Echocardiographic view and feature selection for the estimation of the response to CRT.

Alban Gallard,Elena Galli,Alfredo I Hernández,Arnaud Hubert,Otto Smiseth,Erwan Donal,Auriane Bidaut,Jens-Uwe Voigt,Virginie Le Rolle

doi:10.1371/journal.pone.0252857

Abstract

Cardiac resynchronization therapy (CRT) is an implant-based therapy applied to patients with a specific heart failure (HF) profile. The identification of patients that may benefit from CRT is a challenging task and the application of current guidelines still induce a non-responder rate of about 30%. Several studies have shown that the assessment of left ventricular (LV) mechanics by speckle tracking echocardiography can provide useful information for CRT patient selection. A comprehensive evaluation of LV mechanics is normally performed using three different echocardioraphic views: 4, 3 or 2-chamber views. The aim of this study is to estimate the relative importance of strain-based features extracted from these three views, for the estimation of CRT response. Several features were extracted from the longitudinal strain curves of 130 patients and different methods of feature selection (out-of-bag random forest, wrapping and filtering) have been applied. Results show that more than 50% of the 20 most important features are calculated from the 4-chamber view. Although features from the 2- and 3-chamber views are less represented in the most important features, some of the former have been identified to provide complementary information. A thorough analysis and interpretation of the most informative features is also provided, as a first step towards the construction of a machine-learning chain for an improved selection of CRT candidates.

Highlights

Cardiac resynchronization therapy (CRT) is one of the most effective therapies for patients suffering from heart failure with reduced ejection fraction
CRT leads to improved quality of life and significant reductions in heart failure hospitalization rates and all-cause mortality [1, 2]. 20 to 30% of heart failure patients with reduced ejection fraction show a left bundle branch block (LBBB)
The authors identified four natural groups and characterized these groups through expert knowledge according to their phenotypes. This data mining approach allowed for the identification of two phenogroups presenting a higher proportion of some clinical characteristics that are known from the literature to be predictive of CRT response. We propose another view to the problem, directly focused on the quantitative analysis of myocardial deformation for the selection of the most informative echocardiographic views and features for the estimation of CRT response

Summary

Introduction

Cardiac resynchronization therapy (CRT) is one of the most effective therapies for patients suffering from heart failure with reduced ejection fraction. 20 to 30% of heart failure patients with reduced ejection fraction show a left bundle branch block (LBBB). CRT leads to improved quality of life and significant reductions in heart failure hospitalization rates and all-cause mortality [1, 2]. These patients might benefit from a CRT implantation, with a reverse remodeling of the left ventricle (LV), an improvement in systolic function, a better control of symptoms and, an improved quality of life and life expectancy [3].

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