Comparative study of algorithms for ECG segmentation

HARDC : A novel ECG-based heartbeat classification method to detect arrhythmia using hierarchical attention based dual structured RNN with dilated CNN

Deep learning-based models have achieved significant success in detecting cardiac arrhythmia by analyzing ECG signals to categorize patient heartbeats. To improve the performance of such models, we have developed a novel hybrid hierarchical attention-based bidirectional recurrent neural network with dilated CNN (HARDC) method for arrhythmia classification. This solves problems that arise when traditional dilated convolutional neural network (CNN) models disregard the correlation between contexts and gradient dispersion. The proposed HARDC fully exploits the dilated CNN and bidirectional recurrent neural network unit (BiGRU-BiLSTM) architecture to generate fusion features. As a result of incorporating both local and global feature information and an attention mechanism, the model's performance for prediction is improved. By combining the fusion features with a dilated CNN and a hierarchical attention mechanism, the trained HARDC model showed significantly improved classification results and interpretability of feature extraction on the PhysioNet 2017 challenge dataset. Sequential Z-Score normalization, filtering, denoising, and segmentation are used to prepare the raw data for analysis. CGAN (Conditional Generative Adversarial Network) is then used to generate synthetic signals from the processed data. The experimental results demonstrate that the proposed HARDC model significantly outperforms other existing models, achieving an accuracy of 99.60%, F1 score of 98.21%, a precision of 97.66%, and recall of 99.60% using MIT-BIH generated ECG. In addition, this approach significantly reduces run time when using dilated CNN compared to normal convolution. Overall, this hybrid model demonstrates an innovative and cost-effective strategy for ECG signal compression and high-performance ECG recognition. Our results indicate that an automated and highly computed method to classify multiple types of arrhythmia signals holds considerable promise.

Characterization of rheumatic heart disease from electrocardiogram recordings

Objective. Rheumatic Heart Disease (RHD) is one of the highly prevalent heart diseases in developing countries that can affect the pericardium, myocardium, or endocardium. Rheumatic endocarditis is a common RHD variant that gradually deteriorates the normal function of the heart valves. RHD can be diagnosed using standard echocardiography or listened to as a heart murmur using a stethoscope. The electrocardiogram (ECG), on the other hand, is critical in the study and identification of heart rhythms and abnormalities. The effectiveness of ECG to identify distinguishing signs of rheumatic heart problems, however, has not been adequately examined. This study addressed the possible use of ECG recordings for the characterization of problems of the heart in RHD patients.Approach. To this end, an extensive ECG dataset was collected from patients suffering from RHD (PwRHD), and healthy control subjects (HC). Bandpass filtering was used at the preprocessing stage. Each data was then standardized by removing its mean and dividing by its standard deviation. Delineation of the onsets and offsets of waves was performed using KIT-IBT open ECG MATLAB toolbox. PR interval, QRS duration, RR intervals, QT intervals, and QTc intervals were computed for each heartbeat. The median values of the temporal parameters were used to eliminate possible outliers due to missed ECG waves. The data were clustered in different age groups and sex. Another categorization was done based on the time duration since the first RHD diagnosis.Main results. In 47.2% of the cases, a PR elongation was observed, and in 26.4% of the cases, the QRS duration was elongated. QTc was elongated in 44.3% of the cases. It was also observed that 62.2% of the cases had bradycardia.Significance. The end product of this research can lead to new medical devices and services that can screen RHD based on ECG which could somehow assist in the detection and diagnosis of the disease in low-resource settings and alleviate the burden of the disease.

Temporal change in repolarization parameters after surgical correction of valvular heart diseases

BACKGROUND

Ventricular tachyarrhythmia is a potentially fatal outcome of cardiac surgery. Abrupt changes in the hemodynamics after surgical correction of valvular heart disease (VHD) can lead to alterations in ventricular repolarization. We compared the difference between temporal changes in repolarization parameters after correction of left-sided VHD.

METHODS

We retrospectively analyzed the electrograms of patients who underwent surgical correction of isolated VHD between 2006 and 2015 at Asan Medical Center, including mitral stenosis (MS), mitral regurgitation (MR), aortic stenosis (AS), and aortic regurgitation (AR). Ventricular repolarization parameters were measured at pre-specified time intervals after index surgery using a custom-made ECG analysis program. We compared repolarization parameters, including QT and corrected QT intervals, T peak-to-end interval, and corrected T peak-to-end interval.

