Expanding interpretability through complexity reduction in machine learning-based modelling of cardiovascular disease: A myocardial perfusion imaging PET/CT prognostic study

BACKGROUND: Machine learning-based analysis can be used in myocardial perfusion imaging data to improve risk stratification and the prediction of major adverse cardiovascular events for patients with suspected or established coronary artery disease. We present a new machine learning approach for the identification of patients who develop major adverse cardiovascular events. The new method is robust against the deleterious effect of outliers in the training set stratification and training process.

METHODS: The proposed sum-of-sigmoids model is obtained by averaging the contributions of various input variables in an ensemble of XGBoost models. To illustrate its performance, we have applied it to predict major adverse cardiovascular events from advanced imaging data extracted from rest and adenosine stress 13N-ammonia positron emission tomography myocardial perfusion imaging polar maps. There were 1185 individual studies performed, and the event occurrence was tracked over a follow-up period of 2 years.

RESULTS: The sum-of-sigmoids model achieved a prediction accuracy of .83 on the test set, matching the performance of significantly more complex and less interpretable models (whose accuracies were .83-.84).

CONCLUSION: The sum-of-sigmoids model is interpretable and simple, while achieving similar prediction accuracy to significantly more complex machine learning models in the considered prediction task. It should be suitable for applications such as automated clinical risk stratification, where clear and explicit justification of the classification procedure is highly pertinent.