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Dawes TJW, de Marvao A, Shi W, Fletcher T, Watson GMJ, Wharton J, Rhodes CJ, Howard LSGE, Gibbs JSR, Rueckert D, Cook SA, Wilkins MR, O'Regan DP. Machine Learning of Three-dimensional Right Ventricular Motion Enables Outcome Prediction in Pulmonary Hypertension: A Cardiac MR Imaging Study. Radiology 2017; 283:381-390. [PMID: 28092203 PMCID: PMC5398374 DOI: 10.1148/radiol.2016161315] [Citation(s) in RCA: 116] [Impact Index Per Article: 16.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Applying machine learning of complex motion phenotypes obtained from cardiac MR images allows more accurate prediction of patient outcomes in pulmonary hypertension. Purpose To determine if patient survival and mechanisms of right ventricular failure in pulmonary hypertension could be predicted by using supervised machine learning of three-dimensional patterns of systolic cardiac motion. Materials and Methods The study was approved by a research ethics committee, and participants gave written informed consent. Two hundred fifty-six patients (143 women; mean age ± standard deviation, 63 years ± 17) with newly diagnosed pulmonary hypertension underwent cardiac magnetic resonance (MR) imaging, right-sided heart catheterization, and 6-minute walk testing with a median follow-up of 4.0 years. Semiautomated segmentation of short-axis cine images was used to create a three-dimensional model of right ventricular motion. Supervised principal components analysis was used to identify patterns of systolic motion that were most strongly predictive of survival. Survival prediction was assessed by using difference in median survival time and area under the curve with time-dependent receiver operating characteristic analysis for 1-year survival. Results At the end of follow-up, 36% of patients (93 of 256) died, and one underwent lung transplantation. Poor outcome was predicted by a loss of effective contraction in the septum and free wall, coupled with reduced basal longitudinal motion. When added to conventional imaging and hemodynamic, functional, and clinical markers, three-dimensional cardiac motion improved survival prediction (area under the receiver operating characteristic curve, 0.73 vs 0.60, respectively; P < .001) and provided greater differentiation according to difference in median survival time between high- and low-risk groups (13.8 vs 10.7 years, respectively; P < .001). Conclusion A machine-learning survival model that uses three-dimensional cardiac motion predicts outcome independent of conventional risk factors in patients with newly diagnosed pulmonary hypertension. Online supplemental material is available for this article.
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Affiliation(s)
- Timothy J W Dawes
- From the MRC Clinical Sciences Centre, Du Cane Rd, London W12 0NN, England (T.J.W.D., A.d.M., W.S., T.F., S.A.C., D.P.O.); Division of Experimental Medicine, Department of Medicine (T.J.W.D, T.F., G.M.J.W., J.W., C.J.R., M.R.W.), Department of Computing (W.S., D.R.), and National Heart and Lung Institute (J.S.R.G.), Imperial College London, London, England; National Heart Centre Singapore, Singapore and Duke-NUS Graduate Medical School, Singapore (S.A.C.); and Department of Cardiology, National Pulmonary Hypertension Service, Imperial College Healthcare NHS Trust, London, England (L.S.G.E.H., J.S.R.G.)
| | - Antonio de Marvao
- From the MRC Clinical Sciences Centre, Du Cane Rd, London W12 0NN, England (T.J.W.D., A.d.M., W.S., T.F., S.A.C., D.P.O.); Division of Experimental Medicine, Department of Medicine (T.J.W.D, T.F., G.M.J.W., J.W., C.J.R., M.R.W.), Department of Computing (W.S., D.R.), and National Heart and Lung Institute (J.S.R.G.), Imperial College London, London, England; National Heart Centre Singapore, Singapore and Duke-NUS Graduate Medical School, Singapore (S.A.C.); and Department of Cardiology, National Pulmonary Hypertension Service, Imperial College Healthcare NHS Trust, London, England (L.S.G.E.H., J.S.R.G.)
