.); (G.G.); (P.B.); (P.S.); (N.S.); (G.N.); (V.E.S.); (C.F.)
| | - Giulia Greco
- University Cardiology Unit, Interdisciplinary Department of Medicine, University of Bari Aldo Moro, 70121 Bari, Italy; (A.A.); (M.C.C.); (D.M.); (G.G.); (P.B.); (P.S.); (N.S.); (G.N.); (V.E.S.); (C.F.)
| | - Saima Mushtaq
- Perioperative and Cardiovascular Imaging Department, Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy; (S.M.); (A.B.); (F.F.); (L.F.); (G.P.)
| | - Andrea Baggiano
- Perioperative and Cardiovascular Imaging Department, Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy; (S.M.); (A.B.); (F.F.); (L.F.); (G.P.)
| | - Fabio Fazzari
- Perioperative and Cardiovascular Imaging Department, Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy; (S.M.); (A.B.); (F.F.); (L.F.); (G.P.)
| | - Laura Fusini
- Perioperative and Cardiovascular Imaging Department, Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy; (S.M.); (A.B.); (F.F.); (L.F.); (G.P.)
| | | | - Paolo Basile
- University Cardiology Unit, Interdisciplinary Department of Medicine, University of Bari Aldo Moro, 70121 Bari, Italy; (A.A.); (M.C.C.); (D.M.); (G.G.); (P.B.); (P.S.); (N.S.); (G.N.); (V.E.S.); (C.F.)
| | - Paola Siena
- University Cardiology Unit, Interdisciplinary Department of Medicine, University of Bari Aldo Moro, 70121 Bari, Italy; (A.A.); (M.C.C.); (D.M.); (G.G.); (P.B.); (P.S.); (N.S.); (G.N.); (V.E.S.); (C.F.)
| | - Nicolò Soldato
- University Cardiology Unit, Interdisciplinary Department of Medicine, University of Bari Aldo Moro, 70121 Bari, Italy; (A.A.); (M.C.C.); (D.M.); (G.G.); (P.B.); (P.S.); (N.S.); (G.N.); (V.E.S.); (C.F.)
| | - Gianluigi Napoli
- University Cardiology Unit, Interdisciplinary Department of Medicine, University of Bari Aldo Moro, 70121 Bari, Italy; (A.A.); (M.C.C.); (D.M.); (G.G.); (P.B.); (P.S.); (N.S.); (G.N.); (V.E.S.); (C.F.)
| | - Vincenzo Ezio Santobuono
- University Cardiology Unit, Interdisciplinary Department of Medicine, University of Bari Aldo Moro, 70121 Bari, Italy; (A.A.); (M.C.C.); (D.M.); (G.G.); (P.B.); (P.S.); (N.S.); (G.N.); (V.E.S.); (C.F.)
| | - Cinzia Forleo
- University Cardiology Unit, Interdisciplinary Department of Medicine, University of Bari Aldo Moro, 70121 Bari, Italy; (A.A.); (M.C.C.); (D.M.); (G.G.); (P.B.); (P.S.); (N.S.); (G.N.); (V.E.S.); (C.F.)
| | - Eduard Claver Garrido
- Bio-Heart Cardiovascular Diseases Research Group, Bellvitge Biomedical Research Institute (IDIBELL), L’Hospitalet de Llobregat, 08907 Barcelona, Spain; (E.C.G.); (A.D.M.)
- Department of Cardiology, Hospital Universitari de Bellvitge, L’Hospitalet de Llobregat, 08907 Barcelona, Spain
| | - Andrea Di Marco
- Bio-Heart Cardiovascular Diseases Research Group, Bellvitge Biomedical Research Institute (IDIBELL), L’Hospitalet de Llobregat, 08907 Barcelona, Spain; (E.C.G.); (A.D.M.)
- Department of Cardiology, Hospital Universitari de Bellvitge, L’Hospitalet de Llobregat, 08907 Barcelona, Spain
| | - Gianluca Pontone
- Perioperative and Cardiovascular Imaging Department, Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy; (S.M.); (A.B.); (F.F.); (L.F.); (G.P.)
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, 20122 Milan, Italy
| | - Andrea Igoren Guaricci
- University Cardiology Unit, Interdisciplinary Department of Medicine, University of Bari Aldo Moro, 70121 Bari, Italy; (A.A.); (M.C.C.); (D.M.); (G.G.); (P.B.); (P.S.); (N.S.); (G.N.); (V.E.S.); (C.F.)
