7,119 research outputs found
Usefulness of regional right ventricular and right atrial strain for prediction of early and late right ventricular failure following a left ventricular assist device implant: A machine learning approach
Background: Identifying candidates for left ventricular assist device surgery at risk of right ventricular failure remains difficult. The aim was to identify the most accurate predictors of right ventricular failure among clinical, biological, and imaging markers, assessed by agreement of different supervised machine learning algorithms. Methods: Seventy-four patients, referred to HeartWare left ventricular assist device since 2010 in two Italian centers, were recruited. Biomarkers, right ventricular standard, and strain echocardiography, as well as cath-lab measures, were compared among patients who did not develop right ventricular failure (N = 56), those with acute–right ventricular failure (N = 8, 11%) or chronic–right ventricular failure (N = 10, 14%). Logistic regression, penalized logistic regression, linear support vector machines, and naïve Bayes algorithms with leave-one-out validation were used to evaluate the efficiency of any combination of three collected variables in an “all-subsets” approach. Results: Michigan risk score combined with central venous pressure assessed invasively and apical longitudinal systolic strain of the right ventricular–free wall were the most significant predictors of acute–right ventricular failure (maximum receiver operating characteristic–area under the curve = 0.95, 95% confidence interval = 0.91–1.00, by the naïve Bayes), while the right ventricular–free wall systolic strain of the middle segment, right atrial strain (QRS-synced), and tricuspid annular plane systolic excursion were the most significant predictors of Chronic-RVF (receiver operating characteristic–area under the curve = 0.97, 95% confidence interval = 0.91–1.00, according to naïve Bayes). Conclusion: Apical right ventricular strain as well as right atrial strain provides complementary information, both critical to predict acute–right ventricular failure and chronic–right ventricular failure, respectively
Hemodynamic management of cardiogenic shock in the intensive care unit
Hemodynamic derangements are defining features of cardiogenic shock. Randomized clinical trials have examined the efficacy of various therapeutic interventions, from percutaneous coronary intervention to inotropes and mechanical circulatory support (MCS). However, hemodynamic management in cardiogenic shock has not been well-studied. This State-of-the-Art review will provide a framework for hemodynamic management in cardiogenic shock, including a description of the 4 therapeutic phases from initial 'Rescue' to 'Optimization', 'Stabilization' and 'de-Escalation or Exit therapy' (RO-S-E), phenotyping and phenotype-guided tailoring of pharmacological and MCS support, to achieve hemodynamic and therapeutic goals. Finally, the premises that form the basis for clinical management and the hypotheses for randomized controlled trials will be discussed, with a view to the future direction of cardiogenic shock. (c) 2024 The Authors. Published by Elsevier Inc. on behalf of International Society for Heart and Lung Transplantation. This is an open access article under the CC BY license (http://creativecommons.org/ licenses/by/4.0/)
A dynamic risk score for early prediction of cardiogenic shock using machine learning
Myocardial infarction and heart failure are major cardiovascular diseases
that affect millions of people in the US. The morbidity and mortality are
highest among patients who develop cardiogenic shock. Early recognition of
cardiogenic shock is critical. Prompt implementation of treatment measures can
prevent the deleterious spiral of ischemia, low blood pressure, and reduced
cardiac output due to cardiogenic shock. However, early identification of
cardiogenic shock has been challenging due to human providers' inability to
process the enormous amount of data in the cardiac intensive care unit (ICU)
and lack of an effective risk stratification tool. We developed a deep
learning-based risk stratification tool, called CShock, for patients admitted
into the cardiac ICU with acute decompensated heart failure and/or myocardial
infarction to predict onset of cardiogenic shock. To develop and validate
CShock, we annotated cardiac ICU datasets with physician adjudicated outcomes.
CShock achieved an area under the receiver operator characteristic curve
(AUROC) of 0.820, which substantially outperformed CardShock (AUROC 0.519), a
well-established risk score for cardiogenic shock prognosis. CShock was
externally validated in an independent patient cohort and achieved an AUROC of
0.800, demonstrating its generalizability in other cardiac ICUs
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Prediction of Recovery From Severe Hemorrhagic Shock Using Logistic Regression.
This paper implements logistic regression models (LRMs) and feature selection for creating a predictive model for recovery form hemorrhagic shock (HS) with resuscitation using blood in the multiple experimental rat animal protocols. A total of 61 animals were studied across multiple HS experiments, which encompassed two different HS protocols and two resuscitation protocols using blood stored for short periods using five different techniques. Twenty-seven different systemic hemodynamics, cardiac function, and blood gas parameters were measured in each experiment, of which feature selection deemed only 25% of the them as relevant. The reduced feature set was used to train a final logistic regression model. A final test set accuracy is 84% compared to 74% for a baseline classifier using only MAP and HR measurements. Receiver operating characteristics (ROC) curve analysis and Cohens kappa statistics were also used as measures of performance, with the final reduced model outperforming the model, including all parameters. Our results suggest that LRMs trained with a combination of systemic hemodynamics, cardiac function, and blood gas parameters measured at multiple timepoints during HS can successfully classify HS recovery groups. Our results show the predictive ability of traditional and novel hemodynamic and cardiac function features and their combinations, many of which had not previously been taken into consideration, for monitoring HS. Furthermore, we have devised an effective methodology for feature selection and shown ways in which the performance of such predictive models should be assessed in future studies
Improving the acute and perioperative hemodynamic assessment
First, this thesis aimed to extend the evidence on the applicability of hemodynamic monitoring during the perioperative period and after admission to the ICU. Second, we aimed to gain knowledge on how to improve the conduct of studies in perioperative and critical care medicine.We provided an overview of the current evidence for hemodynamic monitoring in perioperative goal-directed therapy. We showed that the studies on this subject showed clinical heterogeneity and risk of bias. Extension of all aspects of hemodynamic monitoring was considered in this thesis. A study was performed on the educated guess of physicians when estimating cardiac output using clinical examination to help improve the reliability of the clinical examination. We showed that physicians at the bed-side mainly consider mottling score and norepinephrine dose when estimating cardiac output. In another study, we demonstrated that blood pressure measurements differ when measured invasively or non-invasively and that these differences may have clinical consequences. We also showed that echocardiography could be performed by novices, but experts are needed to interpret obtained images. We demonstrated that cardiac output measurements vary in critically ill patients when measured with echocardiography or uncalibrated pulse wave analysis.For the second part of this thesis, we demonstrated that various mortality prediction models exist for critically ill patients. Quality of methodology often lacks for these models, and improvements have to be made to help patient care. To help improve the quality of studies, we finally propose that study protocols are prepublished and made available for peer-review before conduct
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