| | - Wenzhe Shi
- From the MRC Clinical Sciences Centre, Du Cane Rd, London W12 0NN, England (T.J.W.D., A.d.M., W.S., T.F., S.A.C., D.P.O.); Division of Experimental Medicine, Department of Medicine (T.J.W.D, T.F., G.M.J.W., J.W., C.J.R., M.R.W.), Department of Computing (W.S., D.R.), and National Heart and Lung Institute (J.S.R.G.), Imperial College London, London, England; National Heart Centre Singapore, Singapore and Duke-NUS Graduate Medical School, Singapore (S.A.C.); and Department of Cardiology, National Pulmonary Hypertension Service, Imperial College Healthcare NHS Trust, London, England (L.S.G.E.H., J.S.R.G.)
| | - Tristan Fletcher
- From the MRC Clinical Sciences Centre, Du Cane Rd, London W12 0NN, England (T.J.W.D., A.d.M., W.S., T.F., S.A.C., D.P.O.); Division of Experimental Medicine, Department of Medicine (T.J.W.D, T.F., G.M.J.W., J.W., C.J.R., M.R.W.), Department of Computing (W.S., D.R.), and National Heart and Lung Institute (J.S.R.G.), Imperial College London, London, England; National Heart Centre Singapore, Singapore and Duke-NUS Graduate Medical School, Singapore (S.A.C.); and Department of Cardiology, National Pulmonary Hypertension Service, Imperial College Healthcare NHS Trust, London, England (L.S.G.E.H., J.S.R.G.)
| | - Geoffrey M J Watson
- From the MRC Clinical Sciences Centre, Du Cane Rd, London W12 0NN, England (T.J.W.D., A.d.M., W.S., T.F., S.A.C., D.P.O.); Division of Experimental Medicine, Department of Medicine (T.J.W.D, T.F., G.M.J.W., J.W., C.J.R., M.R.W.), Department of Computing (W.S., D.R.), and National Heart and Lung Institute (J.S.R.G.), Imperial College London, London, England; National Heart Centre Singapore, Singapore and Duke-NUS Graduate Medical School, Singapore (S.A.C.); and Department of Cardiology, National Pulmonary Hypertension Service, Imperial College Healthcare NHS Trust, London, England (L.S.G.E.H., J.S.R.G.)
| | - John Wharton
- From the MRC Clinical Sciences Centre, Du Cane Rd, London W12 0NN, England (T.J.W.D., A.d.M., W.S., T.F., S.A.C., D.P.O.); Division of Experimental Medicine, Department of Medicine (T.J.W.D, T.F., G.M.J.W., J.W., C.J.R., M.R.W.), Department of Computing (W.S., D.R.), and National Heart and Lung Institute (J.S.R.G.), Imperial College London, London, England; National Heart Centre Singapore, Singapore and Duke-NUS Graduate Medical School, Singapore (S.A.C.); and Department of Cardiology, National Pulmonary Hypertension Service, Imperial College Healthcare NHS Trust, London, England (L.S.G.E.H., J.S.R.G.)
| | - Christopher J Rhodes
- From the MRC Clinical Sciences Centre, Du Cane Rd, London W12 0NN, England (T.J.W.D., A.d.M., W.S., T.F., S.A.C., D.P.O.); Division of Experimental Medicine, Department of Medicine (T.J.W.D, T.F., G.M.J.W., J.W., C.J.R., M.R.W.), Department of Computing (W.S., D.R.), and National Heart and Lung Institute (J.S.R.G.), Imperial College London, London, England; National Heart Centre Singapore, Singapore and Duke-NUS Graduate Medical School, Singapore (S.A.C.); and Department of Cardiology, National Pulmonary Hypertension Service, Imperial College Healthcare NHS Trust, London, England (L.S.G.E.H., J.S.R.G.)
| | - Luke S G E Howard
- From the MRC Clinical Sciences Centre, Du Cane Rd, London W12 0NN, England (T.J.W.D., A.d.M., W.S., T.F., S.A.C., D.P.O.); Division of Experimental Medicine, Department of Medicine (T.J.W.D, T.F., G.M.J.W., J.W., C.J.R., M.R.W.), Department of Computing (W.S., D.R.), and National Heart and Lung Institute (J.S.R.G.), Imperial College London, London, England; National Heart Centre Singapore, Singapore and Duke-NUS Graduate Medical School, Singapore (S.A.C.); and Department of Cardiology, National Pulmonary Hypertension Service, Imperial College Healthcare NHS Trust, London, England (L.S.G.E.H., J.S.R.G.)
