Cardiac decision making using higher order spectra

Cardiovascular disease detection from cardiac arrhythmia ECG signals using artificial intelligence models with hyperparameters tuning methodologies

Cardiovascular disease (CVD) is connected with irregular cardiac electrical activity, which can be seen in ECG alterations. Due to its convenience and non-invasive aspect, the ECG is routinely exploited to identify different arrhythmias and automatic ECG recognition is needed immediately. In this paper, enhancement for the detection of CVDs such as Ventricular Tachycardia (VT), Premature Ventricular Contraction (PVC) and ST Change (ST) arrhythmia using different dimensionality reduction techniques and multiple classifiers are presented. Three-dimensionality reduction methods, such as Local Linear Embedding (LLE), Diffusion Maps (DM), and Laplacian Eigen (LE), are employed. The dimensionally reduced ECG samples are further feature selected with Cuckoo Search (CS) and Harmonic Search Optimization (HSO) algorithms. A publicly available MIT-BIH (Physionet) - VT database, PVC database, ST Change database and NSR database were used in this work. The cardiac vascular disturbances are classified by using seven classifiers such as Gaussian Mixture Model (GMM), Expectation Maximization (EM), Non-linear Regression (NLR), Logistic Regression (LR), Bayesian Linear Discriminant Analysis (BDLC), Detrended Fluctuation Analysis (Detrended FA), and Firefly. For different classes, the average overall accuracy of the classification techniques is 55.65 % when without CS and HSO feature selection, 64.36 % when CS feature selection is used, and 75.39 % when HSO feature selection is used. Also, to improve the performance of classifiers, the hyperparameters of four classifiers (GMM, EM, BDLC and Firefly) are tuned with the Adam and Grid Search Optimization (GSO) approaches. The average accuracy of classification for the CS feature-based classifiers that used GSO and Adam hyperparameter tuning was 79.92 % and 85.78 %, respectively. The average accuracy of classification for the HSO feature-based classifiers that used GSO and Adam hyperparameter tuning was 86.87 % and 93.77 %, respectively. The performance of the classifier is analyzed based on the accuracy parameter for both with and without feature selection methods and with hyperparameter tuning techniques. In the case of ST vs. NSR, a higher accuracy of 98.92 % is achieved for the LLE dimensionality reduction with HSO feature selection for the GMM classifier with Adam's hyperparameter tuning approach. The GMM classifier with the Adam hyperparameter tuning approach with 98.92 % accuracy in detecting ST vs. NSR cardiac disease is outperforming all other classifiers and methodologies.

Automatic Classification of Anomalous ECG Heartbeats from Samples Acquired by Compressed Sensing

In this paper, a method for the classification of anomalous heartbeats from compressed ECG signals is proposed. The method operating on signals acquired by compressed sensing is based on a feature extraction stage consisting of the evaluation of the Discrete Cosine Transform (DCT) coefficients of the compressed signal and a classification stage performed by means of a set of k-nearest neighbor ensemble classifiers. The method was preliminarily tested on five classes of anomalous heartbeats, and it achieved a classification accuracy of 99.40%.

Automated cardiac arrhythmia detection techniques: a comprehensive review for prospective approach

Abnormal cardiac functionality produces irregular heart rhythms which are commonly known as arrhythmias. In some conditions, arrhythmias are treated as very dangerous which may lead to sudden cardiac arrest. The incidence and prevalence of cardiac anomalies seeks early detection of arrhythmias using automated classification techniques. In the past, numerous automated arrhythmia detection techniques have been developed that are based on electrocardiogram (ECG) signal analysis. Focusing on the prospective research in this field, this article reports a comprehensive review of existing techniques that are obtained using search engines such as IEEE explore, Google scholar and science direct. Based on the review, the existing techniques are broadly categorized into two types: machine-learning and deep-learning-based techniques. In this study, it is noticed that the performance of the machine-learning-based arrhythmia detection techniques depend on pre-processing of ECG signal, R-peaks detection, features extraction and classification tools while the deep-learning-based techniques do not require the features extraction step. Generally, the existing techniques utilize Massachusetts Institute of Technology-Beth Israel Hospital arrhythmia database to evaluate the classification performance. The classification performance of automated techniques also depends on ECG data used for training and testing of the classifier. It is expected that the performance should be evaluated using a variety of ECG signals including the cases of inter-patient and intra-patient paradigm. The existing techniques also require to deal with the class-imbalance problem. In addition to this, a specific partition-ratio between training and testing datasets should be maintained for fair comparison of performance of different techniques.

