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Gurnani M, Patlatzoglou K, Barker J, Bivona D, Pastika L, Sieliwonczyk E, Zeidaabadi B, Inglese P, Curran L, Arnold AD, O'Regan D, Whinnett Z, Bilchick KC, Peters NS, Kramer DB, Waks JW, Sau A, Ng FS. Revisiting Abnormalities of Ventricular Depolarization: Redefining Phenotypes and Associated Outcomes Using Tree-Based Dimensionality Reduction. J Am Heart Assoc 2025:e040814. [PMID: 40530476 DOI: 10.1161/jaha.124.040814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2025] [Accepted: 05/14/2025] [Indexed: 06/20/2025]
Abstract
BACKGROUND Abnormal ventricular depolarization, evident as a broad QRS complex on an ECG, is traditionally categorized into left bundle-branch block (LBBB) and right bundle-branch block or nonspecific intraventricular conduction delay. This categorization, although physiologically accurate, may fail to capture the nuances of diseases subtypes. METHODS We used unsupervised machine learning to identify and characterize novel broad QRS phenogroups. First, we trained a variational autoencoder on 1.1 million ECGs and discovered 51 latent features that showed high disentanglement and ECG reconstruction accuracy. We then extracted these features from 42 538 ECGs with QRS durations >120 milliseconds and employed a reversed graph embedding method to model population heterogeneity as a tree structure with different branches representing phenogroups. RESULTS Six phenogroups were identified, including phenogroups of right bundle-branch block and LBBB with varying risk of cardiovascular disease and mortality. The higher risk right bundle-branch block phenogroup exhibited increased risk of cardiovascular death (adjusted hazard ratio [aHR], 1.46 [1.30-1.63], P<0.0001) and all-cause mortality (aHR, 1.24 [1.16-1.33], P<0.0001) compared with the baseline phenogroup. Within LBBB ECGs, tree position predicted future cardiovascular disease risk differentially. Additionally, for subjects with LBBB undergoing cardiac resynchronization therapy, tree position predicted cardiac resynchronization therapy response independent of covariates, including QRS duration (adjusted odds ratio [aOR], 0.47 [0.25-0.86], P<0.05). CONCLUSIONS Our findings challenge the current paradigm, highlighting the potential for these phenogroups to enhance cardiac resynchronization therapy patient selection for subjects with LBBB and guide investigation and follow-up strategies for subjects with higher risk right bundle-branch block.
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Affiliation(s)
- Mehak Gurnani
- National Heart and Lung Institute, Imperial College London London UK
| | | | - Joseph Barker
- National Heart and Lung Institute, Imperial College London London UK
| | - Derek Bivona
- Department of Biomedical Engineering University of Virginia Charlottesville VA USA
| | - Libor Pastika
- National Heart and Lung Institute, Imperial College London London UK
| | - Ewa Sieliwonczyk
- National Heart and Lung Institute, Imperial College London London UK
- MRC Laboratory of Medical Sciences Imperial College London London UK
- University of Antwerp and Antwerp University Hospital Antwerp Belgium
| | | | | | - Lara Curran
- MRC Laboratory of Medical Sciences Imperial College London London UK
| | - Ahran D Arnold
- National Heart and Lung Institute, Imperial College London London UK
- Department of Cardiology Imperial College Healthcare NHS Trust London UK
| | - Declan O'Regan
- MRC Laboratory of Medical Sciences Imperial College London London UK
| | - Zachary Whinnett
- National Heart and Lung Institute, Imperial College London London UK
- Department of Cardiology Imperial College Healthcare NHS Trust London UK
| | - Kenneth C Bilchick
- Department of Medicine University of Virginia Health System Charlottesville VA USA
| | - Nicholas S Peters
- National Heart and Lung Institute, Imperial College London London UK
- Department of Cardiology Imperial College Healthcare NHS Trust London UK
| | - Daniel B Kramer
- Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Beth Israel Deaconess Medical Center Harvard Medical School Boston MA USA
| | - Jonathan W Waks
- Harvard-Thorndike Electrophysiology Institute, Beth Israel Deaconess Medical Center Harvard Medical School Boston MA USA
| | - Arunashis Sau
- National Heart and Lung Institute, Imperial College London London UK
- Department of Cardiology Imperial College Healthcare NHS Trust London UK
| | - Fu Siong Ng
- National Heart and Lung Institute, Imperial College London London UK
- Department of Cardiology Imperial College Healthcare NHS Trust London UK
- Department of Cardiology Chelsea and Westminster Hospital NHS Foundation Trust London UK
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Tian F, Hu C, Liu W, Zhang B, Chen H, Shu X. Noninvasive Right Ventricular Myocardial Work by Pressure-Strain Loop: A New Perspective on Right Ventricular Function and Cardiac Resynchronization Therapy. Am J Cardiol 2025; 252:8-15. [PMID: 40414269 DOI: 10.1016/j.amjcard.2025.05.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2025] [Revised: 04/25/2025] [Accepted: 05/21/2025] [Indexed: 05/27/2025]
