A new machine learning approach for predicting likelihood of recurrence following ablation for atrial fibrillation from CT.

OBJECTIVE: To investigate left atrial shape differences on CT scans of atrial fibrillation (AF) patients with (AF+) versus without (AF-) post-ablation recurrence and whether these shape differences predict AF recurrence. METHODS: This retrospective study included 68 AF patients who had pre-catheter ablation cardiac CT scans with contrast. AF recurrence was defined at 1 year, excluding a 3-month post-ablation blanking period. After creating atlases of atrial models from segmented AF+ and AF- CT images, an atlas-based implicit shape differentiation method was used to identify surface of interest (SOI). After registering the SOI to each patient model, statistics of the deformation on the SOI were used to create shape descriptors. The performance in predicting AF recurrence using shape features at and outside the SOI and eight clinical factors (age, sex, left atrial volume, left ventricular ejection fraction, body mass index, sinus rhythm, and AF type [persistent vs paroxysmal], catheter-ablation type [Cryoablation vs Irrigated RF]) were compared using 100 runs of fivefold cross validation. RESULTS: Differences in atrial shape were found surrounding the pulmonary vein ostia and the base of the left atrial appendage. In the prediction of AF recurrence, the area under the receiver-operating characteristics curve (AUC) was 0.67 for shape features from the SOI, 0.58 for shape features outside the SOI, 0.71 for the clinical parameters, and 0.78 combining shape and clinical features. CONCLUSION: Differences in left atrial shape were identified between AF recurrent and non-recurrent patients using pre-procedure CT scans. New radiomic features corresponding to the differences in shape were found to predict post-ablation AF recurrence.

New Radiomic Markers of Pulmonary Vein Morphology Associated With Post-Ablation Recurrence of Atrial Fibrillation.

Objective: To identify radiomic and clinical features associated with post-ablation recurrence of AF, given that cardiac morphologic changes are associated with persistent atrial fibrillation (AF), and initiating triggers of AF often arise from the pulmonary veins which are targeted in ablation. Methods: Subjects with pre-ablation contrast CT scans prior to first-time catheter ablation for AF between 2014-2016 were retrospectively identified. A training dataset (D1) was constructed from left atrial and pulmonary vein morphometric features extracted from equal numbers of consecutively included subjects with and without AF recurrence determined at 1 year. The top-performing combination of feature selection and classifier methods based on C-statistic was evaluated on a validation dataset (D2), composed of subjects retrospectively identified between 2005-2010. Clinical models ([Formula: see text]) were similarly evaluated and compared to radiomic ([Formula: see text]) and radiomic-clinical models ([Formula: see text]), each independently validated on D2. Results: Of 150 subjects in D1, 108 received radiofrequency ablation and 42 received cryoballoon. Radiomic features of recurrence included greater right carina angle, reduced anterior-posterior atrial diameter, greater atrial volume normalized to height, and steeper right inferior pulmonary vein angle. Clinical features predicting recurrence included older age, greater BMI, hypertension, and warfarin use; apixaban use was associated with reduced recurrence. AF recurrence was predicted with radio-frequency ablation models on D2 subjects with C-statistics of 0.68, 0.63, and 0.70 for radiomic, clinical, and combined feature models, though these were not prognostic in patients treated with cryoballoon. Conclusions: Pulmonary vein morphology associated with increased likelihood of AF recurrence within 1 year of catheter ablation was identified on cardiac CT. Significance: Radiomic and clinical features-based predictive models may assist in identifying atrial fibrillation ablation candidates with greatest likelihood of successful outcome.

Machine Learning-Derived Fractal Features of Shape and Texture of the Left Atrium and Pulmonary Veins From Cardiac Computed Tomography Scans Are Associated With Risk of Recurrence of Atrial Fibrillation Postablation.

[Figure: see text].

Machine Learning Prediction of Response to Cardiac Resynchronization Therapy: Improvement Versus Current Guidelines.

