Abstract
Risk of cardiovascular diseases (CVD) is driven by both genetic and environmental factors. Deep learning (DL) has shown that retinal images contain latent information indicating CVD risk. At the same time, genome-wide polygenic risk scores have demonstrated CVD risk prediction accuracy similar to conventional clinical factor-based risk scores. We speculated that information conveying CVD risk in retinal images may predominantly indicate environment factors rather than genetic factors, i.e., provide complementary information. Hence, we developed a DL model applied to diabetes retinal screening photographs from patients with type 2 diabetes based on EfficientNetB2 for predicting clinical atherosclerotic cardiovascular disease (ASCVD) risk score and a genome-wide polygenic risk score (PRS) for CVD. Results from 6656 photographs suggest a correlation between the actual and predicted ASCVD risk score (R2 = 0.534, 95% CI [0.504, 0.563]; MAE = 0.109 [0.105, 0.112]), but not so for actual and predicted PRS (R2 = −0.005 [−0.02, 0.01]; MAE = 0.484 [0.467, 0.5]. This suggests that retinal and genetic information are potentially complementary within an individual’s cardiovascular risk, hence their combination may provide an efficient and powerful approach to screening for CVD risk. To our best knowledge, this is the first time that DL is used to investigate the complementarity of retinal and genetic information for CVD risk.
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References
Bradski, G.: The OpenCV Library. Dr. Dobb’s Journal of Software Tools (2000)
Chang, J., Ko, A., Park, S.M., et al.: Association of cardiovascular mortality and deep learning-funduscopic atherosclerosis score derived from retinal fundus images. Am. J. Ophth. 217, 121–130 (2020)
Cheung, C.Y.I., Zheng, Y., Hsu, W., et al.: Retinal vascular tortuosity, blood pressure, and cardiovascular risk factors. Ophthalmology 118(5), 812–818 (2011)
Cheung, C.Y.I., Chan V.T., Mok V.C., et al.: Potential retinal biomarkers for dementia: what is new? Curr. Opin. Neurol. 32(1), 82–91 (2019)
Chollet, F., et al.: Keras. https://keras.io (2015). Last accessed 2 March 2021
Elliott, J., Bodinier, B., Bond, T.A., et al.: Predictive accuracy of a polygenic risk score-enhanced prediction model vs a clinical risk score for coronary artery disease. JAMA 323(7), 636–645 (2020). https://doi.org/10.1001/jama.2019.22241
Fetit, A., Doney, A.S., Hogg, S., et al.: A multimodal approach to cardiovascular risk stratification in patients with type 2 diabetes incorporating retinal, genomic and clinical features. Sci. Rep. 9(1), 3591 (2019). https://doi.org/10.1038/s41598-019-40403-1
Gerrits, N., Elen, B., Van Craenendonck, T., et al.: Age and sex affect deep learning prediction of cardiometabolic risk factors from retinal images. Sci. Rep. 10(1), 1–9 (2020)
Goff, D., Lloyd-Jones, D.M., Bennett, G., et al.: 2013 ACC/AHA guideline on the assessment of cardiovascular risk: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation 129(25_suppl_2), S49–S73 (2014). https://doi.org/10.1161/01.cir.0000437741.48606.98
Health Informatics Center (HIC) Services: Homepage, https://www.dundee.ac.uk/hic/hicservices/. Last accessed 21 July 2021
Ho, H., Cheung, C.Y., Sabanayagam, C., Yip, W., et al.: Retinopathy signs improved prediction and reclassification of cardiovascular disease risk in diabetes: a prospective cohort study. Sci. Rep. 7(1), 1–8 (2017). https://doi.org/10.1038/srep41492
Hébert, H.L., Shepherd, B., Milburn, K., et al.: Cohort profile: genetics of diabetes audit and research in tayside scotland (godarts). Int. J. Epidemiol. 47(2), 380–381j (2018). https://doi.org/10.1093/ije/dyx140
Hemelings, R., Elen, B., Stalmans, I., et al.: Artery-vein segmentation in fundus images using a fully convolutional network. Comp. Med. Img. Graph. 76, 101636 (2019)
Khera, A.V., Chaffin, M., Aragam, K.G., et al.: Genome-wide polygenic scores for common diseases identify individuals with risk equivalent to monogenic mutations. Nat. Genet. 50(9), 1219–1224 (2018). https://doi.org/10.1038/s41588-018-0183-z
Kim, Y.D., Noh, K.J., Byun, S.J., et al.: Effects of hypertension, diabetes, and smoking on age and sex prediction from retinal fundus images. Sci. Rep. 10, 4623 (2020)
Lau, Q.P., Lee, M.L., Hsu, W., Wong, T.Y.: Simultaneously identifying all true vessels from segmented retinal images. IEEE Trans. Biomed. Eng. 60(7), 1851–1858 (2013)