| |
Collapse
|
3
|
Zhang J, Xu Y, Li W, Zhang C, Liu W, Li D, Chen Y. The Predictive Value of Myocardial Native T1 Mapping Radiomics in Dilated Cardiomyopathy: A Study in a Chinese Population. J Magn Reson Imaging 2023; 58:772-779. [PMID: 36416613 DOI: 10.1002/jmri.28527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 10/26/2022] [Accepted: 10/27/2022] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Investigation of the factors influencing dilated cardiomyopathy (DCM) prognosis is important as it could facilitate risk stratification and guide clinical decision-making. PURPOSE To assess the prognostic value of magnetic resonance imaging (MRI) radiomics analysis of native T1 mapping in DCM. STUDY TYPE Prospective. SUBJECTS Three hundred and thirty consecutive patients with non-ischemic DCM (mean age 48.42 ± 14.20 years, 247 males). FIELD STRENGTH/SEQUENCE Balanced steady-state free precession and modified Look-Locker inversion recovery T1 mapping sequences at 3 T. ASSESSMENT Clinical characteristics, conventional MRI parameters (ventricular volumes, function, and mass), native myocardial T1, and radiomics features extracted from native T1 mapping were obtained. The study endpoint was defined as all-cause mortality or heart transplantation. Models were developed based on 1) clinical data; 2) radiomics data based on T1 mapping; 3) clinical and conventional MRI data; 4) clinical, conventional MRI, and native T1 data; and 5) clinical, conventional MRI, and radiomics T1 mapping data. Each prediction model was trained according to follow-up results with AdaBoost, random forest, and logistic regression classifiers. STATISTICAL TESTS The predictive performance was evaluated using the area under the receiver operating characteristic curve (AUC) and F1 score by 5-fold cross-validation. RESULTS During a median follow-up of 53.5 months (interquartile range, 41.6-69.5 months), 77 patients with DCM experienced all-cause mortality or heart transplantation. The random forest model based on radiomics combined with clinical and conventional MRI parameters achieved the best performance, with AUC and F1 score of 0.95 and 0.89, respectively. DATA CONCLUSION A machine-learning framework based on radiomics analysis of T1 mapping prognosis prediction in DCM. LEVEL OF EVIDENCE 1 TECHNICAL EFFICACY: Stage 2.
Collapse
Affiliation(s)
- Jian Zhang
- West China Biomedical Big Data Center, West China Hospital, Sichuan University, Chengdu, China
- Med-X Center for Informatics, Sichuan University, Chengdu, China
| | - Yuanwei Xu
- Division of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | - Weihao Li
- Division of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | - Chao Zhang
- West China Biomedical Big Data Center, West China Hospital, Sichuan University, Chengdu, China
- Med-X Center for Informatics, Sichuan University, Chengdu, China
| | - Wentao Liu
- Fundamental Technology Center of CCB Financial Technology Co., Ltd, Shanghai, China
| | - Dong Li
- Division of Hospital Medicine, Emory School of Medicine, Atlanta, Georgia, USA
| | - Yucheng Chen
- Division of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| |
Collapse
|
4
|
Koktzoglou I, Mordini FE. Editorial for "The Predictive Value of Myocardial Native T1 Mapping Radiomics in Dilated Cardiomyopathy: A Study in a Chinese Population". J Magn Reson Imaging 2023; 58:780-781. [PMID: 36399112 DOI: 10.1002/jmri.28532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Accepted: 10/20/2022] [Indexed: 11/19/2022] Open
Affiliation(s)
- Ioannis Koktzoglou
- Department of Radiology, NorthShore University HealthSystem, Evanston, Illinois, USA
- Pritzker School of Medicine, University of Chicago, Chicago, Illinois, USA
| | - Federico E Mordini
- Section of Cardiology, Heart Center, Veterans Affairs Medical Center, Washington, DC, USA
- Georgetown University School of Medicine, Washington, DC, USA
| |
Collapse
|
5
|
Artificial Intelligence in Cardiovascular CT and MR Imaging. Life (Basel) 2023; 13:life13020507. [PMID: 36836864 PMCID: PMC9968221 DOI: 10.3390/life13020507] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2023] [Revised: 02/06/2023] [Accepted: 02/09/2023] [Indexed: 02/15/2023] Open
Abstract
The technological development of Artificial Intelligence (AI) has grown rapidly in recent years. The applications of AI to cardiovascular imaging are various and could improve the radiologists' workflow, speeding up acquisition and post-processing time, increasing image quality and diagnostic accuracy. Several studies have already proved AI applications in Coronary Computed Tomography Angiography and Cardiac Magnetic Resonance, including automatic evaluation of calcium score, quantification of coronary stenosis and plaque analysis, or the automatic quantification of heart volumes and myocardial tissue characterization. The aim of this review is to summarize the latest advances in the field of AI applied to cardiovascular CT and MR imaging.
