{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T12:14:44Z","timestamp":1785413684129,"version":"3.56.0"},"reference-count":21,"publisher":"MDPI AG","issue":"15","license":[{"start":{"date-parts":[[2026,7,24]],"date-time":"2026-07-24T00:00:00Z","timestamp":1784851200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100004587","name":"Institute of Health Carlos III","doi-asserted-by":"publisher","award":["PI23\/01072"],"award-info":[{"award-number":["PI23\/01072"]}],"id":[{"id":"10.13039\/501100004587","id-type":"DOI","asserted-by":"publisher"}]},{"award":["PI23\/01072"],"award-info":[{"award-number":["PI23\/01072"]}],"id":[{"id":"https:\/\/ror.org\/00ca2c886","id-type":"ROR","asserted-by":"publisher"}]},{"name":"Fundaci\u00f3n La Caixa","award":["CI24-10743"],"award-info":[{"award-number":["CI24-10743"]}]},{"name":"Gerencia Regional de Salud de Castilla y Le\u00f3n","award":["GRS2929\/A1\/2023"],"award-info":[{"award-number":["GRS2929\/A1\/2023"]}]},{"award":["GRS2929\/A1\/2023"],"award-info":[{"award-number":["GRS2929\/A1\/2023"]}],"id":[{"id":"https:\/\/ror.org\/04jg27733","id-type":"ROR","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J. Clin. Med.","JCM"],"abstract":"<jats:p>Background\/Objectives: Vegetation length is a guideline-endorsed criterion for surgery in left-sided infective endocarditis (LSIE). However, its measurement is highly variable with crucial implications for decision making. A standardized measurement system would not only facilitate decision making in these patients, but also cutoff-point optimization for improving clinical guidelines. For this purpose, this work introduces an Artificial Intelligence (AI)-based system capable of extracting vegetation length from standard transesophageal echocardiography (TEE). Methods: Five echocardiographers independently measured the vegetation length of 76 vegetations from 67 consecutive patients with LSIE using offline TEE images. The AI-based system was trained on a multicenter registry with 353 patients with LSIE, comprising 282,096 echocardiographic frames annotated by an independent expert. This system was applied to measure vegetation length as an independent observer. The variability and correlation between operators and the system were assessed. Results: Lin\u2019s concordance correlation coefficient between the AI-based system and the mean of the measurements obtained by the echocardiographers was 0.74, comparable to the coefficient obtained between the echocardiographers themselves. Bland\u2013Altman analysis showed a mean difference of \u22121.0 mm between the AI-based system and the mean of the measurements obtained by the echocardiographers. Conclusions: The AI-based system for vegetation measurement demonstrates a high level of correlation and agreement with experts, similar to the concordance between human operators themselves. This level of agreement suggests that the method has the potential to reduce inter-operator variability in the measurement process. Whether AI-based vegetation size improves embolism prediction has to be further investigated.<\/jats:p>","DOI":"10.3390\/jcm15155806","type":"journal-article","created":{"date-parts":[[2026,7,27]],"date-time":"2026-07-27T09:47:41Z","timestamp":1785145661000},"page":"5806","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Standardizing Vegetation Size Measurement in Native Left-Sided Infective Endocarditis Using Artificial Intelligence"],"prefix":"10.3390","volume":"15","author":[{"given":"Daniel","family":"Pinilla-Garc\u00eda","sequence":"first","affiliation":[{"name":"Cardiology, Hospital Cl\u00ednico Universitario de Valladolid, 47003 