Assessment of the relationship between central venous pressure waveform and the severity of tricuspid valve regurgitation using data science

Figures

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  Fig. 1. We are collecting CVP waveforms for each case from the start of CVP measurement to the beginning of the surgery.

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  Fig. 2. Here is a diagram of the Transformer architecture used in this research. It is composed of a Transformer encoder. Feed Forward, Feed Forward Network; MLP, MultiLayer Perceptron.

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  Fig. 3. Among the patients who underwent surgery under general anesthesia at the University of Tokyo Hospital between April 2021 and June 2023, those who underwent preoperative echocardiography, intraoperative CV catheter insertion, and pressure waveform measurements were included in this study (n = 607). Thirty-six patients had AF or AFL on ECG, and 39 patients underwent echocardiography without TR measurement. Ninety-six patients did not have CVP waveform data before the start of surgery. Consequently, 436 patients were included. CVP, central venous pressure; TR, tricuspid regurgitation; AF, atrial fibrillation; AFL, atrial flutter; ECG, echocardiogram.

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  Fig. 4. Individual CVP waveforms were drawn in black with increased transparency. All CVP waveforms after the removal of artifacts were included. The CVP waveform underwent resizing to standardize the time scale and normalize the maximum and minimum pressure values. CVP, central venous pressure.

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  Fig. 5. V wave - Y descent, X descent - Y descent, and C wave - Y descent were calculated for each waveform in the cases and the median value was determined for each case. Jonckheere–Terpstra test was performed using these values according to the severity of TR. C wave - Y descent (p value = 0.0018), X descent - Y descent (p value = 0.027), and V wave - Y descent (p value = 0.077). The p-value is written above the bar in cases with a significant difference in Steel–Dwass’s multiple comparison test. TR, tricuspid regurgitation.

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  Fig. 6. C wave - Y descent and X descent - Y descent were calculated for each waveform in the cases and the median value was determined for each case. Using these values, ROC curve was drawn for the two groups, TR none to moderate and severe. C wave - Y descent (AUC: 0.66, 95% CI by the Hanley method [0.47, 0.83], Youden index: 5.9 mmHg, specificity: 0.96, sensitivity: 0.36). X descent - Y descent (AUC: 0.83, 95% CI by the Hanley method [0.68, 0.98], Youden index: 1.3 mmHg, specificity: 0.94, sensitivity: 0.64). TR, tricuspid regurgitation; AUC, Area under the receiver operating characteristic curve; ROC, receiver operating characteristic curve; CI, confidence interval.

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  Fig. 7. Results of the prediction of the validation data in the model created by Transformer in Time Series with the confusion matrix.

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  Fig. 8. Transformer in Time Series model used to predict CVP waveform of the none and severe groups, and the prediction basis was visualized using attention Map. CVP, central venous pressure.