Interpretable Multimodal Learning for Cardiovascular Hemodynamics Assessment

Pulmonary Arterial Wedge Pressure (PAWP) is an essential cardiovascular hemodynamics marker to detect heart failure. In clinical practice, Right Heart Catheterization is considered a gold standard for assessing cardiac hemodynamics while non-invasive methods are often needed to screen high-risk patients from a large population. In this paper, we propose a multimodal learning pipeline to predict PAWP marker. We utilize complementary information from Cardiac Magnetic Resonance Imaging (CMR) scans (short-axis and four-chamber) and Electronic Health Records (EHRs). We extract spatio-temporal features from CMR scans using tensor-based learning. We propose a graph attention network to select important EHR features for prediction, where we model subjects as graph nodes and feature relationships as graph edges using the attention mechanism. We design four feature fusion strategies: early, intermediate, late, and hybrid fusion. With a linear classifier and linear fusion strategies, our pipeline is interpretable. We validate our pipeline on a large dataset of $2,641$ subjects from our ASPIRE registry. The comparative study against state-of-the-art methods confirms the superiority of our pipeline. The decision curve analysis further validates that our pipeline can be applied to screen a large population. The code is available at https://github.com/prasunc/hemodynamics.

Multimodal Variational Autoencoder for Low-cost Cardiac Hemodynamics Instability Detection

Recent advancements in non-invasive detection of cardiac hemodynamic instability (CHDI) primarily focus on applying machine learning techniques to a single data modality, e.g. cardiac magnetic resonance imaging (MRI). Despite their potential, these approaches often fall short especially when the size of labeled patient data is limited, a common challenge in the medical domain. Furthermore, only a few studies have explored multimodal methods to study CHDI, which mostly rely on costly modalities such as cardiac MRI and echocardiogram. In response to these limitations, we propose a novel multimodal variational autoencoder ($\text{CardioVAE}_\text{X,G}$) to integrate low-cost chest X-ray (CXR) and electrocardiogram (ECG) modalities with pre-training on a large unlabeled dataset. Specifically, $\text{CardioVAE}_\text{X,G}$ introduces a novel tri-stream pre-training strategy to learn both shared and modality-specific features, thus enabling fine-tuning with both unimodal and multimodal datasets. We pre-train $\text{CardioVAE}_\text{X,G}$ on a large, unlabeled dataset of $50,982$ subjects from a subset of MIMIC database and then fine-tune the pre-trained model on a labeled dataset of $795$ subjects from the ASPIRE registry. Comprehensive evaluations against existing methods show that $\text{CardioVAE}_\text{X,G}$ offers promising performance (AUROC $=0.79$ and Accuracy $=0.77$), representing a significant step forward in non-invasive prediction of CHDI. Our model also excels in producing fine interpretations of predictions directly associated with clinical features, thereby supporting clinical decision-making.

MeDSLIP: Medical Dual-Stream Language-Image Pre-training for Fine-grained Alignment

Vision-language pre-training (VLP) models have shown significant advancements in the medical domain. Yet, most VLP models align raw reports to images at a very coarse level, without modeling fine-grained relationships between anatomical and pathological concepts outlined in reports and the corresponding semantic counterparts in images. To address this problem, we propose a Medical Dual-Stream Language-Image Pre-training (MeDSLIP) framework. Specifically, MeDSLIP establishes vision-language fine-grained alignments via disentangling visual and textual representations into anatomy-relevant and pathology-relevant streams. Moreover, a novel vision-language Prototypical Contr-astive Learning (ProtoCL) method is adopted in MeDSLIP to enhance the alignment within the anatomical and pathological streams. MeDSLIP further employs cross-stream Intra-image Contrastive Learning (ICL) to ensure the consistent coexistence of paired anatomical and pathological concepts within the same image. Such a cross-stream regularization encourages the model to exploit the synchrony between two streams for a more comprehensive representation learning. MeDSLIP is evaluated under zero-shot and supervised fine-tuning settings on three public datasets: NIH CXR14, RSNA Pneumonia, and SIIM-ACR Pneumothorax. Under these settings, MeDSLIP outperforms six leading CNN-based models on classification, grounding, and segmentation tasks.

Deep learning automated quantification of lung disease in pulmonary hypertension on CT pulmonary angiography: A preliminary clinical study with external validation

Purpose: Lung disease assessment in precapillary pulmonary hypertension (PH) is essential for appropriate patient management. This study aims to develop an artificial intelligence (AI) deep learning model for lung texture classification in CT Pulmonary Angiography (CTPA), and evaluate its correlation with clinical assessment methods. Materials and Methods: In this retrospective study with external validation, 122 patients with pre-capillary PH were used to train (n=83), validate (n=17) and test (n=10 internal test, n=12 external test) a patch based DenseNet-121 classification model. "Normal", "Ground glass", "Ground glass with reticulation", "Honeycombing", and "Emphysema" were classified as per the Fleishner Society glossary of terms. Ground truth classes were segmented by two radiologists with patches extracted from the labelled regions. Proportion of lung volume for each texture was calculated by classifying patches throughout the entire lung volume to generate a coarse texture classification mapping throughout the lung parenchyma. AI output was assessed against diffusing capacity of carbon monoxide (DLCO) and specialist radiologist reported disease severity. Results: Micro-average AUCs for the validation, internal test, and external test were 0.92, 0.95, and 0.94, respectively. The model had consistent performance across parenchymal textures, demonstrated strong correlation with diffusing capacity of carbon monoxide (DLCO), and showed good correspondence with disease severity reported by specialist radiologists. Conclusion: The classification model demonstrates excellent performance on external validation. The clinical utility of its output has been demonstrated. This objective, repeatable measure of disease severity can aid in patient management in adjunct to radiological reporting.

Tensor-based Multimodal Learning for Prediction of Pulmonary Arterial Wedge Pressure from Cardiac MRI

Heart failure is a serious and life-threatening condition that can lead to elevated pressure in the left ventricle. Pulmonary Arterial Wedge Pressure (PAWP) is an important surrogate marker indicating high pressure in the left ventricle. PAWP is determined by Right Heart Catheterization (RHC) but it is an invasive procedure. A non-invasive method is useful in quickly identifying high-risk patients from a large population. In this work, we develop a tensor learning-based pipeline for identifying PAWP from multimodal cardiac Magnetic Resonance Imaging (MRI). This pipeline extracts spatial and temporal features from high-dimensional scans. For quality control, we incorporate an epistemic uncertainty-based binning strategy to identify poor-quality training samples. To improve the performance, we learn complementary information by integrating features from multimodal data: cardiac MRI with short-axis and four-chamber views, and Electronic Health Records. The experimental analysis on a large cohort of $1346$ subjects who underwent the RHC procedure for PAWP estimation indicates that the proposed pipeline has a diagnostic value and can produce promising performance with significant improvement over the baseline in clinical practice (i.e., $\Delta$AUC $=0.10$, $\Delta$Accuracy $=0.06$, and $\Delta$MCC $=0.39$). The decision curve analysis further confirms the clinical utility of our method.