Background: The hypothesis that a deep learning (DL) model can produce long-term prognostic information from chest X-ray (CXR) has already been confirmed within cancer screening programs. We summarize our experience with DL prediction of long-term mortality, from plain CXR, in patients referred for angina and coronary angiography. Methods: Data of patients referred to an Italian academic hospital were analyzed retrospectively. We designed a deep convolutional neural network (DCNN) that, from CXR, could predict long-term mortality. External validation was performed on patients referred to a Dutch academic hospital. Results: A total of 6,031 were used for model training (71%; n=4,259) and fine-tuning/validation (10%; n=602). Internal validation was performed with the remaining patients (19%; n=1,170). Patients’ stratification followed the DL-CXR risk score quartiles division. Median follow-up was 6.1 years [interquartile range (IQR), 3.3–8.7 years]. We observed an increment in estimated mortality with the increase of DL-CXR risk score (low-risk 5%, moderate 17%, high 29%, very high 46%; P<0.001). The DL-CXR risk score predicted median follow-up outcome with an area under the curve (AUC) of 0.793 [95% confidence interval (CI): 0.759–0.827, sensitivity 78%, specificity 68%]. Prediction was better than that achieved using coronary angiography findings (AUC: 0.569, 95% CI: 0.52–0.61, P<0.001) and age (AUC: 0.735, 95% CI: 0.69–0.77, P<0.004). At Cox regression, the DL-CXR risk score predicted follow-up mortality (P<0.005, hazard ratio: 3.30, 95% CI: 2.35–4.64). External validation confirmed the DL-CXR risk score performance (AUC: 0.71, 95% CI: 0.49–0.92; sensitivity 0.838; specificity 0.338). Conclusions: In patients referred for coronary angiogram because of angina, the DL-CXR risk score could be used to stratify mortality risk and predict long-term outcome better than age and coronary artery disease status.
Deep learning to predict long-term mortality from plain chest X-ray in patients referred for suspected coronary artery disease / D’Ancona, G.; Savardi, M.; Massussi, M.; Valk, V. V. D.; Scherptong, R. W. C.; Signoroni, A.; Farina, D.; Murero, M.; Ince, H.; Benussi, S.; Curello, S.; &, ; Arslan, F.. - In: JOURNAL OF THORACIC DISEASE. - ISSN 2072-1439. - 16:(2024). [10.21037/jtd-24-322]
Deep learning to predict long-term mortality from plain chest X-ray in patients referred for suspected coronary artery disease
Murero M.;
2024
Abstract
Background: The hypothesis that a deep learning (DL) model can produce long-term prognostic information from chest X-ray (CXR) has already been confirmed within cancer screening programs. We summarize our experience with DL prediction of long-term mortality, from plain CXR, in patients referred for angina and coronary angiography. Methods: Data of patients referred to an Italian academic hospital were analyzed retrospectively. We designed a deep convolutional neural network (DCNN) that, from CXR, could predict long-term mortality. External validation was performed on patients referred to a Dutch academic hospital. Results: A total of 6,031 were used for model training (71%; n=4,259) and fine-tuning/validation (10%; n=602). Internal validation was performed with the remaining patients (19%; n=1,170). Patients’ stratification followed the DL-CXR risk score quartiles division. Median follow-up was 6.1 years [interquartile range (IQR), 3.3–8.7 years]. We observed an increment in estimated mortality with the increase of DL-CXR risk score (low-risk 5%, moderate 17%, high 29%, very high 46%; P<0.001). The DL-CXR risk score predicted median follow-up outcome with an area under the curve (AUC) of 0.793 [95% confidence interval (CI): 0.759–0.827, sensitivity 78%, specificity 68%]. Prediction was better than that achieved using coronary angiography findings (AUC: 0.569, 95% CI: 0.52–0.61, P<0.001) and age (AUC: 0.735, 95% CI: 0.69–0.77, P<0.004). At Cox regression, the DL-CXR risk score predicted follow-up mortality (P<0.005, hazard ratio: 3.30, 95% CI: 2.35–4.64). External validation confirmed the DL-CXR risk score performance (AUC: 0.71, 95% CI: 0.49–0.92; sensitivity 0.838; specificity 0.338). Conclusions: In patients referred for coronary angiogram because of angina, the DL-CXR risk score could be used to stratify mortality risk and predict long-term outcome better than age and coronary artery disease status.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
