Medical image classification using convolutional neural networks (CNNs) is promising but often requires extensive manual tuning for optimal model definition. Neural architecture search (NAS) automates this process, reducing human intervention significantly. This study applies NAS to [18F]-Florbetaben PET cardiac images for classifying cardiac amyloidosis (CA) sub-types (amyloid light chain (AL) and transthyretin amyloid (ATTR)) and controls. Following data preprocessing and augmentation, an evolutionary cell-based NAS approach with a fixed network macro-structure is employed, automatically deriving cells' micro-structure. The algorithm is executed five times, evaluating 100 mutating architectures per run on an augmented dataset of 4048 images (originally 597), totaling 5000 architectures evaluated. The best network (NAS-Net) achieves 76.95% overall accuracy. K-fold analysis yields mean ± SD percentages of sensitivity, specificity, and accuracy on the test dataset: AL subjects (98.7 ± 2.9, 99.3 ± 1.1, 99.7 ± 0.7), ATTR-CA subjects (93.3 ± 7.8, 78.0 ± 2.9, 70.9 ± 3.7), and controls (35.8 ± 14.6, 77.1 ± 2.0, 96.7 ± 4.4). NAS-derived network performance rivals manually determined networks in the literature while using fewer parameters, validating its automatic approach's efficacy.

Cardiovascular disease (CVD) is the leading cause of death worldwide. Coronary artery disease (CAD), a prevalent form of CVD, is typically assessed using catheter coronary angiography (CCA), an invasive, costly procedure with associated risks. While cardiac computed tomography angiography (CTA) presents a less invasive alternative, it suffers from limited temporal resolution, often resulting in motion artifacts that degrade diagnostic quality. Traditional ECG-based gating methods for CTA inadequately capture cardiac mechanical motion. To address this, we propose a novel multimodal approach that enhances CTA imaging by predicting cardiac quiescent periods using seismocardiogram (SCG) and ECG data, integrated through a weighted fusion (WF) approach and artificial neural networks (ANNs). We developed a regression-based ANN framework (r-ANN WF) designed to improve prediction accuracy and reduce computational complexity, which was compared with a classification-based framework (c-ANN WF), ECG gating, and US data. Our results demonstrate that the r-ANN WF approach improved overall diastolic and systolic cardiac quiescence prediction accuracy by 52.6% compared to ECG-based predictions, using ultrasound (US) as the ground truth, with an average prediction time of 4.83 ms. Comparative evaluations based on reconstructed CTA images show that both r-ANN WF and c-ANN WF offer diagnostic quality comparable to US-based gating, underscoring their clinical potential. Additionally, the lower computational complexity of r-ANN WF makes it suitable for real-time applications. This approach could enhance CTA's diagnostic quality, offering a more accurate and efficient method for CVD diagnosis and management.

Cardiac magnetic resonance (CMR) is a key investigation in clinical cardiovascular medicine and has been used extensively in population research. However, extracting clinically important measurements such as ejection fraction for diagnosing cardiovascular diseases remains time-consuming and subjective. We developed CineMA, a foundation AI model automating these tasks with limited labels. CineMA is a self-supervised autoencoder model trained on 74,916 cine CMR studies to reconstruct images from masked inputs. After fine-tuning, it was evaluated across eight datasets on 23 tasks from four categories: ventricle and myocardium segmentation, left and right ventricle ejection fraction calculation, disease detection and classification, and landmark localisation. CineMA is the first foundation model for cine CMR to match or outperform convolutional neural networks (CNNs). CineMA demonstrated greater label efficiency than CNNs, achieving comparable or better performance with fewer annotations. This reduces the burden of clinician labelling and supports replacing task-specific training with fine-tuning foundation models in future cardiac imaging applications. Models and code for pre-training and fine-tuning are available at https://github.com/mathpluscode/CineMA, democratising access to high-performance models that otherwise require substantial computational resources, promoting reproducibility and accelerating clinical translation.

