Validation of a semi-automatic software for optical coherence tomography – analysis in heart transplanted patients

• Published in: The international journal of cardiovascular imaging Vol. 39; no. 2; pp. 257 - 268
• Main Authors: Jensen, Niels Møller, Chen, Zhi, Clemmensen, Tor Skibsted, Neghabat, Omeed, Holck, Emil Nielsen, Pazdernik, Michal, Mogensen, Lone Juul Hune, Wahle, Andreas, Sonka, Milan, Eiskjær, Hans
• Format: Journal Article
• Language: English
• Published: Dordrecht Springer Netherlands 01.02.2023; Springer Nature B.V
• Subjects: Arteries; Automation; Cardiac Imaging; Cardiology; Coronary artery; Coronary Artery Disease; Coronary Vessels; Data structures; Evaluation; Heart Diseases; Heart Transplantation; Humans; Imaging; Medicine; Medicine & Public Health; Optical Coherence Tomography; Original Paper; Predictive Value of Tests; Progressions; Quantitative analysis; Radiology; Software; Statistical analysis; Tomography; Tomography, Optical Coherence - methods; Transplantation; Vascular diseases; Validation; Intravascular imaging; Optical coherence tomography; Heart transplantation; Cardiac allograft vasculopathy
• ISSN: 1875-8312; 1569-5794; 1875-8312; 1573-0743
• DOI: 10.1007/s10554-022-02722-9

Optical Coherence Tomography (OCT) is an intravascular imaging modality enabling detailed evaluation of cardiac allograft vasculopathy (CAV) after heart transplantation (HTx). However, its clinical application remains hampered by time-consuming manual quantitative analysis. We aimed to validate a semi-automated quantitative OCT analysis software (Iowa Coronary Wall Analyzer, ICWA-OCT) to improve OCT-analysis in HTx patients. 23 patients underwent OCT evaluation of all three major coronary arteries at 3 months (3M) and 12 months (12M) after HTx. We analyzed OCT recordings using the semiautomatic software and compared results with measurements from a validated manual software. For semi-automated analysis, 31,228 frames from 114 vessels were available. The validation was based on a subset of 4287 matched frames. We applied mixed model statistics to accommodate the multilevel data structure with method as a fixed effect. Lumen (minimum, mean, maximum) and media (mean, maximum) metrics showed no significant differences. Mean and maximum intima area were underestimated by the semi-automated method (β-method mean  = − 0.289 mm 2 , p < 0.01; β-method max  = − 0.695 mm 2 , p < 0.01). Bland–Altman analyses showed increasing semi-automatic underestimation of intima measurements with increasing intimal extent. Comparing 3M to 12M progression between methods, mean intimal area showed minor underestimation (β-method mean  = − 1.03 mm 2 , p = 0.04). Lumen and media metrics showed excellent agreement between the manual and semi-automated method. Intima metrics and progressions from 3M to 12M were slightly underestimated by the semi-automated OCT software with unknown clinical relevance. The semi-automated software has the future potential to provide robust and time-saving evaluation of CAV progression.