Prediction of echocardiographic parameters in Chagas disease using heart rate variability and machine learning

Abstract Objective Investigate whether heart rate variability (HRV) indices can be used to predict morpho-functional parameters obtained from the echocardiogram in a population of patients with Chagas disease (CD). Methods Sixty-three patients with CD and a recent echocardiogram had their ECG and respiratory signals recorded for 15 min. The cardiac interval series were generated from the ECG and 27 HRV indices, plus the respiratory frequency, were calculated. The correlation between HRV and echocardiographic variables was estimated. The HRV indices were also utilized as inputs in four machine learning schemes to create predictive models for numeric and categorical echocardiographic parameters. Attribute selection schemes were also performed to identify the subset of HRV indices that best represent each parameter for each machine learning algorithm. Results Only three echocardiographic parameters had no HRV index significantly correlated to them. The most frequently selected HRV index in the attribute selection process was the fractal short-term scaling exponent. The regression models (numeric parameters) reached reasonable performance (R > 0.5) for all except two parameters, while the classification models (categorical variables) achieved better performance, with precision and recall values higher than 0.74. Conclusion HRV indices, both isolated and combined, are associated with cardiac morpho-functional properties in patients with CD, and may be used to predict echocardiographic parameters. Significance The possibility of modeling the cardiac morpho-functional parameters in patients with CD using HRV indices opens the possibility to use HRV for risk assessment in patients with CD, especially those harboring the indeterminate form of the disease.

[1]  Simon Haykin,et al.  Neural Networks: A Comprehensive Foundation , 1998 .

[2]  S. Laucella,et al.  Value of echocardiography for diagnosis and prognosis of chronic Chagas disease cardiomyopathy without heart failure , 2004, Heart.

[3]  H. Acquatella Echocardiography in Chagas Heart Disease , 2007, Circulation.

[4]  J. Richman,et al.  Physiological time-series analysis using approximate entropy and sample entropy. , 2000, American journal of physiology. Heart and circulatory physiology.

[5]  M. Drazner,et al.  2013 ACCF/AHA guideline for the management of heart failure: executive summary: a report of the American College of Cardiology Foundation/American Heart Association Task Force on practice guidelines. , 2013, Circulation.

[6]  B. Pompe,et al.  Permutation entropy: a natural complexity measure for time series. , 2002, Physical review letters.

[7]  R. Bestetti,et al.  Heart rate variability in the frequency domain in chronic Chagas disease: correlation of autonomic dysfunction with variables of daily clinical practice. , 2011, International journal of cardiology.

[8]  P. Macfarlane,et al.  Heart rate variability in left ventricular hypertrophy. , 1995, British heart journal.

[9]  C. Peng,et al.  Fractal analysis of heart rate dynamics as a predictor of mortality in patients with depressed left ventricular function after acute myocardial infarction. TRACE Investigators. TRAndolapril Cardiac Evaluation. , 1999, The American journal of cardiology.

[10]  John C. Platt,et al.  Fast training of support vector machines using sequential minimal optimization, advances in kernel methods , 1999 .

[11]  J. Suzić-Lazić,et al.  The relationship between right ventricular deformation and heart rate variability in asymptomatic diabetic patients. , 2017, Journal of diabetes and its complications.

[12]  Herbert F. Jelinek,et al.  Estimating Left Ventricle Ejection Fraction Levels Using Circadian Heart Rate Variability Features and Support Vector Regression Models , 2020, IEEE Journal of Biomedical and Health Informatics.

[13]  J. Pérez,et al.  Limited myocardial contractile reserve and chronotropic incompetence in patients with chronic Chagas' disease: assessment by dobutamine stress echocardiography. , 1999, Journal of the American College of Cardiology.

[14]  R. Cohen,et al.  Power spectrum analysis of heart rate fluctuation: a quantitative probe of beat-to-beat cardiovascular control. , 1981, Science.

[15]  A. Rassi,et al.  Predictors of Mortality in Chronic Chagas Disease: A Systematic Review of Observational Studies , 2007, Circulation.

