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Steven Niederer

Publications and source records attributed to Steven Niederer.

15 recordsLinked to original sources

Multi-Fidelity Gaussian Processes for Translational Modelling of Clinical Outcomes

Bridging the gap between animal and human experiments remains a major challenge in translational medicine, particularly in early drug development. Progress is constrained by financial cost, the difficulty of integrating heterogeneous in vitro and in vivo data, and the desire to reduce the use of animal testing balanced against minimising the risk to human participants. We present a statistical machine learning framework using multi-fidelity Gaussian processes, in which animal studies are considered as lower fidelity but informative approximations to human experiments. This allows cross-species similarities and nonlinear exposure-response relationships to be learned simultaneously, enabling principled extrapolation between species while quantifying uncertainty. By leveraging information from multiple experimental fidelities, our method improves estimation of clinically relevant quantities of interest and supports the replacement, reduction, and refinement of in vivo testing. We first illustrate this approach in a simulated scenario, before validating it on real clinical data. We simulate data for drug-induced QT-interval prolongation, a key cardiac safety assessment required for regulatory approval. This framework provides a probabilistic surrogate capable of integrating in vitro pharmacology, animal experiments and human data within a unified statistical model. Crucially, it achieves this at no additional experimental cost while also enabling transfer learning across compounds. As a result, predictions and uncertainty quantification for new drugs can be generated from in vitro findings alone, providing additional efficiency gains and accelerating decision making. For validation, we use a clinical dataset measuring change in heart rate under autonomic blockade, which represents some of the challenges commonly found in multi-species datasets.

stat.AP

Self-prompting and cross-model consensus enable reproducible data extraction from scientific literature with large language models

Accurately extracting nuanced, contextualized data from research articles is laborious and time intensive. Here, we investigate the performance of frontier, browser-based large language models (LLMs) to extract highly contextualized information. We demonstrate four escalating workflows, 1) given an expert curated prompt and research articles, most frontier LLMs perform well at data extraction, however can struggle with interpreting scientific context and nuance, 2) given simple instructions, LLMs can author their own prompts which were almost as eNective as expert-written prompts, 3) autonomous discovery of research literature was diNicult, agents either missed or hallucinated references, and 4) LLMs can create new datasets from published guidelines that closely match human-expert judges, but still require a human-in-the-loop. Together, these findings define an auditable division of labour in which experts specify the evidence standard, models cross-check repeated extractions and researchers resolve disputed cases, providing a practical route to scaling scientific data curation without relinquishing expert oversight.

cs.AI

Learning a dynamic four-chamber shape model of the human heart for 95,695 UK Biobank participants

The human heart is a sophisticated system composed of four cardiac chambers with distinct shapes, which function in a coordinated manner. Existing shape models of the heart mainly focus on the ventricular chambers and they are derived from relatively small datasets. Here, we present a spatio-temporal (3D+t) statistical shape model of all four cardiac chambers, learnt from a large population of nearly 100,000 participants from the UK Biobank. A deep learning-based pipeline is developed to reconstruct 3D+t four-chamber meshes from the cardiac magnetic resonance images of the UK Biobank imaging population. Based on the reconstructed meshes, a 3D+t statistical shape model is learnt to characterise the shape variations and motion patterns of the four cardiac chambers. We reveal the associations of the four-chamber shape model with demographics, anthropometrics, cardiovascular risk factors, and cardiac diseases. Compared to conventional image-derived phenotypes, we validate that the four-chamber shape-derived phenotypes significantly enhance the performance in downstream tasks, including cardiovascular disease classification and heart age prediction. Furthermore, we demonstrate the effectiveness of shape-derived phenotypes in novel applications such as heart shape retrieval and heart re-identification from longitudinal data. To facilitate future research, we will release the learning-based mesh reconstruction pipeline, the four-chamber cardiac shape model, and return all derived four-chamber meshes to the UK Biobank.

eess.IV

A unified framework for geometry-independent operator learning in cardiac electrophysiology simulations

