Assessment of left ventricular relaxation time constant using arterial pressure waveform.

Abstract

Objective: Instantaneous determination of left ventricular (LV) diastolic function would be a useful aid in diagnosis and treatment of heart failure. The time constant of LV pressure decay (also known as Tau) is an established metric for evaluating LV stiffness and assessing LV diastolic function. Approach: In this study, we present a novel approach that uses a single arterial (aortic) pressure waveform to classify abnormal Tau through a physics-based machine learning (ML) methodology. This study is based on a clinical LV catheterization at the University of Southern California Keck Medical Center. We included 54 patients (13 females, age 36-90 (66.3±10.8), BMI 20.2-38.5 (27.8±4.6)) that were subjected to the same exclusion criteria of the primary study. Invasive pressure waveforms at LV and ascending aorta were measured using 2.5 F transducer tipped electronic micro-catheters. Intrinsic frequency (IF) parameters were computed from aortic pressure waveforms. Tau was calculated using an exponential curve-fitting approach based on LV pressure. Tau ranges were 25.7-86.5 ms (50.3±11), and Tau = 48 ms was used as a binary classification cut-off. Random forest and K-nearest neighbors classifiers were trained on 44 patients and blindly tested on 10 patients. 3- fold cross-validation was used to prevent overfitting. Main Results: Our proposed ML classifier model accurately predicts true Tau classes using physics-based features, where the most accurate one demonstrates 80.0% (elevated) and 100.0% (normal) success in predicting true Tau classes on blind data. Significance: We demonstrate that our proposed physics-based ML models can instantaneously classify Tau using information from a single aortic pressure waveform. Although an invasive proof, the required model inputs can be acquired non-invasively using carotid waveforms, working toward a smartphone-based, patient-activated tool for assessing diastolic dysfunction. .