Transesophageal Echocardiography Generation using Anatomical Models

Through automation, deep learning (DL) can enhance the analysis of transesophageal echocardiography (TEE) images. However, DL methods require large amounts of high-quality data to produce accurate results, which is difficult to satisfy. Data augmentation is commonly used to tackle this issue. In this work, we develop a pipeline to generate synthetic TEE images and corresponding semantic labels. The proposed data generation pipeline expands on an existing pipeline that generates synthetic transthoracic echocardiography images by transforming slices from anatomical models into synthetic images. We also demonstrate that such images can improve DL network performance through a left-ventricle semantic segmentation task. For the pipeline's unpaired image-to-image (I2I) translation section, we explore two generative methods: CycleGAN and contrastive unpaired translation. Next, we evaluate the synthetic images quantitatively using the Fr\'echet Inception Distance (FID) Score and qualitatively through a human perception quiz involving expert cardiologists and the average researcher. In this study, we achieve a dice score improvement of up to 10% when we augment datasets with our synthetic images. Furthermore, we compare established methods of assessing unpaired I2I translation and observe a disagreement when evaluating the synthetic images. Finally, we see which metric better predicts the generated data's efficacy when used for data augmentation.

NeCA: 3D Coronary Artery Tree Reconstruction from Two 2D Projections by Neural Implicit Representation

Cardiovascular diseases (CVDs) are the most common health threats worldwide. 2D x-ray invasive coronary angiography (ICA) remains as the most widely adopted imaging modality for CVDs diagnosis. However, in current clinical practice, it is often difficult for the cardiologists to interpret the 3D geometry of coronary vessels based on 2D planes. Moreover, due to the radiation limit, in general only two angiographic projections are acquired, providing limited information of the vessel geometry and necessitating 3D coronary tree reconstruction based only on two ICA projections. In this paper, we propose a self-supervised deep learning method called NeCA, which is based on implicit neural representation using the multiresolution hash encoder and differentiable cone-beam forward projector layer in order to achieve 3D coronary artery tree reconstruction from two projections. We validate our method using six different metrics on coronary computed tomography angiography data in terms of right coronary artery and left anterior descending respectively. The evaluation results demonstrate that our NeCA method, without 3D ground truth for supervision and large datasets for training, achieves promising performance in both vessel topology preservation and branch-connectivity maintaining compared to the supervised deep learning model.

Personalized Topology-Informed 12-Lead ECG Electrode Localization from Incomplete Cardiac MRIs for Efficient Cardiac Digital Twins

Cardiac digital twins (CDTs) offer personalized \textit{in-silico} cardiac representations for the inference of multi-scale properties tied to cardiac mechanisms. The creation of CDTs requires precise information about the electrode position on the torso, especially for the personalized electrocardiogram (ECG) calibration. However, current studies commonly rely on additional acquisition of torso imaging and manual/semi-automatic methods for ECG electrode localization. In this study, we propose a novel and efficient topology-informed model to fully automatically extract personalized ECG electrode locations from 2D clinically standard cardiac MRIs. Specifically, we obtain the sparse torso contours from the cardiac MRIs and then localize the electrodes from the contours. Cardiac MRIs aim at imaging of the heart instead of the torso, leading to incomplete torso geometry within the imaging. To tackle the missing topology, we incorporate the electrodes as a subset of the keypoints, which can be explicitly aligned with the 3D torso topology. The experimental results demonstrate that the proposed model outperforms the time-consuming conventional method in terms of accuracy (Euclidean distance: $1.24 \pm 0.293$ cm vs. $1.48 \pm 0.362$ cm) and efficiency ($2$~s vs. $30$-$35$~min). We further demonstrate the effectiveness of using the detected electrodes for \textit{in-silico} ECG simulation, highlighting their potential for creating accurate and efficient CDT models. The code will be released publicly after the manuscript is accepted for publication.