Learning neural operators on heterogeneous and irregular geometries remains a fundamental challenge, as existing approaches typically rely on structured discretisations or explicit mappings to a shared reference domain. We propose a unified framework for geometry-independent operator learning that reformulates the learning problem in an intrinsic coordinate space defined on the underlying manifold. By expressing both inputs and outputs in this shared coordinate domain, the framework decouples operator learning from mesh discretisation and geometric variability, while preserving meaningful spatial organisation and enabling faithful reconstruction on the original geometry. We demonstrate the framework on cardiac electrophysiology, a particularly challenging setting due to extreme anatomical variability across heart geometries. Leveraging a GPU-accelerated simulation pipeline, we generate large-scale datasets of high-fidelity electrophysiology simulations across diverse patient-specific anatomies and train customised neural operators to predict full-field local activation time maps. The proposed approach outperforms established neural operators on both atrial and ventricular geometries. Beyond cardiac electrophysiology, we further show that the same representation enables operator learning in cardiac biomechanics, a distinct problem involving volumetric deformation, highlighting the generality of the proposed framework. Together, these results establish intrinsic coordinate representations as a principled and extensible pathway for neural operator learning on complex physical systems characterised by heterogeneous geometry.

cs.LG

Multi-Agent Reasoning for Cardiovascular Imaging Phenotype Analysis

Identifying associations between imaging phenotypes, disease risk factors, and clinical outcomes is essential for understanding disease mechanisms. However, traditional approaches rely on human-driven hypothesis testing and selection of association factors, often overlooking complex, non-linear dependencies among imaging phenotypes and other multi-modal data. To address this, we introduce Multi-agent Exploratory Synergy for the Heart (MESHAgents): a framework that leverages large language models as agents to dynamically elicit, surface, and decide confounders and phenotypes in association studies. Specifically, we orchestrate a multi-disciplinary team of AI agents, which spontaneously generate and converge on insights through iterative, self-organizing reasoning. The framework dynamically synthesizes statistical correlations with multi-expert consensus, providing an automated pipeline for phenome-wide association studies (PheWAS). We demonstrate the system's capabilities through a population-based study of imaging phenotypes of the heart and aorta. MESHAgents autonomously uncovered correlations between imaging phenotypes and a wide range of non-imaging factors, identifying additional confounder variables beyond standard demographic factors. Validation on diagnosis tasks reveals that MESHAgents-discovered phenotypes achieve performance comparable to expert-selected phenotypes, with mean AUC differences as small as $-0.004_{\pm0.010}$ on disease classification tasks. Notably, the recall score improves for 6 out of 9 disease types. Our framework provides clinically relevant imaging phenotypes with transparent reasoning, offering a scalable alternative to expert-driven methods.

cs.AI

Cardiac Digital Twins at Scale from MRI: Open Tools and Representative Models from ~55000 UK Biobank Participants

A cardiac digital twin is a virtual replica of a patient's heart for screening, diagnosis, prognosis, risk assessment, and treatment planning of cardiovascular diseases. This requires an anatomically accurate patient-specific 3D structural representation of the heart, suitable for electro-mechanical simulations or study of disease mechanisms. However, generation of cardiac digital twins at scale is demanding and there are no public repositories of models across demographic groups. We describe an automatic open-source pipeline for creating patient-specific left and right ventricular meshes from cardiovascular magnetic resonance images, its application to a large cohort of ~55000 participants from UK Biobank, and the construction of the most comprehensive cohort of adult heart models to date, comprising 1423 representative meshes across sex (male, female), body mass index (range: 16 - 42 kg/m$^2$) and age (range: 49 - 80 years). Our code is available at https://github.com/cdttk/biv-volumetric-meshing/tree/plos2025 , and pre-trained networks, representative volumetric meshes with fibers and UVCs will be made available soon.

eess.IV

In Silico Trials for Sex-Specific patient Inclusion Criteria in Cardiac Resynchronization Therapy: Advancing Precision in Heart Failure Treatment

