Identifying novel phenotypes of elevated left ventricular end diastolic pressure using hierarchical clustering of features derived from electromechanical waveform data

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  • Burton, Timothy
    • Other Affiliation: CorVista Health
  • Ramchandani, Shyam
    • Other Affiliation: CorVista Health
  • Bhavnani, Sanjeev P.
    • Other Affiliation: Scripps Clinic Division of Cardiology
  • Khedraki, Rola
    • Other Affiliation: Scripps Clinic Division of Cardiology
  • Cohoon, Travis J.
    • Other Affiliation: Scripps Clinic Division of Cardiology
  • Stuckey, Thomas D.
    • Other Affiliation: Cone Health Heart and Vascular Center
  • Steuter, John A.
    • Other Affiliation: Bryan Heart
  • Meine, Frederick J.
    • Other Affiliation: Novant Health New Hanover Regional Medical Center
  • Bennett, Brett A.
    • Other Affiliation: Jackson Heart Clinic
  • Carroll, William S.
    • Other Affiliation: Cardiology Associates of North Mississippi
  • Lange, Emmanuel
    • Other Affiliation: CorVista Health
  • Fathieh, Farhad
    • Other Affiliation: CorVista Health
  • Khosousi, Ali
    • Other Affiliation: CorVista Health
  • Rabbat, Mark
    • Other Affiliation: Loyola University Medical Center
  • Sanders, William E.
    • Affiliation: University of North Carolina at Chapel Hill
Abstract
  • Introduction Elevated left ventricular end diastolic pressure (LVEDP) is a consequence of compromised left ventricular compliance and an important measure of myocardial dysfunction. An algorithm was developed to predict elevated LVEDP utilizing electro-mechanical (EM) waveform features. We examined the hierarchical clustering of selected features developed from these EM waveforms in order to identify important patient subgroups and assess their possible prognostic significance. Materials and methods Patients presenting with cardiovascular symptoms (N = 396) underwent EM data collection and direct LVEDP measurement by left heart catheterization. LVEDP was classified as non-elevated ( ≤ 12 mmHg) or elevated (≥25 mmHg). The 30 most contributive features to the algorithm output were extracted from EM data and input to an unsupervised hierarchical clustering algorithm. The resultant dendrogram was divided into five clusters, and patient metadata overlaid. Results The cluster with highest LVEDP (cluster 1) was most dissimilar from the lowest LVEDP cluster (cluster 5) in both clustering and with respect to clinical characteristics. In contrast to the cluster demonstrating the highest percentage of elevated LVEDP patients, the lowest was predominantly non-elevated LVEDP, younger, lower BMI, and males with a higher rate of significant coronary artery disease (CAD). The next adjacent cluster (cluster 2) to that of the highest LVEDP (cluster 1) had the second lowest LVEDP of all clusters. Cluster 2 differed from Cluster 1 primarily based on features extracted from the electrical data, and those that quantified predictability and variability of the signal. There was a low predictability and high variability in the highest LVEDP cluster 1, and the opposite in adjacent cluster 2. Conclusion This analysis identified subgroups of patients with varying degrees of LVEDP elevation based on waveform features. An approach to stratify movement between clusters and possible progression of myocardial dysfunction may include changes in features that differentiate clusters; specifically, reductions in electrical signal predictability and increases in variability. Identification of phenotypes of myocardial dysfunction evidenced by elevated LVEDP and knowledge of factors promoting transition to clusters with higher levels of left ventricular filling pressures could permit early risk stratification and improve patient selection for novel therapeutic interventions.
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  • Article
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  • In Copyright
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  • Attribution 4.0 International
Journal title
  • Frontiers in Cardiovascular Medicine
Journal volume
  • 9
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  • English
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  • 2297-055X

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