Abstract
Myocardial work (MW) by noninvasive pressure-strain loop (PSL) is a novel echocardiographic tool that provides a more precise estimation of right ventricular (RV) performance by accounting for the RV loading conditions. The study sought to investigate the impact of cardiac resynchronization therapy (CRT) on RV function and explore the role of RV MW indices in predicting CRT response. Ninety-one CRT-candidates were prospectively enrolled. Left ventricular (LV) MW parameters, RV global longitudinal strain (RV GLS) and RV free wall strain (RV FWS) were obtained. RV MW indices, including RV global work index (RV GWI), RV global constructive work (RV GCW), RV global wasted work (RV GWW), and RV global work efficiency (RV GWE), were measured by PSL analysis. Response to CRT was defined as a reduction in left ventricular end-systolic volume of ≥15% at follow-up. RV GWI significantly increased in responders. CRT caused significant improvements in RV GWI, RV GCW, and RV GWE (p <0.05). In multivariate analysis, RV GWI (adjusted odds ratio (OR): 1.010; 95% CI: 1.003 to 1.017; p <0.05), and LV GCW (adjusted OR: 1.002; 95% CI: 1.000 to 1.003; p <0.05) were associated with CRT response. Adding RV GWI to the basal model yielded a significant improvement in continuous net reclassification improvement at 0.284 (p = 0.032), while other function parameters failed to improve reclassification. RV MW indices provide a new reference for the quantitative evaluation of RV myocardial performance before and after CRT. Although both RV GWI and LV GCW have prognostic value, RV GWI may better predict the response to CRT.
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Affiliation(s)
- Fangyan Tian
- Department of Ultrasound Medicine, The Affiliated Hospital of Guizhou Medical University, Guiyang, China; Department of Echocardiography, Shanghai Institute of Medical Imaging, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Chunqiang Hu
- Department of Echocardiography, Shanghai Institute of Medical Imaging, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Wen Liu
- Department of Echocardiography, Shanghai Institute of Medical Imaging, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Bei Zhang
- Department of Ultrasound Medicine, The Affiliated Hospital of Guizhou Medical University, Guiyang, China
| | - Haiyan Chen
- Department of Echocardiography, Shanghai Institute of Medical Imaging, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Xianhong Shu
- Department of Echocardiography, Shanghai Institute of Medical Imaging, Zhongshan Hospital, Fudan University, Shanghai, China.
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Curtis E, Lemarchand L, Lee KC, Galli E, L'Official G, Auffret V, Leurent G, Oger E, Donal E. Right atrial and right ventricular strain: prognostic value depends on the severity of tricuspid regurgitation. Eur Heart J Cardiovasc Imaging 2024; 25:1734-1742. [PMID: 39012790 DOI: 10.1093/ehjci/jeae182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2024] [Revised: 01/31/2024] [Accepted: 06/17/2024] [Indexed: 07/18/2024] Open
Abstract
AIMS Assessing right heart function is challenging, particularly when significant tricuspid regurgitation (TR) is present. Amongst available echocardiographic techniques for assessment, literatures suggest that strain imaging may be more reliable and less susceptible to loading conditions. Thus, we aimed to assess the validity of right atrial (RA) and right ventricular (RV) strain relative to conventional metrics as well as their utility in predicting patient outcomes in TR. METHODS AND RESULTS We studied 262 consecutive patients (mean age 74 ± 11.2 years, 53% male) who underwent same-day echocardiography and right heart catheterization between 2018 and 2023. We compared right heart strain to traditional metrics of RV function and subsequently correlated RA and RV strain to heart failure (HF)-related death or hospitalization, whichever came first. Over a mean follow-up of 34 ± 15 months, there were 103 deaths and HF hospitalizations. Both RA strain and RV strain were correlated with echocardiographic and invasive measures of right heart function. Across all patients, preserved RA strain was associated with lower risk of adverse outcomes [hazard ratio (HR) 0.763, 95% confidence interval (CI) 0.618-0.943]. Similarly, preserved RV strain was correlated with better outcomes, although this was only statistically significant in patients without severe TR or pulmonary hypertension (HR 2.450, 95% CI 1.244-4.825). Moreover, abnormal ratios of RV strain to pulmonary pressures and RV size were significantly correlated with adverse outcomes (P < 0.05 each). CONCLUSION RA and RV strain are independently correlated with echocardiographic and invasive measures of cardiac function. Moreover, preserved RA and RV strain is likely associated with better clinical outcomes.
