Abstract
Disturbances of the cardiac conduction system constitute a major risk after surgical repair of complex cases of congenital heart disease. Intraoperative identification of the conduction system may reduce the incidence of these disturbances. We previously developed an approach to identify cardiac tissue types using fiber-optics confocal microscopy and extracellular fluorophores. Here, we applied this approach to investigate sensitivity and specificity of human and automated classification in discriminating images of atrial working myocardium and specialized tissue of the conduction system. Two-dimensional image sequences from atrial working myocardium and nodal tissue of isolated perfused rodent hearts were acquired using a fiber-optics confocal microscope (Leica FCM1000). We compared two methods for local application of extracellular fluorophores: topical via pipette and with a dye carrier. Eight blinded examiners evaluated 162 randomly selected images of atrial working myocardium (n = 81) and nodal tissue (n = 81). In addition, we evaluated the images using automated classification. Blinded examiners achieved a sensitivity and specificity of 99.2±0.3% and 98.0±0.7%, respectively, with the dye carrier method of dye application. Sensitivity and specificity was similar for dye application via a pipette (99.2±0.3% and 94.0±2.4%, respectively). Sensitivity and specificity for automated methods of tissue discrimination were similarly high. Human and automated classification achieved high sensitivity and specificity in discriminating atrial working myocardium and nodal tissue. We suggest that our findings facilitate clinical translation of fiber-optics confocal microscopy as an intraoperative imaging modality to reduce the incidence of conduction disturbances during surgical correction of congenital heart disease.
Highlights
Congenital heart disease is the most common birth defect, which affects approximately 1% of all live births [1]
Our studies provide evidence that human examiners can discriminate images of atrial working myocardium (AWM) and nodal tissue acquired using Fiber-optics confocal microscopy (FCM) with extremely high sensitivity and specificity
We found that automated classification systems were effective at discriminating these cardiac tissue types as human examiners
Summary
Congenital heart disease is the most common birth defect, which affects approximately 1% of all live births [1]. Our hypothesis is that human and automated tissue classification can discriminate FCM images of AWM and specialized tissue of the conduction system with high sensitivity and specificity. For this purpose, we used conventional three-dimensional laser-scanning confocal microscopy, FCM, and two methods for local delivery of extracellular fluorophores to acquire images from AWM and nodal tissue from the SAN and AVN. We evaluated the sensitivity and specificity of blinded human examiners, as well as automated classification based on optimal cutoff values in discriminating a set of randomly selected images of AWM and nodal tissue
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