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Flower L, Waite A, Boulton A, Peck M, Akhtar W, Boyle AJ, Gudibande S, Ingram TE, Johnston B, Marsh S, Miller A, Nash A, Olusanya O, Parulekar P, Wagstaff D, Wilkinson J, Proudfoot AG. The use of echocardiography in the management of shock in critical care: a prospective, multi-centre, observational study. Intensive Care Med 2024:10.1007/s00134-024-07590-6. [PMID: 39158704 DOI: 10.1007/s00134-024-07590-6] [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: 06/20/2024] [Accepted: 08/01/2024] [Indexed: 08/20/2024]
Abstract
PURPOSE Echocardiography is recommended as a first-line tool in the assessment of patients with shock. The current provision of echocardiography in critical care is poorly defined. The aims of this work were to evaluate the utilisation of echocardiography in patients presenting to critical care with shock, its impact on decision making, and adherence to governance guidelines. METHODS We conducted a prospective, multi-centre, observational study in 178 critical care units across the United Kingdom (UK) and Crown Dependencies, led by the UK's Trainee Research in Intensive Care Network. Consecutive adult patients (≥ 18 years) admitted with shock were followed up for 72 h to ascertain whether they received an echocardiogram, the nature of any scan performed, and its effect on critical treatment decision making. RESULTS 1015 patients with shock were included. An echocardiogram was performed on 545 (54%) patients within 72 h and 436 (43%) within 24 h of admission. Most scans were performed by the critical care team (n = 314, 58%). Echocardiography was reported to either reduce diagnostic uncertainty or change management in 291 (54%) cases. Patients with obstructive or cardiogenic shock had their management altered numerically more often by echocardiography (n = 15 [75%] and n = 100 [58%] respectively). Twenty-five percent of echocardiograms performed adhered to current national governance and image storage guidance. CONCLUSION Use of echocardiography in the assessment of patients with shock remains heterogenous. When echocardiography is used, it improves diagnostic certainty or changes management in most patients. Future research should explore barriers to increasing use of echocardiography in assessing patients presenting with shock.
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Affiliation(s)
- Luke Flower
- Victor Phillip Dahdaleh Heart and Lung Research Institute, University of Cambridge, Cambridge, UK.
- Department of Critical Care, Addenbrooke's Hospital, Cambridge University Hospitals, Cambridge, UK.
- London School of Intensive Care Medicine, London, UK.
| | - Alicia Waite
- North West Deanery School of Intensive Care Medicine, Liverpool, UK
- University of Liverpool, Liverpool, UK
- Department of Critical Care, Liverpool University Hospitals NHS Trust, Liverpool, UK
| | - Adam Boulton
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK
| | - Marcus Peck
- Department of Anaesthesia and Critical Care, Royal Hampshire County Hospital, Winchester, UK
| | - Waqas Akhtar
- Department of Critical Care, Guys & St Thomas' NHS Foundation Trust, London, UK
| | - Andrew J Boyle
- Wellcome-Wolfson Institute for Experimental Medicine, Queen's University Belfast, Belfast, Northern Ireland
- Regional Intensive Care Unit, Royal Victoria Hospital, Belfast, Northern Ireland
| | - Sandeep Gudibande
- Department of Critical Care, Lancashire Teaching Hospitals NHS Trust, Lancashire, UK
- Professional Affairs and Standards Committee, Faculty of Intensive Care Medicine, London, UK
| | - Thomas E Ingram
- Department of Cardiology, Royal Wolverhampton Hospitals NHS Trust, Wolverhampton, UK
| | - Brian Johnston
- University of Liverpool, Liverpool, UK
- Department of Critical Care, Liverpool University Hospitals NHS Trust, Liverpool, UK
| | - Sarah Marsh
- Department of Critical Care, Harrogate and District NHS Foundation Trust, Harrogate, UK
| | - Ashley Miller
- Department of Critical Care, Shrewsbury and Telford Hospitals NHS Trust, Shrewsbury, UK
| | - Amy Nash
- NHS England Wessex School of Anaesthesia, Wessex, UK
| | | | | | - Daniel Wagstaff
- Wessex School of Intensive Care Medicine, NHS England, Wessex, UK
| | - Jonathan Wilkinson
- Department of Critical Care, Northampton General Hospital, Northampton, UK
| | - Alastair G Proudfoot
- Department of Critical Care, Barts Health NHS Trust, London, UK
- Critical Care and Perioperative Medicine Group, School of Medicine and Dentistry, Queen Mary University London, London, UK
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Soh CH, Wright L, Baumann A, Seidel B, Yu C, Nolan M, Mylius T, Marwick TH. Use of artificial intelligence-guided echocardiography to detect cardiac dysfunction and heart valve disease in rural and remote areas: Rationale and design of the AGILE-echo trial. Am Heart J 2024; 277:11-19. [PMID: 39128659 DOI: 10.1016/j.ahj.2024.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2024] [Revised: 08/01/2024] [Accepted: 08/06/2024] [Indexed: 08/13/2024]
Abstract
BACKGROUND Transthoracic echocardiography (TTE) is essential in the diagnosis of cardiovascular diseases (CVD), including but not limited to heart failure (HF) and heart valve disease (HVD). However, its dependence on expert acquisition means that its accessibility in rural areas may be limited, leading to delayed management decisions and potential missed diagnoses. Artificial intelligence-guided (AI)-TTE offers a solution by permitting non-expert image acquisition. The impact of AI-TTE on the timing of diagnosis and early initiation of cardioprotection is undefined. METHODS AGILE-Echo (use of Artificial intelligence-Guided echocardiography to assIst cardiovascuLar patient managEment) is a randomized-controlled trial conducted in 5 rural and remote areas around Australia. Adults with CV risk factors and exercise intolerance, or concerns regarding HVD are randomized into AI-TTE or usual care (UC). AI-TTE participants may have a cardiovascular problem excluded, identified (leading to AI-guided interventions) or unresolved (leading to conventional TTE). UC participants undergo usual management, including referral for standard TTE. The primary endpoint is a composite of HVD or HF diagnosis at 12-months. Subgroup analysis, stratified based on age range and sex, will be conducted. All statistical analyses will be conducted using R. RESULTS Of the first 157 participants, 78 have been randomized into AI-TTE (median age 68 [IQR 17]) and 79 to UC (median age 65 [IQR 17], P = .034). HVD was the primary concern in 37 participants (23.6%) while 84.7% (n = 133) experienced exercise intolerance. The overall 10-year HF incidence risk was 13.4% and 20.0% (P = .089) for UC and AI-TTE arm respectively. Atrial remodeling, left ventricular remodeling and valvular regurgitation were the most common findings. Thirty-three patients (42.3%) showed no abnormalities. CONCLUSIONS This randomized-controlled trial of AI-TTE will provide proof-of-concept for the role of AI-TTE in identifying pre-symptomatic HF or HVD when access to TTE is limited. Additionally, this could promote the usage of AI-TTE in rural or remote areas, ultimately improving health and quality of life of community dwelling adults with risks, signs or symptoms of cardiac dysfunction.
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Affiliation(s)
- Cheng Hwee Soh
- Imaging Research, Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia; Baker Department of Cardiometabolic Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Leah Wright
- Imaging Research, Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
| | - Angus Baumann
- Alice Springs Hospital, The Gap, Northern Territory, Australia
| | | | - Christopher Yu
- Walgett Aboriginal Medical Service Limited, Walgett, New South Wales, Australia; Nepean Clinical School, University of Sydney, Sydney, New South Wales, Australia
| | - Mark Nolan
- Imaging Research, Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
| | - Tony Mylius
- Merredin District Hospital, Western Australian Country Health Service, Wheatbelt, Western Australia, Australia
| | - Thomas H Marwick
- Imaging Research, Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia; Baker Department of Cardiometabolic Health, University of Melbourne, Melbourne, Victoria, Australia; Menzies Institute for Medical Research, Hobart, Tasmania, Australia.
