Journal article
Algorithmic Versus Expert Human Interpretation of Instantaneous Wave-Free Ratio Coronary Pressure-Wire Pull Back Data.
- Cook CM Hammersmith Hospital, Imperial College NHS Trust, London, United Kingdom.
- Warisawa T Hammersmith Hospital, Imperial College NHS Trust, London, United Kingdom; St. Marianna University School of Medicine, Kawasaki, Japan.
- Howard JP Hammersmith Hospital, Imperial College NHS Trust, London, United Kingdom.
- Keeble TR Essex Cardiothoracic Centre, Basildon, United Kingdom; Anglia Ruskin School of Medicine, Chelmsford, Essex, United Kingdom.
- Iglesias JF Geneva University Hospital, Geneva, Switzerland.
- Schampaert E Hôpital Sacré-Coeur de Montréal, Université de Montréal, Montréal, Canada.
- Bhindi R Royal North Shore, Sydney, Australia.
- Ambrosia A Banner Heart Hospital, Mesa, Arizona.
- Matsuo H Gifu Heart Centre, Gifu, Japan.
- Nishina H Tsukuba Medical Center Hospital, Tsukuba, Japan.
- Kikuta Y Fukuyama Cardiovascular Hospital, Fukuyama, Japan.
- Shiono Y Wakayama Medical University, Wakayama, Japan.
- Nakayama M Toda Central General Hospital, Toda, Japan.
- Doi S St. Marianna University School of Medicine, Kawasaki, Japan.
- Takai M St. Marianna University School of Medicine Yokohama City Seibu Hospital, Yokohama, Japan.
- Goto S Toda Central General Hospital, Toda, Japan; Hospital Clinico San Carlos, Madrid, Spain.
- Yakuta Y Kanazawa Cardiovascular Hospital, Kanazawa, Japan.
- Karube K Okaya City Hospital, Okaya, Japan.
- Akashi YJ St. Marianna University School of Medicine, Kawasaki, Japan.
- Clesham GJ Essex Cardiothoracic Centre, Basildon, United Kingdom; Anglia Ruskin School of Medicine, Chelmsford, Essex, United Kingdom.
- Kelly PA Essex Cardiothoracic Centre, Basildon, United Kingdom.
- Davies JR Essex Cardiothoracic Centre, Basildon, United Kingdom; Anglia Ruskin School of Medicine, Chelmsford, Essex, United Kingdom.
- Karamasis GV Essex Cardiothoracic Centre, Basildon, United Kingdom; Anglia Ruskin School of Medicine, Chelmsford, Essex, United Kingdom.
- Kawase Y Gifu Heart Centre, Gifu, Japan.
- Robinson NM Essex Cardiothoracic Centre, Basildon, United Kingdom.
- Sharp ASP Royal Devon and Exeter Hospital, Exeter, United Kingdom.
- Escaned J Hospital Clinico San Carlos, Madrid, Spain.
- Davies JE Hammersmith Hospital, Imperial College NHS Trust, London, United Kingdom. Electronic address: justindavies@heart123.com.
- 2019-07-20
Published in:
- JACC. Cardiovascular interventions. - 2019
artificial intelligence
coronary physiology
iFR
instantaneous wave-free ratio
percutaneous coronary intervention
Aged
Algorithms
Cardiac Catheterization
Cardiac Catheters
Clinical Decision-Making
Coronary Artery Disease
Coronary Circulation
Decision Support Techniques
Europe
Female
Hemodynamics
Humans
Japan
Male
Middle Aged
Observer Variation
Patient Selection
Percutaneous Coronary Intervention
Predictive Value of Tests
Reproducibility of Results
Retrospective Studies
Signal Processing, Computer-Assisted
Transducers, Pressure
English
OBJECTIVES
The aim of this study was to investigate whether algorithmic interpretation (AI) of instantaneous wave-free ratio (iFR) pressure-wire pull back data would be noninferior to expert human interpretation.
BACKGROUND
Interpretation of iFR pressure-wire pull back data can be complex and is subjective.
METHODS
Fifteen human experts interpreted 1,008 iFR pull back traces (691 unique, 317 duplicate). For each trace, experts determined the hemodynamic appropriateness for percutaneous coronary intervention (PCI) and, in such cases, the optimal physiological strategy for PCI. The heart team (HT) interpretation was determined by consensus of the individual expert opinions. The same 1,008 pull back traces were also interpreted algorithmically. The coprimary hypotheses of this study were that AI would be noninferior to the interpretation of the median expert human in determining: 1) the hemodynamic appropriateness for PCI; and 2) the physiological strategy for PCI.
RESULTS
Regarding the hemodynamic appropriateness for PCI, the median expert human demonstrated 89.3% agreement with the HT in comparison with 89.4% for AI (p < 0.01 for noninferiority). Across the 372 cases judged as hemodynamically appropriate for PCI according to the HT, the median expert human demonstrated 88.8% agreement with the HT in comparison with 89.7% for AI (p < 0.0001 for noninferiority). On reproducibility testing, the HT opinion itself changed 1 in 10 times for both the appropriateness for PCI and the physiological PCI strategy. In contrast, AI showed no change.
CONCLUSIONS
AI of iFR pressure-wire pull back data was noninferior to expert human interpretation in determining both the hemodynamic appropriateness for PCI and the optimal physiological strategy for PCI.
The aim of this study was to investigate whether algorithmic interpretation (AI) of instantaneous wave-free ratio (iFR) pressure-wire pull back data would be noninferior to expert human interpretation.
BACKGROUND
Interpretation of iFR pressure-wire pull back data can be complex and is subjective.
METHODS
Fifteen human experts interpreted 1,008 iFR pull back traces (691 unique, 317 duplicate). For each trace, experts determined the hemodynamic appropriateness for percutaneous coronary intervention (PCI) and, in such cases, the optimal physiological strategy for PCI. The heart team (HT) interpretation was determined by consensus of the individual expert opinions. The same 1,008 pull back traces were also interpreted algorithmically. The coprimary hypotheses of this study were that AI would be noninferior to the interpretation of the median expert human in determining: 1) the hemodynamic appropriateness for PCI; and 2) the physiological strategy for PCI.
RESULTS
Regarding the hemodynamic appropriateness for PCI, the median expert human demonstrated 89.3% agreement with the HT in comparison with 89.4% for AI (p < 0.01 for noninferiority). Across the 372 cases judged as hemodynamically appropriate for PCI according to the HT, the median expert human demonstrated 88.8% agreement with the HT in comparison with 89.7% for AI (p < 0.0001 for noninferiority). On reproducibility testing, the HT opinion itself changed 1 in 10 times for both the appropriateness for PCI and the physiological PCI strategy. In contrast, AI showed no change.
CONCLUSIONS
AI of iFR pressure-wire pull back data was noninferior to expert human interpretation in determining both the hemodynamic appropriateness for PCI and the optimal physiological strategy for PCI.
- Language
-
- English
- Open access status
- hybrid
- Identifiers
-
- DOI 10.1016/j.jcin.2019.05.025
- PMID 31320025
- Persistent URL
- https://sonar.ch/global/documents/46468
Statistics
Document views: 58
File downloads: