Automatic SVM classification of sudden cardiac death and pump failure death from autonomic and repolarization ECG markers

- We analyze the individual and combined performance of ECG-derived markers to separate chronic heart failure (CHF) patients according to their mode of death.
- Low values of heart rate turbulence and T-peak-to-T-end (Tpe)/RR slopes are related to pump failure death (PFD).
- High values of Tpe/RR slope and T-wave alternans are related to sudden cardiac death (SCD).
- CHF patients can be successfully classified into SCD, PFD and others using two-and three-class support vector machines based on combinations of the three analyzed ECG markers.

BackgroundConsidering the rates of sudden cardiac death (SCD) and pump failure death (PFD) in chronic heart failure (CHF) patients and the cost-effectiveness of their preventing treatments, identification of CHF patients at risk is an important challenge. In this work, we studied the prognostic performance of the combination of an index potentially related to dispersion of repolarization restitution (Δα), an index quantifying T-wave alternans (IAA) and the slope of heart rate turbulence (TS) for classification of SCD and PFD.MethodsHolter ECG recordings of 597 CHF patients with sinus rhythm enrolled in the MUSIC study were analyzed and Δα, IAA and TS were obtained. A strategy was implemented using support vector machines (SVM) to classify patients in three groups: SCD victims, PFD victims and other patients (the latter including survivors and victims of non-cardiac causes). Cross-validation was used to evaluate the performance of the implemented classifier.ResultsΔα and IAA, dichotomized at 0.035 (dimensionless) and 3.73 μV, respectively, were the ECG markers most strongly associated with SCD, while TS, dichotomized at 2.5 ms/RR, was the index most strongly related to PFD. When separating SCD victims from the rest of patients, the individual marker with best performance was Δα ≥ 0.035, which, for a fixed specificity (Sp) of 90%, showed a sensitivity (Se) value of 10%, while the combination of Δα and IAA increased Se to 18%. For separation of PFD victims from the rest of patients, the best individual marker was TS ≤ 2.5 ms/RR, which, for Sp = 90%, showed a Se of 26%, this value being lower than Se = 34%, produced by the combination of Δα and TS. Furthermore, when performing SVM classification into the three reported groups, the optimal combination of risk markers led to a maximum Sp of 79% (Se = 18%) for SCD and Sp of 81% (Se = 14%) for PFD.ConclusionsThe results shown in this work suggest that it is possible to efficiently discriminate SCD and PFD in a population of CHF patients using ECG-derived risk markers like Δα, TS and IAA.