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Moradi A, Olanisa OO, Nzeako T, Shahrokhi M, Esfahani E, Fakher N, Khazeei Tabari MA. Revolutionizing Cardiac Imaging: A Scoping Review of Artificial Intelligence in Echocardiography, CTA, and Cardiac MRI. J Imaging 2024; 10:193. [PMID: 39194982 DOI: 10.3390/jimaging10080193] [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: 06/19/2024] [Revised: 08/01/2024] [Accepted: 08/03/2024] [Indexed: 08/29/2024] Open
Abstract
BACKGROUND AND INTRODUCTION Cardiac imaging is crucial for diagnosing heart disorders. Methods like X-rays, ultrasounds, CT scans, and MRIs provide detailed anatomical and functional heart images. AI can enhance these imaging techniques with its advanced learning capabilities. METHOD In this scoping review, following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) Guidelines, we searched PubMed, Scopus, Web of Science, and Google Scholar using related keywords on 16 April 2024. From 3679 articles, we first screened titles and abstracts based on the initial inclusion criteria and then screened the full texts. The authors made the final selections collaboratively. RESULT The PRISMA chart shows that 3516 articles were initially selected for evaluation after removing duplicates. Upon reviewing titles, abstracts, and quality, 24 articles were deemed eligible for the review. The findings indicate that AI enhances image quality, speeds up imaging processes, and reduces radiation exposure with sensitivity and specificity comparable to or exceeding those of qualified radiologists or cardiologists. Further research is needed to assess AI's applicability in various types of cardiac imaging, especially in rural hospitals where access to medical doctors is limited. CONCLUSIONS AI improves image quality, reduces human errors and radiation exposure, and can predict cardiac events with acceptable sensitivity and specificity.
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Affiliation(s)
- Ali Moradi
- Internal Medicine, HCA Florida, Blake Hospital, Morsani College of Medicine, University of South Florida, Bradenton, FL 34209, USA
- Center for Translational Medicine, Semmelweis University, 1428 Budapest, Hungary
| | - Olawale O Olanisa
- Internal Medicine, Adjunct Clinical Faculty, Michigan State University College of Human Medicine, Trinity Health Grand Rapids, Grand Rapids, MI 49503, USA
| | - Tochukwu Nzeako
- Internal Medicine, Christiana Care Hospital, Newark, DE 19718, USA
| | - Mehregan Shahrokhi
- School of Medicine, Shiraz University of Medical Sciences, Shiraz 71348-45794, Iran
| | - Eman Esfahani
- Faculty of Medicine, Semmelweis University, 1085 Budapest, Hungary
| | - Nastaran Fakher
- Faculty of Medicine, Semmelweis University, 1085 Budapest, Hungary
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Nedadur R, Bhatt N, Lui T, Chu MWA, McCarthy PM, Kline A. The Emerging and Important Role of Artificial Intelligence in Cardiac Surgery. Can J Cardiol 2024:S0828-282X(24)00586-5. [PMID: 39098601 DOI: 10.1016/j.cjca.2024.07.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2024] [Revised: 07/29/2024] [Accepted: 07/29/2024] [Indexed: 08/06/2024] Open
Abstract
Artificial Intelligence (AI) has greatly affected our everyday lives and holds great promise to change the landscape of medicine. AI is particularly positioned to improve care for the increasingly complex patients undergoing cardiac surgery utilizing immense amount of data generated in the course of their care. When deployed, AI can be used to analyze this information at the patient's bedside more expediently and accurately, all while providing new insights. This review summarizes the current applications of AI in cardiac surgery, from the vantage point of a patient's journey. Applications of AI include pre-operative risk assessment, intraoperative planning, post-operative patient care and out-patient telemonitoring, encompassing the spectrum of cardiac surgical care. Offloading of administrative processes and enhanced experience with information gathering also represent a unique and underrepresented avenue for future utilization of AI. As clinicians, understanding the nomenclature and applications of AI is important to contextualize problems, to ensure problem-driven solutions and for clinical benefit. Precision medicine, and thus clinically relevant AI, remains dependent on data curation and warehousing to gather insights from large multicenter repositories while treating privacy with the utmost importance. AI tasks should not be siloed but rather holistically integrated into clinical workflow to retain context and relevance. As cardiac surgeons, AI allows us to look forward to a bright future of more efficient utilization of our clinical expertise toward high-level decision making and technical prowess.
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Affiliation(s)
- Rashmi Nedadur
- Feinberg School of Medicine, Division of Cardiac Surgery, Northwestern University, Chicago, Illinois, United States; Center for Artificial Intelligence, Bluhm Cardiovascular Institute, Northwestern Medicine, Chicago, Illinois, United States
| | - Nitish Bhatt
- Peter Munk Cardiac Center, Toronto General Hospital, Toronto, Ontario, Canada
| | - Tom Lui
- Feinberg School of Medicine, Division of Cardiac Surgery, Northwestern University, Chicago, Illinois, United States; Center for Artificial Intelligence, Bluhm Cardiovascular Institute, Northwestern Medicine, Chicago, Illinois, United States
| | | | - Patrick M McCarthy
- Feinberg School of Medicine, Division of Cardiac Surgery, Northwestern University, Chicago, Illinois, United States; Center for Artificial Intelligence, Bluhm Cardiovascular Institute, Northwestern Medicine, Chicago, Illinois, United States
| | - Adrienne Kline
- Feinberg School of Medicine, Division of Cardiac Surgery, Northwestern University, Chicago, Illinois, United States; Center for Artificial Intelligence, Bluhm Cardiovascular Institute, Northwestern Medicine, Chicago, Illinois, United States
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Pan JA, Patel AR. The Role of Multimodality Imaging in Cardiomyopathy. Curr Cardiol Rep 2024; 26:689-703. [PMID: 38753290 PMCID: PMC11236518 DOI: 10.1007/s11886-024-02068-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/24/2024] [Indexed: 06/25/2024]
Abstract
PURPOSE OF REVIEW There has been increasing use of multimodality imaging in the evaluation of cardiomyopathies. RECENT FINDINGS Echocardiography, cardiac magnetic resonance (CMR), cardiac nuclear imaging, and cardiac computed tomography (CCT) play an important role in the diagnosis, risk stratification, and management of patients with cardiomyopathies. Echocardiography is essential in the initial assessment of suspected cardiomyopathy, but a multimodality approach can improve diagnostics and management. CMR allows for accurate measurement of volumes and function, and can easily detect unique pathologic structures. In addition, contrast imaging and parametric mapping enable the characterization of tissue features such as scar, edema, infiltration, and deposition. In non-ischemic cardiomyopathies, metabolic and molecular nuclear imaging is used to diagnose rare but life-threatening conditions such amyloidosis and sarcoidosis. There is an expanding use of CCT for planning electrophysiology procedures such as cardioversion, ablations, and device placement. Furthermore, CCT can evaluate for complications associated with advanced heart failure therapies such as cardiac transplant and mechanical support devices. Innovations in multimodality cardiac imaging should lead to increased volumes and better outcomes.
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Affiliation(s)
- Jonathan A Pan
- Cardiovascular Division, Department of Medicine, University of Virginia Health System, 1215 Lee Street, Box 800158, Charlottesville, VA, 22908, USA
| | - Amit R Patel
- Cardiovascular Division, Department of Medicine, University of Virginia Health System, 1215 Lee Street, Box 800158, Charlottesville, VA, 22908, USA.
