Echocardiographic Left Ventricular Mass Assessment: Correlation between 2D-Derived Linear Dimensions and 3-Dimensional Automated, Machine Learning-Based Methods in Unselected Patients

Andrea Barbieri; Francesca Bursi; Giovanni Camaioni; Anna Maisano; Jacopo Francesco Imberti; Alessandro Albini; Gerardo De Mitri; Francesca Mantovani; Giuseppe Boriani

doi:10.3390/jcm10061279

Echocardiographic Left Ventricular Mass Assessment: Correlation between 2D-Derived Linear Dimensions and 3-Dimensional Automated, Machine Learning-Based Methods in Unselected Patients

J Clin Med. 2021 Mar 19;10(6):1279. doi: 10.3390/jcm10061279.

Authors

Andrea Barbieri¹, Francesca Bursi², Giovanni Camaioni¹, Anna Maisano¹, Jacopo Francesco Imberti¹, Alessandro Albini¹, Gerardo De Mitri¹, Francesca Mantovani³, Giuseppe Boriani¹

Affiliations

¹ Division of Cardiology, Department of Diagnostics, Clinical and Public Health Medicine, Policlinico University Hospital of Modena, University of Modena and Reggio Emilia, 41121 Modena, Italy.
² Division of Cardiology, San Paolo Hospital, ASST Santi Paolo and Carlo, Department of Health Sciences, University of Milan, 20142 Milan, Italy.
³ Cardiology, Azienda USL-IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy.

Abstract

A recently developed algorithm for 3D analysis based on machine learning (ML) principles detects left ventricular (LV) mass without any human interaction. We retrospectively studied the correlation between 2D-derived linear dimensions using the ASE/EACVI-recommended formula and 3D automated, ML-based methods (Philips HeartModel) regarding LV mass quantification in unselected patients undergoing echocardiography. We included 130 patients (mean age 60 ± 18 years; 45% women). There was only discrete agreement between 2D and 3D measurements of LV mass (r = 0.662, r² = 0.348, p < 0.001). The automated algorithm yielded an overestimation of LV mass compared to the linear method (Bland-Altman positive bias of 13.1 g with 95% limits of the agreement at 4.5 to 21.6 g, p = 0.003, ICC 0.78 (95%CI 0.68-8.4). There was a significant proportional bias (Beta -0.22, t = -2.9) p = 0.005, the variance of the difference varied across the range of LV mass. When the published cut-offs for LV mass abnormality were used, the observed proportion of overall agreement was 77% (kappa = 0.32, p < 0.001). In consecutive patients undergoing echocardiography for any indications, LV mass assessment by 3D analysis using a novel ML-based algorithm showed systematic differences and wide limits of agreements compared with quantification by ASE/EACVI- recommended formula when the current cut-offs and partition values were applied.

Keywords: 2D echocardiography; 3D echocardiography; left ventricular mass; machine learning.