Development and validation of a moderate aortic stenosis disease progression model

Background

Understanding the multifactorial determinants of rapid progression in patients with aortic stenosis (AS) remains limited. We aimed to develop and validate a machine learning model (ML) for predicting rapid progression from moderate to severe AS within one year.

Methods

8746 patients were identified with moderate AS across seven healthcare organizations. Three ML models were trained using demographic, and echocardiographic variables, namely Random Forest, XGBoost and causal discovery-logistic regression. An ensemble model was developed integrating the aforementioned three. A total of 3355 patients formed the training and internal validation cohort. External validation was performed on 171 patients from one institution.

Results

An ensemble model was selected due to its superior F1 score and precision in internal validation (0.382 and 0.301, respectively). Its performance on the external validation cohort was modest (F1 score = 0.626, precision = 0.532).

Conclusion

An ensemble model comprising only demographic and echocardiographic variables was shown to have modest performance in predicting one-year progression from moderate to severe AS. Further validation in larger populations, along with integration of comprehensive clinical data, is crucial for broader applicability.