Deep Learning-based 3D Coronary Tree Reconstruction from Two 2D Non-simultaneous X-ray Angiography Projections

Cardiovascular diseases (CVDs) are the most common cause of death worldwide. Invasive x-ray coronary angiography (ICA) is one of the most important imaging modalities for the diagnosis of CVDs. ICA typically acquires only two 2D projections, which makes the 3D geometry of coronary vessels difficult to interpret, thus requiring 3D coronary tree reconstruction from two projections. State-of-the-art approaches require significant manual interactions and cannot correct the non-rigid cardiac and respiratory motions between non-simultaneous projections. In this study, we propose a novel deep learning pipeline. We leverage the Wasserstein conditional generative adversarial network with gradient penalty, latent convolutional transformer layers, and a dynamic snake convolutional critic to implicitly compensate for the non-rigid motion and provide 3D coronary tree reconstruction. Through simulating projections from coronary computed tomography angiography (CCTA), we achieve the generalisation of 3D coronary tree reconstruction on real non-simultaneous ICA projections. We incorporate an application-specific evaluation metric to validate our proposed model on both a CCTA dataset and a real ICA dataset, together with Chamfer L1 distance. The results demonstrate the good performance of our model in vessel topology preservation, recovery of missing features, and generalisation ability to real ICA data. To the best of our knowledge, this is the first study that leverages deep learning to achieve 3D coronary tree reconstruction from two real non-simultaneous x-ray angiography projections.

Solving the Inverse Problem of Electrocardiography for Cardiac Digital Twins: A Survey

Cardiac digital twins are personalized virtual representations used to understand complex heart mechanisms. Solving the ECG inverse problem is crucial for accurate virtual heart modelling, enabling the derivation of internal electrical activity information from recorded surface potentials. Despite challenges from cardiac complexity, noisy ECG data, and computational efficiency, recent advancements hold significant promise for enhancing virtual heart modelling, ultimately advancing precision medicine in cardiology. This paper aims to provide a comprehensive review of the methods of solving ECG inverse problem, the validation strategies, the clinical applications, and future perspectives. For the computing methodologies, we broadly classify state-of-the-art approaches into two categories: deterministic and probabilistic methods, including conventional and deep learning-based techniques. Integrating physics laws with deep learning models holds promise, but challenges such as capturing dynamic electrophysiology accurately, accessing accurate domain knowledge, and quantifying prediction uncertainty persist. Integrating models into clinical workflows while ensuring interpretability and usability for healthcare professionals is essential. Overcoming these challenges will drive further research in cardiac digital twins.

Large Language Model-informed ECG Dual Attention Network for Heart Failure Risk Prediction

Heart failure (HF) poses a significant public health challenge, with a rising global mortality rate. Early detection and prevention of HF could significantly reduce its impact. We introduce a novel methodology for predicting HF risk using 12-lead electrocardiograms (ECGs). We present a novel, lightweight dual-attention ECG network designed to capture complex ECG features essential for early HF risk prediction, despite the notable imbalance between low and high-risk groups. This network incorporates a cross-lead attention module and twelve lead-specific temporal attention modules, focusing on cross-lead interactions and each lead's local dynamics. To further alleviate model overfitting, we leverage a large language model (LLM) with a public ECG-Report dataset for pretraining on an ECG-report alignment task. The network is then fine-tuned for HF risk prediction using two specific cohorts from the UK Biobank study, focusing on patients with hypertension (UKB-HYP) and those who have had a myocardial infarction (UKB-MI).The results reveal that LLM-informed pre-training substantially enhances HF risk prediction in these cohorts. The dual-attention design not only improves interpretability but also predictive accuracy, outperforming existing competitive methods with C-index scores of 0.6349 for UKB-HYP and 0.5805 for UKB-MI. This demonstrates our method's potential in advancing HF risk assessment with clinical complex ECG data.

Anatomical basis of sex differences in human post-myocardial infarction ECG phenotypes identified by novel automated torso-cardiac 3D reconstruction

The electrocardiogram (ECG) is routinely used in cardiology, though its interpretation is confounded by anatomical variability. A novel, automated computational pipeline enables quantification of torso-ventricular anatomy metrics from magnetic resonance imaging, and comparison to ECG characteristics. Sex and myocardial infarction differences are investigated based on 1051 healthy and 425 post-MI subjects from UK Biobank. Smaller ventricles in females explain ~50% of shorter QRS durations than in males, and contribute to lower STJ amplitudes in females (also due to more superior and posterior position). In females, torso-ventricular anatomy, particularly from larger BMI, is a stronger modulator of T wave amplitude reductions and left-deviated R axis angles in post-MI than in males. Thus, female MI phenotype is less reflective of pathology, and baseline STJ amplitudes and QRS durations are further from clinical thresholds. Therefore, quantification of anatomical sex-differences and impact on ECG in health and disease is critical to avoid clinical sex-bias.

