Abstract
Machine learning techniques designed to recognize views and perform measurements are increasingly used to address the need for automation of the interpretation of echocardiographic images. The current study was designed to determine whether a recently developed and validated deep learning (DL) algorithm for automated measurements of echocardiographic parameters of left heart chamber size and function can improve the reproducibility and shorten the analysis time, compared to the conventional methodology. The DL algorithm trained to identify standard views and provide automated measurements of 20 standard parameters, was applied to images obtained in 12 randomly selected echocardiographic studies. The resultant measurements were reviewed and revised as necessary by 10 independent expert readers. The same readers also performed conventional manual measurements, which were averaged and used as the reference standard for the DL-assisted approach with and without the manual revisions. Inter-reader variability was quantified using coefficients of variation, which together with analysis times, were compared between the conventional reads and the DL-assisted approach. The fully automated DL measurements showed good agreement with the reference technique: Bland–Altman biases 0–14% of the measured values. Manual revisions resulted in only minor improvement in accuracy: biases 0–11%. This DL-assisted approach resulted in a 43% decrease in analysis time and less inter-reader variability than the conventional methodology: 2–3 times smaller coefficients of variation. In conclusion, DL-assisted approach to analysis of echocardiographic images can provide accurate left heart measurements with the added benefits of improved reproducibility and time savings, compared to conventional methodology.
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Acknowledgements
This work was supported by the American Society of Echocardiography (ASE) by allowing us to use the images collected in World Alliance of Societies of Echocardiography (WASE) Multicenter Study of Normal Values.
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VM performed statistical analysis and wrote the main manuscript text. AB, MS, AR, GS and DL developed the deep learning algorithm, analyzed the data and critically reviewed the manuscript. KA, KK, GS, LPB, JNK, PG-F, ACTD, AS, EST, ADP, WR, KOO performed the measurements and critically reviewed the manuscript. FMA and RML designed the study and critically reviewed the manuscript.
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Mor-Avi, V., Blitz, A., Schreckenberg, M. et al. Deep learning assisted measurement of echocardiographic left heart parameters: improvement in interobserver variability and workflow efficiency. Int J Cardiovasc Imaging 39, 2507–2516 (2023). https://doi.org/10.1007/s10554-023-02960-5
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DOI: https://doi.org/10.1007/s10554-023-02960-5