Characterization of the Electrophysiologic Remodeling of Patients With Ischemic Cardiomyopathy by Clinical Measurements and Computer Simulations Coupled With Machine Learning.
Characterization of the Electrophysiologic Remodeling of Patients With Ischemic Cardiomyopathy by Clinical Measurements and Computer Simulations Coupled With Machine Learning.
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DOI：
10.3389/fphys.2021.684149
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发表时间：
2021
影响因子：
4
通讯作者：
Trayanova NA
中科院分区：
文献类型：
--
作者：
Aronis KN;Prakosa A;Bergamaschi T;Berger RD;Boyle PM;Chrispin J;Ju S;Marine JE;Sinha S;Tandri H;Ashikaga H;Trayanova NA
缺血性心肌病（ICMP）患者发生恶性心律失常的风险很高，主要是由于非梗死心肌的电生理重构。ICMP患者非梗死心肌的电生理特性在很大程度上仍然未知。评估ICMP患者非梗死心肌的促心律失常行为，并将计算模拟与机器学习相结合，建立基于临床测量的动作电位持续时间恢复（APDR）数据的疾病特异性动作电位模型的开发方法。我们招募了22例接受左侧消融术（10例ICMP）的患者，并比较了ICMP和结构正常左心室（snlv）的APDRs。apdr的临床评估采用减量起搏方案。使用遗传算法（GAs），我们构建了包含队列特定apdr的动作电位模型群体。利用无监督机器学习，基于相似性的聚类模型捕获了ICMP和SNLV模型群体的可变性。在细胞和组织水平模拟中评估ICMP和SNLV模型的促心律失常电位。临床测量表明，ICMP患者的APDR斜率比SNLV患者更陡（相差38%，p < 0.01）。在细胞水平的模拟中，与SNLV模型相比，ICMP模型在更长的周期长度下诱导APD交替（385-400 vs 355 ms）。在组织级模拟中，与SNLV模型相比，ICMP模型更容易出现持续的功能性再入。与SNLV相比，ICMP患者的心肌重构表现为更陡峭的APDR，这是这些患者更大的致心律失常倾向的基础，这是由GAs从临床测量中开发的动作电位模型的细胞和组织水平模拟所证明的。本文提出的方法抓住了GAs模型发展中固有的不确定性，并为未来旨在评估其他心脏疾病引起的电生理重塑的研究提供了蓝图。
Patients with ischemic cardiomyopathy (ICMP) are at high risk for malignant arrhythmias, largely due to electrophysiological remodeling of the non-infarcted myocardium. The electrophysiological properties of the non-infarcted myocardium of patients with ICMP remain largely unknown. To assess the pro-arrhythmic behavior of non-infarcted myocardium in ICMP patients and couple computational simulations with machine learning to establish a methodology for the development of disease-specific action potential models based on clinically measured action potential duration restitution (APDR) data. We enrolled 22 patients undergoing left-sided ablation (10 ICMP) and compared APDRs between ICMP and structurally normal left ventricles (SNLVs). APDRs were clinically assessed with a decremental pacing protocol. Using genetic algorithms (GAs), we constructed populations of action potential models that incorporate the cohort-specific APDRs. The variability in the populations of ICMP and SNLV models was captured by clustering models based on their similarity using unsupervised machine learning. The pro-arrhythmic potential of ICMP and SNLV models was assessed in cell- and tissue-level simulations. Clinical measurements established that ICMP patients have a steeper APDR slope compared to SNLV (by 38%, p < 0.01). In cell-level simulations, APD alternans were induced in ICMP models at a longer cycle length compared to SNLV models (385–400 vs 355 ms). In tissue-level simulations, ICMP models were more susceptible for sustained functional re-entry compared to SNLV models. Myocardial remodeling in ICMP patients is manifested as a steeper APDR compared to SNLV, which underlies the greater arrhythmogenic propensity in these patients, as demonstrated by cell- and tissue-level simulations using action potential models developed by GAs from clinical measurements. The methodology presented here captures the uncertainty inherent to GAs model development and provides a blueprint for use in future studies aimed at evaluating electrophysiological remodeling resulting from other cardiac diseases.
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影响因子：
29
作者：
Gorski PA;Ceholski DK;Hajjar RJ
通讯作者：
Hajjar RJ
影响因子：
20.1
作者：
BEUCKELMANN, DJ;NABAUER, M;ERDMANN, E
通讯作者：
ERDMANN, E
影响因子：
1.3
作者：
Berger, RD
通讯作者：
Berger, RD
DOI：
10.1152/ajpheart.00082.2004
发表时间：
2004-09-01
影响因子：
4.8
作者：
Dun, W;Baba, SG;Boyden, PA
通讯作者：
Boyden, PA
影响因子：
10.8
作者：
Camelliti, P;Devlin, GP;Green, CR
通讯作者：
Green, CR