Multimodal deep learning enhances diagnostic precision in left ventricular hypertrophy

Determining the etiology of left ventricular hypertrophy (LVH) can be challenging due to the similarity in clinical presentation and cardiac morphological features of diverse causes of disease. In particular, distinguishing individuals with hypertrophic cardiomyopathy (HCM) from the much larger set of individuals with manifest or occult hypertension (HTN) is of major importance for family screening and the prevention of sudden death. We hypothesized that deep learning based joint interpretation of 12 lead electrocardiograms and echocardiogram videos could augment physician interpretation. We chose not to train on proximate data labels such as physician over-reads of ECGs or echocardiograms but instead took advantage of electronic health record derived clinical blood pressure measurements and diagnostic consensus (often including molecular testing) among physicians in an HCM center of excellence. Using over 18,000 combined instances of electrocardiograms and echocardiograms from 2,728 patients, we developed LVH-Fusion. On held-out test data, LVH-Fusion achieved an F1-score of 0.71 in predicting HCM, and 0.96 in predicting HTN. In head-to-head comparison with human readers LVH-Fusion had higher sensitivity and specificity rates than its human counterparts. Finally, we use explainability techniques to investigate local and global features that positively and negatively impact LVH-Fusion prediction estimates providing confirmation from unsupervised analysis the diagnostic power of lateral T wave inversion on the ECG and proximal septal hypertrophy on the echocardiogram for HCM. In conclusion, these results show that deep learning can provide effective physician augmentation in the face of a common diagnostic dilemma with far reaching implications for the prevention of sudden cardiac death.