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. 2022 Jul 22:9:937068.
doi: 10.3389/fcvm.2022.937068. eCollection 2022.

Automated analysis of limited echocardiograms: Feasibility and relationship to outcomes in COVID-19

Patricia A Pellikka  1 , Jordan B Strom  2 , Gabriel M Pajares-Hurtado  2 , Martin G Keane  3 , Benjamin Khazan  3 , Salima Qamruddin  4 , Austin Tutor  4 , Fahad Gul  5 , Eric Peterson  5 , Ritu Thamman  6 , Shivani Watson  6 , Deepa Mandale  7 , Christopher G Scott  8 , Tasneem Naqvi  7 , Gary M Woodward  9 , William Hawkes  9
Affiliations

Automated analysis of limited echocardiograms: Feasibility and relationship to outcomes in COVID-19

Patricia A Pellikka et al. Front Cardiovasc Med. .

Abstract

Background: As automated echocardiographic analysis is increasingly utilized, continued evaluation within hospital settings is important to further understand its potential value. The importance of cardiac involvement in patients hospitalized with COVID-19 provides an opportunity to evaluate the feasibility and clinical relevance of automated analysis applied to limited echocardiograms.

Methods: In this multisite US cohort, the feasibility of automated AI analysis was evaluated on 558 limited echocardiograms in patients hospitalized with COVID-19. Reliability of automated assessment of left ventricular (LV) volumes, ejection fraction (EF), and LV longitudinal strain (LS) was assessed against clinically obtained measures and echocardiographic findings. Automated measures were evaluated against patient outcomes using ROC analysis, survival modeling, and logistic regression for the outcomes of 30-day mortality and in-hospital sequelae.

Results: Feasibility of automated analysis for both LVEF and LS was 87.5% (488/558 patients). AI analysis was performed with biplane method in 300 (61.5%) and single plane apical 4- or 2-chamber analysis in 136 (27.9%) and 52 (10.7%) studies, respectively. Clinical LVEF was assessed using visual estimation in 192 (39.3%), biplane in 163 (33.4%), and single plane or linear methods in 104 (21.2%) of the 488 studies; 29 (5.9%) studies did not have clinically reported LVEF. LV LS was clinically reported in 80 (16.4%). Consistency between automated and clinical values demonstrated Pearson's R, root mean square error (RMSE) and intraclass correlation coefficient (ICC) of 0.61, 11.3% and 0.72, respectively, for LVEF; 0.73, 3.9% and 0.74, respectively for LS; 0.76, 24.4ml and 0.87, respectively, for end-diastolic volume; and 0.82, 12.8 ml, and 0.91, respectively, for end-systolic volume. Abnormal automated measures of LVEF and LS were associated with LV wall motion abnormalities, left atrial enlargement, and right ventricular dysfunction. Automated analysis was associated with outcomes, including survival.

Conclusion: Automated analysis was highly feasible on limited echocardiograms using abbreviated protocols, consistent with equivalent clinically obtained metrics, and associated with echocardiographic abnormalities and patient outcomes.

Keywords: COVID-19; artificial intelligence; deformation imaging; echocardiography; machine learning; strain rate imaging.

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Figures

Figure 1
Figure 1
Agreement analysis between automated metrics of LV function relative to clinically derived values using Bland Altman analysis and Deming Regression. LVEF and LS values represent all available data, including biplane and single plane (either apical 4- or 2-chamber).
Figure 2
Figure 2
ROC curve analysis for detection of clinically reported LV systolic dysfunction by automated LVEF and LS. PPV, Positive predictive value; NPV, Negative predictive value.
Figure 3
Figure 3
Kaplan-Meier survival analysis of 30-day mortality using LVEF and LS for both automated and clinically derived values according to strata of systolic dysfunction. Events are right-censored at 30 days.
See this image and copyright information in PMC

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