Revealing unforeseen diagnostic image features with deep learning by detecting cardiovascular diseases from apical four-chamber ultrasounds

Background. With the rise of highly portable, wireless, and low-cost ultrasound devices and automatic ultrasound acquisition techniques, an automated interpretation method requiring only a limited set of views as input could make preliminary cardiovascular disease diagnoses more accessible. In this study, we developed a deep learning (DL) method for automated detection of impaired left ventricular (LV) function and aortic valve (AV) regurgitation from apical four-chamber (A4C) ultrasound cineloops and investigated which anatomical structures or temporal frames provided the most relevant information for the DL model to enable disease classification. Methods and Results. A4C ultrasounds were extracted from 3,554 echocardiograms of patients with either impaired LV function (n=928), AV regurgitation (n=738), or no significant abnormalities (n=1,888). Two convolutional neural networks (CNNs) were trained separately to classify the respective disease cases against normal cases. The overall classification accuracy of the impaired LV function detection model was 86%, and that of the AV regurgitation detection model was 83%. Feature importance analyses demonstrated that the LV myocardium and mitral valve were important for detecting impaired LV function, while the tip of the mitral valve anterior leaflet, during opening, was considered important for detecting AV regurgitation. Conclusion. The proposed method demonstrated the feasibility of a 3D CNN approach in detection of impaired LV function and AV regurgitation using A4C ultrasound cineloops. The current research shows that DL methods can exploit large training data to detect diseases in a different way than conventionally agreed upon methods, and potentially reveal unforeseen diagnostic image features.