Machine learning evaluation of LV outflow obstruction in hypertrophic cardiomyopathy using three-chamber cardiovascular magnetic resonance
Tóm tắt
Left ventricular outflow tract obstruction (LVOTO) is common in hypertrophic cardiomyopathy (HCM), but relationships between anatomical metrics and obstruction are poorly understood. We aimed to develop machine learning methods to evaluate LVOTO in HCM patients and quantify relationships between anatomical metrics and obstruction. This retrospective analysis of 1905 participants of the HCM Registry quantified 11 anatomical metrics derived from 14 landmarks automatically detected on the three-chamber long axis cine CMR images. Linear and logistic regression was used to quantify strengths of relationships with the presence of LVOTO (defined by resting Doppler pressure drop of > 30 mmHg), using the area under the receiver operating characteristic (AUC). Intraclass correlation coefficients between the network predictions and three independent observers showed similar agreement to that between observers. The distance from anterior mitral valve leaflet tip to basal septum (AML-BS) was most highly correlated with Doppler pressure drop (R2 = 0.19, p < 10–5). Multivariate stepwise regression found the best predictive model included AML-BS, AML length to aortic valve diameter ratio, AML length to LV width ratio, and midventricular septal thickness metrics (AUC 0.84). Excluding AML-BS, metrics grouped according to septal hypertrophy, LV geometry, and AML anatomy each had similar associations with LVOTO (AUC 0.71, 0.71, 0.68 respectively, p = ns), significantly less than their combination (AUC 0.77, p < 0.05 for each). Anatomical metrics derived from a standard three-chamber CMR cine acquisition can be used to highlight risk of LVOTO, and suggest further investigation if necessary. A combination of geometric factors is required to provide the best risk prediction.
Tài liệu tham khảo
Maron BJ, Maron MS (2013) Hypertrophic cardiomyopathy. Lancet 381:242–255
Hypertropic cardiomyopathy | British Heart Foundation. https://www.bhf.org.uk/informationsupport/conditions/cardiomyopathy/hypertrophic-cardiomyopathy. Accessed 30 Nov 2021
Maron BJ (2018) Clinical course and management of hypertrophic cardiomyopathy. N Engl J Med 379:655–668
Authors/Task Force members, ElliottAnastasakis PMA et al (2014) 2014 ESC Guidelines on diagnosis and management of hypertrophic cardiomyopathy. Eur Heart J 35:2733–2779
Autore C, Bernabò P, Barillà CS, Bruzzi P, Spirito P (2005) The prognostic importance of left ventricular outflow obstruction in hypertrophic cardiomyopathy varies in relation to the severity of symptoms. J Am Coll Cardiol 45:1076–1080
Nishimura RA, Holmes DR (2004) Hypertrophic obstructive cardiomyopathy. N Engl J Med 350:1320–1327
Donati F, Myerson S, Bissell MM, Smith NP, Neubauer S, Monaghan MJ, Nordsletten DA, Lamata P (2017) Beyond Bernoulli: improving the accuracy and precision of noninvasive estimation of peak pressure drops. Circ Cardiovasc Imaging. https://doi.org/10.1161/CIRCIMAGING.116.005207
Gill H, Fernandes J, Chehab O, Prendergast B, Redwood S, Chiribiri A, Nordsletten D, Rajani R, Lamata P (2021) Evaluation of aortic stenosis: from Bernoulli and Doppler to Navier-stokes. Trends Cardiovasc Med. https://doi.org/10.1016/j.tcm.2021.12.003
Bois JP, Geske JB, Foley TA, Ommen SR, Pellikka PA (2017) Comparison of maximal wall thickness in hypertrophic cardiomyopathy differs between magnetic resonance imaging and transthoracic echocardiography. Am J Cardiol 119:643–650
Hindieh W, Weissler-Snir A, Hammer H, Adler A, Rakowski H, Chan RH (2017) Discrepant measurements of maximal left ventricular wall thickness between cardiac magnetic resonance imaging and echocardiography in patients with hypertrophic cardiomyopathy. Circ Cardiovasc Imaging. https://doi.org/10.1161/CIRCIMAGING.117.006309
Phelan D, Sperry BW, Thavendiranathan P, Collier P, Popović ZB, Lever HM, Smedira NG, Desai MY (2017) Comparison of ventricular septal measurements in hypertrophic cardiomyopathy patients who underwent surgical myectomy using multimodality imaging and implications for diagnosis and management. Am J Cardiol 119:1656–1662
Rickers C, Wilke NM, Jerosch-Herold M, Casey SA, Panse P, Panse N, Weil J, Zenovich AG, Maron BJ (2005) Utility of cardiac magnetic resonance imaging in the diagnosis of hypertrophic cardiomyopathy. Circulation 112:855–861
