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Siranart N, Deepan N, Techasatian W, Phutinart S, Sowalertrat W, Kaewkanha P, Pajareya P, Tokavanich N, Prasitlumkum N, Chokesuwattanaskul R. Diagnostic accuracy of artificial intelligence in detecting left ventricular hypertrophy by electrocardiograph: a systematic review and meta-analysis. Sci Rep 2024; 14:15882. [PMID: 38987652 PMCID: PMC11237160 DOI: 10.1038/s41598-024-66247-y] [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: 10/19/2023] [Accepted: 06/29/2024] [Indexed: 07/12/2024] Open
Abstract
Several studies suggested the utility of artificial intelligence (AI) in screening left ventricular hypertrophy (LVH). We hence conducted systematic review and meta-analysis comparing diagnostic accuracy of AI to Sokolow-Lyon's and Cornell's criteria. Our aim was to provide a comprehensive overview of the newly developed AI tools for diagnosing LVH. We searched MEDLINE, EMBASE, and Cochrane databases for relevant studies until May 2023. Included were observational studies evaluating AI's accuracy in LVH detection. The area under the receiver operating characteristic curves (ROC) and pooled sensitivities and specificities assessed AI's performance against standard criteria. A total of 66,479 participants, with and without LVH, were included. Use of AI was associated with improved diagnostic accuracy with summary ROC (SROC) of 0.87. Sokolow-Lyon's and Cornell's criteria had lower accuracy (0.68 and 0.60). AI had sensitivity and specificity of 69% and 87%. In comparison, Sokolow-Lyon's specificity was 92% with a sensitivity of 25%, while Cornell's specificity was 94% with a sensitivity of 19%. This indicating its superior diagnostic accuracy of AI based algorithm in LVH detection. Our study demonstrates that AI-based methods for diagnosing LVH exhibit higher diagnostic accuracy compared to conventional criteria, with notable increases in sensitivity. These findings contribute to the validation of AI as a promising tool for LVH detection.
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Affiliation(s)
- Noppachai Siranart
- Division of Cardiology, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, 1873 Rama 4 Road, Pathumwan, Bangkok, 10330, Thailand
- Division of Cardiovascular Medicine, Center of Excellence in Arrhythmia Research, Cardiac Center, King Chulalongkorn Memorial Hospital, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
- Department of Cardiovascular Medicine, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - Natee Deepan
- Department of Biochemistry, Faculty of Medicine, Chulalongkorn University, Bangkok, 10330, Thailand
| | - Witina Techasatian
- Department of Medicine, John A. Burns School of Medicine, University of Hawai'i, Honolulu, HI, USA
| | - Somkiat Phutinart
- Division of Cardiology, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, 1873 Rama 4 Road, Pathumwan, Bangkok, 10330, Thailand
| | - Walit Sowalertrat
- Division of Cardiology, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, 1873 Rama 4 Road, Pathumwan, Bangkok, 10330, Thailand
| | - Ponthakorn Kaewkanha
- Division of Cardiology, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, 1873 Rama 4 Road, Pathumwan, Bangkok, 10330, Thailand
| | - Patavee Pajareya
- Division of Cardiology, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, 1873 Rama 4 Road, Pathumwan, Bangkok, 10330, Thailand
| | - Nithi Tokavanich
- Division of Cardiovascular Medicine, Frankel Cardiovascular Center, University of Michigan Health, Ann Arbor, MI, USA
| | - Narut Prasitlumkum
- Department of Cardiovascular Medicine, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - Ronpichai Chokesuwattanaskul
- Division of Cardiology, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, 1873 Rama 4 Road, Pathumwan, Bangkok, 10330, Thailand.
- Division of Cardiovascular Medicine, Center of Excellence in Arrhythmia Research, Cardiac Center, King Chulalongkorn Memorial Hospital, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
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2
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Elias P, Jain SS, Poterucha T, Randazzo M, Lopez Jimenez F, Khera R, Perez M, Ouyang D, Pirruccello J, Salerno M, Einstein AJ, Avram R, Tison GH, Nadkarni G, Natarajan V, Pierson E, Beecy A, Kumaraiah D, Haggerty C, Avari Silva JN, Maddox TM. Artificial Intelligence for Cardiovascular Care-Part 1: Advances: JACC Review Topic of the Week. J Am Coll Cardiol 2024; 83:2472-2486. [PMID: 38593946 DOI: 10.1016/j.jacc.2024.03.400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Accepted: 03/14/2024] [Indexed: 04/11/2024]
Abstract
Recent artificial intelligence (AI) advancements in cardiovascular care offer potential enhancements in diagnosis, treatment, and outcomes. Innovations to date focus on automating measurements, enhancing image quality, and detecting diseases using novel methods. Applications span wearables, electrocardiograms, echocardiography, angiography, genetics, and more. AI models detect diseases from electrocardiograms at accuracy not previously achieved by technology or human experts, including reduced ejection fraction, valvular heart disease, and other cardiomyopathies. However, AI's unique characteristics necessitate rigorous validation by addressing training methods, real-world efficacy, equity concerns, and long-term reliability. Despite an exponentially growing number of studies in cardiovascular AI, trials showing improvement in outcomes remain lacking. A number are currently underway. Embracing this rapidly evolving technology while setting a high evaluation benchmark will be crucial for cardiology to leverage AI to enhance patient care and the provider experience.
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Affiliation(s)
- Pierre Elias
- Seymour, Paul and Gloria Milstein Division of Cardiology, Columbia University Irving Medical Center, New York, New York, USA; Department of Biomedical Informatics Columbia University Irving Medical Center, New York, New York, USA
| | - Sneha S Jain
- Division of Cardiology, Stanford University School of Medicine, Palo Alto, California, USA
| | - Timothy Poterucha
- Seymour, Paul and Gloria Milstein Division of Cardiology, Columbia University Irving Medical Center, New York, New York, USA
| | - Michael Randazzo
- Division of Cardiology, University of Chicago Medical Center, Chicago, Illinois, USA
| | | | - Rohan Khera
- Division of Cardiology, Yale School of Medicine, New Haven, Connecticut, USA
| | - Marco Perez
- Division of Cardiology, Stanford University School of Medicine, Palo Alto, California, USA
| | - David Ouyang
- Division of Cardiology, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - James Pirruccello
- Division of Cardiology, University of California-San Francisco, San Francisco, California, USA
| | - Michael Salerno
- Division of Cardiology, Stanford University School of Medicine, Palo Alto, California, USA
| | - Andrew J Einstein
- Seymour, Paul and Gloria Milstein Division of Cardiology, Columbia University Irving Medical Center, New York, New York, USA
| | - Robert Avram
- Division of Cardiology, Montreal Heart Institute, Montreal, Quebec, Canada
| | - Geoffrey H Tison
- Division of Cardiology, University of California-San Francisco, San Francisco, California, USA
| | - Girish Nadkarni
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | | | - Emma Pierson
- Department of Computer Science, Cornell Tech, New York, New York, USA
| | - Ashley Beecy
- NewYork-Presbyterian Health System, New York, New York, USA; Division of Cardiology, Weill Cornell Medical College, New York, New York, USA
| | - Deepa Kumaraiah
- Seymour, Paul and Gloria Milstein Division of Cardiology, Columbia University Irving Medical Center, New York, New York, USA; NewYork-Presbyterian Health System, New York, New York, USA
| | - Chris Haggerty
- Department of Biomedical Informatics Columbia University Irving Medical Center, New York, New York, USA; NewYork-Presbyterian Health System, New York, New York, USA
| | - Jennifer N Avari Silva
- Division of Cardiology, Washington University School of Medicine, St Louis, Missouri, USA
| | - Thomas M Maddox
- Division of Cardiology, Washington University School of Medicine, St Louis, Missouri, USA.
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3
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Bhave S, Rodriguez V, Poterucha T, Mutasa S, Aberle D, Capaccione KM, Chen Y, Dsouza B, Dumeer S, Goldstein J, Hodes A, Leb J, Lungren M, Miller M, Monoky D, Navot B, Wattamwar K, Wattamwar A, Clerkin K, Ouyang D, Ashley E, Topkara VK, Maurer M, Einstein AJ, Uriel N, Homma S, Schwartz A, Jaramillo D, Perotte AJ, Elias P. Deep learning to detect left ventricular structural abnormalities in chest X-rays. Eur Heart J 2024; 45:2002-2012. [PMID: 38503537 PMCID: PMC11156488 DOI: 10.1093/eurheartj/ehad782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 09/24/2023] [Accepted: 11/14/2023] [Indexed: 03/21/2024] Open
Abstract
BACKGROUND AND AIMS Early identification of cardiac structural abnormalities indicative of heart failure is crucial to improving patient outcomes. Chest X-rays (CXRs) are routinely conducted on a broad population of patients, presenting an opportunity to build scalable screening tools for structural abnormalities indicative of Stage B or worse heart failure with deep learning methods. In this study, a model was developed to identify severe left ventricular hypertrophy (SLVH) and dilated left ventricle (DLV) using CXRs. METHODS A total of 71 589 unique CXRs from 24 689 different patients completed within 1 year of echocardiograms were identified. Labels for SLVH, DLV, and a composite label indicating the presence of either were extracted from echocardiograms. A deep learning model was developed and evaluated using area under the receiver operating characteristic curve (AUROC). Performance was additionally validated on 8003 CXRs from an external site and compared against visual assessment by 15 board-certified radiologists. RESULTS The model yielded an AUROC of 0.79 (0.76-0.81) for SLVH, 0.80 (0.77-0.84) for DLV, and 0.80 (0.78-0.83) for the composite label, with similar performance on an external data set. The model outperformed all 15 individual radiologists for predicting the composite label and achieved a sensitivity of 71% vs. 66% against the consensus vote across all radiologists at a fixed specificity of 73%. CONCLUSIONS Deep learning analysis of CXRs can accurately detect the presence of certain structural abnormalities and may be useful in early identification of patients with LV hypertrophy and dilation. As a resource to promote further innovation, 71 589 CXRs with adjoining echocardiographic labels have been made publicly available.
