Machine Learning Prediction of Cardiac Resynchronisation Therapy Response From Combination of Clinical and
Svyatoslav Khamzin1, Arsenii Dokuchaev1, Anastasia Bazhutina1,2
1Institute of Immunology and Physiology Ural Branch of the Russian Academy of Sciences, Yekaterinburg, Russia.
Insights
Predicting cardiac resynchronization therapy (CRT) success is challenging. Combining clinical data with computational modeling significantly improves prediction accuracy for CRT outcomes in heart failure patients.
Area of Science:
- Cardiology
- Biomedical Engineering
- Computational Biology
Background:
- Cardiac resynchronization therapy (CRT) is effective for many heart failure patients, but 30-50% do not respond.
- Patient selection and device optimization for CRT remain significant clinical challenges.
Purpose of the Study:
- To develop a predictive model for CRT outcomes.
- To integrate pre-implantation clinical data with personalized cardiac electrophysiology simulations.
Main Methods:
- Utilized retrospective data from 57 CRT patients.
- Created personalized computational heart models from imaging and ECG data.
- Employed machine learning on a hybrid dataset of clinical and simulation-derived biomarkers.
Main Results:
- The best model combining clinical and simulation data achieved an ROC AUC of 0.82.
- This hybrid model outperformed models using only clinical data.
- Key predictors included pacing site proximity to scar tissue and ventricular activation patterns.
Conclusions:
- Integrating computational modeling with clinical data enhances the accuracy of CRT outcome prediction.
- This approach offers a promising strategy for patient stratification and treatment optimization.
Abstract:
Background: Up to 30-50% of chronic heart failure patients who underwent cardiac resynchronization therapy (CRT) do not respond to the treatment. Therefore, patient stratification for CRT and optimization of CRT device settings remain a challenge. Objective: The main goal of our study is to develop a predictive model of CRT outcome using a combination of clinical data recorded in patients before CRT and simulations of the response to biventricular (BiV) pacing in personalized computational models of the cardiac electrophysiology. Materials and Methods: Retrospective data from 57 patients who underwent CRT device implantation was utilized. Positive response to CRT was defined by a 10% increase in the left ventricular ejection fraction in a year after implantation. For each patient, an anatomical model of the heart and torso was reconstructed from MRI and CT images and tailored to ECG recorded in the participant. The models were used to compute ventricular activation time, ECG duration and electrical dyssynchrony indices during intrinsic rhythm and BiV pacing from the sites of implanted leads. For building a predictive model of CRT response, we used clinical data recorded before CRT device implantation together with model-derived biomarkers of ventricular excitation in the left bundle branch block mode of activation and under BiV stimulation. Several Machine Learning (ML) classifiers and feature selection algorithms were tested on the hybrid dataset, and the quality of predictors was assessed using the area under receiver operating curve (ROC AUC). The classifiers on the hybrid data were compared with ML models built on clinical data only. Results: The best ML classifier utilizing a hybrid set of clinical and model-driven data demonstrated ROC AUC of 0.82, an accuracy of 0.82, sensitivity of 0.85, and specificity of 0.78, improving quality over that of ML predictors built on clinical data from much larger datasets by more than 0.1. Distance from the LV pacing site to the post-infarction zone and ventricular activation characteristics under BiV pacing were shown as the most relevant model-driven features for CRT response classification. Conclusion: Our results suggest that combination of clinical and model-driven data increases the accuracy of classification models for CRT outcomes.
