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Accurate Detection of Arrhythmias on Raw Electrocardiogram Images:An Aggregation Attention Multi-label Model for Diagnostic Assistance. Med Eng Phys 2023; 114:103964. [PMID: 37030892 DOI: 10.1016/j.medengphy.2023.103964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 12/24/2022] [Accepted: 02/23/2023] [Indexed: 03/06/2023]
Abstract
BACKGROUND The low rate of detection of abnormalities has been a major problem with current artificial intelligence-based electrocardiogram diagnostic algorithms, particularly when applied under real-world clinical scenarios. METHODS We proposed an aggregation attention multilabel electrocardiogram classification model (AA-ECG) that can be applied directly to raw images to identify cardiac abnormalities using image-level annotation only. To develop and validate the model, we conducted a prospective two-site study to build two large-scale real-world datasets of 12-lead electrocardiogram images, annotated by clinical experts in a multilabeled manner. We compared the proposed model with seven state-of-the-art classifiers on both datasets in 27 main categories. RESULTS In total, 47,733 electrocardiogram images from 37,442 consecutive patients were included in the development set, while 18,581 from 18,345 in the external set. The proposed model achieved better overall performance than the other seven models.The visualization of the attention maps provided an approach to build medical interpretability for machine intelligence. CONCLUSIONS The proposed model had high diagnostic accuracy in identifying cardiac abnormalities on two real-world datasets. It has the potential to help clinicians provide more efficient cardiac care with fewer medical resources.
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Kuznetsova N, Gubina A, Sagirova Z, Dhif I, Gognieva D, Melnichuk A, Orlov O, Syrkina E, Sedov V, Chomakhidze P, Saner H, Kopylov P. Left Ventricular Diastolic Dysfunction Screening by a Smartphone-Case Based on Single Lead ECG. CLINICAL MEDICINE INSIGHTS-CARDIOLOGY 2022; 16:11795468221120088. [PMID: 36046179 PMCID: PMC9421020 DOI: 10.1177/11795468221120088] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 07/26/2022] [Indexed: 12/03/2022]
Abstract
Aims To investigate the potential of a signal processed by smartphone-case based on single lead electrocardiogram (ECG) for left ventricular diastolic dysfunction (LVDD) determination as a screening method. Methods and Results We included 446 subjects for sample learning and 259 patients for sample test aged 39 to 74 years for testing with 2D-echocardiography, tissue Doppler imaging and ECG using a smartphone-case based single lead ECG monitor for the assessment of LVDD. Spectral analysis of ECG signals (spECG) has been used in combination with advanced signal processing and artificial intelligence methods. Wavelengths slope, time intervals between waves, amplitudes at different points of the ECG complexes, energy of the ECG signal and asymmetry indices were analyzed. The QTc interval indicated significant diastolic dysfunction with a sensitivity of 78% and a specificity of 65%, a Tpeak parameter >590 ms with 63% and 58%, a T value off >695 ms with 63% and 74%, and QRSfi > 674 ms with 74% and 57%, respectively. A combination of the threshold values from all 4 parameters increased sensitivity to 86% and specificity to 70%, respectively (OR 11.7 [2.7-50.9], P < .001). Algorithm approbation have shown: Sensitivity-95.6%, Specificity-97.7%, Diagnostic accuracy-96.5% and Repeatability-98.8%. Conclusion Our results indicate a great potential of a smartphone-case based on single lead ECG as novel screening tool for LVDD if spECG is used in combination with advanced signal processing and machine learning technologies.
