A Novel Two-Dimensional Echocardiographic Image Analysis System Using Artificial Intelligence-Learned Pattern Recognition for Rapid Automated Ejection Fraction
Maxime Cannesson, MD*,
Masaki Tanabe, MD*,
Matthew S. Suffoletto, MD*,
Dennis M. McNamara, MD, FACC*,
Shobhit Madan, MD ,
Joan M. Lacomis, MD and
John Gorcsan, III, MD, FACC*,*
* Cardiovascular Institute
Department of Radiology, University of Pittsburgh, Pittsburgh, Pennsylvania
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Figure 1 Auto EF Automated Time–Volume Curves
Examples of left ventricular (LV) endocardial tracings by Auto ejection fraction (EF) of the apical 4- chamber and 2-chamber views (left) and corresponding volume curves and EF (right). (A) A patient with normal ventricular function. (B) A heart failure patient with LV dysfunction.
Please see the Appendix for accompanying videos.
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Figure 2 Auto EF Versus Manual Biplane Simpson's Rule
Ejection fraction (EF) scatter plots with linear regression (left) and Bland-Altman (right) analyses of assessment of biplane left ventricular EF by Auto EF versus manual tracings using Simpson's rule, demonstrating a close correlation and narrow limits of agreement.
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Figure 3 Auto EF Versus Manual Biplane Simpson's Rule Volumes
Scatter plots with linear regression (left) and Bland-Altman (right) analyses of assessment of left ventricular end-diastolic (top) and end-systolic (bottom) volumes by Auto EF versus manual tracings using Simpson's rule, demonstrating a close correlation with a tendency for slight underestimation of volume by Auto EF.
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Figure 4 Comparison of Auto EF in Patients With Ischemic Heart Disease Versus Others
Scatter plots with linear regression (left) and Bland-Altman (right) analyses of assessment of biplane ejection fraction (EF) by Auto EF versus manual tracings in 97 patients with ischemic disease (top) and regional wall abnormalities and 53 patients with nonischemic cardiomyopathy (bottom), demonstrating similar close correlations and narrow limits of agreement.
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Figure 5 Auto EF Versus Visual EF by Expert Readers
Scatter plots with linear regression (left) and Bland-Altman (right) analyses of assessment of biplane left ventricular ejection fraction (EF) by Auto EF versus visual assessment by expert readers, demonstrating a significant correlation but wider limits of agreement. The EF was visually estimated by 5% ranges, which appear as horizontal bars.
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Figure 6 Auto EF Versus Visual EF by Novice Readers
Results of linear regression (top) and Bland-Altman (bottom) analyses of assessment of left ventricular ejection fraction (EF) by novice trainee readers compared with manual biplane tracing by expert readers. Their visual assessment (left) was in 5% ranges and appear as vertical bars. Their results operating Auto EF for the first time (right) demonstrate a closer correlation and more favorable limits of agreement.
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Figure 7 Auto EF Versus Magnetic Resonance Imaging
Scatter plots with linear regression (left) and Bland-Altman (right) analyses of assessment of left ventricular ejection fraction (EF) by Auto EF versus magnetic resonance imaging (MRI) (top) and combined end-systolic and end-diastolic volumes from the same patients (bottom), demonstrating significant correlations but underestimation of absolute volumes.
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