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Gregory A, Ender J, Shaw AD, Denault A, Ibekwe S, Stoppe C, Alli A, Manning MW, Brodt JL, Galhardo C, Sander M, Zarbock A, Fletcher N, Ghadimi K, Grant MC. ERAS/STS 2024 Expert Consensus Statement on Perioperative Care in Cardiac Surgery: Continuing the Evolution of Optimized Patient Care and Recovery. J Cardiothorac Vasc Anesth 2024:S1053-0770(24)00399-9. [PMID: 39004570 DOI: 10.1053/j.jvca.2024.06.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2024] [Accepted: 06/20/2024] [Indexed: 07/16/2024]
Affiliation(s)
- Alexander Gregory
- Department of Anesthesiology, Perioperative and Pain Medicine, Cumming School of Medicine and Libin Cardiovascular Institute, University of Calgary, Calgary, Canada
| | - Joerg Ender
- Department of Anesthesiology and Intensive Care Medicine, Heartcenter Leipzig GmbH, Leipzig, Germany
| | - Andrew D Shaw
- Department of Intensive Care and Resuscitation, Cleveland Clinic, Cleveland, OH
| | - André Denault
- Montreal Heart Institute, University of Montreal, Montreal, Quebec, Canada
| | - Stephanie Ibekwe
- Department of Anesthesiology, Baylor College of Medicine, Houston, TX
| | - Christian Stoppe
- Department of Cardiac Anesthesiology and Intensive Care Medicine, Charité Berlin, Berlin, Germany
| | - Ahmad Alli
- Department of Anesthesiology & Pain Medicine, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada
| | | | - Jessica L Brodt
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Palo Alto CA
| | - Carlos Galhardo
- Department of Anesthesia, McMaster University, Ontario, Canada
| | - Michael Sander
- Anesthesiology and Intensive Care Medicine, Justus Liebig University Giessen, University Hospital Giessen, Giessen, Germany
| | - Alexander Zarbock
- Department of Anesthesiology, Intensive Care and Pain Medicine, University Hospital Münster, Münster, Germany
| | - Nick Fletcher
- Institute of Anaesthesia and Critical Care, Cleveland Clinic London, London, UK
| | | | - Michael C Grant
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
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Stamate E, Piraianu AI, Ciobotaru OR, Crassas R, Duca O, Fulga A, Grigore I, Vintila V, Fulga I, Ciobotaru OC. Revolutionizing Cardiology through Artificial Intelligence-Big Data from Proactive Prevention to Precise Diagnostics and Cutting-Edge Treatment-A Comprehensive Review of the Past 5 Years. Diagnostics (Basel) 2024; 14:1103. [PMID: 38893630 PMCID: PMC11172021 DOI: 10.3390/diagnostics14111103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2024] [Revised: 05/12/2024] [Accepted: 05/23/2024] [Indexed: 06/21/2024] Open
Abstract
BACKGROUND Artificial intelligence (AI) can radically change almost every aspect of the human experience. In the medical field, there are numerous applications of AI and subsequently, in a relatively short time, significant progress has been made. Cardiology is not immune to this trend, this fact being supported by the exponential increase in the number of publications in which the algorithms play an important role in data analysis, pattern discovery, identification of anomalies, and therapeutic decision making. Furthermore, with technological development, there have appeared new models of machine learning (ML) and deep learning (DP) that are capable of exploring various applications of AI in cardiology, including areas such as prevention, cardiovascular imaging, electrophysiology, interventional cardiology, and many others. In this sense, the present article aims to provide a general vision of the current state of AI use in cardiology. RESULTS We identified and included a subset of 200 papers directly relevant to the current research covering a wide range of applications. Thus, this paper presents AI applications in cardiovascular imaging, arithmology, clinical or emergency cardiology, cardiovascular prevention, and interventional procedures in a summarized manner. Recent studies from the highly scientific literature demonstrate the feasibility and advantages of using AI in different branches of cardiology. CONCLUSIONS The integration of AI in cardiology offers promising perspectives for increasing accuracy by decreasing the error rate and increasing efficiency in cardiovascular practice. From predicting the risk of sudden death or the ability to respond to cardiac resynchronization therapy to the diagnosis of pulmonary embolism or the early detection of valvular diseases, AI algorithms have shown their potential to mitigate human error and provide feasible solutions. At the same time, limits imposed by the small samples studied are highlighted alongside the challenges presented by ethical implementation; these relate to legal implications regarding responsibility and decision making processes, ensuring patient confidentiality and data security. All these constitute future research directions that will allow the integration of AI in the progress of cardiology.
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Affiliation(s)
- Elena Stamate
- Department of Cardiology, Emergency University Hospital of Bucharest, 050098 Bucharest, Romania; (E.S.); (V.V.)
- Faculty of Medicine and Pharmacy, University “Dunarea de Jos” of Galati, 35 AI Cuza Street, 800010 Galati, Romania; (O.D.); (A.F.); (I.G.); (I.F.); (O.C.C.)
| | - Alin-Ionut Piraianu
- Faculty of Medicine and Pharmacy, University “Dunarea de Jos” of Galati, 35 AI Cuza Street, 800010 Galati, Romania; (O.D.); (A.F.); (I.G.); (I.F.); (O.C.C.)
| | - Oana Roxana Ciobotaru
- Faculty of Medicine and Pharmacy, University “Dunarea de Jos” of Galati, 35 AI Cuza Street, 800010 Galati, Romania; (O.D.); (A.F.); (I.G.); (I.F.); (O.C.C.)
- Railway Hospital Galati, 800223 Galati, Romania
| | - Rodica Crassas
- Emergency County Hospital Braila, 810325 Braila, Romania;
| | - Oana Duca
- Faculty of Medicine and Pharmacy, University “Dunarea de Jos” of Galati, 35 AI Cuza Street, 800010 Galati, Romania; (O.D.); (A.F.); (I.G.); (I.F.); (O.C.C.)
- Emergency County Hospital Braila, 810325 Braila, Romania;
| | - Ana Fulga
- Faculty of Medicine and Pharmacy, University “Dunarea de Jos” of Galati, 35 AI Cuza Street, 800010 Galati, Romania; (O.D.); (A.F.); (I.G.); (I.F.); (O.C.C.)
- Saint Apostle Andrew Emergency County Clinical Hospital, 177 Brailei Street, 800578 Galati, Romania
| | - Ionica Grigore
- Faculty of Medicine and Pharmacy, University “Dunarea de Jos” of Galati, 35 AI Cuza Street, 800010 Galati, Romania; (O.D.); (A.F.); (I.G.); (I.F.); (O.C.C.)
- Emergency County Hospital Braila, 810325 Braila, Romania;
| | - Vlad Vintila
- Department of Cardiology, Emergency University Hospital of Bucharest, 050098 Bucharest, Romania; (E.S.); (V.V.)
- Clinical Department of Cardio-Thoracic Pathology, University of Medicine and Pharmacy “Carol Davila” Bucharest, 37 Dionisie Lupu Street, 4192910 Bucharest, Romania
| | - Iuliu Fulga
- Faculty of Medicine and Pharmacy, University “Dunarea de Jos” of Galati, 35 AI Cuza Street, 800010 Galati, Romania; (O.D.); (A.F.); (I.G.); (I.F.); (O.C.C.)
- Saint Apostle Andrew Emergency County Clinical Hospital, 177 Brailei Street, 800578 Galati, Romania
| | - Octavian Catalin Ciobotaru
- Faculty of Medicine and Pharmacy, University “Dunarea de Jos” of Galati, 35 AI Cuza Street, 800010 Galati, Romania; (O.D.); (A.F.); (I.G.); (I.F.); (O.C.C.)
- Railway Hospital Galati, 800223 Galati, Romania
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Jacobs P, Khoche S. Artificial Intelligence and Echocardiography: A Genuinely Interesting Conundrum. J Cardiothorac Vasc Anesth 2024; 38:1065-1067. [PMID: 38378322 DOI: 10.1053/j.jvca.2024.01.014] [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] [Received: 01/15/2024] [Accepted: 01/17/2024] [Indexed: 02/22/2024]
Affiliation(s)
- Paul Jacobs
- Department of Anesthesiology, Division of Cardiothoracic Anesthesia, University of California, San Diego, Thornton Hospital, La Jolla, CA.
