Continuous monitoring of left ventricular function in postoperative intensive care patients using artificial intelligence and transesophageal echocardiography

Intensive Care Med Exp. 2024 Jun 10;12(1):54. doi: 10.1186/s40635-024-00640-9.

Abstract

Background: Continuous monitoring of mitral annular plane systolic excursion (MAPSE) using transesophageal echocardiography (TEE) may improve the evaluation of left ventricular (LV) function in postoperative intensive care patients. We aimed to assess the utility of continuous monitoring of LV function using TEE and artificial intelligence (autoMAPSE) in postoperative intensive care patients.

Methods: In this prospective observational study, we monitored 50 postoperative intensive care patients for 120 min immediately after cardiac surgery. We recorded a set of two-chamber and four-chamber TEE images every five minutes. We defined monitoring feasibility as how often the same wall from the same patient could be reassessed, and categorized monitoring feasibility as excellent if the same LV wall could be reassessed in ≥ 90% of the total recordings. To compare autoMAPSE with manual measurements, we rapidly recorded three sets of repeated images to assess precision (least significant change), bias, and limits of agreement (LOA). To assess the ability to identify changes (trending ability), we compared changes in autoMAPSE with the changes in manual measurements in images obtained during the initiation of cardiopulmonary bypass as well as before and after surgery.

Results: Monitoring feasibility was excellent in most patients (88%). Compared with manual measurements, autoMAPSE was more precise (least significant change 2.2 vs 3.1 mm, P < 0.001), had low bias (0.4 mm), and acceptable agreement (LOA - 2.7 to 3.5 mm). AutoMAPSE had excellent trending ability, as its measurements changed in the same direction as manual measurements (concordance rate 96%).

Conclusion: Continuous monitoring of LV function was feasible using autoMAPSE. Compared with manual measurements, autoMAPSE had excellent trending ability, low bias, acceptable agreement, and was more precise.

Keywords: AutoMAPSE; Critical care; Deep learning; Hemodynamic monitoring; Left ventricular function; Mitral annular plane systolic excursion; Transesophageal echocardiography.