Scar-Aware Late Mechanical Activation Detection Network for Optimal Cardiac Resynchronization Therapy Planning

Accurate identification of late mechanical activation (LMA) regions is crucial for optimal cardiac resynchronization therapy (CRT) lead implantation. However, existing approaches using cardiac magnetic resonance (CMR) imaging often over-look myocardial scar information, which may be mistakenly identified as delayed activation regions. To address this issue, we propose a scar-aware LMA detection network that simultaneously detects myocardial scar and prevents LMA localization in these scarred regions. More specifically, our model integrates a pre-trained scar segmentation network using late gadolinium enhancement (LGE) CMRs into a LMA detection network based on highly accurate strain derived from displacement encoding with stimulated echoes (DENSE) CMRs. We introduce a novel scar-aware loss function that utilizes the segmented scar information to discourage false-positive detections of late activated areas. Our model can be trained with or without paired LGE data. During inference, our model does not require the input of LGE images, leveraging learned patterns from strain data alone to mitigate false-positive LMA detection in potential scar regions. We evaluate our model on subjects with and without myocardial scar, demonstrating significantly improved LMA detection accuracy in both scenarios. Our work paves the way for improved CRT planning, potentially leading to better patient outcomes.