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Affiliation(s)
- Shreyas Bhave
- Division of Cardiology and Department of Biomedical Informatics, Columbia University Irving Medical Center, 622 West 168th Street, PH20, NewYork, NY 10032, USA
| | - Victor Rodriguez
- Division of Cardiology and Department of Biomedical Informatics, Columbia University Irving Medical Center, 622 West 168th Street, PH20, NewYork, NY 10032, USA
| | - Timothy Poterucha
- Seymour, Paul, and Gloria Milstein Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, NewYork-Presbyterian Hospital, 630 West 168th Street, NewYork, NY 10032, USA
| | - Simukayi Mutasa
- Department of Radiology, Columbia University Irving Medical Center, NewYork, NY, USA
| | - Dwight Aberle
- Department of Radiology, Columbia University Irving Medical Center, NewYork, NY, USA
| | - Kathleen M Capaccione
- Department of Radiology, Columbia University Irving Medical Center, NewYork, NY, USA
| | - Yibo Chen
- Inova Fairfax Hospital Imaging Center, Inova Fairfax Medical Campus, Falls Church, VA, USA
| | - Belinda Dsouza
- Department of Radiology, Columbia University Irving Medical Center, NewYork, NY, USA
| | - Shifali Dumeer
- Department of Radiology, Columbia University Irving Medical Center, NewYork, NY, USA
| | - Jonathan Goldstein
- Department of Radiology, Columbia University Irving Medical Center, NewYork, NY, USA
| | - Aaron Hodes
- Hackensack Radiology Group, Hackensack Meridian School of Medicine, Nutley, NJ, USA
| | - Jay Leb
- Department of Radiology, Columbia University Irving Medical Center, NewYork, NY, USA
| | - Matthew Lungren
- Department of Radiology, University of California, SanFrancisco, CA, USA
| | - Mitchell Miller
- Hackensack Radiology Group, Hackensack Meridian School of Medicine, Nutley, NJ, USA
| | - David Monoky
- Hackensack Radiology Group, Hackensack Meridian School of Medicine, Nutley, NJ, USA
| | - Benjamin Navot
- Department of Radiology, Columbia University Irving Medical Center, NewYork, NY, USA
| | - Kapil Wattamwar
- Division of Vascular and Interventional Radiology, Department of Radiology, Montefiore Medical Center, Bronx, NY, USA
| | - Anoop Wattamwar
- Hackensack Radiology Group, Hackensack Meridian School of Medicine, Nutley, NJ, USA
| | - Kevin Clerkin
- Seymour, Paul, and Gloria Milstein Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, NewYork-Presbyterian Hospital, 630 West 168th Street, NewYork, NY 10032, USA
| | - David Ouyang
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Euan Ashley
- Stanford Center for Inherited Cardiovascular Disease, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Veli K Topkara
- Seymour, Paul, and Gloria Milstein Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, NewYork-Presbyterian Hospital, 630 West 168th Street, NewYork, NY 10032, USA
| | - Mathew Maurer
- Seymour, Paul, and Gloria Milstein Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, NewYork-Presbyterian Hospital, 630 West 168th Street, NewYork, NY 10032, USA
| | - Andrew J Einstein
- Seymour, Paul, and Gloria Milstein Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, NewYork-Presbyterian Hospital, 630 West 168th Street, NewYork, NY 10032, USA
- Department of Radiology, Columbia University Irving Medical Center, NewYork, NY, USA
| | - Nir Uriel
- Seymour, Paul, and Gloria Milstein Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, NewYork-Presbyterian Hospital, 630 West 168th Street, NewYork, NY 10032, USA
| | - Shunichi Homma
- Seymour, Paul, and Gloria Milstein Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, NewYork-Presbyterian Hospital, 630 West 168th Street, NewYork, NY 10032, USA
| | - Allan Schwartz
- Seymour, Paul, and Gloria Milstein Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, NewYork-Presbyterian Hospital, 630 West 168th Street, NewYork, NY 10032, USA
| | - Diego Jaramillo
- Department of Radiology, Columbia University Irving Medical Center, NewYork, NY, USA
| | - Adler J Perotte
- Division of Cardiology and Department of Biomedical Informatics, Columbia University Irving Medical Center, 622 West 168th Street, PH20, NewYork, NY 10032, USA
| | - Pierre Elias
- Division of Cardiology and Department of Biomedical Informatics, Columbia University Irving Medical Center, 622 West 168th Street, PH20, NewYork, NY 10032, USA
- Seymour, Paul, and Gloria Milstein Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, NewYork-Presbyterian Hospital, 630 West 168th Street, NewYork, NY 10032, USA
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4
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Wong CK, Lau YM, Lui HW, Chan WF, San WC, Zhou M, Cheng Y, Huang D, Lai WH, Lau YM, Siu CW. Automatic detection of cardiac conditions from photos of electrocardiogram captured by smartphones. Heart 2024:heartjnl-2023-323822. [PMID: 38768982 DOI: 10.1136/heartjnl-2023-323822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2023] [Accepted: 05/02/2024] [Indexed: 05/22/2024] Open
Abstract
BACKGROUND Researchers have developed machine learning-based ECG diagnostic algorithms that match or even surpass cardiologist level of performance. However, most of them cannot be used in real-world, as older generation ECG machines do not permit installation of new algorithms. OBJECTIVE To develop a smartphone application that automatically extract ECG waveforms from photos and to convert them to voltage-time series for downstream analysis by a variety of diagnostic algorithms built by researchers. METHODS A novel approach of using objective detection and image segmentation models to automatically extract ECG waveforms from photos taken by clinicians was devised. Modular machine learning models were developed to sequentially perform waveform identification, gridline removal, and scale calibration. The extracted data were then analysed using a machine learning-based cardiac rhythm classifier. RESULTS Waveforms from 40 516 scanned and 444 photographed ECGs were automatically extracted. 12 828 of 13 258 (96.8%) scanned and 5399 of 5743 (94.0%) photographed waveforms were correctly cropped and labelled. 11 604 of 12 735 (91.1%) scanned and 5062 of 5752 (88.0%) photographed waveforms achieved successful voltage-time signal extraction after automatic gridline and background noise removal. In a proof-of-concept demonstration, an atrial fibrillation diagnostic algorithm achieved 91.3% sensitivity, 94.2% specificity, 95.6% positive predictive value, 88.6% negative predictive value and 93.4% F1 score, using photos of ECGs as input. CONCLUSION Object detection and image segmentation models allow automatic extraction of ECG signals from photos for downstream diagnostics. This novel pipeline circumvents the need for costly ECG hardware upgrades, thereby paving the way for large-scale implementation of machine learning-based diagnostic algorithms.
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Affiliation(s)
- Chun-Ka Wong
- Cardiology Division, Department of Medicine, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Yuk Ming Lau
- Cardiology Division, Department of Medicine, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Hin Wai Lui
- Cardiology Division, Department of Medicine, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Wai Fung Chan
- Cardiology Division, Department of Medicine, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Wing Chun San
- Cardiology Division, Department of Medicine, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Mi Zhou
- Cardiology Division, Department of Medicine, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Yangyang Cheng
- Cardiology Division, Department of Medicine, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Duo Huang
- Cardiology Division, Department of Medicine, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Wing Hon Lai
- Cardiology Division, Department of Medicine, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Yee Man Lau
- Cardiology Division, Department of Medicine, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Chung Wah Siu
- Cardiology Division, Department of Medicine, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
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Kalmady SV, Salimi A, Sun W, Sepehrvand N, Nademi Y, Bainey K, Ezekowitz J, Hindle A, McAlister F, Greiner R, Sandhu R, Kaul P. Development and validation of machine learning algorithms based on electrocardiograms for cardiovascular diagnoses at the population level. NPJ Digit Med 2024; 7:133. [PMID: 38762623 PMCID: PMC11102430 DOI: 10.1038/s41746-024-01130-8] [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: 08/16/2023] [Accepted: 04/26/2024] [Indexed: 05/20/2024] Open
Abstract
Artificial intelligence-enabled electrocardiogram (ECG) algorithms are gaining prominence for the early detection of cardiovascular (CV) conditions, including those not traditionally associated with conventional ECG measures or expert interpretation. This study develops and validates such models for simultaneous prediction of 15 different common CV diagnoses at the population level. We conducted a retrospective study that included 1,605,268 ECGs of 244,077 adult patients presenting to 84 emergency departments or hospitals, who underwent at least one 12-lead ECG from February 2007 to April 2020 in Alberta, Canada, and considered 15 CV diagnoses, as identified by International Classification of Diseases, 10th revision (ICD-10) codes: atrial fibrillation (AF), supraventricular tachycardia (SVT), ventricular tachycardia (VT), cardiac arrest (CA), atrioventricular block (AVB), unstable angina (UA), ST-elevation myocardial infarction (STEMI), non-STEMI (NSTEMI), pulmonary embolism (PE), hypertrophic cardiomyopathy (HCM), aortic stenosis (AS), mitral valve prolapse (MVP), mitral valve stenosis (MS), pulmonary hypertension (PHTN), and heart failure (HF). We employed ResNet-based deep learning (DL) using ECG tracings and extreme gradient boosting (XGB) using ECG measurements. When evaluated on the first ECGs per episode of 97,631 holdout patients, the DL models had an area under the receiver operating characteristic curve (AUROC) of <80% for 3 CV conditions (PTE, SVT, UA), 80-90% for 8 CV conditions (CA, NSTEMI, VT, MVP, PHTN, AS, AF, HF) and an AUROC > 90% for 4 diagnoses (AVB, HCM, MS, STEMI). DL models outperformed XGB models with about 5% higher AUROC on average. Overall, ECG-based prediction models demonstrated good-to-excellent prediction performance in diagnosing common CV conditions.
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Affiliation(s)
- Sunil Vasu Kalmady
- Department of Computing Science, University of Alberta, Edmonton, AB, Canada
- Canadian VIGOUR Centre, Department of Medicine, University of Alberta, Edmonton, AB, Canada
- Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Amir Salimi
- Department of Computing Science, University of Alberta, Edmonton, AB, Canada
| | - Weijie Sun
- Department of Computing Science, University of Alberta, Edmonton, AB, Canada
| | - Nariman Sepehrvand
- Canadian VIGOUR Centre, Department of Medicine, University of Alberta, Edmonton, AB, Canada
- Department of Medicine, University of Calgary, Calgary, AB, Canada
| | - Yousef Nademi
- Department of Computing Science, University of Alberta, Edmonton, AB, Canada
| | - Kevin Bainey
- Canadian VIGOUR Centre, Department of Medicine, University of Alberta, Edmonton, AB, Canada
- Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Justin Ezekowitz
- Canadian VIGOUR Centre, Department of Medicine, University of Alberta, Edmonton, AB, Canada
- Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Abram Hindle
- Department of Computing Science, University of Alberta, Edmonton, AB, Canada
| | - Finlay McAlister
- Canadian VIGOUR Centre, Department of Medicine, University of Alberta, Edmonton, AB, Canada
- Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Russel Greiner
- Department of Computing Science, University of Alberta, Edmonton, AB, Canada
| | - Roopinder Sandhu
- Canadian VIGOUR Centre, Department of Medicine, University of Alberta, Edmonton, AB, Canada
- Smidt Heart Institute, Cedars-Sinai Medical Center Hospital System, Los Angeles, CA, USA
| | - Padma Kaul
- Canadian VIGOUR Centre, Department of Medicine, University of Alberta, Edmonton, AB, Canada.
- Department of Medicine, University of Alberta, Edmonton, AB, Canada.
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Lin YT, Lin CS, Tsai CS, Tsai DJ, Lou YS, Fang WH, Lee YT, Lin C. Comprehensive clinical application analysis of artificial intelligence-enabled electrocardiograms for screening multiple valvular heart diseases. Aging (Albany NY) 2024; 16:8717-8731. [PMID: 38761181 PMCID: PMC11164519 DOI: 10.18632/aging.205835] [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: 12/26/2023] [Accepted: 04/16/2024] [Indexed: 05/20/2024]
Abstract
BACKGROUND Valvular heart disease (VHD) is becoming increasingly important to manage the risk of future complications. Electrocardiographic (ECG) changes may be related to multiple VHDs, and (AI)-enabled ECG has been able to detect some VHDs. We aimed to develop five deep learning models (DLMs) to identify aortic stenosis, aortic regurgitation, pulmonary regurgitation, tricuspid regurgitation, and mitral regurgitation. METHODS Between 2010 and 2021, 77,047 patients with echocardiography and 12-lead ECG performed within 7 days were identified from an academic medical center to provide DLM development (122,728 ECGs), and internal validation (7,637 ECGs). Additional 11,800 patients from a community hospital were identified to external validation. The ECGs were classified as with or without moderate-to-severe VHDs according to transthoracic echocardiography (TTE) records, and we also collected the other echocardiographic data and follow-up TTE records to identify new-onset valvular heart diseases. RESULTS AI-ECG adjusted for age and sex achieved areas under the curves (AUCs) of >0.84, >0.80, >0.77, >0.83, and >0.81 for detecting aortic stenosis, aortic regurgitation, pulmonary regurgitation, tricuspid regurgitation, and mitral regurgitation, respectively. Since predictions of each DLM shared similar components of ECG rhythms, the positive findings of each DLM were highly correlated with other valvular heart diseases. Of note, a total of 37.5-51.7% of false-positive predictions had at least one significant echocardiographic finding, which may lead to a significantly higher risk of future moderate-to-severe VHDs in patients with initially minimal-to-mild VHDs. CONCLUSION AI-ECG may be used as a large-scale screening tool for detecting VHDs and a basis to undergo an echocardiography.
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Affiliation(s)
- Yu-Ting Lin
- Department of Surgery, Division of Cardiovascular Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Chin-Sheng Lin
- Department of Internal Medicine, Division of Cardiology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Chien-Sung Tsai
- Department of Surgery, Division of Cardiovascular Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Dung-Jang Tsai
- Artificial Intelligence of Things Center, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
- Graduate Institutes of Life Sciences, National Defense Medical Center, Taipei, Taiwan
- Medical Technology Education Center, School of Medicine, National Defense Medical Center, Taipei, Taiwan
- Department of Statistics and Information Science, Fu Jen Catholic University, New Taipei City, Taiwan
| | - Yu-Sheng Lou
- Artificial Intelligence of Things Center, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
- Graduate Institutes of Life Sciences, National Defense Medical Center, Taipei, Taiwan
| | - Wen-Hui Fang
- Artificial Intelligence of Things Center, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
- Department of Family and Community Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Yung-Tsai Lee
- Division of Cardiovascular Surgery, Cheng Hsin Rehabilitation and Medical Center, Taipei, Taiwan
- Department of Exercise and Healthy Science, National Taipei University of Nursing and Healthy Science, Taipei, Taiwan
| | - Chin Lin
- Artificial Intelligence of Things Center, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
- Graduate Institutes of Life Sciences, National Defense Medical Center, Taipei, Taiwan
- Medical Technology Education Center, School of Medicine, National Defense Medical Center, Taipei, Taiwan
- Graduate Institute of Aerospace and Undersea Medicine, National Defense Medical Center, Taipei, Taiwan
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7
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Sigfstead S, Jiang R, Avram R, Davies B, Krahn AD, Cheung CC. Applying Artificial Intelligence for Phenotyping of Inherited Arrhythmia Syndromes. Can J Cardiol 2024:S0828-282X(24)00335-0. [PMID: 38670456 DOI: 10.1016/j.cjca.2024.04.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Revised: 04/08/2024] [Accepted: 04/21/2024] [Indexed: 04/28/2024] Open
Abstract
Inherited arrhythmia disorders account for a significant proportion of sudden cardiac death, particularly among young individuals. Recent advances in our understanding of these syndromes have improved patient diagnosis and care, yet certain clinical gaps remain, particularly within case ascertainment, access to genetic testing, and risk stratification. Artificial intelligence (AI), specifically machine learning and its subset deep learning, present promising solutions to these challenges. The capacity of AI to process vast amounts of patient data and identify disease patterns differentiates them from traditional methods, which are time- and resource-intensive. To date, AI models have shown immense potential in condition detection (including asymptomatic/concealed disease) and genotype and phenotype identification, exceeding expert cardiologists in these tasks. Additionally, they have exhibited applicability for general population screening, improving case ascertainment in a set of conditions that are often asymptomatic such as left ventricular dysfunction. Third, models have shown the ability to improve testing protocols; through model identification of disease and genotype, specific clinical testing (eg, drug challenges or further diagnostic imaging) can be avoided, reducing health care expenses, speeding diagnosis, and possibly allowing for more incremental or targeted genetic testing approaches. These significant benefits warrant continued investigation of AI, particularly regarding the development and implementation of clinically applicable screening tools. In this review we summarize key developments in AI, including studies in long QT syndrome, Brugada syndrome, hypertrophic cardiomyopathy, and arrhythmogenic cardiomyopathies, and provide direction for effective future AI implementation in clinical practice.
