A machine learning model using echocardiographic myocardial strain to detect myocardial ischemia.

Journal: Internal and emergency medicine
Published Date: May 21, 2025

Abstract

Coronary functional assessment plays a critical role in guiding decisions regarding coronary revascularization. Traditional methods for evaluating functional myocardial ischemia, such as invasive procedures or those involving radiation, have their limitations. Echocardiographic myocardial strain has emerged as a non-invasive and convenient indicator. However, the interpretation of strain values can be subject to inter-operator variability. Artificial intelligence (AI) and machine learning techniques may promise to reduce the variability. By training AI algorithms on a diverse range of echocardiographic data, including strain values, and correlating them with ischemia, it may be possible to develop a robust and automated diagnostic tool. This study aims to provide a non-invasive and effective solution for automated myocardial ischemia detection that can be used in clinical practice. To construct the machine learning model, we used an automatic left ventricular endocardium tracing tool to extract myocardial strain data and integrated it with six clinical features. A coronary angiography-derived fractional flow reserve (caFFR) ≤ 0.80 was defined as the indicator of myocardial ischemia. A total of 636 suspected coronary artery disease subjects were enrolled in this pilot study, where 282 cases (44.3%) had myocardial ischemia. These subjects were randomly divided into training (n = 508) and testing (n = 128) sets at a 4:1. Using ensemble-learning algorithms to train and optimize the model, its diagnostic performance versus caFFR was diagnostic accuracy 85.9%, sensitivity 88.9%, specificity 83.1%, positive predictive value 83.6%, negative predictive value 88.5%. The optimized model achieved an area under the receiver operating characteristic curve (AUC) of 0.915 (95% confidence interval [CI] 0.862-0.968). Our machine learning prototype model based on echocardiographic myocardial strain shows promising results in detecting myocardial ischemia. Further studies are needed to validate its robustness and generalizability on larger patient populations.

Authors

  • Bo Zheng
    State Key Joint Laboratory of Environment Simulation and Pollution Control, School of Environment, Tsinghua University, Beijing 100084, China.
  • Yaokun Liu
    Department of Cardiology, Peking University First Hospital, Beijing, China.
  • Jingyi Zhang
    Department of Health Management of Public Health, College of Public Health, Zhengzhou University, 100 Kexue Road, Gaoxin district, Zhengzhou, 450001, Henan, China.
  • Terry T Ma
    Department of Statistics, University of Georgia, Athens, GA, USA.
  • Yun Zhou
    MOE Key Lab of Environmental and Occupational Health, School of Public Health, Tongji Medical College, Huazhong University of Science & Technology, Wuhan 430030, China.
  • Yongkai Chen
    Department of Statistics, University of Georgia, Athens, GA, USA.
  • Ying Yang
    Department of Endocrinology, The Affiliated Hospital of Yunnan University, Kunming, China.
  • Wei Ma
    Institute of Urban Agriculture, Chinese Academy of Agricultural Sciences, Chengdu, China.
  • Fangfang Fan
    Department of Cardiology, Peking University First Hospital, Beijing, China.
  • Jia Jia
    Department of Pathology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
  • Yan Zhang
    Affiliated Hospital of Liaoning University of Traditional Chinese Medicine, Shenyang, 110032, China.
  • Jianping Li
    College of Chemistry and Bioengineering, Guilin University of Technology, Guilin, 541004, China.
  • Wenxuan Zhong
    Department of Statistics, Franklin College of Arts and Sciences, University of Georgia, Athens, Georgia 30602, United States.

Keywords

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