Subclinical atrial fibrillation (SCAF), also known as atrial high-rate episodes (AHREs), refers to asymptomatic heart rate elevations associated with increased risks of atrial fibrillation and cardiovascular events. Although deep learning (DL) models leveraging echocardiographic images from ultrasound are widely used for cardiac function analysis, their application to AHRE prediction remains unexplored. This study introduces a novel DL-based framework for automatic AHRE detection using echocardiograms. The approach encompasses left atrium (LA) segmentation, LA strain feature extraction, and AHRE classification. Data from 117 patients with cardiac implantable electronic devices undergoing echocardiography were analyzed, with 80% allocated to the development set and 20% to the test set. LA segmentation accuracy was quantified using the Dice coefficient, yielding scores of 0.923 for the LA cavity and 0.741 for the LA wall. For AHRE classification, metrics such as area under the curve (AUC), accuracy, sensitivity, and specificity were employed. A transformer-based model integrating patient characteristics demonstrated robust performance, achieving mean AUC of 0.815, accuracy of 0.809, sensitivity of 0.800, and specificity of 0.783 for a 24-h AHRE duration threshold. This framework represents a reliable tool for AHRE assessment and holds significant potential for early SCAF detection, enhancing clinical decision-making and patient outcomes.

Aortic pulse wave velocity (PWV) is a prognostic biomarker for cardiovascular disease, which can be measured by dividing the aortic path length by the pulse transit time. However, current MRI techniques require special sequences and time-consuming manual analysis. We aimed to fully automate the process using deep learning to measure PWV from standard sequences, facilitating PWV measurement in routine clinical and research scans. A deep learning (DL) model was developed to generate high-resolution 3D aortic segmentations from routine 2D trans-axial SSFP localizer images, and the centerlines of the resulting segmentations were used to estimate the aortic path length. A further DL model was built to automatically segment the ascending and descending aorta in phase contrast images, and pulse transit time was estimated from the sampled flow curves. Quantitative comparison with trained observers was performed for path length, aortic flow segmentation and transit time, either using an external clinical dataset with both localizers and paired 3D images acquired or on a sample of UK Biobank subjects. Potential application to clinical research scans was evaluated on 1053 subjects from the UK Biobank. Aortic path length measurement was accurate with no major difference between the proposed method (125 ± 19 mm) and manual measurement by a trained observer (124 ± 19 mm) (P = 0.88). Automated phase contrast image segmentation was similar to that of a trained observer for both the ascending (Dice vs manual: 0.96) and descending (Dice 0.89) aorta with no major difference in transit time estimation (proposed method = 21 ± 9 ms, manual = 22 ± 9 ms; P = 0.15). 966 of 1053 (92 %) UK Biobank subjects were successfully analyzed, with a median PWV of 6.8 m/s, increasing 27 % per decade of age and 6.5 % higher per 10 mmHg higher systolic blood pressure. We describe a fully automated method for measuring PWV from standard cardiac MRI localizers and a single phase contrast imaging plane. The method is robust and can be applied to routine clinical scans, and could unlock the potential of measuring PWV in large-scale clinical and population studies. All models and deployment codes are available online.

This study develops a deep-learning method for automatic segmentation of the interventricular septum (IS) in MR images to measure myocardial T2* and estimate cardiac iron deposition in patients with thalassemia. This retrospective study used multiple-gradient-echo cardiac MR scans from 419 thalassemia patients to develop and evaluate the segmentation network. The network was trained on 1.5 T images from Center 1 and evaluated on 3.0 T unseen images from Center 1, all data from Center 2, and the CHMMOTv1 dataset. Model performance was assessed using five metrics, and T2* values were obtained by fitting the network output. Bland-Altman analysis, coefficient of variation (CoV), and regression analysis were used to evaluate the consistency between automatic and manual methods. MA-BBIsegNet achieved a Dice of 0.90 on the internal test set, 0.85 on the external test set, and 0.81 on the CHMMOTv1 dataset. Bland-Altman analysis showed mean differences of 0.08 (95% LoA: -2.79 ∼ 2.63) ms (internal), 0.29 (95% LoA: -4.12 ∼ 3.54) ms (external) and 0.19 (95% LoA: -3.50 ∼ 3.88) ms (CHMMOTv1), with CoV of 8.9%, 6.8%, and 9.3%. Regression analysis yielded r values of 0.98 for the internal and CHMMOTv1 datasets, and 0.99 for the external dataset (p < 0.05). The IS segmentation network based on multiple-gradient-echo bright-blood images yielded T2* values that were in strong agreement with manual measurements, highlighting its potential for the efficient, non-invasive monitoring of myocardial iron deposition in patients with thalassemia.