Cardiac resynchronization therapy (CRT) guidelines are based on clinical trials with limited female representation and inconsistent left bundle branch block (LBBB) definitions. Conventional QRS duration (QRSd) criteria show variable diagnostic accuracy between sexes, partly due to differences in heart size and remodeling. We evaluated the influence of sex, heart size, LBBB, and conduction delay on QRSd and assessed the diagnostic performance of conventional and indexed QRSd criteria using a population-based modelling approach. Simulated QRSd were derived from electrophysiological simulations conducted in 2627 UK Biobank healthy participants and 359 patients with ischemic heart disease, by modelling LBBB and normal activation combined with/without conduction delay. QRSd criteria under-selected LBBB females and over-selected non-LBBB patients. Indexing by LVEDV and LV mass reduced sex disparities but increased the over-selection in non-LBBB patients. Height-indexed QRSd effectively resolved sex differences and maintained low non-LBBB selection rates, demonstrating superior performance and potential for more equitable CRT selection.

physics.med-ph

MorphiNet: A Graph Subdivision Network for Adaptive Bi-ventricle Surface Reconstruction

Cardiac Magnetic Resonance (CMR) imaging is widely used for heart model reconstruction and digital twin computational analysis because of its ability to visualize soft tissues and capture dynamic functions. However, CMR images have an anisotropic nature, characterized by large inter-slice distances and misalignments from cardiac motion. These limitations result in data loss and measurement inaccuracies, hindering the capture of detailed anatomical structures. In this work, we introduce MorphiNet, a novel network that reproduces heart anatomy learned from high-resolution Computed Tomography (CT) images, unpaired with CMR images. MorphiNet encodes the anatomical structure as gradient fields, deforming template meshes into patient-specific geometries. A multilayer graph subdivision network refines these geometries while maintaining a dense point correspondence, suitable for computational analysis. MorphiNet achieved state-of-the-art bi-ventricular myocardium reconstruction on CMR patients with tetralogy of Fallot with 0.3 higher Dice score and 2.6 lower Hausdorff distance compared to the best existing template-based methods. While matching the anatomical fidelity of comparable neural implicit function methods, MorphiNet delivered 50$\times$ faster inference. Cross-dataset validation on the Automated Cardiac Diagnosis Challenge confirmed robust generalization, achieving a 0.7 Dice score with 30\% improvement over previous template-based approaches. We validate our anatomical learning approach through the successful restoration of missing cardiac structures and demonstrate significant improvement over standard Loop subdivision. Motion tracking experiments further confirm MorphiNet's capability for cardiac function analysis, including accurate ejection fraction calculation that correctly identifies myocardial dysfunction in tetralogy of Fallot patients.

eess.IV

ISLES'24: Final Infarct Prediction with Multimodal Imaging and Clinical Data. Where Do We Stand?

Accurate estimation of brain infarction (i.e., irreversibly damaged tissue) is critical for guiding treatment decisions in acute ischemic stroke. Reliable infarct prediction informs key clinical interventions, including the need for patient transfer to comprehensive stroke centers, the potential benefit of additional reperfusion attempts during mechanical thrombectomy, decisions regarding secondary neuroprotective treatments, and ultimately, prognosis of clinical outcomes. This work introduces the Ischemic Stroke Lesion Segmentation (ISLES) 2024 challenge, which focuses on the prediction of final infarct volumes from pre-interventional acute stroke imaging and clinical data. ISLES24 provides a comprehensive, multimodal setting where participants can leverage all clinically and practically available data, including full acute CT imaging, sub-acute follow-up MRI, and structured clinical information, across a train set of 150 cases. On the hidden test set of 98 cases, the top-performing model, a multimodal nnU-Net-based architecture, achieved a Dice score of 0.285 (+/- 0.213) and an absolute volume difference of 21.2 (+/- 37.2) mL, underlining the significant challenges posed by this task and the need for further advances in multimodal learning. This work makes two primary contributions: first, we establish a standardized, clinically realistic benchmark for post-treatment infarct prediction, enabling systematic evaluation of multimodal algorithmic strategies on a longitudinal stroke dataset; second, we analyze current methodological limitations and outline key research directions to guide the development of next-generation infarct prediction models.

eess.IV

The TopCoW Challenge -- Topology-Aware Circle of Willis Segmentation for CT and MR Angiography

