Skip to main content
Top
Published in: European Radiology 8/2022

11-03-2022 | Artificial Intelligence | Cardiac

Diagnostic accuracy and performance of artificial intelligence in measuring left atrial volumes and function on multiphasic CT in patients with atrial fibrillation

Authors: Gilberto J. Aquino, Jordan Chamberlin, Basel Yacoub, Madison R. Kocher, Ismail Kabakus, Selcuk Akkaya, Megan Mercer, Jeffrey Waltz, Matthew Fiegel, Nathan Leaphart, Athira Jacob, Mehmet Akif Gulsun, James Gilkes, Joe Stephenson, Puneet Sharma, Pooyan Sahbaee, Joseph Schoepf, Stefan Zimmerman, Michael E. Field, Ali M. Agha, Jeremy R. Burt

Published in: European Radiology | Issue 8/2022

Login to get access

Abstract

Objectives

To evaluate the effectiveness of a novel artificial intelligence (AI) algorithm for fully automated measurement of left atrial (LA) volumes and function using cardiac CT in patients with atrial fibrillation.

Methods

We included 79 patients (mean age 63 ± 12 years; 35 with atrial fibrillation (AF) and 44 controls) between 2017 and 2020 in this retrospective study. Images were analyzed by a trained AI algorithm and an expert radiologist. Left atrial volumes were obtained at cardiac end-systole, end-diastole, and pre-atrial contraction, which were then used to obtain LA function indices. Intraclass correlation coefficient (ICC) analysis of the LA volumes and function parameters was performed and receiver operating characteristic (ROC) curve analysis was used to compare the ability to detect AF patients.

Results

The AI was significantly faster than manual measurement of LA volumes (4 s vs 10.8 min, respectively). Agreement between the manual and automated methods was good to excellent overall, and there was stronger agreement in AF patients (all ICCs ≥ 0.877; p < 0.001) than controls (all ICCs ≥ 0.799; p < 0.001). The AI comparably estimated LA volumes in AF patients (all within 1.3 mL of the manual measurement), but overestimated volumes by clinically negligible amounts in controls (all by ≤ 4.2 mL). The AI’s ability to distinguish AF patients from controls using the LA volume index was similar to the expert’s (AUC 0.81 vs 0.82, respectively; p = 0.62).

Conclusion

The novel AI algorithm efficiently performed fully automated multiphasic CT-based quantification of left atrial volume and function with similar accuracy as compared to manual quantification.

Summary statement

Novel CT-based AI algorithm efficiently quantifies left atrial volumes and function with similar accuracy as manual quantification in controls and atrial fibrillation patients.