Differential diagnosis between dilated cardiomyopathy and ischemic cardiomyopathy based on variational mode decomposition and high order spectra analysis

The clinical manifestations of ischemic cardiomyopathy (ICM) bear resemblance to dilated cardiomyopathy (DCM). The definitive diagnosis of DCM necessitates the identification of invasive, costly, and contraindicated coronary angiography. Many diagnostic studies of cardiovascular disease have tried modal decomposition based on electrocardiogram (ECG) signals. However, these studies ignored the connection between modes and other fields, thus limiting the interpretability of modes to ECG signals and the classification performance of models. This study proposes a classification algorithm based on variational mode decomposition (VMD) and high order spectra, which decomposes the preprocessed ECG signal and extracts its first five modes obtained through VMD. After that, these modes are estimated for their corresponding bispectrums, and the feature vector is composed of fifteen features including bispectral, frequency, and nonlinear features based on this. Finally, a dataset containing 75 subjects (38 DCM, 37 ICM) is classified and compared using random forest (RF), decision tree, support vector machine, and K-nearest neighbor. The results show that, in comparison to previous approaches, the technique proposed provides a better categorization for DCM and ICM of ECG signals, which delivers 98.21% classification accuracy, 98.22% sensitivity, and 98.19% specificity. And mode 3 always has the best performance among single mode. The proposed computerized framework significantly improves automatic diagnostic performance, which can help relieve the working pressure on doctors, possible economic burden and health threaten.

Electrocardiogram morphological arrhythmia classification using fuzzy entropy-based feature selection and optimal classifier

Electrocardiogram (ECG) signal analysis has become significant in recent years as cardiac arrhythmia shares a major portion of all mortality worldwide. To detect these arrhythmias, computer-assisted algorithms play a pivotal role as beat-by-beat monitoring of holter ECG signals is required. In this paper, a morphological arrhythmia classification algorithm has been proposed to classify seven different ECG beats, namely Normal Beat (N), Left Bundle Branch Block Beat (L), Right Bundle Branch Block Beat (R), Atrial Premature Contraction Beat (A), Premature Ventricular Contraction Beat (V), Fusion of Normal and Ventricle Beat (F) and Pace Beat (P). A novel feature set of 25 attributes has been extracted from each ECG beat and ranked using the Fuzzy Entropy-based feature selection (FEBFS) technique. In addition, two distinct classifiers, support vector machine with radial basis function as the kernel (SVM-RBF) and weighted K-nearest neighbor (WKNN), are used to categorize ECG beats, and their performances are also evaluated after adjusting vital parameters. The performance of classifiers is compared for four different ECG beat segmentation approaches and further analyzed using three similarity measurement techniques and two fuzzy entropy methods while feature selection. The classifier results are also cross-validated using a 10-fold cross-validation scheme, and the MIT-BIH Arrhythmia Database has been used to validate the proposed work. After selecting 21 highly ranked features, WKNN achieves the best results with the nearest neighbor value K = 3 and cityblock distance metrics, with Average Sensitivity (Sen) = 94.89%, Positive Predictivity (Ppre) = 97.13%, Specificity (Spe) = 99.72%, F1 Score = 95.95%, and Overall Accuracy (Acc) = 99.15%. The novelty of this work relies on formulating a unique feature set, including proposed symbolic features, followed by the FEBFS technique making this algorithm efficient and reliable for morphological arrhythmia classification. The above results demonstrate that the proposed algorithm performs better than many existing state-of-the-art works.

Practical intelligent diagnostic algorithm for wearable 12-lead ECG via self-supervised learning on large-scale dataset

Cardiovascular disease is a major global public health problem, and intelligent diagnostic approaches play an increasingly important role in the analysis of electrocardiograms (ECGs). Convenient wearable ECG devices enable the detection of transient arrhythmias and improve patient health by making it possible to seek intervention during continuous monitoring. We collected 658,486 wearable 12-lead ECGs, among which 164,538 were annotated, and the remaining 493,948 were without diagnostic. We present four data augmentation operations and a self-supervised learning classification framework that can recognize 60 ECG diagnostic terms. Our model achieves an average area under the receiver-operating characteristic curve (AUROC) and average F1 score on the offline test of 0.975 and 0.575. The average sensitivity, specificity and F1-score during the 2-month online test are 0.736, 0.954 and 0.468, respectively. This approach offers real-time intelligent diagnosis, and detects abnormal segments in long-term ECG monitoring in the clinical setting for further diagnosis by cardiologists.

ECG Heartbeat Classification Using Machine Learning and Metaheuristic Optimization for Smart Healthcare Systems

