Can Large Language Models Logically Predict Myocardial Infarction? Evaluation based on UK Biobank Cohort

Background: Large language models (LLMs) have seen extraordinary advances with applications in clinical decision support. However, high-quality evidence is urgently needed on the potential and limitation of LLMs in providing accurate clinical decisions based on real-world medical data. Objective: To evaluate quantitatively whether universal state-of-the-art LLMs (ChatGPT and GPT-4) can predict the incidence risk of myocardial infarction (MI) with logical inference, and to further make comparison between various models to assess the performance of LLMs comprehensively. Methods: In this retrospective cohort study, 482,310 participants recruited from 2006 to 2010 were initially included in UK Biobank database and later on resampled into a final cohort of 690 participants. For each participant, tabular data of the risk factors of MI were transformed into standardized textual descriptions for ChatGPT recognition. Responses were generated by asking ChatGPT to select a score ranging from 0 to 10 representing the risk. Chain of Thought (CoT) questioning was used to evaluate whether LLMs make prediction logically. The predictive performance of ChatGPT was compared with published medical indices, traditional machine learning models and other large language models. Conclusions: Current LLMs are not ready to be applied in clinical medicine fields. Future medical LLMs are suggested to be expert in medical domain knowledge to understand both natural languages and quantified medical data, and further make logical inferences.

Autonomous Iterative Motion Learning (AI-MOLE) of a SCARA Robot for Automated Myocardial Injection

Stem cell therapy is a promising approach to treat heart insufficiency and benefits from automated myocardial injection which requires highly precise motion of a robotic manipulator that is equipped with a syringe. This work investigates whether sufficiently precise motion can be achieved by combining a SCARA robot and learning control methods. For this purpose, the method Autonomous Iterative Motion Learning (AI-MOLE) is extended to be applicable to multi-input/multi-output systems. The proposed learning method solves reference tracking tasks in systems with unknown, nonlinear, multi-input/multi-output dynamics by iteratively updating an input trajectory in a plug-and-play fashion and without requiring manual parameter tuning. The proposed learning method is validated in a preliminary simulation study of a simplified SCARA robot that has to perform three desired motions. The results demonstrate that the proposed learning method achieves highly precise reference tracking without requiring any a priori model information or manual parameter tuning in as little as 15 trials per motion. The results further indicate that the combination of a SCARA robot and learning method achieves sufficiently precise motion to potentially enable automatic myocardial injection if similar results can be obtained in a real-world setting.

Practicality meets precision: Wearable vest with integrated multi-channel PCG sensors for effective coronary artery disease pre-screening

The leading cause of mortality and morbidity worldwide is cardiovascular disease (CVD), with coronary artery disease (CAD) being the largest sub-category. Unfortunately, myocardial infarction or stroke can manifest as the first symptom of CAD, underscoring the crucial importance of early disease detection. Hence, there is a global need for a cost-effective, non-invasive, reliable, and easy-to-use system to pre-screen CAD. Previous studies have explored weak murmurs arising from CAD for classification using phonocardiogram (PCG) signals. However, these studies often involve tedious and inconvenient data collection methods, requiring precise subject preparation and environmental conditions. This study proposes using a novel data acquisition system (DAQS) designed for simplicity and convenience. The DAQS incorporates multi-channel PCG sensors into a wearable vest. The entire signal acquisition process can be completed in under two minutes, from fitting the vest to recording signals and removing it, requiring no specialist training. This exemplifies the potential for mass screening, which is impractical with current state-of-the-art protocols. Seven PCG signals are acquired, six from the chest and one from the subject's back, marking a novel approach. Our classification approach, which utilizes linear-frequency cepstral coefficients (LFCC) as features and employs a support vector machine (SVM) to distinguish between normal and CAD-affected heartbeats, outperformed alternative low-computational methods suitable for portable applications. Utilizing feature-level fusion, multiple channels are combined, and the optimal combination yields the highest subject-level accuracy and F1-score of 80.44% and 81.00%, respectively, representing a 7% improvement over the best-performing single channel. The proposed system's performance metrics have been demonstrated to be clinically significant.