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Affiliation(s)
- Sophie Sigfstead
- Department of Mathematical and Statistical Sciences, University of Alberta, Edmonton, Alberta, Canada
| | - River Jiang
- Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Robert Avram
- Heartwise (heartwise.ai), Montreal Heart Institute, Montreal, Quebec, Canada; Department of Medicine, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada
| | - Brianna Davies
- Center for Cardiovascular Innovation, Division of Cardiology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Andrew D Krahn
- Center for Cardiovascular Innovation, Division of Cardiology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.
| | - Christopher C Cheung
- Division of Cardiology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
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8
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Cai C, Imai T, Hasumi E, Fujiu K. One-shot screening: Utilization of a two-dimensional convolutional neural network for automatic detection of left ventricular hypertrophy using electrocardiograms. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2024; 247:108097. [PMID: 38428250 DOI: 10.1016/j.cmpb.2024.108097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 02/20/2024] [Accepted: 02/20/2024] [Indexed: 03/03/2024]
Abstract
BACKGROUND AND OBJECTIVE Left ventricular hypertrophy (LVH) can impair ejection function and elevate the risk of heart failure. Therefore, early detection through screening is crucial. This study aimed to propose a novel method to enhance LVH detection using 12-lead electrocardiogram (ECG) waveforms with a two-dimensional (2D) convolutional neural network (CNN). METHODS Utilizing 42,127 pairs of ECG-transthoracic echocardiogram data, we pre-processed raw data into single-shot images derived from each ECG lead and conducted lead selection to optimize LVH diagnosis. Our proposed one-shot screening method, implemented during pre-processing, enables the superimposition of waveform source data of any length onto a single-frame image, thereby addressing the limitations of the one-dimensional (1D) approach. We developed a deep learning model with a 2D-CNN structure and machine learning models for LVH detection. To assess our method, we also compared our results with conventional ECG criteria and those of a prior study that used a 1D-CNN approach, utilizing the same dataset from the University of Tokyo Hospital for LVH diagnosis. RESULTS For LVH detection, the average area under the receiver operating characteristic curve (AUROC) was 0.916 for the 2D-CNN model, which was significantly higher than that obtained using logistic regression and random forest methods, as well as the two conventional ECG criteria (AUROC of 0.766, 0.790, 0.599, and 0.622, respectively). Incorporating additional metadata, such as ECG measurement data, further improved the average AUROC to 0.921. The model's performance remained stable across two different annotation criteria and demonstrated significant superiority over the performance of the 1D-CNN model used in a previous study (AUROC of 0.807). CONCLUSIONS This study introduces a robust and computationally efficient method that outperforms 1D-CNN models utilized in previous studies for LVH detection. Our method can transform waveforms of any length into fixed-size images and leverage the selected lead of the ECG, ensuring adaptability in environments with limited computational resources. The proposed method holds promise for integration into clinical practice as a tool for early diagnosis, potentially enhancing patient outcomes by facilitating earlier treatment and management.
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Affiliation(s)
- Chun Cai
- Center for Disease Biology and Integrative Medicine, Graduate School of Medicine, The University of Tokyo, Japan
| | - Takeshi Imai
- Center for Disease Biology and Integrative Medicine, Graduate School of Medicine, The University of Tokyo, Japan.
| | - Eriko Hasumi
- Department of Cardiovascular Medicine, The University of Tokyo Hospital, Japan
| | - Katsuhito Fujiu
- Department of Cardiovascular Medicine, The University of Tokyo Hospital, Japan
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9
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Chang A, Wu X, Liu K. Deep learning from latent spatiotemporal information of the heart: Identifying advanced bioimaging markers from echocardiograms. BIOPHYSICS REVIEWS 2024; 5:011304. [PMID: 38559589 PMCID: PMC10978053 DOI: 10.1063/5.0176850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Accepted: 03/01/2024] [Indexed: 04/04/2024]
Abstract
A key strength of echocardiography lies in its integration of comprehensive spatiotemporal cardiac imaging data in real-time, to aid frontline or bedside patient risk stratification and management. Nonetheless, its acquisition, processing, and interpretation are known to all be subject to heterogeneity from its reliance on manual and subjective human tracings, which challenges workflow and protocol standardization and final interpretation accuracy. In the era of advanced computational power, utilization of machine learning algorithms for big data analytics in echocardiography promises reduction in cost, cognitive errors, and intra- and inter-observer variability. Novel spatiotemporal deep learning (DL) models allow the integration of temporal arm information based on unlabeled pixel echocardiographic data for convolution of an adaptive semantic spatiotemporal calibration to construct personalized 4D heart meshes, assess global and regional cardiac function, detect early valve pathology, and differentiate uncommon cardiovascular disorders. Meanwhile, data visualization on spatiotemporal DL prediction models helps extract latent temporal imaging features to develop advanced imaging biomarkers in early disease stages and advance our understanding of pathophysiology to support the development of personalized prevention or treatment strategies. Since portable echocardiograms have been increasingly used as point-of-care imaging tools to aid rural care delivery, the application of these new spatiotemporal DL techniques show the potentials in streamlining echocardiographic acquisition, processing, and data analysis to improve workflow standardization and efficiencies, and provide risk stratification and decision supporting tools in real-time, to prompt the building of new imaging diagnostic networks to enhance rural healthcare engagement.
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Affiliation(s)
- Amanda Chang
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Iowa, Iowa City, Iowa 52242, USA
| | - Xiaodong Wu
- Department of Electrical and Computer Engineering, College of Engineering, University of Iowa, Iowa City, Iowa 52242, USA
| | - Kan Liu
- Division of Cardiology, Department of Internal Medicine, Washington University in St. Louis, St. Louis, Missouri 63110, USA
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10
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Chen WW, Tseng CC, Huang CC, Lu HHS. Improving deep-learning electrocardiogram classification with an effective coloring method. Artif Intell Med 2024; 149:102809. [PMID: 38462295 DOI: 10.1016/j.artmed.2024.102809] [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: 07/22/2023] [Revised: 12/07/2023] [Accepted: 02/08/2024] [Indexed: 03/12/2024]
Abstract
Cardiovascular diseases, particularly arrhythmias, remain a leading cause of mortality worldwide. Electrocardiogram (ECG) analysis plays a pivotal role in cardiovascular disease diagnosis. Although previous studies have focused on waveform analysis and model training, integrating additional clinical information, especially demographic data, remains challenging. In this study, we present an innovative approach to ECG classification by incorporating demographic information from patients' medical histories through a colorization technique. Our proposed method maps demographic features onto the (R, G, B) color space through normalized scaling. Each demographic feature corresponds to a distinct color, allowing for different ECG leads to be colored. This approach preserves the relationships between data by maintaining the color correlations in the statistical features, enhancing ECG analytics and supporting precision medicine. We conducted experiments with PTB-XL dataset and achieved 1%-6% improvements in the area under the receiving operator characteristic curve performance compared with other methods for various classification problems. Notably, our method excelled in multiclass and challenging classification tasks. The combined use of color features and the original waveform shape features enhanced prediction accuracy for various deep learning models. Our findings suggest that colorization is a promising avenue for advancing ECG classification and diagnosis, contributing to improved prediction and diagnosis of cardiovascular diseases and ultimately enhancing clinical outcomes.
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Affiliation(s)
- Wei-Wen Chen
- Institute of Computer Science and Engineering, National Yang Ming Chiao Tung University, Hsinchu, Taiwan
| | - Chien-Chao Tseng
- Institute of Computer Science and Engineering, National Yang Ming Chiao Tung University, Hsinchu, Taiwan
| | - Ching-Chun Huang
- Institute of Computer Science and Engineering, National Yang Ming Chiao Tung University, Hsinchu, Taiwan
| | - Henry Horng-Shing Lu
- Institute of Statistics, National Yang Ming Chiao Tung University, Hsinchu, Taiwan; Department of Statistics and Data Science, Cornell University, Ithaca, New York, USA.
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11
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Bacharova L, Chevalier P, Gorenek B, Jons C, Li Y, Locati ET, Maanja M, Pérez‐Riera AR, Platonov PG, Ribeiro ALP, Schocken D, Soliman EZ, Svehlikova J, Tereshchenko LG, Ugander M, Varma N, Elena Z, Ikeda T. ISE/ISHNE expert consensus statement on the ECG diagnosis of left ventricular hypertrophy: The change of the paradigm. Ann Noninvasive Electrocardiol 2024; 29:e13097. [PMID: 37997698 PMCID: PMC10770819 DOI: 10.1111/anec.13097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Revised: 10/30/2023] [Accepted: 11/01/2023] [Indexed: 11/25/2023] Open
Abstract
The ECG diagnosis of LVH is predominantly based on the QRS voltage criteria. The classical paradigm postulates that the increased left ventricular mass generates a stronger electrical field, increasing the leftward and posterior QRS forces, reflected in the augmented QRS amplitude. However, the low sensitivity of voltage criteria has been repeatedly documented. We discuss possible reasons for this shortcoming and proposal of a new paradigm. The theoretical background for voltage measured at the body surface is defined by the solid angle theorem, which relates the measured voltage to spatial and non-spatial determinants. The spatial determinants are represented by the extent of the activation front and the distance of the recording electrodes. The non-spatial determinants comprise electrical characteristics of the myocardium, which are comparatively neglected in the interpretation of the QRS patterns. Various clinical conditions are associated with LVH. These conditions produce considerable diversity of electrical properties alterations thereby modifying the resultant QRS patterns. The spectrum of QRS patterns observed in LVH patients is quite broad, including also left axis deviation, left anterior fascicular block, incomplete and complete left bundle branch blocks, Q waves, and fragmented QRS. Importantly, the QRS complex can be within normal limits. The new paradigm stresses the electrophysiological background in interpreting QRS changes, i.e., the effect of the non-spatial determinants. This postulates that the role of ECG is not to estimate LV size in LVH, but to understand and decode the underlying electrical processes, which are crucial in relation to cardiovascular risk assessment.
