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Sengupta PP, Kluin J, Lee SP, Oh JK, Smits AIPM. The future of valvular heart disease assessment and therapy. Lancet 2024; 403:1590-1602. [PMID: 38554727 DOI: 10.1016/s0140-6736(23)02754-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Revised: 08/15/2023] [Accepted: 12/06/2023] [Indexed: 04/02/2024]
Abstract
Valvular heart disease (VHD) is becoming more prevalent in an ageing population, leading to challenges in diagnosis and management. This two-part Series offers a comprehensive review of changing concepts in VHD, covering diagnosis, intervention timing, novel management strategies, and the current state of research. The first paper highlights the remarkable progress made in imaging and transcatheter techniques, effectively addressing the treatment paradox wherein populations at the highest risk of VHD often receive the least treatment. These advances have attracted the attention of clinicians, researchers, engineers, device manufacturers, and investors, leading to the exploration and proposal of treatment approaches grounded in pathophysiology and multidisciplinary strategies for VHD management. This Series paper focuses on innovations involving computational, pharmacological, and bioengineering approaches that are transforming the diagnosis and management of patients with VHD. Artificial intelligence and digital methods are enhancing screening, diagnosis, and planning procedures, and the integration of imaging and clinical data is improving the classification of VHD severity. The emergence of artificial intelligence techniques, including so-called digital twins-eg, computer-generated replicas of the heart-is aiding the development of new strategies for enhanced risk stratification, prognostication, and individualised therapeutic targeting. Various new molecular targets and novel pharmacological strategies are being developed, including multiomics-ie, analytical methods used to integrate complex biological big data to find novel pathways to halt the progression of VHD. In addition, efforts have been undertaken to engineer heart valve tissue and provide a living valve conduit capable of growth and biological integration. Overall, these advances emphasise the importance of early detection, personalised management, and cutting-edge interventions to optimise outcomes amid the evolving landscape of VHD. Although several challenges must be overcome, these breakthroughs represent opportunities to advance patient-centred investigations.
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Affiliation(s)
- Partho P Sengupta
- Division of Cardiovascular Diseases and Hypertension, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA; Cardiovascular Services, Robert Wood Johnson University Hospital, New Brunswick, NJ, USA.
| | - Jolanda Kluin
- Department of Cardiothoracic Surgery, Erasmus MC Rotterdam, Thorax Center, Rotterdam, Netherlands
| | - Seung-Pyo Lee
- Department of Internal Medicine, Seoul National University Hospital and Seoul National University College of Medicine, Seoul, South Korea
| | - Jae K Oh
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | - Anthal I P M Smits
- Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, Netherlands; Institute for Complex Molecular Systems, Eindhoven University of Technology, Eindhoven, Netherlands
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2
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Myasoedova VA, Chiesa M, Cosentino N, Bonomi A, Ludergnani M, Bozzi M, Valerio V, Moschetta D, Massaiu I, Mantegazza V, Marenzi G, Poggio P. Non-stenotic fibro-calcific aortic valve as a predictor of myocardial infarction recurrence. Eur J Prev Cardiol 2024:zwae062. [PMID: 38365224 DOI: 10.1093/eurjpc/zwae062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Revised: 02/07/2024] [Accepted: 02/12/2024] [Indexed: 02/18/2024]
Abstract
BACKGROUND Patients with acute myocardial infarction (AMI) are at increased risk of recurrent cardiovascular events. Non-stenotic aortic valve fibro-calcific remodeling (AVSc), reflecting systemic damage, may serve as a new marker of risk. OBJECTIVES To stratify subgroups of AMI patients with specific probabilities of recurrent AMI and to evaluate the importance of AVSc in this setting. METHODS Consecutive AMI patients (n = 2530) were admitted at Centro Cardiologico Monzino (2010-2019) and followed up for 5 years. Patients were divided into study (n = 1070) and test (n = 966) cohorts. Topological data analysis (TDA) was used to stratify patient subgroups, while Kaplan-Meier and Cox regressions analyses were used to evaluate the significance of baseline characteristics. RESULTS TDA identified 11 subgroups of AMI patients with specific baseline characteristics. Two subgroups showed the highest rate of reinfarction after 5 years from the indexed AMI with a combined hazard ratio (HR) of 3.8 (95%CI: 2.7-5.4) compared to the other subgroups. This was confirmed in the test cohort (HR = 3.1; 95%CI: 2.2-4.3). These two subgroups were mostly men, with hypertension and dyslipidemia, who exhibit higher prevalence of AVSc, higher levels of high-sensitive c-reactive protein and creatinine. In the year-by-year analysis, AVSc, adjusted for all confounders, showed an independent association with the increased risk of reinfarction (odds ratio of ∼2 at all time-points), in both the study and the test cohorts (all p < 0.01). CONCLUSIONS AVSc is a crucial variable for identifying AMI patients at high risk of recurrent AMI and its presence should be considered when assessing the management of AMI patients. The inclusion of AVSc in risk stratification models may improve the accuracy of predicting the likelihood of recurrent AMI, leading to more personalized treatment decisions.
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Affiliation(s)
| | - Mattia Chiesa
- Centro Cardiologico Monzino, IRCCS, Milan Italy
- Department of Electronics, Information and Biomedical engineering, Politecnico di Milano, Milan, Italy
| | - Nicola Cosentino
- Centro Cardiologico Monzino, IRCCS, Milan Italy
- Department of Clinical Sciences and Community Health, Cardiovascular Section, University of Milan, Milan, Italy
| | | | | | | | | | | | | | - Valentina Mantegazza
- Centro Cardiologico Monzino, IRCCS, Milan Italy
- Department of Clinical Sciences and Community Health, Cardiovascular Section, University of Milan, Milan, Italy
| | | | - Paolo Poggio
- Centro Cardiologico Monzino, IRCCS, Milan Italy
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milano, Italy
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3
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Sengupta PP, Chandrashekhar Y. Advancing Myocardial Tissue Analysis Using Echocardiography. JACC Cardiovasc Imaging 2024; 17:228-231. [PMID: 38325962 DOI: 10.1016/j.jcmg.2024.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/09/2024]
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4
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Schwertner WR, Tokodi M, Veres B, Behon A, Merkel ED, Masszi R, Kuthi L, Szijártó Á, Kovács A, Osztheimer I, Zima E, Gellér L, Vámos M, Sághy L, Merkely B, Kosztin A, Becker D. Phenogrouping and risk stratification of patients undergoing cardiac resynchronization therapy upgrade using topological data analysis. Sci Rep 2023; 13:20594. [PMID: 37996448 PMCID: PMC10667223 DOI: 10.1038/s41598-023-47092-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 11/09/2023] [Indexed: 11/25/2023] Open
Abstract
Choosing the optimal device during cardiac resynchronization therapy (CRT) upgrade can be challenging. Therefore, we sought to provide a solution for identifying patients in whom upgrading to a CRT-defibrillator (CRT-D) is associated with better long-term survival than upgrading to a CRT-pacemaker (CRT-P). To this end, we first applied topological data analysis to create a patient similarity network using 16 clinical features of 326 patients without prior ventricular arrhythmias who underwent CRT upgrade. Then, in the generated circular network, we delineated three phenogroups exhibiting significant differences in clinical characteristics and risk of all-cause mortality. Importantly, only in the high-risk phenogroup was upgrading to a CRT-D associated with better survival than upgrading to a CRT-P (hazard ratio: 0.454 (0.228-0.907), p = 0.025). Finally, we assigned each patient to one of the three phenogroups based on their location in the network and used this labeled data to train multi-class classifiers to enable the risk stratification of new patients. During internal validation, an ensemble of 5 multi-layer perceptrons exhibited the best performance with a balanced accuracy of 0.898 (0.854-0.942) and a micro-averaged area under the receiver operating characteristic curve of 0.983 (0.980-0.986). To allow further validation, we made the proposed model publicly available ( https://github.com/tokmarton/crt-upgrade-risk-stratification ).
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Affiliation(s)
| | - Márton Tokodi
- Heart and Vascular Center, Semmelweis University, 68 Városmajor Street, 1122, Budapest, Hungary
| | - Boglárka Veres
- Heart and Vascular Center, Semmelweis University, 68 Városmajor Street, 1122, Budapest, Hungary
| | - Anett Behon
- Heart and Vascular Center, Semmelweis University, 68 Városmajor Street, 1122, Budapest, Hungary
| | - Eperke Dóra Merkel
- Heart and Vascular Center, Semmelweis University, 68 Városmajor Street, 1122, Budapest, Hungary
| | - Richárd Masszi
- Heart and Vascular Center, Semmelweis University, 68 Városmajor Street, 1122, Budapest, Hungary
| | - Luca Kuthi
- Heart and Vascular Center, Semmelweis University, 68 Városmajor Street, 1122, Budapest, Hungary
| | - Ádám Szijártó
- Heart and Vascular Center, Semmelweis University, 68 Városmajor Street, 1122, Budapest, Hungary
| | - Attila Kovács
- Heart and Vascular Center, Semmelweis University, 68 Városmajor Street, 1122, Budapest, Hungary
| | - István Osztheimer
- Heart and Vascular Center, Semmelweis University, 68 Városmajor Street, 1122, Budapest, Hungary
| | - Endre Zima
- Heart and Vascular Center, Semmelweis University, 68 Városmajor Street, 1122, Budapest, Hungary
| | - László Gellér
- Heart and Vascular Center, Semmelweis University, 68 Városmajor Street, 1122, Budapest, Hungary
| | - Máté Vámos
- Cardiac Electrophysiology Division, Department of Internal Medicine, University of Szeged, Szeged, Hungary
| | - László Sághy
- Cardiac Electrophysiology Division, Department of Internal Medicine, University of Szeged, Szeged, Hungary
| | - Béla Merkely
- Heart and Vascular Center, Semmelweis University, 68 Városmajor Street, 1122, Budapest, Hungary.
| | - Annamária Kosztin
- Heart and Vascular Center, Semmelweis University, 68 Városmajor Street, 1122, Budapest, Hungary
| | - Dávid Becker
- Heart and Vascular Center, Semmelweis University, 68 Városmajor Street, 1122, Budapest, Hungary
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Sulaiman S, Kawsara A, El Sabbagh A, Mahayni AA, Gulati R, Rihal CS, Alkhouli M. Machine learning vs. conventional methods for prediction of 30-day readmission following percutaneous mitral edge-to-edge repair. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2023; 56:18-24. [PMID: 37248108 PMCID: PMC10762683 DOI: 10.1016/j.carrev.2023.05.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 05/12/2023] [Accepted: 05/15/2023] [Indexed: 05/31/2023]
Abstract
BACKGROUND Identifying predictors of readmissions after mitral valve transcatheter edge-to-edge repair (MV-TEER) is essential for risk stratification and optimization of clinical outcomes. AIMS We investigated the performance of machine learning [ML] algorithms vs. logistic regression in predicting readmissions after MV-TEER. METHODS We utilized the National-Readmission-Database to identify patients who underwent MV-TEER between 2015 and 2018. The database was randomly split into training (70 %) and testing (30 %) sets. Lasso regression was used to remove non-informative variables and rank informative ones. The top 50 informative predictors were tested using 4 ML models: ML-logistic regression [LR], Naive Bayes [NB], random forest [RF], and artificial neural network [ANN]/For comparison, we used a traditional statistical method (principal component analysis logistic regression PCA-LR). RESULTS A total of 9425 index hospitalizations for MV-TEER were included. Overall, the 30-day readmission rate was 14.6 %, and heart failure was the most common cause of readmission (32 %). The readmission cohort had a higher burden of comorbidities (median Elixhauser score 5 vs. 3) and frailty score (3.7 vs. 2.9), longer hospital stays (3 vs. 2 days), and higher rates of non-home discharges (17.4 % vs. 8.5 %). The traditional PCA-LR model yielded a modest predictive value (area under the curve [AUC] 0.615 [0.587-0.644]). Two ML algorithms demonstrated superior performance than the traditional PCA-LR model; ML-LR (AUC 0.692 [0.667-0.717]), and NB (AUC 0.724 [0.700-0.748]). RF (AUC 0.62 [0.592-0.677]) and ANN (0.65 [0.623-0.677]) had modest performance. CONCLUSION Machine learning algorithms may provide a useful tool for predicting readmissions after MV-TEER using administrative databases.
