Using Machine-Learning for Prediction of the Response to Cardiac Resynchronization Therapy
| Autor: | Kenneth Stein, Kenneth A. Ellenbogen, Stacey J. Howell, Tim Stivland, Larisa G. Tereshchenko |
|---|---|
| Rok vydání: | 2021 |
| Předmět: |
Elastic net regularization
Receiver operating characteristic business.industry medicine.medical_treatment Cardiac resynchronization therapy Odds ratio medicine.disease Machine learning computer.software_genre Logistic regression Confidence interval Heart failure Clinical endpoint medicine Artificial intelligence business computer |
| Zdroj: | JACC: Clinical Electrophysiology. 7:1505-1515 |
| ISSN: | 2405-500X |
| DOI: | 10.1016/j.jacep.2021.06.009 |
| Popis: | Objectives This study aimed to apply machine learning (ML) to develop a prediction model for short-term cardiac resynchronization therapy (CRT) response to identifying CRT candidates for early multidisciplinary CRT heart failure (HF) care. Background Multidisciplinary optimization of cardiac resynchronization therapy (CRT) delivery can improve long-term CRT outcomes but requires substantial staff resources. Methods Participants from the SMART-AV (SmartDelay-Determined AV Optimization: Comparison of AV Optimization Methods Used in Cardiac Resynchronization Therapy [CRT]) trial (n = 741; age: 66 ± 11 years; 33% female; 100% New York Heart Association HF class III-IV; 100% ejection fraction ≤35%) were randomly split into training/testing (80%; n = 593) and validation (20%; n = 148) samples. Baseline clinical, electrocardiographic, echocardiographic, and biomarker characteristics, and left ventricular (LV) lead position (43 variables) were included in 8 ML models (random forests, convolutional neural network, lasso, adaptive lasso, plugin lasso, elastic net, ridge, and logistic regression). A composite of freedom from death and HF hospitalization and a >15% reduction in LV end-systolic volume index at 6 months after CRT was the end point. Results The primary end point was met by 337 patients (45.5%). The adaptive lasso model was the most more accurate (area under the receiver operating characteristic curve: 0.759; 95% confidence interval [CI]: 0.678-0.840), well calibrated, and parsimonious (19 predictors; nearly half potentially modifiable). Participants in the 5th quintile compared with those in the 1st quintile of the prediction model had 14-fold higher odds of composite CRT response (odds ratio: 14.0; 95% CI: 8.0-14.4). The model predicted CRT response with 70% accuracy, 70% sensitivity, and 70% specificity, and should be further validated in prospective studies. Conclusions ML predicts short-term CRT response and thus may help with CRT procedure and early post-CRT care planning. (SmartDelay-Determined AV Optimization: A Comparison of AV Optimization Methods Used in Cardiac Resynchronization Therapy [CRT] [SMART-AV]; NCT00677014 ) |
| Databáze: | OpenAIRE |
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