A Collaborative Approach for the Development and Application of Machine Learning Solutions for CMR-Based Cardiac Disease Classification

Perfect Match: Radiomics and Artificial Intelligence in Cardiac Imaging

Cardiovascular diseases remain a significant health burden, with imaging modalities like echocardiography, cardiac computed tomography, and cardiac magnetic resonance imaging playing a crucial role in diagnosis and prognosis. However, the inherent heterogeneity of these diseases poses challenges, necessitating advanced analytical methods like radiomics and artificial intelligence. Radiomics extracts quantitative features from medical images, capturing intricate patterns and subtle variations that may elude visual inspection. Artificial intelligence techniques, including deep learning, can analyze these features to generate knowledge, define novel imaging biomarkers, and support diagnostic decision-making and outcome prediction. Radiomics and artificial intelligence thus hold promise for significantly enhancing diagnostic and prognostic capabilities in cardiac imaging, paving the way for more personalized and effective patient care. This review explores the synergies between radiomics and artificial intelligence in cardiac imaging, following the radiomics workflow and introducing concepts from both domains. Potential clinical applications, challenges, and limitations are discussed, along with solutions to overcome them.

Heart failure with preserved ejection fraction: diagnosis, risk assessment, and treatment

The aetiology of heart failure with preserved ejection fraction (HFpEF) is heterogenous and overlaps with that of several comorbidities like atrial fibrillation, diabetes mellitus, chronic kidney disease, valvular heart disease, iron deficiency, or sarcopenia. The diagnosis of HFpEF involves evaluating cardiac dysfunction through imaging techniques and assessing increased left ventricular filling pressure, which can be measured directly or estimated through various proxies including natriuretic peptides. To better narrow down the differential diagnosis of HFpEF, European and American heart failure guidelines advocate the use of different algorithms including comorbidities that require diagnosis and rigorous treatment during the evaluation process. Therapeutic recommendations differ between guidelines. Whilst sodium glucose transporter 2 inhibitors have a solid evidence base, the recommendations differ with regard to the use of inhibitors of the renin-angiotensin-aldosterone axis. Unless indicated for specific comorbidities, the use of beta-blockers should be discouraged in HFpEF. The aim of this article is to provide an overview of the current state of the art in HFpEF diagnosis, clinical evaluation, and treatment.

Towards automatic classification of cardiovascular magnetic resonance Task Force Criteria for diagnosis of arrhythmogenic right ventricular cardiomyopathy

BACKGROUND

Arrhythmogenic right ventricular cardiomyopathy (ARVC) is diagnosed according to the Task Force Criteria (TFC) in which cardiovascular magnetic resonance (CMR) imaging plays an important role. Our study aims to apply an automatic deep learning-based segmentation for right and left ventricular CMR assessment and evaluate this approach for classification of the CMR TFC.

METHODS

We included 227 subjects suspected of ARVC who underwent CMR. Subjects were classified into (1) ARVC patients fulfilling TFC; (2) at-risk family members; and (3) controls. To perform automatic segmentation, a Bayesian Dilated Residual Neural Network was trained and tested. Performance of automatic versus manual segmentation was assessed using Dice-coefficient and Hausdorff distance. Since automatic segmentation is most challenging in basal slices, manual correction of the automatic segmentation in the most basal slice was simulated (automatic^-basal). CMR TFC calculated using manual and automatic^-basal segmentation were compared using Cohen's Kappa (κ).

RESULTS

Automatic segmentation was trained on CMRs of 70 subjects (39.6 ± 18.1 years, 47% female) and tested on 157 subjects (36.9 ± 17.6 years, 59% female). Dice-coefficient and Hausdorff distance showed good agreement between manual and automatic segmentations (≥ 0.89 and ≤ 10.6 mm, respectively) which further improved after simulated correction of the most basal slice (≥ 0.92 and ≤ 9.2 mm, p < 0.001). Pearson correlation of volumetric and functional CMR measurements was good to excellent (automatic (r = 0.78-0.99, p < 0.001) and automatic^-basal (r = 0.88-0.99, p < 0.001) measurements). CMR TFC classification using automatic^-basal segmentations was comparable to manual segmentations (κ 0.98 ± 0.02) with comparable diagnostic performance.

CONCLUSIONS

Combining automatic segmentation of CMRs with correction of the most basal slice results in accurate CMR TFC classification of subjects suspected of ARVC.