DeepMI: Deep multi-lead ECG fusion for identifying myocardial infarction and its occurrence-time

Myocardial infarction detection method based on the continuous T-wave area feature and multi-lead-fusion deep features

Objective.Myocardial infarction (MI) is one of the most threatening cardiovascular diseases. This paper aims to explore a method for using an algorithm to autonomously classify MI based on the electrocardiogram (ECG).Approach.A detection method of MI that fuses continuous T-wave area (C_TWA) feature and ECG deep features is proposed. This method consists of three main parts: (1) The onset of MI is often accompanied by changes in the shape of the T-wave in the ECG, thus the area of the T-wave displayed on different heartbeats will be quite different. The adaptive sliding window method is used to detect the start and end of the T-wave, and calculate the C_TWA on the same ECG record. Additionally, the coefficient of variation of C_TWA is defined as the C_TWA feature of the ECG. (2) The multi lead fusion convolutional neural network was implemented to extract the deep features of the ECG. (3) The C_TWA feature and deep features of the ECG were fused by soft attention, and then inputted into the multi-layer perceptron to obtain the detection result.Main results.According to the inter-patient paradigm, the proposed method reached a 97.67% accuracy, 96.59% precision, and 98.96% recall on the PTB dataset, as well as reached 93.15% accuracy, 93.20% precision, and 95.14% recall on the clinical dataset.Significance.This method accurately extracts the feature of the C_TWA, and combines the deep features of the signal, thereby improving the detection accuracy and achieving favorable results on clinical datasets.

ECG-based data-driven solutions for diagnosis and prognosis of cardiovascular diseases: A systematic review

Cardiovascular diseases (CVD) are a leading cause of death globally, and result in significant morbidity and reduced quality of life. The electrocardiogram (ECG) plays a crucial role in CVD diagnosis, prognosis, and prevention; however, different challenges still remain, such as an increasing unmet demand for skilled cardiologists capable of accurately interpreting ECG. This leads to higher workload and potential diagnostic inaccuracies. Data-driven approaches, such as machine learning (ML) and deep learning (DL) have emerged to improve existing computer-assisted solutions and enhance physicians' ECG interpretation of the complex mechanisms underlying CVD. However, many ML and DL models used to detect ECG-based CVD suffer from a lack of explainability, bias, as well as ethical, legal, and societal implications (ELSI). Despite the critical importance of these Trustworthy Artificial Intelligence (AI) aspects, there is a lack of comprehensive literature reviews that examine the current trends in ECG-based solutions for CVD diagnosis or prognosis that use ML and DL models and address the Trustworthy AI requirements. This review aims to bridge this knowledge gap by providing a systematic review to undertake a holistic analysis across multiple dimensions of these data-driven models such as type of CVD addressed, dataset characteristics, data input modalities, ML and DL algorithms (with a focus on DL), and aspects of Trustworthy AI like explainability, bias and ethical considerations. Additionally, within the analyzed dimensions, various challenges are identified. To these, we provide concrete recommendations, equipping other researchers with valuable insights to understand the current state of the field comprehensively.

An interpretable shapelets-based method for myocardial infarction detection using dynamic learning and deep learning

Objective.Myocardial infarction (MI) is a prevalent cardiovascular disease that contributes to global mortality rates. Timely diagnosis and treatment of MI are crucial in reducing its fatality rate. Currently, electrocardiography (ECG) serves as the primary tool for clinical diagnosis. However, detecting MI accurately through ECG remains challenging due to the complex and subtle pathological ECG changes it causes. To enhance the accuracy of ECG in detecting MI, a more thorough exploration of ECG signals is necessary to extract significant features.Approach.In this paper, we propose an interpretable shapelet-based approach for MI detection using dynamic learning and deep learning. Firstly, the intrinsic dynamics of ECG signals are learned through dynamic learning. Then, a deep neural network is utilized to extract and select shapelets from ECG dynamics, which can capture locally specific ECG changes, and serve as discriminative features for identifying MI patients. Finally, the ensemble model for MI detection is built by integrating shapelets of multi-dimensional ECG dynamic signals.Main results.The performance of the proposed method is evaluated on the public PTB dataset with accuracy, sensitivity, and specificity of 94.11%, 94.97%, and 90.98%.Significance.The shapelets obtained in this study exhibit significant morphological differences between MI and healthy subjects.