Key Points

There was good-to-excellent agreement between manual and automated methods for left atrial volume quantification.
The AI comparably estimated LA volumes in AF patients, but overestimated volumes by clinically negligible amounts in controls.
The AI’s ability to distinguish AF patients from controls was similar to the manual methods.
Appendix
Available only for authorised users
Literature
1.
go back to reference Colilla S, Crow A, Petkun W, Singer DE, Simon T, Liu X (2013) Estimates of current and future incidence and prevalence of atrial fibrillation in the U.S. adult population. Am J Cardiol 112:1142–1147CrossRef Colilla S, Crow A, Petkun W, Singer DE, Simon T, Liu X (2013) Estimates of current and future incidence and prevalence of atrial fibrillation in the U.S. adult population. Am J Cardiol 112:1142–1147CrossRef
2.
go back to reference Savelieva I, Camm J (2008) Update on atrial fibrillation: part I. Clin Cardiol 31:55–62CrossRef Savelieva I, Camm J (2008) Update on atrial fibrillation: part I. Clin Cardiol 31:55–62CrossRef
3.
go back to reference Gupta DK, Shah AM, Giugliano RP et al (2014) Left atrial structure and function in atrial fibrillation: ENGAGE AF-TIMI 48. Eur Heart J 35:1457–1465CrossRef Gupta DK, Shah AM, Giugliano RP et al (2014) Left atrial structure and function in atrial fibrillation: ENGAGE AF-TIMI 48. Eur Heart J 35:1457–1465CrossRef
4.
go back to reference Gucuk Ipek E, Marine JE, Habibi M et al (2016) Association of left atrial function with incident atypical atrial flutter after atrial fibrillation ablation. Heart Rhythm 13:391–398CrossRef Gucuk Ipek E, Marine JE, Habibi M et al (2016) Association of left atrial function with incident atypical atrial flutter after atrial fibrillation ablation. Heart Rhythm 13:391–398CrossRef
5.
go back to reference Thomas L, Boyd A, Thomas SP, Schiller NB, Ross DL (2003) Atrial structural remodelling and restoration of atrial contraction after linear ablation for atrial fibrillation. Eur Heart J 24:1942–1951CrossRef Thomas L, Boyd A, Thomas SP, Schiller NB, Ross DL (2003) Atrial structural remodelling and restoration of atrial contraction after linear ablation for atrial fibrillation. Eur Heart J 24:1942–1951CrossRef
6.
go back to reference Olsen FJ, Bertelsen L, de Knegt MC et al (2016) Multimodality cardiac imaging for the assessment of left atrial function and the association with atrial arrhythmias. Circ Cardiovasc Imaging 9 Olsen FJ, Bertelsen L, de Knegt MC et al (2016) Multimodality cardiac imaging for the assessment of left atrial function and the association with atrial arrhythmias. Circ Cardiovasc Imaging 9
7.
go back to reference Hoit BD (2014) Left atrial size and function: role in prognosis. J Am Coll Cardiol 63:493–505CrossRef Hoit BD (2014) Left atrial size and function: role in prognosis. J Am Coll Cardiol 63:493–505CrossRef
8.
go back to reference Habibi M, Chahal H, Opdahl A et al (2014) Association of CMR-measured LA function with heart failure development: results from the MESA study. JACC Cardiovasc Imaging 7:570–579CrossRef Habibi M, Chahal H, Opdahl A et al (2014) Association of CMR-measured LA function with heart failure development: results from the MESA study. JACC Cardiovasc Imaging 7:570–579CrossRef
9.
go back to reference Donal E, Lip GY, Galderisi M et al (2016) EACVI/EHRA Expert Consensus Document on the role of multi-modality imaging for the evaluation of patients with atrial fibrillation. Eur Heart J Cardiovasc Imaging 17:355–383CrossRef Donal E, Lip GY, Galderisi M et al (2016) EACVI/EHRA Expert Consensus Document on the role of multi-modality imaging for the evaluation of patients with atrial fibrillation. Eur Heart J Cardiovasc Imaging 17:355–383CrossRef
10.
go back to reference Thomas L, Marwick TH, Popescu BA, Donal E, Badano LP (2019) Left atrial structure and function, and left ventricular diastolic dysfunction: JACC State-of-the-Art Review. J Am Coll Cardiol 73:1961–1977CrossRef Thomas L, Marwick TH, Popescu BA, Donal E, Badano LP (2019) Left atrial structure and function, and left ventricular diastolic dysfunction: JACC State-of-the-Art Review. J Am Coll Cardiol 73:1961–1977CrossRef
11.
go back to reference Guglielmo M, Baggiano A, Muscogiuri G et al (2019) Multimodality imaging of left atrium in patients with atrial fibrillation. J Cardiovasc Comput Tomogr 13:340–346CrossRef Guglielmo M, Baggiano A, Muscogiuri G et al (2019) Multimodality imaging of left atrium in patients with atrial fibrillation. J Cardiovasc Comput Tomogr 13:340–346CrossRef
12.
go back to reference Wen Z, Zhang Z, Yu W, Fan Z, Du J, Lv B (2010) Assessing the left atrial phasic volume and function with dual-source CT: comparison with 3T MRI. Int J Cardiovasc Imaging 26(Suppl 1):83–92CrossRef Wen Z, Zhang Z, Yu W, Fan Z, Du J, Lv B (2010) Assessing the left atrial phasic volume and function with dual-source CT: comparison with 3T MRI. Int J Cardiovasc Imaging 26(Suppl 1):83–92CrossRef
