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Zhang X, Wang X, Xu L, Liu J, Ren P, Wu H. The predictive value of machine learning for mortality risk in patients with acute coronary syndromes: a systematic review and meta-analysis. Eur J Med Res 2023; 28:451. [PMID: 37864271 PMCID: PMC10588162 DOI: 10.1186/s40001-023-01027-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Accepted: 01/20/2023] [Indexed: 10/22/2023] Open
Abstract
BACKGROUND Acute coronary syndromes (ACS) are the leading cause of global death. Optimizing mortality risk prediction and early identification of high-risk patients is essential for developing targeted prevention strategies. Many researchers have built machine learning (ML) models to predict the mortality risk in ACS patients. Our meta-analysis aimed to evaluate the predictive value of various ML models in predicting death in ACS patients at different times. METHODS PubMed, Embase, Web of Science, and Cochrane Library were searched systematically from database establishment to March 12, 2022 for studies developing or validating at least one ML predictive model for death in ACS patients. We used PROBAST to assess the risk of bias in the reported predictive models and a random-effects model to assess the pooled C-index and accuracy of these models. RESULTS Fifty papers were included, involving 216 ML prediction models, 119 of which were externally validated. The combined C-index of the ML models in the validation cohort predicting the in-hospital mortality, 30-day mortality, 3- or 6-month mortality, and 1 year or above mortality in ACS patients were 0.8633 (95% CI 0.8467-0.8802), 0.8296 (95% CI 0.8134-0.8462), 0.8205 (95% CI 0.7881-0.8541), and 0.8197 (95% CI 0.8042-0.8354), respectively, with the corresponding combined accuracy of 0.8569 (95% CI 0.8411-0.8715), 0.8282 (95% CI 0.7922-0.8591), 0.7303 (95% CI 0.7184-0.7418), and 0.7837 (95% CI 0.7455-0.8175), indicating that the ML models were relatively excellent in predicting ACS mortality at different times. Furthermore, common predictors of death in ML models included age, sex, systolic blood pressure, serum creatinine, Killip class, heart rate, diastolic blood pressure, blood glucose, and hemoglobin. CONCLUSIONS The ML models had excellent predictive power for mortality in ACS, and the methodologies may need to be addressed before they can be used in clinical practice.
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Affiliation(s)
- Xiaoxiao Zhang
- Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Xi Wang
- Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Luxin Xu
- Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Jia Liu
- Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Peng Ren
- School of Life Science and Engineering, Southwest University of Science and Technology, Mianyang, China
| | - Huanlin Wu
- Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China.
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2
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Ledziński Ł, Grześk G. Artificial Intelligence Technologies in Cardiology. J Cardiovasc Dev Dis 2023; 10:jcdd10050202. [PMID: 37233169 DOI: 10.3390/jcdd10050202] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 05/03/2023] [Accepted: 05/04/2023] [Indexed: 05/27/2023] Open
Abstract
As the world produces exabytes of data, there is a growing need to find new methods that are more suitable for dealing with complex datasets. Artificial intelligence (AI) has significant potential to impact the healthcare industry, which is already on the road to change with the digital transformation of vast quantities of information. The implementation of AI has already achieved success in the domains of molecular chemistry and drug discoveries. The reduction in costs and in the time needed for experiments to predict the pharmacological activities of new molecules is a milestone in science. These successful applications of AI algorithms provide hope for a revolution in healthcare systems. A significant part of artificial intelligence is machine learning (ML), of which there are three main types-supervised learning, unsupervised learning, and reinforcement learning. In this review, the full scope of the AI workflow is presented, with explanations of the most-often-used ML algorithms and descriptions of performance metrics for both regression and classification. A brief introduction to explainable artificial intelligence (XAI) is provided, with examples of technologies that have developed for XAI. We review important AI implementations in cardiology for supervised, unsupervised, and reinforcement learning and natural language processing, emphasizing the used algorithm. Finally, we discuss the need to establish legal, ethical, and methodical requirements for the deployment of AI models in medicine.
