Precision Phenotyping in Heart Failure and Pattern Clustering of Ultrasound Data for the Assessment of Diastolic Dysfunction

• Published in: JACC. Cardiovascular imaging Vol. 10; no. 11; pp. 1291 - 1303
• Main Authors: Omar, Alaa Mabrouk Salem, Narula, Sukrit, Abdel Rahman, Mohamed Ahmed, Pedrizzetti, Gianni, Raslan, Hala, Rifaie, Osama, Narula, Jagat, Sengupta, Partho P.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.11.2017
• Subjects: Aged; Automation; big-data analytics; Cardiac Catheterization; Cardiovascular; Chi-Square Distribution; Cluster Analysis; Diastole; diastolic dysfunction; Echocardiography, Doppler; Female; Heart Failure - diagnostic imaging; Heart Failure - physiopathology; Humans; Image Interpretation, Computer-Assisted - methods; left ventricular filling pressures; Linear Models; Male; Middle Aged; Multivariate Analysis; Pattern Recognition, Automated; Predictive Value of Tests; Prospective Studies; Pulmonary Wedge Pressure; Reproducibility of Results; speckle-tracking echocardiography; Ventricular Dysfunction, Left - diagnostic imaging; Ventricular Dysfunction, Left - physiopathology; Ventricular Function, Left; SRA; VRA; AV-S; big-data analytics; SRE; VRE; LV; AV; LA; SRS; VRS; diastolic dysfunction; speckle-tracking echocardiography; left ventricular filling pressures; peak longitudinal strain rate during left atrial contraction; peak volume expansion rate during left ventricular systole; peak longitudinal strain rate during early left ventricular diastole; left ventricle; single beat simultaneous atrioventricular measurement; atrio-ventricular longitudinal strain at peak left ventricular systole; peak longitudinal strain rate during left ventricular systole; peak volume expansion rate during left atrial contraction; left atrium; peak volume expansion rate during early left ventricular diastole
• ISSN: 1936-878X; 1876-7591
• DOI: 10.1016/j.jcmg.2016.10.012

The aim of this study was to investigate whether cluster analysis of left atrial and left ventricular (LV) mechanical deformation parameters provide sufficient information for Doppler-independent assessment of LV diastolic function. Medical imaging produces substantial phenotyping data, and superior computational analyses could allow automated classification of repetitive patterns into patient groups with similar behavior. The authors performed a cluster analysis and developed a model of LV diastolic function from an initial exploratory cohort of 130 patients that was subsequently tested in a prospective cohort of 44 patients undergoing cardiac catheterization. Patients in both study groups had standard echocardiographic examination with Doppler-derived assessment of diastolic function. Both the left ventricle and the left atrium were tracked simultaneously using speckle-tracking echocardiography (STE) for measuring simultaneous changes in left atrial and ventricular volumes, volume rates, longitudinal strains, and strain rates. Patients in the validation group also underwent invasive measurements of pulmonary capillary wedge pressure and LV end diastolic pressure immediately after echocardiography. The similarity between STE and conventional 2-dimensional and Doppler methods of diastolic function was investigated in both the exploratory and validation cohorts. STE demonstrated strong correlations with the conventional indices and independently clustered the patients into 3 groups with conventional measurements verifying increasing severity of diastolic dysfunction and LV filling pressures. A multivariable linear regression model also allowed estimation of E/e′ and pulmonary capillary wedge pressure by STE in the validation cohort. Tracking deformation of the left-sided cardiac chambers from routine cardiac ultrasound images provides accurate information for Doppler-independent phenotypic characterization of LV diastolic function and noninvasive assessment of LV filling pressures. [Display omitted]