Modeling 3D cardiac contraction and relaxation with point cloud deformation networks

Global single-valued biomarkers of cardiac function typically used in clinical practice, such as ejection fraction, provide limited insight on the true 3D cardiac deformation process and hence, limit the understanding of both healthy and pathological cardiac mechanics. In this work, we propose the Point Cloud Deformation Network (PCD-Net) as a novel geometric deep learning approach to model 3D cardiac contraction and relaxation between the extreme ends of the cardiac cycle. It employs the recent advances in point cloud-based deep learning into an encoder-decoder structure, in order to enable efficient multi-scale feature learning directly on multi-class 3D point cloud representations of the cardiac anatomy. We evaluate our approach on a large dataset of over 10,000 cases from the UK Biobank study and find average Chamfer distances between the predicted and ground truth anatomies below the pixel resolution of the underlying image acquisition. Furthermore, we observe similar clinical metrics between predicted and ground truth populations and show that the PCD-Net can successfully capture subpopulation-specific differences between normal subjects and myocardial infarction (MI) patients. We then demonstrate that the learned 3D deformation patterns outperform multiple clinical benchmarks by 13% and 7% in terms of area under the receiver operating characteristic curve for the tasks of prevalent MI detection and incident MI prediction and by 7% in terms of Harrell's concordance index for MI survival analysis.

Multi-objective point cloud autoencoders for explainable myocardial infarction prediction

Myocardial infarction (MI) is one of the most common causes of death in the world. Image-based biomarkers commonly used in the clinic, such as ejection fraction, fail to capture more complex patterns in the heart's 3D anatomy and thus limit diagnostic accuracy. In this work, we present the multi-objective point cloud autoencoder as a novel geometric deep learning approach for explainable infarction prediction, based on multi-class 3D point cloud representations of cardiac anatomy and function. Its architecture consists of multiple task-specific branches connected by a low-dimensional latent space to allow for effective multi-objective learning of both reconstruction and MI prediction, while capturing pathology-specific 3D shape information in an interpretable latent space. Furthermore, its hierarchical branch design with point cloud-based deep learning operations enables efficient multi-scale feature learning directly on high-resolution anatomy point clouds. In our experiments on a large UK Biobank dataset, the multi-objective point cloud autoencoder is able to accurately reconstruct multi-temporal 3D shapes with Chamfer distances between predicted and input anatomies below the underlying images' pixel resolution. Our method outperforms multiple machine learning and deep learning benchmarks for the task of incident MI prediction by 19% in terms of Area Under the Receiver Operating Characteristic curve. In addition, its task-specific compact latent space exhibits easily separable control and MI clusters with clinically plausible associations between subject encodings and corresponding 3D shapes, thus demonstrating the explainability of the prediction.

Multi-class point cloud completion networks for 3D cardiac anatomy reconstruction from cine magnetic resonance images

Cine magnetic resonance imaging (MRI) is the current gold standard for the assessment of cardiac anatomy and function. However, it typically only acquires a set of two-dimensional (2D) slices of the underlying three-dimensional (3D) anatomy of the heart, thus limiting the understanding and analysis of both healthy and pathological cardiac morphology and physiology. In this paper, we propose a novel fully automatic surface reconstruction pipeline capable of reconstructing multi-class 3D cardiac anatomy meshes from raw cine MRI acquisitions. Its key component is a multi-class point cloud completion network (PCCN) capable of correcting both the sparsity and misalignment issues of the 3D reconstruction task in a unified model. We first evaluate the PCCN on a large synthetic dataset of biventricular anatomies and observe Chamfer distances between reconstructed and gold standard anatomies below or similar to the underlying image resolution for multiple levels of slice misalignment. Furthermore, we find a reduction in reconstruction error compared to a benchmark 3D U-Net by 32% and 24% in terms of Hausdorff distance and mean surface distance, respectively. We then apply the PCCN as part of our automated reconstruction pipeline to 1000 subjects from the UK Biobank study in a cross-domain transfer setting and demonstrate its ability to reconstruct accurate and topologically plausible biventricular heart meshes with clinical metrics comparable to the previous literature. Finally, we investigate the robustness of our proposed approach and observe its capacity to successfully handle multiple common outlier conditions.