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<article article-type="research-article" dtd-version="1.3" xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" xml:lang="ru"><front><journal-meta><journal-id journal-id-type="publisher-id">vtio</journal-id><journal-title-group><journal-title xml:lang="ru">Вестник трансплантологии и искусственных органов</journal-title><trans-title-group xml:lang="en"><trans-title>Russian Journal of Transplantology and Artificial Organs</trans-title></trans-title-group></journal-title-group><issn pub-type="ppub">1995-1191</issn><publisher><publisher-name>Academician V.I.Shumakov National Medical Research Center of Transplantology and Artificial Organs", Ministry of Health of the Russian Federation</publisher-name></publisher></journal-meta><article-meta><article-id pub-id-type="doi">10.15825/1995-1191-2025-4-183-195</article-id><article-id custom-type="elpub" pub-id-type="custom">vtio-1968</article-id><article-categories><subj-group subj-group-type="heading"><subject>Research Article</subject></subj-group><subj-group subj-group-type="section-heading" xml:lang="ru"><subject>Смежные дисциплины</subject></subj-group><subj-group subj-group-type="section-heading" xml:lang="en"><subject>Related Disciplines</subject></subj-group></article-categories><title-group><article-title>Паттерны кальцификации биологических протезов клапанов сердца: кластеризация графических данных</article-title><trans-title-group xml:lang="en"><trans-title>Image-based clustering analysis of calcification patterns in bioprosthetic heart valves</trans-title></trans-title-group></title-group><contrib-group><contrib contrib-type="author" corresp="yes"><contrib-id contrib-id-type="orcid">https://orcid.org/0000-0002-0033-9376</contrib-id><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Овчаренко</surname><given-names>Е. А.</given-names></name><name name-style="western" xml:lang="en"><surname>Ovcharenko</surname><given-names>E. A.</given-names></name></name-alternatives><bio xml:lang="ru"><p>Овчаренко Евгений Андреевич</p><p>650002, Кемерово, бульвар Академика Л.С. Барбараша, д. 6</p></bio><bio xml:lang="en"><p>Evgeny Ovcharenko</p><p>Address: 6, Akademika Leonida Barbarasha bul’var, Kemerovo, 650002</p></bio><email xlink:type="simple">ovchea@kemcardio.ru</email><xref ref-type="aff" rid="aff-1"/></contrib><contrib contrib-type="author" corresp="yes"><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Клышников</surname><given-names>К. Ю.</given-names></name><name name-style="western" xml:lang="en"><surname>Klyshnikov</surname><given-names>K. Yu.</given-names></name></name-alternatives><bio xml:lang="ru"><p>Кемерово</p></bio><bio xml:lang="en"><p>Kemerovo</p></bio><xref ref-type="aff" rid="aff-1"/></contrib><contrib contrib-type="author" corresp="yes"><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Онищенко</surname><given-names>П. С.</given-names></name><name name-style="western" xml:lang="en"><surname>Onishchenko</surname><given-names>P. S.</given-names></name></name-alternatives><bio xml:lang="ru"><p>Кемерово</p></bio><bio xml:lang="en"><p>Kemerovo</p></bio><xref ref-type="aff" rid="aff-1"/></contrib><contrib contrib-type="author" corresp="yes"><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Костюнин</surname><given-names>А. Е.</given-names></name><name name-style="western" xml:lang="en"><surname>Kostyunin</surname><given-names>A. E.</given-names></name></name-alternatives><bio xml:lang="ru"><p>Кемерово</p></bio><bio xml:lang="en"><p>Kemerovo</p></bio><xref ref-type="aff" rid="aff-1"/></contrib><contrib contrib-type="author" corresp="yes"><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Хромов</surname><given-names>А. А.</given-names></name><name name-style="western" xml:lang="en"><surname>Khromov</surname><given-names>A. A.</given-names></name></name-alternatives><bio xml:lang="ru"><p>Кемерово</p></bio><bio xml:lang="en"><p>Kemerovo</p></bio><xref ref-type="aff" rid="aff-1"/></contrib><contrib contrib-type="author" corresp="yes"><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Стасев</surname><given-names>А. Н.</given-names></name><name name-style="western" xml:lang="en"><surname>Stasev</surname><given-names>A. N.</given-names></name></name-alternatives><bio xml:lang="ru"><p>Кемерово</p></bio><bio xml:lang="en"><p>Kemerovo</p></bio><xref ref-type="aff" rid="aff-1"/></contrib><contrib contrib-type="author" corresp="yes"><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Акентьева</surname><given-names>Т. Н.</given-names></name><name name-style="western" xml:lang="en"><surname>Akentyeva</surname><given-names>T. N.</given-names></name></name-alternatives><bio xml:lang="ru"><p>Кемерово</p></bio><bio xml:lang="en"><p>Kemerovo</p></bio><xref ref-type="aff" rid="aff-1"/></contrib><contrib contrib-type="author" corresp="yes"><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Фокеева</surname><given-names>М. П.