Valladolid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gonzalo","family":"Cabez\u00f3n-Villalba","sequence":"additional","affiliation":[{"name":"Cardiology, Hospital Cl\u00ednico Universitario de Valladolid, 47003 Valladolid, Spain"},{"name":"Instituto de Investigaci\u00f3n Sanitaria de Valladolid (IBioVALL), 47010 Valladolid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-5153-6268","authenticated-orcid":false,"given":"Luis","family":"Llamas-Fern\u00e1ndez","sequence":"additional","affiliation":[{"name":"Cardiology, Hospital Cl\u00ednico Universitario de Valladolid, 47003 Valladolid, Spain"},{"name":"Centro de Investigaci\u00f3n Biom\u00e9dica en Red de Enfermedades Cardiovasculares (CIBERCV), 28029 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4483-9778","authenticated-orcid":false,"given":"Carlos","family":"Gonz\u00e1lez-Juanatey","sequence":"additional","affiliation":[{"name":"Cardiology, Hospital Universitario Lucus Augusti, 27003 Lugo, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0198-2611","authenticated-orcid":false,"given":"Juan Carlos","family":"L\u00f3pez-Azor","sequence":"additional","affiliation":[{"name":"Cardiology, Hospital Universitario Puerta De Hierro Majadahonda, 28222 Madrid, Spain"},{"name":"Heart Failure and Inherited Cardiac Diseases, Cardiology, Hospital Universitario Puerta De Hierro Majadahonda, 28222 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9544-0508","authenticated-orcid":false,"given":"Carmen","family":"Olmos","sequence":"additional","affiliation":[{"name":"Cardiology, Hospital Cl\u00ednico San Carlos, Instituto de Investigaci\u00f3n Sanitaria del Hospital Cl\u00ednico San Carlos (IdISSC), 28040 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0822-7499","authenticated-orcid":false,"given":"Chiara","family":"Pidone","sequence":"additional","affiliation":[{"name":"Institut de Recerca Germans Trias i Pujol, 08916 Badalona, Spain"},{"name":"Department of Clinical and Molecular Medicine, Sapienza University of Rome, 00185 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Manuel","family":"Anguita-S\u00e1nchez","sequence":"additional","affiliation":[{"name":"Centro de Investigaci\u00f3n Biom\u00e9dica en Red de Enfermedades Cardiovasculares (CIBERCV), 28029 Madrid, Spain"},{"name":"Hospital Universitario Reina Sof\u00eda Cardiolog\u00eda, 14004 C\u00f3rdoba, Spain"},{"name":"Department of Medical and Surgical Sciences, Universidad de C\u00f3rdoba, 14014 C\u00f3rdoba, Spain"},{"name":"UGC Cardiolog\u00eda, Inst. Maimonides de Investigaci\u00f3n Biom\u00e9dica de C\u00f3rdoba, 14004 C\u00f3rdoba, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luis","family":"Mart\u00ednez-Dolz","sequence":"additional","affiliation":[{"name":"Centro de Investigaci\u00f3n Biom\u00e9dica en Red de Enfermedades Cardiovasculares (CIBERCV), 28029 Madrid, Spain"},{"name":"Cardiology, Hospital Universitario y Politecnico La Fe, 46026 Valencia, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2846-5315","authenticated-orcid":false,"given":"Itziar","family":"G\u00f3mez-Salvador","sequence":"additional","affiliation":[{"name":"Cardiology, Hospital Cl\u00ednico Universitario de Valladolid, 47003 Valladolid, Spain"},{"name":"Instituto de Investigaci\u00f3n Sanitaria de Valladolid (IBioVALL), 47010 Valladolid, Spain"},{"name":"Centro de Investigaci\u00f3n Biom\u00e9dica en Red de Enfermedades Cardiovasculares (CIBERCV), 28029 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-6478-262X","authenticated-orcid":false,"given":"Alejandro Manuel","family":"L\u00f3pez-Pena","sequence":"additional","affiliation":[{"name":"Cardiology, Hospital Universitario Lucus Augusti, 27003 Lugo, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Noem\u00ed","family":"Ramos-L\u00f3pez","sequence":"additional","affiliation":[{"name":"Cardiology, Hospital