RESULTS

Analysis of 8265 ECGs from 2110 patients (266 MS, 1059 MR, 421 AS, and 364 AR) was performed. Patients with AS were characterized by older age and more comorbidities than other VHDs. The corrected QT interval showed a peak value immediately after surgery and decreased thereafter in the AS groups. However, a gradual increase over 1 month after surgery in AR, MS, and MR groups was observed. The corrected T peak-to-end interval increased in the MS and MR groups and was unchanged in the AS and AR groups.

CONCLUSIONS

The repolarization parameters of surgery changed dynamically after left-sided valvular surgery. Understanding differential temporal change of repolarization parameters according to the type of VHD would help clinicians avoid fatal arrhythmias related to the repolarization changes.

Toward ECG-based analysis of hypertrophic cardiomyopathy: a novel ECG segmentation method for handling abnormalities

OBJECTIVE

Abnormalities in impulse propagation and cardiac repolarization are frequent in hypertrophic cardiomyopathy (HCM), leading to abnormalities in 12-lead electrocardiograms (ECGs). Computational ECG analysis can identify electrophysiological and structural remodeling and predict arrhythmias. This requires accurate ECG segmentation. It is unknown whether current segmentation methods developed using datasets containing annotations for mostly normal heartbeats perform well in HCM. Here, we present a segmentation method to effectively identify ECG waves across 12-lead HCM ECGs.

METHODS

We develop (1) a web-based tool that permits manual annotations of P, P', QRS, R', S', T, T', U, J, epsilon waves, QRS complex slurring, and atrial fibrillation by 3 experts and (2) an easy-to-implement segmentation method that effectively identifies ECG waves in normal and abnormal heartbeats. Our method was tested on 131 12-lead HCM ECGs and 2 public ECG sets to evaluate its performance in non-HCM ECGs.

RESULTS

Over the HCM dataset, our method obtained a sensitivity of 99.2% and 98.1% and a positive predictive value of 92% and 95.3% when detecting QRS complex and T-offset, respectively, significantly outperforming a state-of-the-art segmentation method previously employed for HCM analysis. Over public ECG sets, it significantly outperformed 3 state-of-the-art methods when detecting P-onset and peak, T-offset, and QRS-onset and peak regarding the positive predictive value and segmentation error. It performed at a level similar to other methods in other tasks.

CONCLUSION

Our method accurately identified ECG waves in the HCM dataset, outperforming a state-of-the-art method, and demonstrated similar good performance as other methods in normal/non-HCM ECG sets.

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%.

A machine learning algorithm for electrocardiographic fQRS quantification validated on multi-center data

Fragmented QRS (fQRS) is an electrocardiographic (ECG) marker of myocardial conduction abnormality, characterized by additional notches in the QRS complex. The presence of fQRS has been associated with an increased risk of all-cause mortality and arrhythmia in patients with cardiovascular disease. However, current binary visual analysis is prone to intra- and inter-observer variability and different definitions are problematic in clinical practice. Therefore, objective quantification of fQRS is needed and could further improve risk stratification of these patients. We present an automated method for fQRS detection and quantification. First, a novel robust QRS complex segmentation strategy is proposed, which combines multi-lead information and excludes abnormal heartbeats automatically. Afterwards extracted features, based on variational mode decomposition (VMD), phase-rectified signal averaging (PRSA) and the number of baseline-crossings of the ECG, were used to train a machine learning classifier (Support Vector Machine) to discriminate fragmented from non-fragmented ECG-traces using multi-center data and combining different fQRS criteria used in clinical settings. The best model was trained on the combination of two independent previously annotated datasets and, compared to these visual fQRS annotations, achieved Kappa scores of 0.68 and 0.44, respectively. We also show that the algorithm might be used in both regular sinus rhythm and irregular beats during atrial fibrillation. These results demonstrate that the proposed approach could be relevant for clinical practice by objectively assessing and quantifying fQRS. The study sets the path for further clinical application of the developed automated fQRS algorithm.

