Background: In heart failure therapy, the real-time estimation of remaining cardiac contractility (RCC) can facilitate patient management, as well as, the performance of physiological controllers for ventricular assist devices (VAD). In this study, the real-time estimation of RCC based on time series data (TSD) of the left ventricular pressure (LVP) was investigated by exploiting two traditional time series classifiers (TSC) and two graph-based neural networks (GNN). All classifiers were assessed with respect to their RCC estimation accuracy and their applicability for real-time VAD control. Methods: For the RCC estimation (Figure 1), LVP TSD was generated using a hybrid mock circulation (HMC). On the HMC instantaneous pressure, volume, and flowrate values were computed by a numerical model of the human cardiovascular system and applied by a hydraulic interface on the inlet and outlet mixed-flow blood pump. The experimental protocol for the acquisition of the LVP TSD included 63 experiments, where preload, afterload, pump speed, and heart rate variations were performed for 9 RCC values. The data was pre-processed by segmenting and normalizing the TSD, producing 6300 cardiac cycle samples, which were used for the TSC approaches. The TSCs comprised the dynamic time warping nearest neighbor (DTW-NN) classifier and the support vector (SVM) classifier. Furthermore, the maturity of two GNN approaches was explored, including a simple custom architecture (C-GNN) and a pretrained architecture (P-GNN) provided by the KERAS library (Inception V3). The C-GNN comprised a convolutional layer with 32 filters of size 3x3, a max pooling layer with filter size 2x2, a dense layer with 128 units, and a dense layer with 9 units for the classification output. For the TSD to be used in the GNN frameworks, two different image encoders (IE), namely direct plot and recurrence plot encoders, were used and assessed. The data was split 80/20 for network training and validation. Results: All four classifiers, DTW-NN, SVM, C-GNN (IE: recurrence plot), and the P-GNN (IE: direct plot) achieved an accuracy of at least 98%. The SVM had the highest accuracy (99.9%) and the shortest prediction time (63 μs/sample). The prediction time of DTW-NN was on average 4.84 s/sample, prohibiting the implementation in real-time VAD control. Both GNN architectures achieve high accuracy and short prediction time, however, their performance does not reach the benchmark set by the SVM. A comparison of the image encoders showed that both the direct plot and the recurrence plot encoder lead to similar classification performances when using the same GNN, but different performances between the two investigated GNNs. Conclusion: All classification methods provided accurate RCC estimation with the SVM showing superior performance and being the most promising for real-time clinical implementation. These estimation approaches could substantially support patient surveillance and physiologic VAD control approaches. Figure 1. Schematic of the sequential steps for the estimation of the remaining cardiac contractility from time-series data (TSD) of the left ventricular pressure (LVP). a) LVP TSD is produced through a hybrid mock circulation, where the human cardiovascular system is simulated and the pressures, volume, and flowrates calculated are applied on the inlet and outlet of a ventricular assist device in real-time via a hydraulic interface. LVP TSD was acquired for various physiologic conditions. b) Pre-processing of the data, including cardiac cycle segmentation and time normalization. c) Translation of the TSD to images through different image encoders. d) Time series classifiers, including dynamic time warping nearest neighbor (DTW-NN) and the support vector (SVM) classifiers. e) Graph-based neural networks (GNN). f) Classified cardiac contractility.
Read full abstract