Universitario Puerta De Hierro Majadahonda, 28222 Madrid, Spain"},{"name":"Heart Failure and Inherited Cardiac Diseases, Cardiology, Hospital Universitario Puerta De Hierro Majadahonda, 28222 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-6446-7748","authenticated-orcid":false,"given":"Daniel","family":"G\u00f3mez-Ram\u00edrez","sequence":"additional","affiliation":[{"name":"Cardiology, Hospital Cl\u00ednico San Carlos, Instituto de Investigaci\u00f3n Sanitaria del Hospital Cl\u00ednico San Carlos (IdISSC), 28040 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9841-2737","authenticated-orcid":false,"given":"Victoria","family":"Delgado","sequence":"additional","affiliation":[{"name":"Institut de Recerca Germans Trias i Pujol, 08916 Badalona, Spain"},{"name":"Center of Comparative Medicine and Bioimaging, Institut de Recerca Germans Trias i Pujol, 08916 Badalona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3164-0823","authenticated-orcid":false,"given":"Juan C.","family":"Castillo-Dom\u00ednguez","sequence":"additional","affiliation":[{"name":"Centro de Investigaci\u00f3n Biom\u00e9dica en Red de Enfermedades Cardiovasculares (CIBERCV), 28029 Madrid, Spain"},{"name":"Hospital Universitario Reina Sof\u00eda Cardiolog\u00eda, 14004 C\u00f3rdoba, Spain"},{"name":"Department of Medical and Surgical Sciences, Universidad de C\u00f3rdoba, 14014 C\u00f3rdoba, Spain"},{"name":"UGC Cardiolog\u00eda, Inst. Maimonides de Investigaci\u00f3n Biom\u00e9dica de C\u00f3rdoba, 14004 C\u00f3rdoba, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Raquel","family":"Ladr\u00f3n","sequence":"additional","affiliation":[{"name":"Cardiology, Hospital Cl\u00ednico Universitario de Valladolid, 47003 Valladolid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6268-5928","authenticated-orcid":false,"given":"Jos\u00e9 Francisco","family":"Gil","sequence":"additional","affiliation":[{"name":"Cardiology, Hospital Cl\u00ednico Universitario de Valladolid, 47003 Valladolid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mar\u00eda","family":"de Miguel","sequence":"additional","affiliation":[{"name":"Cardiology, Hospital Cl\u00ednico Universitario de Valladolid, 47003 Valladolid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9450-0887","authenticated-orcid":false,"given":"Teresa","family":"Sevilla","sequence":"additional","affiliation":[{"name":"Cardiology, Hospital Cl\u00ednico Universitario de Valladolid, 47003 Valladolid, Spain"},{"name":"Instituto de Investigaci\u00f3n Sanitaria de Valladolid (IBioVALL), 47010 Valladolid, Spain"},{"name":"Centro de Investigaci\u00f3n Biom\u00e9dica en Red de Enfermedades Cardiovasculares (CIBERCV), 28029 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ana","family":"Revilla-Orodea","sequence":"additional","affiliation":[{"name":"Cardiology, Hospital Cl\u00ednico Universitario de Valladolid, 47003 Valladolid, Spain"},{"name":"Instituto de Investigaci\u00f3n Sanitaria de Valladolid (IBioVALL), 47010 Valladolid, Spain"},{"name":"Centro de Investigaci\u00f3n Biom\u00e9dica en Red de Enfermedades Cardiovasculares (CIBERCV), 28029 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6193-629X","authenticated-orcid":false,"given":"Javier","family":"L\u00f3pez","sequence":"additional","affiliation":[{"name":"Cardiology, Hospital Cl\u00ednico Universitario de Valladolid, 47003 Valladolid, Spain"},{"name":"Instituto de Investigaci\u00f3n Sanitaria de Valladolid (IBioVALL), 47010 Valladolid, Spain"},{"name":"Centro de Investigaci\u00f3n Biom\u00e9dica en Red de Enfermedades Cardiovasculares (CIBERCV), 28029 