Echocardiographic Detection of Regional Wall Motion Abnormalities using Artificial Intelligence Compared to Human Readers

Abstract

Background

Although regional wall motion abnormality (RWMA) detection is foundational to transthoracic echocardiography (TTE), current methods are prone to inter-observer variability. We aimed to develop a deep learning (DL) model for RWMA assessment and compare it to expert and novice readers.

Methods

We used 15,746 TTE studies—including 25,529 apical videos—which were split into training, validation, and test datasets. A convolutional neural network was trained and validated using apical 2-, 3-, and 4-chamber videos to predict the presence of RWMA in 7 regions defined by coronary perfusion territories, using the ground truth derived from clinical TTE reports. Within the test cohort, DL model accuracy was compared to 6 expert and 3 novice readers using F1 score evaluation, with the ground truth of RWMA defined by expert readers. Significance between the DL model and novices was assessed using the permutation test.

Results

Within the test cohort, the DL model accurately identified any RWMA with AUC 0.96 (0.92-0.98). The mean F1 scores of the experts and the DL model were numerically similar for 6/7 regions: anterior (86 vs 84), anterolateral (80 vs 74), inferolateral (83 vs 87), inferoseptal (86 vs 86), apical (88 vs 87), inferior (79 vs 81), and any RWMA (90 vs 94 respectively), while in the anteroseptal region F1 score of the DL model was lower than the experts (75 vs 89). Using F1 scores, the DL model outperformed both novices 1 (p=0.002) and 2 (p=0.02) for the detection of any RWMA.

Conclusions

DL provides accurate detection of RWMA which was comparable to experts and outperformed a majority of novices. DL may improve the efficiency of RWMA assessment and serve as a teaching tool for novices.