Pre-implant echocardiography plus EHR for post-LVAD risk stratification for survival: Single-center exploratory study.
TL;DR
This multimodal approach identifies high-risk phenotypes, specifically right-heart and systemic frailty, providing a framework for personalized clinical decision support and future multicenter validation.
Abstract
Purpose
Durable LVAD therapy improves survival for advanced heart failure, yet adverse outcomes remain common. We evaluated whether combining pre-implant echocardiography with routinely available Electronic Health Record (EHR) data yields clinically useful post-LVAD risk predictions to improve patient selection and perioperative management.
Methods
In this retrospective study (2015-2022), pre-implant apical four-chamber echocardiograms were processed via raw loops and U-Net segmentation. CNN embeddings were integrated with PCA-reduced EHR variables including demographics, laboratories, and hemodynamics. Survival models, including Cox proportional hazards and random survival forests, were trained on multimodal inputs. Performance was validated using stratified 5-fold cross-validation, targeting a primary endpoint of time to death or missed follow-up. Saliency mapping was utilized to ensure clinical interpretability of the model's features.
Results
Multimodal models achieved higher discrimination than single-modality models, with segmented-echo inputs outperforming raw videos (mean C-index of 0.711). Saliency mapping identified clinically coherent predictors: right ventricular and septal geometry on imaging, alongside renal, hepatic, and nutritional status from the EHR.
Conclusions
Integrating pre-implant echocardiography with EHR data enhances risk stratification survival for LVAD candidates. This multimodal approach identifies high-risk phenotypes, specifically right-heart and systemic frailty, providing a framework for personalized clinical decision support and future multicenter validation.