Posma JL, Blanksma PK, van der Wall EE, Hamer HP, Mooyaart EL, Lie KI (1996) Assessment of quantitative hypertrophy scores in hypertrophic cardiomyopathy: magnetic resonance imaging versus echocardiography. Am Heart J 132:1020–1027
Schulz-Menger J, Abdel-Aty H, Busjahn A, Wassmuth R, Pilz B, Dietz R, Friedrich M (2006) Left ventricular outflow tract planimetry by cardiovascular magnetic resonance differentiates obstructive from non-obstructive hypertrophic cardiomyopathy. J Cardiovasc Magn Reson 8:741–746
Ibrahim M, Rao C, Ashrafian H, Chaudhry U, Darzi A, Athanasiou T (2012) Modern management of systolic anterior motion of the mitral valve. Eur J Cardiothorac Surg 41:1260–1270
Raut M, Maheshwari A, Swain B (2018) Awareness of “systolic anterior motion” in different conditions. Clin Med Insights Cardiol 12:1179546817751921
Patel P, Dhillon A, Popovic ZB, Smedira NG, Rizzo J, Thamilarasan M, Agler D, Lytle BW, Lever HM, Desai MY (2015) Left ventricular outflow tract obstruction in hypertrophic cardiomyopathy patients without severe septal hypertrophy: implications of mitral valve and papillary muscle abnormalities assessed using cardiac magnetic resonance and echocardiography. Circ Cardiovasc Imaging 8:e003132
Nara I, Iino T, Watanabe H, Sato W, Watanabe K, Shimbo M, Umeta Y, Ito H (2018) Morphological determinants of obstructive hypertrophic cardiomyopathy obtained using echocardiography. Int Heart J 59:339–346
Kramer CM, Appelbaum E, Desai MY et al (2015) Hypertrophic cardiomyopathy registry: the rationale and design of an international, observational study of hypertrophic cardiomyopathy. Am Heart J 170:223–230
Neubauer S, Kolm P, Ho CY et al (2019) Distinct subgroups in hypertrophic cardiomyopathy in the NHLBI HCM registry. J Am Coll Cardiol 74:2333–2345
Hatle L, Brubakk A, Tromsdal A, Angelsen B (1978) Noninvasive assessment of pressure drop in mitral stenosis by Doppler ultrasound. Br Heart J 40:131–140
Yushkevich PA, Piven J, Hazlett HC, Smith RG, Ho S, Gee JC, Gerig G (2006) User-guided 3D active contour segmentation of anatomical structures: significantly improved efficiency and reliability. Neuroimage 31:1116–1128
Cicchetti DV (1994) Guidelines, criteria, and rules of thumb for evaluating normed and standardized assessment instruments in psychology. Psychol Assess 6:284–290
MathWorks MATLAB—MathWorks, Natick, MA, USA. https://uk.mathworks.com/products/matlab.html. Accessed 13 Mar 2021
Sun X, Xu W (2014) Fast implementation of DeLong’s algorithm for comparing the areas under correlated receiver operating characteristic curves. IEEE Signal Process Lett 21:1389–1393
YOUDEN WJ, (1950) Index for rating diagnostic tests. Cancer 3:32–35
Koo TK, Li MY (2016) A guideline of selecting and reporting intraclass correlation coefficients for reliability research. J Chiropr Med 15:155–163
Maron MS, Olivotto I, Harrigan C, Appelbaum E, Gibson CM, Lesser JR, Haas TS, Udelson JE, Manning WJ, Maron BJ (2011) Mitral valve abnormalities identified by cardiovascular magnetic resonance represent a primary phenotypic expression of hypertrophic cardiomyopathy. Circulation 124:40–47
Brownlee J. (2021) Impact of dataset size on deep learning model skill and performance estimates. In: Machine learning mastery. https://machinelearningmastery.com/impact-of-dataset-size-on-deep-learning-model-skill-and-performance-estimates/. Accessed 10 Apr 2021
Luo Y, Yang D, Liu H, Wan K, Sun J, Zhang T, Chen Y (2016) Mitral valve leaflet length as an important factor to differentiate hypertrophic cardiomyopathy from other causes of left ventricular hypertrophy. J Cardiovasc Magn Reson 18:P272
Healio (2021) Venturi effect. In: Healio. https://www.healio.com/cardiology/learn-the-heart/cardiology-review/topic-reviews/venturi-effect. Accessed 14 Apr 2021
Critoph CH, Pantazis A, Tome Esteban MT, Salazar-Mendiguchía J, Pagourelias ED, Moon JC, Elliott PM (2014) The influence of aortoseptal angulation on provocable left ventricular outflow tract obstruction in hypertrophic cardiomyopathy. Open Heart 1:e000176
Doddamani S, Bello R, Friedman MA et al (2007) Demonstration of left ventricular outflow tract eccentricity by real time 3D echocardiography: implications for the determination of aortic valve area. Echocardiography 24:860–866
Ferreira PF, Gatehouse PD, Mohiaddin RH, Firmin DN (2013) Cardiovascular magnetic resonance artefacts. J Cardiovasc Magn Reson 15:41
Maron BJ, Desai MY, Nishimura RA, Spirito P, Rakowski H, Towbin JA, Rowin EJ, Maron MS, Sherrid MV (2022) Diagnosis and evaluation of hypertrophic cardiomyopathy: JACC state-of-the-art review. J Am Coll Cardiol 79:372–389