Deep Learning for Detection of Elevated Pulmonary Artery Wedge Pressure using Standard Chest X-Ray.

Abstract Background To accurately diagnose and control heart failure (HF), it is important to carry out a simple assessment of elevated pulmonary arterial wedge pressure (PAWP). The aim of this study was to develop and validate an objective method for detecting elevated PAWP by applying deep learning (DL) to a chest X-ray (CXR). Methods We enrolled 1,013 consecutive patients with a right heart catheter between October 2009 and February 2020. We developed a convolutional neural network to identify patients with an elevated PAWP (> 18 mmHg) as the actual value of PAWP to be used in the dataset for training. In the prospective validation dataset used to detect elevated PAWP, the area under the receiver operating characteristic curve (AUC) was calculated using the DL model that evaluated the CXR. Results In the prospective validation dataset, the AUC of the DL model with CXR was not significantly different than the AUC produced by brain natriuretic peptide and the echocardiographic left ventricular diastolic dysfunction algorithm (DL model: 0.77 vs. BNP: 0.77 vs. DD algorithm: 0.70; respectively; p=NS for all comparisons), however was significantly higher than the AUC of the cardiothoracic ratio (DL model vs. CTR: 0.66, p=0.044). The model based on three parameters (BNP, DD algorithm, and CTR) was improved by adding the DL model (AUC: from 0.80 to 0.86; p=0.041). Conclusions Applying the DL model based on a CXR (a classical, universal, and low-cost test) is useful for screening for elevated PAWP.