Whole Heart Perfusion with High-Multiband Simultaneous Multislice Imaging via Linear Phase Modulated Extended Field of View (SMILE)

Purpose: To develop a simultaneous multislice (SMS) first-pass perfusion technique that can achieve whole heart coverage with high multi-band factors, while avoiding the issue of slice leakage. Methods: The proposed Simultaneous Multislice Imaging via Linear phase modulated Extended field of view (SMILE) treats the SMS acquisition and reconstruction within an extended field of view framework, allowing arbitrarily under-sampling of phase encoding lines of the extended k-space matrix and enabling the direct application of 2D parallel imaging reconstruction techniques. We presented a theoretical framework that offers insights into the performance of SMILE. We performed retrospective comparison on 28 subjects and prospective perfusion experiments on 49 patients undergoing routine clinical CMR studies with SMILE at multiband (MB) factors of 3-5, with a total acceleration factor ($R$) of 8 and 10 respectively, and compared SMILE to conventional SMS techniques using standard FOV 2D CAIPI acquisition and standard 2D slice separation techniques including split-slice GRAPPA and ROCK-SPIRiT. Results: Retrospective studies demonstrated 5.2 to 8.0 dB improvement in signal to error ratio (SER) of SMILE over CAIPI perfusion. Prospective studies showed good image quality with grades of 4.5 $\pm$ 0.5 for MB=3, $R$=8 and 3.6 $\pm$ 0.8 for MB=5, $R$=10. (5-point Likert Scale) Conclusion: The theoretical derivation and experimental results validate the SMILE's improved performance at high acceleration and MB factors as compared to the existing 2D CAIPI SMS acquisition and reconstruction techniques for first-pass myocardial perfusion imaging.

Explicit Differentiable Slicing and Global Deformation for Cardiac Mesh Reconstruction

Mesh reconstruction of the cardiac anatomy from medical images is useful for shape and motion measurements and biophysics simulations to facilitate the assessment of cardiac function and health. However, 3D medical images are often acquired as 2D slices that are sparsely sampled and noisy, and mesh reconstruction on such data is a challenging task. Traditional voxel-based approaches rely on pre- and post-processing that compromises image fidelity, while mesh-level deep learning approaches require mesh annotations that are difficult to get. Therefore, direct cross-domain supervision from 2D images to meshes is a key technique for advancing 3D learning in medical imaging, but it has not been well-developed. While there have been attempts to approximate the optimized meshes' slicing, few existing methods directly use 2D slices to supervise mesh reconstruction in a differentiable manner. Here, we propose a novel explicit differentiable voxelization and slicing (DVS) algorithm that allows gradient backpropagation to a mesh from its slices, facilitating refined mesh optimization directly supervised by the losses defined on 2D images. Further, we propose an innovative framework for extracting patient-specific left ventricle (LV) meshes from medical images by coupling DVS with a graph harmonic deformation (GHD) mesh morphing descriptor of cardiac shape that naturally preserves mesh quality and smoothness during optimization. Experimental results demonstrate that our method achieves state-of-the-art performance in cardiac mesh reconstruction tasks from CT and MRI, with an overall Dice score of 90% on multi-datasets, outperforming existing approaches. The proposed method can further quantify clinically useful parameters such as ejection fraction and global myocardial strains, closely matching the ground truth and surpassing the traditional voxel-based approach in sparse images.

CNN Based Detection of Cardiovascular Diseases from ECG Images

This study develops a Convolutional Neural Network (CNN) model for detecting myocardial infarction (MI) from Electrocardiogram (ECG) images. The model, built using the InceptionV3 architecture and optimized through transfer learning, was trained using ECG data obtained from the Ch. Pervaiz Elahi Institute of Cardiology in Pakistan. The dataset includes ECG images representing four different cardiac conditions: myocardial infarction, abnormal heartbeat, history of myocardial infarction, and normal heart activity. The developed model successfully detects MI and other cardiovascular conditions with an accuracy of 93.27%. This study demonstrates that deep learning-based models can provide significant support to clinicians in the early detection and prevention of heart attacks.

Improving the Scan-rescan Precision of AI-based CMR Biomarker Estimation

Quantification of cardiac biomarkers from cine cardiovascular magnetic resonance (CMR) data using deep learning (DL) methods offers many advantages, such as increased accuracy and faster analysis. However, only a few studies have focused on the scan-rescan precision of the biomarker estimates, which is important for reproducibility and longitudinal analysis. Here, we propose a cardiac biomarker estimation pipeline that not only focuses on achieving high segmentation accuracy but also on improving the scan-rescan precision of the computed biomarkers, namely left and right ventricular ejection fraction, and left ventricular myocardial mass. We evaluate two approaches to improve the apical-basal resolution of the segmentations used for estimating the biomarkers: one based on image interpolation and one based on segmentation interpolation. Using a database comprising scan-rescan cine CMR data acquired from 92 subjects, we compare the performance of these two methods against ground truth (GT) segmentations and DL segmentations obtained before interpolation (baseline). The results demonstrate that both the image-based and segmentation-based interpolation methods were able to narrow Bland-Altman scan-rescan confidence intervals for all biomarkers compared to the GT and baseline performances. Our findings highlight the importance of focusing not only on segmentation accuracy but also on the consistency of biomarkers across repeated scans, which is crucial for longitudinal analysis of cardiac function.

