Automated, machine learning‐based, 3D echocardiographic quantification of left ventricular mass

Abstract

Background: Although 3D echocardiography (3DE) circumvents many limitations of 2D echocardiography by allowing direct measurements of left ventricular (LV) mass, it is seldom used in clinical practice due to time-consuming analysis. A recently developed 3DE machine learning (ML) approach allows automated determination of LV mass. We aimed to evaluate the accuracy of this new approach by comparing it to cardiac magnetic resonance (CMR) reference and to conventional 3DE volumetric analysis. Methods:We prospectively studied 23 patients who underwent 3DE (Philips EPIQ) and CMR imaging on the same day. Single-beat wide-angle 3D datasets of the left ventricle were acquired. LV mass was quantified using the new automated software (Philips HeartModel) with manual corrections when necessary and using conventional volumetric analysis (TomTec). CMR analysis was performed by manual slice-byslice tracing of LV endo-and epicardial boundaries. Reproducibility of the ML approach was assessed using repeated measurements and quantified by intra-class correlation (ICC) and coefficients of variation (CoV).Results: Automated LV mass measurements were feasible in 20 patients (87%). The results were similar to CMR-derived values (Bland-Altman bias 5 g, limits of agreement ±37 g) and also to the conventional 3DE analysis (bias 7 g, ±27 g). Processing time was considerably shorter: 1.02 ± 0.24 minutes (CMR: 2.20 ± 0.13 minutes;TomTec: 2.36 ± 0.09 minutes), although manual corrections were performed in most patients. Repeated measurements showed high reproducibility: ICC = 0.99; CoV = 4 ± 5%.Conclusions: 3D Echocardiography analysis of LV mass using novel ML-based algorithm is feasible, fast, and accurate and may thus facilitate the incorporation of 3DE measurements of LV mass into clinical practice. K E Y W O R D S2D echocardiography, 3D echocardiography, cardiac magnetic resonance imaging, left ventricular mass, machine learning | 313 VOLPATO eT AL.

Clinical Value of Complex Echocardiographic Left Ventricular Hypertrophy Classification Based on Concentricity, Mass, and Volume Quantification

“…It should be stressed that the determination of RWT can be limited by non-uniform wall thickness and regional shape deformation (37). Three-dimensional echocardiography (3D), without geometric assumptions about LV form and wall thickening distribution, is the only echocardiographic technique that accurately measures the LV mass in these patients (38). It is worth noting that in hypertensive patients, a high 3D-LV mass/EDV ratio identified a higher incidence of concentric LVH compared to 2D-derived relative wall thickness, which is inversely correlated with the stroke volume (39) and early systolic and diastolic dysfunction (40).…”

Letter to the Editor: Comments Regarding Recent Paper by Chetrit et al.

“…1 On the other hand, the COAPT trial found that among patients with moderateto-severe or severe MR who remain symptomatic despite optimal medical therapy, MitraClip (Abbott Vascular, Santa Clara, CA) implantation resulted in a lower rate of hospitalization for heart failure and lower all-cause mortality within 2 years of follow-up compared with those referred to medical therapy alone. 2 In the last years, there has been an increasing interest in intraventricular (IV) fluid dynamics, assessed by Echo Particle Imaging Velocimetry (Echo-PIV), [3][4][5] and their epigenetic role in inducing changes in left ventricular (LV) dimensions and function in different clinical conditions. [3][4][5] Only a few computational studies have investigated the impact of the revised valve anatomy following MitraClip implantation on IV vortices formation.…”

“…2 In the last years, there has been an increasing interest in intraventricular (IV) fluid dynamics, assessed by Echo Particle Imaging Velocimetry (Echo-PIV), [3][4][5] and their epigenetic role in inducing changes in left ventricular (LV) dimensions and function in different clinical conditions. [3][4][5] Only a few computational studies have investigated the impact of the revised valve anatomy following MitraClip implantation on IV vortices formation. 5,6 Previous studies clearly showed that some parameters derived from IV flow analysis are closely associated with adverse LV remodeling.…”

“…5,6 Previous studies clearly showed that some parameters derived from IV flow analysis are closely associated with adverse LV remodeling. [3][4][5]7 We evaluated the in vivo effects of percutaneous mitral repair on LV intracavitary fluid dynamics in patients with secondary MR. To achieve this aim, 20 patients with dilated cardiomyopathy and symptomatic functional MR with clinical indication for MitraClip implantation were enrolled.…”

“…Given the above considerations, we feel that the results from this study should only be hypothesis generating as a result of the above issues as the authors suggest in the Conclusion. As we are moving into a new era of advanced 3D echocardiography technology 3 and multiple modality cardiac imaging, we should move in a direction to emphasize more use of 3D echocardiography to obtain LV quantifications.…”