170 research outputs found

    Towards a tricorder: clinical, health economic, and ethical investigation of point-of-care artificial intelligence electrocardiogram for heart failure

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    Heart failure (HF) is an international public health priority and a focus of the NHS Long Term Plan. There is a particular need in primary care for screening and early detection of heart failure with reduced ejection fraction (HFrEF) – the most common and serious HF subtype, and the only one with an abundant evidence base for effective therapies. Digital health technologies (DHTs) integrating artificial intelligence (AI) could improve diagnosis of HFrEF. Specifically, through a convergence of DHTs and AI, a single-lead electrocardiogram (ECG) can be recorded by a smart stethoscope and interrogated by AI (AI-ECG) to potentially serve as a point-of-care HFrEF test. However, there are concerning evidence gaps for such DHTs applying AI; across intersecting clinical, health economic, and ethical considerations. My thesis therefore investigates hypotheses that AI-ECG is 1.) Reliable, accurate, unbiased, and can be patient self-administered, 2.) Of justifiable health economic impact for primary care deployment, and 3.) Appropriate across ethical domains for deployment as a tool for patient self-administered screening. The theoretical basis for this work is presented in the Introduction (Chapter 1). Chapter 2 describes the first large-scale, multi-centre independent external validation study of AI-ECG, prospectively recruiting 1,050 patients and highlighting impressive performance: area under the curve, sensitivity, and specificity up to 0·91 (95% confidence interval: 0·88–0·95), 91·9% (78·1–98·3), and 80·2% (75·5–84·3) respectively; and absence of bias by age, sex, and ethnicity. Performance was independent of operator, and usability of the tool extended to patients being able to self-examine. Chapter 3 presents a clinical and health economic outcomes analysis using a contemporary digital repository of 2.5 million NHS patient records. A propensity-matched cohort was derived using all patients diagnosed with HF from 2015-2020 (n = 34,208). Novel findings included the unacceptable reality that 70% of index HF diagnoses are made through hospitalisation; where index diagnosis through primary care conferred a medium-term survival advantage and long-term cost saving (£2,500 per patient). This underpins a health economic model for the deployment of AI-ECG across primary care. Chapter 4 approaches a normative ethical analysis focusing on equity, agency, data rights, and responsibility for safe, effective, and trustworthy implementation of an unprecedented at-home patient self-administered AI-ECG screening programme. I propose approaches to mitigating any potential harms, towards preserving and promoting trust, patient engagement, and public health. Collectively, this thesis marks novel work highlighting AI-ECG as tool with the potential to address major cardiovascular public health priorities. Scrutiny through complimentary clinical, health economic, and ethical considerations can directly serve patients and health systems by blueprinting best-practice for the evaluation and implementation of DHTs integrating AI – building the conviction needed to realise the full potential of such technologies.Open Acces

    Hemodynamic Quantifications By Contrast-Enhanced Ultrasound:From In-Vitro Modelling To Clinical Validation

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    Polygenic Risk Score for Cardiovascular Diseases in Artificial Intelligence Paradigm

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    Cardiovascular disease (CVD) related mortality and morbidity heavily strain society. The relationship between external risk factors and our genetics have not been well established. It is widely acknowledged that environmental influence and individual behaviours play a significant role in CVD vulnerability, leading to the development of polygenic risk scores (PRS). We employed the PRISMA search method to locate pertinent research and literature to extensively review artificial intelligence (AI)-based PRS models for CVD risk prediction. Furthermore, we analyzed and compared conventional vs. AI-based solutions for PRS. We summarized the recent advances in our understanding of the use of AI-based PRS for risk prediction of CVD. Our study proposes three hypotheses: i) Multiple genetic variations and risk factors can be incorporated into AI-based PRS to improve the accuracy of CVD risk predicting. ii) AI-based PRS for CVD circumvents the drawbacks of conventional PRS calculators by incorporating a larger variety of genetic and non-genetic components, allowing for more precise and individualised risk estimations. iii) Using AI approaches, it is possible to significantly reduce the dimensionality of huge genomic datasets, resulting in more accurate and effective disease risk prediction models. Our study highlighted that the AI-PRS model outperformed traditional PRS calculators in predicting CVD risk. Furthermore, using AI-based methods to calculate PRS may increase the precision of risk predictions for CVD and have significant ramifications for individualized prevention and treatment plans

    Novel near-infrared spectroscopy-intravascular ultrasound-based deep-learning methodology for accurate coronary computed tomography plaque quantification and characterization.

