AI-Enabled Accurate Non-Invasive Assessment of Pulmonary Hypertension Progression via Multi-Modal Echocardiography

Echocardiographers can detect pulmonary hypertension using Doppler echocardiography; however, accurately assessing its progression often proves challenging. Right heart catheterization (RHC), the gold standard for precise evaluation, is invasive and unsuitable for routine use, limiting its practicality for timely diagnosis and monitoring of pulmonary hypertension progression. Here, we propose MePH, a multi-view, multi-modal vision-language model to accurately assess pulmonary hypertension progression using non-invasive echocardiography. We constructed a large dataset comprising paired standardized echocardiogram videos, spectral images and RHC data, covering 1,237 patient cases from 12 medical centers. For the first time, MePH precisely models the correlation between non-invasive multi-view, multi-modal echocardiography and the pressure and resistance obtained via RHC. We show that MePH significantly outperforms echocardiographers' assessments using echocardiography, reducing the mean absolute error in estimating mean pulmonary arterial pressure (mPAP) and pulmonary vascular resistance (PVR) by 49.73% and 43.81%, respectively. In eight independent external hospitals, MePH achieved a mean absolute error of 3.147 for PVR assessment. Furthermore, MePH achieved an area under the curve of 0.921, surpassing echocardiographers (area under the curve of 0.842) in accurately predicting the severity of pulmonary hypertension, whether mild or severe. A prospective study demonstrated that MePH can predict treatment efficacy for patients. Our work provides pulmonary hypertension patients with a non-invasive and timely method for monitoring disease progression, improving the accuracy and efficiency of pulmonary hypertension management while enabling earlier interventions and more personalized treatment decisions.

Segmentation with Multiple Acceptable Annotations: A Case Study of Myocardial Segmentation in Contrast Echocardiography

Most existing deep learning-based frameworks for image segmentation assume that a unique ground truth is known and can be used for performance evaluation. This is true for many applications, but not all. Myocardial segmentation of Myocardial Contrast Echocardiography (MCE), a critical task in automatic myocardial perfusion analysis, is an example. Due to the low resolution and serious artifacts in MCE data, annotations from different cardiologists can vary significantly, and it is hard to tell which one is the best. In this case, how can we find a good way to evaluate segmentation performance and how do we train the neural network? In this paper, we address the first problem by proposing a new extended Dice to effectively evaluate the segmentation performance when multiple accepted ground truth is available. Then based on our proposed metric, we solve the second problem by further incorporating the new metric into a loss function that enables neural networks to flexibly learn general features of myocardium. Experiment results on our clinical MCE data set demonstrate that the neural network trained with the proposed loss function outperforms those existing ones that try to obtain a unique ground truth from multiple annotations, both quantitatively and qualitatively. Finally, our grading study shows that using extended Dice as an evaluation metric can better identify segmentation results that need manual correction compared with using Dice.

EchoCP: An Echocardiography Dataset in Contrast Transthoracic Echocardiography for Patent Foramen Ovale Diagnosis

Patent foramen ovale (PFO) is a potential separation between the septum, primum and septum secundum located in the anterosuperior portion of the atrial septum. PFO is one of the main factors causing cryptogenic stroke which is the fifth leading cause of death in the United States. For PFO diagnosis, contrast transthoracic echocardiography (cTTE) is preferred as being a more robust method compared with others. However, the current PFO diagnosis through cTTE is extremely slow as it is proceeded manually by sonographers on echocardiography videos. Currently there is no publicly available dataset for this important topic in the community. In this paper, we present EchoCP, as the first echocardiography dataset in cTTE targeting PFO diagnosis. EchoCP consists of 30 patients with both rest and Valsalva maneuver videos which covers various PFO grades. We further establish an automated baseline method for PFO diagnosis based on the state-of-the-art cardiac chamber segmentation technique, which achieves 0.89 average mean Dice score, but only 0.70/0.67 mean accuracies for PFO diagnosis, leaving large room for improvement. We hope that the challenging EchoCP dataset can stimulate further research and lead to innovative and generic solutions that would have an impact in multiple domains. Our dataset is released.