</given-names></name><name name-style="western" xml:lang="en"><surname>Fokeeva</surname><given-names>M. P.</given-names></name></name-alternatives><bio xml:lang="ru"><p>Кемерово</p></bio><bio xml:lang="en"><p>Kemerovo</p></bio><xref ref-type="aff" rid="aff-1"/></contrib><contrib contrib-type="author" corresp="yes"><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Барбараш</surname><given-names>О. Л.</given-names></name><name name-style="western" xml:lang="en"><surname>Barbarash</surname><given-names>O. L.</given-names></name></name-alternatives><bio xml:lang="ru"><p>Кемерово</p></bio><bio xml:lang="en"><p>Kemerovo</p></bio><xref ref-type="aff" rid="aff-1"/></contrib><contrib contrib-type="author" corresp="yes"><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Глушкова</surname><given-names>Т. В.</given-names></name><name name-style="western" xml:lang="en"><surname>Glushkova</surname><given-names>T. V.</given-names></name></name-alternatives><bio xml:lang="ru"><p>Кемерово</p></bio><bio xml:lang="en"><p>Kemerovo</p></bio><xref ref-type="aff" rid="aff-1"/></contrib></contrib-group><aff-alternatives id="aff-1"><aff xml:lang="ru"><institution>ФГБНУ «Научно-исследовательский институт комплексных проблем сердечно-сосудистых заболеваний»</institution><country>Россия</country></aff><aff xml:lang="en"><institution>Research Institute for Complex Issues of Cardiovascular Diseases</institution><country>Russian Federation</country></aff></aff-alternatives><pub-date pub-type="collection"><year>2025</year></pub-date><pub-date pub-type="epub"><day>10</day><month>01</month><year>2026</year></pub-date><volume>27</volume><issue>4</issue><fpage>183</fpage><lpage>195</lpage><permissions><copyright-statement>Copyright &amp;#x00A9; Овчаренко Е.А., Клышников К.Ю., Онищенко П.С., Костюнин А.Е., Хромов А.А., Стасев А.Н., Акентьева Т.Н., Фокеева М.П., Барбараш О.Л., Глушкова Т.В., 2026</copyright-statement><copyright-year>2026</copyright-year><copyright-holder xml:lang="ru">Овчаренко Е.А., Клышников К.Ю., Онищенко П.С., Костюнин А.Е., Хромов А.А., Стасев А.Н., Акентьева Т.Н., Фокеева М.П., Барбараш О.Л., Глушкова Т.В.</copyright-holder><copyright-holder xml:lang="en">Ovcharenko E.A., Klyshnikov K.Y., Onishchenko P.S., Kostyunin A.E., Khromov A.A., Stasev A.N., Akentyeva T.N., Fokeeva M.P., Barbarash O.L., Glushkova T.V.</copyright-holder><license xml:lang="ru" license-type="creative-commons-attribution" xlink:href="https://creativecommons.org/licenses/by/4.0/" xlink:type="simple"><license-p>Данная работа распространяется под лицензией Creative Commons Attribution 4.0.</license-p></license><license xml:lang="en" license-type="creative-commons-attribution" xlink:href="https://creativecommons.org/licenses/by/4.0/" xlink:type="simple"><license-p>This work is licensed under a Creative Commons Attribution 4.0 License.</license-p></license></permissions><self-uri xlink:href="https://journal.transpl.ru/vtio/article/view/1968">https://journal.transpl.ru/vtio/article/view/1968</self-uri><abstract><sec><title>Цель</title><p>Цель: выявление ключевых паттернов кальцификации створчатого аппарата эксплантированных биопротезов клапанов сердца на основе кластерного анализа графических данных, полученных с применением компьютерной томографии.</p></sec><sec><title>Материалы и методы</title><p>Материалы и методы. В исследование включены 11 ксеноперикардиальных биопротезов «ЮниЛайн», планово эксплантированных в результате реоперации по причине дисфункции. С использованием компьютерной томографии образцов были получены DICOM-изображения с последующим построением проекции максимальной интенсивности и сегментацией каждого биопротеза на отдельные створки (n = 33). Изображения предварительно обрабатывали методами бинарного порогового преобразования для выделения областей кальцификации или некальцинированного биологического материала. Кластерный анализ выполнен с использованием различных алгоритмов: модель гауссовой смеси (Gaussian mixture models); упорядочение точек для обнаружения кластерной структуры (OPTICS); метод k-средних; агломеративный метод (иерархическая кластеризация); спектральная кластеризация. В качестве алгоритма сравнения использован базовый метод на основе количественной оценки пикселей, соответствующих областям кальцификации. Эффективность методов оценена с использованием коэффициента силуэта. Наличие кальция в створках, а также корректность бинарного порогового преобразования дополнительно подтверждали гистологическим методом путем окрашивания криосрезов створок ализариновым красным С.