Collapse
|
6
|
Automated Classification of Left Ventricular Hypertrophy on Cardiac MRI. APPLIED SCIENCES-BASEL 2022. [DOI: 10.3390/app12094151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Left ventricular hypertrophy is an independent predictor of coronary artery disease, stroke, and heart failure. Our aim was to detect LVH cardiac magnetic resonance (CMR) scans with automatic methods. We developed an ensemble model based on a three-dimensional version of ResNet. The input of the network included short-axis and long-axis images. We also introduced a standardization methodology to unify the input images for noise reduction. The output of the network is the decision whether the patient has hypertrophy or not. We included 428 patients (mean age: 49 ± 18 years, 262 males) with LVH (346 hypertrophic cardiomyopathy, 45 cardiac amyloidosis, 11 Anderson–Fabry disease, 16 endomyocardial fibrosis, 10 aortic stenosis). Our control group consisted of 234 healthy subjects (mean age: 35 ± 15 years; 126 males) without any known cardiovascular diseases. The developed machine-learning-based model achieved a 92% F1-score and 97% recall on the hold-out dataset, which is comparable to the medical experts. Experiments showed that the standardization method was able to significantly boost the performance of the algorithm. The algorithm could improve the diagnostic accuracy, and it could open a new door to AI applications in CMR.
Collapse
|
7
|
Kagiyama N, Tokodi M, Sengupta PP. Machine Learning in Cardiovascular Imaging. Heart Fail Clin 2022; 18:245-258. [DOI: 10.1016/j.hfc.2021.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
8
|
Effectiveness of Artificial Intelligence Models for Cardiovascular Disease Prediction: Network Meta-Analysis. COMPUTATIONAL INTELLIGENCE AND NEUROSCIENCE 2022; 2022:5849995. [PMID: 35251153 PMCID: PMC8894073 DOI: 10.1155/2022/5849995] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/28/2021] [Accepted: 01/18/2022] [Indexed: 11/23/2022]
Abstract
Heart failure is the most common cause of death in both males and females around the world. Cardiovascular diseases (CVDs), in particular, are the main cause of death worldwide, accounting for 30% of all fatalities in the United States and 45% in Europe. Artificial intelligence (AI) approaches such as machine learning (ML) and deep learning (DL) models are playing an important role in the advancement of heart failure therapy. The main objective of this study was to perform a network meta-analysis of patients with heart failure, stroke, hypertension, and diabetes by comparing the ML and DL models. A comprehensive search of five electronic databases was performed using ScienceDirect, EMBASE, PubMed, Web of Science, and IEEE Xplore. The search strategy was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement. The methodological quality of studies was assessed by following the Quality Assessment of Diagnostic Accuracy Studies 2 (QUADAS-2) guidelines. The random-effects network meta-analysis forest plot with categorical data was used, as were subgroups testing for all four types of treatments and calculating odds ratio (OR) with a 95% confidence interval (CI). Pooled network forest, funnel plots, and the league table, which show the best algorithms for each outcome, were analyzed. Seventeen studies, with a total of 285,213 patients with CVDs, were included in the network meta-analysis. The statistical evidence indicated that the DL algorithms performed well in the prediction of heart failure with AUC of 0.843 and CI [0.840–0.845], while in the ML algorithm, the gradient boosting machine (GBM) achieved an average accuracy of 91.10% in predicting heart failure. An artificial neural network (ANN) performed well in the prediction of diabetes with an OR and CI of 0.0905 [0.0489; 0.1673]. Support vector machine (SVM) performed better for the prediction of stroke with OR and CI of 25.0801 [11.4824; 54.7803]. Random forest (RF) results performed well in the prediction of hypertension with OR and CI of 10.8527 [4.7434; 24.8305]. The findings of this work suggest that the DL models can effectively advance the prediction of and knowledge about heart failure, but there is a lack of literature regarding DL methods in the field of CVDs. As a result, more DL models should be applied in this field. To confirm our findings, more meta-analysis (e.g., Bayesian network) and thorough research with a larger number of patients are encouraged.
Collapse
|
9
|
Wang M, Xu Y, Wang S, Zhao T, Cai H, Wang Y, Zou R, Wang C. Predictive value of electrocardiographic markers in children with dilated cardiomyopathy. Front Pediatr 2022; 10:917730. [PMID: 36081634 PMCID: PMC9445218 DOI: 10.3389/fped.2022.917730] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Accepted: 08/01/2022] [Indexed: 11/13/2022] Open
Abstract
Dilated cardiomyopathy (DCM) refers to a heterogeneous group of cardiomyopathies characterized by ventricular dilatation and myocardial systolic dysfunction, which can lead to serious consequences such as malign arrhythmia, sudden death, heart failure, and thromboembolism. With its economical, non-invasive, simple and reproducible advantages, electrocardiogram (ECG) has become an important indicator for assessing the prognosis of cardiovascular diseases. In recent years, more and more studies of electrocardiography on DCM have been carried out, but there is still a lack of a comprehensive summary of its prognostic value. This article reviews the prognostic value of electrocardiographic markers in children with DCM.
