The Construction of a Risk Prediction Model Based on Neural Network for Pre-operative Acute Ischemic Stroke in Acute Type A Aortic Dissection Patients.

Hongliang Zhao,Yuanqiang Zhu,Weixun Duan,Minwen Zheng,Ziliang Xu,Wenjia Wang,Ruijia Xue,Jing Wang,Jialiang Ren

doi:10.3389/fneur.2021.792678

Hongliang Zhao, Yuanqiang Zhu + Show 7 more

Open Access

https://doi.org/10.3389/fneur.2021.792678

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Abstract

Objective: To establish a pre-operative acute ischemic stroke risk (AIS) prediction model using the deep neural network in patients with acute type A aortic dissection (ATAAD).Methods: Between January 2015 and February 2019, 300 ATAAD patients diagnosed by aorta CTA were analyzed retrospectively. Patients were divided into two groups according to the presence or absence of pre-operative AIS. Pre-operative AIS risk prediction models based on different machine learning algorithm was established with clinical, transthoracic echocardiography (TTE) and CTA imaging characteristics as input. The performance of the difference models was evaluated using the receiver operating characteristic (ROC), precision-recall curve (PRC) and decision curve analysis (DCA).Results: Pre-operative AIS was detected in 86 of 300 patients with ATAAD (28.7%). The cohort was split into a training (211, 70% patients) and validation cohort (89, 30% patients) according to stratified sampling strategy. The constructed deep neural network model had the best performance on the discrimination of AIS group compare with other machine learning model, with an accuracy of 0.934 (95% CI: 0.891–0.963), 0.921 (95% CI: 0.845–0.968), sensitivity of 0.934, 0.960, specificity of 0.933, 0.906, and AUC of 0.982 (95% CI: 0.967–0.997), 0.964 (95% CI: 0.932–0.997) in the training and validation cohort, respectively.Conclusion: The established risk prediction model based on the deep neural network method may have the big potential to evaluate the risk of pre-operative AIS in patients with ATAAD.

Highlights

Pre-operative acute ischemic stroke (AIS) is one of important factors that affects the outcomes of surgical treatment and longterm post-operative survival in patients with acute type A aortic dissection (ATAAD) [1]
Some studies have suggested about 5–10% of patients with ATAAD had an AIS before surgery, which was caused by the extension of the dissection into the common carotid arteries, thromboembolism or cerebral hypoperfusion [2, 4, 7]
Among clinical and transthoracic echocardiography (TTE) imaging characteristics, the age (52.5 ± 9.8 years vs. 48.1 ± 10.5 years, p = 0.001), the incidence of hypotension (14.0 vs. 5.1%, p = 0.019) and tamponade (11.6 vs. 4.7%, p = 0.029) were significantly higher in the AIS+ group compared to the AIS- group, the systolic blood pressure (129.3 ± 34.0 vs. 137.5 ± 31.4 ml/Hg, p = 0.040) and the incidence of the chest and back pain (24.4 vs. 39.3%, p = 0.021) and were significantly lower in the AIS+ group compared to the AISgroup

Summary

Introduction

Pre-operative acute ischemic stroke (AIS) is one of important factors that affects the outcomes of surgical treatment and longterm post-operative survival in patients with acute type A aortic dissection (ATAAD) [1]. ATAAD is a serious aortic disease that requires immediate surgical repair once diagnosed [1, 2], The treatment of ATAAD with pre-operative AIS is more challenging. Many studies had proven that neurological damage caused by pre-operative AIS or cerebral malperfusion indicates a poor prognosis following ATAAD [3, 4]. Some studies have suggested about 5–10% of patients with ATAAD had an AIS before surgery, which was caused by the extension of the dissection into the common carotid arteries, thromboembolism or cerebral hypoperfusion [2, 4, 7]

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