In Heart rhythm O2
Background : Cardiac resynchronization therapy (CRT) response is complex, and better approaches are required to predict survival and need for advanced therapies.
Objective : The objective was to use machine learning to characterize multidimensional CRT response and its relationship with long-term survival.
Methods : Associations of 39 baseline features (including cardiac magnetic resonance [CMR] findings and clinical parameters such as glomerular filtration rate [GFR]) with a multidimensional CRT response vector (consisting of post-CRT left ventricular end-systolic volume index [LVESVI] fractional change, post-CRT B-type natriuretic peptide, and change in peak VO2) were evaluated. Machine learning generated response clusters, and cross-validation assessed associations of clusters with 4-year survival.
Results : Among 200 patients (median age 67.4 years, 27.0% women) with CRT and CMR, associations with more than 1 response parameter were noted for the CMR CURE-SVD dyssynchrony parameter (associated with post-CRT brain natriuretic peptide [BNP] and LVESVI fractional change) and GFR (associated with peak VO2 and post-CRT BNP). Machine learning defined 3 response clusters: cluster 1 (n = 123, 90.2% survival [best]), cluster 2 (n = 45, 60.0% survival [intermediate]), and cluster 3 (n = 32, 34.4% survival [worst]). Adding the 6-month response cluster to baseline features improved the area under the receiver operating characteristic curve for 4-year survival from 0.78 to 0.86 (P = .02). A web-based application was developed for cluster determination in future patients.
Conclusion : Machine learning characterizes distinct CRT response clusters influenced by CMR features, kidney function, and other factors. These clusters have a strong and additive influence on long-term survival relative to baseline features.
Bivona Derek J, Tallavajhala Srikar, Abdi Mohamad, Oomen Pim J A, Gao Xu, Malhotra Rohit, Darby Andrew E, Monfredi Oliver J, Mangrum J Michael, Mason Pamela K, Mazimba Sula, Salerno Michael, Kramer Christopher M, Epstein Frederick H, Holmes Jeffrey W, Bilchick Kenneth C
2022-Oct
Cardiac resynchronization therapy, Heart failure, Implantable cardioverter-defibrillator, Machine learning, Magnetic resonance imaging