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Affiliation(s)
- Samian Sulaiman
- Division of Cardiology, West Virginia University, Morgantown, WV, United States of America.
| | - Akram Kawsara
- Division of Cardiology, West Virginia University, Morgantown, WV, United States of America
| | - Abdallah El Sabbagh
- Department of Cardiovascular Disease, Mayo Clinic, Jacksonville, FL, United States of America
| | - Abdulah Amer Mahayni
- Department of Cardiovascular Disease, Mayo Clinic, Rochester, MN, United States of America
| | - Rajiv Gulati
- Department of Cardiovascular Disease, Mayo Clinic, Rochester, MN, United States of America
| | - Charanjit S Rihal
- Department of Cardiovascular Disease, Mayo Clinic, Rochester, MN, United States of America
| | - Mohamad Alkhouli
- Department of Cardiovascular Disease, Mayo Clinic, Rochester, MN, United States of America
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Bernard J, Yanamala N, Shah R, Seetharam K, Altes A, Dupuis M, Toubal O, Mahjoub H, Dumortier H, Tartar J, Salaun E, O'Connor K, Bernier M, Beaudoin J, Côté N, Vincentelli A, LeVen F, Maréchaux S, Pibarot P, Sengupta PP. Integrating Echocardiography Parameters With Explainable Artificial Intelligence for Data-Driven Clustering of Primary Mitral Regurgitation Phenotypes. JACC Cardiovasc Imaging 2023; 16:1253-1267. [PMID: 37178071 DOI: 10.1016/j.jcmg.2023.02.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 01/20/2023] [Accepted: 02/09/2023] [Indexed: 05/15/2023]
Abstract
BACKGROUND Primary mitral regurgitation (MR) is a heterogeneous clinical disease requiring integration of echocardiographic parameters using guideline-driven recommendations to identify severe disease. OBJECTIVES The purpose of this preliminary study was to explore novel data-driven approaches to delineate phenotypes of MR severity that benefit from surgery. METHODS The authors used unsupervised and supervised machine learning and explainable artificial intelligence (AI) to integrate 24 echocardiographic parameters in 400 primary MR subjects from France (n = 243; development cohort) and Canada (n = 157; validation cohort) followed up during a median time of 3.2 years (IQR: 1.3-5.3 years) and 6.8 (IQR: 4.0-8.5 years), respectively. The authors compared the phenogroups' incremental prognostic value over conventional MR profiles and for the primary endpoint of all-cause mortality incorporating time-to-mitral valve repair/replacement surgery as a covariate for survival analysis (time-dependent exposure). RESULTS High-severity (HS) phenogroups from the French cohort (HS: n = 117; low-severity [LS]: n = 126) and the Canadian cohort (HS: n = 87; LS: n = 70) showed improved event-free survival in surgical HS subjects over nonsurgical subjects (P = 0.047 and P = 0.020, respectively). A similar benefit of surgery was not seen in the LS phenogroup in both cohorts (P = 0.70 and P = 0.50, respectively). Phenogrouping showed incremental prognostic value in conventionally severe or moderate-severe MR subjects (Harrell C statistic improvement; P = 0.480; and categorical net reclassification improvement; P = 0.002). Explainable AI specified how each echocardiographic parameter contributed to phenogroup distribution. CONCLUSIONS Novel data-driven phenogrouping and explainable AI aided in improved integration of echocardiographic data to identify patients with primary MR and improved event-free survival after mitral valve repair/replacement surgery.
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Affiliation(s)
- Jérémy Bernard
- Institut Universitaire de Cardiologie et de Pneumologie de Québec-Université Laval/Québec Heart and Lung Institute, Laval University, Québec City, Québec, Canada
| | - Naveena Yanamala
- Robert Wood Johnson University Hospital, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
| | - Rohan Shah
- Robert Wood Johnson University Hospital, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
| | - Karthik Seetharam
- Robert Wood Johnson University Hospital, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
| | - Alexandre Altes
- Department of Cardiology, GCS-Groupement des Hôpitaux de l'Institut Catholique de Lille, Université Catholique de Lille, Lille, France
| | - Marlène Dupuis
- Institut Universitaire de Cardiologie et de Pneumologie de Québec-Université Laval/Québec Heart and Lung Institute, Laval University, Québec City, Québec, Canada
| | - Oumhani Toubal
- Institut Universitaire de Cardiologie et de Pneumologie de Québec-Université Laval/Québec Heart and Lung Institute, Laval University, Québec City, Québec, Canada
| | - Haïfa Mahjoub
- Institut Universitaire de Cardiologie et de Pneumologie de Québec-Université Laval/Québec Heart and Lung Institute, Laval University, Québec City, Québec, Canada
| | - Hélène Dumortier
- Department of Cardiology, GCS-Groupement des Hôpitaux de l'Institut Catholique de Lille, Université Catholique de Lille, Lille, France
| | - Jean Tartar
- Department of Cardiology, GCS-Groupement des Hôpitaux de l'Institut Catholique de Lille, Université Catholique de Lille, Lille, France
| | - Erwan Salaun
- Institut Universitaire de Cardiologie et de Pneumologie de Québec-Université Laval/Québec Heart and Lung Institute, Laval University, Québec City, Québec, Canada
| | - Kim O'Connor
- Institut Universitaire de Cardiologie et de Pneumologie de Québec-Université Laval/Québec Heart and Lung Institute, Laval University, Québec City, Québec, Canada
| | - Mathieu Bernier
- Institut Universitaire de Cardiologie et de Pneumologie de Québec-Université Laval/Québec Heart and Lung Institute, Laval University, Québec City, Québec, Canada
| | - Jonathan Beaudoin
- Institut Universitaire de Cardiologie et de Pneumologie de Québec-Université Laval/Québec Heart and Lung Institute, Laval University, Québec City, Québec, Canada
| | - Nancy Côté
- Institut Universitaire de Cardiologie et de Pneumologie de Québec-Université Laval/Québec Heart and Lung Institute, Laval University, Québec City, Québec, Canada
| | - André Vincentelli
- Cardiac Surgery Department, Centre Hospitalier Régional et Universitaire de Lille, Lille, France
| | - Florent LeVen
- Department of Cardiology, Hôpital La Cavale Blanche-Centre Hospitalier Regional Universitaire de Brest, Brest, France
| | - Sylvestre Maréchaux
- Department of Cardiology, GCS-Groupement des Hôpitaux de l'Institut Catholique de Lille, Université Catholique de Lille, Lille, France
| | - Philippe Pibarot
- Institut Universitaire de Cardiologie et de Pneumologie de Québec-Université Laval/Québec Heart and Lung Institute, Laval University, Québec City, Québec, Canada.
| | - Partho P Sengupta
- Robert Wood Johnson University Hospital, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA.
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Veres B, Schwertner WR, Tokodi M, Szijártó Á, Kovács A, Merkel ED, Behon A, Kuthi L, Masszi R, Gellér L, Zima E, Molnár L, Osztheimer I, Becker D, Kosztin A, Merkely B. Topological data analysis to identify cardiac resynchronization therapy patients exhibiting benefit from an implantable cardioverter-defibrillator. Clin Res Cardiol 2023:10.1007/s00392-023-02281-6. [PMID: 37624394 DOI: 10.1007/s00392-023-02281-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 07/28/2023] [Indexed: 08/26/2023]
Abstract
BACKGROUND Current guidelines recommend considering multiple factors while deciding between cardiac resynchronization therapy with a defibrillator (CRT-D) or a pacemaker (CRT-P). Nevertheless, it is still challenging to pinpoint those candidates who will benefit from choosing a CRT-D device in terms of survival. OBJECTIVE We aimed to use topological data analysis (TDA) to identify phenogroups of CRT patients in whom CRT-D is associated with better survival than CRT-P. METHODS We included 2603 patients who underwent CRT-D (54%) or CRT-P (46%) implantation at Semmelweis University between 2000 and 2018. The primary endpoint was all-cause mortality. We applied TDA to create a patient similarity network using 25 clinical features. Then, we identified multiple phenogroups in the generated network and compared the groups' clinical characteristics and survival. RESULTS Five- and 10-year mortality were 43 (40-46)% and 71 (67-74)% in patients with CRT-D and 48 (45-50)% and 71 (68-74)% in those with CRT-P, respectively. TDA created a circular network in which we could delineate five phenogroups showing distinct patterns of clinical characteristics and outcomes. Three phenogroups (1, 2, and 3) included almost exclusively patients with non-ischemic etiology, whereas the other two phenogroups (4 and 5) predominantly comprised ischemic patients. Interestingly, only in phenogroups 2 and 5 were CRT-D associated with better survival than CRT-P (adjusted hazard ratio 0.61 [0.47-0.80], p < 0.001 and adjusted hazard ratio 0.84 [0.71-0.99], p = 0.033, respectively). CONCLUSIONS By simultaneously evaluating various clinical features, TDA may identify patients with either ischemic or non-ischemic etiology who will most likely benefit from the implantation of a CRT-D instead of a CRT-P. Topological data analysis to identify phenogroups of CRT patients in whom CRT-D is associated with better survival than CRT-P. AF atrial fibrillation, CRT cardiac resynchronization therapy, CRT-D cardiac resynchronization therapy defibrillator, CRT-P cardiac resynchronization therapy pacemaker, DM diabetes mellitus, HTN hypertension, LBBB left bundle branch block, LVEF left ventricular ejection fraction, MDS multidimensional scaling, MRA mineralocorticoid receptor antagonist, NYHA New York Heart Association.
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Affiliation(s)
- Boglárka Veres
- Heart and Vascular Center, Semmelweis University, Városmajor Str. 68, 1122, Budapest, Hungary
| | | | - Márton Tokodi
- Heart and Vascular Center, Semmelweis University, Városmajor Str. 68, 1122, Budapest, Hungary
| | - Ádám Szijártó
- Heart and Vascular Center, Semmelweis University, Városmajor Str. 68, 1122, Budapest, Hungary
| | - Attila Kovács
- Heart and Vascular Center, Semmelweis University, Városmajor Str. 68, 1122, Budapest, Hungary
| | - Eperke Dóra Merkel
- Heart and Vascular Center, Semmelweis University, Városmajor Str. 68, 1122, Budapest, Hungary
| | - Anett Behon
- Heart and Vascular Center, Semmelweis University, Városmajor Str. 68, 1122, Budapest, Hungary
| | - Luca Kuthi
- Heart and Vascular Center, Semmelweis University, Városmajor Str. 68, 1122, Budapest, Hungary
| | - Richárd Masszi
- Heart and Vascular Center, Semmelweis University, Városmajor Str. 68, 1122, Budapest, Hungary
| | - László Gellér
- Heart and Vascular Center, Semmelweis University, Városmajor Str. 68, 1122, Budapest, Hungary
| | - Endre Zima
- Heart and Vascular Center, Semmelweis University, Városmajor Str. 68, 1122, Budapest, Hungary
| | - Levente Molnár
- Heart and Vascular Center, Semmelweis University, Városmajor Str. 68, 1122, Budapest, Hungary
| | - István Osztheimer
- Heart and Vascular Center, Semmelweis University, Városmajor Str. 68, 1122, Budapest, Hungary
| | - Dávid Becker
- Heart and Vascular Center, Semmelweis University, Városmajor Str. 68, 1122, Budapest, Hungary
| | - Annamária Kosztin
- Heart and Vascular Center, Semmelweis University, Városmajor Str. 68, 1122, Budapest, Hungary
| | - Béla Merkely
- Heart and Vascular Center, Semmelweis University, Városmajor Str. 68, 1122, Budapest, Hungary.
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Strange G, Stewart S, Watts A, Playford D. Enhanced detection of severe aortic stenosis via artificial intelligence: a clinical cohort study. Open Heart 2023; 10:e002265. [PMID: 37491129 PMCID: PMC10373677 DOI: 10.1136/openhrt-2023-002265] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 06/30/2023] [Indexed: 07/27/2023] Open
Abstract
OBJECTIVE We developed an artificial intelligence decision support algorithm (AI-DSA) that uses routine echocardiographic measurements to identify severe aortic stenosis (AS) phenotypes associated with high mortality. METHODS 631 824 individuals with 1.08 million echocardiograms were randomly spilt into two groups. Data from 442 276 individuals (70%) entered a Mixture Density Network (MDN) model to train an AI-DSA to predict an aortic valve area <1 cm2, excluding all left ventricular outflow tract velocity or dimension measurements and then using the remainder of echocardiographic measurement data. The optimal probability threshold for severe AS detection was identified at the f1 score probability of 0.235. An automated feature also ensured detection of guideline-defined severe AS. The AI-DSA's performance was independently evaluated in 184 301 (30%) individuals. RESULTS The area under receiver operating characteristic curve for the AI-DSA to detect severe AS was 0.986 (95% CI 0.985 to 0.987) with 4622/88 199 (5.2%) individuals (79.0±11.9 years, 52.4% women) categorised as 'high-probability' severe AS. Of these, 3566 (77.2%) met guideline-defined severe AS. Compared with the AI-derived low-probability AS group (19.2% mortality), the age-adjusted and sex-adjusted OR for actual 5-year mortality was 2.41 (95% CI 2.13 to 2.73) in the high probability AS group (67.9% mortality)-5-year mortality being slightly higher in those with guideline-defined severe AS (69.1% vs 64.4%; age-adjusted and sex-adjusted OR 1.26 (95% CI 1.04 to 1.53), p=0.021). CONCLUSIONS An AI-DSA can identify the echocardiographic measurement characteristics of AS associated with poor survival (with not all cases guideline defined). Deployment of this tool in routine clinical practice could improve expedited identification of severe AS cases and more timely referral for therapy.