Early diagnosis and classification of arrhythmia from an electrocardiogram (ECG) plays a significant role in smart healthcare systems for the health monitoring of individuals with cardiovascular diseases. Unfortunately, the nonlinearity and low amplitude of ECG recordings make the classification process difficult. Thus, the performance of most traditional machine learning (ML) classifiers is questionable, as the interrelationship between the learning parameters is not well modeled, especially for data features with high dimensions. To address the limitations of ML classifiers, this paper introduces an automatic arrhythmia classification approach based on the integration of a recent metaheuristic optimization (MHO) algorithm and ML classifiers. The role of the MHO is to optimize the search parameters of the classifiers. The approach consists of three steps: the preprocessing of the ECG signal, the extraction of the features, and the classification. The learning parameters of four supervised ML classifiers were utilized for the classification task; support vector machine (SVM), k-nearest neighbors (kNNs), gradient boosting decision tree (GBDT), and random forest (RF) were optimized using the MHO algorithm. To validate the advantage of the proposed approach, several experiments were conducted on three common databases, including the Massachusetts Institute of Technology (MIT-BIH), the European Society of Cardiology ST-T (EDB), and the St. Petersburg Institute of Cardiological Techniques 12-lead Arrhythmia (INCART). The obtained results showed that the performance of all the tested classifiers were significantly improved after integrating the MHO algorithm, with the average ECG arrhythmia classification accuracy reaching 99.92% and a sensitivity of 99.81%, outperforming the state-of the-art methods.

ECG classification using 1-D convolutional deep residual neural network

An electrocardiograph (ECG) is widely used in diagnosis and prediction of cardiovascular diseases (CVDs). The traditional ECG classification methods have complex signal processing phases that leads to expensive designs. This paper provides a deep learning (DL) based system that employs the convolutional neural networks (CNNs) for classification of ECG signals present in PhysioNet MIT-BIH Arrhythmia database. The proposed system implements 1-D convolutional deep residual neural network (ResNet) model that performs feature extraction by directly using the input heartbeats. We have used synthetic minority oversampling technique (SMOTE) that process class-imbalance problem in the training dataset and effectively classifies the five heartbeat types in the test dataset. The classifier's performance is evaluated with ten-fold cross validation (CV) using accuracy, precision, sensitivity, F1-score, and kappa. We have obtained an average accuracy of 98.63%, precision of 92.86%, sensitivity of 92.41%, and specificity of 99.06%. The average F1-score and Kappa obtained were 92.63% and 95.5% respectively. The study shows that proposed ResNet performs well with deep layers compared to other 1-D CNNs.

Multi-Scale Deep Residual Shrinkage Network for Atrial Fibrillation Recognition

In this paper, a novel multi-scale deep residual shrinkage network (MS-DRSN) is proposed for signal denoising and atrial fibrillation (AF) recognition. Signal denoising is done by multi-scale threshold denoising module (MS-TDM), which consists of two parts: threshold acquisition and threshold denoising. The thresholds are automatically obtained through the global attention module constructed by the neural network. Threshold denoising chooses Garrote as the threshold function, which combines the advantages of soft and hard thresholding. The multi-scale features consist of global attention module and local attention module, and then the multi-scale features are denoised using the acquired thresholds and threshold functions, and the AF recognition task is finally completed in the Softmax layer after the superposition of multiple MS-TDMs. An adaptive synthetic sampling (ADASYN) algorithm is also used to oversample the dataset and achieve data category balancing by generating new samples, which improves the accuracy of AF recognition and alleviates the overfitting of the neural network. This method was experimented and validated on the PhysioNet2017 dataset. The experimental results show that the approach achieves an accuracy of 0.894 and an [Formula: see text] score of 0.881, which is better than current machine learning and deep learning models.

Automatic ECG analysis system with hybrid optimization algorithm based feature selection and classifier

Cardio vascular disease threatens human life with higher mortality rate. Therefore it is quite important to monitor. An arrhythmia is an abnormal heart beat and rhythm which causes the disease. The best tool to find the heart rhythm of heart is Electro Cardiogram (ECG) which provides information about the different types of arrhythmias. This paper aims at proposing an automatic framework by employing multi-domain features to classify ECG signals. Proposed work uses optimum method of feature selection to improvise the efficiency of the classification process. A hybrid optimization algorithm is used for feature selection and proposed to optimize the parameters of the existing Support Vector Machine (SVM) classifier. Proposed hybrid optimization algorithm was developed using Particle Swarm Optimization (PSO) and Migration Modified Biogeography Based Optimization (MMBBO) algorithm. Algorithm provides an improved solution to the optimizing the parameters of ECG signals. Results are evaluated by implementing in MATLAB software and the performance is justified with comparative analysis. The proposed framework enhances the process of automatic prediction of various arrhythmias or rhythm abnormalities which performs in gaining better accuracy. For data sets, the average classification accuracy of this method is 97.89%. This result is an improvement of 4–5% over the comparison of other methods.

Nonlinear model-based cardiac arrhythmia diagnosis using the optimization-based inverse problem solution

This study investigates a nonlinear model-based feature extraction approach for the accurate classification of four types of heartbeats. The features are the morphological parameters of ECG signal derived from the nonlinear ECG model using an optimization-based inverse problem solution. In the model-based methods, high feature extraction time is a crucial issue. In order to reduce the feature extraction time, a new structure was employed in the optimization algorithms. Using the proposed structure has considerably increased the speed of feature extraction. In the following, the effectiveness of two types of optimization methods (genetic algorithm and particle swarm optimization) and the McSharry ECG model has been studied and compared in terms of speed and accuracy of diagnosis. In the classification section, the adaptive neuro-fuzzy inference system and fuzzy c-mean clustering methods, along with the principal component analysis data reduction method, have been utilized. The obtained results reveal that using an adaptive neuro-fuzzy inference system with data obtained from particle swarm optimization will have the shortest process time and the best diagnosis, with a mean accuracy of 99% and a mean sensitivity of 99.11%.