| | - J Simon R Gibbs
- From the MRC Clinical Sciences Centre, Du Cane Rd, London W12 0NN, England (T.J.W.D., A.d.M., W.S., T.F., S.A.C., D.P.O.); Division of Experimental Medicine, Department of Medicine (T.J.W.D, T.F., G.M.J.W., J.W., C.J.R., M.R.W.), Department of Computing (W.S., D.R.), and National Heart and Lung Institute (J.S.R.G.), Imperial College London, London, England; National Heart Centre Singapore, Singapore and Duke-NUS Graduate Medical School, Singapore (S.A.C.); and Department of Cardiology, National Pulmonary Hypertension Service, Imperial College Healthcare NHS Trust, London, England (L.S.G.E.H., J.S.R.G.)
| | - Daniel Rueckert
- From the MRC Clinical Sciences Centre, Du Cane Rd, London W12 0NN, England (T.J.W.D., A.d.M., W.S., T.F., S.A.C., D.P.O.); Division of Experimental Medicine, Department of Medicine (T.J.W.D, T.F., G.M.J.W., J.W., C.J.R., M.R.W.), Department of Computing (W.S., D.R.), and National Heart and Lung Institute (J.S.R.G.), Imperial College London, London, England; National Heart Centre Singapore, Singapore and Duke-NUS Graduate Medical School, Singapore (S.A.C.); and Department of Cardiology, National Pulmonary Hypertension Service, Imperial College Healthcare NHS Trust, London, England (L.S.G.E.H., J.S.R.G.)
| | - Stuart A Cook
- From the MRC Clinical Sciences Centre, Du Cane Rd, London W12 0NN, England (T.J.W.D., A.d.M., W.S., T.F., S.A.C., D.P.O.); Division of Experimental Medicine, Department of Medicine (T.J.W.D, T.F., G.M.J.W., J.W., C.J.R., M.R.W.), Department of Computing (W.S., D.R.), and National Heart and Lung Institute (J.S.R.G.), Imperial College London, London, England; National Heart Centre Singapore, Singapore and Duke-NUS Graduate Medical School, Singapore (S.A.C.); and Department of Cardiology, National Pulmonary Hypertension Service, Imperial College Healthcare NHS Trust, London, England (L.S.G.E.H., J.S.R.G.)
| | - Martin R Wilkins
- From the MRC Clinical Sciences Centre, Du Cane Rd, London W12 0NN, England (T.J.W.D., A.d.M., W.S., T.F., S.A.C., D.P.O.); Division of Experimental Medicine, Department of Medicine (T.J.W.D, T.F., G.M.J.W., J.W., C.J.R., M.R.W.), Department of Computing (W.S., D.R.), and National Heart and Lung Institute (J.S.R.G.), Imperial College London, London, England; National Heart Centre Singapore, Singapore and Duke-NUS Graduate Medical School, Singapore (S.A.C.); and Department of Cardiology, National Pulmonary Hypertension Service, Imperial College Healthcare NHS Trust, London, England (L.S.G.E.H., J.S.R.G.)
| | - Declan P O'Regan
- From the MRC Clinical Sciences Centre, Du Cane Rd, London W12 0NN, England (T.J.W.D., A.d.M., W.S., T.F., S.A.C., D.P.O.); Division of Experimental Medicine, Department of Medicine (T.J.W.D, T.F., G.M.J.W., J.W., C.J.R., M.R.W.), Department of Computing (W.S., D.R.), and National Heart and Lung Institute (J.S.R.G.), Imperial College London, London, England; National Heart Centre Singapore, Singapore and Duke-NUS Graduate Medical School, Singapore (S.A.C.); and Department of Cardiology, National Pulmonary Hypertension Service, Imperial College Healthcare NHS Trust, London, England (L.S.G.E.H., J.S.R.G.)
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