Abstract
Aims
We aimed to develop models to detect aortic stenosis (AS) from chest radiographs—one of the most basic imaging tests—with artificial intelligence.
Methods and Results
We used 10433 retrospectively collected digital chest radiographs from 5638 patients to train, validate, and test three deep learning models. Chest radiographs were collected from patients who had also undergone echocardiography at a single institution between July 2016 and May 2019. These were labelled from the corresponding echocardiography assessments as AS-positive or AS-negative. The radiographs were separated on a patient basis into training (8327 images from 4512 patients, mean age 65 ± [SD] 15 years), validation (1041 images from 563 patients, mean age 65 ± 14 years), and test (1065 images from 563 patients, mean age 65 ± 14 years) datasets. The soft voting-based ensemble of the three developed models had the best overall performance for predicting AS with an AUC, sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of 0.83 (95% CI 0.77–0.88), 0.78 (0.67–0.86), 0.71 (0.68–0.73), 0.71 (0.68–0.74), 0.18 (0.14–0.23), and 0.97 (0.96–0.98), respectively, in the validation dataset and 0.83 (0.78–0.88), 0.83 (0.74–0.90), 0.69 (0.66–0.72), 0.71 (0.68–0.73), 0.23 (0.19–0.28), and 0.97 (0.96–0.98), respectively, in the test dataset.
Conclusion
Deep learning models using chest radiographs have the potential to differentiate between radiographs of patients with and without AS.
Lay summary
We created AI models using deep learning to identify aortic stenosis from chest radiographs. Three AI models were developed and evaluated with 10433 retrospectively collected radiographs and labelled from echocardiography reports. The ensemble AI model could detect aortic stenosis in a test dataset with an AUC of 0.83 (95% CI 0.78–0.88). Since chest radiography is a cost effective and widely available imaging test, our model can provide an additive resource for the detection of aortic stenosis.