Beat-Level Interpretation of Intra-Patient Paradigm Based on Object Detection

Electrocardiogram (ECG), as a product that can most directly reflect the electrical activity of the heart, has become the most common clinical technique used for the analysis of cardiac abnormalities. However, it is a heavy and tedious burden for doctors to analyze a large amount of ECG data from the long-term monitoring system. The realization of automatic ECG analysis is of great significance. This work proposes a beat-level interpretation method based on the automatic annotation algorithm and object detector, which abandons the previous mode of separate R peak detection and heartbeat classification. The ground truth of the QRS complex is automatically annotated and also regarded as the object the model can learn like category information. The object detector unifies the localization and classification tasks, achieving an end-to-end optimization as well as decoupling the high dependence on the R peak. Compared with most advanced methods, this work shows superior performance. For the interpretation of 12 heartbeat types in the MIT-BIH dataset, the average accuracy is 99.60%, the average sensitivity is 97.56%, and the average specificity is 99.78%. This method can be used as a clinical auxiliary tool to help doctors diagnose arrhythmia after receiving large-scale database training.

Novel feature extraction method for signal analysis based on independent component analysis and wavelet transform

Feature extraction is an important part of data processing that provides a basis for more complicated tasks such as classification or clustering. Recently many approaches for signal feature extraction were created. However, plenty of proposed methods are based on convolutional neural networks. This class of models requires a high amount of computational power to train and deploy and large dataset. Our work introduces a novel feature extraction method that uses wavelet transform to provide additional information in the Independent Component Analysis mixing matrix. The goal of our work is to combine good performance with a low inference cost. We used the task of Electrocardiography (ECG) heartbeat classification to evaluate the usefulness of the proposed approach. Experiments were carried out with an MIT-BIH database with four target classes (Normal, Vestibular ectopic beats, Ventricular ectopic beats, and Fusion strikes). Several base wavelet functions with different classifiers were used in experiments. Best was selected with 5-fold cross-validation and Wilcoxon test with significance level 0.05. With the proposed method for feature extraction and multi-layer perceptron classifier, we obtained 95.81% BAC-score. Compared to other literature methods, our approach was better than most feature extraction methods except for convolutional neural networks. Further analysis indicates that our method performance is close to convolutional neural networks for classes with a limited number of learning examples. We also analyze the number of required operations at test time and argue that our method enables easy deployment in environments with limited computing power.

Fusion of Higher Order Spectra and Texture Extraction Methods for Automated Stroke Severity Classification with MRI Images

This paper presents a scientific foundation for automated stroke severity classification. We have constructed and assessed a system which extracts diagnostically relevant information from Magnetic Resonance Imaging (MRI) images. The design was based on 267 images that show the brain from individual subjects after stroke. They were labeled as either Lacunar Syndrome (LACS), Partial Anterior Circulation Syndrome (PACS), or Total Anterior Circulation Stroke (TACS). The labels indicate different physiological processes which manifest themselves in distinct image texture. The processing system was tasked with extracting texture information that could be used to classify a brain MRI image from a stroke survivor into either LACS, PACS, or TACS. We analyzed 6475 features that were obtained with Gray-Level Run Length Matrix (GLRLM), Higher Order Spectra (HOS), as well as a combination of Discrete Wavelet Transform (DWT) and Gray-Level Co-occurrence Matrix (GLCM) methods. The resulting features were ranked based on the p-value extracted with the Analysis Of Variance (ANOVA) algorithm. The ranked features were used to train and test four types of Support Vector Machine (SVM) classification algorithms according to the rules of 10-fold cross-validation. We found that SVM with Radial Basis Function (RBF) kernel achieves: Accuracy (ACC) = 93.62%, Specificity (SPE) = 95.91%, Sensitivity (SEN) = 92.44%, and Dice-score = 0.95. These results indicate that computer aided stroke severity diagnosis support is possible. Such systems might lead to progress in stroke diagnosis by enabling healthcare professionals to improve diagnosis and management of stroke patients with the same resources.