SleepMI: An AI-based screening algorithm for myocardial infarction using nocturnal electrocardiography

Myocardial infarction (MI) is a common cardiovascular disease, the early diagnosis of which is essential for effective treatment and reduced mortality. Therefore, novel methods are required for automatic screening or early diagnosis of MI, and many studies have proposed diverse conventional methods for its detection. In this study, we aimed to develop a sleep-myocardial infarction (sleepMI) algorithm for automatic screening of MI based on nocturnal electrocardiography (ECG) findings from diagnostic polysomnography (PSG) data using artificial intelligence (AI) models. The proposed sleepMI algorithm was designed using representation and ensemble learning methods and optimized via dropout and batch normalization. In the sleepMI algorithm, a deep convolutional neural network and light gradient boost machine (LightGBM) models were mixed to obtain robust and stable performance for screening MI from nocturnal ECG findings. The nocturnal ECG signal was extracted from 2,691 participants (2,331 healthy individuals and 360 patients with MI) from the PSG data of the second follow-up stage of the Sleep Heart Health Study. The nocturnal ECG signal was extracted 3 h after sleep onset and segmented at 30-s intervals for each participant. All ECG datasets were divided into training, validation, and test sets consisting of 574,729, 143,683, and 718,412 segments, respectively. The proposed sleepMI model exhibited very high performance with precision, recall, and F1-score of 99.38%, 99.38%, and 99.38%, respectively. The total mean accuracy for automatic screening of MI using a nocturnal single-lead ECG was 99.387%. MI events can be detected using conventional 12-lead ECG signals and polysomnographic ECG recordings using our model.

An Artificial Intelligence Analysis of Electrocardiograms for the Clinical Diagnosis of Cardiovascular Diseases: A Narrative Review

Artificial intelligence (AI) applied to cardiovascular disease (CVD) is enjoying great success in the field of scientific research. Electrocardiograms (ECGs) are the cornerstone form of examination in cardiology and are the most widely used diagnostic tool because they are widely available, inexpensive, and fast. Applications of AI to ECGs, especially deep learning (DL) methods using convolutional neural networks (CNNs), have been developed in many fields of cardiology in recent years. Deep learning methods provide valuable support for rapid ECG interpretation, demonstrating a diagnostic capability overlapping with specialists in the diagnosis of CVD by a classical analysis of macroscopic changes in the ECG trace. Through photoplethysmography, wearable devices can obtain single-derivative ECGs for the recognition of AI-diagnosed arrhythmias. In addition, CNNs have been developed that recognize no macroscopic electrocardiographic changes and can predict, from a 12-lead ECG, atrial fibrillation, even from sinus rhythm; left and right ventricular function; hypertrophic cardiomyopathy; acute coronary syndromes; or aortic stenosis. The fields of application are many, but numerous are the limitations, mainly associated with the reliability of the acquired data, an inability to verify black box processes, and medico-legal and ethical problems. The challenge of modern medicine is to recognize the limitations of AI and overcome them.

Classification feasibility test on multi-lead electrocardiography signals generated from single-lead electrocardiography signals

Nowadays, Electrocardiogram (ECG) signals can be measured using wearable devices, such as smart watches. Most wearable devices provide only a few details; however, they have the advantage of recording data in real time. In this study, 12-lead ECG signals were generated from lead I and their feasibility was tested to obtain more details. The 12-lead ECG signals were generated using a U-net-based generative adversarial network (GAN) that was trained on ECG data obtained from the Asan Medical Center. Subsequently, unseen PTB-XL PhysioNet data were used to produce real 12-lead ECG signals for classification. The generated and real 12-lead ECG signals were then compared using a ResNet classification model; and the normal, atrial fibrillation (A-fib), left bundle branch block (LBBB), right bundle branch block (RBBB), left ventricular hypertrophy (LVH), and right ventricular hypertrophy (RVH) were classified. The mean precision, recall, and f1-score for the real 12-lead ECG signals are 0.70, 0.72, and 0.70, and that for the generated 12-lead ECG signals are 0.82, 0.80, and 0.81, respectively. In our study, according to the result generated 12-lead ECG signals performed better than real 12-lead ECG.