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Affiliation(s)
| | - Philippe Chevalier
- Neuromyogene InstituteClaude Bernard UniversityVilleurbanneFrance
- Service de RythmologieHospices Civils de LyonLyonFrance
| | - Bulent Gorenek
- Eskisehir Osmangazi University Cardiology DepartmentEskisehirTurkey
| | - Christian Jons
- Department of CardiologyRigshospitalet, Copenhagen University HospitalCopenhagenDenmark
| | - Yi‐Gang Li
- Department of Cardiology, Xinhua HospitalShanghai Jiao Tong University School of MedicineShanghaiChina
| | - Emanuela T. Locati
- Department of Arrhythmology and ElectrophysiologyIRCCS Policlinico San DonatoMilanoItaly
| | - Maren Maanja
- Department of Clinical PhysiologyKarolinska University Hospital, and Karolinska InstitutetStockholmSweden
| | | | - Pyotr G. Platonov
- Department of Cardiology, Clinical SciencesLund UniversityLundSweden
| | - Antonio Luiz Pinho Ribeiro
- Internal Medicine, Faculdade de Medicina da Universidade Federal de Minas GeraisBelo HorizonteBrazil
- Telehealth Center, Hospital das Clínicas da Universidade Federal de Minas GeraisBelo HorizonteBrazil
| | - Douglas Schocken
- Division of Cardiology, Department of MedicineDuke University Medical CenterDurhamNorth CarolinaUSA
| | - Elsayed Z. Soliman
- Section on Cardiovascular Medicine, Department of Medicine, Epidemiological Cardiology Research CenterWake Forest University School of MedicineWinston‐SalemNorth CarolinaUSA
| | - Jana Svehlikova
- Institute of Measurement Sciences, Slovak Academy of SciencesBratislavaSlovak Republic
| | - Larisa G. Tereshchenko
- Department of Quantitative Health SciencesLerner Research Institute, Cleveland ClinicClevelandOhioUSA
| | - Martin Ugander
- Faculty of Medicine and HealthThe University of SydneySydneyNew South WalesAustralia
- Department of Clinical PhysiologyKarolinska InstituteStockholmSweden
| | - Niraj Varma
- Cardiac Pacing & ElectrophysiologyHeart and Vascular Institute, Cleveland ClinicClevelandOhioUSA
| | - Zaklyazminskaya Elena
- Medical Genetics LaboratoryPetrovsky National Research Centre of SurgeryMoscowRussia
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12
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Raileanu G, de Jong JSSG. Electrocardiogram Interpretation Using Artificial Intelligence: Diagnosis of Cardiac and Extracardiac Pathologic Conditions. How Far Has Machine Learning Reached? Curr Probl Cardiol 2024; 49:102097. [PMID: 37739276 DOI: 10.1016/j.cpcardiol.2023.102097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 09/18/2023] [Indexed: 09/24/2023]
Abstract
Artificial intelligence (AI) is already widely used in different fields of medicine, making possible the integration of the paraclinical exams with the clinical findings in patients, for a more accurate and rapid diagnosis and treatment decision. The electrocardiogram remains one of the most important, fastest, cheapest, and noninvasive methods of diagnosis in cardiology, despite the rapid development and progression of the technology. Even if studied a long time ago, it still has a lot of less understood features that, with a better understanding, can give more clues to a correct and prompt diagnosis in a short time. The use of AI in the interpretation of the ECG improved the accuracy and the time to diagnosis in different cardiovascular diseases, and more than this, explaining the decision to make AI diagnosis improved the human understanding of the different features of the ECG that might be considered for a more accurate diagnosis. The purpose of this article is to provide an overview of the most recently published articles about the use of AI in ECG interpretation.
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Affiliation(s)
- Gabriela Raileanu
- Department of Cardiology, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands.
| | - Jonas S S G de Jong
- Department of Cardiology, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands
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13
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Kolasa K, Admassu B, Hołownia-Voloskova M, Kędzior KJ, Poirrier JE, Perni S. Systematic reviews of machine learning in healthcare: a literature review. Expert Rev Pharmacoecon Outcomes Res 2024; 24:63-115. [PMID: 37955147 DOI: 10.1080/14737167.2023.2279107] [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: 07/17/2023] [Accepted: 10/31/2023] [Indexed: 11/14/2023]
Abstract
INTRODUCTION The increasing availability of data and computing power has made machine learning (ML) a viable approach to faster, more efficient healthcare delivery. METHODS A systematic literature review (SLR) of published SLRs evaluating ML applications in healthcare settings published between1 January 2010 and 27 March 2023 was conducted. RESULTS In total 220 SLRs covering 10,462 ML algorithms were reviewed. The main application of AI in medicine related to the clinical prediction and disease prognosis in oncology and neurology with the use of imaging data. Accuracy, specificity, and sensitivity were provided in 56%, 28%, and 25% SLRs respectively. Internal and external validation was reported in 53% and less than 1% of the cases respectively. The most common modeling approach was neural networks (2,454 ML algorithms), followed by support vector machine and random forest/decision trees (1,578 and 1,522 ML algorithms, respectively). EXPERT OPINION The review indicated considerable reporting gaps in terms of the ML's performance, both internal and external validation. Greater accessibility to healthcare data for developers can ensure the faster adoption of ML algorithms into clinical practice.
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Affiliation(s)
- Katarzyna Kolasa
- Division of Health Economics and Healthcare Management, Kozminski University, Warsaw, Poland
| | - Bisrat Admassu
- Division of Health Economics and Healthcare Management, Kozminski University, Warsaw, Poland
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14
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Bacharova L, Chevalier P, Gorenek B, Jons C, Li YG, Locati ET, Maanja M, Pérez-Riera AR, Platonov PG, Ribeiro ALP, Schocken D, Soliman EZ, Svehlikova J, Tereshchenko LG, Ugander M, Varma N, Zaklyazminskaya E, Ikeda T. ISE/ISHNE Expert Consensus Statement on ECG Diagnosis of Left Ventricular Hypertrophy: The Change of the Paradigm. The joint paper of the International Society of Electrocardiology and the International Society for Holter Monitoring and Noninvasive Electrocardiology. J Electrocardiol 2023; 81:85-93. [PMID: 37647776 DOI: 10.1016/j.jelectrocard.2023.08.005] [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: 08/07/2023] [Accepted: 08/08/2023] [Indexed: 09/01/2023]
Abstract
The ECG diagnosis of LVH is predominantly based on the QRS voltage criteria, i.e. the increased QRS complex amplitude in defined leads. The classical ECG diagnostic paradigm postulates that the increased left ventricular mass generates a stronger electrical field, increasing the leftward and posterior QRS forces. These increased forces are reflected in the augmented QRS amplitude in the corresponding leads. However, the clinical observations document increased QRS amplitude only in the minority of patients with LVH. The low sensitivity of voltage criteria has been repeatedly documented. We discuss possible reasons for this shortcoming and proposal of a new paradigm.
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Affiliation(s)
- Ljuba Bacharova
- International Laser Center CVTI, Ilkovicova 3, 841 04 Bratislava, Slovak Republic.
| | - Philippe Chevalier
- Neuromyogene Institute, Claude Bernard University, Lyon 1, Villeurbanne, France; Service de Rythmologie, Hospices Civils de Lyon, Lyon, France.
| | - Bulent Gorenek
- Eskisehir Osmangazi University, Cardiology Department, Eskisehir, Turkiye.
| | - Christian Jons
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Yi-Gang Li
- Department of Cardiology, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, 200092 Shanghai, PR China.
| | - Emanuela T Locati
- Department of Arrhythmology and Electrophysiology, IRCCS Policlinico San Donato, Piazza E. Malan 2, 20097 San Donato Milanese, Milano, Italy.
| | - Maren Maanja
- Department of Clinical Physiology, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden.
| | | | - Pyotr G Platonov
- Department of Cardiology, Clinical Sciences, Lund University, Lund, Sweden.
| | - Antonio Luiz P Ribeiro
- Internal Medicine, Faculdade de Medicina da Universidade Federal de Minas Gerais, Belo Horizonte, Brazil; Telehealth Center, Hospital das Clínicas da Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Douglas Schocken
- Division of Cardiology, Department of Medicine, Duke University Medical Center, Durham, NC, USA.
| | - Elsayed Z Soliman
- Epidemiological Cardiology Research Center, Section on Cardiovascular Medicine, Department of Medicine, Wake Forest University School of Medicine, Winston-Salem, NC, USA.
| | - Jana Svehlikova
- Institute of Measurement Sciences, Slovak Academy of Sciences, Bratislava, Slovak Republic.
| | - Larisa G Tereshchenko
- Department of Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic, 9500 Euclid Ave JJN3-01, Cleveland, OH 44195, USA.
| | - Martin Ugander
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia; Department of Clinical Physiology, Karolinska Institute, Stockholm, Stockholm, Sweden
| | - Niraj Varma
- Cardiac Pacing & Electrophysiology, Heart and Vascular Institute, Cleveland Clinic, 9500 Euclid Ave J2-2, Cleveland, OH 44195, USA.
| | - Elena Zaklyazminskaya
- Medical Genetics Laboratory, Petrovsky National Research Centre of Surgery, Moscow 119991, Russia
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15
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Jeon KH, Jang JH, Kang S, Lee HS, Lee MS, Son JM, Jo YY, Park TJ, Oh IY, Kwon JM, Lee JH. Identifying Atrial Fibrillation With Sinus Rhythm Electrocardiogram in Embolic Stroke of Undetermined Source: A Validation Study With Insertable Cardiac Monitors. Korean Circ J 2023; 53:758-771. [PMID: 37973386 PMCID: PMC10654409 DOI: 10.4070/kcj.2023.0009] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 05/30/2023] [Accepted: 06/28/2023] [Indexed: 11/19/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Paroxysmal atrial fibrillation (AF) is a major potential cause of embolic stroke of undetermined source (ESUS). However, identifying AF remains challenging because it occurs sporadically. Deep learning could be used to identify hidden AF based on the sinus rhythm (SR) electrocardiogram (ECG). We combined known AF risk factors and developed a deep learning algorithm (DLA) for predicting AF to optimize diagnostic performance in ESUS patients. METHODS A DLA was developed to identify AF using SR 12-lead ECG with the database consisting of AF patients and non-AF patients. The accuracy of the DLA was validated in 221 ESUS patients who underwent insertable cardiac monitor (ICM) insertion to identify AF. RESULTS A total of 44,085 ECGs from 12,666 patient were used for developing the DLA. The internal validation of the DLA revealed 0.862 (95% confidence interval, 0.850-0.873) area under the curve (AUC) in the receiver operating curve analysis. In external validation data from 221 ESUS patients, the diagnostic accuracy of DLA and AUC were 0.811 and 0.827, respectively, and DLA outperformed conventional predictive models, including CHARGE-AF, C2HEST, and HATCH. The combined model, comprising atrial ectopic burden, left atrial diameter and the DLA, showed excellent performance in AF prediction with AUC of 0.906. CONCLUSIONS The DLA accurately identified paroxysmal AF using 12-lead SR ECG in patients with ESUS and outperformed the conventional models. The DLA model along with the traditional AF risk factors could be a useful tool to identify paroxysmal AF in ESUS patients.
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Affiliation(s)
- Ki-Hyun Jeon
- Division of Cardiology, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Jong-Hwan Jang
- Medical Research Team, Medical AI Inc., San Francisco, CA, USA
| | - Sora Kang
- Medical Research Team, Medical AI Inc., San Francisco, CA, USA
| | - Hak Seung Lee
- Medical Research Team, Medical AI Inc., San Francisco, CA, USA
| | - Min Sung Lee
- Medical Research Team, Medical AI Inc., San Francisco, CA, USA
| | - Jeong Min Son
- Medical Research Team, Medical AI Inc., San Francisco, CA, USA
| | - Yong-Yeon Jo
- Medical Research Team, Medical AI Inc., San Francisco, CA, USA
| | - Tae Jun Park
- Medical Research Team, Medical AI Inc., San Francisco, CA, USA
| | - Il-Young Oh
- Division of Cardiology, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Joon-Myoung Kwon
- Medical Research Team, Medical AI Inc., San Francisco, CA, USA
- Department of Critical Care and Emergency Medicine, Incheon Sejong Hospital, Incheon, Korea.
| | - Ji Hyun Lee
- Division of Cardiology, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea.
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Asatryan B, Bleijendaal H, Wilde AAM. Toward advanced diagnosis and management of inherited arrhythmia syndromes: Harnessing the capabilities of artificial intelligence and machine learning. Heart Rhythm 2023; 20:1399-1407. [PMID: 37442407 DOI: 10.1016/j.hrthm.2023.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 06/20/2023] [Accepted: 07/02/2023] [Indexed: 07/15/2023]
Abstract
The use of advanced computational technologies, such as artificial intelligence (AI), is now exerting a significant influence on various aspects of life, including health care and science. AI has garnered remarkable public notice with the release of deep learning models that can model anything from artwork to academic papers with minimal human intervention. Machine learning, a method that uses algorithms to extract information from raw data and represent it in a model, and deep learning, a method that uses multiple layers to progressively extract higher-level features from the raw input with minimal human intervention, are increasingly leveraged to tackle problems in the health sector, including utilization for clinical decision support in cardiovascular medicine. Inherited arrhythmia syndromes are a clinical domain where multiple unanswered questions remain despite unprecedented progress over the past 2 decades with the introduction of large panel genetic testing and the first steps in precision medicine. In particular, AI tools can help address gaps in clinical diagnosis by identifying individuals with concealed or transient phenotypes; enhance risk stratification by elevating recognition of underlying risk burden beyond widely recognized risk factors; improve prediction of response to therapy, and further prognostication. In this contemporary review, we provide a summary of the AI models developed to solve challenges in inherited arrhythmia syndromes and also outline gaps that can be filled with the development of intelligent AI models.
