Developing an Echocardiography-Based, Automatic Deep Learning Framework
for the Differentiation of Increased Left Ventricular Wall Thickness
Etiologies
Abstract
Aims Increased LV wall thickness is frequently encountered in
transthoracic echocardiography (TTE). While accurate and early diagnosis
is clinically important, given the differences in available therapeutic
options and prognosis, an extensive workup is often required to
establish the diagnosis. We propose the first echo-based, automated deep
learning model with a fusion architecture to facilitate the evaluation
and diagnosis of increased left ventricular (LV) wall thickness.
Methods and Results Patients with an established diagnosis of
increased LV wall thickness (hypertrophic cardiomyopathy (HCM), cardiac
amyloidosis (CA), and hypertensive heart disease (HTN)/others) between
1/2015 to 11/2019 at Mayo Clinic Arizona were identified. The cohort was
divided into 80%/10%/10% for training, validation, and testing sets,
respectively. Six baseline TTE views were used to optimize a pre-trained
InceptionResnetV2 model. Each model output was used to train a
meta-learner under a fusion architecture. Model performance was assessed
by multiclass area under the receiver operating characteristic curve
(AUROC). A total of 586 patients were used for the final analysis (194
HCM, 201 CA, and 191 HTN/others). The mean age was 55.0 years, and
57.8% were male. Among the individual view-dependent models, the apical
4 chamber model had the best performance (AUROC: HCM: 0.94, CA: 0.73,
and HTN/other: 0.87). The final fusion model outperformed all the
view-dependent models (AUROC: CA: 0.90, HCM: 0.93, and HTN/other: 0.92).
Conclusion The echo-based InceptionResnetV2 fusion model can
accurately classify the main etiologies of increased LV wall thickness
and can facilitate the process of diagnosis and workup.