Aims Our aim was to develop a machine learning (ML)-based risk stratification system to predict 1-, 2-, 3-, 4-, and 5-year all-cause mortality from pre-implant parameters of patients undergoing cardiac resynchronization therapy (CRT). Methods and results Multiple ML models were trained on a retrospective database of 1510 patients undergoing CRT implantation to predict 1- to 5-year all-cause mortality. Thirty-three pre-implant clinical features were selected to train the models. The best performing model [SEMMELWEIS-CRT score (perSonalizEd assessMent of estiMatEd risk of mortaLity With machinE learnIng in patientS undergoing CRT implantation)], along with pre-existing scores (Seattle Heart Failure Model, VALID-CRT, EAARN, ScREEN, and CRT-score), was tested on an independent cohort of 158 patients. There were 805 (53%) deaths in the training cohort and 80 (51%) deaths in the test cohort during the 5-year follow-up period. Among the trained classifiers, random forest demonstrated the best performance. For the prediction of 1-, 2-, 3-, 4-, and 5-year mortality, the areas under the receiver operating characteristic curves of the SEMMELWEIS-CRT score were 0.768 (95% CI: 0.674–0.861; P < 0.001), 0.793 (95% CI: 0.718–0.867; P < 0.001), 0.785 (95% CI: 0.711–0.859; P < 0.001), 0.776 (95% CI: 0.703–0.849; P < 0.001), and 0.803 (95% CI: 0.733–0.872; P < 0.001), respectively. The discriminative ability of our model was superior to other evaluated scores. Conclusion The SEMMELWEIS-CRT score (available at semmelweiscrtscore.com) exhibited good discriminative capabilities for the prediction of all-cause death in CRT patients and outperformed the already existing risk scores. By capturing the non-linear association of predictors, the utilization of ML approaches may facilitate optimal candidate selection and prognostication of patients undergoing CRT implantation.

Background: The relative importance of variables explaining sex-related differences in outcomes is scarcely explored in patients undergoing cardiac resynchronization therapy (CRT). We sought to implement and evaluate machine learning (ML) algorithms for the prediction of 1- and 3-year all-cause mortality in CRT patients. We also aimed to assess the sex-specific differences in predictors of mortality utilizing ML.Methods: Using a retrospective registry of 2,191 CRT patients, ML models were implemented in 6 partially overlapping patient subsets (all patients, females, or males with 1- or 3-year follow-up). Each cohort was randomly split into training (80%) and test sets (20%). After hyperparameter tuning in the training sets, the best performing algorithm was evaluated in the test sets. Model discrimination was quantified using the area under the receiver-operating characteristic curves (AUC). The most important predictors were identified using the permutation feature importances method.Results: Conditional inference random forest exhibited the best performance with AUCs of 0.728 (0.645–0.802) and 0.732 (0.681–0.784) for the prediction of 1- and 3-year mortality, respectively. Etiology of heart failure, NYHA class, left ventricular ejection fraction, and QRS morphology had higher predictive power, whereas hemoglobin was less important in females compared to males. The importance of atrial fibrillation and age increased, while the importance of serum creatinine decreased from 1- to 3-year follow-up in both sexes.Conclusions: Using ML techniques in combination with easily obtainable clinical features, our models effectively predicted 1- and 3-year all-cause mortality in CRT patients. Sex-specific patterns of predictors were identified, showing a dynamic variation over time.

The existence of place cells (PCs), grid cells (GCs), border cells (BCs), and head direction cells (HCs) as well as the dependencies between them have been enigmatic. We make an effort to explain their nature by introducing the concept of Cartesian Factors. These factors have specific properties: (i) they assume and complement each other, like direction and position and (ii) they have localized discrete representations with predictive attractors enabling implicit metric-like computations. In our model, HCs make the distributed and local representation of direction. Predictive attractor dynamics on that network forms the Cartesian Factor “direction.” We embed these HCs and idiothetic visual information into a semi-supervised sparse autoencoding comparator structure that compresses its inputs and learns PCs, the distributed local and direction independent (allothetic) representation of the Cartesian Factor of global space. We use a supervised, information compressing predictive algorithm and form direction sensitive (oriented) GCs from the learned PCs by means of an attractor-like algorithm. Since the algorithm can continue the grid structure beyond the region of the PCs, i.e., beyond its learning domain, thus the GCs and the PCs together form our metric-like Cartesian Factors of space. We also stipulate that the same algorithm can produce BCs. Our algorithm applies (a) a bag representation that models the “what system” and (b) magnitude ordered place cell activities that model either the integrate-and-fire mechanism, or theta phase precession, or both. We relate the components of the algorithm to the entorhinal-hippocampal complex and to its working. The algorithm requires both spatial and lifetime sparsification that may gain support from the two-stage memory formation of this complex.

Indoor navigation in emergency scenarios poses a challenge to evacuation and emergency support, especially for injured or physically encumbered individuals. Navigation systems must be lightweight, easy to use, and provide robust localization and accurate navigation instructions in adverse conditions. To address this challenge, we combine magnetic location tracking with an optical character recognition (OCR) and eye gaze based method to recognize door plates and position related text to provide more robust localization. In contrast to typical wireless or sensor based tracking, our fused system can be used in low-lighting, smoke, and areas without power or wireless connectivity. Eye gaze tracking is also used to improve time to localization and accuracy of the OCR algorithm. Once localized, navigation instructions are transmitted directly into the user's immediate field of view via head mounted display (HMD). Additionally, setting up the system is simple and can be done with minimal calibration, requiring only a walk-through of the environment and numerical annotation of a 2D area map. We conduct an evaluation for the magnetic and OCR systems individually to evaluate feasibility for use in the fused framework.

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