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Affiliation(s)
- Babken Asatryan
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland.
| | - Hidde Bleijendaal
- University of Amsterdam, Heart Center; Department of Clinical and Experimental Cardiology, Amsterdam Cardiovascular Sciences, Heart Failure and Arrhythmias, Amsterdam, The Netherlands; Department of Clinical Epidemiology, Biostatistics and Bioinformatics, University of Amsterdam, Amsterdam, The Netherlands
| | - Arthur A M Wilde
- University of Amsterdam, Heart Center; Department of Clinical and Experimental Cardiology, Amsterdam Cardiovascular Sciences, Heart Failure and Arrhythmias, Amsterdam, The Netherlands; Department of Clinical Epidemiology, Biostatistics and Bioinformatics, University of Amsterdam, Amsterdam, The Netherlands; European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart (ERN GUARD-Heart)
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17
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Svennberg E, Caiani EG, Bruining N, Desteghe L, Han JK, Narayan SM, Rademakers FE, Sanders P, Duncker D. The digital journey: 25 years of digital development in electrophysiology from an Europace perspective. Europace 2023; 25:euad176. [PMID: 37622574 PMCID: PMC10450797 DOI: 10.1093/europace/euad176] [Citation(s) in RCA: 17] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 06/03/2023] [Indexed: 08/26/2023] Open
Abstract
AIMS Over the past 25 years there has been a substantial development in the field of digital electrophysiology (EP) and in parallel a substantial increase in publications on digital cardiology.In this celebratory paper, we provide an overview of the digital field by highlighting publications from the field focusing on the EP Europace journal. RESULTS In this journey across the past quarter of a century we follow the development of digital tools commonly used in the clinic spanning from the initiation of digital clinics through the early days of telemonitoring, to wearables, mobile applications, and the use of fully virtual clinics. We then provide a chronicle of the field of artificial intelligence, a regulatory perspective, and at the end of our journey provide a future outlook for digital EP. CONCLUSION Over the past 25 years Europace has published a substantial number of papers on digital EP, with a marked expansion in digital publications in recent years.
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Affiliation(s)
- Emma Svennberg
- Department of Medicine Huddinge, Karolinska Institutet, Karolinska University Hospital Huddinge, SE-141 86 Stockholm, Sweden
| | - Enrico G Caiani
- Politecnico di Milano, Electronic, Information and Biomedical Engineering Department, Milan, Italy
- Istituto Auxologico Italiano IRCCS, Milan, Italy
| | - Nico Bruining
- Department of Clinical and Experimental Information processing (Digital Cardiology), Erasmus Medical Center, Thoraxcenter, Rotterdam, The Netherlands
| | - Lien Desteghe
- Research Group Cardiovascular Diseases, University of Antwerp, 2000 Antwerp, Belgium
- Department of Cardiology, Antwerp University Hospital, 2056 Edegem, Belgium
- Faculty of Medicine and Life Sciences, Hasselt University, 3500 Hasselt, Belgium
- Department of Cardiology, Heart Centre Hasselt, Jessa Hospital, 3500 Hasselt, Belgium
| | - Janet K Han
- Division of Cardiology, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA 90073, USA
- Cardiac Arrhythmia Center, University of California Los Angeles, Los Angeles, CA, USA
| | - Sanjiv M Narayan
- Cardiology Division, Cardiovascular Institute and Institute for Computational and Mathematical Engineering, Stanford University, Stanford, CA, USA
| | | | - Prashanthan Sanders
- Centre for Heart Rhythm Disorders, University of Adelaide and Royal Adelaide Hospital, 5005 Adelaide, Australia
| | - David Duncker
- Hannover Heart Rhythm Center, Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany
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18
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Somani S, Hughes JW, Ashley EA, Witteles RM, Perez MV. Development and validation of a rapid visual technique for left ventricular hypertrophy detection from the electrocardiogram. Front Cardiovasc Med 2023; 10:1251511. [PMID: 37711561 PMCID: PMC10499494 DOI: 10.3389/fcvm.2023.1251511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Accepted: 08/08/2023] [Indexed: 09/16/2023] Open
Abstract
Introduction Left ventricular hypertrophy (LVH) detection techniques on by electrocardiogram (ECG) are cumbersome to remember with modest performance. This study validated a rapid technique for LVH detection and measured its performance against other techniques. Methods This was a retrospective cohort study of patients at Stanford Health Care who received ECGs and resting transthoracic echocardiograms (TTE) from 2006 through 2018. The novel technique, Witteles-Somani (WS), assesses for S- and R-wave overlap on adjacent precordial leads. The WS, Sokolow-Lyon, Cornell, and Peguero-Lo Presti techniques were algorithmically implemented on ECGs. Classification metrics, receiver-operator curves, and Pearson correlations measured performance. Age- and sex-adjusted Cox proportional hazard models evaluated associations between incident cardiovascular outcomes and each technique. Results A total of 53,333 ECG-TTE pairs from 18,873 patients were identified. Of all ECG-TTE pairs, 21,638 (40.6%) had TTE-diagnosed LVH. The WS technique had a sensitivity of 0.46, specificity of 0.66, and AUROC of 0.56, compared to Sokolow-Lyon (AUROC 0.55), Cornell (AUROC 0.63), and Peguero-Lo Presti (AUROC 0.63). Patients meeting LVH by WS technique had a higher risk of cardiovascular mortality [HR 1.18, 95% CI (1.12, 1.24), P < 0.001] and a higher risk of developing any cardiovascular disease [HR 1.29, 95% CI (1.22, 1.36), P < 0.001], myocardial infarction [HR 1.60, 95% CI (1.44, 1.78), P < 0.005], and heart failure [HR 1.24, 95% CI (1.17, 1.32), P < 0.001]. Conclusions The WS criteria is a rapid visual technique for LVH detection with performance like other LVH detection techniques and is associated with incident cardiovascular outcomes.
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Affiliation(s)
- Sulaiman Somani
- Division of Internal Medicine, Department of Medicine, Stanford University, Stanford, CA, United States
- Stanford Cardiovascular Institute, Stanford, CA, United States
| | - J. Weston Hughes
- Division of Cardiovascular Medicine, Department of Medicine, Stanford University, Stanford, CA, United States
- Department of Computer Science, Stanford University, Stanford, CA, United States
| | - Euan A. Ashley
- Division of Cardiovascular Medicine, Department of Medicine, Stanford University, Stanford, CA, United States
| | - Ronald M. Witteles
- Division of Cardiovascular Medicine, Department of Medicine, Stanford University, Stanford, CA, United States
| | - Marco V. Perez
- Division of Cardiovascular Medicine, Department of Medicine, Stanford University, Stanford, CA, United States
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19
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Komuro J, Kusumoto D, Hashimoto H, Yuasa S. Machine learning in cardiology: Clinical application and basic research. J Cardiol 2023; 82:128-133. [PMID: 37141938 DOI: 10.1016/j.jjcc.2023.04.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 04/23/2023] [Accepted: 04/28/2023] [Indexed: 05/06/2023]
Abstract
Machine learning is a subfield of artificial intelligence. The quality and versatility of machine learning have been rapidly improving and playing a critical role in many aspects of social life. This trend is also observed in the medical field. Generally, there are three main types of machine learning: supervised, unsupervised, and reinforcement learning. Each type of learning is adequately selected for the purpose and type of data. In the field of medicine, various types of information are collected and used, and research using machine learning is becoming increasingly relevant. Many clinical studies are conducted using electronic health and medical records, including in the cardiovascular area. Machine learning has also been applied in basic research. Machine learning has been widely used for several types of data analysis, such as clustering of microarray analysis and RNA sequence analysis. Machine learning is essential for genome and multi-omics analyses. This review summarizes the recent advancements in the use of machine learning in clinical applications and basic cardiovascular research.
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Affiliation(s)
- Jin Komuro
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Dai Kusumoto
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Hisayuki Hashimoto
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Shinsuke Yuasa
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan.
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20
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Ryu JS, Lee S, Chu Y, Ahn MS, Park YJ, Yang S. CoAt-Mixer: Self-attention deep learning framework for left ventricular hypertrophy using electrocardiography. PLoS One 2023; 18:e0286916. [PMID: 37289800 PMCID: PMC10249819 DOI: 10.1371/journal.pone.0286916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Accepted: 05/25/2023] [Indexed: 06/10/2023] Open
Abstract
Left ventricular hypertrophy is a significant independent risk factor for all-cause mortality and morbidity, and an accurate diagnosis at an early stage of heart change is clinically significant. Electrocardiography is the most convenient, economical, and non-invasive method for screening in primary care. However, the coincidence rate of the actual left ventricular hypertrophy and diagnostic findings was low, consequently increasing the interest in algorithms using big data and deep learning. We attempted to diagnose left ventricular hypertrophy using big data and deep learning algorithms, and aimed to confirm its diagnostic power according to the differences between males and females. This retrospective study used electrocardiographs obtained at Yonsei University Wonju Severance Christian Hospital, Wonju, Korea, from October 2010 to February 2020. Binary classification was performed for primary screening for left ventricular hypertrophy. Three datasets were used for the experiment: the male, female, and entire dataset. A cutoff for binary classification was defined as the meaningful as a screening test (<132 g/m2 vs. ≥132 g/m2, <109 g/m2 vs. ≥109 g/m2). Six types of input were used for the classification tasks. We attempted to determine whether electrocardiography had predictive power for left ventricular hypertrophy diagnosis. For the entire dataset, the model achieved an area under the receiver operating characteristic (AUROC) curve of 0.836 (95% CI, 0.833-838) with a sensitivity of 78.37% (95% CI, 76.79-79.95). For the male dataset, the AUROC was 0.826 (95% CI, 0.822-830) with a sensitivity of 76.73% (95% CI, 75.14-78.33). For the female dataset, the AUROC was 0.772 (95% CI, 0.769-775) with a sensitivity of 72.90% (95% CI, 70.33-75.46). Our model confirmed that left ventricular hypertrophy can be classified to some extent using electrocardiography, demographics, and electrocardiography features. In particular, a learning environment that considered gender differences was constructed. Consequently, the difference in diagnostic power between men and women was confirmed. Our model will help patients with suspected left ventricular hypertrophy to undergo screening tests at a low cost. In addition, our research and attempts will show the expected effect that gender-consideration approaches can help with various currently proposed diagnostic methods.
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Affiliation(s)
- Ji Seung Ryu
- Department of Precision Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Solam Lee
- Department of Preventive Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea
- Department of Dermatology, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Yuseong Chu
- Department of Biomedical Engineering, Yonsei University, Wonju, Korea
| | - Min-Soo Ahn
- Division of Cardiology, Department of Internal Medicine, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Young Jun Park
- Division of Cardiology, Department of Internal Medicine, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Sejung Yang
- Department of Precision Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea
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21
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Holmstrom L, Christensen M, Yuan N, Weston Hughes J, Theurer J, Jujjavarapu M, Fatehi P, Kwan A, Sandhu RK, Ebinger J, Cheng S, Zou J, Chugh SS, Ouyang D. Deep learning-based electrocardiographic screening for chronic kidney disease. COMMUNICATIONS MEDICINE 2023; 3:73. [PMID: 37237055 DOI: 10.1038/s43856-023-00278-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Accepted: 03/10/2023] [Indexed: 05/28/2023] Open
Abstract
BACKGROUND Undiagnosed chronic kidney disease (CKD) is a common and usually asymptomatic disorder that causes a high burden of morbidity and early mortality worldwide. We developed a deep learning model for CKD screening from routinely acquired ECGs. METHODS We collected data from a primary cohort with 111,370 patients which had 247,655 ECGs between 2005 and 2019. Using this data, we developed, trained, validated, and tested a deep learning model to predict whether an ECG was taken within one year of the patient receiving a CKD diagnosis. The model was additionally validated using an external cohort from another healthcare system which had 312,145 patients with 896,620 ECGs between 2005 and 2018. RESULTS Using 12-lead ECG waveforms, our deep learning algorithm achieves discrimination for CKD of any stage with an AUC of 0.767 (95% CI 0.760-0.773) in a held-out test set and an AUC of 0.709 (0.708-0.710) in the external cohort. Our 12-lead ECG-based model performance is consistent across the severity of CKD, with an AUC of 0.753 (0.735-0.770) for mild CKD, AUC of 0.759 (0.750-0.767) for moderate-severe CKD, and an AUC of 0.783 (0.773-0.793) for ESRD. In patients under 60 years old, our model achieves high performance in detecting any stage CKD with both 12-lead (AUC 0.843 [0.836-0.852]) and 1-lead ECG waveform (0.824 [0.815-0.832]). CONCLUSIONS Our deep learning algorithm is able to detect CKD using ECG waveforms, with stronger performance in younger patients and more severe CKD stages. This ECG algorithm has the potential to augment screening for CKD.