Collapse
Affiliation(s)
- Miao Wang
- Department of Pediatric Cardiovasology, Children's Medical Center, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Yi Xu
- Department of Pediatric Cardiovasology, Children's Medical Center, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Shuo Wang
- Department of Neonatology, Xiangya Hospital, Central South University, Changsha, China
| | - Ting Zhao
- Department of Pediatric Cardiovasology, Children's Medical Center, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Hong Cai
- Department of Pediatric Cardiovasology, Children's Medical Center, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Yuwen Wang
- Department of Pediatric Cardiovasology, Children's Medical Center, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Runmei Zou
- Department of Pediatric Cardiovasology, Children's Medical Center, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Cheng Wang
- Department of Pediatric Cardiovasology, Children's Medical Center, The Second Xiangya Hospital, Central South University, Changsha, China
| |
Collapse
|
10
|
Asher C, Puyol-Antón E, Rizvi M, Ruijsink B, Chiribiri A, Razavi R, Carr-White G. The Role of AI in Characterizing the DCM Phenotype. Front Cardiovasc Med 2021; 8:787614. [PMID: 34993240 PMCID: PMC8724536 DOI: 10.3389/fcvm.2021.787614] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Accepted: 12/02/2021] [Indexed: 12/13/2022] Open
Abstract
Dilated Cardiomyopathy is conventionally defined by left ventricular dilatation and dysfunction in the absence of coronary disease. Emerging evidence suggests many patients remain vulnerable to major adverse outcomes despite clear therapeutic success of modern evidence-based heart failure therapy. In this era of personalized medical care, the conventional assessment of left ventricular ejection fraction falls short in fully predicting evolution and risk of outcomes in this heterogenous group of heart muscle disease, as such, a more refined means of phenotyping this disease appears essential. Cardiac MRI (CMR) is well-placed in this respect, not only for its diagnostic utility, but the wealth of information captured in global and regional function assessment with the addition of unique tissue characterization across different disease states and patient cohorts. Advanced tools are needed to leverage these sensitive metrics and integrate with clinical, genetic and biochemical information for personalized, and more clinically useful characterization of the dilated cardiomyopathy phenotype. Recent advances in artificial intelligence offers the unique opportunity to impact clinical decision making through enhanced precision image-analysis tasks, multi-source extraction of relevant features and seamless integration to enhance understanding, improve diagnosis, and subsequently clinical outcomes. Focusing particularly on deep learning, a subfield of artificial intelligence, that has garnered significant interest in the imaging community, this paper reviews the main developments that could offer more robust disease characterization and risk stratification in the Dilated Cardiomyopathy phenotype. Given its promising utility in the non-invasive assessment of cardiac diseases, we firstly highlight the key applications in CMR, set to enable comprehensive quantitative measures of function beyond the standard of care assessment. Concurrently, we revisit the added value of tissue characterization techniques for risk stratification, showcasing the deep learning platforms that overcome limitations in current clinical workflows and discuss how they could be utilized to better differentiate at-risk subgroups of this phenotype. The final section of this paper is dedicated to the allied clinical applications to imaging, that incorporate artificial intelligence and have harnessed the comprehensive abundance of data from genetics and relevant clinical variables to facilitate better classification and enable enhanced risk prediction for relevant outcomes.
Collapse
Affiliation(s)
- Clint Asher
- Department of Cardiovascular Imaging, School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
- Department of Cardiology, Guys and St Thomas' NHS Trust, London, United Kingdom
| | - Esther Puyol-Antón
- Department of Cardiovascular Imaging, School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
| | - Maleeha Rizvi
- Department of Cardiovascular Imaging, School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
- Department of Cardiology, Guys and St Thomas' NHS Trust, London, United Kingdom
| | - Bram Ruijsink
- Department of Cardiovascular Imaging, School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
- Department of Cardiology, Guys and St Thomas' NHS Trust, London, United Kingdom
- Division of Heart and Lungs, Department of Cardiology, University Medical Center Utrecht, Utrecht, Netherlands
| | - Amedeo Chiribiri
- Department of Cardiovascular Imaging, School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
- Department of Cardiology, Guys and St Thomas' NHS Trust, London, United Kingdom
| | - Reza Razavi
- Department of Cardiovascular Imaging, School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
- Department of Cardiology, Guys and St Thomas' NHS Trust, London, United Kingdom
| | - Gerry Carr-White
- Department of Cardiovascular Imaging, School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
- Department of Cardiology, Guys and St Thomas' NHS Trust, London, United Kingdom
| |
Collapse
|
11
|
Shu S, Hong Z, Peng Q, Zhou X, Zhang T, Wang J, Zheng C. A machine-learning-based method to predict adverse events in patients with dilated cardiomyopathy and severely reduced ejection fractions. Br J Radiol 2021; 94:20210259. [PMID: 34464552 DOI: 10.1259/bjr.20210259] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