[16]  Ary L. Goldberger,et al.  Heart Rate Fragmentation: A Symbolic Dynamical Approach , 2017, Front. Physiol..

[17]  Wangxin Yu,et al.  Characterization of Surface EMG Signal Based on Fuzzy Entropy , 2007, IEEE Transactions on Neural Systems and Rehabilitation Engineering.

[18]  A. Porta,et al.  Power-law behavior of heart rate variability in Chagas' disease. , 2002, The American journal of cardiology.

[19]  Hamed Azami,et al.  Dispersion Entropy: A Measure for Time-Series Analysis , 2016, IEEE Signal Processing Letters.

[20]  G. Aquaro,et al.  Scar extent, left ventricular end-diastolic volume, and wall motion abnormalities identify high-risk patients with previous myocardial infarction: a multiparametric approach for prognostic stratification. , 2013, European heart journal.

[21]  Victor Mor-Avi,et al.  Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. , 2015, European heart journal cardiovascular Imaging.

[22]  D. Dávila,et al.  Cardiac Autonomic Control Mechanisms in the Pathogenesis of Chagas' Heart Disease , 2012, Interdisciplinary perspectives on infectious diseases.

[23]  D. Altman,et al.  Measuring agreement in method comparison studies , 1999, Statistical methods in medical research.

[24]  H. Huikuri,et al.  Fractal analysis of heart rate variability and mortality after an acute myocardial infarction. , 2002, The American journal of cardiology.

[25]  John G. Cleary,et al.  K*: An Instance-based Learner Using and Entropic Distance Measure , 1995, ICML.

[26]  D. Altman,et al.  Comparing methods of measurement: why plotting difference against standard method is misleading , 1995, The Lancet.

[27]  P. Welch The use of fast Fourier transform for the estimation of power spectra: A method based on time averaging over short, modified periodograms , 1967 .

[28]  Sergio Cerutti,et al.  Entropy, entropy rate, and pattern classification as tools to typify complexity in short heart period variability series , 2001, IEEE Transactions on Biomedical Engineering.

[29]  D. Dávila,et al.  Chagas' heart disease and the autonomic nervous system. , 1998, International journal of cardiology.

[30]  A. Hasslocher-Moreno,et al.  Development and validation of a risk score for predicting death in Chagas' heart disease. , 2006, The New England journal of medicine.

[31]  A. Ribeiro,et al.  Parasympathetic dysautonomia precedes left ventricular systolic dysfunction in Chagas disease. , 2001, American heart journal.

[32]  A. Schmidt,et al.  Chagas Disease Cardiomyopathy , 2018 .

[33]  B. Maciel,et al.  Pathogenesis of Chronic Chagas Heart Disease , 2007, Circulation.

[34]  J. A. Neto,et al.  Functional alterations of the autonomic nervous system in Chagas' heart disease , 1995 .

[35]  L. F. Junqueira Insights into the clinical and functional significance of cardiac autonomic dysfunction in Chagas disease. , 2012, Revista da Sociedade Brasileira de Medicina Tropical.

[36]  Alberto Porta,et al.  Assessment of cardiac autonomic modulation during graded head-up tilt by symbolic analysis of heart rate variability. , 2007, American journal of physiology. Heart and circulatory physiology.

[37]  R Gorlin,et al.  Problems in echocardiographic volume determinations: echocardiographic-angiographic correlations in the presence of absence of asynergy. , 1976, The American journal of cardiology.

[38]  G. Breithardt,et al.  Heart rate variability: standards of measurement, physiological interpretation and clinical use. Task Force of the European Society of Cardiology and the North American Society of Pacing and Electrophysiology. , 1996 .

[39]  A. Goldberger,et al.  Heart rate fragmentation: using cardiac pacemaker dynamics to probe the pace of biological aging. , 2019, American journal of physiology. Heart and circulatory physiology.

[40]  Ashish Rohila,et al.  Phase entropy: a new complexity measure for heart rate variability , 2019, Physiological measurement.