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Affiliation(s)
- Lauri Holmstrom
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
- Center for Cardiac Arrest Prevention, Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
- Research Unit of Internal Medicine, Medical Research Center Oulu, University of Oulu and Oulu University Hospital, Oulu, Finland
- Division of Artificial Intelligence in Medicine, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Matthew Christensen
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
- Division of Artificial Intelligence in Medicine, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Neal Yuan
- Department of Medicine, Division of Cardiology, San Francisco VA, UCSF, San Francisco, CA, USA
| | - J Weston Hughes
- Department of Computer Science, Stanford University, Palo Alto, CA, USA
| | - John Theurer
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
- Division of Artificial Intelligence in Medicine, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Melvin Jujjavarapu
- Enterprise Information Service, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Pedram Fatehi
- Division of Nephrology, Department of Medicine, Stanford University, Palo Alto, CA, USA
| | - Alan Kwan
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Roopinder K Sandhu
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Joseph Ebinger
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Susan Cheng
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - James Zou
- Department of Computer Science, Stanford University, Palo Alto, CA, USA
- Department of Biomedical Data Science, Stanford University, Palo Alto, CA, USA
| | - Sumeet S Chugh
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
- Center for Cardiac Arrest Prevention, Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
- Division of Artificial Intelligence in Medicine, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - David Ouyang
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
- Division of Artificial Intelligence in Medicine, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
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22
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Haimovich JS, Diamant N, Khurshid S, Di Achille P, Reeder C, Friedman S, Singh P, Spurlock W, Ellinor PT, Philippakis A, Batra P, Ho JE, Lubitz SA. Artificial Intelligence Enabled Classification of Hypertrophic Heart Diseases Using Electrocardiograms. CARDIOVASCULAR DIGITAL HEALTH JOURNAL 2023; 4:48-59. [PMID: 37101945 PMCID: PMC10123506 DOI: 10.1016/j.cvdhj.2023.03.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/09/2023] Open
Abstract
Background Differentiating among cardiac diseases associated with left ventricular hypertrophy (LVH) informs diagnosis and clinical care. Objective To evaluate if artificial intelligence-enabled analysis of the 12-lead electrocardiogram (ECG) facilitates automated detection and classification of LVH. Methods We used a pretrained convolutional neural network to derive numerical representations of 12-lead ECG waveforms from patients in a multi-institutional healthcare system who had cardiac diseases associated with LVH (n = 50,709), including cardiac amyloidosis (n = 304), hypertrophic cardiomyopathy (n = 1056), hypertension (n = 20,802), aortic stenosis (n = 446), and other causes (n = 4766). We then regressed LVH etiologies relative to no LVH on age, sex, and the numerical 12-lead representations using logistic regression ("LVH-Net"). To assess deep learning model performance on single-lead data analogous to mobile ECGs, we also developed 2 single-lead deep learning models by training models on lead I ("LVH-Net Lead I") or lead II ("LVH-Net Lead II") from the 12-lead ECG. We compared the performance of the LVH-Net models to alternative models fit on (1) age, sex, and standard ECG measures, and (2) clinical ECG-based rules for diagnosing LVH. Results The areas under the receiver operator characteristic curve of LVH-Net by specific LVH etiology were cardiac amyloidosis 0.95 [95% CI, 0.93-0.97], hypertrophic cardiomyopathy 0.92 [95% CI, 0.90-0.94], aortic stenosis LVH 0.90 [95% CI, 0.88-0.92], hypertensive LVH 0.76 [95% CI, 0.76-0.77], and other LVH 0.69 [95% CI 0.68-0.71]. The single-lead models also discriminated LVH etiologies well. Conclusion An artificial intelligence-enabled ECG model is favorable for detection and classification of LVH and outperforms clinical ECG-based rules.
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Affiliation(s)
- Julian S. Haimovich
- Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
- Cardiovascular Research Center, Massachusetts General Hospital, Boston, Massachusetts
- Cardiovascular Disease Initiative, Broad Institute of MIT and Harvard, Cambridge, Massachusetts
| | - Nate Diamant
- Data Sciences Platform, Broad Institute of MIT and Harvard, Cambridge, Massachusetts
| | - Shaan Khurshid
- Cardiovascular Research Center, Massachusetts General Hospital, Boston, Massachusetts
- Cardiovascular Disease Initiative, Broad Institute of MIT and Harvard, Cambridge, Massachusetts
- Demoulas Center for Cardiac Arrhythmias, Massachusetts General Hospital, Boston, Massachusetts
| | - Paolo Di Achille
- Data Sciences Platform, Broad Institute of MIT and Harvard, Cambridge, Massachusetts
| | - Christopher Reeder
- Data Sciences Platform, Broad Institute of MIT and Harvard, Cambridge, Massachusetts
| | - Sam Friedman
- Data Sciences Platform, Broad Institute of MIT and Harvard, Cambridge, Massachusetts
| | - Pulkit Singh
- Data Sciences Platform, Broad Institute of MIT and Harvard, Cambridge, Massachusetts
| | - Walter Spurlock
- Data Sciences Platform, Broad Institute of MIT and Harvard, Cambridge, Massachusetts
| | - Patrick T. Ellinor
- Cardiovascular Research Center, Massachusetts General Hospital, Boston, Massachusetts
- Cardiovascular Disease Initiative, Broad Institute of MIT and Harvard, Cambridge, Massachusetts
- Demoulas Center for Cardiac Arrhythmias, Massachusetts General Hospital, Boston, Massachusetts
| | - Anthony Philippakis
- Demoulas Center for Cardiac Arrhythmias, Massachusetts General Hospital, Boston, Massachusetts
- Eric and Wendy Schmidt Center, Broad Institute of MIT and Harvard, Cambridge, Massachusetts
| | - Puneet Batra
- Data Sciences Platform, Broad Institute of MIT and Harvard, Cambridge, Massachusetts
| | - Jennifer E. Ho
- CardioVascular Institute and Division of Cardiology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Steven A. Lubitz
- Cardiovascular Research Center, Massachusetts General Hospital, Boston, Massachusetts
- Cardiovascular Disease Initiative, Broad Institute of MIT and Harvard, Cambridge, Massachusetts
- Demoulas Center for Cardiac Arrhythmias, Massachusetts General Hospital, Boston, Massachusetts
- Address reprint requests and correspondence: Dr Steven A. Lubitz, Demoulas Center for Cardiac Arrhythmias and Cardiovascular Research Center, Massachusetts General Hospital, 55 Fruit Street, GRB 109, Boston, MA 02114.
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23
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Liu CW, Wu FH, Hu YL, Pan RH, Lin CH, Chen YF, Tseng GS, Chan YK, Wang CL. Left ventricular hypertrophy detection using electrocardiographic signal. Sci Rep 2023; 13:2556. [PMID: 36781924 PMCID: PMC9924839 DOI: 10.1038/s41598-023-28325-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2022] [Accepted: 01/17/2023] [Indexed: 02/15/2023] Open
Abstract
Left ventricular hypertrophy (LVH) indicates subclinical organ damage, associating with the incidence of cardiovascular diseases. From the medical perspective, electrocardiogram (ECG) is a low-cost, non-invasive, and easily reproducible tool that is often used as a preliminary diagnosis for the detection of heart disease. Nowadays, there are many criteria for assessing LVH by ECG. These criteria usually include that voltage combination of RS peaks in multi-lead ECG must be greater than one or more thresholds for diagnosis. We developed a system for detecting LVH using ECG signals by two steps: firstly, the R-peak and S-valley amplitudes of the 12-lead ECG were extracted to automatically obtain a total of 24 features and ECG beats of each case (LVH or non-LVH) were segmented; secondly, a back propagation neural network (BPN) was trained using a dataset with these features. Echocardiography (ECHO) was used as the gold standard for diagnosing LVH. The number of LVH cases (of a Taiwanese population) identified was 173. As each ECG sequence generally included 8 to 13 cycles (heartbeats) due to differences in heart rate, etc., we identified 1466 ECG cycles of LVH patients after beat segmentation. Results showed that our BPN model for detecting LVH reached the testing accuracy, precision, sensitivity, and specificity of 0.961, 0.958, 0.966 and 0.956, respectively. Detection performances of our BPN model, on the whole, outperform 7 methods using ECG criteria and many ECG-based artificial intelligence (AI) models reported previously for detecting LVH.
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Affiliation(s)
- Cheng-Wei Liu
- Division of Cardiology, Department of Internal Medicine, Tri-Service General Hospital Songshan Branch, National Defense Medical Center, Taipei, Taiwan
| | - Fu-Hsing Wu
- Bachelor Degree Program of Artificial Intelligence, National Taichung University of Science and Technology, Taichung, Taiwan
| | - Yu-Lun Hu
- Department of Management Information Systems, National Chung-Hsing University, Taichung, Taiwan
| | - Ren-Hao Pan
- La Vida Tec. Co. Ltd., Taichung, Taiwan
- Preventive Medicine Center, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Department of Information Management, Tunghai University, Taichung, Taiwan
| | - Chuen-Horng Lin
- Department of Computer Science and Information Engineering, National Taichung University of Science and Technology, Taichung, Taiwan
| | - Yung-Fu Chen
- Department of Dental Technology and Materials Science, Central Taiwan University of Science and Technology, Taichung, Taiwan
| | - Guo-Shiang Tseng
- Division of Cardiology, Department of Internal Medicine, Taoyuan Armed Force General Hospital Hsinchu Branch, Hsinchu, Taiwan
| | - Yung-Kuan Chan
- Department of Management Information Systems, National Chung-Hsing University, Taichung, Taiwan.
| | - Ching-Lin Wang
- Department of Information Management, National Chin-Yi University of Technology, Taichung, Taiwan.
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24
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Libiseller-Egger J, Phelan JE, Attia ZI, Benavente ED, Campino S, Friedman PA, Lopez-Jimenez F, Leon DA, Clark TG. Deep learning-derived cardiovascular age shares a genetic basis with other cardiac phenotypes. Sci Rep 2022; 12:22625. [PMID: 36587059 PMCID: PMC9805465 DOI: 10.1038/s41598-022-27254-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 12/28/2022] [Indexed: 01/01/2023] Open
Abstract
Artificial intelligence (AI)-based approaches can now use electrocardiograms (ECGs) to provide expert-level performance in detecting heart abnormalities and diagnosing disease. Additionally, patient age predicted from ECGs by AI models has shown great potential as a biomarker for cardiovascular age, where recent work has found its deviation from chronological age ("delta age") to be associated with mortality and co-morbidities. However, despite being crucial for understanding underlying individual risk, the genetic underpinning of delta age is unknown. In this work we performed a genome-wide association study using UK Biobank data (n=34,432) and identified eight loci associated with delta age ([Formula: see text]), including genes linked to cardiovascular disease (CVD) (e.g. SCN5A) and (heart) muscle development (e.g. TTN). Our results indicate that the genetic basis of cardiovascular ageing is predominantly determined by genes directly involved with the cardiovascular system rather than those connected to more general mechanisms of ageing. Our insights inform the epidemiology of CVD, with implications for preventative and precision medicine.
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Affiliation(s)
- Julian Libiseller-Egger
- Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
| | - Jody E Phelan
- Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
| | - Zachi I Attia
- Department of Cardiovascular Medicine, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - Ernest Diez Benavente
- Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
- Laboratory of Experimental Cardiology, University Medical Center Utrecht, Utrecht, Netherlands
| | - Susana Campino
- Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
| | - Paul A Friedman
- Department of Cardiovascular Medicine, Mayo Clinic College of Medicine, Rochester, MN, USA
| | | | - David A Leon
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
- Department of Community Medicine, UiT the Arctic University of Norway, Tromsø, Norway
| | - Taane G Clark
- Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK.
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK.
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25
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Shaikh F, Kenny JE, Awan O, Markovic D, Friedman O, He T, Singh S, Yan P, Qadir N, Barjaktarevic I. Measuring the accuracy of cardiac output using POCUS: the introduction of artificial intelligence into routine care. Ultrasound J 2022; 14:47. [DOI: 10.1186/s13089-022-00301-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 12/07/2022] [Indexed: 12/15/2022] Open
Abstract
Abstract
Background
Shock management requires quick and reliable means to monitor the hemodynamic effects of fluid resuscitation. Point-of-care ultrasound (POCUS) is a relatively quick and non-invasive imaging technique capable of capturing cardiac output (CO) variations in acute settings. However, POCUS is plagued by variable operator skill and interpretation. Artificial intelligence may assist healthcare professionals obtain more objective and precise measurements during ultrasound imaging, thus increasing usability among users with varying experience. In this feasibility study, we compared the performance of novice POCUS users in measuring CO with manual techniques to a novel automation-assisted technique that provides real-time feedback to correct image acquisition for optimal aortic outflow velocity measurement.
Methods
28 junior critical care trainees with limited experience in POCUS performed manual and automation-assisted CO measurements on a single healthy volunteer. CO measurements were obtained using left ventricular outflow tract (LVOT) velocity time integral (VTI) and LVOT diameter. Measurements obtained by study subjects were compared to those taken by board-certified echocardiographers. Comparative analyses were performed using Spearman’s rank correlation and Bland–Altman matched-pairs analysis.