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Affiliation(s)
- Elizabeth Curtis
- Cardiology, University of Rennes, CHU Rennes, Inserm, LTSI - UMR 1099, 2 Rue Henri le Guilloux, F-35000 Rennes, France
| | - Léo Lemarchand
- Cardiology, University of Rennes, CHU Rennes, Inserm, LTSI - UMR 1099, 2 Rue Henri le Guilloux, F-35000 Rennes, France
| | - K Charlotte Lee
- Perelman School of Medicine, University of Pennsylvania, 3400 Civic Center Boulevard, Philadelphia 19104, PA, USA
| | - Elena Galli
- Cardiology, University of Rennes, CHU Rennes, Inserm, LTSI - UMR 1099, 2 Rue Henri le Guilloux, F-35000 Rennes, France
| | - Guillaume L'Official
- Cardiology, University of Rennes, CHU Rennes, Inserm, LTSI - UMR 1099, 2 Rue Henri le Guilloux, F-35000 Rennes, France
| | - Vincent Auffret
- Cardiology, University of Rennes, CHU Rennes, Inserm, LTSI - UMR 1099, 2 Rue Henri le Guilloux, F-35000 Rennes, France
| | - Guillaume Leurent
- Cardiology, University of Rennes, CHU Rennes, Inserm, LTSI - UMR 1099, 2 Rue Henri le Guilloux, F-35000 Rennes, France
| | - Emmanuel Oger
- Clinical Section of Fundamental and Clinical Pharmacology, CHU Rennes, University of Rennes, 2 Rue du Thabor, Rennes, France
| | - Erwan Donal
- Cardiology, University of Rennes, CHU Rennes, Inserm, LTSI - UMR 1099, 2 Rue Henri le Guilloux, F-35000 Rennes, France
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Taconné M, Le Rolle V, Galli E, Owashi KP, Al Wazzan A, Donal E, Hernández A. Characterization of cardiac resynchronization therapy response through machine learning and personalized models. Comput Biol Med 2024; 180:108986. [PMID: 39142225 DOI: 10.1016/j.compbiomed.2024.108986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2024] [Revised: 07/25/2024] [Accepted: 08/02/2024] [Indexed: 08/16/2024]
Abstract
INTRODUCTION The characterization and selection of heart failure (HF) patients for cardiac resynchronization therapy (CRT) remain challenging, with around 30% non-responder rate despite following current guidelines. This study aims to propose a novel hybrid approach, integrating machine-learning and personalized models, to identify explainable phenogroups of HF patients and predict their CRT response. METHODS The paper proposes the creation of a complete personalized model population based on preoperative CRT patient strain curves. Based on the parameters and features extracted from these personalized models, phenotypes of patients are identified thanks to a clustering algorithm and a random forest classification is provided. RESULTS A close match was observed between the 162 experimental and simulated myocardial strain curves, with a mean RMSE of 4.48% (±1.08) for the 162 patients. Five phenogroups of personalized models were identified from the clustering, with response rates ranging from 52% to 94%. The classification results show a mean area under the curves (AUC) of 0.86 ± 0.06 and provided a feature importance analysis with 22 features selected. Results show both regional myocardial contractility (from 22.5% to 33.0%), tissue viability and electrical activation delays importance on CRT response for each HF patient (from 55.8 ms to 88.4 ms). DISCUSSION The patient-specific model parameters' analysis provides an explainable interpretation of HF patient phenogroups in relation to physiological mechanisms that seem predictive of the CRT response. These novel combined approaches appear as promising tools to improve understanding of LV mechanical dyssynchrony for HF patient characterization and CRT selection.
