Sabo Sigbjorn, Pettersen Hakon Neergaard, Smistad Erik, Pasdeloup David, Stølen Stian Bergseng, Grenne Bjørnar Leangen, Lovstakken Lasse, Holte Espen, Dalen Havard
Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, NTNU, Box 8905, 7491 Trondheim, Norway.
Department of Internal Medicine, Kristiansund Hospital, More and Romsdal Hospital Trust, Herman Døhlens vei 1, 6508 Kristiansund, Norway.
Eur Heart J Imaging Methods Pract. 2023 Aug 1;1(1):qyad012. doi: 10.1093/ehjimp/qyad012. eCollection 2023 May.
Apical foreshortening leads to an underestimation of left ventricular (LV) volumes and an overestimation of LV ejection fraction and global longitudinal strain. Real-time guiding using deep learning (DL) during echocardiography to reduce foreshortening could improve standardization and reduce variability. We aimed to study the effect of real-time DL guiding during echocardiography on measures of LV foreshortening and inter-observer variability.
Patients ( = 88) in sinus rhythm referred for echocardiography without indication for contrast were included. All participants underwent three echocardiograms. The first two examinations were performed by sonographers, and the third by cardiologists. In Period 1, the sonographers were instructed to provide high-quality echocardiograms. In Period 2, the DL guiding was used by the second sonographer. One blinded expert measured LV length in all recordings. Tri-plane recordings by cardiologists were used as reference. Apical foreshortening was calculated at the end-diastole. Both sonographer groups significantly foreshortened the LV in Period 1 (mean foreshortening: Sonographer 1: 4 mm; Sonographer 2: 3 mm, both < 0.001 vs. reference) and reduced foreshortening in Period 2 (2 and 0 mm, respectively. Period 1 vs. Period 2, < 0.05). Sonographers using DL guiding did not foreshorten more than cardiologists ( ≥ 0.409). Real-time guiding did not improve intra-class correlation (ICC) [LV end-diastolic volume ICC, (95% confidence interval): DL guiding 0.87 (0.77-0.93) vs. no guiding 0.92 (0.88-0.95)].
Real-time guiding reduced foreshortening among experienced operators and has the potential to improve image standardization. Even though the effect on inter-operator variability was minimal among experienced users, real-time guiding may improve test-retest variability among less experienced users.
ClinicalTrials.gov, Identifier: NCT04580095.
心尖部缩短会导致左心室（LV）容积低估以及左心室射血分数和整体纵向应变高估。在超声心动图检查期间使用深度学习（DL）进行实时引导以减少缩短情况，可能会提高标准化程度并减少变异性。我们旨在研究超声心动图检查期间实时DL引导对LV缩短测量及观察者间变异性的影响。
纳入88例窦性心律且无造影剂使用指征而接受超声心动图检查的患者。所有参与者均接受了三次超声心动图检查。前两次检查由超声检查医师进行，第三次由心脏病专家进行。在第1阶段，指导超声检查医师提供高质量的超声心动图。在第2阶段，第二位超声检查医师使用DL引导。一位盲法专家测量了所有记录中的LV长度。心脏病专家的三平面记录用作参考。在舒张末期计算心尖部缩短情况。两个超声检查医师组在第1阶段均显著缩短了LV（平均缩短：超声检查医师1：4 mm；超声检查医师2：3 mm，两者与参考值相比均P<0.001），并在第2阶段减少了缩短情况（分别为2和0 mm。第1阶段与第2阶段相比，P<0.05）。使用DL引导的超声检查医师缩短程度并不比心脏病专家更多（P≥0.409）。实时引导并未改善组内相关系数（ICC）[左心室舒张末期容积ICC，（95%置信区间）：DL引导为0.87（0.77 - 0.93），无引导为0.92（0.88 - 0.95）]。
实时引导减少了经验丰富的操作者的缩短情况，并且有可能改善图像标准化。尽管在经验丰富的使用者中对操作者间变异性的影响最小，但实时引导可能会改善经验较少的使用者的重测变异性。
ClinicalTrials.gov，标识符：NCT04580095。