| | - Swapnil Khoche
- Department of Anesthesiology, Division of Cardiothoracic Anesthesia, University of California, San Diego, Thornton Hospital, La Jolla, CA
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Recco DP, Kneier NE, Earley PD, Kizilski SB, Hammer PE, Hoganson DM. Fiberscope-Based Measurement of Coaptation Height for Intraoperative Assessment of Mitral Valve Repair. World J Pediatr Congenit Heart Surg 2024; 15:371-379. [PMID: 38327093 DOI: 10.1177/21501351231221459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2024]
Abstract
BACKGROUND Restoring adequate coaptation height is a key principle of mitral valve (MV) repair. This study aimed to evaluate the utility of fiberscope (FS) technology to assess MV coaptation height for intraoperative use. METHODS Ex-vivo testing was performed on five adult porcine hearts. The left atrium (LA) was resected, and the left ventricle (LV) was pressurized retrograde to 27 ± 1mm Hg. An endoscope was inserted into the LV apex, centered under the MV orifice. An FS system (Milliscope II camera, LED light source, and 0.7 mm diameter × 15 cm long) 90° semirigid scope with 1.2 mm focal length) was mounted above the MV annulus in a custom alignment and measuring fixture. Three blinded measurements were taken at two locations on each MV, A2 and P2 segment, from the top of coaptation to the leaflet edge identified by the FS. Accurate positioning was verified using the LV endoscope. A control (metal rod of similar thickness) was used for comparison, with coaptation height recorded when the control was seen via the endoscope. RESULTS Coaptation heights were similar for the control and FS methods across all hearts at A2 (11.6 ± 2.6 mm control vs 11.8 ± 2.2 mm FS) and P2 (13.3 ± 2.6 mm control vs 13.4 ± 2.9 mm FS) segments, with similar measurement variability (control SD 0.1-1.0 mm; FS SD 0.1-0.9 mm). One outlier was excluded from analysis (n = 19/20). The maximum absolute difference and percent error between measurement methods were less than 1.1 mm (median [IQR], 0.6 [0.3-0.9] mm) and less than 14% (4.1 [2.2-7.6]%). CONCLUSIONS Utilization of a miniaturized FS enabled precise and accurate quantification of MV coaptation. This technique is promising for evaluating post-repair valve competence and coaptation height.
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Affiliation(s)
- Dominic P Recco
- Department of Cardiac Surgery, Boston Children's Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Nicholas E Kneier
- Department of Cardiac Surgery, Boston Children's Hospital, Boston, MA, USA
| | - Patrick D Earley
- Department of Cardiac Surgery, Boston Children's Hospital, Boston, MA, USA
| | - Shannen B Kizilski
- Department of Cardiac Surgery, Boston Children's Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Peter E Hammer
- Department of Cardiac Surgery, Boston Children's Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - David M Hoganson
- Department of Cardiac Surgery, Boston Children's Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
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Oliveros E, Grapsa J. Finding New Echocardiographic Parameters for Reverse Cardiac Remodeling: Isovolumic Contraction Velocity in Heart Failure with Reduced Ejection Fraction and Effect of Sacubitril/Valsartan: the PROVE-HF Study. J Card Fail 2024; 30:666-668. [PMID: 38160996 DOI: 10.1016/j.cardfail.2023.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Revised: 11/30/2023] [Accepted: 12/12/2023] [Indexed: 01/03/2024]
Affiliation(s)
- Estefania Oliveros
- Lewis Katz School of Medicine, Temple University Hospital, Philadelphia, PA, USA.
| | - Julia Grapsa
- Guy's and St Thomas' NHS Trust Hospitals, London, UK
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Singh Y. Echocardiography in the neonatal unit: current status and future prospects. Expert Rev Med Devices 2024; 21:307-316. [PMID: 38526192 DOI: 10.1080/17434440.2024.2334449] [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: 01/04/2024] [Accepted: 03/20/2024] [Indexed: 03/26/2024]
Abstract
INTRODUCTION Traditionally echocardiography was used by pediatric cardiologists to diagnose congenital heart defects in neonates. Formalized neonatal hemodynamic fellowships have been established where neonatologists acquire advanced echocardiographic skills to gain anatomical, physiological, and hemodynamic information in real time and utilize this information in making a timely and accurate physiology-based clinical decision. AREA COVERED Differences between a comprehensive formal structural echocardiography, neonatologist performed targeted echocardiography and limited assessment on point-of-care-ultrasonography for specific indications have been covered. This article is focused at providing a comprehensive review of the status of echocardiography in the neonatal units, recent advancements and its future prospects in the neonatal intensive care units. EXPERT OPINION Comprehensive guidelines providing the scope of practice, a framework for training, and robust clinical governance process for the neonatologist performed targeted echocardiography have been established. In the last decade, echocardiography has emerged as essential vital bedside diagnostic tool in providing high-quality care to the sick infants in the neonatal units, and it has proved to improve the outcomes in neonates. It is now being considered as a modern hemodynamic monitoring tool. Advances in technology, machine learning, and application of artificial intelligence in applications of echocardiography seem promising adjunct tools for rapid assessment in emergency situations.
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Affiliation(s)
- Yogen Singh
- Division of Neonatology, Loma Linda University School of Medicine, Loma Linda, CA, USA
- Division of Neonatology, University of Southern California, Los Angeles, USA
- Department of Pediatrics, University of Cambridge Clinical School of Medicine, Cambridge, UK
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Shiokawa N, Izumo M, Shimamura T, Kurosaka Y, Sato Y, Okamura T, Akashi YJ. Accuracy and Efficacy of Artificial Intelligence-Derived Automatic Measurements of Transthoracic Echocardiography in Routine Clinical Practice. J Clin Med 2024; 13:1861. [PMID: 38610628 PMCID: PMC11012797 DOI: 10.3390/jcm13071861] [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: 03/13/2024] [Revised: 03/22/2024] [Accepted: 03/22/2024] [Indexed: 04/14/2024] Open
Abstract
Background: Transthoracic echocardiography (TTE) is the gold standard modality for evaluating cardiac morphology, function, and hemodynamics in clinical practice. While artificial intelligence (AI) is expected to contribute to improved accuracy and is being applied clinically, its impact on daily clinical practice has not been fully evaluated. Methods: We retrospectively examined 30 consecutive patients who underwent AI-equipped TTE at a single institution. All patients underwent manual and automatic measurements of TTE parameters using the AI-equipped TTE. Measurements were performed by three sonographers with varying experience levels: beginner, intermediate, and expert. Results: A comparison between the manual and automatic measurements assessed by the experts showed extremely high agreement in the left ventricular (LV) filling velocities (E wave: r = 0.998, A wave: r = 0.996; both p < 0.001). The automated measurements of LV end-diastolic and end-systolic diameters were slightly smaller (-2.41 mm and -1.19 mm) than the manual measurements, although without significant differences, and both methods showing high agreement (r = 0.942 and 0.977, both p < 0.001). However, LV wall thickness showed low agreement between the automated and manual measurements (septum: r = 0.670, posterior: r = 0.561; both p < 0.01), with automated measurements tending to be larger. Regarding interobserver variabilities, statistically significant agreement was observed among the measurements of expert, intermediate, and beginner sonographers for all the measurements. In terms of measurement time, automatic measurement significantly reduced measurement time compared to manual measurement (p < 0.001). Conclusions: This preliminary study confirms the accuracy and efficacy of AI-equipped TTE in routine clinical practice. A multicenter study with a larger sample size is warranted.
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Affiliation(s)
- Noriko Shiokawa
- Ultrasound Center, St. Marianna University Hospital, 2-16-1 Sugao, Miyamae-ku, Kawasaki 216-8511, Japan; (N.S.); (T.S.); (Y.K.); (T.O.)
| | - Masaki Izumo
- Department of Cardiology, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kawasaki 216-8511, Japan; (Y.S.); (Y.J.A.)
| | - Toshio Shimamura
- Ultrasound Center, St. Marianna University Hospital, 2-16-1 Sugao, Miyamae-ku, Kawasaki 216-8511, Japan; (N.S.); (T.S.); (Y.K.); (T.O.)
| | - Yui Kurosaka
- Ultrasound Center, St. Marianna University Hospital, 2-16-1 Sugao, Miyamae-ku, Kawasaki 216-8511, Japan; (N.S.); (T.S.); (Y.K.); (T.O.)
| | - Yukio Sato
- Department of Cardiology, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kawasaki 216-8511, Japan; (Y.S.); (Y.J.A.)
| | - Takanori Okamura
- Ultrasound Center, St. Marianna University Hospital, 2-16-1 Sugao, Miyamae-ku, Kawasaki 216-8511, Japan; (N.S.); (T.S.); (Y.K.); (T.O.)
| | - Yoshihiro Johnny Akashi
- Department of Cardiology, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kawasaki 216-8511, Japan; (Y.S.); (Y.J.A.)
