title: Machine Learning of Three-dimensional Right Ventricular Motion Enables Outcome Prediction in Pulmonary Hypertension: A Cardiac MR Imaging Study.
abstract: Purpose To determine if patient survival and mechanisms of right ventricular failure in pulmonary hypertension could be predicted by using supervised machine learning of three-dimensional patterns of systolic cardiac motion. Materials and Methods The study was approved by a research ethics committee, and participants gave written informed consent. Two hundred fifty-six patients (143 women; mean age ± standard deviation, 63 years ± 17) with newly diagnosed pulmonary hypertension underwent cardiac magnetic resonance (MR) imaging, right-sided heart catheterization, and 6-minute walk testing with a median follow-up of 4.0 years. Semiautomated segmentation of short-axis cine images was used to create a three-dimensional model of right ventricular motion. Supervised principal components analysis was used to identify patterns of systolic motion that were most strongly predictive of survival. Survival prediction was assessed by using difference in median survival time and area under the curve with time-dependent receiver operating characteristic analysis for 1-year survival. Results At the end of follow-up, 36% of patients (93 of 256) died, and one underwent lung transplantation. Poor outcome was predicted by a loss of effective contraction in the septum and free wall, coupled with reduced basal longitudinal motion. When added to conventional imaging and hemodynamic, functional, and clinical markers, three-dimensional cardiac motion improved survival prediction (area under the receiver operating characteristic curve, 0.73 vs 0.60, respectively; P < .001) and provided greater differentiation according to difference in median survival time between high- and low-risk groups (13.8 vs 10.7 years, respectively; P < .001). Conclusion A machine-learning survival model that uses three-dimensional cardiac motion predicts outcome independent of conventional risk factors in patients with newly diagnosed pulmonary hypertension. Online supplemental material is available for this article.
authors.affiliation: From the MRC Clinical Sciences Centre, Du Cane Rd, London W12 0NN, England (T.J.W.D., A.d.M., W.S., T.F., S.A.C., D.P.O.); Division of Experimental Medicine, Department of Medicine (T.J.W.D, T.F., G.M.J.W., J.W., C.J.R., M.R.W.), Department of Computing (W.S., D.R.), and National Heart and Lung Institute (J.S.R.G.), Imperial College London, London, England; National Heart Centre Singapore, Singapore and Duke-NUS Graduate Medical School, Singapore (S.A.C.); and Department of Cardiology, National Pulmonary Hypertension Service, Imperial College Healthcare NHS Trust, London, England (L.S.G.E.H., J.S.R.G.).
authors.forename: Timothy J W
authors.initials: TJW
authors.lastname: Dawes
authors.affiliation: From the MRC Clinical Sciences Centre, Du Cane Rd, London W12 0NN, England (T.J.W.D., A.d.M., W.S., T.F., S.A.C., D.P.O.); Division of Experimental Medicine, Department of Medicine (T.J.W.D, T.F., G.M.J.W., J.W., C.J.R., M.R.W.), Department of Computing (W.S., D.R.), and National Heart and Lung Institute (J.S.R.G.), Imperial College London, London, England; National Heart Centre Singapore, Singapore and Duke-NUS Graduate Medical School, Singapore (S.A.C.); and Department of Cardiology, National Pulmonary Hypertension Service, Imperial College Healthcare NHS Trust, London, England (L.S.G.E.H., J.S.R.G.).
authors.forename: Antonio
authors.initials: A
authors.lastname: de Marvao
authors.affiliation: From the MRC Clinical Sciences Centre, Du Cane Rd, London W12 0NN, England (T.J.W.D., A.d.M., W.S., T.F., S.A.C., D.P.O.); Division of Experimental Medicine, Department of Medicine (T.J.W.D, T.F., G.M.J.W., J.W., C.J.R., M.R.W.), Department of Computing (W.S., D.R.), and National Heart and Lung Institute (J.S.R.G.), Imperial College London, London, England; National Heart Centre Singapore, Singapore and Duke-NUS Graduate Medical School, Singapore (S.A.C.); and Department of Cardiology, National Pulmonary Hypertension Service, Imperial College Healthcare NHS Trust, London, England (L.S.G.E.H., J.S.R.G.).
