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Topological data analysis to identify cardiac resynchronization therapy patients exhibiting benefit from an
Boglárka Veres1, Walter Richard Schwertner1, Márton Tokodi1
1Heart and Vascular Center, Semmelweis University, Városmajor Str. 68, 1122, Budapest, Hungary.
Insights
Topological data analysis identified specific patient groups benefiting from cardiac resynchronization therapy with a defibrillator (CRT-D) over a pacemaker (CRT-P). This approach aids in selecting optimal CRT device therapy for improved survival outcomes.
Area of Science:
- Cardiology
- Medical Data Analysis
- Biostatistics
Background:
- Current guidelines for cardiac resynchronization therapy (CRT) involve multiple factors but struggle to identify patients who will most benefit from CRT with a defibrillator (CRT-D) versus a pacemaker (CRT-P).
- Selecting the optimal CRT device (CRT-D vs. CRT-P) remains a clinical challenge for improving patient survival.
Purpose of the Study:
- To utilize topological data analysis (TDA) for identifying distinct patient phenogroups.
- To determine which phenogroups experience improved survival with CRT-D compared to CRT-P.
Main Methods:
- Analysis of 2603 patients who received CRT-D or CRT-P between 2000 and 2018.
- Application of TDA to a patient similarity network constructed from 25 clinical features.
- Identification and comparison of phenogroup characteristics and survival outcomes.
Main Results:
- TDA revealed five distinct phenogroups based on clinical features and outcomes.
- Phenogroups 2 (non-ischemic etiology) and 5 (ischemic etiology) showed significantly better survival with CRT-D compared to CRT-P.
- Adjusted hazard ratios indicated improved survival for CRT-D in phenogroups 2 (0.61) and 5 (0.84).
Conclusions:
- TDA effectively identifies patient phenogroups, differentiating between ischemic and non-ischemic etiologies.
- This method can guide the selection of CRT-D over CRT-P for patients most likely to benefit, potentially improving survival.
- Simultaneous evaluation of multiple clinical features using TDA enhances personalized CRT device selection.
Background:
Current guidelines recommend considering multiple factors while deciding between cardiac resynchronization therapy with a defibrillator (CRT-D) or a pacemaker (CRT-P). Nevertheless, it is still challenging to pinpoint those candidates who will benefit from choosing a CRT-D device in terms of survival.
Objective:
We aimed to use topological data analysis (TDA) to identify phenogroups of CRT patients in whom CRT-D is associated with better survival than CRT-P.
Methods:
We included 2603 patients who underwent CRT-D (54%) or CRT-P (46%) implantation at Semmelweis University between 2000 and 2018. The primary endpoint was all-cause mortality. We applied TDA to create a patient similarity network using 25 clinical features. Then, we identified multiple phenogroups in the generated network and compared the groups' clinical characteristics and survival.
Results:
Five- and 10-year mortality were 43 (40-46)% and 71 (67-74)% in patients with CRT-D and 48 (45-50)% and 71 (68-74)% in those with CRT-P, respectively. TDA created a circular network in which we could delineate five phenogroups showing distinct patterns of clinical characteristics and outcomes. Three phenogroups (1, 2, and 3) included almost exclusively patients with non-ischemic etiology, whereas the other two phenogroups (4 and 5) predominantly comprised ischemic patients. Interestingly, only in phenogroups 2 and 5 were CRT-D associated with better survival than CRT-P (adjusted hazard ratio 0.61 [0.47-0.80], p < 0.001 and adjusted hazard ratio 0.84 [0.71-0.99], p = 0.033, respectively).
Conclusions:
By simultaneously evaluating various clinical features, TDA may identify patients with either ischemic or non-ischemic etiology who will most likely benefit from the implantation of a CRT-D instead of a CRT-P.
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