MBSS-T1: Model-Based Self-Supervised Motion Correction for Robust Cardiac T1 Mapping

T1 mapping is a valuable quantitative MRI technique for diagnosing diffuse myocardial diseases. Traditional methods, relying on breath-hold sequences and echo triggering, face challenges with patient compliance and arrhythmias, limiting their effectiveness. Image registration can enable motion-robust T1 mapping, but inherent intensity differences between time points pose a challenge. We introduce MBSS-T1, a self-supervised model for motion correction in cardiac T1 mapping, constrained by physical and anatomical principles. The physical constraints ensure expected signal decay behavior, while the anatomical constraints maintain realistic deformations. The unique combination of these constraints ensures accurate T1 mapping along the longitudinal relaxation axis. MBSS-T1 outperformed baseline deep-learning-based image registration approaches in a 5-fold experiment on a public dataset of 210 patients (STONE sequence) and an internal dataset of 19 patients (MOLLI sequence). MBSS-T1 excelled in model fitting quality (R2: 0.974 vs. 0.941, 0.946), anatomical alignment (Dice score: 0.921 vs. 0.984, 0.988), and expert visual quality assessment for the presence of visible motion artifacts (4.33 vs. 3.34, 3.62). MBSS-T1 has the potential to enable motion-robust T1 mapping for a broader range of patients, overcoming challenges such as arrhythmias, and suboptimal compliance, and allowing for free-breathing T1 mapping without requiring large training datasets.

Integrating Edge Information into Ground Truth for the Segmentation of the Optic Disc and Cup from Fundus Images

Optic disc and cup segmentation helps in the diagnosis of glaucoma, myocardial infarction, and diabetic retinopathy. Most deep learning methods developed to perform segmentation tasks are built on top of a U-Net-based model architecture. Nevertheless, U-Net and its variants have a tendency to over-segment/ under-segment the required regions of interest. Since the most important outcome is the value of cup-to-disc ratio and not the segmented regions themselves, we are more concerned about the boundaries rather than the regions under the boundaries. This makes learning edges important as compared to learning the regions. In the proposed work, the authors aim to extract both edges of the optic disc and cup from the ground truth using a Laplacian filter. Next, edges are reconstructed to obtain an edge ground truth in addition to the optic disc-cup ground truth. Utilizing both ground truths, the authors study several U-Net and its variant architectures with and without optic disc and cup edges as target, along with the optic disc-cup ground truth for segmentation. The authors have used the REFUGE benchmark dataset and the Drishti-GS dataset to perform the study, and the results are tabulated for the dice and the Hausdorff distance metrics. In the case of the REFUGE dataset, the optic disc mean dice score has improved from 0.7425 to 0.8859 while the mean Hausdorff distance has reduced from 6.5810 to 3.0540 for the baseline U-Net model. Similarly, the optic cup mean dice score has improved from 0.6970 to 0.8639 while the mean Hausdorff distance has reduced from 5.2340 to 2.6323 for the same model. Similar improvement has been observed for the Drishti-GS dataset as well. Compared to the baseline U-Net and its variants (i.e) the Attention U-Net and the U-Net++, the models that learn integrated edges along with the optic disc and cup regions performed well in both validation and testing datasets.

Improved Robustness for Deep Learning-based Segmentation of Multi-Center Myocardial Perfusion MRI Datasets Using Data Adaptive Uncertainty-guided Space-time Analysis

Background. Fully automatic analysis of myocardial perfusion MRI datasets enables rapid and objective reporting of stress/rest studies in patients with suspected ischemic heart disease. Developing deep learning techniques that can analyze multi-center datasets despite limited training data and variations in software and hardware is an ongoing challenge. Methods. Datasets from 3 medical centers acquired at 3T (n = 150 subjects) were included: an internal dataset (inD; n = 95) and two external datasets (exDs; n = 55) used for evaluating the robustness of the trained deep neural network (DNN) models against differences in pulse sequence (exD-1) and scanner vendor (exD-2). A subset of inD (n = 85) was used for training/validation of a pool of DNNs for segmentation, all using the same spatiotemporal U-Net architecture and hyperparameters but with different parameter initializations. We employed a space-time sliding-patch analysis approach that automatically yields a pixel-wise "uncertainty map" as a byproduct of the segmentation process. In our approach, a given test case is segmented by all members of the DNN pool and the resulting uncertainty maps are leveraged to automatically select the "best" one among the pool of solutions. Results. The proposed DAUGS analysis approach performed similarly to the established approach on the internal dataset (p = n.s.) whereas it significantly outperformed on the external datasets (p < 0.005 for exD-1 and exD-2). Moreover, the number of image series with "failed" segmentation was significantly lower for the proposed vs. the established approach (4.3% vs. 17.1%, p < 0.0005). Conclusions. The proposed DAUGS analysis approach has the potential to improve the robustness of deep learning methods for segmentation of multi-center stress perfusion datasets with variations in the choice of pulse sequence, site location or scanner vendor.