Results
Adequate image acquisition was 100% feasible. The correlation between manual and automated VTI values was not significant (p = 0.11) and means from both groups underestimated the mean values obtained by board-certified echocardiographers. Automated measurements of VTI in the trainee cohort were found to have more reproducibility, narrower measurement range (6.2 vs. 10.3 cm), and reduced standard deviation (1.98 vs. 2.33 cm) compared to manual measurements. The coefficient of variation across raters was 11.5%, 13.6% and 15.4% for board-certified echocardiographers, automated, and manual VTI tracing, respectively.
Conclusions
Our study demonstrates that novel automation-assisted VTI is feasible and can decrease variability while increasing precision in CO measurement. These results support the use of artificial intelligence-augmented image acquisition in routine critical care ultrasound and may have a role for evaluating the response of CO to hemodynamic interventions. Further investigations into artificial intelligence-assisted ultrasound systems in clinical settings are warranted.
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Heaney J, Buick J, Hadi MU, Soin N. Internet of Things-Based ECG and Vitals Healthcare Monitoring System. MICROMACHINES 2022; 13:2153. [PMID: 36557452 PMCID: PMC9780965 DOI: 10.3390/mi13122153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 11/29/2022] [Accepted: 11/30/2022] [Indexed: 06/17/2023]
Abstract
Health monitoring and its associated technologies have gained enormous importance over the past few years. The electrocardiogram (ECG) has long been a popular tool for assessing and diagnosing cardiovascular diseases (CVDs). Since the literature on ECG monitoring devices is growing at an exponential rate, it is becoming difficult for researchers and healthcare professionals to select, compare, and assess the systems that meet their demands while also meeting the monitoring standards. This emphasizes the necessity for a reliable reference to guide the design, categorization, and analysis of ECG monitoring systems, which will benefit both academics and practitioners. We present a complete ECG monitoring system in this work, describing the design stages and implementation of an end-to-end solution for capturing and displaying the patient's heart signals, heart rate, blood oxygen levels, and body temperature. The data will be presented on an OLED display, a developed Android application as well as in MATLAB via serial communication. The Internet of Things (IoT) approaches have a clear advantage in tackling the problem of heart disease patient care as they can transform the service mode into a widespread one and alert the healthcare services based on the patient's physical condition. Keeping this in mind, there is also the addition of a web server for monitoring the patient's status via WiFi. The prototype, which is compliant with the electrical safety regulations and medical equipment design, was further benchmarked against a commercially available off-the-shelf device, and showed an excellent accuracy of 99.56%.
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27
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Kokubo T, Kodera S, Sawano S, Katsushika S, Nakamoto M, Takeuchi H, Kimura N, Shinohara H, Matsuoka R, Nakanishi K, Nakao T, Higashikuni Y, Takeda N, Fujiu K, Daimon M, Akazawa H, Morita H, Matsuyama Y, Komuro I. Automatic Detection of Left Ventricular Dilatation and Hypertrophy from Electrocardiograms Using Deep Learning. Int Heart J 2022; 63:939-947. [PMID: 36104234 DOI: 10.1536/ihj.22-132] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Left ventricular dilatation (LVD) and left ventricular hypertrophy (LVH) are risk factors for heart failure, and their detection improves heart failure screening. This study aimed to investigate the ability of deep learning to detect LVD and LVH from a 12-lead electrocardiogram (ECG). Using ECG and echocardiographic data, we developed deep learning and machine learning models to detect LVD and LVH. We also examined conventional ECG criteria for the diagnosis of LVH. We calculated the area under the receiver operating characteristic (AUROC) curve, sensitivity, specificity, and accuracy of each model and compared the performance of the models. We analyzed data for 18,954 patients (mean age (standard deviation): 64.2 (16.5) years, men: 56.7%). For the detection of LVD, the value (95% confidence interval) of the AUROC was 0.810 (0.801-0.819) for the deep learning model, and this was significantly higher than that of the logistic regression and random forest methods (P < 0.001). The AUROCs for the logistic regression and random forest methods (machine learning models) were 0.770 (0.761-0.779) and 0.757 (0.747-0.767), respectively. For the detection of LVH, the AUROC was 0.784 (0.777-0.791) for the deep learning model, and this was significantly higher than that of the logistic regression and random forest methods and conventional ECG criteria (P < 0.001). The AUROCs for the logistic regression and random forest methods were 0.758 (0.751-0.765) and 0.716 (0.708-0.724), respectively. This study suggests that deep learning is a useful method to detect LVD and LVH from 12-lead ECGs.
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Affiliation(s)
- Takahiro Kokubo
- School of Public Health, Graduate School of Medicine, The University of Tokyo
| | - Satoshi Kodera
- Department of Cardiovascular Medicine, The University of Tokyo Hospital
| | - Shinnosuke Sawano
- Department of Cardiovascular Medicine, The University of Tokyo Hospital
| | - Susumu Katsushika
- Department of Cardiovascular Medicine, The University of Tokyo Hospital
| | | | | | - Nisei Kimura
- Department of Technology Management for Innovation, The University of Tokyo
| | - Hiroki Shinohara
- Department of Cardiovascular Medicine, The University of Tokyo Hospital
| | - Ryo Matsuoka
- Department of Cardiovascular Medicine, The University of Tokyo Hospital
| | - Koki Nakanishi
- Department of Cardiovascular Medicine, The University of Tokyo Hospital
| | - Tomoko Nakao
- Department of Cardiovascular Medicine, The University of Tokyo Hospital
| | | | - Norifumi Takeda
- Department of Cardiovascular Medicine, The University of Tokyo Hospital
| | - Katsuhito Fujiu
- Department of Cardiovascular Medicine, The University of Tokyo Hospital
| | - Masao Daimon
- Department of Cardiovascular Medicine, The University of Tokyo Hospital
| | - Hiroshi Akazawa
- Department of Cardiovascular Medicine, The University of Tokyo Hospital
| | - Hiroyuki Morita
- Department of Cardiovascular Medicine, The University of Tokyo Hospital
| | - Yutaka Matsuyama
- School of Public Health, Graduate School of Medicine, The University of Tokyo
| | - Issei Komuro
- Department of Cardiovascular Medicine, The University of Tokyo Hospital
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28
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Liu CM, Hsieh ME, Hu YF, Wei TY, Wu IC, Chen PF, Lin YJ, Higa S, Yagi N, Chen SA, Tseng VS. Artificial Intelligence-Enabled Model for Early Detection of Left Ventricular Hypertrophy and Mortality Prediction in Young to Middle-Aged Adults. Circ Cardiovasc Qual Outcomes 2022; 15:e008360. [PMID: 35959675 DOI: 10.1161/circoutcomes.121.008360] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Concealed left ventricular hypertrophy (LVH) is a prevalent condition that is correlated with a substantial risk of cardiovascular events and mortality, especially in young to middle-aged adults. Early identification of LVH is warranted. In this work, we aimed to develop an artificial intelligence (AI)-enabled model for early detection and risk stratification of LVH using 12-lead ECGs. METHODS By deep learning techniques on the ECG recordings from 28 745 patients (20-60 years old), the AI model was developed to detect verified LVH from transthoracic echocardiography and evaluated on an independent cohort. Two hundred twenty-five patients from Japan were externally validated. Cardiologists' diagnosis of LVH was based on conventional ECG criteria. The area under the curve (AUC), sensitivity, and specificity were applied to evaluate the model performance. A Cox regression model estimated the independent effects of AI-predicted LVH on cardiovascular or all-cause death. RESULTS The AUC of the AI model in diagnosing LVH was 0.89 (sensitivity: 90.3%, specificity: 69.3%), which was significantly better than that of the cardiologists' diagnosis (AUC, 0.64). In the second independent cohort, the diagnostic performance of the AI model was consistent (AUC, 0.86; sensitivity: 85.4%, specificity: 67.0%). After a follow-up of 6 years, AI-predicted LVH was independently associated with higher cardiovascular or all-cause mortality (hazard ratio, 1.91 [1.04-3.49] and 1.54 [1.20-1.97], respectively). The predictive power of the AI model for mortality was consistently valid among patients of different ages, sexes, and comorbidities, including hypertension, diabetes, stroke, heart failure, and myocardial infarction. Last, we also validated the model in the international independent cohort from Japan (AUC, 0.83). CONCLUSIONS The AI model improved the detection of LVH and mortality prediction in the young to middle-aged population and represented an attractive tool for risk stratification. Early identification by the AI model gives every chance for timely treatment to reverse adverse outcomes.
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Affiliation(s)
- Chih-Min Liu
- Heart Rhythm Center, Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taiwan (C.-M.L., Y.-F.H., Y.-J.L., S.-A.C.).,Institute of Clinical Medicine and Faculty of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan (C.-M.L., Y.-F.H., Y.-J.L., S.-A.C.)
| | - Ming-En Hsieh
- Institute of Data Science and Engineering, National Yang Ming Chiao Tung University, Hsinchu, Taiwan (M.-E.H., T.-Y.W., V.S.T.)
| | - Yu-Feng Hu
- Heart Rhythm Center, Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taiwan (C.-M.L., Y.-F.H., Y.-J.L., S.-A.C.).,Institute of Clinical Medicine and Faculty of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan (C.-M.L., Y.-F.H., Y.-J.L., S.-A.C.).,Institute of Biomedical Sciences, Academia Sinica, Taipei, Taiwan (Y.-F.H.)
| | - Tzu-Yin Wei
- Institute of Data Science and Engineering, National Yang Ming Chiao Tung University, Hsinchu, Taiwan (M.-E.H., T.-Y.W., V.S.T.)
| | - I-Chien Wu
- Institute of Population Health Sciences, National Health Research Institutes, Miaoli, Taiwan (I.-C.W., P.-F.C.)
| | - Pei-Fen Chen
- Institute of Population Health Sciences, National Health Research Institutes, Miaoli, Taiwan (I.-C.W., P.-F.C.)
| | - Yenn-Jiang Lin
- Heart Rhythm Center, Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taiwan (C.-M.L., Y.-F.H., Y.-J.L., S.-A.C.).,Institute of Clinical Medicine and Faculty of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan (C.-M.L., Y.-F.H., Y.-J.L., S.-A.C.)
| | - Satoshi Higa
- Cardiac Electrophysiology and Pacing Laboratory, Division of Cardiovascular Medicine, Makiminato Central Hospital, Okinawa, Japan (S.H.)
| | - Nobumori Yagi
- Division of Cardiovascular Medicine, Nakagami Hospital, Okinawa, Japan (N.Y.)
| | - Shih-Ann Chen
- Heart Rhythm Center, Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taiwan (C.-M.L., Y.-F.H., Y.-J.L., S.-A.C.).,Institute of Clinical Medicine and Faculty of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan (C.-M.L., Y.-F.H., Y.-J.L., S.-A.C.).,Cardiovascular Center, Taichung Veterans General Hospital, Taiwan (S.-A.C.).,National Chung Hsing University, Taichung, Taiwan (S.-A.C.)
| | - Vincent S Tseng
- Institute of Data Science and Engineering, National Yang Ming Chiao Tung University, Hsinchu, Taiwan (M.-E.H., T.-Y.W., V.S.T.).,Department of Computer Science, National Yang Ming Chiao Tung University, Hsinchu, Taiwan (V.S.T.)
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29
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Musa N, Gital AY, Aljojo N, Chiroma H, Adewole KS, Mojeed HA, Faruk N, Abdulkarim A, Emmanuel I, Folawiyo YY, Ogunmodede JA, Oloyede AA, Olawoyin LA, Sikiru IA, Katb I. A systematic review and Meta-data analysis on the applications of Deep Learning in Electrocardiogram. JOURNAL OF AMBIENT INTELLIGENCE AND HUMANIZED COMPUTING 2022; 14:9677-9750. [PMID: 35821879 PMCID: PMC9261902 DOI: 10.1007/s12652-022-03868-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Accepted: 04/26/2022] [Indexed: 06/08/2023]
Abstract
The success of deep learning over the traditional machine learning techniques in handling artificial intelligence application tasks such as image processing, computer vision, object detection, speech recognition, medical imaging and so on, has made deep learning the buzz word that dominates Artificial Intelligence applications. From the last decade, the applications of deep learning in physiological signals such as electrocardiogram (ECG) have attracted a good number of research. However, previous surveys have not been able to provide a systematic comprehensive review including biometric ECG based systems of the applications of deep learning in ECG with respect to domain of applications. To address this gap, we conducted a systematic literature review on the applications of deep learning in ECG including biometric ECG based systems. The study analyzed systematically, 150 primary studies with evidence of the application of deep learning in ECG. The study shows that the applications of deep learning in ECG have been applied in different domains. We presented a new taxonomy of the domains of application of the deep learning in ECG. The paper also presented discussions on biometric ECG based systems and meta-data analysis of the studies based on the domain, area, task, deep learning models, dataset sources and preprocessing methods. Challenges and potential research opportunities were highlighted to enable novel research. We believe that this study will be useful to both new researchers and expert researchers who are seeking to add knowledge to the already existing body of knowledge in ECG signal processing using deep learning algorithm. Supplementary information The online version contains supplementary material available at 10.1007/s12652-022-03868-z.