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Affiliation(s)
- Łukasz Ledziński
- Department of Cardiology and Clinical Pharmacology, Faculty of Health Sciences, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Toruń, Ujejskiego 75, 85-168 Bydgoszcz, Poland
| | - Grzegorz Grześk
- Department of Cardiology and Clinical Pharmacology, Faculty of Health Sciences, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Toruń, Ujejskiego 75, 85-168 Bydgoszcz, Poland
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3
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Leha A, Huber C, Friede T, Bauer T, Beckmann A, Bekeredjian R, Bleiziffer S, Herrmann E, Möllmann H, Walther T, Beyersdorf F, Hamm C, Künzi A, Windecker S, Stortecky S, Kutschka I, Hasenfuß G, Ensminger S, Frerker C, Seidler T. Development and validation of explainable machine learning models for risk of mortality in transcatheter aortic valve implantation: TAVI risk machine scores. EUROPEAN HEART JOURNAL. DIGITAL HEALTH 2023; 4:225-235. [PMID: 37265865 PMCID: PMC10232286 DOI: 10.1093/ehjdh/ztad021] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Revised: 02/28/2023] [Accepted: 03/16/2023] [Indexed: 06/03/2023]
Abstract
Aims Identification of high-risk patients and individualized decision support based on objective criteria for rapid discharge after transcatheter aortic valve implantation (TAVI) are key requirements in the context of contemporary TAVI treatment. This study aimed to predict 30-day mortality following TAVI based on machine learning (ML) using data from the German Aortic Valve Registry. Methods and results Mortality risk was determined using a random forest ML model that was condensed in the newly developed TAVI Risk Machine (TRIM) scores, designed to represent clinically meaningful risk modelling before (TRIMpre) and in particular after (TRIMpost) TAVI. Algorithm was trained and cross-validated on data of 22 283 patients (729 died within 30 days post-TAVI) and generalisation was examined on data of 5864 patients (146 died). TRIMpost demonstrated significantly better performance than traditional scores [C-statistics value, 0.79; 95% confidence interval (CI)] [0.74; 0.83] compared to Society of Thoracic Surgeons (STS) with C-statistics value 0.69; 95%-CI [0.65; 0.74]). An abridged (aTRIMpost) score comprising 25 features (calculated using a web interface) exhibited significantly higher performance than traditional scores (C-statistics value, 0.74; 95%-CI [0.70; 0.78]). Validation on external data of 6693 patients (205 died within 30 days post-TAVI) of the Swiss TAVI Registry confirmed significantly better performance for the TRIMpost (C-statistics value 0.75, 95%-CI [0.72; 0.79]) compared to STS (C-statistics value 0.67, CI [0.63; 0.70]). Conclusion TRIM scores demonstrate good performance for risk estimation before and after TAVI. Together with clinical judgement, they may support standardised and objective decision-making before and after TAVI.
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Affiliation(s)
- Andreas Leha
- Department of Medical Statistics, University Medical Center Göttingen, Humboldtallee 32, 37073 Göttingen, Germany
- DZHK (German Center for Cardiovascular Research), Partner Site Göttingen, Robert-Koch str. 40, 37075 Göttingen, Germany
| | - Cynthia Huber
- Department of Medical Statistics, University Medical Center Göttingen, Humboldtallee 32, 37073 Göttingen, Germany
| | - Tim Friede
- Department of Medical Statistics, University Medical Center Göttingen, Humboldtallee 32, 37073 Göttingen, Germany
- DZHK (German Center for Cardiovascular Research), Partner Site Göttingen, Robert-Koch str. 40, 37075 Göttingen, Germany
| | - Timm Bauer
- Department of Cardiology, Sana Klinikum Offenbach, Starkenburgring 66, 63069 Offenbach am Main, Germany
| | - Andreas Beckmann
- German Society for Thoracic and Cardiovascular Surgery, Langenbeck-Virchow-Haus, Luisenstraße 58/59, 10117 Berlin, Germany
- Department for cardiac and pediatric cardiac surgery, Heart Center Duisburg, EVKLN, Gerrickstr. 21, 47137 Duisburg, Germany
| | - Raffi Bekeredjian
- Department of Cardiology, Robert-Bosch-Krankenhaus, Auerbachstraße 110, 70376 Stuttgart, Germany
| | - Sabine Bleiziffer
- Clinic for Thoracic and Cardiovascular Surgery, Heart and Diabetes Center Northrhine-Westphalia, Georgstr 11, 32545 Bad Oeynhausen, Germany
| | - Eva Herrmann
- Goethe University Frankfurt, Department of Medicine, Institute of Biostatistics and Mathematical Modelling, Theodor-Stern-Kai 7, 60590 Frankfurt Main, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Rhine/Main, Theodor-Stern-Kai 7, 60590 Frankfurt Main, Germany