Automated Detection of Hypertension Using Physiological Signals: A Review

Arterial hypertension (HT) is a chronic condition of elevated blood pressure (BP), which may cause increased incidence of cardiovascular disease, stroke, kidney failure and mortality. If the HT is diagnosed early, effective treatment can control the BP and avert adverse outcomes. Physiological signals like electrocardiography (ECG), photoplethysmography (PPG), heart rate variability (HRV), and ballistocardiography (BCG) can be used to monitor health status but are not directly correlated with BP measurements. The manual detection of HT using these physiological signals is time consuming and prone to human errors. Hence, many computer-aided diagnosis systems have been developed. This paper is a systematic review of studies conducted on the automated detection of HT using ECG, HRV, PPG and BCG signals. In this review, we have identified 23 studies out of 250 screened papers, which fulfilled our eligibility criteria. Details of the study methods, physiological signal studied, database used, various nonlinear techniques employed, feature extraction, and diagnostic performance parameters are discussed. The machine learning and deep learning based methods based on ECG and HRV signals have yielded the best performance and can be used for the development of computer-aided diagnosis of HT. This work provides insights that may be useful for the development of wearable for continuous cuffless remote monitoring of BP based on ECG and HRV signals.

Deep convolutional neural networks based ECG beats classification to diagnose cardiovascular conditions

Medical practitioners need to understand the critical features of ECG beats to diagnose and identify cardiovascular conditions accurately. This would be greatly facilitated by identifying the significant features of frequency components in temporal ECG wave-forms using computational methods. In this study, we have proposed a novel ECG beat classifier based on a customized VGG16-based Convolution Neural Network (CNN) that uses the time-frequency representation of temporal ECG, and a method to identify the contribution of interpretable ECG frequencies when classifying based on the SHapley Additive exPlanations (SHAP) values. We applied our model to the MIT-BIH arrhythmia dataset to classify the ECG beats and to characterise of the beats frequencies. This model was evaluated with two advanced time-frequency analysis methods. Our results indicated that for 2-4 classes our proposed model achieves a classification accuracy of 100% and for 5 classes it achieves a classification accuracy of 99.90%. We have also tested the proposed model using premature ventricular contraction beats from the American Heart Association (AHA) database and normal beats from Lobachevsky University Electrocardiography database (LUDB) and obtained a classification accuracy of 99.91% for the 5-classes case. In addition, SHAP value increased the interpretability of the ECG frequency features. Thus, this model could be applicable to the automation of the cardiovascular diagnosis system and could be used by clinicians.

Novel Density Poincaré Plot Based Machine Learning Method to Detect Atrial Fibrillation From Premature Atrial/Ventricular Contractions

OBJECTIVE

Detection of Atrial fibrillation (AF) from premature atrial contraction (PAC) and premature ventricular contraction (PVC) is difficult as frequent occurrences of these ectopic beats can mimic the typical irregular patterns of AF. In this paper, we present a novel density Poincaré plot-based machine learning method to detect AF from PAC/PVCs using electrocardiogram (ECG) recordings.

METHODS

First, we propose the generation of this new density Poincaré plot which is derived from the difference of the heart rate (DHR) and provides the overlapping phase-space trajectory information of the DHR. Next, from this density Poincaré plot, several image processing domain-based approaches including statistical central moments, template correlation, Zernike moment, discrete wavelet transform and Hough transform features are used to extract suitable features. Subsequently, the infinite latent feature selection algorithm is implemented to rank the features. Finally, classification of AF vs. PAC/PVC is performed using K-Nearest Neighbor, Support vector machine (SVM) and Random Forest (RF) classifiers. Our method is developed and validated using a subset of Medical Information Mart for Intensive Care (MIMIC) III database containing 10 AF and 10 PAC/PVC subjects. Results- During the segment-wise 10-fold cross-validation, SVM achieved the best performance with 98.99% sensitivity, 95.18% specificity and 97.45% accuracy with the extracted features. In subject-wise scenario, RF achieved the highest accuracy of 91.93%. Moreover, we further validated the proposed method using two other databases: wearable armband ECG data and the Physionet AFPDB. 100% PAC detection accuracy was obtained for both databases without any further training.

CONCLUSION

Our proposed density Poincaré plot-based method showed superior performance when compared with four existing algorithms; thus showing the efficacy of the extracted image domain-based features.

SIGNIFICANCE

From intensive care unit's ECG to wearable armband ECGs, the proposed method is shown to discriminate PAC/PVCs from AF with high accuracy.

A Hybrid Deep CNN Model for Abnormal Arrhythmia Detection Based on Cardiac ECG Signal

Electrocardiogram (ECG) signals play a vital role in diagnosing and monitoring patients suffering from various cardiovascular diseases (CVDs). This research aims to develop a robust algorithm that can accurately classify the electrocardiogram signal even in the presence of environmental noise. A one-dimensional convolutional neural network (CNN) with two convolutional layers, two down-sampling layers, and a fully connected layer is proposed in this work. The same 1D data was transformed into two-dimensional (2D) images to improve the model’s classification accuracy. Then, we applied the 2D CNN model consisting of input and output layers, three 2D-convolutional layers, three down-sampling layers, and a fully connected layer. The classification accuracy of 97.38% and 99.02% is achieved with the proposed 1D and 2D model when tested on the publicly available Massachusetts Institute of Technology-Beth Israel Hospital (MIT-BIH) arrhythmia database. Both proposed 1D and 2D CNN models outperformed the corresponding state-of-the-art classification algorithms for the same data, which validates the proposed models’ effectiveness.

