A deep learning-derived composite score of right atrial area and right ventricular longitudinal function identified ToF patients at increased risk of adverse outcomes (HR 2.1/unit, p=0.007).
Cohort (n=372)
Yes
Does deep learning-based image analysis of cardiac magnetic resonance predict prognosis in patients with repaired tetralogy of Fallot?
Deep learning-based automated analysis of CMR imaging can independently predict long-term adverse outcomes in patients with repaired tetralogy of Fallot, potentially serving as an efficient surrogate for labor-intensive manual measurements.
Effect estimate: HR 2.1/unit
p-value: p=0.007
OBJECTIVE: To assess the utility of machine learning algorithms for automatically estimating prognosis in patients with repaired tetralogy of Fallot (ToF) using cardiac magnetic resonance (CMR). METHODS: We included 372 patients with ToF who had undergone CMR imaging as part of a nationwide prospective study. Cine loops were retrieved and subjected to automatic deep learning (DL)-based image analysis, trained on independent, local CMR data, to derive measures of cardiac dimensions and function. This information was combined with established clinical parameters and ECG markers of prognosis. RESULTS: Over a median follow-up period of 10 years, 23 patients experienced an endpoint of death/aborted cardiac arrest or documented ventricular tachycardia (defined as >3 documented consecutive ventricular beats). On univariate Cox analysis, various DL parameters, including right atrial median area (HR 1.11/cm², p=0.003) and right ventricular long-axis strain (HR 0.80/%, p=0.009) emerged as significant predictors of outcome. DL parameters were related to adverse outcome independently of left and right ventricular ejection fraction and peak oxygen uptake (p<0.05 for all). A composite score of enlarged right atrial area and depressed right ventricular longitudinal function identified a ToF subgroup at significantly increased risk of adverse outcome (HR 2.1/unit, p=0.007). CONCLUSIONS: We present data on the utility of machine learning algorithms trained on external imaging datasets to automatically estimate prognosis in patients with ToF. Due to the automated analysis process these two-dimensional-based algorithms may serve as surrogates for labour-intensive manually attained imaging parameters in patients with ToF.
Diller et al. (Wed,) conducted a cohort in repaired tetralogy of Fallot (ToF) (n=372). Deep learning-based CMR image analysis was evaluated on death/aborted cardiac arrest or documented ventricular tachycardia (HR 2.1/unit, p=0.007). A deep learning-derived composite score of right atrial area and right ventricular longitudinal function identified ToF patients at increased risk of adverse outcomes (HR 2.1/unit, p=0.007).
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