OBJECTIVE Patients with dilated cardiomyopathy (DCM) and severely reduced left ventricular ejection fractions (LVEFs) are at very high risks of experiencing adverse cardiac events. A machine learning (ML) method could enable more effective risk stratification for these high-risk patients by incorporating various types of data. The aim of this study was to build an ML model to predict adverse events including all-cause deaths and heart transplantation in DCM patients with severely impaired LV systolic function. METHODS One hundred and eighteen patients with DCM and severely reduced LVEFs (<35%) were included. The baseline clinical characteristics, laboratory data, electrocardiographic, and cardiac magnetic resonance (CMR) features were collected. Various feature selection processes and classifiers were performed to select an ML model with the best performance. The predictive performance of tested ML models was evaluated using the area under the curve (AUC) of the receiver operating characteristic curve using 10-fold cross-validation. RESULTS Twelve patients died, and 17 patients underwent heart transplantation during the median follow-up of 508 days. The ML model included systolic blood pressure, left ventricular end-systolic and end-diastolic volume indices, and late gadolinium enhancement (LGE) extents on CMR imaging, and a support vector machine was selected as a classifier. The model showed excellent performance in predicting adverse events in DCM patients with severely reduced LVEF (the AUC and accuracy values were 0.873 and 0.763, respectively). CONCLUSIONS This ML technique could effectively predict adverse events in DCM patients with severely reduced LVEF. ADVANCES IN KNOWLEDGE The ML method has superior ability in risk stratification in severe DCM patients.
Collapse
Affiliation(s)
- Shenglei Shu
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
| | - Ziming Hong
- School of Electronic Information and Communications, Huazhong University of Science and Technology, Wuhan, China
| | - Qinmu Peng
- School of Electronic Information and Communications, Huazhong University of Science and Technology, Wuhan, China
| | - Xiaoyue Zhou
- MR Collaboration, Siemens Healthineers, Shanghai, China
| | | | - Jing Wang
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
| | - Chuansheng Zheng
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
| |
Collapse
|
12
|
de Siqueira VS, Borges MM, Furtado RG, Dourado CN, da Costa RM. Artificial intelligence applied to support medical decisions for the automatic analysis of echocardiogram images: A systematic review. Artif Intell Med 2021; 120:102165. [PMID: 34629153 DOI: 10.1016/j.artmed.2021.102165] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 08/07/2021] [Accepted: 08/31/2021] [Indexed: 12/16/2022]
Abstract
The echocardiogram is a test that is widely used in Heart Disease Diagnoses. However, its analysis is largely dependent on the physician's experience. In this regard, artificial intelligence has become an essential technology to assist physicians. This study is a Systematic Literature Review (SLR) of primary state-of-the-art studies that used Artificial Intelligence (AI) techniques to automate echocardiogram analyses. Searches on the leading scientific article indexing platforms using a search string returned approximately 1400 articles. After applying the inclusion and exclusion criteria, 118 articles were selected to compose the detailed SLR. This SLR presents a thorough investigation of AI applied to support medical decisions for the main types of echocardiogram (Transthoracic, Transesophageal, Doppler, Stress, and Fetal). The article's data extraction indicated that the primary research interest of the studies comprised four groups: 1) Improvement of image quality; 2) identification of the cardiac window vision plane; 3) quantification and analysis of cardiac functions, and; 4) detection and classification of cardiac diseases. The articles were categorized and grouped to show the main contributions of the literature to each type of ECHO. The results indicate that the Deep Learning (DL) methods presented the best results for the detection and segmentation of the heart walls, right and left atrium and ventricles, and classification of heart diseases using images/videos obtained by echocardiography. The models that used Convolutional Neural Network (CNN) and its variations showed the best results for all groups. The evidence produced by the results presented in the tabulation of the studies indicates that the DL contributed significantly to advances in echocardiogram automated analysis processes. Although several solutions were presented regarding the automated analysis of ECHO, this area of research still has great potential for further studies to improve the accuracy of results already known in the literature.
Collapse
Affiliation(s)
- Vilson Soares de Siqueira
- Federal Institute of Tocantins, Av. Bernado Sayão, S/N, Santa Maria, Colinas do Tocantins, TO, Brazil; Federal University of Goias, Alameda Palmeiras, Quadra D, Câmpus Samambaia, Goiânia, GO, Brazil.
| | - Moisés Marcos Borges
- Diagnostic Imaging Center - CDI, Av. Portugal, 1155, St. Marista, Goiânia, GO, Brazil
| | - Rogério Gomes Furtado
- Diagnostic Imaging Center - CDI, Av. Portugal, 1155, St. Marista, Goiânia, GO, Brazil
| | - Colandy Nunes Dourado
- Diagnostic Imaging Center - CDI, Av. Portugal, 1155, St. Marista, Goiânia, GO, Brazil. http://www.cdigoias.com.br
| | - Ronaldo Martins da Costa
- Federal University of Goias, Alameda Palmeiras, Quadra D, Câmpus Samambaia, Goiânia, GO, Brazil.