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Affiliation(s)
- Geoff Strange
- Cardiology, Heart Research Institute Ltd, Newtown, New South Wales, Australia
- The University of Notre Dame Australia, School of Medicine, Fremantle, Western Australia, Australia
| | - Simon Stewart
- Institute for Health Research, The University of Notre Dame Australia, Fremantle, Western Australia, Australia
- School of Medicine, Dentistry & Nursing, University of Glasgow, Glasgow, UK
| | - Andrew Watts
- Echo IQ Pty Ltd, Sydney, New South Wales, Australia
| | - David Playford
- School of Medicine, The University of Notre Dame Australia, Fremantle, Western Australia, Australia
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9
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Prandi FR, Lerakis S, Belli M, Illuminato F, Margonato D, Barone L, Muscoli S, Chiocchi M, Laudazi M, Marchei M, Di Luozzo M, Kini A, Romeo F, Barillà F. Advances in Imaging for Tricuspid Transcatheter Edge-to-Edge Repair: Lessons Learned and Future Perspectives. J Clin Med 2023; 12:jcm12103384. [PMID: 37240489 DOI: 10.3390/jcm12103384] [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: 03/22/2023] [Revised: 04/20/2023] [Accepted: 05/08/2023] [Indexed: 05/28/2023] Open
Abstract
Severe tricuspid valve (TV) regurgitation (TR) has been associated with adverse long-term outcomes in several natural history studies, but isolated TV surgery presents high mortality and morbidity rates. Transcatheter tricuspid valve interventions (TTVI) therefore represent a promising field and may currently be considered in patients with severe secondary TR that have a prohibitive surgical risk. Tricuspid transcatheter edge-to-edge repair (T-TEER) represents one of the most frequently used TTVI options. Accurate imaging of the tricuspid valve (TV) apparatus is crucial for T-TEER preprocedural planning, in order to select the right candidates, and is also fundamental for intraprocedural guidance and post-procedural follow-up. Although transesophageal echocardiography represents the main imaging modality, we describe the utility and additional value of other imaging modalities such as cardiac CT and MRI, intracardiac echocardiography, fluoroscopy, and fusion imaging to assist T-TEER. Developments in the field of 3D printing, computational models, and artificial intelligence hold great promise in improving the assessment and management of patients with valvular heart disease.
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Affiliation(s)
- Francesca Romana Prandi
- Division of Cardiology, Department of Systems Medicine, Tor Vergata University, 00133 Rome, Italy
- Department of Cardiology, Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Stamatios Lerakis
- Department of Cardiology, Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Martina Belli
- Division of Cardiology, Department of Systems Medicine, Tor Vergata University, 00133 Rome, Italy
- Cardiovascular Imaging Unit, San Raffaele Scientific Institute, 20132 Milan, Italy
| | - Federica Illuminato
- Division of Cardiology, Department of Systems Medicine, Tor Vergata University, 00133 Rome, Italy
| | - Davide Margonato
- Cardiovascular Imaging Unit, San Raffaele Scientific Institute, 20132 Milan, Italy
| | - Lucy Barone
- Division of Cardiology, Department of Systems Medicine, Tor Vergata University, 00133 Rome, Italy
| | - Saverio Muscoli
- Division of Cardiology, Department of Systems Medicine, Tor Vergata University, 00133 Rome, Italy
| | - Marcello Chiocchi
- Department of Diagnostic Imaging and Interventional Radiology, Tor Vergata University, 00133 Rome, Italy
| | - Mario Laudazi
- Department of Diagnostic Imaging and Interventional Radiology, Tor Vergata University, 00133 Rome, Italy
| | - Massimo Marchei
- Division of Cardiology, Department of Systems Medicine, Tor Vergata University, 00133 Rome, Italy
| | - Marco Di Luozzo
- Division of Cardiology, Department of Systems Medicine, Tor Vergata University, 00133 Rome, Italy
| | - Annapoorna Kini
- Department of Cardiology, Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Francesco Romeo
- Department of Departmental Faculty of Medicine, Unicamillus-Saint Camillus International University of Health and Medical Sciences, 00131 Rome, Italy
| | - Francesco Barillà
- Division of Cardiology, Department of Systems Medicine, Tor Vergata University, 00133 Rome, Italy
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10
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Singh Y, Farrelly CM, Hathaway QA, Leiner T, Jagtap J, Carlsson GE, Erickson BJ. Topological data analysis in medical imaging: current state of the art. Insights Imaging 2023; 14:58. [PMID: 37005938 PMCID: PMC10067000 DOI: 10.1186/s13244-023-01413-w] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Accepted: 03/22/2023] [Indexed: 04/04/2023] Open
Abstract
Machine learning, and especially deep learning, is rapidly gaining acceptance and clinical usage in a wide range of image analysis applications and is regarded as providing high performance in detecting anatomical structures and identification and classification of patterns of disease in medical images. However, there are many roadblocks to the widespread implementation of machine learning in clinical image analysis, including differences in data capture leading to different measurements, high dimensionality of imaging and other medical data, and the black-box nature of machine learning, with a lack of insight into relevant features. Techniques such as radiomics have been used in traditional machine learning approaches to model the mathematical relationships between adjacent pixels in an image and provide an explainable framework for clinicians and researchers. Newer paradigms, such as topological data analysis (TDA), have recently been adopted to design and develop innovative image analysis schemes that go beyond the abilities of pixel-to-pixel comparisons. TDA can automatically construct filtrations of topological shapes of image texture through a technique known as persistent homology (PH); these features can then be fed into machine learning models that provide explainable outputs and can distinguish different image classes in a computationally more efficient way, when compared to other currently used methods. The aim of this review is to introduce PH and its variants and to review TDA's recent successes in medical imaging studies.
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11
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Szabo L, Raisi-Estabragh Z, Salih A, McCracken C, Ruiz Pujadas E, Gkontra P, Kiss M, Maurovich-Horvath P, Vago H, Merkely B, Lee AM, Lekadir K, Petersen SE. Clinician's guide to trustworthy and responsible artificial intelligence in cardiovascular imaging. Front Cardiovasc Med 2022; 9:1016032. [PMID: 36426221 PMCID: PMC9681217 DOI: 10.3389/fcvm.2022.1016032] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 10/11/2022] [Indexed: 12/01/2023] Open
Abstract
A growing number of artificial intelligence (AI)-based systems are being proposed and developed in cardiology, driven by the increasing need to deal with the vast amount of clinical and imaging data with the ultimate aim of advancing patient care, diagnosis and prognostication. However, there is a critical gap between the development and clinical deployment of AI tools. A key consideration for implementing AI tools into real-life clinical practice is their "trustworthiness" by end-users. Namely, we must ensure that AI systems can be trusted and adopted by all parties involved, including clinicians and patients. Here we provide a summary of the concepts involved in developing a "trustworthy AI system." We describe the main risks of AI applications and potential mitigation techniques for the wider application of these promising techniques in the context of cardiovascular imaging. Finally, we show why trustworthy AI concepts are important governing forces of AI development.
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Affiliation(s)
- Liliana Szabo
- William Harvey Research Institute, NIHR Barts Biomedical Research Centre, Queen Mary University of London, London, United Kingdom
- Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, London, United Kingdom
- Semmelweis University Heart and Vascular Center, Budapest, Hungary
| | - Zahra Raisi-Estabragh
- William Harvey Research Institute, NIHR Barts Biomedical Research Centre, Queen Mary University of London, London, United Kingdom
- Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, London, United Kingdom
| | - Ahmed Salih
- William Harvey Research Institute, NIHR Barts Biomedical Research Centre, Queen Mary University of London, London, United Kingdom
- Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, London, United Kingdom
| | - Celeste McCracken
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, National Institute for Health Research Oxford Biomedical Research Centre, Oxford University Hospitals NHS Foundation Trust, University of Oxford, Oxford, United Kingdom
| | - Esmeralda Ruiz Pujadas
- Departament de Matemàtiques i Informàtica, Artificial Intelligence in Medicine Lab (BCN-AIM), Universitat de Barcelona, Barcelona, Spain
| | - Polyxeni Gkontra
- Departament de Matemàtiques i Informàtica, Artificial Intelligence in Medicine Lab (BCN-AIM), Universitat de Barcelona, Barcelona, Spain
| | - Mate Kiss
- Siemens Healthcare Hungary, Budapest, Hungary
| | - Pal Maurovich-Horvath
- Department of Radiology, Medical Imaging Centre, Semmelweis University, Budapest, Hungary
| | - Hajnalka Vago
- Semmelweis University Heart and Vascular Center, Budapest, Hungary
| | - Bela Merkely
- Semmelweis University Heart and Vascular Center, Budapest, Hungary
| | - Aaron M. Lee
- William Harvey Research Institute, NIHR Barts Biomedical Research Centre, Queen Mary University of London, London, United Kingdom
- Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, London, United Kingdom
| | - Karim Lekadir
- Departament de Matemàtiques i Informàtica, Artificial Intelligence in Medicine Lab (BCN-AIM), Universitat de Barcelona, Barcelona, Spain
| | - Steffen E. Petersen
- William Harvey Research Institute, NIHR Barts Biomedical Research Centre, Queen Mary University of London, London, United Kingdom
- Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, London, United Kingdom
- Health Data Research UK, London, United Kingdom
- Alan Turing Institute, London, United Kingdom
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12
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Lavine SJ, Raby K. Predictors of heart failure and all-cause mortality in asymptomatic patients with moderate and severe aortic regurgitation. Echocardiography 2022; 39:1219-1232. [PMID: 36039483 DOI: 10.1111/echo.15436] [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: 12/10/2021] [Revised: 07/18/2022] [Accepted: 07/26/2022] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Class I indications for aortic valve replacement (AVR) for severe chronic aortic regurgitation (AR) include AR attributable symptoms or left ventricular (LV) ejection fraction <50%. As noninvasive estimates of elevated LV filling pressures (LVFP's) have been noted to predict heart failure (HF) readmission and all-cause mortality (ACM) in HF patients, we hypothesize that elevated LVFP's may also be independent predictors of HF and ACM in chronic AR. METHODS We developed a single center patient database of moderate or greater AR diagnoses between 2003 and 2008 and followed each patient through January 2013. We included patients with >30 days follow-up with interpretable Doppler-echocardiograms. We recorded demographic variables, EuroScore II, incident HF and ACM, and Doppler-echo variables of LV size, systolic and diastolic function. RESULTS Patients with severe AR (105 patients) and moderate AR (201 patients) had similar EuroScore II values and similar incident HF and ACM. For the 180 patients who developed HF, effective arterial elastance (aHR = 1.70 (1.01-2.83), p = .041), LV end-diastolic dimension (aHR = 1.83, (1.11-3.03), p = .0176), E/e' (aHR = 3.04, (1.83-5.05), p < .0001), eccentric hypertrophy (EH) (aHR = 2.39, (1.62-5.12), p = .0004), and tricuspid regurgitation (TR) velocity (aHR = 5.75, (3.70-10.36), p < .0001) were independent predictors. For the 118 patients with ACM, EH (aHR = 1.73, (1.02-3.28), p = .0414), systolic blood pressure (aHR = .58, (.33-.95), p = .0301), left atrial volume index (aHR = 1.82, (1.06-3.06), p = .0293), E/e' (aHR = 1.83, (1.07-3.08), p = .0280), and TR velocity (aHR = 4.14, (2.22-6.49), p < .0001) were independent predictors. CONCLUSIONS Elevated TR velocity and EH were strong markers of HF and ACM in patients with asymptomatic severe AR and in moderate AR.
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Affiliation(s)
- Steven J Lavine
- Washington University of St. Louis, St. Louis, Missouri, USA.,UF Health-Jacksonville, Jacksonville, Florida, USA
| | - Kirsten Raby
- Quillen College of Medicine, East Tennessee State University, Johnson City, Tennessee, USA
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13
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Abstract
In this digital era, artificial intelligence (AI) is establishing a strong foothold in commercial industry and the field of technology. These effects are trickling into the healthcare industry, especially in the clinical arena of cardiology. Machine learning (ML) algorithms are making substantial progress in various subspecialties of cardiology. This will have a positive impact on patient care and move the field towards precision medicine. In this review article, we explore the progress of ML in cardiovascular imaging, electrophysiology, heart failure, and interventional cardiology.
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14
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Karakuş G, Değirmencioğlu A, Nanda NC. Artificial intelligence in echocardiography: Review and limitations including epistemological concerns. Echocardiography 2022; 39:1044-1053. [PMID: 35808922 DOI: 10.1111/echo.15417] [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: 04/08/2022] [Revised: 06/01/2022] [Accepted: 06/13/2022] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND AND PURPOSE In this review we describe the use of artificial intelligence in the field of echocardiography. Various aspects and terminologies used in artificial intelligence are explained in an easy-to-understand manner and supplemented with illustrations related to echocardiography. Limitations of artificial intelligence, including epistemologic concerns from a philosophical standpoint, are also discussed. METHODS A narrative review of relevant papers was conducted. CONCLUSION We provide an overview of the usefulness of artificial intelligence in echocardiography and focus on how it can supplement current day-to-day clinical practice in the assessment of various cardiovascular disease entities. On the other hand, there are significant limitations, including epistemological concerns, which need to be kept in perspective.