The Circle of Willis (CoW) is an important network of arteries connecting major circulations of the brain. Its vascular architecture is believed to influence the risk, severity, and outcome of serious neurovascular diseases. However, characterizing the highly variable CoW anatomy remains a manual and time-consuming expert task. The CoW is commonly imaged by two non-invasive angiographic imaging modalities, magnetic resonance angiography (MRA) and computed tomography angiography (CTA), yet few datasets with annotated CoW anatomy exist, and there have been no established benchmarks for comparing CoW segmentation algorithms. We organized the TopCoW benchmark challenge alongside the release of an annotated CoW dataset with 125 paired MRA and CTA scans from the same patients. Voxel-level annotations for 13 vessel components were created using virtual reality technology and verified by clinical experts. Participants submitted algorithms for CoW segmentation and variant classification, which we evaluated on internal and external test sets comprising 226 scans from over five centers. The benchmark includes voxel-level segmentation, CoW component detection, CoW variant classification, and two clinical application tasks. We received submissions from over 250 participants across six continents. Top-performing teams achieved over 90% Dice scores for CoW segmentation, over 80% F1 scores for detecting key vessel components, and over 70% balanced accuracy in CoW variant classification across nearly all test sets. The best algorithms also supported clinically relevant downstream tasks by accurately classifying fetal-type posterior cerebral arteries and localizing aneurysms in relation to CoW anatomy. This benchmark demonstrated the utility of CoW segmentation algorithms for some downstream clinical applications with explainability.

cs.CV

Real-time whole-heart electromechanical simulations using Latent Neural Ordinary Differential Equations

Cardiac digital twins provide a physics and physiology informed framework to deliver predictive and personalized medicine. However, high-fidelity multi-scale cardiac models remain a barrier to adoption due to their extensive computational costs and the high number of model evaluations needed for patient-specific personalization. Artificial Intelligence-based methods can make the creation of fast and accurate whole-heart digital twins feasible. In this work, we use Latent Neural Ordinary Differential Equations (LNODEs) to learn the temporal pressure-volume dynamics of a heart failure patient. Our surrogate model based on LNODEs is trained from 400 3D-0D whole-heart closed-loop electromechanical simulations while accounting for 43 model parameters, describing single cell through to whole organ and cardiovascular hemodynamics. The trained LNODEs provides a compact and efficient representation of the 3D-0D model in a latent space by means of a feedforward fully-connected Artificial Neural Network that retains 3 hidden layers with 13 neurons per layer and allows for 300x real-time numerical simulations of the cardiac function on a single processor of a standard laptop. This surrogate model is employed to perform global sensitivity analysis and robust parameter estimation with uncertainty quantification in 3 hours of computations, still on a single processor. We match pressure and volume time traces unseen by the LNODEs during the training phase and we calibrate 4 to 11 model parameters while also providing their posterior distribution. This paper introduces the most advanced surrogate model of cardiac function available in the literature and opens new important venues for parameter calibration in cardiac digital twins.

math.NA

Evaluation of an Open-Source Pipeline to Create Patient-Specific Left Atrial Models: A Reproducibility Study

We present an open-source software pipeline to create patient-specific left atrial (LA) models with fibre orientations and a fibrosis map, suitable for electrophysiology simulations. The semi-automatic pipeline takes as input a contrast enhanced magnetic resonance angiogram, and a late gadolinium enhanced (LGE) contrast magnetic resonance (CMR). Five operators were allocated 20 cases each from a set of 50 CMR datasets to create a total of 100 models to evaluate inter/intra-operator variability. Each output model consisted of (1) a labelled surface mesh open at the pulmonary veins (PV) and mitral valve (MV), (2) fibre orientations mapped from a diffusion tensor MRI human atlas, (3) fibrosis map from the LGE-CMR scan, and (4) simulation of local activation time (LAT) and phase singularity (PS) mapping. We evaluated reproducibility in our pipeline by comparing agreement in shape of the output meshes, fibrosis distribution in the LA body, and fibre orientations; simulations outputs were evaluated comparing total activation times of LAT maps, mean conduction velocity (CV), and structural similarity index measure (SSIM) of PS maps. Our workflow allows a single model to be created in 16.72 +/- 12.25 minutes. Results in this abstract are reported as inter/intra. Shape only differed noticeably with users' selection of the MV and the length of the PV from the ostia to the distal end; fibrosis agreement (0.91/0.99 ICC) and fibre orientation agreement (60.63/71.77 %) were high. LAT maps showed good agreement, the median of the absolute difference of the total activation times was 2.02ms/1.37ms. The average of the mean CV difference was -4.04mm/s / 2.1mm/s. PS maps showed a moderately good agreement with SSIM of 0.648/0.608. Although we found notable differences in the models due to user input, our tests show that operator variability was comparable to that of image resolution or fibre estimation.