| | - Helge Möllmann
- Department of Cardiology, St.-Johannes-Hospital Dortmund, Johannesstrasse 9-17, 44137 Dortmund, Germany
| | - Thomas Walther
- Department of Cardiothoracic Surgery, University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590 Frankfurt, Germany
| | - Friedhelm Beyersdorf
- Medical Faculty of the Albert-Ludwigs-University Freiburg, University Hospital Freiburg, Hugstetterstr. 55, 79106 Freiburg, Germany
- Department of Cardiovascular Surgery, Heart Centre Freiburg University, Freiburg, Germany
| | - Christian Hamm
- Department of Cardiology and Angiology, University Hospital Gießen, Klinikstr. 33, 35392 Gießen, Germany
- Department of Cardiology, Kerckhoff Heart and Thorax Center, Benekestraße 2-8, D-61231 Bad Nauheim, Germany
| | - Arnaud Künzi
- CTU Bern, University of Bern, Mittelstrasse 43, 3012 Bern, Switzerland
| | - Stephan Windecker
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland
| | - Stefan Stortecky
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland
| | - Ingo Kutschka
- Clinic for Cardiothoracic and Vascular Surgery/Heart Center, University Medical Center Göttingen, Robert-Koch Str. 40, 37075 Göttingen, Germany
| | - Gerd Hasenfuß
- DZHK (German Center for Cardiovascular Research), Partner Site Göttingen, Robert-Koch str. 40, 37075 Göttingen, Germany
- Clinic for Cardiology and Pulmonology, Heart Center, University Medical Center Göttingen, Robert-Koch Str. 40, 37075 Göttingen, Germany
| | - Stephan Ensminger
- Department of Cardiac and Thoracic Vascular Surgery, University Heart Center Lübeck, Ratzeburger Allee 160, 23538 Lübeck, Germany
- DZHK (German Centre for Cardiovascular Research), partner site Hamburg/Kiel/Lübeck, Lübeck, Germany
| | - Christian Frerker
- Department of Cardiology, University Heart Center Lübeck, Ratzeburger Allee 160, 23538 Lübeck, Germany
- DZHK (German Centre for Cardiovascular Research), partner site Hamburg/Kiel/Lübeck, Lübeck, Germany
| | - Tim Seidler
- Corresponding author. Tel: +49 (0) 551/39-63907, Fax: +49(0)551/39-63906,
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Chopannejad S, Sadoughi F, Bagherzadeh R, Shekarchi S. Predicting major adverse cardiovascular events in acute coronary syndrome: A scoping review of machine learning approaches. Appl Clin Inform 2022; 13:720-740. [PMID: 35617971 PMCID: PMC9329142 DOI: 10.1055/a-1863-1589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
BACKGROUND Acute coronary syndrome is the topmost cause of death worldwide; therefore, it is necessary to predict major adverse cardiovascular events and cardiovascular deaths in patients with acute coronary syndrome to make correct and timely clinical decisions. OBJECTIVE The current review aimed to highlight algorithms and important predictor variables through examining those studies which used machine learning algorithms for predicting major adverse cardiovascular events in patients with acute coronary syndrome. METHODS In order to predict major adverse cardiovascular events in patients with acute coronary syndrome, the preferred reporting items for scoping reviews guidelines were used. PubMed, Embase, Web of Science, Scopus, Springer, and IEEE Xplore databases were searched for articles published between 2005 and 2021. The findings of the studies are presented in the form of a narrative synthesis of evidence. RESULTS According to the results, 14 (63.64%) studies did not perform external validation and only used registry data. The algorithms used in this study comprised, inter alia, Regression Logistic, Random Forest, Boosting Ensemble, Non-Boosting Ensemble, Decision Trees, and Naive Bayes. Multiple studies (N=20) achieved a high Area under the ROC Curve between 0.8 to 0.99 in predicting mortality and major adverse cardiovascular events. The predictor variables used in these studies were divided into demographic, clinical, and therapeutic features. However, no study reported the integration of machine learning model into clinical practice. CONCLUSION Machine learning algorithms rendered acceptable results to predict major adverse cardiovascular events and mortality outcomes in patients with acute coronary syndrome. However, these approaches have never been integrated into clinical practice. Further research is required to develop feasible and effective machine learning prediction models to measure their potentially important implications for optimizing the quality of care in patients with acute coronary syndrome.
