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Moreno-Sánchez PA, García-Isla G, Corino VDA, Vehkaoja A, Brukamp K, van Gils M, Mainardi L. ECG-based data-driven solutions for diagnosis and prognosis of cardiovascular diseases: A systematic review. Comput Biol Med 2024; 172:108235. [PMID: 38460311 DOI: 10.1016/j.compbiomed.2024.108235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Revised: 02/07/2024] [Accepted: 02/25/2024] [Indexed: 03/11/2024]
Abstract
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.
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Affiliation(s)
| | - Guadalupe García-Isla
- Department of Electronics Information and Bioengineering, Politecnico di Milano, Italy
| | - Valentina D A Corino
- Department of Electronics Information and Bioengineering, Politecnico di Milano, Italy
| | - Antti Vehkaoja
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | | | - Mark van Gils
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Luca Mainardi
- Department of Electronics Information and Bioengineering, Politecnico di Milano, Italy
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Dathe H, Krefting D, Spicher N. Completing the Cabrera Circle: deriving adaptable leads from ECG limb leads by combining constraints with a correction factor. Physiol Meas 2023; 44:105005. [PMID: 37673079 DOI: 10.1088/1361-6579/acf754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 09/06/2023] [Indexed: 09/08/2023]
Abstract
Objective.We present a concept for processing 6-lead electrocardiography (ECG) signals which can be applied to various use cases in quantitative electrocardiography.Approach.Our work builds upon the mathematics of the well-known Cabrera sequence which is a re-sorting of the six limb leads (I,II,III,aVR,aVL,aVF) into a clockwise and physiologically-interpretable order. By deriving correction factors for harmonizing lead strengths and choosing an appropriate basis for the leads, we extend this concept towards what we call the 'Cabrera Circle' based on a mathematically sound foundation.Main results.To demonstrate the practical effectiveness and relevance of this concept, we analyze its suitability for deriving interpolated leads between the six limb leads and a 'radial' lead which both can be useful for specific use cases. We focus on the use cases of i) determination of the electrical heart axis by proposing a novel interactive tool for reconstructing the heart's vector loop and ii) improving accuracy in time of automatic R-wave detection and T-wave delineation in 6-lead ECG. For the first use case, we derive an equation which allows projections of the 2-dimensional vector loops to arbitrary angles of the Cabrera Circle. For the second use case, we apply several state-of-the-art algorithms to a freely-available 12-lead dataset (Lobachevsky University Database). Out-of-the-box results show that the derived radial lead outperforms the other limb leads (I,II,III,aVR,aVL,aVF) by improving F1 scores of R-peak and T-peak detection by 0.61 and 2.12, respectively. Results of on- and offset computations are also improved but on a smaller scale.Significance.In summary, the Cabrera Circle offers a methodology that might be useful for quantitative electrocardiography of the 6-lead subsystem-especially in the digital age.
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Affiliation(s)
- Henning Dathe
- Department of Medical Informatics, University Medical Center, Göttingen, Germany
| | - Dagmar Krefting
- Department of Medical Informatics, University Medical Center, Göttingen, Germany
- DZHK (German Centre for Cardiovascular Research), partner site Göttingen, Göttingen, Germany
- Campus Institute Data Science, Georg-August-University Göttingen, Göttingen, Germany
| | - Nicolai Spicher
- Department of Medical Informatics, University Medical Center, Göttingen, Germany
- DZHK (German Centre for Cardiovascular Research), partner site Göttingen, Göttingen, Germany
- Campus Institute Data Science, Georg-August-University Göttingen, Göttingen, Germany
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Cuevas-Chávez A, Hernández Y, Ortiz-Hernandez J, Sánchez-Jiménez E, Ochoa-Ruiz G, Pérez J, González-Serna G. A Systematic Review of Machine Learning and IoT Applied to the Prediction and Monitoring of Cardiovascular Diseases. Healthcare (Basel) 2023; 11:2240. [PMID: 37628438 PMCID: PMC10454027 DOI: 10.3390/healthcare11162240] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 07/21/2023] [Accepted: 07/24/2023] [Indexed: 08/27/2023] Open
Abstract
According to the Pan American Health Organization, cardiovascular disease is the leading cause of death worldwide, claiming an estimated 17.9 million lives each year. This paper presents a systematic review to highlight the use of IoT, IoMT, and machine learning to detect, predict, or monitor cardiovascular disease. We had a final sample of 164 high-impact journal papers, focusing on two categories: cardiovascular disease detection using IoT/IoMT technologies and cardiovascular disease using machine learning techniques. For the first category, we found 82 proposals, while for the second, we found 85 proposals. The research highlights list of IoT/IoMT technologies, machine learning techniques, datasets, and the most discussed cardiovascular diseases. Neural networks have been popularly used, achieving an accuracy of over 90%, followed by random forest, XGBoost, k-NN, and SVM. Based on the results, we conclude that IoT/IoMT technologies can predict cardiovascular diseases in real time, ensemble techniques obtained one of the best performances in the accuracy metric, and hypertension and arrhythmia were the most discussed diseases. Finally, we identified the lack of public data as one of the main obstacles for machine learning approaches for cardiovascular disease prediction.