Wavelet Scattering Transform for ECG Beat Classification

An electrocardiogram (ECG) records the electrical activity of the heart; it contains rich pathological information on cardiovascular diseases, such as arrhythmia. However, it is difficult to visually analyze ECG signals due to their complexity and nonlinearity. The wavelet scattering transform can generate translation-invariant and deformation-stable representations of ECG signals through cascades of wavelet convolutions with nonlinear modulus and averaging operators. We proposed a novel approach using wavelet scattering transform to automatically classify four categories of arrhythmia ECG heartbeats, namely, nonectopic (N), supraventricular ectopic (S), ventricular ectopic (V), and fusion (F) beats. In this study, the wavelet scattering transform extracted 8 time windows from each ECG heartbeat. Two dimensionality reduction methods, principal component analysis (PCA) and time window selection, were applied on the 8 time windows. These processed features were fed to the neural network (NN), probabilistic neural network (PNN), and k-nearest neighbour (KNN) classifiers for classification. The 4th time window in combination with KNN (k = 4) has achieved the optimal performance with an averaged accuracy, positive predictive value, sensitivity, and specificity of 99.3%, 99.6%, 99.5%, and 98.8%, respectively, using tenfold cross-validation. Thus, our proposed model is capable of highly accurate arrhythmia classification and will provide assistance to physicians in ECG interpretation.

Preliminary Results on Density Poincare Plot Based Atrial Fibrillation Detection from Premature Atrial/Ventricular Contractions

Detection of Atrial fibrillation (AF) from premature atrial contraction (PAC) and premature ventricular contraction (PVC) is challenging as frequent occurrences of these ectopic beats can mimic the typical irregular patterns of AF. In this paper, we present a preliminary study of using density Poincare plot based machine learning method to detect AF from PAC/PVCs using electrocardiogram (ECG) recordings. First, we propose creation of this new density Poincare plot which is derived from the difference of the heart rate. Next, from this density Poincare plot, template correlation and discrete wavelet transform are used to extract suitable image-based features, which is followed by infinite latent feature selection algorithm to rank the features. Finally, classification of AF vs PAC/PVC is performed using K-Nearest Neighbor, discriminant analysis and support vector machine (SVM) classifiers. Our method is developed and validated using a subset of Medical Information Mart for Intensive Care (MIMIC) III database containing 8 AF and 8 PAC/PVC subjects. Both 10-fold and leave-one-subject-out cross validations are performed to show the robustness of our proposed method. During the 10-fold cross-validation, SVM achieved the best performance with 99.49% sensitivity, 94.51% specificity and 97.29% accuracy with the extracted features while for the leave-one-subject-out, the highest overall accuracy is 90.91%. Moreover, when compared with two state-of-the-art methods, the proposed algorithm achieves superior AF vs. PAC/PVC discrimination performance.Clinical Relevance-This preliminary study shows that with the help of density Poincare plot, AF can be separated from PAC/PVC with better accuracy.

Arrhythmia Diagnosis by Using Level-Crossing ECG Sampling and Sub-Bands Features Extraction for Mobile Healthcare

Mobile healthcare is an emerging technique for clinical applications. It is usually based on cloud-connected biomedical implants. In this context, a novel solution is presented for the detection of arrhythmia by using electrocardiogram (ECG) signals. The aim is to achieve an effective solution by using real-time compression, efficient signal processing, and data transmission. The system utilizes level-crossing-based ECG signal sampling, adaptive-rate denoising, and wavelet-based sub-band decomposition. Statistical features are extracted from the sub-bands and used for automated arrhythmia classification. The performance of the system was studied by using five classes of arrhythmia, obtained from the MIT-BIH dataset. Experimental results showed a three-fold decrease in the number of collected samples compared to conventional counterparts. This resulted in a significant reduction of the computational cost of the post denoising, features extraction, and classification. Moreover, a seven-fold reduction was achieved in the amount of data that needed to be transmitted to the cloud. This resulted in a notable reduction in the transmitter power consumption, bandwidth usage, and cloud application processing load. Finally, the performance of the system was also assessed in terms of the arrhythmia classification, achieving an accuracy of 97%.

An Automatic Diagnosis of Arrhythmias Using a Combination of CNN and LSTM Technology

Electrocardiogram (ECG) signal evaluation is routinely used in clinics as a significant diagnostic method for detecting arrhythmia. However, it is very labor intensive to externally evaluate ECG signals, due to their small amplitude. Using automated detection and classification methods in the clinic can assist doctors in making accurate and expeditious diagnoses of diseases. In this study, we developed a classification method for arrhythmia based on the combination of a convolutional neural network and long short-term memory, which was then used to diagnose eight ECG signals, including a normal sinus rhythm. The ECG data of the experiment were derived from the MIT-BIH arrhythmia database. The experimental method mainly consisted of two parts. The input data of the model were two-dimensional grayscale images converted from one-dimensional signals, and detection and classification of the input data was carried out using the combined model. The advantage of this method is that it does not require performing feature extraction or noise filtering on the ECG signal. The experimental results showed that the implemented method demonstrated high classification performance in terms of accuracy, specificity, and sensitivity equal to 99.01%, 99.57%, and 97.67%, respectively. Our proposed model can assist doctors in accurately detecting arrhythmia during routine ECG screening.