authors.forename: Wenzhe
authors.initials: W
authors.lastname: Shi
authors.affiliation: From the MRC Clinical Sciences Centre, Du Cane Rd, London W12 0NN, England (T.J.W.D., A.d.M., W.S., T.F., S.A.C., D.P.O.); Division of Experimental Medicine, Department of Medicine (T.J.W.D, T.F., G.M.J.W., J.W., C.J.R., M.R.W.), Department of Computing (W.S., D.R.), and National Heart and Lung Institute (J.S.R.G.), Imperial College London, London, England; National Heart Centre Singapore, Singapore and Duke-NUS Graduate Medical School, Singapore (S.A.C.); and Department of Cardiology, National Pulmonary Hypertension Service, Imperial College Healthcare NHS Trust, London, England (L.S.G.E.H., J.S.R.G.).
authors.forename: Tristan
authors.initials: T
authors.lastname: Fletcher
authors.affiliation: From the MRC Clinical Sciences Centre, Du Cane Rd, London W12 0NN, England (T.J.W.D., A.d.M., W.S., T.F., S.A.C., D.P.O.); Division of Experimental Medicine, Department of Medicine (T.J.W.D, T.F., G.M.J.W., J.W., C.J.R., M.R.W.), Department of Computing (W.S., D.R.), and National Heart and Lung Institute (J.S.R.G.), Imperial College London, London, England; National Heart Centre Singapore, Singapore and Duke-NUS Graduate Medical School, Singapore (S.A.C.); and Department of Cardiology, National Pulmonary Hypertension Service, Imperial College Healthcare NHS Trust, London, England (L.S.G.E.H., J.S.R.G.).
authors.forename: Geoffrey M J
authors.initials: GMJ
authors.lastname: Watson
authors.affiliation: From the MRC Clinical Sciences Centre, Du Cane Rd, London W12 0NN, England (T.J.W.D., A.d.M., W.S., T.F., S.A.C., D.P.O.); Division of Experimental Medicine, Department of Medicine (T.J.W.D, T.F., G.M.J.W., J.W., C.J.R., M.R.W.), Department of Computing (W.S., D.R.), and National Heart and Lung Institute (J.S.R.G.), Imperial College London, London, England; National Heart Centre Singapore, Singapore and Duke-NUS Graduate Medical School, Singapore (S.A.C.); and Department of Cardiology, National Pulmonary Hypertension Service, Imperial College Healthcare NHS Trust, London, England (L.S.G.E.H., J.S.R.G.).
authors.forename: John
authors.initials: J
authors.lastname: Wharton
authors.affiliation: From the MRC Clinical Sciences Centre, Du Cane Rd, London W12 0NN, England (T.J.W.D., A.d.M., W.S., T.F., S.A.C., D.P.O.); Division of Experimental Medicine, Department of Medicine (T.J.W.D, T.F., G.M.J.W., J.W., C.J.R., M.R.W.), Department of Computing (W.S., D.R.), and National Heart and Lung Institute (J.S.R.G.), Imperial College London, London, England; National Heart Centre Singapore, Singapore and Duke-NUS Graduate Medical School, Singapore (S.A.C.); and Department of Cardiology, National Pulmonary Hypertension Service, Imperial College Healthcare NHS Trust, London, England (L.S.G.E.H., J.S.R.G.).
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: Rhodes
authors.affiliation: From the MRC Clinical Sciences Centre, Du Cane Rd, London W12 0NN, England (T.J.W.D., A.d.M., W.S., T.F., S.A.C., D.P.O.); Division of Experimental Medicine, Department of Medicine (T.J.W.D, T.F., G.M.J.W., J.W., C.J.R., M.R.W.), Department of Computing (W.S., D.R.), and National Heart and Lung Institute (J.S.R.G.), Imperial College London, London, England; National Heart Centre Singapore, Singapore and Duke-NUS Graduate Medical School, Singapore (S.A.C.); and Department of Cardiology, National Pulmonary Hypertension Service, Imperial College Healthcare NHS Trust, London, England (L.S.G.E.H., J.S.R.G.).
authors.forename: Luke S G E
authors.initials: LSGE
authors.lastname: Howard
authors.affiliation: From the MRC Clinical Sciences Centre, Du Cane Rd, London W12 0NN, England (T.J.W.D., A.d.M., W.S., T.F., S.A.C., D.P.O.); Division of Experimental Medicine, Department of Medicine (T.J.W.D, T.F., G.M.J.W., J.W., C.J.R., M.R.W.), Department of Computing (W.S., D.R.), and National Heart and Lung Institute (J.S.R.G.), Imperial College London, London, England; National Heart Centre Singapore, Singapore and Duke-NUS Graduate Medical School, Singapore (S.A.C.); and Department of Cardiology, National Pulmonary Hypertension Service, Imperial College Healthcare NHS Trust, London, England (L.S.G.E.H., J.S.R.G.).
