This would also be warranted in the matter of risk stratification, which to date, remains particularly challenging for this cohort and appears to be inadequate when focused on the single parameter of LVEF ( 5). Genetic testing clearly provides a fundamental insight into discriminating part of these diverse DCM subtypes however, the complex interplay of genetics and environmental influences dictates for a deeper characterization of the DCM phenotype through advanced imaging techniques. The final section of this paper is dedicated to the allied clinical applications to imaging, that incorporate artificial intelligence and have harnessed the comprehensive abundance of data from genetics and relevant clinical variables to facilitate better classification and enable enhanced risk prediction for relevant outcomes.Īs such a clinical spectrum of DCM exists, with variable expression of arrhythmic and functional changes over time ( 4). Concurrently, we revisit the added value of tissue characterization techniques for risk stratification, showcasing the deep learning platforms that overcome limitations in current clinical workflows and discuss how they could be utilized to better differentiate at-risk subgroups of this phenotype. Given its promising utility in the non-invasive assessment of cardiac diseases, we firstly highlight the key applications in CMR, set to enable comprehensive quantitative measures of function beyond the standard of care assessment. Focusing particularly on deep learning, a subfield of artificial intelligence, that has garnered significant interest in the imaging community, this paper reviews the main developments that could offer more robust disease characterization and risk stratification in the Dilated Cardiomyopathy phenotype. Recent advances in artificial intelligence offers the unique opportunity to impact clinical decision making through enhanced precision image-analysis tasks, multi-source extraction of relevant features and seamless integration to enhance understanding, improve diagnosis, and subsequently clinical outcomes. Advanced tools are needed to leverage these sensitive metrics and integrate with clinical, genetic and biochemical information for personalized, and more clinically useful characterization of the dilated cardiomyopathy phenotype. Cardiac MRI (CMR) is well-placed in this respect, not only for its diagnostic utility, but the wealth of information captured in global and regional function assessment with the addition of unique tissue characterization across different disease states and patient cohorts. In this era of personalized medical care, the conventional assessment of left ventricular ejection fraction falls short in fully predicting evolution and risk of outcomes in this heterogenous group of heart muscle disease, as such, a more refined means of phenotyping this disease appears essential. Emerging evidence suggests many patients remain vulnerable to major adverse outcomes despite clear therapeutic success of modern evidence-based heart failure therapy. 3Division of Heart and Lungs, Department of Cardiology, University Medical Center Utrecht, Utrecht, Netherlandsĭilated Cardiomyopathy is conventionally defined by left ventricular dilatation and dysfunction in the absence of coronary disease.2Department of Cardiology, Guys and St Thomas' NHS Trust, London, United Kingdom.1Department of Cardiovascular Imaging, School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom.Clint Asher 1,2 * †, Esther Puyol-Antón 1 †, Maleeha Rizvi 1,2, Bram Ruijsink 1,2,3, Amedeo Chiribiri 1,2, Reza Razavi 1,2 ‡ and Gerry Carr-White 1,2 ‡
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