The future of interventional cardiology: Machine learning algorithms for solving diagnostic and therapeutic challenges

Abstract

Coronary artery disease (CAD) is one of the leading causes of death and disability worldwide. In CAD, the coronary arteries, that supply the myocardium with oxygen, are narrowed or even blocked by a process called atherosclerosis. Invasive coronary angiography (ICA) is the gold standard for the diagnosis of CAD, as well as for intraprocedural guidance of percutaneous coronary interventions. At this moment, stenosis severity is determined via visual inspection by a cardiologist. This method has several important drawbacks: a significant inter- and intra-rater variability and a high positive prediction bias. Currently available additional assessment techniques improve results, however, they come with prolonged procedural time, complication risks and increased costs. Additionally, a relevant number of syndromes exists that cannot be diagnosed sufficiently with these techniques. Automated software that uses all information within the ICA images and relates it to the context of complaints and outcomes, could be a valuable tool for improvement. Since machine learning (ML) can find relations between patient groups based on images, this could be a possible solution. However, despite promising results, clinical implementation of ML is still limited. Limited clinical applicability of developed algorithms and a lack of large high-quality datasets are the cause of this. In this research it was investigated if ML can help in solving the diagnostic and therapeutic challenges encountered in interventional cardiology (IC) and what is needed to apply ML to ICA images and other sources of coupled medical data. This was done in several steps. First the expectations and perceived barriers by interventional cardiologists on ML-based algorithms in clinical practice were assessed. Next, the feasibility of health insurance code-based querying of electronic health records (EHRs) for the creation of ML datasets was assessed. Third, a proof-of-concept study on creating a dataset and a deep learning network for predicting lesion significance on ICA images was carried out. Last, a roadmap for the curation of data for the development of ML models in IC was created.
Generally, interventional cardiologists have positive expectations for applying ML in their clinical practice. Furthermore, the willingness to collaborate in the development and clinical validation of ML algorithms is high. This is essential for translating ML models to clinical practice. Health insurance code-based querying of EHRs is not a feasible approach for creating datasets for the complex syndromes which currently pose diagnostic challenges in IC. However, the EHRs hold valuable data for the development of ML datasets. The same goes for the data collection strategy in the proof-of-concept study and it was shown that it is feasible to train deep learning networks on this data.
ML shows promising results for solving the diagnostic and therapeutic challenges encountered in interventional cardiology and directions for further research were identified. For the creation of algorithms that can be applied in clinical practice, close collaboration between ML professionals and clinicians is needed. Besides this, further research is needed to develop scalable strategies for the creation of large datasets, containing adequately labelled patients that represent the real-life population.