Pierre-Yves Courand

Thierry Judge, Nicolas Duchateau, Andreas Østvik et al.

Speckle tracking echocardiography (STE) is the clinical standard for myocardial strain estimation. Despite good performance on global strain (GLS), its accuracy for regional strain remains limited, even though this biomarker is highly relevant for early diagnosis and the characterization of subtle abnormalities. from clinical data. Deep learning is a promising alternative, but its development is constrained by the lack of reliable motion references. Existing solutions rely either on STE-derived labels or on simulations generated by physics-based models, but these synthetic sequences still have limited realism compared with clinical data.In this paper, we propose a novel simulation strategy that incorporates speckle decorrelation measures from real videos and uses an iterative refinement process to improve the motion realism in the simulations. We created an open-source photorealistic dataset of 1,478 videos with reference motion, which was used to train an echocardiographic motion estimation algorithm. The proposed method achieves unmatched performance on global and regional strain, notably reaching a GLS variability of 1.42% in an inter-expert setting compared to 1.78% for the clinical reference.

Nathan Painchaud, Jérémie Stym-Popper, Pierre-Yves Courand et al.

Deep learning enables automatic and robust extraction of cardiac function descriptors from echocardiographic sequences, such as ejection fraction or strain. These descriptors provide fine-grained information that physicians consider, in conjunction with more global variables from the clinical record, to assess patients' condition. Drawing on novel Transformer models applied to tabular data, we propose a method that considers all descriptors extracted from medical records and echocardiograms to learn the representation of a cardiovascular pathology with a difficult-to-characterize continuum, namely hypertension. Our method first projects each variable into its own representation space using modality-specific approaches. These standardized representations of multimodal data are then fed to a Transformer encoder, which learns to merge them into a comprehensive representation of the patient through the task of predicting a clinical rating. This stratification task is formulated as an ordinal classification to enforce a pathological continuum in the representation space. We observe the major trends along this continuum on a cohort of 239 hypertensive patients, providing unprecedented details in the description of hypertension's impact on various cardiac function descriptors. Our analysis shows that i) the XTab foundation model's architecture allows to reach outstanding performance (96.8% AUROC) even with limited data (less than 200 training samples), ii) stratification across the population is reproducible between trainings (within 5.7% mean absolute error), and iii) patterns emerge in descriptors, some of which align with established physiological knowledge about hypertension, while others could pave the way for a more comprehensive understanding of this pathology. Code is available at https://github.com/creatis-myriad/didactic.

Jérémie Stym-Popper, Nathan Painchaud, Clément Rambour et al.

Multimodal data fusion is a key approach for enhancing diagnosis in medical applications. We propose an asymmetric fusion strategy starting from a primary modality and integrating secondary modalities by disentangling shared and modality-specific information. Validated on a dataset of 239 patients with echocardiographic time series and tabular records, our model outperforms existing methods, achieving an AUC over 90%. This improvement marks a crucial benchmark for clinical use.

Hang Jung Ling, Salomé Bru, Julia Puig et al.

Intraventricular vector flow mapping (iVFM) seeks to enhance and quantify color Doppler in cardiac imaging. In this study, we propose novel alternatives to the traditional iVFM optimization scheme by utilizing physics-informed neural networks (PINNs) and a physics-guided nnU-Net-based supervised approach. When evaluated on simulated color Doppler images derived from a patient-specific computational fluid dynamics model and in vivo Doppler acquisitions, both approaches demonstrate comparable reconstruction performance to the original iVFM algorithm. The efficiency of PINNs is boosted through dual-stage optimization and pre-optimized weights. On the other hand, the nnU-Net method excels in generalizability and real-time capabilities. Notably, nnU-Net shows superior robustness on sparse and truncated Doppler data while maintaining independence from explicit boundary conditions. Overall, our results highlight the effectiveness of these methods in reconstructing intraventricular vector blood flow. The study also suggests potential applications of PINNs in ultrafast color Doppler imaging and the incorporation of fluid dynamics equations to derive biomarkers for cardiovascular diseases based on blood flow.

Hang Jung Ling, Nathan Painchaud, Pierre-Yves Courand et al.

Deep learning-based methods have spearheaded the automatic analysis of echocardiographic images, taking advantage of the publication of multiple open access datasets annotated by experts (CAMUS being one of the largest public databases). However, these models are still considered unreliable by clinicians due to unresolved issues concerning i) the temporal consistency of their predictions, and ii) their ability to generalize across datasets. In this context, we propose a comprehensive comparison between the current best performing methods in medical/echocardiographic image segmentation, with a particular focus on temporal consistency and cross-dataset aspects. We introduce a new private dataset, named CARDINAL, of apical two-chamber and apical four-chamber sequences, with reference segmentation over the full cardiac cycle. We show that the proposed 3D nnU-Net outperforms alternative 2D and recurrent segmentation methods. We also report that the best models trained on CARDINAL, when tested on CAMUS without any fine-tuning, still manage to perform competitively with respect to prior methods. Overall, the experimental results suggest that with sufficient training data, 3D nnU-Net could become the first automated tool to finally meet the standards of an everyday clinical device.