Automatic detection of arrhythmia from imbalanced ECG database using CNN model with SMOTE

Timely prediction of cardiovascular diseases with the help of a computer-aided diagnosis system minimizes the mortality rate of cardiac disease patients. Cardiac arrhythmia detection is one of the most challenging tasks, because the variations of electrocardiogram(ECG) signal are very small, which cannot be detected by human eyes. In this study, an 11-layer deep convolutional neural network model is proposed for classification of the MIT-BIH arrhythmia database into five classes according to the ANSI-AAMI standards. In this CNN model, we designed a complete end-to-end structure of the classification method and applied without the denoising process of the database. The major advantage of the new methodology proposed is that the number of classifications will reduce and also the need to detect, and segment the QRS complexes, obviated. This MIT-BIH database has been artificially oversampled to handle the minority classes, class imbalance problem using SMOTE technique. This new CNN model was trained on the augmented ECG database and tested on the real dataset. The experimental results portray that the developed CNN model has better performance in terms of precision, recall, F-score, and overall accuracy as compared to the work mentioned in the literatures. These results also indicate that the best performance accuracy of 98.30% is obtained in the 70:30 train-test data set.

Electrocardiogram Classification Based on Faster Regions with Convolutional Neural Network

The classification of electrocardiograms (ECG) plays an important role in the clinical diagnosis of heart disease. This paper proposes an effective system development and implementation for ECG classification based on faster regions with a convolutional neural network (Faster R-CNN) algorithm. The original one-dimensional ECG signals contain the preprocessed patient ECG signals and some ECG recordings from the MIT-BIH database in this experiment. Each ECG beat of one-dimensional ECG signals was transformed into a two-dimensional image for experimental training sets and test sets. As a result, we classified the ECG beats into five categories with an average accuracy of 99.21%. In addition, we did a comparative experiment using the one versus rest support vector machine (OVR SVM) algorithm, and the classification accuracy of the proposed Faster R-CNN was shown to be 2.59% higher.

VENTRICULAR TACHYCARDIA AND FIBRILLATION DETECTION USING DWT AND DECISION TREE CLASSIFIER

Ventricular tachycardia (VT) and ventricular fibrillation (VF) are the life-threatening ventricular arrhythmias that require treatment in an emergency. Detection of VT and VF at an early stage is crucial for achieving the success of the defibrillation treatment. Hence an automatic system using computer-aided diagnosis tool is helpful in detecting the ventricular arrhythmias in electrocardiogram (ECG) signal. In this paper, a discrete wavelet transform (DWT) was used to denoise and decompose the ECG signals into different consecutive frequency bands to reduce noise. The methodology was tested using ECG data from standard CU ventricular tachyarrhythmia database (CUDB) and MIT-BIH malignant ventricular ectopy database (VFDB) datasets of PhysioNet databases. A set of time-frequency features consists of temporal, spectral, and statistical were extracted and ranked by the correlation attribute evaluation with ranker search method in order to improve the accuracy of detection. The ranked features were classified for VT and VF conditions using support vector machine (SVM) and decision tree (C4.5) classifier. The proposed DWT based features yielded the average sensitivity of 98%, specificity of 99.32%, and accuracy of 99.23% using a decision tree (C4.5) classifier. These results were better than the SVM classifier having an average accuracy of 92.43%. The obtained results prove that using DWT based time-frequency features with decision tree (C4.5) classifier can be one of the best choices for clinicians for precise detection of ventricular arrhythmias.

ECG BEAT DETECTION AND CLASSIFICATION SYSTEM USING WAVELET TRANSFORM AND ONLINE SEQUENTIAL ELM

Electrocardiogram (ECG) signals consist of data containing measurements of electrical activity in the heartbeats. These signals include relevant information used to detect abnormalities such as arrhythmia. In this study, a recognition system is proposed for detection and classification of heartbeats in ECG signals. Heartbeats in the ECG data were detected by using the wavelet transform (WT) method and these beats are segmented with determined periods. For obtaining distinctive features from the beats, multi-resolution WT is applied to these segmented signals, and wavelet coefficients are obtained from different frequency levels. Feature vectors are generated on these coefficients by using various statistical methods. The proposed recognition system is trained on feature vectors by using the Online Sequential Extreme Learning Machine (OSELM) classifier during the learning phase to automatically recognize the signals. Five different beat types were obtained from the MIT-BIH arrhythmia dataset. The multi-class dataset that includes five classes and the binary-class dataset that includes two classes were created among these beat types. Performance tests of the proposed wavelet-based-OSELM (W-OSELM) method were realized with these two datasets. The proposed recognition system provided 97.29% correct beat detection rate from raw ECG signals. The classification accuracy is 99.44% for the binary-class dataset and 98.51% for the multi-class dataset. Furthermore, the proposed classifier has shown very fast recognition performance on ECG signals.