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Affiliation(s)
- Marion Taconné
- Univ Rennes, CHU Rennes, Inserm, LTSI - UMR 1099, Rennes, France.
| | | | - Elena Galli
- Univ Rennes, CHU Rennes, Inserm, LTSI - UMR 1099, Rennes, France
| | - Kimi P Owashi
- Univ Rennes, CHU Rennes, Inserm, LTSI - UMR 1099, Rennes, France
| | - Adrien Al Wazzan
- Univ Rennes, CHU Rennes, Inserm, LTSI - UMR 1099, Rennes, France
| | - Erwan Donal
- Univ Rennes, CHU Rennes, Inserm, LTSI - UMR 1099, Rennes, France
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Nazar W, Szymanowicz S, Nazar K, Kaufmann D, Wabich E, Braun-Dullaeus R, Daniłowicz-Szymanowicz L. Artificial intelligence models in prediction of response to cardiac resynchronization therapy: a systematic review. Heart Fail Rev 2024; 29:133-150. [PMID: 37861853 PMCID: PMC10904439 DOI: 10.1007/s10741-023-10357-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/28/2023] [Indexed: 10/21/2023]
Abstract
The aim of the presented review is to summarize the literature data on the accuracy and clinical applicability of artificial intelligence (AI) models as a valuable alternative to the current guidelines in predicting cardiac resynchronization therapy (CRT) response and phenotyping of patients eligible for CRT implantation. This systematic review was performed according to the PRISMA guidelines. After a search of Scopus, PubMed, Cochrane Library, and Embase databases, 675 records were identified. Twenty supervised (prediction of CRT response) and 9 unsupervised (clustering and phenotyping) AI models were analyzed qualitatively (22 studies, 14,258 patients). Fifty-five percent of AI models were based on retrospective studies. Unsupervised AI models were able to identify clusters of patients with significantly different rates of primary outcome events (death, heart failure event). In comparison to the guideline-based CRT response prediction accuracy of 70%, supervised AI models trained on cohorts with > 100 patients achieved up to 85% accuracy and an AUC of 0.86 in their prediction of response to CRT for echocardiographic and clinical outcomes, respectively. AI models seem to be an accurate and clinically applicable tool in phenotyping of patients eligible for CRT implantation and predicting potential responders. In the future, AI may help to increase CRT response rates to over 80% and improve clinical decision-making and prognosis of the patients, including reduction of mortality rates. However, these findings must be validated in randomized controlled trials.
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Affiliation(s)
- Wojciech Nazar
- Faculty of Medicine, Medical University of Gdańsk, Marii Skłodowskiej-Curie 3a, 80-210, Gdańsk, Poland
| | | | - Krzysztof Nazar
- Faculty of Electronics, Telecommunications and Informatics, Gdańsk University of Technology, Gabriela Narutowicza 11/12, 80-233, Gdańsk, Poland
| | - Damian Kaufmann
- Department of Cardiology and Electrotherapy, Faculty of Medicine, Medical University of Gdańsk, Smoluchowskiego 17, 80-213, Gdańsk, Poland
| | - Elżbieta Wabich
- Department of Cardiology and Electrotherapy, Faculty of Medicine, Medical University of Gdańsk, Smoluchowskiego 17, 80-213, Gdańsk, Poland
| | - Rüdiger Braun-Dullaeus
- Department of Cardiology and Angiology, Otto von Guericke University Magdeburg, Leipziger Street 44, 39120, Magdeburg, Germany
| | - Ludmiła Daniłowicz-Szymanowicz
- Department of Cardiology and Electrotherapy, Faculty of Medicine, Medical University of Gdańsk, Smoluchowskiego 17, 80-213, Gdańsk, Poland.