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13
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Palermi S, Vecchiato M, Saglietto A, Niederseer D, Oxborough D, Ortega-Martorell S, Olier I, Castelletti S, Baggish A, Maffessanti F, Biffi A, D'Andrea A, Zorzi A, Cavarretta E, D'Ascenzi F. Unlocking the potential of artificial intelligence in sports cardiology: does it have a role in evaluating athlete's heart? Eur J Prev Cardiol 2024; 31:470-482. [PMID: 38198776 DOI: 10.1093/eurjpc/zwae008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 01/01/2024] [Accepted: 01/03/2024] [Indexed: 01/12/2024]
Abstract
The integration of artificial intelligence (AI) technologies is evolving in different fields of cardiology and in particular in sports cardiology. Artificial intelligence offers significant opportunities to enhance risk assessment, diagnosis, treatment planning, and monitoring of athletes. This article explores the application of AI in various aspects of sports cardiology, including imaging techniques, genetic testing, and wearable devices. The use of machine learning and deep neural networks enables improved analysis and interpretation of complex datasets. However, ethical and legal dilemmas must be addressed, including informed consent, algorithmic fairness, data privacy, and intellectual property issues. The integration of AI technologies should complement the expertise of physicians, allowing for a balanced approach that optimizes patient care and outcomes. Ongoing research and collaborations are vital to harness the full potential of AI in sports cardiology and advance our management of cardiovascular health in athletes.
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Affiliation(s)
- Stefano Palermi
- Public Health Department, University of Naples Federico II, via Pansini 5, 80131 Naples, Italy
| | - Marco Vecchiato
- Sports and Exercise Medicine Division, Department of Medicine, University of Padova, 35128 Padova, Italy
| | - Andrea Saglietto
- Division of Cardiology, Cardiovascular and Thoracic Department, 'Citta della Salute e della Scienza' Hospital, 10129 Turin, Italy
- Department of Medical Sciences, University of Turin, 10129 Turin, Italy
| | - David Niederseer
- Department of Cardiology, University Heart Center Zurich, University Hospital Zurich, University of Zurich, 8091 Zurich, Switzerland
| | - David Oxborough
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UK
| | - Sandra Ortega-Martorell
- Data Science Research Centre, Liverpool John Moores University, Liverpool, UK
- Liverpool Centre for Cardiovascular Science, Liverpool John Moores University, Liverpool, UK
| | - Ivan Olier
- Data Science Research Centre, Liverpool John Moores University, Liverpool, UK
- Liverpool Centre for Cardiovascular Science, Liverpool John Moores University, Liverpool, UK
| | - Silvia Castelletti
- Cardiology Department, Istituto Auxologico Italiano IRCCS, 20149 Milan, Italy
| | - Aaron Baggish
- Cardiovascular Performance Program, Massachusetts General Hospital, Boston, MA 02114, USA
| | | | - Alessandro Biffi
- Med-Ex, Medicine & Exercise, Medical Partner Scuderia Ferrari, 00187 Rome, Italy
| | - Antonello D'Andrea
- Department of Cardiology, Umberto I Hospital, 84014 Nocera Inferiore, Italy
| | - Alessandro Zorzi
- Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padova, 35128 Padova, Italy
| | - Elena Cavarretta
- Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, 04100 Latina, Italy
- Mediterranea Cardiocentro, 80122 Naples, Italy
| | - Flavio D'Ascenzi
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, 53100 Siena, Italy
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14
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Kingsmore SF, Nofsinger R, Ellsworth K. Rapid genomic sequencing for genetic disease diagnosis and therapy in intensive care units: a review. NPJ Genom Med 2024; 9:17. [PMID: 38413639 PMCID: PMC10899612 DOI: 10.1038/s41525-024-00404-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Accepted: 02/15/2024] [Indexed: 02/29/2024] Open
Abstract
Single locus (Mendelian) diseases are a leading cause of childhood hospitalization, intensive care unit (ICU) admission, mortality, and healthcare cost. Rapid genome sequencing (RGS), ultra-rapid genome sequencing (URGS), and rapid exome sequencing (RES) are diagnostic tests for genetic diseases for ICU patients. In 44 studies of children in ICUs with diseases of unknown etiology, 37% received a genetic diagnosis, 26% had consequent changes in management, and net healthcare costs were reduced by $14,265 per child tested by URGS, RGS, or RES. URGS outperformed RGS and RES with faster time to diagnosis, and higher rate of diagnosis and clinical utility. Diagnostic and clinical outcomes will improve as methods evolve, costs decrease, and testing is implemented within precision medicine delivery systems attuned to ICU needs. URGS, RGS, and RES are currently performed in <5% of the ~200,000 children likely to benefit annually due to lack of payor coverage, inadequate reimbursement, hospital policies, hospitalist unfamiliarity, under-recognition of possible genetic diseases, and current formatting as tests rather than as a rapid precision medicine delivery system. The gap between actual and optimal outcomes in children in ICUs is currently increasing since expanded use of URGS, RGS, and RES lags growth in those likely to benefit through new therapies. There is sufficient evidence to conclude that URGS, RGS, or RES should be considered in all children with diseases of uncertain etiology at ICU admission. Minimally, diagnostic URGS, RGS, or RES should be ordered early during admissions of critically ill infants and children with suspected genetic diseases.
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Affiliation(s)
- Stephen F Kingsmore
- Rady Children's Institute for Genomic Medicine, Rady Children's Hospital, San Diego, CA, USA.
| | - Russell Nofsinger
- Rady Children's Institute for Genomic Medicine, Rady Children's Hospital, San Diego, CA, USA
| | - Kasia Ellsworth
- Rady Children's Institute for Genomic Medicine, Rady Children's Hospital, San Diego, CA, USA
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15
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Paiste HJ, Godwin RC, Smith AD, Berkowitz DE, Melvin RL. Strengths-weaknesses-opportunities-threats analysis of artificial intelligence in anesthesiology and perioperative medicine. Front Digit Health 2024; 6:1316931. [PMID: 38444721 PMCID: PMC10912557 DOI: 10.3389/fdgth.2024.1316931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Accepted: 02/01/2024] [Indexed: 03/07/2024] Open
Abstract
The use of artificial intelligence (AI) and machine learning (ML) in anesthesiology and perioperative medicine is quickly becoming a mainstay of clinical practice. Anesthesiology is a data-rich medical specialty that integrates multitudes of patient-specific information. Perioperative medicine is ripe for applications of AI and ML to facilitate data synthesis for precision medicine and predictive assessments. Examples of emergent AI models include those that assist in assessing depth and modulating control of anesthetic delivery, event and risk prediction, ultrasound guidance, pain management, and operating room logistics. AI and ML support analyzing integrated perioperative data at scale and can assess patterns to deliver optimal patient-specific care. By exploring the benefits and limitations of this technology, we provide a basis of considerations for evaluating the adoption of AI models into various anesthesiology workflows. This analysis of AI and ML in anesthesiology and perioperative medicine explores the current landscape to understand better the strengths, weaknesses, opportunities, and threats (SWOT) these tools offer.
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Affiliation(s)
- Henry J. Paiste
- Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
| | - Ryan C. Godwin
- Department of Anesthesiology and Perioperative Medicine, University of Alabama Birmingham School of Medicine, Birmingham, AL, United States
- Department of Radiology, University of Alabama Birmingham School of Medicine, Birmingham, AL, United States
| | - Andrew D. Smith
- Department of Radiology, University of Alabama Birmingham School of Medicine, Birmingham, AL, United States
| | - Dan E. Berkowitz
- Department of Anesthesiology and Perioperative Medicine, University of Alabama Birmingham School of Medicine, Birmingham, AL, United States
| | - Ryan L. Melvin
- Department of Anesthesiology and Perioperative Medicine, University of Alabama Birmingham School of Medicine, Birmingham, AL, United States
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16
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Fazlalizadeh H, Khan MS, Fox ER, Douglas PS, Adams D, Blaha MJ, Daubert MA, Dunn G, van den Heuvel E, Kelsey MD, Martin RP, Thomas JD, Thomas Y, Judd SE, Vasan RS, Budoff MJ, Bloomfield GS. Closing the Last Mile Gap in Access to Multimodality Imaging in Rural Settings: Design of the Imaging Core of the Risk Underlying Rural Areas Longitudinal Study. Circ Cardiovasc Imaging 2024; 17:e015496. [PMID: 38377236 PMCID: PMC10883604 DOI: 10.1161/circimaging.123.015496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/22/2024]
Abstract
Achieving optimal cardiovascular health in rural populations can be challenging for several reasons including decreased access to care with limited availability of imaging modalities, specialist physicians, and other important health care team members. Therefore, innovative solutions are needed to optimize health care and address cardiovascular health disparities in rural areas. Mobile examination units can bring imaging technology to underserved or remote communities with limited access to health care services. Mobile examination units can be equipped with a wide array of assessment tools and multiple imaging modalities such as computed tomography scanning and echocardiography. The detailed structural assessment of cardiovascular and lung pathology, as well as the detection of extracardiac pathology afforded by computed tomography imaging combined with the functional and hemodynamic assessments acquired by echocardiography, yield deep phenotyping of heart and lung disease for populations historically underrepresented in epidemiological studies. Moreover, by bringing the mobile examination unit to local communities, innovative approaches are now possible including engagement with local professionals to perform these imaging assessments, thereby augmenting local expertise and experience. However, several challenges exist before mobile examination unit-based examinations can be effectively integrated into the rural health care setting including standardizing acquisition protocols, maintaining consistent image quality, and addressing ethical and privacy considerations. Herein, we discuss the potential importance of cardiac multimodality imaging to improve cardiovascular health in rural regions, outline the emerging experience in this field, highlight important current challenges, and offer solutions based on our experience in the RURAL (Risk Underlying Rural Areas Longitudinal) cohort study.