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Affiliation(s)
- Sara Chopannejad
- Student Research Committee, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran (the Islamic Republic of)
| | - Farahnaz Sadoughi
- School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran (the Islamic Republic of)
| | - Rafat Bagherzadeh
- English Language Department, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran (the Islamic Republic of)
| | - Sakineh Shekarchi
- School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran (the Islamic Republic of)
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5
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Ain QU, Sarfraz M, Prasesti GK, Dewi TI, Kurniati NF. Confounders in Identification and Analysis of Inflammatory Biomarkers in Cardiovascular Diseases. Biomolecules 2021; 11:biom11101464. [PMID: 34680097 PMCID: PMC8533132 DOI: 10.3390/biom11101464] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 09/27/2021] [Accepted: 09/29/2021] [Indexed: 02/08/2023] Open
Abstract
Proinflammatory biomarkers have been increasingly used in epidemiologic and intervention studies over the past decades to evaluate and identify an association of systemic inflammation with cardiovascular diseases. Although there is a strong correlation between the elevated level of inflammatory biomarkers and the pathology of various cardiovascular diseases, the mechanisms of the underlying cause are unclear. Identification of pro-inflammatory biomarkers such as cytokines, chemokines, acute phase proteins, and other soluble immune factors can help in the early diagnosis of disease. The presence of certain confounding factors such as variations in age, sex, socio-economic status, body mass index, medication and other substance use, and medical illness, as well as inconsistencies in methodological practices such as sample collection, assaying, and data cleaning and transformation, may contribute to variations in results. The purpose of the review is to identify and summarize the effect of demographic factors, epidemiological factors, medication use, and analytical and pre-analytical factors with a panel of inflammatory biomarkers CRP, IL-1b, IL-6, TNFa, and the soluble TNF receptors on the concentration of these inflammatory biomarkers in serum.
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Affiliation(s)
- Qurrat Ul Ain
- Department of Pharmacology and Clinical Pharmacy, School of Pharmacy, Bandung Institute of Technology, Bandung 40132, Indonesia; (Q.U.A.); (G.K.P.)
| | - Mehak Sarfraz
- Department of Pharmacy, Comsats University Islamabad Abbottabad Campus, Abbottabad 22060, Pakistan;
| | - Gayuk Kalih Prasesti
- Department of Pharmacology and Clinical Pharmacy, School of Pharmacy, Bandung Institute of Technology, Bandung 40132, Indonesia; (Q.U.A.); (G.K.P.)
| | - Triwedya Indra Dewi
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Padjadjaran, Bandung 40124, Indonesia;
| | - Neng Fisheri Kurniati
- Department of Pharmacology and Clinical Pharmacy, School of Pharmacy, Bandung Institute of Technology, Bandung 40132, Indonesia; (Q.U.A.); (G.K.P.)