| |
Collapse
|
13
|
Lin W, Que L, Lin G, Chen R, Lu Q, Zhicheng Du MD, Hui Liu MD, Yu Z, Huang M. Using Machine Learning to Predict Five-Year Reintervention Risk in Type B Aortic Dissection Patients After Thoracic Endovascular Aortic Repair. JOURNAL OF MEDICAL IMAGING AND HEALTH INFORMATICS 2021. [DOI: 10.1166/jmihi.2021.3813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Purpose: Type B aortic dissection (TBAD) is a high-risk disease, commonly treated with thoracic endovascular aortic repair (TEVAR). However, for the long-term follow-up, it is associated with a high 5-year reintervention rate for patients after TEVAR. There is no accurate definition
of prognostic risk factors for TBAD in medical guidelines, and there is no scientific judgment standard for patients’ quality of life or survival outcome in the next five years in clinical practice. A large amount of medical data features makes prognostic analysis difficult. However,
machine learning (ML) permits lots of objective data features to be considered for clinical risk stratification and patient management. We aimed to predict the 5-year prognosis in TBAD after TEVAR by Ml, based on baseline, stent characteristics and computed tomography angiography (CTA) imaging
data, and provided a certain degree of scientific basis for prognostic risk score and stratification in medical guidelines. Materials and Methods: Dataset we recorded was obtained from 172 TBAD patients undergoing TEVAR. Totally 40 features were recorded, including 14 baseline, 5 stent
characteristics and 21 CTA imaging data. Information gain (IG) was used to select features highly associated with adverse outcome. Then, the Gradient Boost classifier was trained using grid search and stratified 5-fold cross-validation, and Its predictive performance was evaluated by the area
under the curve (AUC) in the receiver operating characteristic (ROC). Results: Totally 60 patients underwent reintervention during follow-up. Combing 24 features selected by IG, ML model predicted prognosis well in TBAD after TEVAR, with an AUC of 0.816 and a 95% confidence interval
of 0.797 to 0.837. Reintervention rate of prediction was slightly higher than the actual (48.2% vs. 34.8%). Conclusion: Machine learning, which combined with baseline, stent characteristics and CTA imaging data for personalized risk computations, effectively predicted reintervention
risk in TBAD patients after TEVAR in 5-year follow-up. The model could be used to efficiently assist the clinical management of TBAD patients and prompt high-risk factors.
Collapse
Affiliation(s)
- Weiyuan Lin
- College of Automation Science and Technology, South China University of Technology, Guangzhou, 510640, China
| | - Lifeng Que
- Medical Imaging Center, Shenzhen Hospital, Southern Medical University, Shenzhen, Guangdong, 518110, China
| | - Guisen Lin
- Department of Radiology, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, China
| | - Rui Chen
- Department of Radiology, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, China
| | - Qiyang Lu
- College of Automation Science and Technology, South China University of Technology, Guangzhou, 510640, China
| | - M. D. Zhicheng Du
- Department of Medical Statistics and Epidemiology, Health Information Research Center, Guangdong Key Laboratory of Medicine, School of Public Health, Sun Yat-sen University, Guangzhou, 510080, China
| | - M. D. Hui Liu
- Department of Radiology, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, China
| | - Zhuliang Yu
- College of Automation Science and Technology, South China University of Technology, Guangzhou, 510640, China
| | - Meiping Huang
- Department of Radiology, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, China
| |
Collapse
|
14
|
Predicting mortality and hospitalization in heart failure using machine learning: A systematic literature review. IJC HEART & VASCULATURE 2021; 34:100773. [PMID: 33912652 PMCID: PMC8065274 DOI: 10.1016/j.ijcha.2021.100773] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Revised: 03/11/2021] [Accepted: 03/23/2021] [Indexed: 12/13/2022]
Abstract
Objective The partnership between humans and machines can enhance clinical decisions accuracy, leading to improved patient outcomes. Despite this, the application of machine learning techniques in the healthcare sector, particularly in guiding heart failure patient management, remains unpopular. This systematic review aims to identify factors restricting the integration of machine learning derived risk scores into clinical practice when treating adults with acute and chronic heart failure. Methods Four academic research databases and Google Scholar were searched to identify original research studies where heart failure patient data was used to build models predicting all-cause mortality, cardiac death, all-cause and heart failure-related hospitalization. Results Thirty studies met the inclusion criteria. The selected studies' sample size ranged between 71 and 716 790 patients, and the median age was 72.1 (interquartile range: 61.1–76.8) years. The minimum and maximum area under the receiver operating characteristic curve (AUC) for models predicting mortality were 0.48 and 0.92, respectively. Models predicting hospitalization had an AUC of 0.47 to 0.84. Nineteen studies (63%) used logistic regression, 53% random forests, and 37% of studies used decision trees to build predictive models. None of the models were built or externally validated using data originating from Africa or the Middle-East. Conclusions The variation in the aetiologies of heart failure, limited access to structured health data, distrust in machine learning techniques among clinicians and the modest accuracy of existing predictive models are some of the factors precluding the widespread use of machine learning derived risk calculators.