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Vidal-Perez R, Grapsa J, Bouzas-Mosquera A, Fontes-Carvalho R, Vazquez-Rodriguez JM. Current role and future perspectives of artificial intelligence in echocardiography. World J Cardiol 2023; 15:284-292. [PMID: 37397831 PMCID: PMC10308270 DOI: 10.4330/wjc.v15.i6.284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 05/02/2023] [Accepted: 06/21/2023] [Indexed: 06/26/2023] Open
Abstract
Echocardiography is an essential tool in diagnostic cardiology and is fundamental to clinical care. Artificial intelligence (AI) can help health care providers serving as a valuable diagnostic tool for physicians in the field of echocardiography specially on the automation of measurements and interpretation of results. In addition, it can help expand the capabilities of research and discover alternative pathways in medical management specially on prognostication. In this review article, we describe the current role and future perspectives of AI in echocardiography.
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Affiliation(s)
- Rafael Vidal-Perez
- Servicio de Cardiología, Unidad de Imagen y Función Cardíaca, Complexo Hospitalario Universitario A Coruña Centro de Investigación Biomédica en Red-Instituto de Salud Carlos III, A Coruña 15006, Spain.
| | - Julia Grapsa
- Department of Cardiology, Guys and St Thomas NHS Trust, London SE1 7EH, United Kingdom
| | - Alberto Bouzas-Mosquera
- Servicio de Cardiología, Unidad de Imagen y Función Cardíaca, Complexo Hospitalario Universitario A Coruña Centro de Investigación Biomédica en Red-Instituto de Salud Carlos III, A Coruña 15006, Spain
| | - Ricardo Fontes-Carvalho
- Cardiology Department, Centro Hospitalar de Vila Nova de Gaia/Espinho, Vilanova de Gaia 4434-502, Portugal
- Cardiovascular R&D Centre - UnIC@RISE, Department of Surgery and Physiology, Faculty of Medicine of the University of Porto, Porto 4200-319, Portugal
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Galli E, Galand V, Le Rolle V, Taconne M, Wazzan AA, Hernandez A, Leclercq C, Donal E. The saga of dyssynchrony imaging: Are we getting to the point. Front Cardiovasc Med 2023; 10:1111538. [PMID: 37063957 PMCID: PMC10103462 DOI: 10.3389/fcvm.2023.1111538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Accepted: 02/27/2023] [Indexed: 04/03/2023] Open
Abstract
Cardiac resynchronisation therapy (CRT) has an established role in the management of patients with heart failure, reduced left ventricular ejection fraction (LVEF < 35%) and widened QRS (>130 msec). Despite the complex pathophysiology of left ventricular (LV) dyssynchrony and the increasing evidence supporting the identification of specific electromechanical substrates that are associated with a higher probability of CRT response, the assessment of LVEF is the only imaging-derived parameter used for the selection of CRT candidates.This review aims to (1) provide an overview of the evolution of cardiac imaging for the assessment of LV dyssynchrony and its role in the selection of patients undergoing CRT; (2) highlight the main pitfalls and advantages of the application of cardiac imaging for the assessment of LV dyssynchrony; (3) provide some perspectives for clinical application and future research in this field.Conclusionthe road for a more individualized approach to resynchronization therapy delivery is open and imaging might provide important input beyond the assessment of LVEF.
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Galli E, Baritussio A, Sitges M, Donnellan E, Jaber WA, Gimelli A. Multi-modality imaging to guide the implantation of cardiac electronic devices in heart failure: is the sum greater than the individual components? Eur Heart J Cardiovasc Imaging 2023; 24:163-176. [PMID: 36458875 DOI: 10.1093/ehjci/jeac237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Accepted: 11/03/2022] [Indexed: 12/05/2022] Open
Abstract
Heart failure is a clinical syndrome with an increasing prevalence and incidence worldwide that impacts patients' quality of life, morbidity, and mortality. Implantable cardioverter-defibrillator and cardiac resynchronization therapy are pillars of managing patients with HF and reduced left ventricular ejection fraction. Despite the advances in cardiac imaging, the assessment of patients needing cardiac implantable electronic devices relies essentially on the measure of left ventricular ejection fraction. However, multi-modality imaging can provide important information concerning the aetiology of heart failure, the extent and localization of myocardial scar, and the pathophysiological mechanisms of left ventricular conduction delay. This paper aims to highlight the main novelties and progress in the field of multi-modality imaging to identify patients who will benefit from cardiac resynchronization therapy and/or implantable cardioverter-defibrillator. We also want to underscore the boundaries that prevent the application of imaging-derived parameters to patients who will benefit from cardiac implantable electronic devices and orient the choice of the device. Finally, we aim at providing some reflections for future research in this field.