Electrocardiogram Interpretation Using Artificial Intelligence: Diagnosis of Cardiac and Extracardiac Pathologic Conditions. How Far Has Machine Learning Reached?

Artificial intelligence (AI) is already widely used in different fields of medicine, making possible the integration of the paraclinical exams with the clinical findings in patients, for a more accurate and rapid diagnosis and treatment decision. The electrocardiogram remains one of the most important, fastest, cheapest, and noninvasive methods of diagnosis in cardiology, despite the rapid development and progression of the technology. Even if studied a long time ago, it still has a lot of less understood features that, with a better understanding, can give more clues to a correct and prompt diagnosis in a short time. The use of AI in the interpretation of the ECG improved the accuracy and the time to diagnosis in different cardiovascular diseases, and more than this, explaining the decision to make AI diagnosis improved the human understanding of the different features of the ECG that might be considered for a more accurate diagnosis. The purpose of this article is to provide an overview of the most recently published articles about the use of AI in ECG interpretation.

Electrocardiogram-based deep learning algorithm for the screening of obstructive coronary artery disease

BACKGROUND

Information on electrocardiogram (ECG) has not been quantified in obstructive coronary artery disease (ObCAD), despite the deep learning (DL) algorithm being proposed as an effective diagnostic tool for acute myocardial infarction (AMI). Therefore, this study adopted a DL algorithm to suggest the screening of ObCAD from ECG.

METHODS

ECG voltage-time traces within a week from coronary angiography (CAG) were extracted for the patients who received CAG for suspected CAD in a single tertiary hospital from 2008 to 2020. After separating the AMI group, those were classified into ObCAD and non-ObCAD groups based on the CAG results. A DL-based model adopting ResNet was built to extract information from ECG data in the patients with ObCAD relative to those with non-ObCAD, and compared the performance with AMI. Moreover, subgroup analysis was conducted using ECG patterns of computer-assisted ECG interpretation.

RESULTS

The DL model demonstrated modest performance in suggesting the probability of ObCAD but excellent performance in detecting AMI. The AUC of the ObCAD model adopting 1D ResNet was 0.693 and 0.923 in detecting AMI. The accuracy, sensitivity, specificity, and F1 score of the DL model for screening ObCAD were 0.638, 0.639, 0.636, and 0.634, respectively, while the figures were up to 0.885, 0.769, 0.921, and 0.758 for detecting AMI, respectively. Subgroup analysis showed that the difference between normal and abnormal/borderline ECG groups was not notable.

CONCLUSIONS

ECG-based DL model showed fair performance for assessing ObCAD and it may serve as an adjunct to the pre-test probability in patients with suspected ObCAD during the initial evaluation. With further refinement and evaluation, ECG coupled with the DL algorithm may provide potential front-line screening support in the resource-intensive diagnostic pathways.

Recent developments in modeling, imaging, and monitoring of cardiovascular diseases using machine learning

Cardiovascular diseases are the leading cause of mortality, morbidity, and hospitalization around the world. Recent technological advances have facilitated analyzing, visualizing, and monitoring cardiovascular diseases using emerging computational fluid dynamics, blood flow imaging, and wearable sensing technologies. Yet, computational cost, limited spatiotemporal resolution, and obstacles for thorough data analysis have hindered the utility of such techniques to curb cardiovascular diseases. We herein discuss how leveraging machine learning techniques, and in particular deep learning methods, could overcome these limitations and offer promise for translation. We discuss the remarkable capacity of recently developed machine learning techniques to accelerate flow modeling, enhance the resolution while reduce the noise and scanning time of current blood flow imaging techniques, and accurate detection of cardiovascular diseases using a plethora of data collected by wearable sensors.