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Affiliation(s)
- Gültekin Karakuş
- Department of Cardiology, School of Medicine, Acibadem University, Istanbul, Turkey
| | - Aleks Değirmencioğlu
- Department of Cardiology, School of Medicine, Acibadem University, Istanbul, Turkey
| | - Navin C Nanda
- Division of Cardiology, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
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15
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Network Analysis of Cardiac Remodeling by Primary Mitral Regurgitation Emphasizes the Role of Diastolic Function. JACC Cardiovasc Imaging 2022; 15:974-986. [PMID: 35680229 DOI: 10.1016/j.jcmg.2021.12.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Revised: 12/20/2021] [Accepted: 12/23/2021] [Indexed: 01/25/2023]
Abstract
BACKGROUND Topological data analysis (TDA) can generate patient-patient similarity networks by analyzing large, complex data and derive new insights that may not be possible with standard statistics. OBJECTIVES The purpose of this paper was to discover novel phenotypes of chronic primary mitral regurgitation (MR) patients and to analyze their clinical implications using network analysis of echocardiographic data. METHODS Patients with chronic moderate to severe primary MR were prospectively enrolled from 11 Asian tertiary hospitals (n = 850; mean age 56.9 ± 14.2 years, 57.9% men). We performed TDA to generate network models using 14 demographic and echocardiographic variables. The patients were grouped by phenotypes in the network, and the prognosis was compared by groups. RESULTS The network model by TDA revealed 3 distinct phenogroups. Group A was the youngest with fewer comorbidities but increased left ventricular (LV) end-systolic volume, representing compensatory LV dilation commonly seen in chronic primary MR. Group B was the oldest with high blood pressure and a predominant diastolic dysfunction but relatively preserved LV size, an unnoticed phenotype in chronic primary MR. Group C showed advanced LV remodeling with impaired systolic, diastolic function, and LV dilation, indicating advanced chronic primary MR. During follow-up (median 3.5 years), 60 patients received surgery for symptomatic MR or died of cardiovascular causes. Kaplan-Meier curves demonstrated that although group C had the worst clinical outcome (P < 0.001), group B, characterized by diastolic dysfunction, had an event-free survival comparable to group A despite preserved LV chamber size. The grouping information by the network model was an independent predictor for the composite of MR surgery or cardiovascular death (adjusted HR: 1.918; 95% CI: 1.257-2.927; P = 0.003). CONCLUSIONS The patient-patient similarity network by TDA visualized diverse remodeling patterns in chronic primary MR and revealed distinct phenotypes not emphasized currently. Importantly, diastolic dysfunction deserves equal attention when understanding the clinical presentation of chronic primary MR.
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16
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Skaf Y, Laubenbacher R. Topological data analysis in biomedicine: A review. J Biomed Inform 2022; 130:104082. [PMID: 35508272 DOI: 10.1016/j.jbi.2022.104082] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 03/20/2022] [Accepted: 04/23/2022] [Indexed: 01/22/2023]
Abstract
Significant technological advances made in recent years have shepherded a dramatic increase in utilization of digital technologies for biomedicine- everything from the widespread use of electronic health records to improved medical imaging capabilities and the rising ubiquity of genomic sequencing contribute to a "digitization" of biomedical research and clinical care. With this shift toward computerized tools comes a dramatic increase in the amount of available data, and current tools for data analysis capable of extracting meaningful knowledge from this wealth of information have yet to catch up. This article seeks to provide an overview of emerging mathematical methods with the potential to improve the abilities of clinicians and researchers to analyze biomedical data, but may be hindered from doing so by a lack of conceptual accessibility and awareness in the life sciences research community. In particular, we focus on topological data analysis (TDA), a set of methods grounded in the mathematical field of algebraic topology that seeks to describe and harness features related to the "shape" of data. We aim to make such techniques more approachable to non-mathematicians by providing a conceptual discussion of their theoretical foundations followed by a survey of their published applications to scientific research. Finally, we discuss the limitations of these methods and suggest potential avenues for future work integrating mathematical tools into clinical care and biomedical informatics.
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Affiliation(s)
- Yara Skaf
- University of Florida, Department of Mathematics, Gainesville, FL, USA; University of Florida, Department of Medicine, Division of Pulmonary, Critical Care, & Sleep Medicine, Gainesville, FL, USA.
| | - Reinhard Laubenbacher
- University of Florida, Department of Mathematics, Gainesville, FL, USA; University of Florida, Department of Medicine, Division of Pulmonary, Critical Care, & Sleep Medicine, Gainesville, FL, USA.
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17
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Hung J, Passeri J. The Landscape of Primary Mitral Regurgitation Phenotypes: Smoothing the Terrain. JACC Cardiovasc Imaging 2022; 15:987-988. [PMID: 35680230 DOI: 10.1016/j.jcmg.2022.03.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 03/31/2022] [Indexed: 12/01/2022]
Affiliation(s)
- Judy Hung
- Division of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA.
| | - Jonathan Passeri
- Division of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
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18
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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]
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19
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Nedadur R, Wang B, Tsang W. Artificial intelligence for the echocardiographic assessment of valvular heart disease. Heart 2022; 108:1592-1599. [PMID: 35144983 PMCID: PMC9554049 DOI: 10.1136/heartjnl-2021-319725] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Accepted: 12/29/2021] [Indexed: 11/18/2022] Open
Abstract
Developments in artificial intelligence (AI) have led to an explosion of studies exploring its application to cardiovascular medicine. Due to the need for training and expertise, one area where AI could be impactful would be in the diagnosis and management of valvular heart disease. This is because AI can be applied to the multitude of data generated from clinical assessments, imaging and biochemical testing during the care of the patient. In the area of valvular heart disease, the focus of AI has been on the echocardiographic assessment and phenotyping of patient populations to identify high-risk groups. AI can assist image acquisition, view identification for review, and segmentation of valve and cardiac structures for automated analysis. Using image recognition algorithms, aortic and mitral valve disease states have been directly detected from the images themselves. Measurements obtained during echocardiographic valvular assessment have been integrated with other clinical data to identify novel aortic valve disease subgroups and describe new predictors of aortic valve disease progression. In the future, AI could integrate echocardiographic parameters with other clinical data for precision medical management of patients with valvular heart disease.
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Affiliation(s)
- Rashmi Nedadur
- Division of Cardiac Surgery, University of Toronto, Toronto, Ontario, Canada.,Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
| | - Bo Wang
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada.,Department of Computer Science, University of Toronto, Toronto, Ontario, Canada.,Vector Institute of Artificial Intelligence, University of Toronto, Toronto, Ontario, Canada.,Peter Munk Cardiac Center, University Health Network, Toronto, Ontario, Canada
| | - Wendy Tsang
- Peter Munk Cardiac Center, University Health Network, Toronto, Ontario, Canada .,Division of Cardiology, University of Toronto, Toronto, Ontario, Canada
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20
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Ito S, Oh JK. Aortic Stenosis: New Insights in Diagnosis, Treatment, and Prevention. Korean Circ J 2022; 52:721-736. [PMID: 36217595 PMCID: PMC9551229 DOI: 10.4070/kcj.2022.0234] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Accepted: 09/07/2022] [Indexed: 12/02/2022] Open
Abstract
There has been an explosion of diagnostic, prognostic, and treatment data in aortic stenosis (AS). Severity of AS should be based not only on valve hemodynamics, but underlying LV dysfunction and comorbidities. Indications for aortic valve replacement continue to evolve, extending to patients with less than severe AS. There are several trials to find a medical therapy to reduce the progression of AS. An application of artificial intelligence and clinical trial results will have a major impact in identifying asymptomatic patients and optimal treatment to the right patient at the right time. Aortic stenosis (AS) is one of the most common valvular heart diseases and the number of patients with AS is expected to increase globally as the older population is growing fast. Since the majority of patients are elderly, AS is no longer a simple valvular heart disease of left ventricular outflow obstruction but is accompanied by other cardiac and comorbid conditions. Because of the significant variations of the disease, identifying patients at high risk and even earlier detection of patients with AS before developing symptomatic severe AS is becoming increasingly important. With the proven of efficacy and safety of transcatheter aortic valve replacement (TAVR) in the severe AS population, there is a growing interest in applying TAVR in those with less than severe AS. A medical therapy to reduce or prevent the progression in AS is actively investigated by several randomized control trials. In this review, we will summarize the most recent findings in AS and discuss potential future management strategies of patients with AS.
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Affiliation(s)
- Saki Ito
- 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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21
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Bax JJ, Chandrashekhar Y. The Power of Large Clinical Databases and Registries in our Understanding of Cardiovascular Diseases. JACC Cardiovasc Imaging 2021; 14:2272-2274. [PMID: 34736602 DOI: 10.1016/j.jcmg.2021.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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22
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Lachmann M, Rippen E, Schuster T, Xhepa E, von Scheidt M, Pellegrini C, Trenkwalder T, Rheude T, Stundl A, Thalmann R, Harmsen G, Yuasa S, Schunkert H, Kastrati A, Laugwitz KL, Kupatt C, Joner M. Subphenotyping of Patients With Aortic Stenosis by Unsupervised Agglomerative Clustering of Echocardiographic and Hemodynamic Data. JACC Cardiovasc Interv 2021; 14:2127-2140. [PMID: 34620391 DOI: 10.1016/j.jcin.2021.08.034] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 07/26/2021] [Accepted: 08/03/2021] [Indexed: 01/29/2023]
Abstract
OBJECTIVES The aim of this retrospective analysis was to categorize patients with severe aortic stenosis (AS) according to clinical presentation by applying unsupervised machine learning. BACKGROUND Patients with severe AS present with heterogeneous clinical phenotypes, depending on disease progression and comorbidities. METHODS Unsupervised agglomerative clustering was applied to preprocedural data from echocardiography and right heart catheterization from 366 consecutively enrolled patients undergoing transcatheter aortic valve replacement for severe AS. RESULTS Cluster analysis revealed 4 distinct phenotypes. Patients in cluster 1 (n = 164 [44.8%]), serving as a reference, presented with regular cardiac function and without pulmonary hypertension (PH). Accordingly, estimated 2-year survival was 90.6% (95% CI: 85.8%-95.6%). Clusters 2 (n = 66 [18.0%]) and 4 (n = 91 [24.9%]) both comprised patients with postcapillary PH. Yet patients in cluster 2 with preserved left and right ventricular structure and function showed a similar survival as those in cluster 1 (2-year survival 85.8%; 95% CI: 76.9%-95.6%), whereas patients in cluster 4 with dilatation of all heart chambers and a high prevalence of mitral and tricuspid regurgitation (12.5% and 14.8%, respectively) died more often (2-year survival 74.9% [95% CI: 65.9%-85.2%]; HR for 2-year mortality: 2.8 [95% CI: 1.4-5.5]). Patients in cluster 3, the smallest (n = 45 [12.3%]), displayed the most extensive disease characteristics (ie, left and right heart dysfunction together with combined pre- and postcapillary PH), and 2-year survival was accordingly reduced (77.3% [95% CI: 65.2%-91.6%]; HR for 2-year mortality: 2.6 [95% CI: 1.1-6.2]). CONCLUSIONS Unsupervised machine learning aids in capturing complex clinical presentations as observed in patients with severe AS. Importantly, structural alterations in left and right heart morphology, possibly due to genetic predisposition, constitute an equally sensitive indicator of poor prognosis compared with high-grade PH.