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    AIMS: Coronary computed tomography angiography (CCTA) is inferior to intravascular imaging in detecting plaque morphology and quantifying plaque burden. We aim to, for the first time, train a deep-learning (DL) methodology for accurate plaque quantification and characterization in CCTA using near-infrared spectroscopy-intravascular ultrasound (NIRS-IVUS). METHODS AND RESULTS: Seventy patients were prospectively recruited who underwent CCTA and NIRS-IVUS imaging. Corresponding cross sections were matched using an in-house developed software, and the estimations of NIRS-IVUS for the lumen, vessel wall borders, and plaque composition were used to train a convolutional neural network in 138 vessels. The performance was evaluated in 48 vessels and compared against the estimations of NIRS-IVUS and the conventional CCTA expert analysis. Sixty-four patients (186 vessels, 22 012 matched cross sections) were included. Deep-learning methodology provided estimations that were closer to NIRS-IVUS compared with the conventional approach for the total atheroma volume (ΔDL-NIRS-IVUS: -37.8 ± 89.0 vs. ΔConv-NIRS-IVUS: 243.3 ± 183.7 mm3, variance ratio: 4.262, P < 0.001) and percentage atheroma volume (-3.34 ± 5.77 vs. 17.20 ± 7.20%, variance ratio: 1.578, P < 0.001). The DL methodology detected lesions more accurately than the conventional approach (Area under the curve (AUC): 0.77 vs. 0.67, P < 0.001) and quantified minimum lumen area (ΔDL-NIRS-IVUS: -0.35 ± 1.81 vs. ΔConv-NIRS-IVUS: 1.37 ± 2.32 mm2, variance ratio: 1.634, P < 0.001), maximum plaque burden (4.33 ± 11.83% vs. 5.77 ± 16.58%, variance ratio: 2.071, P = 0.004), and calcific burden (-51.2 ± 115.1 vs. -54.3 ± 144.4, variance ratio: 2.308, P < 0.001) more accurately than conventional approach. The DL methodology was able to segment a vessel on CCTA in 0.3 s. CONCLUSIONS: The DL methodology developed for CCTA analysis from co-registered NIRS-IVUS and CCTA data enables rapid and accurate assessment of lesion morphology and is superior to expert analysts (Clinicaltrials.gov: NCT03556644)

    A Pharmaceutical Paradigm for Cardiovascular Composite Risk Assessment Using Novel Radiogenomics Risk Predictors in Precision Explainable Artificial Intelligence Framework: Clinical Trial Tool

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    Background: Cardiovascular disease (CVD) is challenging to diagnose and treat since symptoms appear late during the progression of atherosclerosis. Conventional risk factors alone are not always sufficient to properly categorize at-risk patients, and clinical risk scores are inadequate in predicting cardiac events. Integrating genomic-based biomarkers (GBBM) found in plasma/serum samples with novel non-invasive radiomics-based biomarkers (RBBM) such as plaque area, plaque burden, and maximum plaque height can improve composite CVD risk prediction in the pharmaceutical paradigm. These biomarkers consider several pathways involved in the pathophysiology of atherosclerosis disease leading to CVD. Objective: This review proposes two hypotheses: (i) The composite biomarkers are strongly correlated and can be used to detect the severity of CVD/Stroke precisely, and (ii) an explainable artificial intelligence (XAI)-based composite risk CVD/Stroke model with survival analysis using deep learning (DL) can predict in preventive, precision, and personalized (aiP 3 ) framework benefiting the pharmaceutical paradigm. Method: The PRISMA search technique resulted in 214 studies assessing composite biomarkers using radiogenomics for CVD/Stroke. The study presents a XAI model using AtheroEdge TM 4.0 to determine the risk of CVD/Stroke in the pharmaceutical framework using the radiogenomics biomarkers. Conclusions: Our observations suggest that the composite CVD risk biomarkers using radiogenomics provide a new dimension to CVD/Stroke risk assessment. The proposed review suggests a unique, unbiased, and XAI model based on AtheroEdge TM 4.0 that can predict the composite risk of CVD/Stroke using radiogenomics in the pharmaceutical paradigm

    Artificial Intelligence and Chest Computational Tomography to predict prognosis in Pulmonary Hypertension and lung disease.

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    Pulmonary hypertension (PH) is an incurable severe condition with poor survival and multiple clinically distinct sub-groups and phenotypes. Accurate diagnosis and identification of the underlying phenotype is an integral step in patient management as it informs treatment choice. Outcomes vary significantly between phenotypes. Patients presenting with signs of both PH and lung disease pose a clinical dilemma between two phenotypes - idiopathic pulmonary arterial hypertension (IPAH) and pulmonary hypertension secondary to lung disease (PH-CLD) as they can present with overlapping features. The impact of lung disease on outcomes is not well understood and this is a challenging area in the literature with limited progress. All patients suspected with PH undergo routine chest Computed Tomography Pulmonary Angiography (CTPA) imaging. Despite this, the prognostic significance of commonly visualised lung parenchymal patterns is currently unknown. Current radiological assessment is also limited by its visual and subjective nature. Recent breakthroughs in deep-learning Artificial Intelligence (AI) approaches have enabled automated quantitative analysis of medical imaging features. This thesis demonstrates the prognostic impact of common lung parenchymal patterns on CT in IPAH and PH-CLD. It describes how this data could aid in phenotyping, and in identification of new sub-groups of patients with distinct clinical characteristics, imaging features and prognostic profiles. It further develops and clinically evaluates an automated CT AI model which quantifies the percentage of lung involvement of prognostic lung parenchymal patterns. Combining this AI model with radiological assessment improves the prognostic predictive strength of lung disease severity in these patients