authors.forename: J Simon R
authors.initials: JSR
authors.lastname: Gibbs
authors.affiliation: From the MRC Clinical Sciences Centre, Du Cane Rd, London W12 0NN, England (T.J.W.D., A.d.M., W.S., T.F., S.A.C., D.P.O.); Division of Experimental Medicine, Department of Medicine (T.J.W.D, T.F., G.M.J.W., J.W., C.J.R., M.R.W.), Department of Computing (W.S., D.R.), and National Heart and Lung Institute (J.S.R.G.), Imperial College London, London, England; National Heart Centre Singapore, Singapore and Duke-NUS Graduate Medical School, Singapore (S.A.C.); and Department of Cardiology, National Pulmonary Hypertension Service, Imperial College Healthcare NHS Trust, London, England (L.S.G.E.H., J.S.R.G.).
authors.forename: Daniel
authors.initials: D
authors.lastname: Rueckert
authors.affiliation: From the MRC Clinical Sciences Centre, Du Cane Rd, London W12 0NN, England (T.J.W.D., A.d.M., W.S., T.F., S.A.C., D.P.O.); Division of Experimental Medicine, Department of Medicine (T.J.W.D, T.F., G.M.J.W., J.W., C.J.R., M.R.W.), Department of Computing (W.S., D.R.), and National Heart and Lung Institute (J.S.R.G.), Imperial College London, London, England; National Heart Centre Singapore, Singapore and Duke-NUS Graduate Medical School, Singapore (S.A.C.); and Department of Cardiology, National Pulmonary Hypertension Service, Imperial College Healthcare NHS Trust, London, England (L.S.G.E.H., J.S.R.G.).
authors.forename: Stuart A
authors.initials: SA
authors.lastname: Cook
authors.affiliation: From the MRC Clinical Sciences Centre, Du Cane Rd, London W12 0NN, England (T.J.W.D., A.d.M., W.S., T.F., S.A.C., D.P.O.); Division of Experimental Medicine, Department of Medicine (T.J.W.D, T.F., G.M.J.W., J.W., C.J.R., M.R.W.), Department of Computing (W.S., D.R.), and National Heart and Lung Institute (J.S.R.G.), Imperial College London, London, England; National Heart Centre Singapore, Singapore and Duke-NUS Graduate Medical School, Singapore (S.A.C.); and Department of Cardiology, National Pulmonary Hypertension Service, Imperial College Healthcare NHS Trust, London, England (L.S.G.E.H., J.S.R.G.).
authors.forename: Martin R
authors.initials: MR
authors.lastname: Wilkins
authors.affiliation: From the MRC Clinical Sciences Centre, Du Cane Rd, London W12 0NN, England (T.J.W.D., A.d.M., W.S., T.F., S.A.C., D.P.O.); Division of Experimental Medicine, Department of Medicine (T.J.W.D, T.F., G.M.J.W., J.W., C.J.R., M.R.W.), Department of Computing (W.S., D.R.), and National Heart and Lung Institute (J.S.R.G.), Imperial College London, London, England; National Heart Centre Singapore, Singapore and Duke-NUS Graduate Medical School, Singapore (S.A.C.); and Department of Cardiology, National Pulmonary Hypertension Service, Imperial College Healthcare NHS Trust, London, England (L.S.G.E.H., J.S.R.G.).
authors.forename: Declan P
authors.identifier: 0000-0002-0691-0270
authors.initials: DP
authors.lastname: O'Regan
mesh_terms: D000368:Aged; D005260:Female; D006352:Heart Ventricles / Q000000981:diagnostic imaging; D006801:Humans; D006976:Hypertension, Pulmonary / Q000150:complications / Q000000981:diagnostic imaging*; D007090:Image Interpretation, Computer-Assisted / Q000379:methods*; D021621:Imaging, Three-Dimensional / Q000379:methods*; D000069550:Machine Learning; D019028:Magnetic Resonance Imaging, Cine / Q000379:methods*; D008297:Male; D008875:Middle Aged; D010363:Pattern Recognition, Automated / Q000379:methods; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D013318:Stroke Volume; D018497:Ventricular Dysfunction, Right / Q000150:complications / Q000209:etiology*