Collapse
|
15
|
Marrow BA, Cook SA, Prasad SK, McCann GP. Emerging Techniques for Risk Stratification in Nonischemic Dilated Cardiomyopathy: JACC Review Topic of the Week. J Am Coll Cardiol 2020; 75:1196-1207. [PMID: 32164893 DOI: 10.1016/j.jacc.2019.12.058] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Accepted: 12/04/2019] [Indexed: 02/06/2023]
Abstract
Dilated cardiomyopathy (DCM) is a common condition, which carries significant mortality from sudden cardiac death and pump failure. Left ventricular ejection fraction has conventionally been used as a risk marker for sudden cardiac death, but has performed poorly in trials. There have been significant advances in the areas of cardiac magnetic resonance imaging and genetics, which are able to provide useful rick prediction in DCM. Biomarkers and cardiopulmonary exercise testing are well validated in the prediction of risk in heart failure; however, they have been tested less specifically in the DCM setting. This review will discuss these methods with a view toward multiparametric risk assessment in DCM with the hope of creating parametric risk models to predict sudden cardiac death and pump failure in the DCM population.
Collapse
Affiliation(s)
- Benjamin A Marrow
- Department of Cardiovascular Sciences, University of Leicester and the National Institute for Health Research (NIHR) Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, United Kingdom
| | - Stuart A Cook
- Department of Cardiovascular Medicine, National Heart & Lung Institute, Imperial College, London, United Kingdom; Department of Cardiology, National Heart Centre Singapore, Singapore
| | - Sanjay K Prasad
- Department of Cardiovascular Medicine, National Heart & Lung Institute, Imperial College, London, United Kingdom
| | - Gerry P McCann
- Department of Cardiovascular Sciences, University of Leicester and the National Institute for Health Research (NIHR) Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, United Kingdom.
| |
Collapse
|
16
|
Abstract
Artificial intelligence (AI) is entering the clinical arena, and in the early stage, its implementation will be focused on the automatization tasks, improving diagnostic accuracy and reducing reading time. Many studies investigate the potential role of AI to support cardiac radiologist in their day-to-day tasks, assisting in segmentation, quantification, and reporting tasks. In addition, AI algorithms can be also utilized to optimize image reconstruction and image quality. Since these algorithms will play an important role in the field of cardiac radiology, it is increasingly important for radiologists to be familiar with the potential applications of AI. The main focus of this article is to provide an overview of cardiac-related AI applications for CT and MRI studies, as well as non-imaging-based applications for reporting and image optimization.
Collapse
|
17
|
Dziewięcka E, Gliniak M, Winiarczyk M, Karapetyan A, Wiśniowska-Śmiałek S, Karabinowska A, Dziewięcki M, Podolec P, Rubiś P. Mortality risk in dilated cardiomyopathy: the accuracy of heart failure prognostic models and dilated cardiomyopathy-tailored prognostic model. ESC Heart Fail 2020; 7:2455-2467. [PMID: 32853471 PMCID: PMC7524139 DOI: 10.1002/ehf2.12809] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Revised: 04/04/2020] [Accepted: 05/14/2020] [Indexed: 12/28/2022] Open
Abstract
Aims The aims of this paper were to investigate the analytical performance of the nine prognostic scales commonly used in heart failure (HF), in patients with dilated cardiomyopathy (DCM), and to develop a unique prognostic model tailored to DCM patients. Methods and results The hospital and outpatient records of 406 DCM patients were retrospectively analysed. The information on patient status was gathered after 48.2 ± 32.0 months. Tests were carried out to ascertain the prognostic accuracy in DCM using some of the most frequently applied HF prognostic scales (Barcelona Bio‐Heart Failure, Candesartan in Heart Failure‐Assessment of Reduction in Mortality and Morbidity, Studio della Streptochinasi nell'Infarto Miocardico‐Heart Failure, Eplerenone in Mild Patients Hospitalization and Survival Study in Heart Failure, Meta‐Analysis Global Group in Chronic Heart Failure, MUerte Subita en Insuficiencia Cardiaca, Organized Program to Initiate Lifesaving Treatment in Hospitalized Patients With Heart Failure, Seattle Heart Failure Model) and one dedicated to DCM, that of Miura et al. At follow‐up, 70 DCM patients (17.2%) died. Most analysed scores substantially overestimated the mortality risk, especially in survivors. The prognostic accuracy of the scales were suboptimal, varying between 60% and 80%, with the best performance from Barcelona Bio‐Heart Failure and Seattle Heart Failure Model for 1–5 year mortality [areas under the receiver operating curve 0.792–0.890 (95% confidence interval 0.725–0.918) and 0.764–0.808 (95% confidence interval 0.682–0.934), respectively].Based on our accumulated data, a self‐developed DCM prognostic model was constructed. The model consists of age, gender, body mass index, symptoms duration, New York Heart Association class, diabetes mellitus, prior stroke, abnormal liver function, dyslipidaemia, left bundle branch block, left ventricle end‐diastolic diameter, ejection fraction, N terminal pro brain natriuretic peptide, haemoglobin, estimated glomerular filtration rate, and pharmacological and resynchronisation therapy. This newly created prognostic model outperformed the analysed HF scales. Conclusions An analysis of various HF prognostic models found them to be suboptimal for DCM patients. A self‐developed DCM prognostic model showed improved performance over the nine other models studied. However, further validation of the prognostic model in different DCM populations is required.