- Correspondence: ; +62-853-1582-6154
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6
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Banerjee A, Chen S, Fatemifar G, Zeina M, Lumbers RT, Mielke J, Gill S, Kotecha D, Freitag DF, Denaxas S, Hemingway H. Machine learning for subtype definition and risk prediction in heart failure, acute coronary syndromes and atrial fibrillation: systematic review of validity and clinical utility. BMC Med 2021; 19:85. [PMID: 33820530 PMCID: PMC8022365 DOI: 10.1186/s12916-021-01940-7] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Accepted: 02/12/2021] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Machine learning (ML) is increasingly used in research for subtype definition and risk prediction, particularly in cardiovascular diseases. No existing ML models are routinely used for cardiovascular disease management, and their phase of clinical utility is unknown, partly due to a lack of clear criteria. We evaluated ML for subtype definition and risk prediction in heart failure (HF), acute coronary syndromes (ACS) and atrial fibrillation (AF). METHODS For ML studies of subtype definition and risk prediction, we conducted a systematic review in HF, ACS and AF, using PubMed, MEDLINE and Web of Science from January 2000 until December 2019. By adapting published criteria for diagnostic and prognostic studies, we developed a seven-domain, ML-specific checklist. RESULTS Of 5918 studies identified, 97 were included. Across studies for subtype definition (n = 40) and risk prediction (n = 57), there was variation in data source, population size (median 606 and median 6769), clinical setting (outpatient, inpatient, different departments), number of covariates (median 19 and median 48) and ML methods. All studies were single disease, most were North American (n = 61/97) and only 14 studies combined definition and risk prediction. Subtype definition and risk prediction studies respectively had limitations in development (e.g. 15.0% and 78.9% of studies related to patient benefit; 15.0% and 15.8% had low patient selection bias), validation (12.5% and 5.3% externally validated) and impact (32.5% and 91.2% improved outcome prediction; no effectiveness or cost-effectiveness evaluations). CONCLUSIONS Studies of ML in HF, ACS and AF are limited by number and type of included covariates, ML methods, population size, country, clinical setting and focus on single diseases, not overlap or multimorbidity. Clinical utility and implementation rely on improvements in development, validation and impact, facilitated by simple checklists. We provide clear steps prior to safe implementation of machine learning in clinical practice for cardiovascular diseases and other disease areas.
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Affiliation(s)
- Amitava Banerjee
- Institute of Health Informatics, University College London, 222 Euston Road, London, NW1 2DA, UK.
- Health Data Research UK, University College London, London, UK.
- University College London Hospitals NHS Trust, 235 Euston Road, London, UK.
- Barts Health NHS Trust, The Royal London Hospital, Whitechapel Rd, London, UK.
| | - Suliang Chen
- Institute of Health Informatics, University College London, 222 Euston Road, London, NW1 2DA, UK
- Health Data Research UK, University College London, London, UK
| | - Ghazaleh Fatemifar
- Institute of Health Informatics, University College London, 222 Euston Road, London, NW1 2DA, UK
- Health Data Research UK, University College London, London, UK
| | | | - R Thomas Lumbers
- Institute of Health Informatics, University College London, 222 Euston Road, London, NW1 2DA, UK
- Health Data Research UK, University College London, London, UK
- University College London Hospitals NHS Trust, 235 Euston Road, London, UK
| | - Johanna Mielke
- Bayer AG, Division Pharmaceuticals, Open Innovation & Digital Technologies, Wuppertal, Germany
| | - Simrat Gill
- University of Birmingham Institute of Cardiovascular Sciences and University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Dipak Kotecha
- University of Birmingham Institute of Cardiovascular Sciences and University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
- Department of Cardiology, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - Daniel F Freitag
- Bayer AG, Division Pharmaceuticals, Open Innovation & Digital Technologies, Wuppertal, Germany
| | - Spiros Denaxas
- Institute of Health Informatics, University College London, 222 Euston Road, London, NW1 2DA, UK
- Health Data Research UK, University College London, London, UK
- The Alan Turing Institute, London, UK
| | - Harry Hemingway
- Institute of Health Informatics, University College London, 222 Euston Road, London, NW1 2DA, UK
- Health Data Research UK, University College London, London, UK
- University College London Hospitals Biomedical Research Centre (UCLH BRC), London, UK
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7
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Pieszko K, Hiczkiewicz J, Budzianowski J, Musielak B, Hiczkiewicz D, Faron W, Rzeźniczak J, Burchardt P. Clinical applications of artificial intelligence in cardiology on the verge of the decade. Cardiol J 2020; 28:460-472. [PMID: 32648252 DOI: 10.5603/cj.a2020.0093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Revised: 04/29/2020] [Accepted: 05/25/2020] [Indexed: 11/25/2022] Open
Abstract
Artificial intelligence (AI) has been hailed as the fourth industrial revolution and its influence on people's lives is increasing. The research on AI applications in medicine is progressing rapidly. This revolution shows promise for more precise diagnoses, streamlined workflows, increased accessibility to healthcare services and new insights into ever-growing population-wide datasets. While some applications have already found their way into contemporary patient care, we are still in the early days of the AI-era in medicine. Despite the popularity of these new technologies, many practitioners lack an understanding of AI methods, their benefits, and pitfalls. This review aims to provide information about the general concepts of machine learning (ML) with special focus on the applications of such techniques in cardiovascular medicine. It also sets out the current trends in research related to medical applications of AI. Along with new possibilities, new threats arise - acknowledging and understanding them is as important as understanding the ML methodology itself. Therefore, attention is also paid to the current opinions and guidelines regarding the validation and safety of AI-powered tools.