A novel temporal generative adversarial network for electrocardiography anomaly detection

Cardiac abnormality detection from Electrocardiogram (ECG) signals is a common task for cardiologists. To facilitate efficient and objective detection, automated ECG classification by using deep learning based methods have been developed in recent years. Despite their impressive performance, these methods perform poorly when presented with cardiac abnormalities that are not well represented, or absent, in the training data. To this end, we propose a novel one-class classification based ECG anomaly detection generative adversarial network (GAN). Specifically, we embedded a Bi-directional Long-Short Term Memory (Bi-LSTM) layer into a GAN architecture and used a mini-batch discrimination training strategy in the discriminator to synthesis ECG signals. Our method generates samples to match the data distribution from normal signals of healthy group so that a generalised anomaly detector can be built reliably. The experimental results demonstrate our method outperforms several state-of-the-art semi-supervised learning based ECG anomaly detection algorithms and robustly detects the unknown anomaly class in the MIT-BIH arrhythmia database. Experiments show that our method achieves the accuracy of 95.5% and AUC of 95.9% which outperforms the most competitive baseline by 0.7% and 1.7% respectively. Our method may prove to be a helpful diagnostic method for helping cardiologists identify arrhythmias.

A dynamic learning-based ECG feature extraction method for myocardial infarction detection

Objective.Myocardial infarction (MI) is one of the leading causes of human mortality in all cardiovascular diseases globally. Currently, the 12-lead electrocardiogram (ECG) is widely used as a first-line diagnostic tool for MI. However, visual inspection of pathological ECG variations induced by MI remains a great challenge for cardiologists, since pathological changes are usually complex and slight.Approach.To have an accuracy of the MI detection, the prominent features extracted from in-depth mining of ECG signals need to be explored. In this study, a dynamic learning algorithm is applied to discover prominent features for identifying MI patients via mining the hidden inherent dynamics in ECG signals. Firstly, the distinctive dynamic features extracted from the multi-scale decomposition of dynamic modeling of the ECG signals effectively and comprehensibly represent the pathological ECG changes. Secondly, a few most important dynamic features are filtered through a hybrid feature selection algorithm based on filter and wrapper to form a representative reduced feature set. Finally, different classifiers based on the reduced feature set are trained and tested on the public PTB dataset and an independent clinical data set.Main results.Our proposed method achieves a significant improvement in detecting MI patients under the inter-patient paradigm, with an accuracy of 94.75%, sensitivity of 94.18%, and specificity of 96.33% on the PTB dataset. Furthermore, classifiers trained on PTB are verified on the test data set collected from 200 patients, yielding a maximum accuracy of 84.96%, sensitivity of 85.04%, and specificity of 84.80%.Significance.The experimental results demonstrate that our method performs distinctive dynamic feature extraction and may be used as an effective auxiliary tool to diagnose MI patients.

Applying Artificial Intelligence to Wearable Sensor Data to Diagnose and Predict Cardiovascular Disease: A Review

Cardiovascular disease (CVD) is the world's leading cause of mortality. There is significant interest in using Artificial Intelligence (AI) to analyse data from novel sensors such as wearables to provide an earlier and more accurate prediction and diagnosis of heart disease. Digital health technologies that fuse AI and sensing devices may help disease prevention and reduce the substantial morbidity and mortality caused by CVD worldwide. In this review, we identify and describe recent developments in the application of digital health for CVD, focusing on AI approaches for CVD detection, diagnosis, and prediction through AI models driven by data collected from wearables. We summarise the literature on the use of wearables and AI in cardiovascular disease diagnosis, followed by a detailed description of the dominant AI approaches applied for modelling and prediction using data acquired from sensors such as wearables. We discuss the AI algorithms and models and clinical applications and find that AI and machine-learning-based approaches are superior to traditional or conventional statistical methods for predicting cardiovascular events. However, further studies evaluating the applicability of such algorithms in the real world are needed. In addition, improvements in wearable device data accuracy and better management of their application are required. Lastly, we discuss the challenges that the introduction of such technologies into routine healthcare may face.

