Key result
Assessment with tissue Doppler imaging and speckle tracking echocardiography mid-term after arterial switch operation showed decreased biventricular function, and clustering identified a high-risk phenotype.
Why the study?
Advanced echocardiography can detect subtle changes in ventricular performance, but ventricular performance and clinical phenotypes identified by machine learning in TGA patients at mid-term follow-up after ASO warranted investigation.
Does advanced echocardiography (TDI and STE) combined with machine learning identify patterns of ventricular dysfunction in patients with TGA after ASO?
Observational (n=124)
Yes
Does advanced echocardiography (TDI and STE) combined with machine learning identify patterns of ventricular dysfunction in patients with TGA after ASO?
Advanced echocardiography combined with unsupervised machine learning identifies distinct clinical phenotypes of biventricular dysfunction in patients with transposition of the great arteries mid-term after the arterial switch operation.
Background: Advanced echocardiographic techniques such as Tissue Doppler imaging (TDI) and speckle tracking echocardiography (STE) can detect more subtle changes in ventricular performance. We aimed to study the ventricular performance in patients with transposition of the great arteries (TGA) at mid-term follow-up after the arterial switch operation (ASO) with advanced echocardiographic techniques. In addition, we sought to discover new clinical phenotypes using unsupervised machine learning. Methods: Conventional, TDI and STE echocardiographic parameters were prospectively obtained from 124 TGA patients (66.1 % male, age 10.8 ± 5.1 years, 24.2 % with ventricular septal defect) in this observational study. The data was analyzed with conventional statistics and new machine learning techniques. Results: TGA patients had reduced biventricular systolic (septal s' Z-score -2.28 ± 1.26; RV s' Z-score -2.16 ± 0.71; mean left ventricular longitudinal strain Z-score of the LV -2.49 ± 1.68) and RV diastolic performance (RV E/e' Z-score 2.35 ± 1.70) mid-term after ASO. Unsupervised clustering within the TGA population revealed 3 clusters. Interestingly, cluster 3 defined a group of patients with older age at ASO, the most reduced ventricular performance as well as the highest rates of reoperations and interventions. Conclusions: Assessment of ventricular performance with TDI and STE 10 years after ASO showed that TGA patients have decreased biventricular systolic and diastolic function, especially at the septal regions. Novel analytical methods such as unsupervised clustering may help identify new clinical phenotypes from multiple variables and may contribute to improved risk stratification.
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Monteros et al. (2024) conducted an observational in Transposition of the great arteries after arterial switch operation (n=124). Transposition of the great arteries after arterial switch operation vs. Reference values / Unsupervised clusters was evaluated on Ventricular performance assessed by tissue Doppler imaging and speckle tracking echocardiography Z-scores. Assessment with tissue Doppler imaging and speckle tracking echocardiography mid-term after arterial switch operation showed decreased biventricular function, and clustering identified a high-risk phenotype.
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