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Affiliation(s)
- Hooman Fazlalizadeh
- Lundquist Institute, Harbor-University of California Los Angeles Medical Center, Torrance (H.F., M.J.B.)
| | - Muhammad Shahzeb Khan
- Division of Cardiology, Department of Medicine (M.S.K., P.S.D., M.A.D., M.D.K., G.S.B.), Duke University, Durham, NC
| | - Ervin R Fox
- Division of Cardiology, Department of Medicine University of Mississippi Medical Center, Jackson, MS (E.R.F.)
| | - Pamela S Douglas
- Division of Cardiology, Department of Medicine (M.S.K., P.S.D., M.A.D., M.D.K., G.S.B.), Duke University, Durham, NC
- Duke Clinical Research Institute (P.S.D., M.A.D., G.D., M.D.K., G.S.B.), Duke University, Durham, NC
| | - David Adams
- Caption Health, Inc, San Francisco, CA (D.A., R.P.M., Y.T.)
| | - Michael J Blaha
- Lundquist Institute, Harbor-University of California Los Angeles Medical Center, Torrance (H.F., M.J.B.)
| | - Melissa A Daubert
- Division of Cardiology, Department of Medicine (M.S.K., P.S.D., M.A.D., M.D.K., G.S.B.), Duke University, Durham, NC
- Duke Clinical Research Institute (P.S.D., M.A.D., G.D., M.D.K., G.S.B.), Duke University, Durham, NC
| | - Gary Dunn
- Duke Clinical Research Institute (P.S.D., M.A.D., G.D., M.D.K., G.S.B.), Duke University, Durham, NC
| | - Edwin van den Heuvel
- Department of Mathematics and Computer Science, Eindhoven University of Technology, The Netherlands (E.v.d.H.)
| | - Michelle D Kelsey
- Division of Cardiology, Department of Medicine (M.S.K., P.S.D., M.A.D., M.D.K., G.S.B.), Duke University, Durham, NC
- Duke Clinical Research Institute (P.S.D., M.A.D., G.D., M.D.K., G.S.B.), Duke University, Durham, NC
| | | | - James D Thomas
- Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (J.D.T.)
- Center for Artificial Intelligence, Northwestern Medicine Bluhm Cardiovascular Institute, Chicago, IL (J.D.T.)
| | - Yngvil Thomas
- Caption Health, Inc, San Francisco, CA (D.A., R.P.M., Y.T.)
| | - Suzanne E Judd
- Department of Biostatistics, University of Alabama at Birmingham (S.E.J.)
| | - Ramachandran S Vasan
- University of Texas Health Sciences Center, University of Texas School of Public Health, San Antonio (R.S.V.)
| | - Matthew J Budoff
- Division of Cardiology, John Hopkins University School of Medicine, Baltimore, MD (M.J.B.)
| | - Gerald S Bloomfield
- Division of Cardiology, Department of Medicine (M.S.K., P.S.D., M.A.D., M.D.K., G.S.B.), Duke University, Durham, NC
- Duke Clinical Research Institute (P.S.D., M.A.D., G.D., M.D.K., G.S.B.), Duke University, Durham, NC
- Duke Global Health Institute (G.S.B.), Duke University, Durham, NC
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17
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Palermi S, Sperlongano S, Mandoli GE, Pastore MC, Lisi M, Benfari G, Ilardi F, Malagoli A, Russo V, Ciampi Q, Cameli M, D’Andrea A. Exercise Stress Echocardiography in Athletes: Applications, Methodology, and Challenges. J Clin Med 2023; 12:7678. [PMID: 38137747 PMCID: PMC10743501 DOI: 10.3390/jcm12247678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Revised: 11/23/2023] [Accepted: 12/11/2023] [Indexed: 12/24/2023] Open
Abstract
This comprehensive review explores the role of exercise stress echocardiography (ESE) in assessing cardiovascular health in athletes. Athletes often exhibit cardiovascular adaptations because of rigorous physical training, making the differentiation between physiological changes and potential pathological conditions challenging. ESE is a crucial diagnostic tool, offering detailed insights into an athlete's cardiac function, reserve, and possible arrhythmias. This review highlights the methodology of ESE, emphasizing its significance in detecting exercise-induced anomalies and its application in distinguishing between athlete's heart and other cardiovascular diseases. Recent advancements, such as LV global longitudinal strain (GLS) and myocardial work (MW), are introduced as innovative tools for the early detection of latent cardiac dysfunctions. However, the use of ESE also subsumes limitations and possible pitfalls, particularly in interpretation and potential false results, as explained in this article.
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Affiliation(s)
- Stefano Palermi
- Public Health Department, University of Naples Federico II, 80131 Naples, Italy;
| | - Simona Sperlongano
- Division of Cardiology, Department of Translational Medical Sciences, University of Campania Luigi Vanvitelli, 80131 Naples, Italy; (S.S.); (V.R.)
| | - Giulia Elena Mandoli
- Division of Cardiology, Department of Medical Biotechnologies, University of Siena, 53100 Siena, Italy; (G.E.M.); (M.C.P.); (M.L.); (M.C.)
| | - Maria Concetta Pastore
- Division of Cardiology, Department of Medical Biotechnologies, University of Siena, 53100 Siena, Italy; (G.E.M.); (M.C.P.); (M.L.); (M.C.)
| | - Matteo Lisi
- Division of Cardiology, Department of Medical Biotechnologies, University of Siena, 53100 Siena, Italy; (G.E.M.); (M.C.P.); (M.L.); (M.C.)
| | - Giovanni Benfari
- Section of Cardiology, Department of Medicine, University of Verona, 37126 Verona, Italy;
| | - Federica Ilardi
- Department of Advanced Biomedical Sciences, University of Naples Federico II, 80131 Naples, Italy;
| | - Alessandro Malagoli
- Division of Cardiology, Nephro-Cardiovascular Department, Baggiovara Hospital, University of Modena and Reggio Emilia, 41126 Modena, Italy;
| | - Vincenzo Russo
- Division of Cardiology, Department of Translational Medical Sciences, University of Campania Luigi Vanvitelli, 80131 Naples, Italy; (S.S.); (V.R.)
| | - Quirino Ciampi
- Cardiology Division, Fatebenefratelli Hospital, 82100 Benevento, Italy;
| | - Matteo Cameli
- Division of Cardiology, Department of Medical Biotechnologies, University of Siena, 53100 Siena, Italy; (G.E.M.); (M.C.P.); (M.L.); (M.C.)