13.
go back to reference Agner BF, Kuhl JT, Linde JJ et al (2014) Assessment of left atrial volume and function in patients with permanent atrial fibrillation: comparison of cardiac magnetic resonance imaging, 320-slice multi-detector computed tomography, and transthoracic echocardiography. Eur Heart J Cardiovasc Imaging 15:532–540CrossRef Agner BF, Kuhl JT, Linde JJ et al (2014) Assessment of left atrial volume and function in patients with permanent atrial fibrillation: comparison of cardiac magnetic resonance imaging, 320-slice multi-detector computed tomography, and transthoracic echocardiography. Eur Heart J Cardiovasc Imaging 15:532–540CrossRef
14.
go back to reference Zareian M, Ciuffo L, Habibi M et al (2015) Left atrial structure and functional quantitation using cardiovascular magnetic resonance and multimodality tissue tracking: validation and reproducibility assessment. J Cardiovasc Magn Reson 17:52CrossRef Zareian M, Ciuffo L, Habibi M et al (2015) Left atrial structure and functional quantitation using cardiovascular magnetic resonance and multimodality tissue tracking: validation and reproducibility assessment. J Cardiovasc Magn Reson 17:52CrossRef
15.
go back to reference Medvedofsky D, Mor-Avi V, Amzulescu M et al (2018) Three-dimensional echocardiographic quantification of the left-heart chambers using an automated adaptive analytics algorithm: multicentre validation study. Eur Heart J Cardiovasc Imaging 19:47–58CrossRef Medvedofsky D, Mor-Avi V, Amzulescu M et al (2018) Three-dimensional echocardiographic quantification of the left-heart chambers using an automated adaptive analytics algorithm: multicentre validation study. Eur Heart J Cardiovasc Imaging 19:47–58CrossRef
16.
go back to reference Almeida N, Papachristidis A, Pearson P et al (2017) Left atrial volumetric assessment using a novel automated framework for 3D echocardiography: a multi-centre analysis. Eur Heart J Cardiovasc Imaging 18:1008–1015CrossRef Almeida N, Papachristidis A, Pearson P et al (2017) Left atrial volumetric assessment using a novel automated framework for 3D echocardiography: a multi-centre analysis. Eur Heart J Cardiovasc Imaging 18:1008–1015CrossRef
17.
go back to reference Otani K, Nakazono A, Salgo IS, Lang RM, Takeuchi M (2016) Three-dimensional echocardiographic assessment of left heart chamber size and function with fully automated quantification software in patients with atrial fibrillation. J Am Soc Echocardiogr 29:955–965CrossRef Otani K, Nakazono A, Salgo IS, Lang RM, Takeuchi M (2016) Three-dimensional echocardiographic assessment of left heart chamber size and function with fully automated quantification software in patients with atrial fibrillation. J Am Soc Echocardiogr 29:955–965CrossRef
18.
go back to reference Wolf F, Ourednicek P, Loewe C et al (2010) Evaluation of left atrial function by multidetector computed tomography before left atrial radiofrequency-catheter ablation: comparison of a manual and automated 3D volume segmentation method. Eur J Radiol 75:e141–e146CrossRef Wolf F, Ourednicek P, Loewe C et al (2010) Evaluation of left atrial function by multidetector computed tomography before left atrial radiofrequency-catheter ablation: comparison of a manual and automated 3D volume segmentation method. Eur J Radiol 75:e141–e146CrossRef
19.
go back to reference Mao SS, Li D, Vembar M et al (2014) Model-based automatic segmentation algorithm accurately assesses the whole cardiac volumetric parameters in patients with cardiac CT angiography: a validation study for evaluating the accuracy of the workstation software and establishing the reference values. Acad Radiol 21:639–647CrossRef Mao SS, Li D, Vembar M et al (2014) Model-based automatic segmentation algorithm accurately assesses the whole cardiac volumetric parameters in patients with cardiac CT angiography: a validation study for evaluating the accuracy of the workstation software and establishing the reference values. Acad Radiol 21:639–647CrossRef
20.
go back to reference Abadi S, Roguin A, Engel A, Lessick J (2010) Feasibility of automatic assessment of four-chamber cardiac function with MDCT: initial clinical application and validation. Eur J Radiol 74:175–181CrossRef Abadi S, Roguin A, Engel A, Lessick J (2010) Feasibility of automatic assessment of four-chamber cardiac function with MDCT: initial clinical application and validation. Eur J Radiol 74:175–181CrossRef
21.