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Affiliation(s)
- Mark Lachmann
- First Department of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Elena Rippen
- First Department of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Tibor Schuster
- Department of Family Medicine, McGill University, Montreal, Quebec, Canada
| | - Erion Xhepa
- Department of Cardiology, Deutsches Herzzentrum München, Technical University of Munich, Munich, Germany; DZHK (German Centre for Cardiovascular Research), partner site Munich Heart Alliance, Munich, Germany
| | - Moritz von Scheidt
- Department of Cardiology, Deutsches Herzzentrum München, Technical University of Munich, Munich, Germany; DZHK (German Centre for Cardiovascular Research), partner site Munich Heart Alliance, Munich, Germany
| | - Costanza Pellegrini
- Department of Cardiology, Deutsches Herzzentrum München, Technical University of Munich, Munich, Germany
| | - Teresa Trenkwalder
- Department of Cardiology, Deutsches Herzzentrum München, Technical University of Munich, Munich, Germany
| | - Tobias Rheude
- Department of Cardiology, Deutsches Herzzentrum München, Technical University of Munich, Munich, Germany
| | - Anja Stundl
- First Department of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Ruth Thalmann
- First Department of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Gerhard Harmsen
- Department of Physics, University of Johannesburg, Auckland Park, South Africa
| | - Shinsuke Yuasa
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Heribert Schunkert
- Department of Cardiology, Deutsches Herzzentrum München, Technical University of Munich, Munich, Germany; DZHK (German Centre for Cardiovascular Research), partner site Munich Heart Alliance, Munich, Germany
| | - Adnan Kastrati
- Department of Cardiology, Deutsches Herzzentrum München, Technical University of Munich, Munich, Germany; DZHK (German Centre for Cardiovascular Research), partner site Munich Heart Alliance, Munich, Germany
| | - Karl-Ludwig Laugwitz
- First Department of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany; DZHK (German Centre for Cardiovascular Research), partner site Munich Heart Alliance, Munich, Germany
| | - Christian Kupatt
- First Department of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany; DZHK (German Centre for Cardiovascular Research), partner site Munich Heart Alliance, Munich, Germany.
| | - Michael Joner
- Department of Cardiology, Deutsches Herzzentrum München, Technical University of Munich, Munich, Germany; DZHK (German Centre for Cardiovascular Research), partner site Munich Heart Alliance, Munich, Germany
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Cheng X, Manandhar I, Aryal S, Joe B. Application of Artificial Intelligence in Cardiovascular Medicine. Compr Physiol 2021; 11:2455-2466. [PMID: 34558666 DOI: 10.1002/cphy.c200034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
The advent of advances in machine learning (ML)-based techniques has popularized wide applications of artificial intelligence (AI) in various fields ranging from robotics to medicine. In recent years, there has been a surge in the application of AI to research in cardiovascular medicine, which is largely driven by the availability of large-scale clinical and multi-omics datasets. Such applications are providing a new perspective for a better understanding of cardiovascular disease (CVD), which could be used to develop novel diagnostic and therapeutic strategies. For example, studies have shown that ML has a substantial potential for early diagnosis of different types of CVD, prediction of adverse disease outcomes such as heart failure, and development of newer and personalized treatments. In this article, we provide an overview and discuss the current status of a wide range of AI applications, including machine learning, reinforcement learning, and deep learning, in cardiovascular medicine. © 2021 American Physiological Society. Compr Physiol 11:1-12, 2021.
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Affiliation(s)
- Xi Cheng
- Bioinformatics & Artificial Intelligence Laboratory, Center for Hypertension and Precision Medicine, Program in Physiological Genomics, Department of Physiology and Pharmacology, University of Toledo College of Medicine and Life Sciences, Toledo, Ohio, USA
| | - Ishan Manandhar
- Bioinformatics & Artificial Intelligence Laboratory, Center for Hypertension and Precision Medicine, Program in Physiological Genomics, Department of Physiology and Pharmacology, University of Toledo College of Medicine and Life Sciences, Toledo, Ohio, USA
| | - Sachin Aryal
- Bioinformatics & Artificial Intelligence Laboratory, Center for Hypertension and Precision Medicine, Program in Physiological Genomics, Department of Physiology and Pharmacology, University of Toledo College of Medicine and Life Sciences, Toledo, Ohio, USA
| | - Bina Joe
- Bioinformatics & Artificial Intelligence Laboratory, Center for Hypertension and Precision Medicine, Program in Physiological Genomics, Department of Physiology and Pharmacology, University of Toledo College of Medicine and Life Sciences, Toledo, Ohio, USA
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24
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Falsetti L, Rucco M, Proietti M, Viticchi G, Zaccone V, Scarponi M, Giovenali L, Moroncini G, Nitti C, Salvi A. Risk prediction of clinical adverse outcomes with machine learning in a cohort of critically ill patients with atrial fibrillation. Sci Rep 2021; 11:18925. [PMID: 34556682 PMCID: PMC8460701 DOI: 10.1038/s41598-021-97218-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 08/23/2021] [Indexed: 11/26/2022] Open
Abstract
Critically ill patients affected by atrial fibrillation are at high risk of adverse events: however, the actual risk stratification models for haemorrhagic and thrombotic events are not validated in a critical care setting. With this paper we aimed to identify, adopting topological data analysis, the risk factors for therapeutic failure (in-hospital death or intensive care unit transfer), the in-hospital occurrence of stroke/TIA and major bleeding in a cohort of critically ill patients with pre-existing atrial fibrillation admitted to a stepdown unit; to engineer newer prediction models based on machine learning in the same cohort. We selected all medical patients admitted for critical illness and a history of pre-existing atrial fibrillation in the timeframe 01/01/2002–03/08/2007. All data regarding patients’ medical history, comorbidities, drugs adopted, vital parameters and outcomes (therapeutic failure, stroke/TIA and major bleeding) were acquired from electronic medical records. Risk factors for each outcome were analyzed adopting topological data analysis. Machine learning was used to generate three different predictive models. We were able to identify specific risk factors and to engineer dedicated clinical prediction models for therapeutic failure (AUC: 0.974, 95%CI: 0.934–0.975), stroke/TIA (AUC: 0.931, 95%CI: 0.896–0.940; Brier score: 0.13) and major bleeding (AUC: 0.930:0.911–0.939; Brier score: 0.09) in critically-ill patients, which were able to predict accurately their respective clinical outcomes. Topological data analysis and machine learning techniques represent a concrete viewpoint for the physician to predict the risk at the patients’ level, aiding the selection of the best therapeutic strategy in critically ill patients affected by pre-existing atrial fibrillation.
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Affiliation(s)
- Lorenzo Falsetti
- Internal and Sub-Intensive Medicine Department, A.O.U. "Ospedali Riuniti" di Ancona, Via Conca 10, 60126, Ancona, Italy.
| | - Matteo Rucco
- Cyber-Physical Department, United Technology Research Center, Trento, Italy
| | - Marco Proietti
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy.,Geriatric Unit, IRCCS Istituti Clinici Scientifici Maugeri, Milan, Italy.,Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart and Chest Hospital, Liverpool, UK
| | - Giovanna Viticchi
- Neurological Clinic Department, A.O.U. "Ospedali Riuniti", Ancona, Italy
| | - Vincenzo Zaccone
- Internal and Sub-Intensive Medicine Department, A.O.U. "Ospedali Riuniti" di Ancona, Via Conca 10, 60126, Ancona, Italy
| | - Mattia Scarponi
- Emergency Medicine Residency Program, Marche Polytechnic University, Ancona, Italy
| | - Laura Giovenali
- Emergency Medicine Residency Program, Marche Polytechnic University, Ancona, Italy
| | - Gianluca Moroncini
- Clinica Medica, Azienda Ospedaliero-Universitaria "Ospedali Riuniti", Ancona, Italy
| | - Cinzia Nitti
- Internal and Sub-Intensive Medicine Department, A.O.U. "Ospedali Riuniti" di Ancona, Via Conca 10, 60126, Ancona, Italy
| | - Aldo Salvi
- Internal and Sub-Intensive Medicine Department, A.O.U. "Ospedali Riuniti" di Ancona, Via Conca 10, 60126, Ancona, Italy
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25
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Lavine SJ, Raby K. Adverse Outcomes with Eccentric Hypertrophy in a Community Based University Cohort with Aortic Stenosis. Am J Med Sci 2021; 362:442-452. [PMID: 34400150 DOI: 10.1016/j.amjms.2021.08.001] [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: 09/20/2020] [Revised: 05/04/2021] [Accepted: 08/09/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Aortic stenosis (AS) patients with eccentric hypertrophy (Ecc-LVH) have increased left ventricular (LV) size and possibly reduced ejection fraction (EF). However, previous studies suggest worse outcomes with concentric remodeling and hypertrophy. We hypothesized that Ecc-LVH pattern in AS patients will also be associated with greater heart failure (HF) and all-cause mortality (ACM). METHODS We queried the electronic medical record from a community-based university practice for all AS patients. We included patients with >60 days follow-up and interpretable Doppler echocardiograms. We recorded demographics, Doppler-echo parameters, laboratories, HF readmission and ACM with follow-up to 2083 days. There were 329 patients divided into 4 groups based on the presence of LV hypertrophy (LVH) and relative wall thickness (RWT) by echocardiography. Ecc-LVH had RWT<0.43 and LVH. RESULTS Patients with severe AS were older, had greater coronary disease prevalence, lower hemoglobin, greater LV mass index, more abnormal diastolic function, greater HF and ACM. Multivariate Cox proportional analysis revealed that valvulo-arterial impedance (p=0.017) and Ecc-LVH (p=0.033) were HF predictors. Brain natriuretic peptide>100 pg/ml (p<0.001) and Ecc-LVH (p=0.019) were ACM predictors. ACM was increased in Ecc-LVH patients with both moderate (HR=3.67-8.18 vs other geometries, p=0.007-0.0007) and severe AS (HR=3.94-9.48 vs normal and concentric remodeling, p=0.0002). In patients with HF, Ecc-LVH was associated with greater HF in moderate AS vs normal geometry (HR=3.28, p=0.0135) and concentric remodeling (HR=2.66, p=0.0472). CONCLUSIONS Patients with AS and Ecc-LVH have greater ACM than other LV geometries with both moderate and severe AS and greater HF in moderate AS.
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Affiliation(s)
- Steven J Lavine
- Quillen College of Medicine, East Tennessee State University, Johnson City, TN, United States; Washington University of St. Louis, St. Louis, MO, United States.
| | - Kirsten Raby
- Quillen College of Medicine, East Tennessee State University, Johnson City, TN, United States
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26
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Sengupta PP, Chandrashekhar YS. Building Trust in AI: Opportunities and Challenges for Cardiac Imaging. JACC Cardiovasc Imaging 2021; 14:520-522. [PMID: 33541532 DOI: 10.1016/j.jcmg.2021.01.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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27
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Pennell D, Delgado V, Knuuti J, Maurovich-Horvat P, Bax JJ. The year in cardiology: imaging. Eur Heart J 2021; 41:739-747. [PMID: 31901937 DOI: 10.1093/eurheartj/ehz930] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Revised: 11/28/2019] [Accepted: 12/11/2019] [Indexed: 12/31/2022] Open
Abstract
Abstract
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Affiliation(s)
- Dudley Pennell
- Cardiovascular Magnetic Resonance Unit, Royal Brompton Hospital, National Heart and Lung Institute, Imperial College, London, UK
| | - Victoria Delgado
- Department of Cardiology, Heart Lung Centre, Leiden University Medical Centre, Leiden, The Netherlands
| | - Juhani Knuuti
- Turku PET Centre, University of Turku, and Turku University Hospital, Turku, Finland
| | - Pàl Maurovich-Horvat
- MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Centre, Semmelweis University, Budapest, Hungary
| | - Jeroen J Bax
- Department of Cardiology, Heart Lung Centre, Leiden University Medical Centre, Leiden, The Netherlands
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28
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Sengupta PP, Shrestha S, Kagiyama N, Hamirani Y, Kulkarni H, Yanamala N, Bing R, Chin CWL, Pawade TA, Messika-Zeitoun D, Tastet L, Shen M, Newby DE, Clavel MA, Pibarot P, Dweck MR. A Machine-Learning Framework to Identify Distinct Phenotypes of Aortic Stenosis Severity. JACC Cardiovasc Imaging 2021; 14:1707-1720. [PMID: 34023273 DOI: 10.1016/j.jcmg.2021.03.020] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 03/02/2021] [Accepted: 03/16/2021] [Indexed: 12/20/2022]
Abstract
OBJECTIVES The authors explored the development and validation of machine-learning models for augmenting the echocardiographic grading of aortic stenosis (AS) severity. BACKGROUND In AS, symptoms and adverse events develop secondarily to valvular obstruction and left ventricular decompensation. The current echocardiographic grading of AS severity focuses on the valve and is limited by diagnostic uncertainty. METHODS Using echocardiography (ECHO) measurements (ECHO cohort, n = 1,052), we performed patient similarity analysis to derive high-severity and low-severity phenogroups of AS. We subsequently developed a supervised machine-learning classifier and validated its performance with independent markers of disease severity obtained using computed tomography (CT) (CT cohort, n = 752) and cardiovascular magnetic resonance (CMR) imaging (CMR cohort, n = 160). The classifier's prognostic value was further validated using clinical outcomes (aortic valve replacement [AVR] and death) observed in the ECHO and CMR cohorts. RESULTS In 1,964 patients from the 3 multi-institutional cohorts, 1,346 (68%) subjects had either nonsevere or discordant AS severity. Machine learning identified 1,117 (57%) patients as having high-severity and 847 (43%) as having low-severity AS. High-severity patients in CT and CMR cohorts had higher valve calcium scores and left ventricular mass and fibrosis, respectively than the low-severity group. In the ECHO cohort, progression to AVR and progression to death in patients who did not receive AVR was faster in the high-severity group. Compared with the conventional classification of disease severity, machine-learning-based severity classification improved discrimination (integrated discrimination improvement: 0.07; 95% confidence interval: 0.02 to 0.12) and reclassification (net reclassification improvement: 0.17; 95% confidence interval: 0.11 to 0.23) for the outcome of AVR at 5 years. For both ECHO and CMR cohorts, we observed prognostic value of the machine-learning classifications for subgroups with asymptomatic, nonsevere or discordant AS. CONCLUSIONS Machine learning can integrate ECHO measurements to augment the classification of disease severity in most patients with AS, with major potential to optimize the timing of AVR.