Automated Detection of Myocardial Infarction and Heart Conduction Disorders Based on Feature Selection and a Deep Learning Model

An electrocardiogram (ECG) is an essential piece of medical equipment that helps diagnose various heart-related conditions in patients. An automated diagnostic tool is required to detect significant episodes in long-term ECG records. It is a very challenging task for cardiologists to analyze long-term ECG records in a short time. Therefore, a computer-based diagnosis tool is required to identify crucial episodes. Myocardial infarction (MI) and conduction disorders (CDs), sometimes known as heart blocks, are medical diseases that occur when a coronary artery becomes fully or suddenly stopped or when blood flow in these arteries slows dramatically. As a result, several researchers have utilized deep learning methods for MI and CD detection. However, there are one or more of the following challenges when using deep learning algorithms: (i) struggles with real-life data, (ii) the time after the training phase also requires high processing power, (iii) they are very computationally expensive, requiring large amounts of memory and computational resources, and it is not easy to transfer them to other problems, (iv) they are hard to describe and are not completely understood (black box), and (v) most of the literature is based on the MIT-BIH or PTB databases, which do not cover most of the crucial arrhythmias. This paper proposes a new deep learning approach based on machine learning for detecting MI and CDs using large PTB-XL ECG data. First, all challenging issues of these heart signals have been considered, as the signal data are from different datasets and the data are filtered. After that, the MI and CD signals are fed to the deep learning model to extract the deep features. In addition, a new custom activation function is proposed, which has fast convergence to the regular activation functions. Later, these features are fed to an external classifier, such as a support vector machine (SVM), for detection. The efficiency of the proposed method is demonstrated by the experimental findings, which show that it improves satisfactorily with an overall accuracy of 99.20% when using a CNN for extracting the features with an SVM classifier.

Application Value of Remote ECG Monitoring in Early Diagnosis of PCI for Acute Myocardial Infarction

The blockage of blood in the vessels results in heart attacks and cardiac arrests which are referred to as myocardial infarction. Early detection of such infarction is feasible through percutaneous coronary intervention (PCI) based on electrocardiogram (ECG) monitoring. The variations in blood flow and clot are precisely observed through periodic ECG monitoring and previous correlations. This article introduces a concentrated value assessment model (CVAM) for determining PCI levels in treating myocardial infarction. The ECG observations from the previous observation sessions are accumulated and organized for validating the infarction rate. This requires the accompanying concentrated data like a heartbeat, blood pressure, and flow rate observed in different sessions. Based on the session observation and normal data correlation, the PCI level is recommended for the patient. In this analysis process, the value shift due to blocks and high and low blood pressure is accounted for through the deep learning paradigm. This paradigm correlates the above factors with the ECG values for precisely determining PCI from the last known concentration. The learning paradigm is trained based on session and normal observation data through different intervals. This model is validated using the metrics precision, analysis rate, diagnosis recommendation, and complexity.

Application of artificial intelligence techniques for automated detection of myocardial infarction: a review

Myocardial infarction (MI) results in heart muscle injury due to receiving insufficient blood flow. MI is the most common cause of mortality in middle-aged and elderly individuals worldwide. To diagnose MI, clinicians need to interpret electrocardiography (ECG) signals, which requires expertise and is subject to observer bias. Artificial intelligence-based methods can be utilized to screen for or diagnose MI automatically using ECG signals. In this work, we conducted a comprehensive assessment of artificial intelligence-based approaches for MI detection based on ECG and some other biophysical signals, including machine learning (ML) and deep learning (DL) models. The performance of traditional ML methods relies on handcrafted features and manual selection of ECG signals, whereas DL models can automate these tasks. The review observed that deep convolutional neural networks (DCNNs) yielded excellent classification performance for MI diagnosis, which explains why they have become prevalent in recent years. To our knowledge, this is the first comprehensive survey of artificial intelligence techniques employed for MI diagnosis using ECG and some other biophysical signals.