Liew, G., Mitchell, P., Rochtchina, E., et al.: Fractal analysis of retinal microvasculature and coronary heart disease mortality. Eur. Heart J. 32(4), 422–429 (2011). https://doi.org/10.1093/eurheartj/ehq431
McGeechan, K., Liew, G., Macaskill, P., et al.: Meta-analysis: retinal vessel caliber and risk for coronary heart disease. Ann. Intern. Med. 151(6), 404–413 (2009). https://doi.org/10.7326/0003-4819-151-6-200909150-00005
Ma, W., Shuang, Y., Ma, K., Wang, J., Ding, X., Zheng, Y.: Multi-task Neural Networks with Spatial Activation for Retinal Vessel Segmentation and Artery/Vein Classification. In: Shen, D., et al. (eds.) Medical Image Computing and Computer Assisted Intervention – MICCAI 2019: 22nd International Conference, Shenzhen, China, October 13–17, 2019, Proceedings, Part I, pp. 769–778. Springer International Publishing, Cham (2019). https://doi.org/10.1007/978-3-030-32239-7_85
Mookiah, M.R.K., Hogg, S., MacGillivray, T.J., et al.: A review of machine learning methods for retinal blood vessel segmentation and artery/vein classification. Med. Image Anal. 68, 101905 (2021). https://doi.org/10.1016/j.media.2020.101905
Mookiah, M.R.K., Hogg, S., MacGillivray, T., Trucco, E., et al.: On the quantitative effects of compression of retinal fundus images on morphometric vascular measurements in vampire. Comp. Meth. Progr. Biomed., 105969 (2021)
Mora, S., Wenger, N.K., Cook, N.R., et al.: Evaluation of the pooled cohort risk equations for cardiovascular risk prediction in a multiethnic cohort from the women’s health initiative. JAMA Intern. Med. 178(9), 1231–1240 (2018)
Pedregosa, F., Varoquaux, G., Gramfort, A., et al.: Scikit-learn: machine learning in Python. J. Mach. Learn. Res. 12, 2825–2830 (2011)
Poplin, R., Varadarajan, A.V., Blumer, K., et al.: Prediction of cardiovascular risk factors from retinal fundus photographs via deep learning. Nat. Biomed. Eng. 2(3), 158–164 (2018)
Rim, T.H., Lee, G., Kim, Y.,, et al.: Prediction of systemic biomarkers from retinal photographs: development and validation of deep-learning algorithms. Lancet Digital Health 2(10), e526–e536 (2020)
Russakovsky, O., Deng, J., Su, H., et al.: ImageNet large scale visual recognition challenge. Int. J. Comput. Vis. 115(3), 211–252 (2015). https://doi.org/10.1007/s11263-015-0816-y
Scottish Diabetic Retinopathy Screening Homepage: https://www.ndrs.scot.nhs.uk/. Last accessed 2 March 2021
Selvaraju, R.R., Cogswell, M., Das, A., et al.: Grad-cam: visual explanations from deep networks via gradient-based localization. Int. J. Comput. Vis. 128(2), 336–359 (2019). https://doi.org/10.1007/s11263-019-01228-7
Singh, A., Sengupta, S., Lakshminarayan, V.: Explainable deep learning models in medical image analysis, https://arxiv.org/pdf/2005.13799.pdf (2020)
Tan, M., Le, Q.: Efficientnet: rethinking model scaling for convolutional neural networks. In: Proc. Int. Conf. on Machine Learning (ICML), pp. 6105–6114. PMLR (2017)
Trucco, E., MacGillivray, T.J., Xu, Y.W.: Computational Retinal Image Analysis. Academic Press, ISBN 9780081028162 (2019)
Welikala, R.A., Foster, P.J., Whincup, P.H., et al.: Automated arteriole and venule classification using deep learning for retinal images from the UK Biobank cohort. Comput. Biol. Med. 90, 23–32 (2017)
Acknowledgements
This research was funded by the National Institute for Health Research (NIHR) (INSPIRED 16/136/102) using UK aid from the UK Government to support global health research. The views expressed in this publication are those of the author(s) and not necessarily those of the NIHR or the UK Department of Health and Social Care. We would like to thank VAMPIRE and INSPIRED project teams, Computing (SSEN), University of Dundee, especially Muthu Mookiah and Stephen Hogg for relevant, useful discussions.
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Syed, M.G., Doney, A., George, G., Mordi, I., Trucco, E. (2021). Are Cardiovascular Risk Scores from Genome and Retinal Image Complementary? A Deep Learning Investigation in a Diabetic Cohort. In: Fu, H., Garvin, M.K., MacGillivray, T., Xu, Y., Zheng, Y. (eds) Ophthalmic Medical Image Analysis. OMIA 2021. Lecture Notes in Computer Science(), vol 12970. Springer, Cham. https://doi.org/10.1007/978-3-030-87000-3_12
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