physics.med-ph

Global Sensitivity Analysis of Four Chamber Heart Hemodynamics Using Surrogate Models

Computational Fluid Dynamics (CFD) is used to assist in designing artificial valves and planning procedures, focusing on local flow features. However, assessing the impact on overall cardiovascular function or predicting longer-term outcomes may require more comprehensive whole heart CFD models. Fitting such models to patient data requires numerous computationally expensive simulations, and depends on specific clinical measurements to constrain model parameters, hampering clinical adoption. Surrogate models can help to accelerate the fitting process while accounting for the added uncertainty. We create a validated patient-specific four-chamber heart CFD model based on the Navier-Stokes-Brinkman (NSB) equations and test Gaussian Process Emulators (GPEs) as a surrogate model for performing a variance-based global sensitivity analysis (GSA). GSA identified preload as the dominant driver of flow in both the right and left side of the heart, respectively. Left-right differences were seen in terms of vascular outflow resistances, with pulmonary artery resistance having a much larger impact on flow than aortic resistance. Our results suggest that GPEs can be used to identify parameters in personalized whole heart CFD models, and highlight the importance of accurate preload measurements.

physics.flu-dyn

On the Incorporation of Obstacles in a Fluid Flow Problem Using a Navier-Stokes-Brinkman Penalization Approach

Simulating the interaction of fluids with immersed moving solids is playing an important role for gaining a better quantitative understanding of how fluid dynamics is altered by the presence of obstacles and which forces are exerted on the solids by the moving fluid. Such problems appear in various contexts, ranging from numerous technical applications such as turbines to medical problems such as the regulation of hemodyamics by valves. Typically, the numerical treatment of such problems is posed within a fluid structure interaction (FSI) framework. General FSI models are able to capture bidirectional interactions, but are challenging to solve and computationally expensive. Simplified methods offer a possible remedy by achieving better computational efficiency to broaden the scope to demanding application problems with focus on understanding the effect of solids on altering fluid dynamics. In this study we report on the development of a novel method for such applications. In our method rigid moving obstacles are incorporated in a fluid dynamics context using concepts from porous media theory. Based on the Navier-Stokes-Brinkman equations which augments the Navier-Stokes equation with a Darcy drag term our method represents solid obstacles as time-varying regions containing a porous medium of vanishing permeability. Numerical stabilization and turbulence modeling is dealt with by using a residual based variational multiscale formulation. The key advantages of our approach -- computational efficiency and ease of implementation -- are demonstrated by solving a standard benchmark problem of a rotating blood pump posed by the Food and Drug Administration Agency (FDA). Validity is demonstrated by conducting a mesh convergence study and by comparison against the extensive set of experimental data provided for this benchmark.

physics.flu-dyn

Probabilistic Models for Integration Error in the Assessment of Functional Cardiac Models

This paper studies the numerical computation of integrals, representing estimates or predictions, over the output $f(x)$ of a computational model with respect to a distribution $p(\mathrm{d}x)$ over uncertain inputs $x$ to the model. For the functional cardiac models that motivate this work, neither $f$ nor $p$ possess a closed-form expression and evaluation of either requires $\approx$ 100 CPU hours, precluding standard numerical integration methods. Our proposal is to treat integration as an estimation problem, with a joint model for both the a priori unknown function $f$ and the a priori unknown distribution $p$. The result is a posterior distribution over the integral that explicitly accounts for dual sources of numerical approximation error due to a severely limited computational budget. This construction is applied to account, in a statistically principled manner, for the impact of numerical errors that (at present) are confounding factors in functional cardiac model assessment.

stat.ME