Enhancing the Prediction of Cardiac Allograft Vasculopathy Using Intravascular Ultrasound and Machine Learning: A Proof of Concept

Author:

Moayedi Yasbanoo12ORCID,Rodenas-Alesina Eduard1ORCID,Somerset Emily3,Fan Chun Po S.3ORCID,Henricksen Erik4ORCID,Aleksova Natasha12ORCID,Billia Filio12ORCID,Chih Sharon5ORCID,Ross Heather J.12ORCID,Teuteberg Jeffrey J.6ORCID

Affiliation:

1. Ted Rogers Centre of Excellence in Heart Research (Y.M., E.R.-A., N.A., F.B., H.J.R.), Peter Munk Cardiac Centre, University Health Network, Toronto, ON, Canada.

2. Ajmera Transplant Centre, University Health Network, Toronto, ON, Canada (Y.M., N.A., F.B., H.J.R.).

3. Ted Rogers Computational Program, Centre of Excellence in Heart Function (E.S., C.P.S.F.), Peter Munk Cardiac Centre, University Health Network, Toronto, ON, Canada.

4. Department of Transplant, Stanford Health Care, CA (E.H.).

5. Ottawa Heart Institute, University of Ottawa, ON, Canada (S.C.).

6. Section of Heart Failure, Cardiac Transplant, and Mechanical Circulatory Support, Department of Medicine, Stanford University, CA (J.J.T.).

Abstract

BACKGROUND: Cardiac allograft vasculopathy (CAV) is the leading cause of late graft dysfunction in heart transplantation. Building on previous unsupervised learning models, we sought to identify CAV clusters using serial maximal intimal thickness and baseline clinical risk factors to predict the development of early CAV. METHODS: This is a single-center retrospective study including adult heart transplantation recipients. A latent class mixed-effects model was used to identify patient clusters with similar trajectories of maximal intimal thickness posttransplant and pretransplant covariates associated with each cluster. RESULTS: Among 186 heart transplantation recipients, we identified 4 patient phenotypes: very low, low, moderate, and high risk. The 5-year risk (95% CI) of the International Society for Heart and Lung Transplantation–defined CAV in the high, moderate, low, and very low risk groups was 49.1% (35.2%–68.5%), 23.4% (13.3%–41.2%), 5.0% (1.3%–19.6%), and 0%, respectively. Only patients in the moderate to high risk cluster developed the International Society for Heart and Lung Transplantation CAV 2-3 at 5 years ( P =0.02). Of the 4 groups, the low risk group had significantly younger female recipients, shorter ischemic time, and younger female donors compared with the high risk group. CONCLUSIONS: We identified 4 clusters characterized by distinct maximal intimal thickness trajectories. These clusters were shown to discriminate against the development of angiographic CAV. This approach allows for the personalization of surveillance and CAV-directed treatment before the development of angiographically apparent disease.

Publisher

Ovid Technologies (Wolters Kluwer Health)

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