Collapse
Affiliation(s)
- Ewa Dziewięcka
- Department of Cardiac and Vascular Diseases, Jagiellonian University Collegium Medicum, John Paul II Hospital, Prądnicka Street 80, Kraków, 31-202, Poland
| | - Matylda Gliniak
- Jagiellonian University Collegium Medicum, Students' Scientific Group at the Department of Cardiac and Vascular Diseases, John Paul II Hospital, Krakow, Poland
| | - Mateusz Winiarczyk
- Jagiellonian University Collegium Medicum, Students' Scientific Group at the Department of Cardiac and Vascular Diseases, John Paul II Hospital, Krakow, Poland
| | - Arman Karapetyan
- Jagiellonian University Collegium Medicum, Students' Scientific Group at the Department of Cardiac and Vascular Diseases, John Paul II Hospital, Krakow, Poland
| | - Sylwia Wiśniowska-Śmiałek
- Department of Cardiac and Vascular Diseases, Jagiellonian University Collegium Medicum, John Paul II Hospital, Prądnicka Street 80, Kraków, 31-202, Poland
| | - Aleksandra Karabinowska
- Department of Cardiac and Vascular Diseases, Jagiellonian University Collegium Medicum, John Paul II Hospital, Prądnicka Street 80, Kraków, 31-202, Poland
| | | | - Piotr Podolec
- Department of Cardiac and Vascular Diseases, Jagiellonian University Collegium Medicum, John Paul II Hospital, Prądnicka Street 80, Kraków, 31-202, Poland
| | - Paweł Rubiś
- Department of Cardiac and Vascular Diseases, Jagiellonian University Collegium Medicum, John Paul II Hospital, Prądnicka Street 80, Kraków, 31-202, Poland
| |
Collapse
|
18
|
Martin-Isla C, Campello VM, Izquierdo C, Raisi-Estabragh Z, Baeßler B, Petersen SE, Lekadir K. Image-Based Cardiac Diagnosis With Machine Learning: A Review. Front Cardiovasc Med 2020; 7:1. [PMID: 32039241 PMCID: PMC6992607 DOI: 10.3389/fcvm.2020.00001] [Citation(s) in RCA: 75] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Accepted: 01/06/2020] [Indexed: 01/28/2023] Open
Abstract
Cardiac imaging plays an important role in the diagnosis of cardiovascular disease (CVD). Until now, its role has been limited to visual and quantitative assessment of cardiac structure and function. However, with the advent of big data and machine learning, new opportunities are emerging to build artificial intelligence tools that will directly assist the clinician in the diagnosis of CVDs. This paper presents a thorough review of recent works in this field and provide the reader with a detailed presentation of the machine learning methods that can be further exploited to enable more automated, precise and early diagnosis of most CVDs.
Collapse
Affiliation(s)
- Carlos Martin-Isla
- Departament de Matemàtiques & Informàtica, Universitat de Barcelona, Barcelona, Spain
| | - Victor M Campello
- Departament de Matemàtiques & Informàtica, Universitat de Barcelona, Barcelona, Spain
| | - Cristian Izquierdo
- Departament de Matemàtiques & Informàtica, Universitat de Barcelona, Barcelona, Spain
| | - Zahra Raisi-Estabragh
- Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom.,William Harvey Research Institute, Queen Mary University of London, London, United Kingdom
| | - Bettina Baeßler
- Department of Diagnostic & Interventional Radiology, University Hospital Zurich, Zurich, Switzerland
| | - Steffen E Petersen
- Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom.,William Harvey Research Institute, Queen Mary University of London, London, United Kingdom
| | - Karim Lekadir
- Departament de Matemàtiques & Informàtica, Universitat de Barcelona, Barcelona, Spain
| |
Collapse
|