Role of AI-assisted automated cardiac biometrics in screening for fetal coarctation of aorta

C A Taksoee-Vester*, K Mikolaj, O B B Petersen, N G Vejlstrup, A N Christensen, A Feragen, M Nielsen, M B S Svendsen, M G Tolsgaard

*Corresponding author af dette arbejde

Abstract

OBJECTIVES: Although there have been remarkable strides in fetal medicine and prenatal diagnosis of congenital heart disease, a significant percentage of newborns with isolated coarctation of the aorta (CoA) - around 60 percent - are still not identified prior to birth. The prenatal detection of CoA has been shown to have a notable impact on the survival rates of affected infants. To this end, the implementation of artificial intelligence (AI) in fetal ultrasound may represent a groundbreaking advancement. Our hypothesis is that leveraging automated cardiac biometric measurements with AI during the 18-22-week anomaly scan will enhance the identification of fetuses that are at risk of developing CoA.

METHODS: We have developed an AI model capable of identifying standard cardiac planes and conducting automated cardiac biometric measurements. Our data consisted of pregnancy ultrasound image and outcome data spanning from 2008 to 2018 and collected from four distinct regions in Denmark. The CoA cases from the period were paired with healthy controls in a ratio of 1:100 and matched on gestational ages of ±2 days. The cardiac biometrics on the four-chamber view and three vessel view were included in a logistic regression-based prediction model. To assess the predictive capabilities, we visualized sensitivity and specificity on Receiver Operating Characteristic (ROC) curves.

RESULTS: At the 18-22 week scan, the right ventricle (RV)area and length, left ventricle (LV) width, and the ratios of RV/LV areas and main pulmonary artery/ascending aorta diameters showed significant differences with z-scores above 0.7 when comparing subjects with a postnatal diagnosis of CoA (n=73) and healthy controls (n=7300). Using logistic regression and backward feature selection, our prediction model produced a ROC curve with an AUC (Area Under the Curve) of 0.96 and a specificity of 88.9% at a sensitivity level of 90.4%.

CONCLUSION: The integration of AI technology with automated cardiac biometric measurements conducted during the 18-22-week anomaly scan in fetal medicine has the potential to substantially enhance the screening for fetal CoA and subsequently the rate of CoA detection. Future research should clarify how AI technology can be used to aid in screening and detection of congenital heart anomalies to improve neonatal outcomes. This article is protected by copyright. All rights reserved.

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