Semantic Segmentation of 12-Lead ECG Using 1D Residual U-Net with Squeeze-Excitation Blocks

Analyzing biomedical data is a complex task that requires specialized knowledge. The development of knowledge and technology in the field of deep machine learning creates an opportunity to try and transfer human knowledge to the computer. In turn, this fact influences the development of systems for the automatic evaluation of the patient’s health based on data acquired from sensors. Electrocardiography (ECG) is a technique that enables visualizing the electrical activity of the heart in a noninvasive way, using electrodes placed on the surface of the skin. This signal carries a lot of information about the condition of heart muscle. The aim of this work is to create a system for semantic segmentation of the ECG signal. For this purpose, we used a database from Lobachevsky University available on Physionet, containing 200, 10-second, and 12-lead ECG signals with annotations, and applied one-dimensional U-Net with the addition of squeeze-excitation blocks. The created model achieved a set of parameters indicating high performance (for the test set: accuracy—0.95, AUC—0.99, specificity—0.95, sensitivity—0.99) in extracting characteristic parts of ECG signal such as P and T-waves and QRS complex, regardless of the lead.

A Shallow Domain Knowledge Injection (SDK-Injection) Method for Improving CNN-Based ECG Pattern Classification

ECG pattern classification for identifying the progress status of various heart diseases is a typical nonlinear problem. Therefore, deep learning-based automatic ECG diagnosis is being widely studied, and for this purpose, the CNN is mainly used to classify ECG patterns. In this case, it is hard to expect any further improvement in accuracy after optimizing the parameters. We propose a shallow domain knowledge injection method that can improve the accuracy of the existing parameter-optimized CNN. The proposed method can improve the accuracy by effectively injecting shallow domain knowledge, that can be acquired by non-medical experts, into the existing parameter-optimized CNN. The experiments show that the proposed method can be applied to both heart disease diagnoses and general ECG classification tasks, while improving the existing accuracy for both types of tasks.

An efficient and fast multi-band focused bioimpedance solution with EIT-based reconstruction for pulmonary embolism assessment: a simulation study from massive to segmental blockage

OBJECTIVE

Pulmonary embolism (PE) is an acute condition that blocks the perfusion to the lungs and is a common complication of Covid-19. However, PE is often not diagnosed in time, especially in the pandemic time due to complicated diagnosis protocol. In this study, a non-invasive, fast and efficient bioimpedance method with the EIT-based reconstruction approach is proposed to assess the lung perfusion reliably.

APPROACH

Some proposals are presented to improve the sensitivity and accuracy for the bioimpedance method: (1) a new electrode configuration and focused pattern to help study deep changes caused by PE within each lung field separately, (2) a measurement strategy to compensate the effect of different boundary shapes and varied respiratory conditions on the perfusion signals and (3) an estimator to predict the lung perfusion capacity, from which the severity of PE can be assessed. The proposals were tested on the first-time simulation of PE events at different locations and degrees from segmental blockages to massive blockages. Different object boundary shapes and varied respiratory conditions were included in the simulation to represent for different populations in real measurements.

RESULTS

The correlation between the estimator and the perfusion was very promising (R = 0.91, errors < 6%). The measurement strategy with the proposed configuration and pattern has helped stabilize the estimator to non-perfusion factors such as the boundary shapes and varied respiration conditions (3-5% errors).

SIGNIFICANCE

This promising preliminary result has demonstrated the proposed bioimpedance method's capability and feasibility, and might start a new direction for this application.

Evolution of single-lead ECG for STEMI detection using a deep learning approach

BACKGROUND

While ST-Elevation Myocardial Infarction (STEMI) door-to-balloon times are often below 90 min, symptom to door times remain long at 2.5-h, due at least in part to a delay in diagnosis.

OBJECTIVES

To develop and validate a machine learning-guided algorithm which uses a single‑lead electrocardiogram (ECG) for STEMI detection to speed diagnosis.

METHODS

Data was extracted from the Latin America Telemedicine Infarct Network (LATIN), a population-based Acute Myocardial Infarction (AMI) program that provides care to patients in Brazil, Colombia, Mexico, and Argentina through telemedicine.

SAMPLE

the first dataset was comprised of 8511 ECGs that were used for various machine learning experiments to test our Deep Learning approach for STEMI diagnosis. The second dataset of 2542 confirmed STEMI diagnosis EKG records, including specific ischemic heart wall information (anterior, inferior, and lateral), was derived from the previous dataset to test the STEMI localization model. Preprocessing: Detection of QRS complexes by wavelet system, segmentation of each EKG record into individual heartbeats with fixed window of 0.4 s to the left and 0.9 s to the right of main. Training & Testing: 90% and 10% of the total dataset, respectively, were used for both models.

