A Lung Ultrasound Radiomics-Based Machine Learning Model for Diagnosing Acute Heart Failure in the Emergency Department

<b>Background/Objectives</b>: Acute heart failure (AHF) is a common critical condition in emergency departments, and traditional diagnostic methods have limitations, including high subjectivity and limited accuracy. This study aimed to develop an integrated machine learning model based on lung ultrasound (LUS) radiomics and clinical data for diagnosing AHF in patients presenting with acute dyspnea. <b>Methods</b>: A total of 301 patients were included and randomly split into training (<i>n</i> = 210) and testing (<i>n</i> = 91) sets. Using PyRadiomics 3.0, 107 radiomics features were extracted from standardized 6-zone LUS images, combined with 52 clinical features. Three random forest models were developed: clinical-only, radiomics-only, and integrated models. <b>Results</b>: The integrated model achieved optimal performance on the testing set with an AUC of 0.976 (95% CI: 0.950-0.994), accuracy of 90.1%, sensitivity of 91.1%, and specificity of 89.1%, significantly outperforming the radiomics model (AUC 0.940, <i>p</i> = 0.046) and clinical model (AUC 0.931, <i>p</i> = 0.111). Feature importance analysis revealed that radiomics features contributed 75.6% of the model's predictive power, with gray level run length matrix (GLRLM) features dominating the top-ranked features. <b>Conclusions</b>: As a proof-of-concept study, this research demonstrates the potential value of multimodal data fusion strategies for AHF diagnosis in the emergency department; however, external validation and prospective studies are required to further confirm its clinical applicability.