go back to reference Kohl SAA, Romera-Paredes B, Meyer C et al (2018) A probabilistic U-net for segmentation of ambiguous images Proceedings of the 32nd International Conference on Neural Information Processing Systems Kohl SAA, Romera-Paredes B, Meyer C et al (2018) A probabilistic U-net for segmentation of ambiguous images Proceedings of the 32nd International Conference on Neural Information Processing Systems
22.
go back to reference Koo TK, Li MY (2016) A guideline of selecting and reporting intraclass correlation coefficients for reliability research. J Chiropr Med 15:155–163CrossRef Koo TK, Li MY (2016) A guideline of selecting and reporting intraclass correlation coefficients for reliability research. J Chiropr Med 15:155–163CrossRef
23.
go back to reference Chen HH, Liu CM, Chang SL et al (2020) Automated extraction of left atrial volumes from two-dimensional computer tomography images using a deep learning technique. Int J Cardiol 316:272–278CrossRef Chen HH, Liu CM, Chang SL et al (2020) Automated extraction of left atrial volumes from two-dimensional computer tomography images using a deep learning technique. Int J Cardiol 316:272–278CrossRef
24.
go back to reference Baskaran L, Maliakal G, Al’Aref SJ et al (2020) Identification and quantification of cardiovascular structures from CCTA: an end-to-end, rapid, pixel-wise, deep-learning method. JACC Cardiovasc Imaging 13:1163–1171CrossRef Baskaran L, Maliakal G, Al’Aref SJ et al (2020) Identification and quantification of cardiovascular structures from CCTA: an end-to-end, rapid, pixel-wise, deep-learning method. JACC Cardiovasc Imaging 13:1163–1171CrossRef
25.
go back to reference Kojima T, Kawasaki M, Tanaka R et al (2012) Left atrial global and regional function in patients with paroxysmal atrial fibrillation has already been impaired before enlargement of left atrium: velocity vector imaging echocardiography study. Eur Heart J Cardiovasc Imaging 13:227–234CrossRef Kojima T, Kawasaki M, Tanaka R et al (2012) Left atrial global and regional function in patients with paroxysmal atrial fibrillation has already been impaired before enlargement of left atrium: velocity vector imaging echocardiography study. Eur Heart J Cardiovasc Imaging 13:227–234CrossRef
26.
go back to reference Stojanovska J, Cronin P, Gross BH et al (2014) Left atrial function and maximum volume as determined by MDCT are independently associated with atrial fibrillation. Acad Radiol 21:1162–1171CrossRef Stojanovska J, Cronin P, Gross BH et al (2014) Left atrial function and maximum volume as determined by MDCT are independently associated with atrial fibrillation. Acad Radiol 21:1162–1171CrossRef
27.
go back to reference Stojanovska J, Cronin P, Patel S et al (2011) Reference normal absolute and indexed values from ECG-gated MDCT: left atrial volume, function, and diameter. AJR Am J Roentgenol 197:631–637CrossRef Stojanovska J, Cronin P, Patel S et al (2011) Reference normal absolute and indexed values from ECG-gated MDCT: left atrial volume, function, and diameter. AJR Am J Roentgenol 197:631–637CrossRef
28.
go back to reference Truong QA, Bamberg F, Mahabadi AA et al (2011) Left atrial volume and index by multi-detector computed tomography: comprehensive analysis from predictors of enlargement to predictive value for acute coronary syndrome (ROMICAT study). Int J Cardiol 146:171–176CrossRef Truong QA, Bamberg F, Mahabadi AA et al (2011) Left atrial volume and index by multi-detector computed tomography: comprehensive analysis from predictors of enlargement to predictive value for acute coronary syndrome (ROMICAT study). Int J Cardiol 146:171–176CrossRef
29.
go back to reference Lin FY, Devereux RB, Roman MJ et al (2008) Cardiac chamber volumes, function, and mass as determined by 64-multidetector row computed tomography: mean values among healthy adults free of hypertension and obesity. JACC Cardiovasc Imaging 1:782–786CrossRef Lin FY, Devereux RB, Roman MJ et al (2008) Cardiac chamber volumes, function, and mass as determined by 64-multidetector row computed tomography: mean values among healthy adults free of hypertension and obesity. JACC Cardiovasc Imaging 1:782–786CrossRef
Metadata
Title
Diagnostic accuracy and performance of artificial intelligence in measuring left atrial volumes and function on multiphasic CT in patients with atrial fibrillation
Authors
Gilberto J. Aquino
Jordan Chamberlin
Basel Yacoub
Madison R. Kocher
Ismail Kabakus
Selcuk Akkaya
Megan Mercer
Jeffrey Waltz
Matthew Fiegel
Nathan Leaphart
Athira Jacob
Mehmet Akif Gulsun
James Gilkes
Joe Stephenson
Puneet Sharma
Pooyan Sahbaee
Joseph Schoepf
Stefan Zimmerman
Michael E. Field
Ali M. Agha
Jeremy R. Burt
Publication date
11-03-2022
Publisher
Springer Berlin Heidelberg
Published in
European Radiology / Issue 8/2022
Print ISSN: 0938-7994
Electronic ISSN: 1432-1084
DOI
https://doi.org/10.1007/s00330-022-08657-y

Other articles of this Issue 8/2022

European Radiology 8/2022 Go to the issue