Using Multi-Task Learning-Based Framework to Detect ST-Segment and J-Point Deviation From Holter

Artificial intelligence is increasingly being used on the clinical electrocardiogram workflows. Few electrocardiograms based on artificial intelligence algorithms have focused on detecting myocardial ischemia using long-term electrocardiogram data. A main reason for this is that interference signals generated from daily activities while wearing the Holter monitor lowered the ability of artificial intelligence to detect myocardial ischemia. In this study, an automatic system combining denoising and segmentation modules was developed to detect the deviation of the ST-segment and J point. We proposed a ECG Bidirectional Transformer network that applied in both denoising and segmentation tasks. The denoising model achieved RMSEde, SNRimp, and PRD values of 0.074, 10.006, and 16.327, respectively. The segmentation model achieved precision, sensitivity (recall), and F1-score of 96.00, 93.06, and 94.51%, respectively. The system’s ability to distinguish the depression and elevation of the ST-segment and J point was also verified by cardiologists as well. From our ECG dataset, 103 patients with ST-segment depression and 10 patients with ST-segment elevation were detected with positive predictive values of 80.6 and 60% respectively. Using Holter ECG and transformer-based deep neural networks, we can detect subtle ST-segment changes in noisy ECG signals. This system has the potential to improve the efficacy of daily medicine and to provide a broader population-level screening for asymptomatic myocardial ischemia.

A New 12-Lead ECG Signals Fusion Method Using Evolutionary CNN Trees for Arrhythmia Detection

The 12 leads of electrocardiogram (ECG) signals show the heart activities from different angles of coronal and axial planes; hence, the signals of these 12 leads have functional dependence on each other. This paper proposes a novel method for fusing the data of 12-lead ECG signals to diagnose heart problems. In the first phase of the proposed method, the time-frequency transform is employed to fuse the functional data of leads and extract the frequency data of ECG signals in 12 leads. After that, their dependence is evaluated through the correlation analysis. In the second phase, a structural learning method is adopted to extract the structural data from these 12 leads. Moreover, deep convolutional neural network (CNN) models are coded in this phase through genetic programming. These trees are responsible for learning deep structural features from functional data extracted from 12 leads. These trees are upgraded through the execution of the genetic programming (GP) algorithm to extract the optimal features. These two phases are used together to fuse the leads of ECG signals to diagnose various heart problems. According to the test results on ChapmanECG, including the signals of 10,646 patients, the proposed method enjoys the mean accuracy of 97.60% in the diagnosis of various types of arrhythmias in the Chapman dataset. It also outperformed the state-of-the-art methods.

State-of-the-art Deep Learning Methods on Electrocardiogram Data: A Systematic Review (Preprint)

Background

Electrocardiogram (ECG) is one of the most common noninvasive diagnostic tools that can provide useful information regarding a patient’s health status. Deep learning (DL) is an area of intense exploration that leads the way in most attempts to create powerful diagnostic models based on physiological signals.

Objective

This study aimed to provide a systematic review of DL methods applied to ECG data for various clinical applications.

Methods

The PubMed search engine was systematically searched by combining “deep learning” and keywords such as “ecg,” “ekg,” “electrocardiogram,” “electrocardiography,” and “electrocardiology.” Irrelevant articles were excluded from the study after screening titles and abstracts, and the remaining articles were further reviewed. The reasons for article exclusion were manuscripts written in any language other than English, absence of ECG data or DL methods involved in the study, and absence of a quantitative evaluation of the proposed approaches.

Results

We identified 230 relevant articles published between January 2020 and December 2021 and grouped them into 6 distinct medical applications, namely, blood pressure estimation, cardiovascular disease diagnosis, ECG analysis, biometric recognition, sleep analysis, and other clinical analyses. We provide a complete account of the state-of-the-art DL strategies per the field of application, as well as major ECG data sources. We also present open research problems, such as the lack of attempts to address the issue of blood pressure variability in training data sets, and point out potential gaps in the design and implementation of DL models.

Conclusions

We expect that this review will provide insights into state-of-the-art DL methods applied to ECG data and point to future directions for research on DL to create robust models that can assist medical experts in clinical decision-making.