    Polygenic Risk Score for Cardiovascular Diseases in Artificial Intelligence Paradigm: A Review

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    Cardiovascular disease (CVD) related mortality and morbidity heavily strain society. The relationship between external risk factors and our genetics have not been well established. It is widely acknowledged that environmental influence and individual behaviours play a significant role in CVD vulnerability, leading to the development of polygenic risk scores (PRS). We employed the PRISMA search method to locate pertinent research and literature to extensively review artificial intelligence (AI)-based PRS models for CVD risk prediction. Furthermore, we analyzed and compared conventional vs. AI-based solutions for PRS. We summarized the recent advances in our understanding of the use of AI-based PRS for risk prediction of CVD. Our study proposes three hypotheses: i) Multiple genetic variations and risk factors can be incorporated into AI-based PRS to improve the accuracy of CVD risk predicting. ii) AI-based PRS for CVD circumvents the drawbacks of conventional PRS calculators by incorporating a larger variety of genetic and non-genetic components, allowing for more precise and individualised risk estimations. iii) Using AI approaches, it is possible to significantly reduce the dimensionality of huge genomic datasets, resulting in more accurate and effective disease risk prediction models. Our study highlighted that the AI-PRS model outperformed traditional PRS calculators in predicting CVD risk. Furthermore, using AI-based methods to calculate PRS may increase the precision of risk predictions for CVD and have significant ramifications for individualized prevention and treatment plans

    Automated detection method of thoracic aorta calcification from non-contrast CT images using mediastinal anatomical label map

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    Progression of thoracic aortic calcification (TAC) has been shown to be associated with hard cardiovascular events including stroke and all-cause mortality as well as coronary events. In this study, we propose an automated detection method of TACs of non-contrast CT images using mediastinal anatomical label map. This method consists of two steps: (1) the construction of a mediastinal anatomical label map, and (2) the detection of TACs using the intensity and the mediastinal anatomical label map. The proposed method was applied to two non-contrast CT image datasets: 24 cases of chronic thromboembolic pulmonary hypertension (CTEPH) and 100 non-CTEPH cases of low-dose CT screening. The method was compared with two-dimensional U-Nets and the Swin UNETR. The results showed that the method achieved significantly higher F1 score of 0.937 than other methods for the non-CTEPH case dataset (p-value < 0.05, pairwise Wilcoxon signed rank test with Bonferroni correction)

    A Pharmaceutical Paradigm for Cardiovascular Composite Risk Assessment Using Novel Radiogenomics Risk Predictors in Precision Explainable Artificial Intelligence Framework: Clinical Trial Tool

    Get PDF
    Cardiovascular disease (CVD) is challenging to diagnose and treat since symptoms appear late during the progression of atherosclerosis. Conventional risk factors alone are not always sufficient to properly categorize at-risk patients, and clinical risk scores are inadequate in predicting cardiac events. Integrating genomic-based biomarkers (GBBM) found in plasma/serum samples with novel non-invasive radiomics-based biomarkers (RBBM) such as plaque area, plaque burden, and maximum plaque height can improve composite CVD risk prediction in the pharmaceutical paradigm. These biomarkers consider several pathways involved in the pathophysiology of atherosclerosis disease leading to CVD.This review proposes two hypotheses: (i) The composite biomarkers are strongly correlated and can be used to detect the severity of CVD/Stroke precisely, and (ii) an explainable artificial intelligence (XAI)-based composite risk CVD/Stroke model with survival analysis using deep learning (DL) can predict in preventive, precision, and personalized (aiP3) framework benefiting the pharmaceutical paradigm.The PRISMA search technique resulted in 214 studies assessing composite biomarkers using radiogenomics for CVD/Stroke. The study presents a XAI model using AtheroEdgeTM 4.0 to determine the risk of CVD/Stroke in the pharmaceutical framework using the radiogenomics biomarkers.Our observations suggest that the composite CVD risk biomarkers using radiogenomics provide a new dimension to CVD/Stroke risk assessment. The proposed review suggests a unique, unbiased, and XAI model based on AtheroEdgeTM 4.0 that can predict the composite risk of CVD/Stroke using radiogenomics in the pharmaceutical paradigm
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