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Affiliation(s)
- Natalia Kuznetsova
- World-Class Research Center “Digital Biodesign and Personalized Healthcare” Sechenov First Moscow State Medical University, Moscow, Russia
- Department of Cardiology, Functional and Ultrasound Diagnostics of N.V. Sklifosovsky Institute for Clinical Medicine Sechenov First Moscow State Medical University, Moscow, Russia
| | - Anastasiia Gubina
- Department of Cardiology, Functional and Ultrasound Diagnostics of N.V. Sklifosovsky Institute for Clinical Medicine Sechenov First Moscow State Medical University, Moscow, Russia
| | - Zhanna Sagirova
- Department of Cardiology, Functional and Ultrasound Diagnostics of N.V. Sklifosovsky Institute for Clinical Medicine Sechenov First Moscow State Medical University, Moscow, Russia
| | - Ines Dhif
- Department of Cardiology, Functional and Ultrasound Diagnostics of N.V. Sklifosovsky Institute for Clinical Medicine Sechenov First Moscow State Medical University, Moscow, Russia
| | - Daria Gognieva
- World-Class Research Center “Digital Biodesign and Personalized Healthcare” Sechenov First Moscow State Medical University, Moscow, Russia
- Department of Cardiology, Functional and Ultrasound Diagnostics of N.V. Sklifosovsky Institute for Clinical Medicine Sechenov First Moscow State Medical University, Moscow, Russia
| | - Anna Melnichuk
- Department of Cardiology, Functional and Ultrasound Diagnostics of N.V. Sklifosovsky Institute for Clinical Medicine Sechenov First Moscow State Medical University, Moscow, Russia
| | - Oleg Orlov
- Department of Cardiology, Functional and Ultrasound Diagnostics of N.V. Sklifosovsky Institute for Clinical Medicine Sechenov First Moscow State Medical University, Moscow, Russia
| | - Elena Syrkina
- Department of Cardiology, Functional and Ultrasound Diagnostics of N.V. Sklifosovsky Institute for Clinical Medicine Sechenov First Moscow State Medical University, Moscow, Russia
| | - Vsevolod Sedov
- Department of Cardiology, Functional and Ultrasound Diagnostics of N.V. Sklifosovsky Institute for Clinical Medicine Sechenov First Moscow State Medical University, Moscow, Russia
| | - Petr Chomakhidze
- World-Class Research Center “Digital Biodesign and Personalized Healthcare” Sechenov First Moscow State Medical University, Moscow, Russia
- Department of Cardiology, Functional and Ultrasound Diagnostics of N.V. Sklifosovsky Institute for Clinical Medicine Sechenov First Moscow State Medical University, Moscow, Russia
| | - Hugo Saner
- World-Class Research Center “Digital Biodesign and Personalized Healthcare” Sechenov First Moscow State Medical University, Moscow, Russia
- ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland
| | - Philippe Kopylov
- World-Class Research Center “Digital Biodesign and Personalized Healthcare” Sechenov First Moscow State Medical University, Moscow, Russia
- Department of Cardiology, Functional and Ultrasound Diagnostics of N.V. Sklifosovsky Institute for Clinical Medicine Sechenov First Moscow State Medical University, Moscow, Russia
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Wang S, Li J, Sun L, Cai J, Wang S, Zeng L, Sun S. Application of machine learning to predict the occurrence of arrhythmia after acute myocardial infarction. BMC Med Inform Decis Mak 2021; 21:301. [PMID: 34724938 PMCID: PMC8560220 DOI: 10.1186/s12911-021-01667-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2021] [Accepted: 10/22/2021] [Indexed: 12/23/2022] Open
Abstract
Background Early identification of the occurrence of arrhythmia in patients with acute myocardial infarction plays an essential role in clinical decision-making. The present study attempted to use machine learning (ML) methods to build predictive models of arrhythmia after acute myocardial infarction (AMI). Methods A total of 2084 patients with acute myocardial infarction were enrolled in this study. (All data is available on Github: https://github.com/wangsuhuai/AMI-database1.git). The primary outcome is whether tachyarrhythmia occurred during admission containing atrial arrhythmia, ventricular arrhythmia, and supraventricular tachycardia. All data is randomly divided into a training set (80%) and an internal testing set (20%). Apply three machine learning algorithms: decision tree, random forest (RF), and artificial neural network (ANN) to learn the training set to build a model, then use the testing set to evaluate the prediction performance, and compare it with the model built by the Global Registry of Acute Coronary Events (GRACE) risk variable set. Results Three ML models predict the occurrence of tachyarrhythmias after AMI. After variable selection, the artificial neural network (ANN) model has reached the highest accuracy rate, which is better than the model constructed using the Grace variable set. After applying SHapley Additive exPlanations (SHAP) to make the model interpretable, the most important features are abnormal wall motion, lesion location, bundle branch block, age, and heart rate. Among them, RBBB (odds ratio [OR]: 4.21; 95% confidence interval [CI]: 2.42–7.02), ≥ 2 ventricular walls motion abnormal (OR: 3.26; 95% CI: 2.01–4.36) and right coronary artery occlusion (OR: 3.00; 95% CI: 1.98–4.56) are significant factors related to arrhythmia after AMI. Conclusions We used advanced machine learning methods to build prediction models for tachyarrhythmia after AMI for the first time (especially the ANN model that has the best performance). The current study can supplement the current AMI risk score, provide a reliable evaluation method for the clinic, and broaden the new horizons of ML and clinical research. Trial registration Clinical Trial Registry No.: ChiCTR2100041960. Supplementary Information The online version contains supplementary material available at 10.1186/s12911-021-01667-8.