Deep Learning for Detecting and Locating Myocardial Infarction by Electrocardiogram: A Literature Review

Myocardial infarction is a common cardiovascular disorder caused by prolonged ischemia, and early diagnosis of myocardial infarction (MI) is critical for lifesaving. ECG is a simple and non-invasive approach in MI detection, localization, diagnosis, and prognosis. Population-based screening with ECG can detect MI early and help prevent it but this method is too labor-intensive and time-consuming to carry out in practice unless artificial intelligence (AI) would be able to reduce the workload. Recent advances in using deep learning (DL) for ECG screening might rekindle this hope. This review aims to take stock of 59 major DL studies applied to the ECG for MI detection and localization published in recent 5 years, covering convolutional neural network (CNN), long short-term memory (LSTM), convolutional recurrent neural network (CRNN), gated recurrent unit (GRU), residual neural network (ResNet), and autoencoder (AE). In this period, CNN obtained the best popularity in both MI detection and localization, and the highest performance has been obtained from CNN and ResNet model. The reported maximum accuracies of the six different methods are all beyond 97%. Considering the usage of different datasets and ECG leads, the network that trained on 12 leads ECG data of PTB database has obtained higher accuracy than that on smaller number leads data of other datasets. In addition, some limitations and challenges of the DL techniques are also discussed in this review.

A Powerful Paradigm for Cardiovascular Risk Stratification Using Multiclass, Multi-Label, and Ensemble-Based Machine Learning Paradigms: A Narrative Review

Background and Motivation: Cardiovascular disease (CVD) causes the highest mortality globally. With escalating healthcare costs, early non-invasive CVD risk assessment is vital. Conventional methods have shown poor performance compared to more recent and fast-evolving Artificial Intelligence (AI) methods. The proposed study reviews the three most recent paradigms for CVD risk assessment, namely multiclass, multi-label, and ensemble-based methods in (i) office-based and (ii) stress-test laboratories. Methods: A total of 265 CVD-based studies were selected using the preferred reporting items for systematic reviews and meta-analyses (PRISMA) model. Due to its popularity and recent development, the study analyzed the above three paradigms using machine learning (ML) frameworks. We review comprehensively these three methods using attributes, such as architecture, applications, pro-and-cons, scientific validation, clinical evaluation, and AI risk-of-bias (RoB) in the CVD framework. These ML techniques were then extended under mobile and cloud-based infrastructure. Findings: Most popular biomarkers used were office-based, laboratory-based, image-based phenotypes, and medication usage. Surrogate carotid scanning for coronary artery risk prediction had shown promising results. Ground truth (GT) selection for AI-based training along with scientific and clinical validation is very important for CVD stratification to avoid RoB. It was observed that the most popular classification paradigm is multiclass followed by the ensemble, and multi-label. The use of deep learning techniques in CVD risk stratification is in a very early stage of development. Mobile and cloud-based AI technologies are more likely to be the future. Conclusions: AI-based methods for CVD risk assessment are most promising and successful. Choice of GT is most vital in AI-based models to prevent the RoB. The amalgamation of image-based strategies with conventional risk factors provides the highest stability when using the three CVD paradigms in non-cloud and cloud-based frameworks.

EvoMBN: Evolving Multi-Branch Networks on Myocardial Infarction Diagnosis Using 12-Lead Electrocardiograms

Multi-branch Networks (MBNs) have been successfully applied to myocardial infarction (MI) diagnosis using 12-lead electrocardiograms. However, most existing MBNs share a fixed architecture. The absence of architecture optimization has become a significant obstacle to a more accurate diagnosis for these MBNs. In this paper, an evolving neural network named EvoMBN is proposed for MI diagnosis. It utilizes a genetic algorithm (GA) to automatically learn the optimal MBN architectures. A novel fixed-length encoding method is proposed to represent each architecture. In addition, the crossover, mutation, selection, and fitness evaluation of the GA are defined to ensure the architecture can be optimized through evolutional iterations. A novel Lead Squeeze and Excitation (LSE) block is designed to summarize features from all the branch networks. It consists of a fully-connected layer and an LSE mechanism that assigns weights to different leads. Five-fold inter-patient cross validation experiments on MI detection and localization are performed using the PTB diagnostic database. Moreover, the model architecture learned from the PTB database is transferred to the PTB-XL database without any changes. Compared with existing studies, our EvoMBN shows superior generalization and the efficiency of its flexible architecture is suitable for auxiliary MI diagnosis in real-world.