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Affiliation(s)
- Partho P Sengupta
- West Virginia University Heart and Vascular Institute, Morgantown, West Virginia, USA.
| | - Sirish Shrestha
- West Virginia University Heart and Vascular Institute, Morgantown, West Virginia, USA
| | - Nobuyuki Kagiyama
- West Virginia University Heart and Vascular Institute, Morgantown, West Virginia, USA
| | - Yasmin Hamirani
- West Virginia University Heart and Vascular Institute, Morgantown, West Virginia, USA
| | - Hemant Kulkarni
- West Virginia University Heart and Vascular Institute, Morgantown, West Virginia, USA; M&H Research, LLC, San Antonio, Texas, USA
| | - Naveena Yanamala
- West Virginia University Heart and Vascular Institute, Morgantown, West Virginia, USA
| | - Rong Bing
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom
| | | | - Tania A Pawade
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom
| | | | - Lionel Tastet
- Department of Medicine, Institut Universitaire de Cardiologie et de Pneumologie de Québec/Québec Heart and Lung Institute, Laval University, Québec, Canada
| | - Mylène Shen
- Department of Medicine, Institut Universitaire de Cardiologie et de Pneumologie de Québec/Québec Heart and Lung Institute, Laval University, Québec, Canada
| | - David E Newby
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom
| | - Marie-Annick Clavel
- Department of Medicine, Institut Universitaire de Cardiologie et de Pneumologie de Québec/Québec Heart and Lung Institute, Laval University, Québec, Canada
| | - Phillippe Pibarot
- Department of Medicine, Institut Universitaire de Cardiologie et de Pneumologie de Québec/Québec Heart and Lung Institute, Laval University, Québec, Canada.
| | - Marc R Dweck
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom
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29
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Yoon YE, Kim S, Chang HJ. Artificial Intelligence and Echocardiography. J Cardiovasc Imaging 2021; 29:193-204. [PMID: 34080347 PMCID: PMC8318807 DOI: 10.4250/jcvi.2021.0039] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 03/30/2021] [Accepted: 04/05/2021] [Indexed: 12/13/2022] Open
Abstract
Artificial intelligence (AI) is evolving in the field of diagnostic medical imaging, including echocardiography. Although the dynamic nature of echocardiography presents challenges beyond those of static images from X-ray, computed tomography, magnetic resonance, and radioisotope imaging, AI has influenced all steps of echocardiography, from image acquisition to automatic measurement and interpretation. Considering that echocardiography often is affected by inter-observer variability and shows a strong dependence on the level of experience, AI could be extremely advantageous in minimizing observer variation and providing reproducible measures, enabling accurate diagnosis. Currently, most reported AI applications in echocardiographic measurement have focused on improved image acquisition and automation of repetitive and tedious tasks; however, the role of AI applications should not be limited to conventional processes. Rather, AI could provide clinically important insights from subtle and non-specific data, such as changes in myocardial texture in patients with myocardial disease. Recent initiatives to develop large echocardiographic databases can facilitate development of AI applications. The ultimate goal of applying AI to echocardiography is automation of the entire process of echocardiogram analysis. Once automatic analysis becomes reliable, workflows in clinical echocardiographic will change radically. The human expert will remain the master controlling the overall diagnostic process, will not be replaced by AI, and will obtain significant support from AI systems to guide acquisition, perform measurements, and integrate and compare data on request.
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Affiliation(s)
- Yeonyee E Yoon
- Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam, Korea.,Department of Internal Medicine, Cardiovascular Center, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Sekeun Kim
- Graduate School of Biomedical Engineering, Yonsei University College of Medicine, Seoul, Korea.,Ontact Health Co., Ltd., Seoul, Korea
| | - Hyuk Jae Chang
- CONNECT-AI Research Center, Yonsei University Health System, Yonsei University College of Medicine, Seoul, Korea.,Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University Health System, Yonsei University College of Medicine, Seoul, Korea.
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30
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Schuuring MJ, Išgum I, Cosyns B, Chamuleau SAJ, Bouma BJ. Routine Echocardiography and Artificial Intelligence Solutions. Front Cardiovasc Med 2021; 8:648877. [PMID: 33708808 PMCID: PMC7940184 DOI: 10.3389/fcvm.2021.648877] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2021] [Accepted: 02/05/2021] [Indexed: 12/28/2022] Open
Abstract
Introduction: Echocardiography is widely used because of its portability, high temporal resolution, absence of radiation, and due to the low-costs. Over the past years, echocardiography has been recommended by the European Society of Cardiology in most cardiac diseases for both diagnostic and prognostic purposes. These recommendations have led to an increase in number of performed studies each requiring diligent processing and reviewing. The standard work pattern of image analysis including quantification and reporting has become highly resource intensive and time consuming. Existence of a large number of datasets with digital echocardiography images and recent advent of AI technology have created an environment in which artificial intelligence (AI) solutions can be developed successfully to automate current manual workflow. Methods and Results: We report on published AI solutions for echocardiography analysis on methods' performance, characteristics of the used data and imaged population. Contemporary AI applications are available for automation and advent in the image acquisition, analysis, reporting and education. AI solutions have been developed for both diagnostic and predictive tasks in echocardiography. Left ventricular function assessment and quantification have been most often performed. Performance of automated image view classification, image quality enhancement, cardiac function assessment, disease classification, and cardiac event prediction was overall good but most studies lack external evaluation. Conclusion: Contemporary AI solutions for image acquisition, analysis, reporting and education are developed for relevant tasks with promising performance. In the future major benefit of AI in echocardiography is expected from improvements in automated analysis and interpretation to reduce workload and improve clinical outcome. Some of the challenges have yet to be overcome, however, none of them are insurmountable.
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Affiliation(s)
- Mark J. Schuuring
- Amsterdam University Medical Centers -Location Academic Medical Center, Department of Cardiology, University of Amsterdam, Amsterdam, Netherlands
| | - Ivana Išgum
- Amsterdam University Medical Centers -Location Academic Medical Center, Department of Biomedical Engineering and Physics, University of Amsterdam, Amsterdam, Netherlands
- Amsterdam University Medical Centers -Location Academic Medical Center, Department of Radiology and Nuclear Medicine, University of Amsterdam, Amsterdam, Netherlands
- Amsterdam Cardiovascular Sciences, Amsterdam University Medical Centers -Location Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands
| | - Bernard Cosyns
- Department of Cardiology, University Hospital Brussel, Brussels, Belgium
| | - Steven A. J. Chamuleau
- Amsterdam University Medical Centers -Location Academic Medical Center, Department of Cardiology, University of Amsterdam, Amsterdam, Netherlands
- Amsterdam Cardiovascular Sciences, Amsterdam University Medical Centers -Location Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands
| | - Berto J. Bouma
- Amsterdam University Medical Centers -Location Academic Medical Center, Department of Cardiology, University of Amsterdam, Amsterdam, Netherlands
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31
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Ribeiro JM, Astudillo P, de Backer O, Budde R, Nuis RJ, Goudzwaard J, Van Mieghem NM, Lumens J, Mortier P, Mattace-Raso F, Boersma E, Cummins P, Bruining N, de Jaegere PP. Artificial Intelligence and Transcatheter Interventions for Structural Heart Disease: A glance at the (near) future. Trends Cardiovasc Med 2021; 32:153-159. [PMID: 33581255 DOI: 10.1016/j.tcm.2021.02.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Revised: 02/03/2021] [Accepted: 02/04/2021] [Indexed: 01/16/2023]
Abstract
With innovations in therapeutic technologies and changes in population demographics, transcatheter interventions for structural heart disease have become the preferred treatment and will keep growing. Yet, a thorough clinical selection and efficient pathway from diagnosis to treatment and follow-up are mandatory. In this review we reflect on how artificial intelligence may help to improve patient selection, pre-procedural planning, procedure execution and follow-up so to establish efficient and high quality health care in an increasing number of patients.
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Affiliation(s)
- Joana Maria Ribeiro
- Department of Cardiology, Thoraxcenter, Erasmus Medical Center, Rotterdam, the Netherlands; Department of Cardiology, Centro Hospitalar de Entre o Douro e Vouga, Santa Maria da Feira, Portugal; Department of Cardiology, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | | | - Ole de Backer
- Department of Cardiology, Rigshospitalet University Hospital, Copenhagen, Denmark
| | - Ricardo Budde
- Department of Radiology, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Rutger Jan Nuis
- Department of Cardiology, Thoraxcenter, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Jeanette Goudzwaard
- Department of Internal Medicine, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Nicolas M Van Mieghem
- Department of Cardiology, Thoraxcenter, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Joost Lumens
- CARIM School for Cardiovascular Diseases, Maastricht University Medical Center, Maastricht, the Netherlands
| | | | | | - Eric Boersma
- Department of Cardiology, Thoraxcenter, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Paul Cummins
- Department of Cardiology, Thoraxcenter, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Nico Bruining
- Department of Cardiology, Thoraxcenter, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Peter Pt de Jaegere
- Department of Cardiology, Thoraxcenter, Erasmus Medical Center, Rotterdam, the Netherlands.
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32
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Seetharam K, Min JK. Artificial Intelligence and Machine Learning in Cardiovascular Imaging. Methodist Debakey Cardiovasc J 2021; 16:263-271. [PMID: 33500754 DOI: 10.14797/mdcj-16-4-263] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Cardiovascular disease is the leading cause of mortality in Western countries and leads to a spectrum of complications that can complicate patient management. The emergence of artificial intelligence (AI) has garnered significant interest in many industries, and the field of cardiovascular imaging is no exception. Machine learning (ML) especially is showing significant promise in various diagnostic imaging modalities. As conventional statistics are reaching their apex in computational capabilities, ML can explore new possibilities and unravel hidden relationships. This will have a positive impact on diagnosis and prognosis for cardiovascular imaging. In this in-depth review, we highlight the role of AI and ML for various cardiovascular imaging modalities.
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33
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Hwang D, Kim HJ, Lee SP, Lim S, Koo BK, Kim YJ, Kook W, Andreini D, Al-Mallah MH, Budoff MJ, Cademartiri F, Chinnaiyan K, Choi JH, Conte E, Marques H, de Araújo Gonçalves P, Gottlieb I, Hadamitzky M, Leipsic JA, Maffei E, Pontone G, Raff GL, Shin S, Lee BK, Chun EJ, Sung JM, Lee SE, Berman DS, Lin FY, Virmani R, Samady H, Stone PH, Narula J, Bax JJ, Shaw LJ, Min JK, Chang HJ. Topological Data Analysis of Coronary Plaques Demonstrates the Natural History of Coronary Atherosclerosis. JACC Cardiovasc Imaging 2021; 14:1410-1421. [PMID: 33454260 DOI: 10.1016/j.jcmg.2020.11.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Revised: 11/02/2020] [Accepted: 11/09/2020] [Indexed: 01/24/2023]
Abstract
OBJECTIVES This study sought to identify distinct patient groups and their association with outcome based on the patient similarity network using quantitative coronary plaque characteristics from coronary computed tomography angiography (CTA). BACKGROUND Coronary CTA can noninvasively assess coronary plaques quantitatively. METHODS Patients who underwent 2 coronary CTAs at a minimum of 24 months' interval were analyzed (n = 1,264). A similarity Mapper network of patients was built by topological data analysis (TDA) based on the whole-heart quantitative coronary plaque analysis on coronary CTA to identify distinct patient groups and their association with outcome. RESULTS Three distinct patient groups were identified by TDA, and the patient similarity network by TDA showed a closed loop, demonstrating a continuous trend of coronary plaque progression. Group A had the least coronary plaque amount (median 12.4 mm3 [interquartile range (IQR): 0.0 to 39.6 mm3]) in the entire coronary tree. Group B had a moderate coronary plaque amount (31.7 mm3 [IQR: 0.0 to 127.4 mm3]) with relative enrichment of fibrofatty and necrotic core (32.6% [IQR: 16.7% to 46.2%] and 2.7% [IQR: 0.1% to 6.9%] of the total plaque, respectively) components. Group C had the largest coronary plaque amount (187.0 mm3 [IQR: 96.7 to 306.4 mm3]) and was enriched for dense calcium component (46.8% [IQR: 32.0% to 63.7%] of the total plaque). At follow-up, total plaque volume, fibrous, and dense calcium volumes increased in all groups, but the proportion of fibrofatty component decreased in groups B and C, whereas the necrotic core portion decreased in only group B (all p < 0.05). Group B showed a higher acute coronary syndrome incidence than other groups (0.3% vs. 2.6% vs. 0.6%; p = 0.009) but both group B and C had a higher revascularization incidence than group A (3.1% vs. 15.5% vs. 17.8%; p < 0.001). Incorporating group information from TDA demonstrated increase of model fitness for predicting acute coronary syndrome or revascularization compared with that incorporating clinical risk factors, percentage diameter stenosis, and high-risk plaque features. CONCLUSIONS The TDA of quantitative whole-heart coronary plaque characteristics on coronary CTA identified distinct patient groups with different plaque dynamics and clinical outcomes. (Progression of AtheRosclerotic PlAque DetermIned by Computed TomoGraphic Angiography Imaging [PARADIGM]; NCT02803411).