CLASSIFICATION

two 1-D convolutional neural networks were implemented, two classes were considered for first models (STEMI/Not-STEMI) and three classes for the second model (Anterior/Inferior/Lateral) each corresponding to the heart wall affected. These individual probabilities were aggregated to generate the final label for each model.

RESULTS

The single‑lead ECG strategy was able to provide an accuracy of 90.5% for STEMI detection with Lead V2, which also yielded the best results overall among individual leads. STEMI Localization model provided promising results for anterior and inferior wall STEMIs but remained suboptimal for Lateral STEMI.

CONCLUSIONS

An Artificial Intelligence-enhanced single‑lead ECG is a promising screening tool. This technology provides an autonomous and accurate STEMI diagnostic alternative that can be incorporated into wearable devices, potentially providing patients reliable means to seek treatment early and offers the potential to thereby improve STEMI outcomes in the long run.

A CNN model embedded with local feature knowledge and its application to time-varying signal classification

A novel convolutional neural network is proposed for local prior feature embedding and imbalanced dataset modeling for multi-channel time-varying signal classification. This model consists of a single-channel signal feature parallel extraction unit, a multi-channel signal feature integration unit, a local feature embedding and feature similarity measurement unit, a full connection layer, and a Softmax classifier. An algorithm combining dynamic clustering and sliding window was used to select segments signals with typical local features in each pattern class, forming a typical local feature set. The one-dimensional CNNs were used to extract features from the single-channel signal in parallel, a comprehensive feature matrix of the multi-channel signal and the local feature matrix templates were produced. Using the method of external embedding, based on the sliding window and dynamic time warping (DTW) algorithm, the local feature similarities between the local feature template of each pattern class and the comprehensive feature sub-matrix of the input signal were measured, and the maximum values were selected to construct a local feature similarity vector in order. The information fusion was realized through a full connection layer. The proposed methodology can extract and represent both global and local signals features, strengthen the role of prior local feature in classification and improve the modeling properties of imbalanced datasets. A comprehensive learning algorithm is presented in this paper. The classification diagnosis of cardiovascular disease based on 12-lead ECG signals was used as a verification experiment. Results showed that the accuracy and generalization for the proposed technique were significantly improved.

A novel and lightweight P, QRS, and T peaks detector using adaptive thresholding and template waveform

Accurate detection of key components in an electrocardiogram (ECG) plays a vital role in identifying cardiovascular diseases. In this work, we proposed a novel and lightweight P, QRS, and T peaks detector using adaptive thresholding and template waveform. In the first stage, we proposed a QRS complex detector, which utilises a novel adaptive thresholding process followed by threshold initialisation. Moreover, false positive QRS complexes were removed using the kurtosis coefficient computation. In the second stage, the ECG segment from the S wave point to the Q wave point was extracted for clustering. The template waveform was generated from the cluster members using the ensemble average method, interpolation, and resampling. Next, a novel conditional thresholding process was used to calculate the threshold values based on the template waveform morphology for P and T peaks detection. Finally, the min-max functions were used to detect the P and T peaks. The proposed technique was applied to the MIT-BIH arrhythmia database (MIT-AD) and the QT database for QRS detection and validation. Sensitivity (Se%) values of 99.81 and 99.90 and positive predictivity (+P%) values of 99.85 and 99.94 were obtained for the MIT-AD and QT database for QRS complex detection, respectively. Further, we found that Se% = 96.50 and +P% = 96.08 for the P peak detection, Se% = 100 and +P% = 100 for the R peak detection, and Se% = 99.54 and +P% = 99.68 for the T peak detection when using the manually annotated QT database. The proposed technique exhibits low computational complexity and can be implemented on low-cost hardware, since it is based on simple decision rules rather than a heuristic approach.