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Affiliation(s)
- Elena Galli
- Department of Cardiology, University Hospital of Rennes, 35000 Rue Henri Le Guilloux, Rennes, France
| | - Anna Baritussio
- Cardiology, Department of Cardiac, Vascular, Thoracic Sciences and Public Health, University Hospital of Padua, 35121 Via Nicolò Giustiniani, Padua, Italy
| | - Marta Sitges
- Cardiovascular Institute, Hospital Clínic, Universitat de Barcelona, 08036 C. de Villarroel, Barcelona, Spain
| | - Eoin Donnellan
- Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA
| | - Wael A Jaber
- Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA
| | - Alessia Gimelli
- Fondazione Toscana G. Monasterio, 56124 Via Giuseppe Moruzzi, Pisa, Italy
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Chen D, Guo J, Liu B, Zheng C, Huang G, Huang L, Zhang H, Luo Y, Wei D. Reference values and the Z-score values of tricuspid annular plane systolic excursion in Chinese children. THE INTERNATIONAL JOURNAL OF CARDIOVASCULAR IMAGING 2022; 38:2117-2125. [PMID: 37726460 DOI: 10.1007/s10554-022-02624-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 04/17/2022] [Indexed: 11/05/2022]
Abstract
To establish age-specific and body surface area (BSA)-specific reference values of Tricuspid Annular Plane Systolic Excursion (TAPSE) for children under 15 years old in China. A retrospective study was conducted in Children's Hospital Attached to the Capital Institute of Pediatrics. A total of 702 cases were included in this research to establish reference values of TAPSE in Chinese children. SPSS 25.0 (IBM) was used for data analysis. Lambda-mu-sigma method was used to calculate and construct the age-specific and BSA-specific percentiles and Z-score curves of TAPSE. The mean value of TAPSE increased with age and BSA from 0 to 15 years in a nonlinear way and reached the adult threshold (17 mm) until 1 year old. There was no difference between genders. TAPSE values increased with age and BSA in Chinese children aged between 0 and 15 years and there was no difference between boys and girls. A prospective, multicenter cohort study from different parts of China is supposed to be conducted in the future to reflect the whole spectrum of TAPSE in Chinese children.
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Affiliation(s)
- Danlei Chen
- Department of Cardiac Intensive Care Unit, Children's Hospital Attached to the Capital Institute of Pediatrics, Beijing, China
| | - Jinghui Guo
- Department of Pediatric Cardiology, Children's Hospital Attached to the Capital Institute of Pediatrics, Beijing, China
| | - Bo Liu
- Department of Pediatric Cardiology, Children's Hospital Attached to the Capital Institute of Pediatrics, Beijing, China
| | - Chunhua Zheng
- Department of Pediatric Cardiology, Children's Hospital Attached to the Capital Institute of Pediatrics, Beijing, China
| | - Guimin Huang
- Department of Epidemiology, Capital Institute of Pediatrics, Beijing, China
| | - Liyi Huang
- Department of Cardiac Intensive Care Unit, Children's Hospital Attached to the Capital Institute of Pediatrics, Beijing, China
| | - Hui Zhang
- Department of Cardiac Surgery, Children's Hospital Attached to the Capital Institute of Pediatrics, Beijing, China
| | - Yi Luo
- Department of Cardiac Surgery, Children's Hospital Attached to the Capital Institute of Pediatrics, Beijing, China
| | - Dan Wei
- Department of Cardiac Intensive Care Unit, Children's Hospital Attached to the Capital Institute of Pediatrics, Beijing, China.
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Gautam N, Ghanta SN, Clausen A, Saluja P, Sivakumar K, Dhar G, Chang Q, DeMazumder D, Rabbat MG, Greene SJ, Fudim M, Al'Aref SJ. Contemporary Applications of Machine Learning for Device Therapy in Heart Failure. JACC. HEART FAILURE 2022; 10:603-622. [PMID: 36049812 DOI: 10.1016/j.jchf.2022.06.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 05/31/2022] [Accepted: 06/16/2022] [Indexed: 06/15/2023]
Abstract
Despite a better understanding of the underlying pathogenesis of heart failure (HF), pharmacotherapy, surgical, and percutaneous interventions do not prevent disease progression in all patients, and a significant proportion of patients end up requiring advanced therapies. Machine learning (ML) is gaining wider acceptance in cardiovascular medicine because of its ability to incorporate large, complex, and multidimensional data and to potentially facilitate the creation of predictive models not constrained by many of the limitations of traditional statistical approaches. With the coexistence of "big data" and novel advanced analytic techniques using ML, there is ever-increasing research into applying ML in the context of HF with the goal of improving patient outcomes. Through this review, the authors describe the basics of ML and summarize the existing published reports regarding contemporary applications of ML in device therapy for HF while highlighting the limitations to widespread implementation and its future promises.
