Heart rate variability feature selection method for automated prediction of sudden cardiac death

Accurate Prediction of Sudden Cardiac Death Based on Heart Rate Variability Analysis Using Convolutional Neural Network

Sudden cardiac death (SCD) is a significant global health issue that affects individuals with and without a history of heart disease. Early identification of SCD risk factors is crucial in reducing mortality rates. This study aims to utilize electrocardiogram (ECG) tools, specifically focusing on heart rate variability (HRV), to detect early SCD risk factors. In this study, we expand the comparison group dataset to include five groups: Normal Sinus Rhythm (NSR), coronary artery disease (CAD), Congestive Heart Failure (CHF), Ventricular Tachycardia (VT), and SCD. ECG signals were recorded for 30 min and segmented into 5 min intervals, following the recommended HRV feature analysis guidelines. We introduce an innovative approach to HRV signal analysis by utilizing Convolutional Neural Networks (CNN). The CNN model was optimized by tuning hyperparameters such as the number of layers, learning rate, and batch size, significantly impacting the prediction accuracy. The findings demonstrate that the HRV approach, in conjunction with linear features and the DL method, achieved a higher accuracy rate, averaging 99.30%, reaching 97% sensitivity, 99.60% specificity, and 97.87% precision. Future research should focus on further exploring and refining DL methods in the context of HRV analysis to improve SCD prediction.

Machine learning of electrophysiological signals for the prediction of ventricular arrhythmias: systematic review and examination of heterogeneity between studies

BACKGROUND

Ventricular arrhythmia (VA) precipitating sudden cardiac arrest (SCD) is among the most frequent causes of death and pose a high burden on public health systems worldwide. The increasing availability of electrophysiological signals collected through conventional methods (e.g. electrocardiography (ECG)) and digital health technologies (e.g. wearable devices) in combination with novel predictive analytics using machine learning (ML) and deep learning (DL) hold potential for personalised predictions of arrhythmic events.

METHODS

This systematic review and exploratory meta-analysis assesses the state-of-the-art of ML/DL models of electrophysiological signals for personalised prediction of malignant VA or SCD, and studies potential causes of bias (PROSPERO, reference: CRD42021283464). Five electronic databases were searched to identify eligible studies. Pooled estimates of the diagnostic odds ratio (DOR) and summary area under the curve (AUROC) were calculated. Meta-analyses were performed separately for studies using publicly available, ad-hoc datasets, versus targeted clinical data acquisition. Studies were scored on risk of bias by the PROBAST tool.

FINDINGS

2194 studies were identified of which 46 were included in the systematic review and 32 in the meta-analysis. Pooling of individual models demonstrated a summary AUROC of 0.856 (95% CI 0.755-0.909) for short-term (time-to-event up to 72 h) prediction and AUROC of 0.876 (95% CI 0.642-0.980) for long-term prediction (time-to-event up to years). While models developed on ad-hoc sets had higher pooled performance (AUROC 0.919, 95% CI 0.867-0.952), they had a high risk of bias related to the re-use and overlap of small ad-hoc datasets, choices of ML tool and a lack of external model validation.

INTERPRETATION

ML and DL models appear to accurately predict malignant VA and SCD. However, wide heterogeneity between studies, in part due to small ad-hoc datasets and choice of ML model, may reduce the ability to generalise and should be addressed in future studies.

FUNDING

This publication is part of the project DEEP RISK ICD (with project number 452019308) of the research programme Rubicon which is (partly) financed by the Dutch Research Council (NWO). This research is partly funded by the Amsterdam Cardiovascular Sciences (personal grant F.V.Y.T).

Using Minimum Redundancy Maximum Relevance Algorithm to Select Minimal Sets of Heart Rate Variability Parameters for Atrial Fibrillation Detection

Heart rate is quite regular during sinus (normal) rhythm (SR) originating from the sinus node. In contrast, heart rate is usually irregular during atrial fibrillation (AF). Complete atrioventricular block with an escape rhythm, ventricular pacing, or ventricular tachycardia are the most common exceptions when heart rate may be regular in AF. Heart rate variability (HRV) is the variation in the duration of consecutive cardiac cycles (RR intervals). We investigated the utility of HRV parameters for automated detection of AF with machine learning (ML) classifiers. The minimum redundancy maximum relevance (MRMR) algorithm, one of the most effective algorithms for feature selection, helped select the HRV parameters (including five original), best suited for distinguishing AF from SR in a database of over 53,000 60 s separate electrocardiogram (ECG) segments cut from longer (up to 24 h) ECG recordings. HRV parameters entered the ML-based classifiers as features. Seven different, commonly used classifiers were trained with one to six HRV-based features with the highest scores resulting from the MRMR algorithm and tested using the 5-fold cross-validation and blindfold validation. The best ML classifier in the blindfold validation achieved an accuracy of 97.2% and diagnostic odds ratio of 1566. From all studied HRV features, the top three HRV parameters distinguishing AF from SR were: the percentage of successive RR intervals differing by at least 50 ms (pRR50), the ratio of standard deviations of points along and across the identity line of the Poincare plots, respectively (SD2/SD1), and coefficient of variation—standard deviation of RR intervals divided by their mean duration (CV). The proposed methodology and the presented results of the selection of HRV parameters have the potential to develop practical solutions and devices for automatic AF detection with minimal sets of simple HRV parameters. Using straightforward ML classifiers and the extremely small sets of simple HRV features, always with pRR50 included, the differentiation of AF from sinus rhythms in the 60 s ECGs is very effective.

