Abstract Body (Do not enter title and authors here): Introduction: Left ventricular assist device (LVAD) offers a lifeline for advanced heart failure patients, but ~30% experience post-operative right heart failure (RHF) with significant morbidity and mortality. Current methods for predicting RHF risk have limited accuracy. This study is the first of its kind to explore the feasibility of using a convolutional neural network (CNN) deep learning model with pulmonary artery pressure (PAP) tracings acquired during pre-operative hemodynamic assessment to identify patients at risk for early RHF.

Methods: A CNN model was pre-trained on PAP tracings from the MIMIC-III Waveform Database to leverage transferable knowledge and improve model performance. The model learned general features and temporal relationships in hemodynamic tracing morphology for RHF prediction. It was then adapted for classification by modifying the output layers. Post-LVAD RHF was definitively adjudicated for each instance included from our 246 patient single center LVAD database. RHF was adjudicated using the 2020 Academic Research Consortium defintion. The database included 205 non-RHF instances and 41 RHF instances. We developed a novel signal processing method utilizing computer vision to extract PAP waveform data from pre-operative right heart catheterization reports. Data was reviewed to ensure accurate pressure tracing representation. SMOTE-ENN (synthetic oversampling) and class weighting addressed dataset imbalance during training to enhance model generalizability and RHF prediction accuracy.

Results: The model achieved strong performance in classifying RHF from non-RHF outcomes, as evidenced by consistent AUC scores of 0.87 and 0.85 on validation and unseen test data, respectively. These findings indicate the potential for hemodynamic tracings to predict RHF after LVAD implantation. Notably, the model maintained its performance on unseen data, highlighting its generalizability.

Conclusions: This study explored the feasibility of using a deep learning model for RHF risk stratification in patients with LVADs. The model, pre-trained on PAP tracings, achieved promising classification performance assessed by AUC. Further validation with larger, more diverse datasets will refine model performance and enhance generalizability for clinical application. Leveraging hemodynamic tracings within a deep learning framework holds promise for improved clinical outcome prediction.