Prognostic Value of Lung Ultrasound Biomarkers for Readmission Risk in Congestive Heart Failure: A Pilot Data-Driven Analysis
Authors: Jana Armouti, Laura Hutchins, Jacob Duplantis, Thomas Deiss, Thales Nogueira Gomes, Keyur H. Patel, Seema Walvekar, Shane Guillory, +7 more
Organizations: Carnegie Mellon University, Pittsburgh, USA · LSUHSC Internal Medicine, New Orleans, USA · Cosmetic Surgery Facility LLC, Baltimore, MD 21093, USA
Abstract
Hospital readmission within 30 days of discharge is a leading driver of morbidity, mortality, and avoidable healthcare expenditure in congestive heart failure (CHF). Current clinical risk stratification tools rely primarily on non-imaging data and exhibit limited predictive performance. Point-of-care lung ultrasound (LUS) offers a sensitive, noninvasive window into the pulmonary congestion that characterizes CHF decompensation, yet its prognostic utility for readmission prediction remains largely unexplored. We present a pilot feasibility study, the first systematic machine learning study using B-mode LUS acquired during hospitalization to predict 30-day CHF readmission. Quantitative spatiotemporal embeddings are extracted from a pretrained Temporal Shift Module (TSM) ResNet-18 encoder, and interpretable biomarker features are separately evaluated. Through structured ablations over lung view, temporal representation, multi-view fusion, and cross-lung augmentation, we identify the key imaging factors driving readmission risk. Our findings reveal that (1) dependent lower-lung regions (Left-3, Right-3) carry the strongest prognostic signal, consistent with their greater susceptibility to hydrostatic congestion; (2) temporal difference features between sequential examinations substantially outperform single-timepoint representations, highlighting the importance of capturing disease trajectory; and (3) multi-view feature concatenation yields the best overall performance, with our top MLP model achieving an F1 score of 0.80 (95% CI: 0.62-0.96). Biomarker analysis further reveals that pleural-line abnormalities, including breaks and indentations, are as informative as the canonical A-line and B-line markers. These results support POCUS-derived biomarkers as practical, interpretable tools for noninvasive CHF risk stratification.
Artificial intelligence-enabled electrocardiography (AI-ECG) can detect heart failure (HF), including disease not captured by left ventricular ejection fraction (LVEF), but the cardiac phenotypes underlying model predictions remain unclear. We therefore investigated whether AI-ECG-predicted HF risk aligns with established echocardiographic measures of myocardial dysfunction, remodelling, and filling pressures. We retrospectively analysed ECG and echocardiography data from 8147 patients who underwent both examinations within three days at Akershus University Hospital between 1 January 2023 and 1 June 2025. A previously validated AI-ECG model for HF detection was applied to all ECGs. Spearman's rank correlation ρ quantified associations between echocardiographic parameters and AI-ECG risk. Subgroup analyses were performed by sex and left ventricular ejection fraction (LVEF). External validation included 36,286 ECG-echocardiography pairs from Columbia University Irving Medical Center. Global longitudinal strain (GLS) showed the strongest correlation (ρ=0.57), followed by mitral annular plane systolic excursion (MAPSE) (ρ=-0.49) and LVEF (ρ=-0.45). In patients with LVEF>50%, correlations remained substantial for GLS, MAPSE, and diastolic-related parameters. Volumetric left ventricular indices correlated less strongly in women, whereas diastolic indices showed stronger correlations in women than in men. Physiological validation showed that AI-ECG HF risk predictions align primarily with measures of systolic function, particularly global longitudinal strain, while also capturing diastolic-related abnormalities in patients with preserved LVEF. This approach may improve clinical interpretability and identify opportunities for model refinement.
Elias Stenhede, Eivind Bjørkan Orstad, Torbjørn Omland +2
Cancer treatments are known to introduce cardiotoxicity, negatively impacting outcomes and survivorship. Identifying cancer patients at risk of heart failure (HF) is critical to improving cancer treatment outcomes and safety. This study examined machine learning (ML) models to identify cancer patients at risk of HF using electronic health records (EHRs), including traditional ML, Time-Aware long short-term memory (T-LSTM), and large language models (LLMs) using novel narrative features derived from the structured medical codes. We identified a cancer cohort of 12,806 patients from the University of Florida Health, diagnosed with lung, breast, and colorectal cancers, among which 1,602 individuals developed HF after cancer. The LLM, GatorTron-3.9B, achieved the best F1 scores, outperforming the traditional support vector machines by 39%, the T-LSTM deep learning model by 7%, and a widely used transformer model, BERT, by 5.6%. The analysis shows that the proposed narrative features remarkably increased feature density and improved performance.
Ziyi Chen, Mengyuan Zhang, Mustafa Mohammed Ahmed +4
Lung ultrasound (LUS) is a bedside tool for assessing pulmonary edema in patients at risk due to heart failure or impaired kidney function. However, automated LUS analysis remains challenging because of speckle noise, imaging artifacts, and operator-dependent acquisition variability. In this work, we present a deep learning framework for multi-class LUS video classification that explores two components: hierarchy-aware training, and anatomy-guided learning. Starting from a strong baseline, we introduce hierarchical training strategies and then introduce pleural line mask supervision to guide model attention toward anatomically relevant regions. We study four clinically relevant classes--healthy, B-lines, consolidations, and mixed B-lines with consolidations--using an open-access dataset of 1,886 videos from 219 patients, evaluated with patient-level five-fold cross-validation. Results show that hierarchy-aware training improves pathological separation relative to flat classification, while mask-guided attention supervision achieves the highest mean macro-F1 of 65.7% and produces more localized attention patterns. Transfer experiments on the external COVID-BLUeS dataset further show competitive and parameter-efficient adaptation while preserving pleural-focused attention behavior. These findings suggest that combining clinically structured objectives with anatomy-guided supervision is a practical approach to robust, interpretable LUS video analysis. Code and model implementations are available at https://github.com/Alya-Almsouti/LUS-video-classification.
Alya Almsouti, Lotfi Mecharbat, Noha Aboukhater +5