Using smart speakers to contactlessly monitor heart rhythms

Heart rhythm assessment is indispensable in diagnosis and management of many cardiac conditions and to study heart rate variability in healthy individuals. We present a proof-of-concept system for acquiring individual heart beats using smart speakers in a fully contact-free manner. Our algorithms transform the smart speaker into a short-range active sonar system and measure heart rate and inter-beat intervals (R-R intervals) for both regular and irregular rhythms. The smart speaker emits inaudible 18–22 kHz sound and receives echoes reflected from the human body that encode sub-mm displacements due to heart beats. We conducted a clinical study with both healthy participants and hospitalized cardiac patients with diverse structural and arrhythmic cardiac abnormalities including atrial fibrillation, flutter and congestive heart failure. Compared to electrocardiogram (ECG) data, our system computed R-R intervals for healthy participants with a median error of 28 ms over 12,280 heart beats and a correlation coefficient of 0.929. For hospitalized cardiac patients, the median error was 30 ms over 5639 heart beats with a correlation coefficient of 0.901. The increasing adoption of smart speakers in hospitals and homes may provide a means to realize the potential of our non-contact cardiac rhythm monitoring system for monitoring of contagious or quarantined patients, skin sensitive patients and in telemedicine settings.

Anran Wang et al. present a contact-free method of monitoring individual heart beats by converting smart-speakers into active sonar systems. Their approach is capable of measuring heart rhythms with high accuracy in both healthy participants and hospitalized patients, and may be a useful healthcare tool for remote diagnosis or patient monitoring.

A greedy graph search algorithm based on changepoint analysis for automatic QRS complex detection

The electrocardiogram (ECG) signal is the most widely used non-invasive tool for the investigation of cardiovascular diseases. Automatic delineation of ECG fiducial points, in particular the R-peak, serves as the basis for ECG processing and analysis. This study proposes a new method of ECG signal analysis by introducing a new class of graphical models based on optimal changepoint detection models, named the graph-constrained changepoint detection (GCCD) model. The GCCD model treats fiducial points delineation in the non-stationary ECG signal as a changepoint detection problem. The proposed model exploits the sparsity of changepoints to detect abrupt changes within the ECG signal; thereby, the R-peak detection task can be relaxed from any preprocessing step. In this novel approach, prior biological knowledge about the expected sequence of changes is incorporated into the model using the constraint graph, which can be defined manually or automatically. First, we define the constraint graph manually; then, we present a graph learning algorithm that can search for an optimal graph in a greedy scheme. Finally, we compare the manually defined graphs and learned graphs in terms of graph structure and detection accuracy. We evaluate the performance of the algorithm using the MIT-BIH Arrhythmia Database. The proposed model achieves an overall sensitivity of 99.64%, positive predictivity of 99.71%, and detection error rate of 0.19 for the manually defined constraint graph and overall sensitivity of 99.76%, positive predictivity of 99.68%, and detection error rate of 0.55 for the automatic learning constraint graph.

Design of wavelet transform based electrocardiogram monitoring system

The new age advancements in information technology due to materials and integrated circuit (IC) technologies and their applications in biomedical sciences have made the healthcare facilities more compact and affordable for the aging population. Market trends in healthcare and related devices indicate a sharp rise in their demand. Hence the researchers have converged the efforts on designing more smart and advanced medical devices using IC technology. Among these devices, cardiac pacemakers have become a recurrent biomedical device which is engrafted in the human body to detect and monitor a person's heart beating rate. The data thus generated is processed for various medical usages and devices via wireless methods. Cardiovascular diseases (CVDs) or diseases related to the heart are due to abnormalities or disorders of the heart and blood vessels. Till date, limited literature is available which focuses on a single technique that can perform all of the ECG signal denoising, ECG detection, lossless data compression and wireless transmission. In this work, a joint approach for denoising, detection, compression, and wireless transmission of ECG signal is proposed. The modified biorthogonal wavelet transform is used for denoising, detection and lossless compression of ECG signal. To reduce the circuit complexity, biorthogonal wavelet transform is realized using linear phase structure. Further, it is found in this work that the usage of modified biorthogonal wavelet transform increases the detection accuracy and CR of the proposed design. Also, in this work, the Wi-Fi-based wireless protocol is used for compressed data transmission. The proposed ECG detector achieves the highest sensitivity and positive predictivity of 99.95% and 99.92%, respectively, with the MIT-BIH arrhythmia database. The use of modified biorthogonal 3.1 wavelet transform and run-length encoding (RLE) for the compression of ECG data achieves a higher compression ratio (CR) of 6.271. To justify the effectiveness of the proposed algorithm, which uses modified biorthogonal wavelet 3.1transform, the results are compared with the existing methods, namely, Huffman coding/simple predictor, Huffman coding/adaptive, and slope predictor/fixed length packaging.