Arrhythmia Recognition and Classification Using ECG Morphology and Segment Feature Analysis

In this work, arrhythmia appearing with the presence of abnormal heart electrical activity is efficiently recognized and classified. A novel method is proposed for accurate recognition and classification of cardiac arrhythmias. Firstly, P-QRS-T waves is segmented from ECG waveform; secondly, morphological features are extracted from P-QRS-T waves, and ECG segment features are extracted from the selected ECG segment by using PCA and dynamic time warping(DTW); finally, SVM is applied to the features and automatic diagnosis results is presented. ECG data set used is derived from the MIT-BIH in which ECG signals are divided into the four classes: normal beats(N), supraventricular ectopic beats (SVEBs), ventricular ectopic beats (VEBs) and fusion of ventricular and normal (F). Our proposed method can distinguish N, SVEBs, VEBs and F with an accuracy of 97.80 percent. The sensitivities for the classes N, SVEBs, VEBs and F are 99.27, 87.47, 94.71, and 73.88 percent and the positive predictivities are 98.48, 95.25, 95.22 and 86.09 percent respectively. The detection sensitivity of SVEBs and VEBs has a better performance by combining proposed features than by using the ECG morphology or ECG segment features separately. The proposed method is compared with four selected peer algorithms and delivers solid results.

Automated beat-wise arrhythmia diagnosis using modified U-net on extended electrocardiographic recordings with heterogeneous arrhythmia types

Abnormality of the cardiac conduction system can induce arrhythmia - abnormal heart rhythm - that can frequently lead to other cardiac diseases and complications, and are sometimes life-threatening. These conduction system perturbations can manifest as morphological changes on the surface electrocardiographic (ECG) signal. Assessment of these morphological changes can be challenging and time-consuming, as ECG signal features are often low in amplitude and subtle. The main aim of this study is to develop an automated computer aided diagnostic (CAD) system that can expedite the process of arrhythmia diagnosis, as an aid to clinicians to provide appropriate and timely intervention to patients. We propose an autoencoder of ECG signals that can diagnose normal sinus beats, atrial premature beats (APB), premature ventricular contractions (PVC), left bundle branch block (LBBB) and right bundle branch block (RBBB). Apart from the first, the rest are morphological beat-to-beat elements that characterize and constitute complex arrhythmia. The novelty of this work lies in how we modified the U-net model to perform beat-wise analysis on heterogeneously segmented ECGs of variable lengths derived from the MIT-BIH arrhythmia database. The proposed system has demonstrated self-learning ability in generating class activations maps, and these generated maps faithfully reflect the cardiac conditions in each ECG cardiac cycle. It has attained a high classification accuracy of 97.32% in diagnosing cardiac conditions, and 99.3% for R peak detection using a ten-fold cross validation strategy. Our developed model can help physicians to screen ECG accurately, potentially resulting in timely intervention of patients with arrhythmia.

NONLINEAR HEART RATE VARIABILITY-BASED ANALYSIS AND PREDICTION OF PERFORMANCE STATUS IN PULMONARY METASTASES PATIENTS

Cancer causes chronic stress and is associated with impaired autonomic nervous system (ANS). Heart rate variability (HRV) has been suggested to be an important tool in the identification and prediction of performance status (PS) in cancer. Lead II surface electrocardiogram (ECG) was recorded from 24 pulmonary metastases (PM) subjects and 30 healthy controls for nonlinear HRV analysis. Artificial neural network (ANN) and support vector machine (SVM) were applied for the prediction analysis. Analysis of variance (ANOVA) along with post-hoc Tukey’s HSD test was conducted using statistical R, 64-bit, v.3.3.2, at [Formula: see text]. The obtained results suggested lower HRV that increases with cancer severity from the Eastern Cooperative Oncology Group (ECOG)1 PS to ECOG4 PS. ANOVA results stated that approximate entropy (ApEn) ([Formula: see text]-[Formula: see text], [Formula: see text]), detrended fluctuation analysis (DFA) [Formula: see text] ([Formula: see text]-[Formula: see text], [Formula: see text]) and correlation dimension (CD) ([Formula: see text]-[Formula: see text], [Formula: see text]) were significant. The 13 nonlinear features were fed to ANN and SVM to obtain 82.25% and 100% accuracies, respectively. Nonlinear HRV analysis has given promising results in the prediction of diagnosis of PS in PM patients. These inputs would be very useful for clinicians to diagnose PS in their cancer patients and improve their quality of living.