Intravascular ultrasound-based machine learning for predicting fractional flow reserve in intermediate coronary artery lesions.

BACKGROUND AND AIMS

Intravascular ultrasound (IVUS)-derived morphological criteria are poor predictors of the functional significance of intermediate coronary stenosis. IVUS-based supervised machine learning (ML) algorithms were developed to identify lesions with a fractional flow reserve (FFR) ≤0.80 (vs. >0.80).

METHODS

A total of 1328 patients with 1328 non-left main coronary lesions were randomized into training and test sets in a 4:1 ratio. Masked IVUS images were generated by an automatic segmentation model, and 99 computed IVUS features and six clinical variables (age, gender, body surface area, vessel type, involved segment, and involvement of the proximal left anterior descending artery) were used for ML training with 5-fold cross-validation. Diagnostic performances of the binary classifiers (L2 penalized logistic regression, artificial neural network, random forest, AdaBoost, CatBoost, and support vector machine) for detecting ischemia-producing lesions were evaluated using the non-overlapping test samples.

RESULTS

In the classification of test set lesions into those with an FFR ≤0.80 vs. >0.80, the overall diagnostic accuracies for predicting an FFR ≤0.80 were 82% with L2 penalized logistic regression, 80% with artificial neural network, 83% with random forest, 83% with AdaBoost, 81% with CatBoost, and 81% with support vector machine (AUCs: 0.84-0.87). With exclusion of the 28 lesions with borderline FFR of 0.75-0.80, the overall accuracies for the test set were 86% with L2 penalized logistic regression, 85% with an artificial neural network, 87% with random forest, 87% with AdaBoost, 85% with CatBoost, and 85% with support vector machine.

CONCLUSIONS

The IVUS-based ML algorithms showed good diagnostic performance for identifying ischemia-producing lesions, and may reduce the need for pressure wires.