Deep Learning Significantly Boosts CRT Response Prediction Using Synthetic Longitudinal Strain Data: Training on Synthetic Data and Testing on Real Patients

Background: Recently, as a relatively novel technology, artificial intelligence (especially in the deep learning fields) has received more and more attention from researchers and has successfully been applied to many biomedical domains. Nonetheless, just a few research works use deep learning skills to predict the cardiac resynchronization therapy (CRT)-response of heart failure patients.

Objective: We try to use the deep learning-based technique to construct a model which is used to predict the CRT response of patients with high prediction accuracy, precision, and sensitivity.

Methods: Using two-dimensional echocardiographic strain traces from 131 patients, we pre-processed the data and synthesized 2,000 model inputs through the synthetic minority oversampling technique (SMOTE). These inputs trained and optimized deep neural networks (DNN) and one-dimensional convolution neural networks (1D-CNN). Visualization of prediction results was performed using t-distributed stochastic neighbor embedding (t-SNE), and model performance was evaluated using accuracy, precision, sensitivity, F1 score, and specificity. Variable importance was assessed using Shapley additive explanations (SHAP) analysis.

Results: Both the optimal DNN and 1D-CNN models demonstrated exceptional predictive performance, with prediction accuracy, precision, and sensitivity all around 90%. Furthermore, the area under the receiver operating characteristic curve (AUROC) of the optimal 1D-CNN and DNN models achieved 0.8734 and 0.9217, respectively. Crucially, the most significant input variables for both models align well with clinical experience, further corroborating their robustness and applicability in real-world settings.

Conclusions: We believe that both the DL models could be an auxiliary to help in treatment response prediction for doctors because of the excellent prediction performance and the convenience of obtaining input data to predict the CRT response of patients clinically.