Deep Learning Assessment of the Right Ventricle: Function, Etiology, and Prognosis

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ABSTRACT Heart failure imposes a tremendous burden of morbidity and mortality, costing the United States in excess of $31 billion annually. An increasingly recognized major determinant of outcomes in heart failure is right ventricular (RV) dysfunction. However, the nature and character of RV contribution to cardiovascular outcomes remains poorly understood, largely due to the imprecision of imaging and interpretation of RV morphology and function. Echocardiography, with its high temporal resolution and low cost of acquisition, serves as frontline cardiovascular imaging and a mainstay in approaches to assessing RV morphology and function. However, echocardiographic imaging of the RV is limited by factors that include technical variation in image acquisition and heterogeneity in image assessment as well as overall interpretation. We postulate that deep learning based phenotyping can offer the ability to not only more precisely characterize RV function but also classify RV imaging phenotypes according to etiologic disease states and, even further, refine prognostic evaluations of future cardiovascular risk. Therefore, in Aim 1, we will use video-based deep learning segmentation models to assess RV function, evaluate its cross-sectional relation with a range of expert-measured parameters, and examine its variation in the context of patient characteristics derived from large hospital-based cohorts. In Aim 2, we will use video-based deep learning models to produce imaging-based classification of RV disease and assess the ability of unsupervised approaches to classify RV dysfunction into various categories of disease etiology. In Aim 3, we will use models developed in part from training in Aims 1 and 2 to predict major cardiovascular outcomes including heart failure in addition to coronary artery disease, stroke, and cardiovascular death in both hospital- based and community-based cohorts. The overarching goal of this proposal is to improve the precision and standardization of RV phenotyping and determine the extent to which deep learning models can augment human assessment of the RV. This research will be accomplished in the setting of a comprehensive career development program designed to provide the candidate with the skills needed to become an independent physician-scientist in cardiovascular medicine and translational imaging science. An advisory committee of established scientists/mentors in the fields of cardiac imaging, deep learning, data science, and translational science will guide the candidate in his transition to scientific independence over the course of the award period.