</p></sec><sec><title>Результаты</title><p>Результаты. Предобработка данных на основе бинаризации позволила получить максимальный коэффициент силуэта 0,55. Среди алгоритмов кластеризации наибольший коэффициент силуэта был получен с использованием агломеративного метода (0,55) и k-средних (0,54), однако был отмечен выраженный дисбаланс данных в распределении кластеров (до 85% в одном кластере), что снижает практическую значимость данного подхода. Наилучший сбалансированный результат был достигнут методами спектральной кластеризации – коэффициент силуэта, равный 0,45, и базового подхода – 0,44. Оба алгоритма выделили три ключевых паттерна кальцификации створок биопротезов: некальцинированные створки, частичная кальцификация, тотальная кальцификация.</p></sec><sec><title>Заключение</title><p>Заключение. Исследование выявило три ключевых паттерна кальцификации створок биопротезов клапанов сердца: отсутствие кальция, частичная и тотальная кальцификация. Наилучшие результаты продемонстрировали спектральная кластеризация и базовый метод, тогда как другие алгоритмы показали выраженный дисбаланс кластеров. Анализ тепловых карт показал, что при частичной кальцификации минерализация начинается в зоне комиссур и в зоне купола створок, приближенной к свободному краю, затем, при тотальной – распространяется на всю площадь купола и основание створок.</p></sec></abstract><trans-abstract xml:lang="en"><sec><title>Objective</title><p>Objective: to identify key patterns of calciﬁcation in explanted bioprosthetic heart valves (BHVs) using cluster analysis of computed tomography-derived graphical data.</p></sec><sec><title>Materials and methods</title><p>Materials and methods. The study included 11 UniLine BHVs that were routinely explanted during reoperations for structural valve dysfunction. Computed tomography was used to obtain DICOM images of each sample, followed by generation of maximum intensity projections and segmentation of the valves into individual leaﬂets (n = 33). The images were pre-processed using binary thresholding to diﬀerentiate calciﬁed regions from non-calciﬁed biological tissue. Cluster analysis was performed using various algorithms: Gaussian mixture models, Ordering Points To Identify the Clustering Structure (OPTICS), k-means clustering, agglomerative (hierarchical) clustering, and spectral clustering. A basic quantitative method assessing the proportion of pixels corresponding to calciﬁed areas was used for comparison. The performance of clustering algorithms was evaluated using the silhouette score. The presence of calcium deposits in the valves and the accuracy of binary thresholding were further veriﬁed histologically by alizarin red S staining of valve cryosections.</p></sec><sec><title>Results</title><p>Results. Data preprocessing based on image binarization yielded a maximum silhouette score of 0.55. Among the clustering algorithms, the highest silhouette scores were achieved with the agglomerative (0.55) and k-means (0.54) methods; however, both demonstrated substantial data imbalance, with up to 85% of samples grouped within a single cluster, limiting their practical applicability. The most balanced clustering was achieved using spectral clustering (silhouette score 0.45) and the basic quantitative approach (0.44). Both methods identiﬁed three distinct patterns of bioprosthetic valve leaﬂet calciﬁcation: (1) non-calciﬁed leaﬂets, (2) partial calciﬁcation, and (3) total calciﬁcation.</p></sec><sec><title>Conclusion</title><p>Conclusion. Three key calciﬁcation patterns were identiﬁed in explanted BHVs – absence of calcium, partial calciﬁcation, and total calciﬁcation. Spectral clustering and the basic quantitative method demonstrated the most balanced results, while other algorithms showed pronounced cluster imbalance. Heat map analysis revealed that in partial calciﬁcation, mineral deposition typically begins in the commissural and dome regions of the leaﬂets, near the free edge, and in total calciﬁcation, extends across the entire dome and leaﬂet base.</p></sec></trans-abstract><kwd-group xml:lang="ru"><kwd>биопротезы клапанов сердца</kwd><kwd>дисфункция протезов клапанов сердца</kwd><kwd>структурная дегенерация клапана</kwd><kwd>кальцификация</kwd><kwd>кластерный анализ</kwd></kwd-group><kwd-group xml:lang="en"><kwd>bioprosthetic heart valves</kwd><kwd>prosthetic valve dysfunction</kwd><kwd>structural valve degeneration</kwd><kwd>calcification</kwd><kwd>cluster analysis</kwd></kwd-group><funding-group><funding-statement xml:lang="ru">Работа выполнена в рамках утвержденной научной темы учреждения «Молекулярные, клеточные и биомеханические механизмы патогенеза сердечно-сосудистых заболеваний в разработке новых методов лечения заболеваний сердечно-сосудистой системы на основе персонифицированной фармакотерапии, внедрения малоинвазивных медицинских изделий, биоматериалов и тканеинженерных имплантатов»</funding-statement></funding-group></article-meta></front><back><ref-list><title>References</title><ref id="cit1"><label>1</label><citation-alternatives><mixed-citation xml:lang="ru">Бокерия ЛА, Милиевская ЕБ, Прянишников ВВ, Юрлов ИА. 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