| | - Antonello D’Andrea
- Department of Cardiology, Umberto I Hospital, 84014 Nocera Inferiore, Italy
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18
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Nundlall N, Playford D, Strange G, Davis TME, Davis WA. The Relationship between Pulmonary Artery Pressure and Mortality in Type 2 Diabetes: A Fremantle Diabetes Study Phase II and National Echocardiographic Database of Australia Data Linkage Study. J Clin Med 2023; 12:7685. [PMID: 38137754 PMCID: PMC10743723 DOI: 10.3390/jcm12247685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Revised: 12/03/2023] [Accepted: 12/12/2023] [Indexed: 12/24/2023] Open
Abstract
An elevated estimated right ventricular systolic pressure (eRVSP) identified on echocardiography is present in one-third of individuals with type 2 diabetes, but its prognostic significance is unknown. To assess the relationship between eRVSP and mortality, prospective data from 1732 participants in the Fremantle Diabetes Study Phase II were linked with the National Echocardiographic Database of Australia. Of this cohort, 416 (mean age 70.6 years, 47.4% males) had an eRVSP measured and 381 (91.4%) had previously confirmed type 2 diabetes. Receiver- operating characteristic analysis of the relationship between eRVSP and all-cause mortality was conducted. Survival analyses were performed for participants with type 2 diabetes diagnosed before first measured eRVSP (n = 349). Cox regression identified clinical and echocardiographic associates of all-cause mortality. There were 141 deaths (40.4%) during 2348 person-years (mean ± SD 6.7 ± 4.0 years) of follow-up. In unadjusted Kaplan-Meier analysis, mortality rose with higher eRVSP (log-rank test, p < 0.001). In unadjusted pairwise comparisons, eRVSP >30 to 35, >35 to 40, and >40 mmHg had significantly increased mortality compared with eRVSP ≤ 30 mmHg (p = 0.025, p = 0.001, p < 0.001, respectively). There were 50 deaths in 173 individuals (29.1%) with eRVSP ≤ 30 mmHg, and 91 in 177 (51.4%) with eRVSP > 30 mmHg (log-rank test, p < 0.001). In adjusted models including age, Aboriginal descent, Charlson Comorbidity Index ≥ 3 and left heart disease, eRVSP > 30 mmHg predicted a two-fold higher all-cause mortality versus ≤ 30 mmHg. An eRVSP > 30 mmHg predicts increased all-cause mortality in type 2 diabetes. Where available, eRVSP could inform type 2 diabetes outcome models.
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Affiliation(s)
- Nishant Nundlall
- School of Medicine, The University of Notre Dame, Fremantle, WA 6160, Australia; (N.N.); (D.P.); (G.S.)
| | - David Playford
- School of Medicine, The University of Notre Dame, Fremantle, WA 6160, Australia; (N.N.); (D.P.); (G.S.)
| | - Geoff Strange
- School of Medicine, The University of Notre Dame, Fremantle, WA 6160, Australia; (N.N.); (D.P.); (G.S.)
- The Heart Research Institute, Newtown, NSW 2042, Australia
- Department of Cardiology, Royal Prince Alfred Hospital, Camperdown, NSW 2050, Australia
| | - Timothy M. E. Davis
- Medical School, The University of Western Australia, Fremantle Hospital, Alma Street, Fremantle, WA 6160, Australia;
| | - Wendy A. Davis
- Medical School, The University of Western Australia, Fremantle Hospital, Alma Street, Fremantle, WA 6160, Australia;
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19
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O'Donnell C, Sanchez PA, Celestin B, McConnell MV, Haddad F. The Echocardiographic Evaluation of the Right Heart: Current and Future Advances. Curr Cardiol Rep 2023; 25:1883-1896. [PMID: 38041726 DOI: 10.1007/s11886-023-02001-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/17/2023] [Indexed: 12/03/2023]
Abstract
PURPOSE OF REVIEW To discuss physiologic and methodologic advances in the echocardiographic assessment of right heart (RH) function, including the emergence of artificial intelligence (AI) and point-of-care ultrasound. RECENT FINDINGS Recent studies have highlighted the prognostic value of right ventricular (RV) longitudinal strain, RV end-systolic dimensions, and right atrial (RA) size and function in pulmonary hypertension and heart failure. While RA pressure is a central marker of right heart diastolic function, the recent emphasis on venous excess imaging (VExUS) has provided granularity to the systemic consequences of RH failure. Several methodological advances are also changing the landscape of RH imaging including post-processing 3D software to delineate the non-longitudinal (radial, anteroposterior, and circumferential) components of RV function, as well as AI segmentation- and non-segmentation-based quantification. Together with recent guidelines and advances in AI technology, the field is shifting from specific RV functional metrics to integrated RH disease-specific phenotypes. A modern echocardiographic evaluation of RH function should focus on the entire cardiopulmonary venous unit-from the venous to the pulmonary arterial system. Together, a multi-parametric approach, guided by physiology and AI algorithms, will help define novel integrated RH profiles for improved disease detection and monitoring.
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Affiliation(s)
- Christian O'Donnell
- Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA.
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Stanford, CA, USA.
| | - Pablo Amador Sanchez
- Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Bettia Celestin
- Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA, USA
- Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA, USA
- Vera Moulton Wall Center for Pulmonary Vascular Disease, Stanford University School of Medicine, Stanford, CA, USA
| | - Michael V McConnell
- Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA, USA
- Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA, USA
| | - Francois Haddad
- Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA, USA
- Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA, USA
- Vera Moulton Wall Center for Pulmonary Vascular Disease, Stanford University School of Medicine, Stanford, CA, USA
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20
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Farina JM, Pereyra M, Mahmoud AK, Scalia IG, Abbas MT, Chao CJ, Barry T, Ayoub C, Banerjee I, Arsanjani R. Artificial Intelligence-Based Prediction of Cardiovascular Diseases from Chest Radiography. J Imaging 2023; 9:236. [PMID: 37998083 PMCID: PMC10672462 DOI: 10.3390/jimaging9110236] [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: 08/30/2023] [Revised: 10/18/2023] [Accepted: 10/24/2023] [Indexed: 11/25/2023] Open
Abstract
Chest radiography (CXR) is the most frequently performed radiological test worldwide because of its wide availability, non-invasive nature, and low cost. The ability of CXR to diagnose cardiovascular diseases, give insight into cardiac function, and predict cardiovascular events is often underutilized, not clearly understood, and affected by inter- and intra-observer variability. Therefore, more sophisticated tests are generally needed to assess cardiovascular diseases. Considering the sustained increase in the incidence of cardiovascular diseases, it is critical to find accessible, fast, and reproducible tests to help diagnose these frequent conditions. The expanded focus on the application of artificial intelligence (AI) with respect to diagnostic cardiovascular imaging has also been applied to CXR, with several publications suggesting that AI models can be trained to detect cardiovascular conditions by identifying features in the CXR. Multiple models have been developed to predict mortality, cardiovascular morphology and function, coronary artery disease, valvular heart diseases, aortic diseases, arrhythmias, pulmonary hypertension, and heart failure. The available evidence demonstrates that the use of AI-based tools applied to CXR for the diagnosis of cardiovascular conditions and prognostication has the potential to transform clinical care. AI-analyzed CXRs could be utilized in the future as a complimentary, easy-to-apply technology to improve diagnosis and risk stratification for cardiovascular diseases. Such advances will likely help better target more advanced investigations, which may reduce the burden of testing in some cases, as well as better identify higher-risk patients who would benefit from earlier, dedicated, and comprehensive cardiovascular evaluation.
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Affiliation(s)
- Juan M. Farina
- Department of Cardiovascular Medicine, Mayo Clinic, Phoenix, AZ 85054, USA (M.P.); (M.T.A.); (T.B.)
| | - Milagros Pereyra
- Department of Cardiovascular Medicine, Mayo Clinic, Phoenix, AZ 85054, USA (M.P.); (M.T.A.); (T.B.)
| | - Ahmed K. Mahmoud
- Department of Cardiovascular Medicine, Mayo Clinic, Phoenix, AZ 85054, USA (M.P.); (M.T.A.); (T.B.)
| | - Isabel G. Scalia
- Department of Cardiovascular Medicine, Mayo Clinic, Phoenix, AZ 85054, USA (M.P.); (M.T.A.); (T.B.)
| | - Mohammed Tiseer Abbas
- Department of Cardiovascular Medicine, Mayo Clinic, Phoenix, AZ 85054, USA (M.P.); (M.T.A.); (T.B.)
| | - Chieh-Ju Chao
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN 55905, USA
| | - Timothy Barry
- Department of Cardiovascular Medicine, Mayo Clinic, Phoenix, AZ 85054, USA (M.P.); (M.T.A.); (T.B.)
| | - Chadi Ayoub
- Department of Cardiovascular Medicine, Mayo Clinic, Phoenix, AZ 85054, USA (M.P.); (M.T.A.); (T.B.)
| | - Imon Banerjee
- Department of Radiology, Mayo Clinic, Phoenix, AZ 85054, USA;
| | - Reza Arsanjani
- Department of Cardiovascular Medicine, Mayo Clinic, Phoenix, AZ 85054, USA (M.P.); (M.T.A.); (T.B.)