To evaluate the effect of model-based deep-learning reconstruction (DLR) compared with that of compressed sensing-sensitivity encoding (CS) on cine cardiac magnetic resonance (CMR). Cine CMR images of 10 healthy volunteers were obtained with reduction factors of 2, 4, 6, and 8 and reconstructed using CS and DLR. The visual image quality scores assessed sharpness, image noise, and artifacts. Left-ventricular (LV) end-diastolic volume (EDV), end-systolic volume (ESV), stroke volume (SV), and ejection fraction (EF) were manually measured. LV global circumferential strain (GCS) was automatically measured using the software. The precision of EDV, ESV, SV, EF, and GCS measurements was compared between CS and DLR using Bland-Altman analysis with full-sampling data as the gold standard. Compared with CS, DLR significantly improved image quality with reduction factors of 6 and 8. The precision of EDV and ESV with a reduction factor of 8, and GCS with reduction factors of 6 and 8 measurements improved with DLR compared with CS, whereas those of SV and EF measurements were not different between DLR and CS. The effect of DLR on cine CMR's image quality and precision in evaluating quantitative volume and strain was equal or superior to that of CS. DLR may replace CS for cine CMR.

Echocardiography is the most common modality for assessing cardiac structure and function. While cardiac magnetic resonance (CMR) imaging is less accessible, CMR can provide unique tissue characterization including late gadolinium enhancement (LGE), T1 and T2 mapping, and extracellular volume (ECV) which are associated with tissue fibrosis, infiltration, and inflammation. Deep learning has been shown to uncover findings not recognized by clinicians, however it is unknown whether CMR-based tissue characteristics can be derived from echocardiography videos using deep learning. To assess the performance of a deep learning model applied to echocardiography to detect CMR-specific parameters including LGE presence, and abnormal T1, T2 or ECV. In a retrospective single-center study, adult patients with CMRs and echocardiography studies within 30 days were included. A video-based convolutional neural network was trained on echocardiography videos to predict CMR-derived labels including LGE presence, and abnormal T1, T2 or ECV across echocardiography views. The model was also trained to predict presence/absence of wall motion abnormality (WMA) as a positive control for model function. The model performance was evaluated in a held-out test dataset not used for training. The study population included 1,453 adult patients (mean age 56±18 years, 42% female) with 2,556 paired echocardiography studies occurring at a median of 2 days after CMR (interquartile range 2 days prior to 6 days after). The model had high predictive capability for presence of WMA (AUC 0.873 [95%CI 0.816-0.922]) which was used for positive control. However, the model was unable to reliably detect the presence of LGE (AUC 0.699 [0.613-0.780]), abnormal native T1 (AUC 0.614 [0.500-0.715]), T2 0.553 [0.420-0.692], or ECV 0.564 [0.455-0.691]). Deep learning applied to echocardiography accurately identified CMR-based WMA, but was unable to predict tissue characteristics, suggesting that signal for these tissue characteristics may not be present within ultrasound videos, and that the use of CMR for tissue characterization remains essential within cardiology.

To assess the prognostic utility of coronary artery calcium (CAC) scoring and coronary computed tomography angiography (CCTA)-derived quantitative plaque metrics for predicting adverse cardiovascular outcomes. The study enrolled 2404 patients with suspected coronary artery disease (CAD) but without a prior history of CAD. All participants underwent CAC scoring and CCTA, with plaque metrics quantified using an artificial intelligence (AI)-based tool (Cleerly, Inc). Percent atheroma volume (PAV) and non-calcified plaque volume percentage (NCPV%), reflecting total plaque burden and the proportion of non-calcified plaque volume normalized to vessel volume, were evaluated. The primary endpoint was a composite of all-cause mortality and non-fatal myocardial infarction (MI). Cox proportional hazard models, adjusted for clinical risk factors and early revascularization, were employed for analysis. During a median follow-up of 7.0 years, 208 patients (8.7%) experienced the primary endpoint, including 73 cases of MI (3%). The model incorporating PAV demonstrated superior discriminatory power for the composite endpoint (AUC = 0.729) compared to CAC scoring (AUC = 0.706, P = 0.016). In MI prediction, PAV (AUC = 0.791) significantly outperformed CAC (AUC = 0.699, P < 0.001), with NCPV% showing the highest prognostic accuracy (AUC = 0.814, P < 0.001). AI-driven assessment of coronary plaque burden enhances prognostic accuracy for future adverse cardiovascular events, highlighting the critical role of comprehensive plaque characterization in refining risk stratification strategies.