Artificial intelligence fully automated myocardial strain quantification for risk stratification following acute myocardial infarction.

Journal: Scientific reports
Published Date:

Abstract

Feasibility of automated volume-derived cardiac functional evaluation has successfully been demonstrated using cardiovascular magnetic resonance (CMR) imaging. Notwithstanding, strain assessment has proven incremental value for cardiovascular risk stratification. Since introduction of deformation imaging to clinical practice has been complicated by time-consuming post-processing, we sought to investigate automation respectively. CMR data (n = 1095 patients) from two prospectively recruited acute myocardial infarction (AMI) populations with ST-elevation (STEMI) (AIDA STEMI n = 759) and non-STEMI (TATORT-NSTEMI n = 336) were analysed fully automated and manually on conventional cine sequences. LV function assessment included global longitudinal, circumferential, and radial strains (GLS/GCS/GRS). Agreements were assessed between automated and manual strain assessments. The former were assessed for major adverse cardiac event (MACE) prediction within 12 months following AMI. Manually and automated derived GLS showed the best and excellent agreement with an intraclass correlation coefficient (ICC) of 0.81. Agreement was good for GCS and poor for GRS. Amongst automated analyses, GLS (HR 1.12, 95% CI 1.08-1.16, p < 0.001) and GCS (HR 1.07, 95% CI 1.05-1.10, p < 0.001) best predicted MACE with similar diagnostic accuracy compared to manual analyses; area under the curve (AUC) for GLS (auto 0.691 vs. manual 0.693, p = 0.801) and GCS (auto 0.668 vs. manual 0.686, p = 0.425). Amongst automated functional analyses, GLS was the only independent predictor of MACE in multivariate analyses (HR 1.10, 95% CI 1.04-1.15, p < 0.001). Considering high agreement of automated GLS and equally high accuracy for risk prediction compared to the reference standard of manual analyses, automation may improve efficiency and aid in clinical routine implementation.Trial registration: ClinicalTrials.gov, NCT00712101 and NCT01612312.

Authors

  • Sören J Backhaus
    Department of Cardiology and Pneumology, University Medical Centre, Georg-August-University Göttingen, Robert-Koch-Str. 40, 37099, Göttingen, Germany.
  • Haneen Aldehayat
    Department of Cardiology and Pneumology, University Medical Centre, Georg-August-University Göttingen, Robert-Koch-Str. 40, 37099, Göttingen, Germany.
  • Johannes T Kowallick
    German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany.
  • Ruben Evertz
    Department of Cardiology and Pneumology, University Medical Centre, Georg-August-University Göttingen, Robert-Koch-Str. 40, 37099, Göttingen, Germany.
  • Torben Lange
    Department of Cardiology and Pneumology, University Medical Centre, Georg-August-University Göttingen, Robert-Koch-Str. 40, 37099, Göttingen, Germany.
  • Shelby Kutty
    Department of Pediatrics, at Johns Hopkins School of Medicine, Baltimore, MD, 21287, USA.
  • Boris Bigalke
    Department of Cardiology, Charité Campus Benjamin Franklin, University Medical Center Berlin, Berlin, Germany.
  • Matthias Gutberlet
    Department of Diagnostic and Interventional Radiology, Heart Center Leipzig - University Leipzig, Strümpellstrasse 39, 04289, Leipzig, Germany.
  • Gerd Hasenfuß
    DZHK (German Center for Cardiovascular Research), Partner Site Göttingen, Robert-Koch str. 40, 37075 Göttingen, Germany.
  • Holger Thiele
    Department of Cardiology, Heart Center Leipzig at University Leipzig, Leipzig, Germany.
  • Thomas Stiermaier
    University Heart Center Lübeck, Medical Clinic II (Cardiology/Angiology/Intensive Care Medicine), University Hospital Schleswig-Holstein, Lübeck, Germany.
  • Ingo Eitel
    University Heart Center Lübeck, Medical Clinic II (Cardiology/Angiology/Intensive Care Medicine), University Hospital Schleswig-Holstein, Lübeck, Germany.
  • Andreas Schuster
    Department of Cardiology and Pneumology, University Medical Centre, Georg-August-University Göttingen, Robert-Koch-Str. 40, 37099, Göttingen, Germany. andreas_schuster@gmx.net.