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Vasile CM, Iriart X. Embracing AI: The Imperative Tool for Echo Labs to Stay Ahead of the Curve. Diagnostics (Basel) 2023; 13:3137. [PMID: 37835880 PMCID: PMC10572870 DOI: 10.3390/diagnostics13193137] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2023] [Revised: 09/26/2023] [Accepted: 10/03/2023] [Indexed: 10/15/2023] Open
Abstract
Advancements in artificial intelligence (AI) have rapidly transformed various sectors, and the field of echocardiography is no exception. AI-driven technologies hold immense potential to revolutionize echo labs' diagnostic capabilities and improve patient care. This paper explores the importance for echo labs to embrace AI and stay ahead of the curve in harnessing its power. Our manuscript provides an overview of the growing impact of AI on medical imaging, specifically echocardiography. It highlights how AI-driven algorithms can enhance image quality, automate measurements, and accurately diagnose cardiovascular diseases. Additionally, we emphasize the importance of training echo lab professionals in AI implementation to optimize its integration into routine clinical practice. By embracing AI, echo labs can overcome challenges such as workload burden and diagnostic accuracy variability, improving efficiency and patient outcomes. This paper highlights the need for collaboration between echocardiography laboratory experts, AI researchers, and industry stakeholders to drive innovation and establish standardized protocols for implementing AI in echocardiography. In conclusion, this article emphasizes the importance of AI adoption in echocardiography labs, urging practitioners to proactively integrate AI technologies into their workflow and take advantage of their present opportunities. Embracing AI is not just a choice but an imperative for echo labs to maintain their leadership and excel in delivering state-of-the-art cardiac care in the era of advanced medical technologies.
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Affiliation(s)
- Corina Maria Vasile
- Department of Pediatric and Adult Congenital Cardiology, Bordeaux University Hospital, 33600 Pessac, France
| | - Xavier Iriart
- Department of Pediatric and Adult Congenital Cardiology, Bordeaux University Hospital, 33600 Pessac, France
- IHU Liryc—Electrophysiology and Heart Modelling Institute, Bordeaux University Foundation, 33600 Pessac, France
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22
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Krishnan G, Singh S, Pathania M, Gosavi S, Abhishek S, Parchani A, Dhar M. Artificial intelligence in clinical medicine: catalyzing a sustainable global healthcare paradigm. Front Artif Intell 2023; 6:1227091. [PMID: 37705603 PMCID: PMC10497111 DOI: 10.3389/frai.2023.1227091] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 08/09/2023] [Indexed: 09/15/2023] Open
Abstract
As the demand for quality healthcare increases, healthcare systems worldwide are grappling with time constraints and excessive workloads, which can compromise the quality of patient care. Artificial intelligence (AI) has emerged as a powerful tool in clinical medicine, revolutionizing various aspects of patient care and medical research. The integration of AI in clinical medicine has not only improved diagnostic accuracy and treatment outcomes, but also contributed to more efficient healthcare delivery, reduced costs, and facilitated better patient experiences. This review article provides an extensive overview of AI applications in history taking, clinical examination, imaging, therapeutics, prognosis and research. Furthermore, it highlights the critical role AI has played in transforming healthcare in developing nations.
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Affiliation(s)
- Gokul Krishnan
- Department of Internal Medicine, Kasturba Medical College, Manipal, India
| | - Shiana Singh
- Department of Emergency Medicine, All India Institute of Medical Sciences, Rishikesh, India
| | - Monika Pathania
- Department of Geriatric Medicine, All India Institute of Medical Sciences, Rishikesh, India
| | - Siddharth Gosavi
- Department of Internal Medicine, Kasturba Medical College, Manipal, India
| | - Shuchi Abhishek
- Department of Internal Medicine, Kasturba Medical College, Manipal, India
| | - Ashwin Parchani
- Department of Geriatric Medicine, All India Institute of Medical Sciences, Rishikesh, India
| | - Minakshi Dhar
- Department of Geriatric Medicine, All India Institute of Medical Sciences, Rishikesh, India
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23
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Vidal-Perez R, Vazquez-Rodriguez JM. Role of artificial intelligence in cardiology. World J Cardiol 2023; 15:116-118. [PMID: 37124979 PMCID: PMC10130891 DOI: 10.4330/wjc.v15.i4.116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 01/19/2023] [Accepted: 04/10/2023] [Indexed: 04/20/2023] Open
Abstract
Artificial intelligence (AI) is the process of having a computational program that can perform tasks of human intelligence by mimicking human thought processes. AI is a rapidly evolving transdisciplinary field which integrates many elements to develop algorithms that aim to simulate human intuition, decision-making, and object recognition. The overarching aims of AI in cardiovascular medicine are threefold: To optimize patient care, improve efficiency, and improve clinical outcomes. In cardiology, there has been a growth in the potential sources of new patient data, as well as advances in investigations and therapies, which position the field well to uniquely benefit from AI. In this editorial, we highlight some of the main research priorities currently and where the next steps are heading us.
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Affiliation(s)
- Rafael Vidal-Perez
- Servicio de Cardiología, Unidad de Imagen y Función Cardíaca, Complexo Hospitalario Universitario A Coruña Centro de Investigación Biomédica en Red-Instituto de Salud Carlos III, A Coruña 15006, A Coruña, Spain
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24
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Doan CT, Tran KH, Luong VT, Dang-Nguyen NH, Ton-Nu V. Efficacy of Artificial Intelligence Software in the Automated Analysis of Left Ventricular Function in Echocardiography in Central Vietnam. Acta Inform Med 2023; 32:32-36. [PMID: 38585607 PMCID: PMC10997171 DOI: 10.5455/aim.2024.32.32-36] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Accepted: 02/28/2024] [Indexed: 04/09/2024] Open
Abstract
Background In recent years, there has been a significant focus on the development of artificial intelligence (AI) applications in healthcare. However, current scientific evidence is still not convincing enough for the general public and the medical community to widely adopt AI in clinical practice. Objective We conducted this study to investigate the correlation between left ventricular function indices assessed by AI and those evaluated by physicians. Methods This cross-sectional descriptive study was conducted on 136 patients who attended and received treatment at Hue University of Medicine and Pharmacy Hospital from April 2022 to June 2023. Using QLAB version 15, Philips Healthcare. Results The AI software accurately identified 98.5% of the echocardiographic cine-loops. However, there were about 1.5% of cine-loops that the software failed to recognize. The sensitivity of Ejection Fraction (EF) calculated by AI was 73.3%, specificity was 81.3%, and accuracy stood at 78.6%. A strong positive correlation was observed between EF measured by AI and that assessed by physicians, r = 0.701, p < 0.01. The sensitivity of Global Longitudinal Strain (GLS) calculated by AI was 42.1%, specificity was 84.8%, and accuracy was 67.6%. A moderate positive correlation was found between GLS measured by AI and physician's assessment, r = 0.460, p < 0.01. Conclusion The use of AI software for evaluating left ventricular function through ejection fraction and global longitudinal strain is rapid and yields results comparable to cardiologists' echocardiographic assessments. The AI-powered software holds a promising and feasible future in clinical practice.
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Affiliation(s)
- Chi Thang Doan
- Department of Cardiology, Hue Central Hospital, Hue city, Vietnam
| | - Khanh Hung Tran
- Department of Internal Medicine, Hue University of Medicine and Pharmacy, Hue University, Hue city, Vietnam
| | - Viet Thang Luong
- Department of Internal Medicine, Hue University of Medicine and Pharmacy, Hue University, Hue city, Vietnam
| | | | - Victoria Ton-Nu
- University of California Irvine, Irvine, CA 92697, United States
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