Multichamber Myocardial Strain for Cardiovascular Risk Stratification in Liver Transplant Recipients Using Interpretable Machine Learning

Figures

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  Figure 1. Discrimination of Machine Learning Models vs Historical Models for Prediction of Post-transplant Major Adverse Cardiovascular Events AP = average precision; AUC = area under the receiver operating characteristic curve; AUPRC = area under the precision-recall curve; CAD-LT = coronary artery disease in liver transplant score; CAR-OLT = cardiovascular risk in orthotopic liver transplantation score; LT = liver transplant; MACE = major adverse cardiovascular event; ML = machine learning; ROC = receiver operating characteristic curve; XGBoost = extreme gradient boosting.

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  Figure 2. Calibration of Predicted vs Observed 3-Year Major Adverse Cardiovascular Event Risk KM = Kaplan-Meier; O/E = observed-to-expected; other abbreviations as in Figure 1.

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  Figure 3. Decision Curve Analysis Showing Net Clinical Benefit Across Threshold Probabilities OOF = out-of-fold; other abbreviations as in Figure 1.

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  Figure 4. Incremental Discrimination of Multichamber Strain Over Clinical Variables Alone CV = cross-validation; NRI = net reclassification improvement; other abbreviations as in Figures 1 and 3.

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  Figure 5. Multidomain Phenotype Characterization by Unsupervised Clustering BMI = body mass index; eGFR = estimated glomerular filtration rate; LA = left atrial; LV = left ventricular; LVEF = left ventricular ejection fraction; MELD = Model for End-Stage Liver Disease; RV = right ventricular.

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  Figure 6. SHapley Additive exPlanations Beeswarm Plot Illustrating Relative Variable Importance MASLD = metabolic dysfunction-associated steatotic liver disease; SHAP = SHapley Additive exPlanations; TR = tricuspid regurgitation; other abbreviations as in Figure 5.

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  Central Illustration. Machine Learning Prediction of Cardiovascular Events After Liver Transplant AUC = area under the receiver operating characteristic curve; AUPRC = area under the precision-recall curve; BMI = body mass index; CAD-LT = coronary artery disease in liver transplant score; CAR-OLT = cardiovascular risk in orthotopic liver transplantation score; MACE = major adverse cardiovascular event; MASLD = metabolic dysfunction-associated steatotic liver disease; MELD = Model for End-Stage Liver Disease; ML = machine learning; ROC = receiver operating characteristic curve; XGBoost = extreme gradient boosting; eGFR = estimated glomerular filtration rate; LA = left atrial; LV = left ventricular; LVEF = left ventricular ejection fraction; RV = right ventricular; SHAP = SHapley Additive exPlanations; TR = tricuspid regurgitation.