Cognitive Machine-Learning Algorithm for Cardiac Imaging: A Pilot Study for Differentiating Constrictive Pericarditis From Restrictive Cardiomyopathy.
Associating a patient's profile with the memories of prototypical patients built through previous repeat clinical experience is a key process in clinical judgment. We hypothesized that a similar process using a cognitive computing tool would be well suited for learning and recalling multidimensional attributes of speckle tracking echocardiography data sets derived from patients with known constrictive pericarditis and restrictive cardiomyopathy.



Clinical and echocardiographic data of 50 patients with constrictive pericarditis and 44 with restrictive cardiomyopathy were used for developing an associative memory classifier-based machine-learning algorithm. The speckle tracking echocardiography data were normalized in reference to 47 controls with no structural heart disease, and the diagnostic area under the receiver operating characteristic curve of the associative memory classifier was evaluated for differentiating constrictive pericarditis from restrictive cardiomyopathy. Using only speckle tracking echocardiography variables, associative memory classifier achieved a diagnostic area under the curve of 89.2%, which improved to 96.2% with addition of 4 echocardiographic variables. In comparison, the area under the curve of early diastolic mitral annular velocity and left ventricular longitudinal strain were 82.1% and 63.7%, respectively. Furthermore, the associative memory classifier demonstrated greater accuracy and shorter learning curves than other machine-learning approaches, with accuracy asymptotically approaching 90% after a training fraction of 0.3 and remaining flat at higher training fractions.



This study demonstrates feasibility of a cognitive machine-learning approach for learning and recalling patterns observed during echocardiographic evaluations. Incorporation of machine-learning algorithms in cardiac imaging may aid standardized assessments and support the quality of interpretations, particularly for novice readers with limited experience.
From the Zena and Michael A. Wiener Cardiovascular Institute and the Marie-Josée and Henry R. Kravis Center for Cardiovascular Health, Mount Sinai School of Medicine, New York, NY (P.P.S., M.B.); Saffron Technology, Inc, Cary, NC (Y.-M.H., A.A., M.F., W.G.); and Icahn Institute for Genomics and Multiscale Biology, Icahn School of Medicine at Mount Sinai, New York, NY (K.S., J.T.D.). Partho.Sengupta@mountsinai.org.
Partho P
PP
Sengupta
From the Zena and Michael A. Wiener Cardiovascular Institute and the Marie-Josée and Henry R. Kravis Center for Cardiovascular Health, Mount Sinai School of Medicine, New York, NY (P.P.S., M.B.); Saffron Technology, Inc, Cary, NC (Y.-M.H., A.A., M.F., W.G.); and Icahn Institute for Genomics and Multiscale Biology, Icahn School of Medicine at Mount Sinai, New York, NY (K.S., J.T.D.).
Yen-Min
YM
Huang
From the Zena and Michael A. Wiener Cardiovascular Institute and the Marie-Josée and Henry R. Kravis Center for Cardiovascular Health, Mount Sinai School of Medicine, New York, NY (P.P.S., M.B.); Saffron Technology, Inc, Cary, NC (Y.-M.H., A.A., M.F., W.G.); and Icahn Institute for Genomics and Multiscale Biology, Icahn School of Medicine at Mount Sinai, New York, NY (K.S., J.T.D.).
Manish
M
Bansal
From the Zena and Michael A. Wiener Cardiovascular Institute and the Marie-Josée and Henry R. Kravis Center for Cardiovascular Health, Mount Sinai School of Medicine, New York, NY (P.P.S., M.B.); Saffron Technology, Inc, Cary, NC (Y.-M.H., A.A., M.F., W.G.); and Icahn Institute for Genomics and Multiscale Biology, Icahn School of Medicine at Mount Sinai, New York, NY (K.S., J.T.D.).
Ali
A
Ashrafi
From the Zena and Michael A. Wiener Cardiovascular Institute and the Marie-Josée and Henry R. Kravis Center for Cardiovascular Health, Mount Sinai School of Medicine, New York, NY (P.P.S., M.B.); Saffron Technology, Inc, Cary, NC (Y.-M.H., A.A., M.F., W.G.); and Icahn Institute for Genomics and Multiscale Biology, Icahn School of Medicine at Mount Sinai, New York, NY (K.S., J.T.D.).
Matt
M
Fisher
From the Zena and Michael A. Wiener Cardiovascular Institute and the Marie-Josée and Henry R. Kravis Center for Cardiovascular Health, Mount Sinai School of Medicine, New York, NY (P.P.S., M.B.); Saffron Technology, Inc, Cary, NC (Y.-M.H., A.A., M.F., W.G.); and Icahn Institute for Genomics and Multiscale Biology, Icahn School of Medicine at Mount Sinai, New York, NY (K.S., J.T.D.).
Khader
K
Shameer
From the Zena and Michael A. Wiener Cardiovascular Institute and the Marie-Josée and Henry R. Kravis Center for Cardiovascular Health, Mount Sinai School of Medicine, New York, NY (P.P.S., M.B.); Saffron Technology, Inc, Cary, NC (Y.-M.H., A.A., M.F., W.G.); and Icahn Institute for Genomics and Multiscale Biology, Icahn School of Medicine at Mount Sinai, New York, NY (K.S., J.T.D.).
Walt
W
Gall
From the Zena and Michael A. Wiener Cardiovascular Institute and the Marie-Josée and Henry R. Kravis Center for Cardiovascular Health, Mount Sinai School of Medicine, New York, NY (P.P.S., M.B.); Saffron Technology, Inc, Cary, NC (Y.-M.H., A.A., M.F., W.G.); and Icahn Institute for Genomics and Multiscale Biology, Icahn School of Medicine at Mount Sinai, New York, NY (K.S., J.T.D.).
Joel T
JT
Dudley
D000368:Aged; D000465:Algorithms; D019540:Area Under Curve; D001706:Biopsy; D002313:Cardiomyopathy, Restrictive / Q000145:classification / Q000000981:diagnostic imaging* / Q000503:physiopathology; D016022:Case-Control Studies; D003661:Decision Support Techniques; D003937:Diagnosis, Differential; D015150:Echocardiography, Doppler / Q000379:methods*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D000069550:Machine Learning; D008297:Male; D008875:Middle Aged; D009206:Myocardium / Q000473:pathology; D010494:Pericarditis, Constrictive / Q000145:classification / Q000000981:diagnostic imaging* / Q000503:physiopathology; D010865:Pilot Projects; D011237:Predictive Value of Tests; D012372:ROC Curve; D015203:Reproducibility of Results; D013318:Stroke Volume; D016277:Ventricular Function, Left
big data; cardiovascular imaging; cognitive tools; machine learning; phenomics; precision medicine; speckle tracking echocardiography