Golden Standard or Obsolete Method? Review of ECG Applications in Clinical and Experimental Context

Cardiovascular system and its functions under both physiological and pathophysiological conditions have been studied for centuries. One of the most important steps in the cardiovascular research was the possibility to record cardiac electrical activity. Since then, numerous modifications and improvements have been introduced; however, an electrocardiogram still represents a golden standard in this field. This paper overviews possibilities of ECG recordings in research and clinical practice, deals with advantages and disadvantages of various approaches, and summarizes possibilities of advanced data analysis. Special emphasis is given to state-of-the-art deep learning techniques intensely expanded in a wide range of clinical applications and offering promising prospects in experimental branches. Since, according to the World Health Organization, cardiovascular diseases are the main cause of death worldwide, studying electrical activity of the heart is still of high importance for both experimental and clinical cardiology.

TTCNN: A Breast Cancer Detection and Classification towards Computer-Aided Diagnosis Using Digital Mammography in Early Stages

Breast cancer is a major research area in the medical image analysis field; it is a dangerous disease and a major cause of death among women. Early and accurate diagnosis of breast cancer based on digital mammograms can enhance disease detection accuracy. Medical imagery must be detected, segmented, and classified for computer-aided diagnosis (CAD) systems to help the radiologists for accurate diagnosis of breast lesions. Therefore, an accurate breast cancer detection and classification approach is proposed for screening of mammograms. In this paper, we present a deep learning system that can identify breast cancer in mammogram screening images using an “end-to-end” training strategy that efficiently uses mammography images for computer-aided breast cancer recognition in the early stages. First, the proposed approach implements the modified contrast enhancement method in order to refine the detail of edges from the source mammogram images. Next, the transferable texture convolutional neural network (TTCNN) is presented to enhance the performance of classification and the energy layer is integrated in this work to extract the texture features from the convolutional layer. The proposed approach consists of only three layers of convolution and one energy layer, rather than the pooling layer. In the third stage, we analyzed the performance of TTCNN based on deep features of convolutional neural network models (InceptionResNet-V2, Inception-V3, VGG-16, VGG-19, GoogLeNet, ResNet-18, ResNet-50, and ResNet-101). The deep features are extracted by determining the best layers which enhance the classification accuracy. In the fourth stage, by using the convolutional sparse image decomposition approach, all the extracted feature vectors are fused and, finally, the best features are selected by using the entropy controlled firefly method. The proposed approach employed on DDSM, INbreast, and MIAS datasets and attained the average accuracy of 97.49%. Our proposed transferable texture CNN-based method for classifying screening mammograms has outperformed prior methods. These findings demonstrate that automatic deep learning algorithms can be easily trained to achieve high accuracy in diverse mammography images, and can offer great potential to improve clinical tools to minimize false positive and false negative screening mammography results.

Short-Term Effect of Percutaneous Coronary Intervention on Heart Rate Variability in Patients with Coronary Artery Disease

Myocardial ischemia in patients with coronary artery disease (CAD) leads to imbalanced autonomic control that increases the risk of morbidity and mortality. To systematically examine how autonomic function responds to percutaneous coronary intervention (PCI) treatment, we analyzed data of 27 CAD patients who had admitted for PCI in this pilot study. For each patient, five-minute resting electrocardiogram (ECG) signals were collected before and after the PCI procedure. The time intervals between ECG collection and PCI were both within 24 h. To assess autonomic function, normal sinus RR intervals were extracted and were analyzed quantitatively using traditional linear time- and frequency-domain measures [i.e., standard deviation of the normal-normal intervals (SDNN), the root mean square of successive differences (RMSSD), powers of low frequency (LF) and high frequency (HF) components, LF/HF] and nonlinear entropy measures [i.e., sample entropy (SampEn), distribution entropy (DistEn), and conditional entropy (CE)], as well as graphical metrics derived from Poincaré plot [i.e., Porta’s index (PI), Guzik’s index (GI), slope index (SI) and area index (AI)]. Results showed that after PCI, AI and PI decreased significantly (p < 0.002 and 0.015, respectively) with effect sizes of 0.88 and 0.70 as measured by Cohen’s d static. These changes were independent of sex. The results suggest that graphical AI and PI metrics derived from Poincaré plot of short-term ECG may be potential for sensing the beneficial effect of PCI on cardiovascular autonomic control. Further studies with bigger sample sizes are warranted to verify these observations.

Prediction of paroxysmal atrial fibrillation using new heart rate variability features

Paroxysmal atrial fibrillation (PAF) is a cardiac arrhythmia that can eventually lead to heart failure or stroke if left untreated. Early detection of PAF is therefore crucial to prevent any further complications and avoid fatalities. An implantable defibrillator device could be used to both detect and treat the condition though such devices have limited computational capability. With this constraint in mind, this paper presents a novel set of features to accurately predict the presence of PAF. The method is evaluated using ECG signals from the widely used atrial fibrillation prediction database (AFPDB) from PhysioNet. We analysed 106 signals from 53 pairs of ECG recordings. Each pair of signals contains one 5-min ECG segment that ends just before the onset of a PAF event and another 5-min ECG segment at least 45 min distant from the PAF event, to represent a non-PAF event. Seven novel features are extracted through the Poincaré representation of R-R interval signals, and are prioritised through feature ranking schemes. The features are used with four standard classification techniques for PAF prediction and compared to the existing state of the art from the literature. Using only the seven proposed features, classification performance outperforms those of the classical state-of-the-art feature set, registering sensitivity and specificity measurements of over 96%. The results further improve when the features are combined with several of the classical features, with an accuracy increasing to 98% using a linear kernel SVM. The results show that the proposed features provide a useful representation of the PAF condition and achieve good prediction with off-the-shelf classification techniques that would be suitable for ICU deployment.