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Affiliation(s)
- Alejandra Cuevas-Chávez
- Computer Science Department, Tecnológico Nacional de México/Cenidet, Cuernavaca 62490, Mexico; (J.O.-H.); (E.S.-J.); (J.P.); (G.G.-S.)
| | - Yasmín Hernández
- Computer Science Department, Tecnológico Nacional de México/Cenidet, Cuernavaca 62490, Mexico; (J.O.-H.); (E.S.-J.); (J.P.); (G.G.-S.)
| | - Javier Ortiz-Hernandez
- Computer Science Department, Tecnológico Nacional de México/Cenidet, Cuernavaca 62490, Mexico; (J.O.-H.); (E.S.-J.); (J.P.); (G.G.-S.)
| | - Eduardo Sánchez-Jiménez
- Computer Science Department, Tecnológico Nacional de México/Cenidet, Cuernavaca 62490, Mexico; (J.O.-H.); (E.S.-J.); (J.P.); (G.G.-S.)
| | - Gilberto Ochoa-Ruiz
- School of Engineering and Sciences, Tecnologico de Monterrey, Av. Eugenio Garza Sada 2501, Monterrey 64849, Mexico;
| | - Joaquín Pérez
- Computer Science Department, Tecnológico Nacional de México/Cenidet, Cuernavaca 62490, Mexico; (J.O.-H.); (E.S.-J.); (J.P.); (G.G.-S.)
| | - Gabriel González-Serna
- Computer Science Department, Tecnológico Nacional de México/Cenidet, Cuernavaca 62490, Mexico; (J.O.-H.); (E.S.-J.); (J.P.); (G.G.-S.)
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Rahman MM, Rivolta MW, Badilini F, Sassi R. A Systematic Survey of Data Augmentation of ECG Signals for AI Applications. SENSORS (BASEL, SWITZERLAND) 2023; 23:s23115237. [PMID: 37299964 DOI: 10.3390/s23115237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 05/23/2023] [Accepted: 05/27/2023] [Indexed: 06/12/2023]
Abstract
AI techniques have recently been put under the spotlight for analyzing electrocardiograms (ECGs). However, the performance of AI-based models relies on the accumulation of large-scale labeled datasets, which is challenging. To increase the performance of AI-based models, data augmentation (DA) strategies have been developed recently. The study presented a comprehensive systematic literature review of DA for ECG signals. We conducted a systematic search and categorized the selected documents by AI application, number of leads involved, DA method, classifier, performance improvements after DA, and datasets employed. With such information, this study provided a better understanding of the potential of ECG augmentation in enhancing the performance of AI-based ECG applications. This study adhered to the rigorous PRISMA guidelines for systematic reviews. To ensure comprehensive coverage, publications between 2013 and 2023 were searched across multiple databases, including IEEE Explore, PubMed, and Web of Science. The records were meticulously reviewed to determine their relevance to the study's objective, and those that met the inclusion criteria were selected for further analysis. Consequently, 119 papers were deemed relevant for further review. Overall, this study shed light on the potential of DA to advance the field of ECG diagnosis and monitoring.
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Affiliation(s)
- Md Moklesur Rahman
- Dipartimento di Informatica, Università degli Studi di Milano, 20133 Milan, Italy
| | | | - Fabio Badilini
- School of Nursing, University of California, San Francisco, CA 94143, USA
- AMPS-LLC, New York, NY 10025, USA
| | - Roberto Sassi
- Dipartimento di Informatica, Università degli Studi di Milano, 20133 Milan, Italy
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An efficient neural network-based method for patient-specific information involved arrhythmia detection. Knowl Based Syst 2022. [DOI: 10.1016/j.knosys.2022.109021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Hooda D, Rani R. An Ontology driven model for detection and classification of cardiac arrhythmias using ECG data. J Intell Inf Syst 2021. [DOI: 10.1007/s10844-021-00685-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Chromik J, Pirl L, Beilharz J, Arnrich B, Polze A. Certainty in QRS detection with artificial neural networks. Biomed Signal Process Control 2021. [DOI: 10.1016/j.bspc.2021.102628] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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