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Affiliation(s)
- Suhuai Wang
- Department of Cardiology, The First Affiliated Hospital of Harbin Medical University, 122 Postal Street, Nangang District, Harbin City, Heilongjiang Province, China
| | - Jingjie Li
- Department of Cardiology, The First Affiliated Hospital of Harbin Medical University, 122 Postal Street, Nangang District, Harbin City, Heilongjiang Province, China.
| | - Lin Sun
- Department of Cardiology, The First Affiliated Hospital of Harbin Medical University, 122 Postal Street, Nangang District, Harbin City, Heilongjiang Province, China.
| | - Jianing Cai
- Department of Cardiology, The First Affiliated Hospital of Harbin Medical University, 122 Postal Street, Nangang District, Harbin City, Heilongjiang Province, China
| | - Shihui Wang
- Department of Cardiology, The First Affiliated Hospital of Harbin Medical University, 122 Postal Street, Nangang District, Harbin City, Heilongjiang Province, China
| | - Linwen Zeng
- Department of Cardiology, The First Affiliated Hospital of Harbin Medical University, 122 Postal Street, Nangang District, Harbin City, Heilongjiang Province, China
| | - Shaoqing Sun
- Department of Cardiology, The First Affiliated Hospital of Harbin Medical University, 122 Postal Street, Nangang District, Harbin City, Heilongjiang Province, China
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Ávila-Tomás JF, Mayer-Pujadas MA, Quesada-Varela VJ. [Artificial intelligence and its applications in medicine II: Current importance and practical applications]. Aten Primaria 2021; 53:81-88. [PMID: 32571595 PMCID: PMC7752970 DOI: 10.1016/j.aprim.2020.04.014] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Accepted: 04/22/2020] [Indexed: 12/16/2022] Open
Abstract
Technology and medicine follow a parallel path during the last decades. Technological advances are changing the concept of health and health needs are influencing the development of technology. Artificial intelligence (AI) is made up of a series of sufficiently trained logical algorithms from which machines are capable of making decisions for specific cases based on general rules. This technology has applications in the diagnosis and follow-up of patients with an individualized prognostic evaluation of them. Furthermore, if we combine this technology with robotics, we can create intelligent machines that make more efficient diagnostic proposals in their work. Therefore, AI is going to be a technology present in our daily work through machines or computer programs, which in a more or less transparent way for the user, will become a daily reality in health processes. Health professionals have to know this technology, its advantages and disadvantages, because it will be an integral part of our work. In these two articles we intend to give a basic vision of this technology adapted to doctors with a review of its history and evolution, its real applications at the present time and a vision of a future in which AI and Big Data will shape the personalized medicine that will characterize the 21st century.
