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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. Eur Heart J Digit 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] [What about the content of this article? (0)] [Affiliation(s)] [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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