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Affiliation(s)
- Nitesh Gautam
- Department of Internal Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Sai Nikhila Ghanta
- Department of Internal Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Alex Clausen
- Department of Internal Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Prachi Saluja
- Department of Internal Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Kalai Sivakumar
- Division of Cardiology, Department of Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Gaurav Dhar
- Division of Cardiology, Department of Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Qi Chang
- Department of Computer Science, Rutgers University, The State University of New Jersey, Newark, New Jersey, USA
| | | | - Mark G Rabbat
- Department of Cardiology, Loyola University Medical Center, Maywood, Illinois, USA
| | - Stephen J Greene
- Department of Cardiology, Duke University Medical Center, Durham, North Carolina, USA; Duke Clinical Research Institute, Durham, North Carolina, USA
| | - Marat Fudim
- Department of Cardiology, Duke University Medical Center, Durham, North Carolina, USA; Duke Clinical Research Institute, Durham, North Carolina, USA
| | - Subhi J Al'Aref
- Division of Cardiology, Department of Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA.
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Tseng AS, Lopez-Jimenez F, Pellikka PA. Future Guidelines for Artificial Intelligence in Echocardiography. J Am Soc Echocardiogr 2022; 35:878-882. [DOI: 10.1016/j.echo.2022.04.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 04/14/2022] [Accepted: 04/16/2022] [Indexed: 11/28/2022]
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Sade LE, Katz WE. Right Ventricle Deserves More Attention in Transcutaneous Aortic Valve Replacement Patients. J Card Fail 2021; 27:1345-1347. [PMID: 34893203 DOI: 10.1016/j.cardfail.2021.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 04/01/2021] [Indexed: 11/18/2022]
Affiliation(s)
- L Elif Sade
- Department of Cardiology, Baskent University, Ankara, Turkey.
| | - William E Katz
- Heart and Vascular Institute, University of Pittsburgh, Pittsburgh, Pennsylvania
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Prediction of response after cardiac resynchronization therapy with machine learning. Int J Cardiol 2021; 344:120-126. [PMID: 34592246 DOI: 10.1016/j.ijcard.2021.09.049] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 09/05/2021] [Accepted: 09/22/2021] [Indexed: 12/28/2022]
Abstract
AIMS Nearly one third of patients receiving cardiac resynchronization therapy (CRT) suffer non-response. We intend to develop predictive models using machine learning (ML) approaches and easily attainable features before CRT implantation. METHODS AND RESULTS The baseline characteristics of 752 CRT recipients from two hospitals were retrospectively collected. Nine ML predictive models were established, including logistic regression (LR), elastic network (EN), lasso regression (Lasso), ridge regression (Ridge), neural network (NN), support vector machine (SVM), random forest (RF), XGBoost and k-nearest neighbour (k-NN). Sensitivity, specificity, precision, accuracy, F1, log-loss, area under the receiver operating characteristic (AU-ROC), and average precision (AP) of each model were evaluated. AU-ROC was compared between models and the latest guidelines. Six models had an AU-ROC value above 0.75. The LR, EN and Ridge models showed the highest overall predictive power compared with other models with AU-ROC at 0.77. The XGBoost model reached the highest sensitivity at 0.72, while the highest specificity was achieved by Ridge model at 0.92. All ML models achieved higher AU-ROCs that those derived from the latest guidelines (all P < 0.05). The effect size analysis identified left bundle branch block, left ventricular end-systolic diameter, and history of percutaneous coronary intervention as the most crucial predictors of CRT response. An online tool to facilitate the prediction of CRT response is freely available at http://www.crt-response.com/. CONCLUSIONS ML algorithms produced efficient predictive models for evaluation of CRT response with features before implantation. Tools developed accordingly could improve the selection of CRT candidates and reduce the incidence of non-response.
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