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Affiliation(s)
- Konrad Pieszko
- University of Zielona Góra, Department of Medicine and Medical Sciences, ul. Licealna 9, 65-417 Zielona Góra, Poland. .,Nowa Sól Multidisciplinary Hospital, Clinical Department of Cardiology,, ul. Chałubińskiego 7, 67-100 Nowa Sól, Poland.
| | - Jarosław Hiczkiewicz
- University of Zielona Góra, Department of Medicine and Medical Sciences, ul. Licealna 9, 65-417 Zielona Góra, Poland.,Nowa Sól Multidisciplinary Hospital, Clinical Department of Cardiology,, ul. Chałubińskiego 7, 67-100 Nowa Sól, Poland
| | - Jan Budzianowski
- University of Zielona Góra, Department of Medicine and Medical Sciences, ul. Licealna 9, 65-417 Zielona Góra, Poland.,Nowa Sól Multidisciplinary Hospital, Clinical Department of Cardiology,, ul. Chałubińskiego 7, 67-100 Nowa Sól, Poland
| | - Bogdan Musielak
- University of Zielona Góra, Department of Medicine and Medical Sciences, ul. Licealna 9, 65-417 Zielona Góra, Poland.,Nowa Sól Multidisciplinary Hospital, Clinical Department of Cardiology,, ul. Chałubińskiego 7, 67-100 Nowa Sól, Poland
| | - Dariusz Hiczkiewicz
- University of Zielona Góra, Department of Medicine and Medical Sciences, ul. Licealna 9, 65-417 Zielona Góra, Poland.,Nowa Sól Multidisciplinary Hospital, Clinical Department of Cardiology,, ul. Chałubińskiego 7, 67-100 Nowa Sól, Poland
| | - Wojciech Faron
- Nowa Sól Multidisciplinary Hospital, Clinical Department of Cardiology,, ul. Chałubińskiego 7, 67-100 Nowa Sól, Poland
| | - Janusz Rzeźniczak
- Józefa Strusia Hospital, Cardiology Clinic, Szwajcarska 3,, 61-285 Poznań, Poland
| | - Paweł Burchardt
- Józefa Strusia Hospital, Cardiology Clinic, Szwajcarska 3,, 61-285 Poznań, Poland.,Department of Biology and Environmental Protection, Poznań University of Medical Sciences, ul. Rokietnicka 8, 60-806 Poznań, Poland
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8
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Hoffmann J, Mas-Peiro S, Berkowitsch A, Boeckling F, Rasper T, Pieszko K, De Rosa R, Hiczkiewicz J, Burchardt P, Fichtlscherer S, Zeiher AM, Dimmeler S, Nicotera MV. Inflammatory signatures are associated with increased mortality after transfemoral transcatheter aortic valve implantation. ESC Heart Fail 2020; 7:2597-2610. [PMID: 32639677 PMCID: PMC7524092 DOI: 10.1002/ehf2.12837] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2020] [Revised: 05/27/2020] [Accepted: 05/29/2020] [Indexed: 01/24/2023] Open
Abstract