BACKGROUND: Cardiac resynchronization therapy (CRT) has significant nonresponse rates. We assessed whether machine learning (ML) could predict CRT response beyond current guidelines. METHODS: We analyzed CRT patients from Cleveland Clinic and Johns Hopkins. A training cohort was created from all Johns Hopkins patients and an equal number of randomly sampled Cleveland Clinic patients. All remaining patients comprised the testing cohort. Response was defined as ≥10% increase in left ventricular ejection fraction. ML models were developed to predict CRT response using different combinations of classification algorithms and clinical variable sets on the training cohort. The model with the highest area under the curve was evaluated on the testing cohort. Probability of response was used to predict survival free from a composite end point of death, heart transplant, or placement of left ventricular assist device. Predictions were compared with current guidelines. RESULTS: Nine hundred twenty-five patients were included. On the training cohort (n=470: 235, Johns Hopkins; 235, Cleveland Clinic), the best ML model was a naive Bayes classifier including 9 variables (QRS morphology, QRS duration, New York Heart Association classification, left ventricular ejection fraction and end-diastolic diameter, sex, ischemic cardiomyopathy, atrial fibrillation, and epicardial left ventricular lead). On the testing cohort (n=455, Cleveland Clinic), ML demonstrated better response prediction than guidelines (area under the curve, 0.70 versus 0.65; P=0.012) and greater discrimination of event-free survival (concordance index, 0.61 versus 0.56; P<0.001). The fourth quartile of the ML model had the greatest risk of reaching the composite end point, whereas the first quartile had the least (hazard ratio, 0.34; P<0.001). CONCLUSIONS: ML with 9 variables incrementally improved prediction of echocardiographic CRT response and survival beyond guidelines. Performance was not improved by incorporating more variables. The model offers potential for improved shared decision-making in CRT (online calculator: http://riskcalc.org:3838/CRTResponseScore ). Significant remaining limitations confirm the need to identify better variables to predict CRT response.

A novel crustacean swimming stroke: coordinated four-paddled locomotion in the cypridoidean ostracode Cypridopsis vidua (Müller).

Despite the diversity and ecological importance of cypridoidean ostracodes, there have been no kinematic studies of how they swim. We used regular and high-speed video of tethered ostracodes to document locomotion in the cypridoidean species Cypridopsis vidua. Swimming in this species is drag-based, with thrust provided by both antennulae and antennae. About 15 complete power and recovery strokes occur per second; maximal speeds for the limb tips were about 30 mm/s for the antennulae and 50 mm/s for the antennae. These speeds correspond to Reynolds numbers on the order of 10(-1) to 10(0) for the limb tips and 10(-2) to 10(-1) for the setae that extend outward from the swimming limbs and provide much of the surface area of the limb. The strokes of the four thrust-producing limbs are coordinated in a manner that seems to be unique among aquatic arthropods. When viewed from the anterior, power strokes are synchronized diagonally: left antennula and right antenna power strokes start at the same time and terminate just as the power strokes for the right antennula and left antenna begin. Because power strokes occur throughout the stroke cycle, swimming in this species is smoothly continuous, without the rapid accelerations and decelerations characteristic of most small aquatic arthropods.

A comparative study of the mechanical properties of Mytilid byssal threads.

Mytilid bivalves employ a set of threads (the byssus) to attach themselves to both hard and soft substrates. In this study, we measured the mechanical properties of byssal threads from two semi-infaunal mytilids (Geukensia demissa Dillwyn and Modiolus modiolus Linnaeus) and two epifaunal mytilids (Mytilus californianus Conrad and Mytilus edulis Linnaeus). We compared material properties with and without the assumption that changes of length and area during tensile testing are insignificant, demonstrating that previous researchers have overestimated extensibility values by 30% and may also have underestimated strength values. We detected significant differences in thread properties among tested mytilid species, contrary to previous findings. Threads from semi-infaunal species were significantly thinner than those from epifaunal species, perhaps to allow the production of a greater number of threads, which form a dense network within the substrate. Geukensia demissa threads were weaker than those of the other species, and had a significantly lower stiffness at failure. Modiolus modiolus threads were significantly stiffer than M. edulis threads but also significantly less extensible, suggesting a trade-off between stiffness and extensibility. The only thread property that did not show significant differences across species was toughness - even when byssal threads differ in strength or stiffness, they seem to absorb similar amounts of energy per unit volume prior to failure. This study reveals notable differences between the byssal thread properties of different mytilid bivalves and provides a reliable and thorough methodology for future comparative studies.