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0764-0839","authenticated-orcid":false,"given":"J. Alberto","family":"San Rom\u00e1n","sequence":"additional","affiliation":[{"name":"Cardiology, Hospital Cl\u00ednico Universitario de Valladolid, 47003 Valladolid, Spain"},{"name":"Instituto de Investigaci\u00f3n Sanitaria de Valladolid (IBioVALL), 47010 Valladolid, Spain"},{"name":"Centro de Investigaci\u00f3n Biom\u00e9dica en Red de Enfermedades Cardiovasculares (CIBERCV), 28029 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carlos","family":"Baladr\u00f3n","sequence":"additional","affiliation":[{"name":"Cardiology, Hospital Cl\u00ednico Universitario de Valladolid, 47003 Valladolid, Spain"},{"name":"Instituto de Investigaci\u00f3n Sanitaria de Valladolid (IBioVALL), 47010 Valladolid, Spain"},{"name":"Centro de Investigaci\u00f3n Biom\u00e9dica en Red de Enfermedades Cardiovasculares (CIBERCV), 28029 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,7,24]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"e2326366","DOI":"10.1001\/jamanetworkopen.2023.26366","article-title":"Guidelines for Diagnosis and Management of Infective Endocarditis in Adults: A WikiGuidelines Group Consensus Statement","volume":"6","author":"McDonald","year":"2023","journal-title":"JAMA Netw. Open"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"3948","DOI":"10.1093\/eurheartj\/ehad193","article-title":"2023 ESC Guidelines for the Management of Endocarditis","volume":"44","author":"Delgado","year":"2023","journal-title":"Eur. Heart J."},{"key":"ref_3","first-page":"e72","article-title":"2020 ACC\/AHA Guideline for the Management of Patients with Valvular Heart Disease","volume":"143","author":"Otto","year":"2021","journal-title":"Circulation"},{"key":"ref_4","first-page":"514","article-title":"Assessing and Managing Embolic Risk in Left-Sided Infective Endocarditis","volume":"42","author":"Sevilla","year":"2026","journal-title":"Can. J. Cardiol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"69","DOI":"10.1161\/CIRCULATIONAHA.104.493155","article-title":"Risk of Embolism and Death in Infective Endocarditis: Prognostic Value of Echocardiography: A Prospective Multicenter Study","volume":"112","author":"Thuny","year":"2005","journal-title":"Circulation"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1384","DOI":"10.1016\/j.jacc.2013.07.029","article-title":"Prediction of Symptomatic Embolism in Infective Endocarditis: Construction and Validation of a Risk Calculator in a Multicenter Cohort","volume":"62","author":"Hubert","year":"2013","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"178","DOI":"10.1016\/j.cmi.2018.08.010","article-title":"Clinical and Echocardiographic Predictors of Embolism in Infective Endocarditis: Systematic Review and Meta-Analysis","volume":"25","author":"Yang","year":"2019","journal-title":"Clin. Microbiol. Infect."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"68","DOI":"10.5603\/CJ.a2022.0119","article-title":"Measurement of Vegetations in Infective Endocarditis: An Inaccurate Method to Decide the Therapeutical Approach","volume":"30","author":"Sevilla","year":"2023","journal-title":"Cardiol. J."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"633","DOI":"10.1086\/313753","article-title":"Proposed Modifications to the Duke Criteria for the Diagnosis of Infective Endocarditis","volume":"30","author":"Li","year":"2000","journal-title":"Clin. Infect. Dis."