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Affiliation(s)
- Jose Francisco Ávila-Tomás
- Medicina de Familia y Comunitaria, Centro de Salud Santa Isabel, Madrid, España; Medicina Preventiva y Salud Pública, Universidad Rey Juan Carlos, Móstoles, Madrid, España; Estrutura Organizativa de Xestión Integrada (EOXI), Vigo, Pontevedra, España.
| | - Miguel Angel Mayer-Pujadas
- Medicina de Familia y Comunitaria, Research Programme on Biomedical Informatics (GRIB), Instituto Hospital del Mar de Investigaciones Médicas, Barcelona, España; Universitat Pompeu Fabra, Barcelona, España; Miembro del Grupo de Trabajo de Innovación Tecnológica y Sistemas de Información de la semFYC
| | - Victor Julio Quesada-Varela
- Medicina de Familia y Comunitaria, Centro de Salud de A Guarda, A Guarda, Pontevedra, España; Estrutura Organizativa de Xestión Integrada (EOXI), Vigo, Pontevedra, España; Miembro del Grupo de Trabajo de Innovación Tecnológica y Sistemas de Información de la semFYC
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Stevens LM, Mortazavi BJ, Deo RC, Curtis L, Kao DP. Recommendations for Reporting Machine Learning Analyses in Clinical Research. Circ Cardiovasc Qual Outcomes 2020; 13:e006556. [PMID: 33079589 DOI: 10.1161/circoutcomes.120.006556] [Citation(s) in RCA: 100] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Use of machine learning (ML) in clinical research is growing steadily given the increasing availability of complex clinical data sets. ML presents important advantages in terms of predictive performance and identifying undiscovered subpopulations of patients with specific physiology and prognoses. Despite this popularity, many clinicians and researchers are not yet familiar with evaluating and interpreting ML analyses. Consequently, readers and peer-reviewers alike may either overestimate or underestimate the validity and credibility of an ML-based model. Conversely, ML experts without clinical experience may present details of the analysis that are too granular for a clinical readership to assess. Overwhelming evidence has shown poor reproducibility and reporting of ML models in clinical research suggesting the need for ML analyses to be presented in a clear, concise, and comprehensible manner to facilitate understanding and critical evaluation. We present a recommendation for transparent and structured reporting of ML analysis results specifically directed at clinical researchers. Furthermore, we provide a list of key reporting elements with examples that can be used as a template when preparing and submitting ML-based manuscripts for the same audience.
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Affiliation(s)
- Laura M Stevens
- Division of Cardiology, University of Colorado School of Medicine, Aurora, CO (L.M.S., D.P.K.).,Institute for Precision Cardiovascular Medicine, American Heart Association, Dallas, TX (L.M.S.)
| | - Bobak J Mortazavi
- Department of Computer Science and Engineering, Texas A&M University, College Station, TX (B.J.M.)
| | - Rahul C Deo
- Division of Cardiovascular Medicine and One Brave Idea, Brigham and Women's Hospital, Boston, MA (R.C.D.)
| | - Lesley Curtis
- Department of Population Health Sciences and Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC (L.C.)
| | - David P Kao
- Division of Cardiology, University of Colorado School of Medicine, Aurora, CO (L.M.S., D.P.K.)
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Abstract
ST-segment elevation myocardial infarction (STEMI) is the most acute manifestation of coronary artery disease and is associated with great morbidity and mortality. A complete thrombotic occlusion developing from an atherosclerotic plaque in an epicardial coronary vessel is the cause of STEMI in the majority of cases. Early diagnosis and immediate reperfusion are the most effective ways to limit myocardial ischaemia and infarct size and thereby reduce the risk of post-STEMI complications and heart failure. Primary percutaneous coronary intervention (PCI) has become the preferred reperfusion strategy in patients with STEMI; if PCI cannot be performed within 120 minutes of STEMI diagnosis, fibrinolysis therapy should be administered to dissolve the occluding thrombus. The initiation of networks to provide around-the-clock cardiac catheterization availability and the generation of standard operating procedures within hospital systems have helped to reduce the time to reperfusion therapy. Together with new advances in antithrombotic therapy and preventive measures, these developments have resulted in a decrease in mortality from STEMI. However, a substantial amount of patients still experience recurrent cardiovascular events after STEMI. New insights have been gained regarding the pathophysiology of STEMI and feed into the development of new treatment strategies.
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