Biomechanics of byssal threads outside the Mytilidae: Atrina rigida and Ctenoides mitis.

The byssus is the set of proteinaceous threads widely used by bivalves to attach themselves to the substrate. Previous researchers have focused on a single byssate family, the Mytilidae. However, the properties of byssal threads from species outside this family are of interest - first, because evolutionary patterns are only detectable if species from a range of taxa are examined, and second, because recent biomimetic research efforts would benefit from a wider range of ;mussel glue' exemplars. In the present study, we measured the mechanical properties of the byssal threads of two species outside the Mytilidae, the pen shell Atrina rigida Lightfoot and the flame ;scallop' Ctenoides mitis Lamarck. The mechanical properties of their byssal threads were significantly different from those of mytilids. For instance, the byssal threads of both species were significantly weaker than mytilid threads. Atrina rigida threads were significantly less extensible than mytilid threads, while C. mitis threads exhibited the highest extensibility ever recorded for the distal region of byssal threads. However, there were also interesting similarities in material properties across taxonomic groups. For instance, the threads of A. rigida and Modiolus modiolus Linnaeus both exhibited a prominent double-yield behavior, high stiffness combined with low extensibility, and similar correlations between stiffness and other thread properties. These similarities suggest that the thread properties of some semi-infaunal species may have evolved convergently. Further research on these patterns, along with biochemical analysis of threads which exhibit unusual properties like double-yield behavior, promises to contribute to both evolutionary biology and materials engineering.

Functional consequences of tooth design: effects of blade shape on energetics of cutting.

Dental structures capture, retain and fragment food for ingestion. Gnathostome dentition should be viewed in the context of the prey's material properties. Animal muscle and skin are mechanically tough materials that resist fragmentation unless energy is continually supplied directly to the tip of the fracture by some device such as a blade edge. Despite the variety of bladed tooth morphologies in gnathostomes, few studies have experimentally examined the effects of different blade designs on cutting efficiency. We tested the effects of blades with and without contained notches and in a 'fang' configuration on the force and energy required to fracture raw, unprocessed biological tissues (fish and shrimp) using a double guillotine device. Blade design strongly affects the work required to fragment biological tissues. A notched blade reduced the work to fracture of tissues tested by up to 600 J m(-2) (50% reduction). The specific angle of the notch had a significant effect, with acute angles more effectively reducing work to fracture. A bladed triangle matched to a notch reduced work to fracture more than a notch-straight blade pair. Strain patterns seen while cutting photoelastic gelatin indicate that the reduction in work to fracture with triangular and notched blades arises from a combination of 'trapping ability' and blade approach angle causing the material to fracture at lower overall strain levels. These results show that the notched blade designs found in a wide variety of vertebrate dentitions reduce the energy expenditure (and presumably handling time) when cutting tough prey materials like animal flesh.

Effects of size and behavior on aerial performance of two species of flying snakes (Chrysopelea).

Aerial locomotion in snakes (genus Chrysopelea) is kinematically distinct from any other type of gliding or powered flight, with prominent, high amplitude body undulations visually dominating the behavior. Because it is not known how flying snakes produce aerodynamic forces in flight, the factors that determine snake flight performance are not clear. In this study, the effects of size and behavior on aerial performance were examined both within a species (C. paradisi) and between two species (C. paradisi and C. ornata), using stepwise multiple regressions to identify relevant variables. Smaller C. paradisi traveled farther than larger snakes at lower sinking speeds, with trajectories that shallowed more quickly and reached lower minimum glide angles. Although wing loading increased faster than expected for isometric size increase, wing loading per se was not responsible for performance differences between large and small snakes. Snakes with higher interactions between relative undulation amplitude and body size transitioned out of the initial acceleration phase at higher airspeeds and sinking speeds, and attained higher maximum airspeeds and horizontal speeds; snakes that used higher average relative amplitudes transitioned out of the initial acceleration phase at higher horizontal speeds. Undulation frequency was not significantly related to any performance variable within C. paradisi and was not significantly different between the two species, suggesting that this variable (in contrast to relative undulation amplitude) may have a minor influence on the aerodynamic mechanism of force production in snake flight. C. paradisi and C. ornata differed significantly in most performance comparisons. C. ornata were more massive than C. paradisi at any given body length and in general exhibited poorer gliding performance than C. paradisi. This study contributes towards understanding how an unconventional body form and kinematics can produce a novel mode of aerial locomotion in a vertebrate glider.