Aims Systemic inflammatory response, identified by increased total leucocyte counts, was shown to be a strong predictor of mortality after transcatheter aortic valve implantation (TAVI). Yet the mechanisms of inflammation‐associated poor outcome after TAVI are unclear. Therefore, the present study aimed at investigating individual inflammatory signatures and functional heterogeneity of circulating myeloid and T‐lymphocyte subsets and their impact on 1 year survival in a single‐centre cohort of patients with severe aortic stenosis undergoing TAVI. Methods and results One hundred twenty‐nine consecutive patients with severe symptomatic aortic stenosis admitted for transfemoral TAVI were included. Blood samples were obtained at baseline, immediately after, and 24 h and 3 days after TAVI, and these were analysed for inflammatory and cardiac biomarkers. Myeloid and T‐lymphocyte subsets were measured using flow cytometry. The inflammatory parameters were first analysed as continuous variables; and in case of association with outcome and area under receiver operating characteristic (ROC) curve (AUC) ≥ 0.6, the values were dichotomized using optimal cut‐off points. Several baseline inflammatory parameters, including high‐sensitivity C‐reactive protein (hsCRP; HR = 1.37, 95% CI: 1.15–1.63; P < 0.0001) and IL‐6 (HR = 1.02, 95% CI: 1.01–1.03; P = 0.003), lower counts of Th2 (HR = 0.95, 95% CI: 0.91–0.99; P = 0.009), and increased percentages of Th17 cells (HR = 1.19, 95% CI: 1.02–1.38; P = 0.024) were associated with 12 month all‐cause mortality. Among postprocedural parameters, only increased post‐TAVI counts of non‐classical monocytes immediately after TAVI were predictive of outcome (HR = 1.03, 95% CI: 1.01–1.05; P = 0.003). The occurrence of SIRS criteria within 48 h post‐TAVI showed no significant association with 12 month mortality (HR = 0.57, 95% CI: 0.13–2.43, P = 0.45). In multivariate analysis of discrete or dichotomized clinical and inflammatory variables, the presence of diabetes mellitus (HR = 3.50; 95% CI: 1.42–8.62; P = 0.006), low left ventricular (LV) ejection fraction (HR = 3.16; 95% CI: 1.35–7.39; P = 0.008), increased baseline hsCRP (HR = 5.22; 95% CI: 2.09–13.01; P < 0.0001), and low baseline Th2 cell counts (HR = 8.83; 95% CI: 3.02–25.80) were significant predictors of death. The prognostic value of the linear prediction score calculated of these parameters was superior to the Society of Thoracic Surgeons score (AUC: 0.88; 95% CI: 0.78–0.99 vs. 0.75; 95% CI: 0.64–0.86, respectively; P = 0.036). Finally, when analysing LV remodelling outcomes, ROC curve analysis revealed that low numbers of Tregs (P = 0.017; AUC: 0.69) and increased Th17/Treg ratio (P = 0.012; AUC: 0.70) were predictive of adverse remodelling after TAVI. Conclusions Our findings demonstrate an association of specific pre‐existing inflammatory phenotypes with increased mortality and adverse LV remodelling after TAVI. Distinct monocyte and T‐cell signatures might provide additive biomarkers to improve pre‐procedural risk stratification in patients referred to TAVI for severe aortic stenosis.