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Affiliation(s)
- Doyeon Hwang
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, South Korea
| | - Haneol J Kim
- Department of Mathematical Science, Seoul National University, Seoul, South Korea
| | - Seung-Pyo Lee
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, South Korea.
| | - Seonhee Lim
- Department of Mathematical Science, Seoul National University, Seoul, South Korea.
| | - Bon-Kwon Koo
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, South Korea
| | - Yong-Jin Kim
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, South Korea
| | - Woong Kook
- Department of Mathematical Science, Seoul National University, Seoul, South Korea
| | - Daniele Andreini
- Department of Medicine, Centro Cardiologico Monzino, IRCCS Milano, Milan, Italy
| | - Mouaz H Al-Mallah
- Department of Cardiology, Houston Methodist DeBakey Heart and Vascular Center, Houston Methodist Hospital, Houston, Texas, USA
| | - Matthew J Budoff
- Department of Medicine, Los Angeles Biomedical Research Institute, Torrance, California, USA
| | | | - Kavitha Chinnaiyan
- Department of Cardiology, William Beaumont Hospital, Royal Oak, Michigan, USA
| | - Jung Hyun Choi
- Division of Cardiology, Department of Internal Medicine, Pusan University Hospital, Busan, South Korea
| | - Edoardo Conte
- Department of Medicine, Centro Cardiologico Monzino, IRCCS Milano, Milan, Italy
| | - Hugo Marques
- Department of Radiology, UNICA, Unit of Cardiovascular Imaging, Hospital da Luz, Nova Medical School, Lisboa, Portugal
| | - Pedro de Araújo Gonçalves
- Department of Radiology, UNICA, Unit of Cardiovascular Imaging, Hospital da Luz, Nova Medical School, Lisboa, Portugal
| | - Ilan Gottlieb
- Department of Radiology, Casa de Saude São Jose, Rio de Janeiro, Brazil
| | - Martin Hadamitzky
- Department of Radiology and Nuclear Medicine, German Heart Center Munich, Munich, Germany
| | - Jonathon A Leipsic
- Department of Medicine and Radiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Erica Maffei
- Department of Radiology, Area Vasta 1/ASUR Marche, Urbino, Italy
| | - Gianluca Pontone
- Department of Medicine, Centro Cardiologico Monzino, IRCCS Milano, Milan, Italy
| | - Gilbert L Raff
- Department of Cardiology, William Beaumont Hospital, Royal Oak, Michigan, USA
| | - Sanghoon Shin
- Division of Cardiology, Department of Internal Medicine, Ewha Womans University Seoul Hospital, Ewha Womans University College of Medicine, Seoul, South Korea
| | - Byoung Kwon Lee
- Division of Cardiology, Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Eun Ju Chun
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Ji Min Sung
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Yonsei University Health System, Seoul, South Korea; Yonsei-Cedars-Sinai Integrative Cardiovascular Imaging Research Center, Yonsei University College of Medicine, Yonsei University Health System, Seoul, South Korea
| | - Sang-Eun Lee
- Division of Cardiology, Department of Internal Medicine, Ewha Womans University Seoul Hospital, Ewha Womans University College of Medicine, Seoul, South Korea; Yonsei-Cedars-Sinai Integrative Cardiovascular Imaging Research Center, Yonsei University College of Medicine, Yonsei University Health System, Seoul, South Korea
| | - Daniel S Berman
- Department of Imaging, Cedars Sinai Medical Center, Los Angeles, California, USA; Department of Medicine, Cedars Sinai Medical Center, Los Angeles, California, USA
| | - Fay Y Lin
- Department of Radiology, Dalio Institute of Cardiovascular Imaging, New York-Presbyterian Hospital and Weill Cornell Medicine, New York, New York, USA
| | - Renu Virmani
- Department of Pathology, CVPath Institute, Gaithersburg, Maryland, USA
| | - Habib Samady
- Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Peter H Stone
- Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Jagat Narula
- Zena and Michael A. Wiener Cardiovascular Institute, Mount Sinai Heart, Icahn School of Medicine at Mount Sinai, New York, New York, USA; Marie-Josée and Henry R. Kravis Center for Cardiovascular Health, Mount Sinai Heart, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Jeroen J Bax
- Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Leslee J Shaw
- Department of Radiology, Dalio Institute of Cardiovascular Imaging, New York-Presbyterian Hospital and Weill Cornell Medicine, New York, New York, USA
| | - James K Min
- Department of Radiology, Dalio Institute of Cardiovascular Imaging, New York-Presbyterian Hospital and Weill Cornell Medicine, New York, New York, USA
| | - Hyuk-Jae Chang
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Yonsei University Health System, Seoul, South Korea; Yonsei-Cedars-Sinai Integrative Cardiovascular Imaging Research Center, Yonsei University College of Medicine, Yonsei University Health System, Seoul, South Korea
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Abstract
PURPOSE OF REVIEW Artificial intelligence is a broad set of sophisticated computer-based statistical tools that have become widely available. Cardiovascular medicine with its large data repositories, need for operational efficiency and growing focus on precision care is set to be transformed by artificial intelligence. Applications range from new pathophysiologic discoveries to decision support for individual patient care to optimization of system-wide logistical processes. RECENT FINDINGS Machine learning is the dominant form of artificial intelligence wherein complex statistical algorithms 'learn' by deducing patterns in datasets. Supervised machine learning uses classified large data to train an algorithm to accurately predict the outcome, whereas in unsupervised machine learning, the algorithm uncovers mathematical relationships within unclassified data. Artificial multilayered neural networks or deep learning is one of the most successful tools. Artificial intelligence has demonstrated superior efficacy in disease phenomapping, early warning systems, risk prediction, automated processing and interpretation of imaging, and increasing operational efficiency. SUMMARY Artificial intelligence demonstrates the ability to learn through assimilation of large datasets to unravel complex relationships, discover prior unfound pathophysiological states and develop predictive models. Artificial intelligence needs widespread exploration and adoption for large-scale implementation in cardiovascular practice.
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Affiliation(s)
- Sagar Ranka
- Department of Cardiovascular Medicine, The University of Kansas, Health System, Kansas City, Kansas, USA
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35
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Seetharam K, Min JK. Artificial intelligence in cardiovascular imaging. Artif Intell Med 2021. [DOI: 10.1016/b978-0-12-821259-2.00019-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Seetharam K, Brito D, Farjo PD, Sengupta PP. The Role of Artificial Intelligence in Cardiovascular Imaging: State of the Art Review. Front Cardiovasc Med 2020; 7:618849. [PMID: 33426010 PMCID: PMC7786371 DOI: 10.3389/fcvm.2020.618849] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2020] [Accepted: 12/08/2020] [Indexed: 12/15/2022] Open
Abstract
In this current digital landscape, artificial intelligence (AI) has established itself as a powerful tool in the commercial industry and is an evolving technology in healthcare. Cutting-edge imaging modalities outputting multi-dimensional data are becoming increasingly complex. In this era of data explosion, the field of cardiovascular imaging is undergoing a paradigm shift toward machine learning (ML) driven platforms. These diverse algorithms can seamlessly analyze information and automate a range of tasks. In this review article, we explore the role of ML in the field of cardiovascular imaging.
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Affiliation(s)
- Karthik Seetharam
- Department of Cardiology, West Virginia University Medicine Heart & Vascular Institute, Morgantown, WV, United States
| | - Daniel Brito
- Department of Cardiology, West Virginia University Medicine Heart & Vascular Institute, Morgantown, WV, United States
| | - Peter D Farjo
- Department of Cardiology, West Virginia University Medicine Heart & Vascular Institute, Morgantown, WV, United States
| | - Partho P Sengupta
- Department of Cardiology, West Virginia University Medicine Heart & Vascular Institute, Morgantown, WV, United States
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Abdul Ghffar Y, Osman M, Shrestha S, Shaukat F, Kagiyama N, Alkhouli M, Raybuck B, Badhwar V, Sengupta PP. Usefulness of Semisupervised Machine-Learning-Based Phenogrouping to Improve Risk Assessment for Patients Undergoing Transcatheter Aortic Valve Implantation. Am J Cardiol 2020; 136:122-130. [PMID: 32941814 DOI: 10.1016/j.amjcard.2020.08.048] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 08/25/2020] [Accepted: 08/28/2020] [Indexed: 12/13/2022]
Abstract
Semisupervised machine-learning methods are able to learn from fewer labeled patient data. We illustrate the potential use of a semisupervised automated machine-learning (AutoML) pipeline for phenotyping patients who underwent transcatheter aortic valve implantation and identifying patient groups with similar clinical outcome. Using the Transcatheter Valve Therapy registry data, we divided 344 patients into 2 sequential cohorts (cohort 1, n = 211, cohort 2, n = 143). We investigated patient similarity analysis to identify unique phenogroups of patients in the first cohort. We subsequently applied the semisupervised AutoML to the second cohort for developing automatic phenogroup labels. The patient similarity network identified 5 patient phenogroups with substantial variations in clinical comorbidities and in-hospital and 30-day outcomes. Cumulative assessment of patients from both cohorts revealed lowest rates of procedural complications in Group 1. In comparison, Group 5 was associated with higher rates of in-hospital cardiovascular mortality (odds ratio [OR] 35, 95% confidence interval [CI] 4 to 309, p = 0.001), in-hospital all-cause mortality (OR 9, 95% CI 2 to 33, p = 0.002), 30-day cardiovascular mortality (OR 18, 95% CI 3 to 94, p <0.001), and 30-day all-cause mortality (OR 3, 95% CI 1.2 to 9, p = 0.02) . For 30-day cardiovascular mortality, using phenogroup data in conjunction with the Society of Thoracic Surgeon score improved the overall prediction of mortality versus using the Society of Thoracic Surgeon scores alone (AUC 0.96 vs AUC 0.8, p = 0.02). In conclusion, we illustrate that semisupervised AutoML platforms identifies unique patient phenogroups who have similar clinical characteristics and overall risk of adverse events post-transcatheter aortic valve implantation.
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Ribeiro JM, Cummins P, Bruining N, de Jaegere PPT. Reply: Patient-Specific Computer Simulation in TAVR: Is Artificial Intelligence Superior to Human Experience in Interventional Cardiology? JACC Cardiovasc Interv 2020; 13:2581-2582. [PMID: 33153574 DOI: 10.1016/j.jcin.2020.09.042] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Accepted: 09/28/2020] [Indexed: 11/30/2022]
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Affiliation(s)
- Rong Bing
- Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
| | - Marc Richard Dweck
- Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
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40
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Updates to a Modern Dilemma: a Practical Approach to the Workup and Management of Low-Gradient Severe Aortic Stenosis Using Transvalvular Flow Rate. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2020. [DOI: 10.1007/s11936-020-00865-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Kutty S. The 21st Annual Feigenbaum Lecture: Beyond Artificial: Echocardiography from Elegant Images to Analytic Intelligence. J Am Soc Echocardiogr 2020; 33:1163-1171. [DOI: 10.1016/j.echo.2020.07.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 07/22/2020] [Accepted: 07/23/2020] [Indexed: 02/02/2023]
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Abstract
PURPOSE OF REVIEW Echocardiography is an indispensable tool in diagnostic cardiology and is fundamental to clinical care. Significant advances in cardiovascular imaging technology paralleled by rapid growth in electronic medical records, miniaturized devices, real-time monitoring, and wearable devices using body sensor network technology have led to the development of complex data. RECENT FINDINGS The intricate nature of these data can be overwhelming and exceed the capabilities of current statistical software. Machine learning (ML), a branch of artificial intelligence (AI), can help health care providers navigate through this complex labyrinth of information and unravel hidden discoveries. Furthermore, ML algorithms can help automate several tasks in echocardiography and clinical care. ML can serve as a valuable diagnostic tool for physicians in the field of echocardiography. In addition, it can help expand the capabilities of research and discover alternative pathways in medical management. In this review article, we describe the role of AI and ML in echocardiography.
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Affiliation(s)
- Karthik Seetharam
- West Virginia University Heart & Vascular Institute, 1 Medical Center Drive, Morgantown, WV, 26506, USA
| | - Sameer Raina
- West Virginia University Heart & Vascular Institute, 1 Medical Center Drive, Morgantown, WV, 26506, USA
| | - Partho P Sengupta
- West Virginia University Heart & Vascular Institute, 1 Medical Center Drive, Morgantown, WV, 26506, USA.