[41]  S. Yusuf,et al.  Effects of Trypanocidal Treatment on Echocardiographic Parameters in Chagas Cardiomyopathy and Prognostic Value of Wall Motion Score Index: A BENEFIT Trial Echocardiographic Substudy , 2019, Journal of the American Society of Echocardiography : official publication of the American Society of Echocardiography.

[42]  A. Malliani,et al.  Impaired heart rate variability in patients with chronic Chagas' disease. , 1991, American heart journal.

[43]  H. Stanley,et al.  Quantification of scaling exponents and crossover phenomena in nonstationary heartbeat time series. , 1995, Chaos.

[44]  J. Marin-Neto,et al.  Chagas disease , 2010, The Lancet.

[45]  A. Porta,et al.  Comparison between spectral analysis and symbolic dynamics for heart rate variability analysis in the rat , 2017, Scientific Reports.

[46]  A. Malliani,et al.  Heart rate variability. Standards of measurement, physiological interpretation, and clinical use , 1996 .

[47]  J. Haerting,et al.  Longitudinal association of short-term, metronome-paced heart rate variability and echocardiographically assessed cardiac structure at a 4-year follow-up: results from the prospective, population-based CARLA cohort , 2017, Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology.

[48]  Distinctive impaired cardiac autonomic modulation of heart rate variability in chronic Chagas' indeterminate and heart diseases. , 2009, Journal of electrocardiology.

[49]  Dingchang Zheng,et al.  Assessing the complexity of short-term heartbeat interval series by distribution entropy , 2014, Medical & Biological Engineering & Computing.

[50]  D. Oral,et al.  Heart rate variability in hypertrophic obstructive cardiomyopathy: association with functional classification and left ventricular outflow gradients. , 2001, International journal of cardiology.

[51]  D Geue,et al.  Temporal asymmetries of short-term heart period variability are linked to autonomic regulation. , 2008, American journal of physiology. Regulatory, integrative and comparative physiology.

[52]  V. Zarzoso,et al.  Association between circadian Holter ECG changes and sudden cardiac death in patients with Chagas heart disease , 2020, Physiological measurement.

[53]  A L Goldberger,et al.  Fractal correlation properties of R-R interval dynamics and mortality in patients with depressed left ventricular function after an acute myocardial infarction. , 2000, Circulation.

[54]  P. Kruzliak,et al.  Left ventricular diastolic function in diabetes mellitus type 2 patients: correlation with heart rate and its variability , 2014, Acta Diabetologica.

[55]  M L Simoons,et al.  Heart rate variability index in congestive heart failure: relation to clinical variables and prognosis. , 1998, European heart journal.

[56]  D. Correia,et al.  Cardiac autonomic modulation and long‐term use of amiodarone in patients with chronic Chagasic cardiopathy , 2018, Pacing and clinical electrophysiology : PACE.

[57]  Leo Breiman,et al.  Random Forests , 2001, Machine Learning.

[58]  Ron Kohavi,et al.  Wrappers for Feature Subset Selection , 1997, Artif. Intell..

[59]  M. Malik,et al.  Deceleration capacity of heart rate as a predictor of mortality after myocardial infarction: cohort study , 2006, The Lancet.

[60]  B. Maciel,et al.  Cardiac autonomic impairment and early myocardial damage involving the right ventricle are independent phenomena in Chagas' disease. , 1998, International journal of cardiology.

[61]  H. Huikuri,et al.  Fractal analysis and time- and frequency-domain measures of heart rate variability as predictors of mortality in patients with heart failure. , 2001, The American journal of cardiology.

[62]  R. Pedrosa,et al.  Dysautonomy in different death risk groups (Rassi score) in patients with Chagas heart disease , 2018, Pacing and clinical electrophysiology : PACE.

[63]  D. Bonaduce,et al.  Heart rate variability in patients with hypertrophic cardiomyopathy: association with clinical and echocardiographic features. , 1997, American heart journal.

[64]  L V Kirchhoff,et al.  Chagas disease. American trypanosomiasis. , 1993, Infectious disease clinics of North America.