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Affiliation(s)
- Jedrzej Hoffmann
- Department of Cardiology, Center of Internal Medicine, Goethe University Frankfurt, Frankfurt, Germany.,German Center for Cardiovascular Research (DZHK), Partner site Rhine-Main, Germany
| | - Silvia Mas-Peiro
- Department of Cardiology, Center of Internal Medicine, Goethe University Frankfurt, Frankfurt, Germany.,German Center for Cardiovascular Research (DZHK), Partner site Rhine-Main, Germany
| | - Alexander Berkowitsch
- Department of Cardiology, Center of Internal Medicine, Goethe University Frankfurt, Frankfurt, Germany
| | - Felicitas Boeckling
- Department of Cardiology, Center of Internal Medicine, Goethe University Frankfurt, Frankfurt, Germany.,German Center for Cardiovascular Research (DZHK), Partner site Rhine-Main, Germany
| | - Tina Rasper
- Institute of Cardiovascular Regeneration, Center of Molecular Medicine, Goethe University Frankfurt, Frankfurt, Germany
| | - Konrad Pieszko
- Department of Cardiology, Nowa Sól Multidisciplinary Hospital, Nowa Sól, Poland.,Faculty of Medicine and Health Sciences, University of Zielona Góra, Zielona Góra, Poland
| | - Roberta De Rosa
- Department of Cardiology, Center of Internal Medicine, Goethe University Frankfurt, Frankfurt, Germany
| | - Jarosław Hiczkiewicz
- Department of Cardiology, Nowa Sól Multidisciplinary Hospital, Nowa Sól, Poland.,Faculty of Medicine and Health Sciences, University of Zielona Góra, Zielona Góra, Poland
| | - Paweł Burchardt
- Biology of Lipid Disorders Department, Poznan University of Medical Sciences, Poznań, Poland
| | - Stephan Fichtlscherer
- Department of Cardiology, Center of Internal Medicine, Goethe University Frankfurt, Frankfurt, Germany.,German Center for Cardiovascular Research (DZHK), Partner site Rhine-Main, Germany
| | - Andreas M Zeiher
- Department of Cardiology, Center of Internal Medicine, Goethe University Frankfurt, Frankfurt, Germany.,German Center for Cardiovascular Research (DZHK), Partner site Rhine-Main, Germany.,Cardiopulmonary Institute, Goethe University Frankfurt, Frankfurt, Germany
| | - Stefanie Dimmeler
- German Center for Cardiovascular Research (DZHK), Partner site Rhine-Main, Germany.,Institute of Cardiovascular Regeneration, Center of Molecular Medicine, Goethe University Frankfurt, Frankfurt, Germany.,Cardiopulmonary Institute, Goethe University Frankfurt, Frankfurt, Germany
| | - Mariuca Vasa Nicotera
- Department of Cardiology, Center of Internal Medicine, Goethe University Frankfurt, Frankfurt, Germany.,German Center for Cardiovascular Research (DZHK), Partner site Rhine-Main, Germany.,Cardiopulmonary Institute, Goethe University Frankfurt, Frankfurt, Germany
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9
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Predicting Long-Term Mortality after Acute Coronary Syndrome Using Machine Learning Techniques and Hematological Markers. DISEASE MARKERS 2019; 2019:9056402. [PMID: 30838085 PMCID: PMC6374871 DOI: 10.1155/2019/9056402] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Accepted: 12/11/2018] [Indexed: 01/09/2023]
Abstract
Introduction Hematological indices including red cell distribution width and neutrophil to lymphocyte ratio are proven to be associated with outcomes of acute coronary syndrome. The usefulness of machine learning techniques in predicting mortality after acute coronary syndrome based on such features has not been studied before. Objective We aim to create an alternative risk assessment tool, which is based on easily obtainable features, including hematological indices and inflammation markers. Patients and Methods We obtained the study data from the electronic medical records of 5053 patients hospitalized with acute coronary syndrome during a 5-year period. The time of follow-up ranged from 12 to 72 months. A machine learning classifier was trained to predict death during hospitalization and within 180 and 365 days from admission. Our method was compared with the Global Registry of Acute Coronary Events (GRACE) Score 2.0 on a test dataset. Results For in-hospital mortality, our model achieved a c-statistic of 0.89 while the GRACE score 2.0 achieved 0.90. For six-month mortality, the results of our model and the GRACE score on the test set were 0.77 and 0.73, respectively. Red cell distribution width (HR 1.23; 95% CL 1.16-1.30; P < 0.001) and neutrophil to lymphocyte ratio (HR 1.08; 95% CL 1.05-1.10; P < 0.001) showed independent association with all-cause mortality in multivariable Cox regression. Conclusions Hematological markers, such as neutrophil count and red cell distribution width have a strong association with all-cause mortality after acute coronary syndrome. A machine-learned model which uses the abovementioned parameters can provide long-term predictions of accuracy comparable or superior to well-validated risk scores.
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