},{"key":"ref_10","doi-asserted-by":"crossref","unstructured":"Pinilla-Garc\u00eda, D., Llamas-Fern\u00e1ndez, L., Olmos, C., Gonz\u00e1lez-Juanatey, C., Pidone, C., Anguita-S\u00e1nchez, M., L\u00f3pez-Azor, J.C., Mart\u00ednez-Dolz, L., G\u00f3mez-Salvador, I., and Carrasco-Moraleja, M. (2025). Automatic Detection of Vegetations with Transesophageal Echocardiography in Infective Endocarditis Using Artificial Intelligence. J. Imaging Inform. Med., in press.","DOI":"10.1007\/s10278-025-01722-0"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"155","DOI":"10.1016\/j.jcm.2016.02.012","article-title":"A Guideline of Selecting and Reporting Intraclass Correlation Coefficients for Reliability Research","volume":"15","author":"Koo","year":"2016","journal-title":"J. Chiropr. Med."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"599","DOI":"10.2307\/2532314","article-title":"Assay Validation Using the Concordance Correlation Coefficient","volume":"48","author":"Lin","year":"1992","journal-title":"Biometrics"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1317","DOI":"10.1016\/j.jacc.2018.12.054","article-title":"Artificial Intelligence in Cardiovascular Imaging: JACC State-of-the-Art Review","volume":"73","author":"Dey","year":"2019","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"109717","DOI":"10.1016\/j.ejrad.2021.109717","article-title":"Artificial Intelligence in Ultrasound","volume":"139","author":"Shen","year":"2021","journal-title":"Eur. J. Radiol."},{"key":"ref_15","doi-asserted-by":"crossref","unstructured":"Yang, R., and Yu, Y. (2021). Artificial Convolutional Neural Network in Object Detection and Semantic Segmentation for Medical Imaging Analysis. Front. Oncol., 11.","DOI":"10.3389\/fonc.2021.638182"},{"key":"ref_16","doi-asserted-by":"crossref","unstructured":"Balasubramani, M., Sung, C.-W., Hsieh, M.-Y., Huang, E.P.-C., Shieh, J.-S., and Abbod, M.F. (2024). Automated Left Ventricle Segmentation in Echocardiography Using YOLO: A Deep Learning Approach for Enhanced Cardiac Function Assessment. Electronics, 13.","DOI":"10.20944\/preprints202405.1196.v1"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"411","DOI":"10.1016\/j.echo.2023.01.006","article-title":"Automated Detection of Aortic Stenosis Using Machine Learning","volume":"36","author":"Wessler","year":"2023","journal-title":"J. Am. Soc. Echocardiogr."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"4053","DOI":"10.1038\/s41598-025-88567-3","article-title":"An Algorithm for Cardiac Disease Detection Based on the Magnetic Resonance Imaging","volume":"15","author":"Li","year":"2025","journal-title":"Sci. Rep."},{"key":"ref_19","unstructured":"Gol Gungor, D., Rao, B., Wolverton, C., and Guracar, I. (2023). View Classification and Object Detection in Cardiac Ultrasound to Localize Valves via Deep Learning. arXiv."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"49455","DOI":"10.31083\/RCM49455","article-title":"Contemporary Transcatheter Approaches to Mitral Regurgitation","volume":"27","author":"Theofilis","year":"2026","journal-title":"Rev. Cardiovasc. Med."},{"key":"ref_21","doi-asserted-by":"crossref","unstructured":"Iliakis, P., Dimitriadis, K., Pyrpyris, N., Beneki, E., Theofilis, P., Tsioufis, P., Kamperidis, V., Aznaouridis, K., Aggeli, K., and Tsioufis, K. (2024). Atrial Functional Mitral Regurgitation: From Diagnosis to Current Interventional Therapies. J. Clin. Med., 13.","DOI":"10.3390\/jcm13175035"}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/15\/5806\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,29]],"date-time":"2026-07-29T04:18:23Z","timestamp":1785298703000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/15\/5806"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,24]]},"references-count":21,"journal-issue":{"issue":"15","published-online":{"date-parts":[[2026,8]]}},"alternative-id":["jcm15155806"],"URL":"https:\/\/doi.org\/10.3390\/jcm15155806","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,24]]}}}