Phenogrouping and risk stratification of patients undergoing cardiac resynchronization therapy upgrade using topological data analysis.

Publisher: Nature Publishing Group Country of Publication: England NLM ID: 101563288 Publication Model: Electronic Cited Medium: Internet ISSN: 2045-2322 (Electronic) Linking ISSN: 20452322 NLM ISO Abbreviation: Sci Rep Subsets: MEDLINE

Original Publication: London : Nature Publishing Group, copyright 2011-

Cardiac Resynchronization Therapy*/adverse effects ; Heart Failure* ; Pacemaker, Artificial* ; Defibrillators, Implantable*; Humans ; Arrhythmias, Cardiac/etiology ; Risk Assessment ; Treatment Outcome

Choosing the optimal device during cardiac resynchronization therapy (CRT) upgrade can be challenging. Therefore, we sought to provide a solution for identifying patients in whom upgrading to a CRT-defibrillator (CRT-D) is associated with better long-term survival than upgrading to a CRT-pacemaker (CRT-P). To this end, we first applied topological data analysis to create a patient similarity network using 16 clinical features of 326 patients without prior ventricular arrhythmias who underwent CRT upgrade. Then, in the generated circular network, we delineated three phenogroups exhibiting significant differences in clinical characteristics and risk of all-cause mortality. Importantly, only in the high-risk phenogroup was upgrading to a CRT-D associated with better survival than upgrading to a CRT-P (hazard ratio: 0.454 (0.228-0.907), p = 0.025). Finally, we assigned each patient to one of the three phenogroups based on their location in the network and used this labeled data to train multi-class classifiers to enable the risk stratification of new patients. During internal validation, an ensemble of 5 multi-layer perceptrons exhibited the best performance with a balanced accuracy of 0.898 (0.854-0.942) and a micro-averaged area under the receiver operating characteristic curve of 0.983 (0.980-0.986). To allow further validation, we made the proposed model publicly available ( https://github.com/tokmarton/crt-upgrade-risk-stratification ).
(© 2023. The Author(s).)

Eur Heart J. 2023 Oct 21;44(40):4259-4269. (PMID: 37632437)
Am J Cardiol. 2006 Apr 15;97(8):1223-7. (PMID: 16616030)
Heart Fail Rev. 2018 Jan;23(1):15-26. (PMID: 29047028)
J Am Coll Cardiol. 2006 Oct 17;48(8):1628-33. (PMID: 17045899)
JACC Clin Electrophysiol. 2018 Feb;4(2):168-177. (PMID: 29749933)
Europace. 2023 Mar 30;25(3):1077-1086. (PMID: 36352513)
Heart Rhythm. 2023 Sep;20(9):e17-e91. (PMID: 37283271)
JACC Cardiovasc Imaging. 2019 Feb;12(2):236-248. (PMID: 30732719)
Sci Rep. 2013;3:1236. (PMID: 23393618)
JACC Cardiovasc Imaging. 2022 Jun;15(6):974-986. (PMID: 35680229)
Eur J Heart Fail. 2018 Oct;20(10):1457-1468. (PMID: 29806208)
Am Heart J. 1995 Jun;129(6):1133-41. (PMID: 7754944)
Europace. 2023 Oct 5;25(10):. (PMID: 37766466)
ESC Heart Fail. 2020 Dec;7(6):3374-3382. (PMID: 33089662)
JACC Cardiovasc Imaging. 2020 May;13(5):1119-1132. (PMID: 32199835)
Am Heart J. 1988 Jul;116(1 Pt 1):16-22. (PMID: 3394616)
Eur Heart J. 2010 Jun;31(12):1477-85. (PMID: 20233792)
Europace. 2019 Aug 1;21(8):1237-1245. (PMID: 31168608)
Heart Fail Clin. 2017 Jan;13(1):153-164. (PMID: 27886920)
Europace. 2018 Jan 1;20(1):89-96. (PMID: 28031276)
JACC Cardiovasc Imaging. 2010 May;3(5):461-71. (PMID: 20466341)
Pacing Clin Electrophysiol. 2018 Mar;41(3):290-298. (PMID: 29369371)
J Am Coll Cardiol. 1994 Jul;24(1):225-32. (PMID: 8006270)
Heart Rhythm. 2005 Aug;2(8):830-4. (PMID: 16051118)
J Am Coll Cardiol. 2009 Aug 25;54(9):764-76. (PMID: 19695453)
Lancet. 1997 Oct 25;350(9086):1210-6. (PMID: 9652562)
JAMA. 2002 Dec 25;288(24):3115-23. (PMID: 12495391)
Eur Heart J. 2020 Jun 1;41(21):1976-1986. (PMID: 31750896)
Eur Heart J. 2022 Jul 14;43(27):2591-2599. (PMID: 35366320)
Pacing Clin Electrophysiol. 2007 Jan;30 Suppl 1:S23-30. (PMID: 17302711)
Europace. 2009 Apr;11(4):495-501. (PMID: 19307283)
Clin Res Cardiol. 2023 Aug 25;:. (PMID: 37624394)
Eur Heart J. 2015 Nov 1;36(41):2767-76. (PMID: 26330420)
JACC Cardiovasc Imaging. 2021 Jul;14(7):1410-1421. (PMID: 33454260)
J Cardiovasc Electrophysiol. 2020 Jan;31(1):286-292. (PMID: 31724791)
Eur Heart J. 2021 Sep 14;42(35):3427-3520. (PMID: 34455430)
Eur Heart J. 2021 Sep 21;42(36):3599-3726. (PMID: 34447992)
Eur Heart J. 2020 May 7;41(18):1747-1756. (PMID: 31923316)
JACC Cardiovasc Imaging. 2021 Oct;14(10):1887-1900. (PMID: 34023263)
J Am Coll Cardiol. 1999 May;33(6):1735-42. (PMID: 10334450)
J Am Coll Cardiol. 1986 Jun;7(6):1228-33. (PMID: 3711479)
Circulation. 2003 Jun 17;107(23):2932-7. (PMID: 12782566)
Europace. 2017 Sep 01;19(9):1549-1555. (PMID: 28339581)

ÚNKP-21-3-II-SE-47 and ÚNKP-20-3-I-SE-43 Ministry for Innovation and Technology in Hungary; RRF-2.3.1-21-2022-00004 Ministry for Innovation and Technology in Hungary; NVKP_16-1-2016-0017 ('National Heart Program') Ministry for Innovation and Technology in Hungary

Date Created: 20231123 Date Completed: 20231127 Latest Revision: 20231220

20231220

PMC10667223

10.1038/s41598-023-47092-x

37996448