A 3-D kinematic analysis of gliding in a flying snake, Chrysopelea paradisi.

Flying snake species (Chrysopelea) locomote through the air despite a lack of appendages or any obvious external morphological specialization for flight. Here photogrammetric techniques were used to investigate C. paradisi's aerial trajectory in three dimensions. Two videocameras arranged in stereo were used to record head, midpoint and vent landmarks on snakes that jumped from a horizontal branch at a height of 9.62 m and landed in an open field. The coordinates of these landmarks were reconstructed in three dimensions and used to analyze patterns of position, glide angle and speed concurrently with changes in body posture in 14 glide sequences from different individuals. C. paradisi's trajectory was composed of a ballistic dive followed by a shallowing phase in which the path became more horizontal; for most glide trials, no equilibrium phase was observed. In the ballistic dive, the snake changed posture from generally straight to a wide 'S' shape in planview and began aerial undulation. Shortly after the ballistic dive, the snake's speed transitioned from an initial acceleration to stable or to a different rate of increase or decrease. Aerial undulation, in which high-amplitude traveling waves pass posteriorly down the body, was a prominent locomotor behavior. In mid-glide, this undulation occurred with the anterior body oriented approximately parallel with the ground and the posterior body cycling up and down in the vertical plane. The body angle of attack for the anterior body for one trial was 20-40 degrees . Snakes traveled a horizontal distance of 10.14+/-2.69 m (mean +/-s.d.) while reaching an airspeed of 10.0+/-0.9 m s(-1), sinking speed of 6.4+/-0.8 m s(-1) and horizontal speed of 8.1+/-0.9 m s(-1). The glide path shallowed at a rate of 20+/-6 degrees s(-1) and reached a minimum glide angle of 28+/-10 degrees , with a minimum recorded glide angle of 13 degrees . C. paradisi are surprisingly good gliders given their unconventional locomotor style, with performance characteristics that rival or surpass more familiar gliding taxa such as flying squirrels. As in other gliders, C. paradisi is potentially capable of using aerial locomotion to move effectively between trees, chase aerial prey, or avoid predators.

FATIGUE DAMAGE: REPEATED LOADING ENABLES CRABS TO OPEN LARGER BIVALVES.

Observations of behavior and direct measurements of force indicated that the cancrid crab Cancer productus could directly crush only the smallest specimens of Protothaca staminea, a venerid bivalve. Crabs opened larger P. staminea by repeatedly loading the same region of the bivalve's shell with a chela; we hypothesized that this repeated loading caused fatigue of the shell material. To test whether significant fatigue damage would accumulate in the number of cycles a crab was likely to exert, live bivalves and cleaned valves were cyclically loaded in a mechanical testing machine to loads of a constant maximum amplitude of 70-100% of the bivalves' predicted static strength. Failure frequently occurred in fewer than 200 cycles. Recordings from strain gauges attached to the chelae of crabs showed that during an attack on a bivalve a crab would squeeze more than 200 times and that failure of the bivalve could occur during a force pulse which was weaker than previous force pulses. We conclude that repeated loading enables crabs to open larger bivalves than could be crushed outright; by greatly increasing the maximum size of prey vulnerability this expands the size range of molluscan prey available to crabs.

A Triassic aquatic protorosaur with an extremely long neck.

By Middle Triassic time, a number of reptile lineages had diversified in shallow epicontinental seas and intraplatform basins along the margins of parts of Pangea, including the giraffe-necked protorosaurid reptile Tanystropheus from the Western Tethys (Europe and the Middle East), which grew to approximately 5 to 6 m long. Here we report another long-necked fossil, Dinocephalosaurus, from southwestern China, recently collected in Middle Triassic marine deposits approximately 230 million years old. This taxon represents unambiguous evidence for a fully aquatic protorosaur. Its extremely elongated neck is explained as an adaptation for aquatic life, perhaps for an increase in feeding efficiency.