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43
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Patient Management in Aortic Stenosis: Towards Precision Medicine Through Protein Analysis, Imaging and Diagnostic Tests. J Clin Med 2020; 9:jcm9082421. [PMID: 32731585 PMCID: PMC7463596 DOI: 10.3390/jcm9082421] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 07/22/2020] [Accepted: 07/24/2020] [Indexed: 01/12/2023] Open
Abstract
Aortic stenosis is the most frequent valvular disease in developed countries. It progresses from mild fibrocalcific leaflet changes to a more severe leaflet calcification at the end stages of the disease. Unfortunately, symptoms of aortic stenosis are unspecific and only appear when it is too late, complicating patients' management. The global impact of aortic stenosis is increasing due to the growing elderly population. The disease supposes a great challenge because of the multiple comorbidities of these patients. Nowadays, the only effective treatment is valve replacement, which has a high cost in both social and economic terms. For that reason, it is crucial to find potential diagnostic, prognostic and therapeutic indicators that could help us to detect this disease in its earliest stages. In this article, we comprehensively review several key observations and translational studies related to protein markers that are promising for being implemented in the clinical field as well as a discussion about the role of precision medicine in aortic stenosis.
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Tokodi M, Shrestha S, Bianco C, Kagiyama N, Casaclang-Verzosa G, Narula J, Sengupta PP. Interpatient Similarities in Cardiac Function: A Platform for Personalized Cardiovascular Medicine. JACC Cardiovasc Imaging 2020; 13:1119-1132. [PMID: 32199835 PMCID: PMC7556337 DOI: 10.1016/j.jcmg.2019.12.018] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Revised: 10/31/2019] [Accepted: 12/19/2019] [Indexed: 12/20/2022]
Abstract
OBJECTIVES The authors applied unsupervised machine-learning techniques for integrating echocardiographic features of left ventricular (LV) structure and function into a patient similarity network that predicted major adverse cardiac event(s) (MACE) in an individual patient. BACKGROUND Patient similarity analysis is an evolving paradigm for precision medicine in which patients are clustered or classified based on their similarities in several clinical features. METHODS A retrospective cohort of 866 patients was used to develop a network architecture using 9 echocardiographic features of LV structure and function. The data for 468 patients from 2 prospective cohort registries were then added to test the model's generalizability. RESULTS The map of cross-sectional data in the retrospective cohort resulted in a looped patient network that persisted even after the addition of data from the prospective cohort registries. After subdividing the loop into 4 regions, patients in each region showed unique differences in LV function, with Kaplan-Meier curves demonstrating significant differences in MACE-related rehospitalization and death (both p < 0.001). Addition of network information to clinical risk predictors resulted in significant improvements in net reclassification, integrated discrimination, and median risk scores for predicting MACE (p < 0.05 for all). Furthermore, the network predicted the cardiac disease cycle in each of the 96 patients who had second echocardiographic evaluations. An improvement or remaining in low-risk regions was associated with lower MACE-related rehospitalization rates than worsening or remaining in high-risk regions (3% vs. 37%; p < 0.001). CONCLUSIONS Patient similarity analysis integrates multiple features of cardiac function to develop a phenotypic network in which patients can be mapped to specific locations associated with specific disease stage and clinical outcomes. The use of patient similarity analysis may have relevance for automated staging of cardiac disease severity, personalized prediction of prognosis, and monitoring progression or response to therapies.
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Affiliation(s)
- Márton Tokodi
- Division of Cardiology, West Virginia University Heart & Vascular Institute, Morgantown, West Virginia; Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Sirish Shrestha
- Division of Cardiology, West Virginia University Heart & Vascular Institute, Morgantown, West Virginia
| | - Christopher Bianco
- Division of Cardiology, West Virginia University Heart & Vascular Institute, Morgantown, West Virginia
| | - Nobuyuki Kagiyama
- Division of Cardiology, West Virginia University Heart & Vascular Institute, Morgantown, West Virginia
| | - Grace Casaclang-Verzosa
- Division of Cardiology, West Virginia University Heart & Vascular Institute, Morgantown, West Virginia
| | - Jagat Narula
- Division of Cardiology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Partho P Sengupta
- Division of Cardiology, West Virginia University Heart & Vascular Institute, Morgantown, West Virginia.
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45
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Ng AC, Delgado V, Bax JJ. Individualized Patient Risk Stratification Using Machine Learning and Topological Data Analysis. JACC Cardiovasc Imaging 2020; 13:1133-1134. [DOI: 10.1016/j.jcmg.2020.02.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Accepted: 02/12/2020] [Indexed: 12/31/2022]
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Lakatos BK, Kovács A. Global Longitudinal Strain in Moderate Aortic Stenosis: A Chance to Synthesize It All? Circ Cardiovasc Imaging 2020; 13:e010711. [PMID: 32268806 DOI: 10.1161/circimaging.120.010711] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Bálint K Lakatos
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Attila Kovács
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
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47
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Kagiyama N, Shrestha S, Cho JS, Khalil M, Singh Y, Challa A, Casaclang-Verzosa G, Sengupta PP. A low-cost texture-based pipeline for predicting myocardial tissue remodeling and fibrosis using cardiac ultrasound. EBioMedicine 2020; 54:102726. [PMID: 32268274 PMCID: PMC7139137 DOI: 10.1016/j.ebiom.2020.102726] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Revised: 03/04/2020] [Accepted: 03/04/2020] [Indexed: 02/06/2023] Open
Abstract
Background Maturation of ultrasound myocardial tissue characterization may have far-reaching implications as a widely available alternative to cardiac magnetic resonance (CMR) for risk stratification in left ventricular (LV) remodeling. Methods We extracted 328 texture-based features of myocardium from still ultrasound images. After we explored the phenotypes of myocardial textures using unsupervised similarity networks, global LV remodeling parameters were predicted using supervised machine learning models. Separately, we also developed supervised models for predicting the presence of myocardial fibrosis using another cohort who underwent cardiac magnetic resonance (CMR). For the prediction, patients were divided into a training and test set (80:20). Findings Texture-based tissue feature extraction was feasible in 97% of total 534 patients. Interpatient similarity analysis delineated two patient groups based on the texture features: one group had more advanced LV remodeling parameters compared to the other group. Furthermore, this group was associated with a higher incidence of cardiac deaths (p = 0.001) and major adverse cardiac events (p < 0.001). The supervised models predicted reduced LV ejection fraction (<50%) and global longitudinal strain (<16%) with area under the receiver-operator-characteristics curves (ROC AUC) of 0.83 and 0.87 in the hold-out test set, respectively. Furthermore, the presence of myocardial fibrosis was predicted from only ultrasound myocardial texture with an ROC AUC of 0.84 (sensitivity 86.4% and specificity 83.3%) in the test set. Interpretation Ultrasound texture-based myocardial tissue characterization identified phenotypic features of LV remodeling from still ultrasound images. Further clinical validation may address critical barriers in the adoption of ultrasound techniques for myocardial tissue characterization. Funding None.
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Affiliation(s)
- Nobuyuki Kagiyama
- West Virginia University Heart and Vascular Institute, 1 Medical Center Drive, Morgantown, WV 26506, USA
| | - Sirish Shrestha
- West Virginia University Heart and Vascular Institute, 1 Medical Center Drive, Morgantown, WV 26506, USA
| | - Jung Sun Cho
- West Virginia University Heart and Vascular Institute, 1 Medical Center Drive, Morgantown, WV 26506, USA
| | - Muhammad Khalil
- West Virginia University Heart and Vascular Institute, 1 Medical Center Drive, Morgantown, WV 26506, USA
| | - Yashbir Singh
- West Virginia University Heart and Vascular Institute, 1 Medical Center Drive, Morgantown, WV 26506, USA
| | - Abhiram Challa
- West Virginia University Heart and Vascular Institute, 1 Medical Center Drive, Morgantown, WV 26506, USA
| | - Grace Casaclang-Verzosa
- West Virginia University Heart and Vascular Institute, 1 Medical Center Drive, Morgantown, WV 26506, USA
| | - Partho P Sengupta
- West Virginia University Heart and Vascular Institute, 1 Medical Center Drive, Morgantown, WV 26506, USA.
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48
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Argulian E, Narula J. Imaging-Verified Disease Stages: Branching Off Into the Landscape of Possibilities. JACC Cardiovasc Imaging 2020; 13:1671-1673. [PMID: 32192930 DOI: 10.1016/j.jcmg.2020.02.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Accepted: 02/26/2020] [Indexed: 01/08/2023]
Affiliation(s)
- Edgar Argulian
- Mount Sinai Heart, Icahn School of Medicine at Mount Sinai, New York, New York.
| | - Jagat Narula
- Mount Sinai Heart, Icahn School of Medicine at Mount Sinai, New York, New York
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49
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Cho JS, Shrestha S, Kagiyama N, Hu L, Ghaffar YA, Casaclang-Verzosa G, Zeb I, Sengupta PP. A Network-Based "Phenomics" Approach for Discovering Patient Subtypes From High-Throughput Cardiac Imaging Data. JACC Cardiovasc Imaging 2020; 13:1655-1670. [PMID: 32762883 DOI: 10.1016/j.jcmg.2020.02.008] [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: 11/04/2019] [Revised: 02/19/2020] [Accepted: 02/20/2020] [Indexed: 12/16/2022]
Abstract
OBJECTIVES The authors present a method that focuses on cohort matching algorithms for performing patient-to-patient comparisons along multiple echocardiographic parameters for predicting meaningful patient subgroups. BACKGROUND Recent efforts in collecting multiomics data open numerous opportunities for comprehensive integration of highly heterogenous data to classify a patient's cardiovascular state, eventually leading to tailored therapies. METHODS A total of 42 echocardiography features, including 2-dimensional and Doppler measurements, left ventricular (LV) and atrial speckle-tracking, and vector flow mapping data, were obtained in 297 patients. A similarity network was developed to delineate distinct patient phenotypes, and then neural network models were trained for discriminating the phenotypic presentations. RESULTS The patient similarity model identified 4 clusters (I to IV), with patients in each cluster showed distinctive clinical presentations based on American College of Cardiology/American Heart Association heart failure stage and the occurrence of short-term major adverse cardiac and cerebrovascular events. Compared with other clusters, cluster IV had a higher prevalence of stage C or D heart failure (78%; p < 0.001), New York Heart Association functional classes III or IV (61%; p < 0.001), and a higher incidence of major adverse cardiac and cerebrovascular events (p < 0.001). The neural network model showed robust prediction of patient clusters, with area under the receiver-operating characteristic curve ranging from 0.82 to 0.99 for the independent hold-out validation set. CONCLUSIONS Automated computational methods for phenotyping can be an effective strategy to fuse multidimensional parameters of LV structure and function. It can identify distinct cardiac phenogroups in terms of clinical characteristics, cardiac structure and function, hemodynamics, and outcomes.
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Affiliation(s)
- Jung Sun Cho
- West Virginia University Heart & Vascular Institute, Morgantown, West Virginia; Division of Cardiology, Daejeon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Sirish Shrestha
- West Virginia University Heart & Vascular Institute, Morgantown, West Virginia
| | - Nobuyuki Kagiyama
- West Virginia University Heart & Vascular Institute, Morgantown, West Virginia
| | - Lan Hu
- West Virginia University Heart & Vascular Institute, Morgantown, West Virginia
| | - Yasir Abdul Ghaffar
- West Virginia University Heart & Vascular Institute, Morgantown, West Virginia
| | | | - Irfan Zeb
- West Virginia University Heart & Vascular Institute, Morgantown, West Virginia
| | - Partho P Sengupta
- West Virginia University Heart & Vascular Institute, Morgantown, West Virginia.
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50
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Abstract
Introduction: With the increase in the number of patients with cardiovascular diseases, better risk-prediction models for cardiovascular events are needed. Statistical-based risk-prediction models for cardiovascular events (CVEs) are available, but they lack the ability to predict individual-level risk. Machine learning (ML) methods are especially equipped to handle complex data and provide accurate risk-prediction models at the individual level.Areas covered: In this review, the authors summarize the literature comparing the performance of machine learning methods to that of traditional, statistical-based models in predicting CVEs. They provide a brief summary of ML methods and then discuss risk-prediction models for CVEs such as major adverse cardiovascular events, heart failure and arrhythmias.Expert opinion: Current evidence supports the superiority of ML methods over statistical-based models in predicting CVEs. Statistical models are applicable at the population level and are subject to overfitting, while ML methods can provide an individualized risk level for CVEs. Further prospective research on ML-guided treatments to prevent CVEs is needed.
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Affiliation(s)
- Brijesh Patel
- Heart and Vascular Institute, West Virginia University, Morgantown, WV, USA
| | - Partho Sengupta
- Heart and Vascular Institute, West Virginia University, Morgantown, WV, USA
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