Image analysis of cardiac hepatopathy secondary to heart failure: Machine learning vs gastroenterologists and radiologists

Table 1 Laboratory data and echocardiographic findings, n (%)

	TR			P value
	(1) Mild	(2) Moderate	(3) Severe	(1) vs (2)	(1) vs (3)	(2) vs (3)
Blood test results
Sex, male	34 (64.2)	45 (68.2)	41 (68.3)	NS	NS	NS
Age (year)	68 (29-93)	70 (25-91)	68 (36-91)	NS	NS	NS
AST (IU/L)	23 (11-83)	23 (7-772)	27 (12-67)	NS	NS	NS
ALT (IU/L)	21 (6-107)	20 (7-459)	19 (6-71)	NS	NS	NS
γ-GTP (IU/L)	36 (8-562)	39 (9-425)	53 (11-377)	NS	NS	0.039
Alb (g/dL)	3.8 (2.1-4.9)	3.8 (1.7-4.9)	3.7 (1.4-4.4)	NS	NS	NS
T-Bil (mg/dL)	0.6 (0.2-1.9)	0.8 (0.3-3.7)	1.1 (0.3-4.1)	NS	0.025	NS
Cre (mg/dL)	0.86 (0.41-5.82)	0.84 (0.38-8.93)	1.01 (0.4-5.52)	NS	NS	0.033
eGFR (mL/minute)	57.8 (2.6-128.8)	62.8 (4.5-153.0)	49.2 (16.2-95.0)	NS	NS	NS
Plt (× 104/µL)	20.7 (7.9-49.6)	19.8 (4.2-40.5)	22.6 (12.7-32.7)	NS	NS	NS
ALBI score	-2.48 (-3.46 to -1.12)	-2.48 (-3.44 to -0.83)	-2.35 (-3.10 to -064)	NS	NS	NS
MELD-XI score	6.39 (-3.12 to 35.9)	7.49 (-6.62 to 33.9)	8.96 (-0.15 to 42.9)	NS	0.024	NS
BNP (pg/dL)	141 (11.8-2110)	264 (6.6-3752)	397 (35.0-3147)	NS	0.047	NS
Echocardiographic findings
LVDd (mm)	55.1 (37.4-82.9)	56.6 (38.7-96.9)	59.9 (37.4-78.9)	NS	NS	NS
EF (%)	36.8 (10.1-49.7)	36.4 (10.8-49.8)	34.7 (17.2-49.9)	NS	NS	NS
E/E’	15.7 (7.1-54.2)	17.3 (2.8-50.7)	15.5 (5.7-46.4)	NS	NS	NS
LAD (mm)	42.8 (25.8-68.9)	47.0 (24.5-87.1)	49.1 (28.5-69.7)	NS	NS	NS
TRPG (mmHg)	23.0 (9.7-49.0)	33.9 (13.0-91.4)	40.8 (22.2-70.9)	< 0.01	< 0.01	< 0.01
IVC (mm)	14.9 (5.5- 27.0)	18.0 (2.2-28.2)	23.0 (13.0-30.0)	< 0.01	< 0.01	0.012

Alb: Albumin; ALP: Alkaline phosphatase; ALT: Alanine aminotransferase; AST: Aspartate aminotransferase; Cre: Creatinine; T-Bil: Total bilirubin; γ-GTP: Gamma-glutamyl transpeptidase; eGFR: Estimated glomerular filtration rate; Plt: Platelet; ALBI: Albumin bilirubin; MELD: Model for End-stage Liver Disease; BNP: B-type natriuretic peptide; LVDd: Left ventricular diastolic dysfunction; EF: Ejection fraction; LAD: Left anterior descending; TRPG: Tricuspid regurgitation pressure gradient; IVC: Inferior vena cava; NS: Not significant.

Table 2 Performance metrics of the three-tier tricuspid regurgitation severity classification

		Predicted severity			Recall
		Mild	Moderate	Severe
Actual severity	Mild	6	7	3	0.375
	Moderate	1	10	2	0.769
	Severe	0	0	7	1
Precision		0.857	0.588	0.583
F-measure		0.522	0.667	0.737

Recall: Proportion of correctly predicted cases for each category. Precision: Proportion of true positive predictions among all positive predictions for each category. F-measure: Harmonic mean of precision and recall, indicating overall classification performance.

Table 3 Predictive accuracy of computed tomography feature-based models with and without biochemical parameters

Model	Input data	AUC (95%CI)	Accuracy (%)	Sensitivity (%)	Specificity (%)
Image-only model	Para-umbilical CT feature maps	0.78 (0.72-0.84)	63.9	60.0	66.7
Multimodal model	CT features + γ-GTP, total bilirubin	0.83 (0.78-0.88)	68.5	70.0	67.8

γ-GTP: Gamma-glutamyl transpeptidase; CT: Computed tomography; AUC: Area under the curve.

Table 4 5-fold cross-validation and sensitivity analysis results

Analysis	Dataset configuration	Accuracy (%)	AUC (95%CI)
A 5-fold cross-validation	Fold 1	62.8	0.77 (0.69-0.85)
	Fold 2	64.2	0.79 (0.71-0.87)
	Fold 3	63.5	0.78 (0.70-0.86)
	Fold 4	64.7	0.79 (0.71-0.87)
	Fold 5	63.9	0.78 (0.70-0.86)
mean ± SD		63.8 ± 0.7	0.78 ± 0.01

AUC: Area under the curve.

Table 5 Scanner-specific model performance after ComBat batch correction

CT scanner (manufacturer & model)	No. of cases (n)	Accuracy (%)	AUC (95%CI)
SOMATOM Definition Flash (Siemens, Munich, Germany)	45	64.4	0.78 (0.70-0.86)
Aquilion ONE (Canon Medical Systems, Otawara, Tochigi, Japan)	40	63.1	0.76 (0.68-0.84)
Aquilion 64 (Canon Medical Systems, Otawara, Tochigi, Japan)	35	62.9	0.77 (0.67-0.87)
Ingenuity Elite (Philips, Amsterdam, Netherlands)	32	64.0	0.79 (0.69-0.89)
Overall mean	152	63.6	0.78 (0.74-0.82)

Accuracy: Proportion of correct tricuspid regurgitation severity classifications. AUC: Area under the curve; CT: Computed tomography.