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Affiliation(s)
- Nehemiah Musa
- Department of Mathematical Sciences, Abubakar Tafawa Balewa University, Bauchi, Nigeria
| | - Abdulsalam Ya’u Gital
- Department of Mathematical Sciences, Abubakar Tafawa Balewa University, Bauchi, Nigeria
| | | | - Haruna Chiroma
- Computer Science and Engineering, University of Hafr Al-Batin, Hafr, Saudi Arabia
- Computer Science and Engineering , University of Hafr Al-Batin, Hafr Al-Batin, Saudi Arabia
| | - Kayode S. Adewole
- Department of Computer Science, University of Ilorin, Ilorin, Nigeria
| | - Hammed A. Mojeed
- Department of Computer Science, University of Ilorin, Ilorin, Nigeria
| | - Nasir Faruk
- Department of Physics, Sule Lamido University, Kafin Hausa, Nigeria
| | - Abubakar Abdulkarim
- Department of Electrical Engineering, Ahmadu Bello University Zaria, Zaria, Nigeria
| | - Ifada Emmanuel
- Department of Physics, Sule Lamido University, Kafin Hausa, Nigeria
| | | | | | | | | | | | - Ibrahim Katb
- Computer Science and Engineering, University of Hafr Al-Batin, Hafr, Saudi Arabia
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30
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Liu CM, Shih ES, Chen JY, Huang CH, Wu IC, Chen PF, Higa S, Yagi N, Hu YF, Hwang MJ, Chen SA. Artificial Intelligence-Enabled Electrocardiogram Improves the Diagnosis and Prediction of Mortality in Patients With Pulmonary Hypertension. JACC. ASIA 2022; 2:258-270. [PMID: 36338407 PMCID: PMC9627911 DOI: 10.1016/j.jacasi.2022.02.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Revised: 02/22/2022] [Accepted: 02/24/2022] [Indexed: 05/12/2023]
Abstract
BACKGROUND Pulmonary hypertension is a disabling and life-threatening cardiovascular disease. Early detection of elevated pulmonary artery pressure (ePAP) is needed for prompt diagnosis and treatment to avoid detrimental consequences of pulmonary hypertension. OBJECTIVES This study sought to develop an artificial intelligence (AI)-enabled electrocardiogram (ECG) model to identify patients with ePAP and related prognostic implications. METHODS From a hospital-based ECG database, the authors extracted the first pairs of ECG and transthoracic echocardiography taken within 2 weeks of each other from 41,097 patients to develop an AI model for detecting ePAP (PAP > 50 mm Hg by transthoracic echocardiography). The model was evaluated on independent data sets, including an external cohort of patients from Japan. RESULTS Tests of 10-fold cross-validation neural-network deep learning showed that the area under the receiver-operating characteristic curve of the AI model was 0.88 (sensitivity 81.0%; specificity 79.6%) for detecting ePAP. The diagnostic performance was consistent across age, sex, and various comorbidities (diagnostic odds ratio >8 for most factors examined). At 6-year follow-up, the patients predicted by the AI model to have ePAP were independently associated with higher cardiovascular mortality (HR: 3.69). Similar diagnostic performance and prediction for cardiovascular mortality could be replicated in the external cohort. CONCLUSIONS The ECG-based AI model identified patients with ePAP and predicted their future risk for cardiovascular mortality. This model could serve as a useful clinical test to identify patients with pulmonary hypertension so that treatment can be initiated early to improve their survival prognosis.
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Affiliation(s)
- Chih-Min Liu
- Heart Rhythm Center, Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
- Institute of Clinical Medicine and Faculty of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Edward S.C. Shih
- Institute of Biomedical Sciences, Academia Sinica, Taipei, Taiwan
| | - Jhih-Yu Chen
- Institute of Biomedical Sciences, Academia Sinica, Taipei, Taiwan
| | - Chih-Han Huang
- Institute of Biomedical Sciences, Academia Sinica, Taipei, Taiwan
- Genome and Systems Biology Degree Program, Academia Sinica and National Taiwan University, Taipei, Taiwan
| | - I-Chien Wu
- Institute of Population Health Sciences, National Health Research Institutes, Miaoli, Taiwan
| | - Pei-Fen Chen
- Institute of Population Health Sciences, National Health Research Institutes, Miaoli, Taiwan
| | - Satoshi Higa
- Cardiac Electrophysiology and Pacing Laboratory, Division of Cardiovascular Medicine, Makiminato Central Hospital, Okinawa, Japan
| | - Nobumori Yagi
- Division of Cardiovascular Medicine, Nakagami Hospital, Okinawa, Japan
| | - Yu-Feng Hu
- Heart Rhythm Center, Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
- Institute of Clinical Medicine and Faculty of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Institute of Biomedical Sciences, Academia Sinica, Taipei, Taiwan
- Address for correspondence: Dr Yu-Feng Hu, Taipei Veterans General Hospital, 201 Sec. 2, Shih-Pai Road, Taipei, Taiwan.
| | - Ming-Jing Hwang
- Institute of Biomedical Sciences, Academia Sinica, Taipei, Taiwan
- Genome and Systems Biology Degree Program, Academia Sinica and National Taiwan University, Taipei, Taiwan
- Dr Ming-Jing Hwang, Institute of Biomedical Sciences, Academia Sinica, 128 Sec. 2, Academia Road, Nankang, Taipei, Taiwan.
| | - Shih-Ann Chen
- Heart Rhythm Center, Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
- Institute of Clinical Medicine and Faculty of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Cardiovascular Center, Taichung Veterans General Hospital, Taichung, Taiwan
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31
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Stracina T, Ronzhina M, Redina R, Novakova M. Golden Standard or Obsolete Method? Review of ECG Applications in Clinical and Experimental Context. Front Physiol 2022; 13:867033. [PMID: 35547589 PMCID: PMC9082936 DOI: 10.3389/fphys.2022.867033] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 03/15/2022] [Indexed: 12/14/2022] Open
Abstract
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.
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Affiliation(s)
- Tibor Stracina
- Department of Physiology, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Marina Ronzhina
- Department of Biomedical Engineering, Faculty of Electrical Engineering and Communication, Brno University of Technology, Brno, Czech Republic
| | - Richard Redina
- Department of Biomedical Engineering, Faculty of Electrical Engineering and Communication, Brno University of Technology, Brno, Czech Republic.,International Clinical Research Center, St. Anne's University Hospital Brno, Brno, Czech Republic
| | - Marie Novakova
- Department of Physiology, Faculty of Medicine, Masaryk University, Brno, Czech Republic
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32
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Langlais ÉL, Thériault-Lauzier P, Marquis-Gravel G, Kulbay M, So DY, Tanguay JF, Ly HQ, Gallo R, Lesage F, Avram R. Novel Artificial Intelligence Applications in Cardiology: Current Landscape, Limitations, and the Road to Real-World Applications. J Cardiovasc Transl Res 2022:10.1007/s12265-022-10260-x. [PMID: 35460017 DOI: 10.1007/s12265-022-10260-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 04/11/2022] [Indexed: 11/25/2022]
Abstract
Cardiovascular diseases are the leading cause of death globally and contribute significantly to the cost of healthcare. Artificial intelligence (AI) is poised to reshape cardiology. Using supervised and unsupervised learning, the two main branches of AI, several applications have been developed in recent years to improve risk prediction, allow large-scale analysis of medical data, and phenotype patients for personalized medicine. In this review, we examine the key advances in AI in cardiology and its limitations regarding bias in the data, standardization in reporting, data access, and model trust and accountability in cases of error. Finally, we discuss implementation methods to unleash AI's potential in making healthcare more accurate and efficient. Several steps need to be followed and challenges overcome in order to successfully integrate AI in clinical practice and ensure its longevity.
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Affiliation(s)
- Élodie Labrecque Langlais
- Division of Cardiology, Department of Medicine, Montreal Heart Institute, University of Montreal, 5000 Belanger Street, Montreal, QC, H1T 1C8, Canada
- Biomedical Engineering, École Polytechnique de Montréal, 2500 Chemin de Polytechnique, Montreal, QC, H3T 1J4, Canada
| | - Pascal Thériault-Lauzier
- Division of Cardiology, Department of Medicine, University of Ottawa Heart Institute, University of Ottawa, 40 Ruskin Street, Ottawa, ON, K1Y 4W7, Canada
| | - Guillaume Marquis-Gravel
- Division of Cardiology, Department of Medicine, Montreal Heart Institute, University of Montreal, 5000 Belanger Street, Montreal, QC, H1T 1C8, Canada
- Department of Medicine, University of Montreal, 2900 Edouard Montpetit Blvd, Montreal, QC, H3T 1J4, Canada
| | - Merve Kulbay
- Department of Medicine, University of Montreal, 2900 Edouard Montpetit Blvd, Montreal, QC, H3T 1J4, Canada
| | - Derek Y So
- Division of Cardiology, Department of Medicine, University of Ottawa Heart Institute, University of Ottawa, 40 Ruskin Street, Ottawa, ON, K1Y 4W7, Canada
| | - Jean-François Tanguay
- Division of Cardiology, Department of Medicine, Montreal Heart Institute, University of Montreal, 5000 Belanger Street, Montreal, QC, H1T 1C8, Canada
| | - Hung Q Ly
- Division of Cardiology, Department of Medicine, Montreal Heart Institute, University of Montreal, 5000 Belanger Street, Montreal, QC, H1T 1C8, Canada
| | - Richard Gallo
- Division of Cardiology, Department of Medicine, Montreal Heart Institute, University of Montreal, 5000 Belanger Street, Montreal, QC, H1T 1C8, Canada
- Department of Medicine, University of Montreal, 2900 Edouard Montpetit Blvd, Montreal, QC, H3T 1J4, Canada
| | - Frédéric Lesage
- Division of Cardiology, Department of Medicine, Montreal Heart Institute, University of Montreal, 5000 Belanger Street, Montreal, QC, H1T 1C8, Canada
- Biomedical Engineering, École Polytechnique de Montréal, 2500 Chemin de Polytechnique, Montreal, QC, H3T 1J4, Canada
| | - Robert Avram
- Division of Cardiology, Department of Medicine, Montreal Heart Institute, University of Montreal, 5000 Belanger Street, Montreal, QC, H1T 1C8, Canada.
- Department of Medicine, University of Montreal, 2900 Edouard Montpetit Blvd, Montreal, QC, H3T 1J4, Canada.
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33
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Automated Classification of Left Ventricular Hypertrophy on Cardiac MRI. APPLIED SCIENCES-BASEL 2022. [DOI: 10.3390/app12094151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Left ventricular hypertrophy is an independent predictor of coronary artery disease, stroke, and heart failure. Our aim was to detect LVH cardiac magnetic resonance (CMR) scans with automatic methods. We developed an ensemble model based on a three-dimensional version of ResNet. The input of the network included short-axis and long-axis images. We also introduced a standardization methodology to unify the input images for noise reduction. The output of the network is the decision whether the patient has hypertrophy or not. We included 428 patients (mean age: 49 ± 18 years, 262 males) with LVH (346 hypertrophic cardiomyopathy, 45 cardiac amyloidosis, 11 Anderson–Fabry disease, 16 endomyocardial fibrosis, 10 aortic stenosis). Our control group consisted of 234 healthy subjects (mean age: 35 ± 15 years; 126 males) without any known cardiovascular diseases. The developed machine-learning-based model achieved a 92% F1-score and 97% recall on the hold-out dataset, which is comparable to the medical experts. Experiments showed that the standardization method was able to significantly boost the performance of the algorithm. The algorithm could improve the diagnostic accuracy, and it could open a new door to AI applications in CMR.
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34
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Khurshid S, Reeder C, Harrington LX, Singh P, Sarma G, Friedman SF, Di Achille P, Diamant N, Cunningham JW, Turner AC, Lau ES, Haimovich JS, Al-Alusi MA, Wang X, Klarqvist MDR, Ashburner JM, Diedrich C, Ghadessi M, Mielke J, Eilken HM, McElhinney A, Derix A, Atlas SJ, Ellinor PT, Philippakis AA, Anderson CD, Ho JE, Batra P, Lubitz SA. Cohort design and natural language processing to reduce bias in electronic health records research. NPJ Digit Med 2022; 5:47. [PMID: 35396454 PMCID: PMC8993873 DOI: 10.1038/s41746-022-00590-0] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Accepted: 03/09/2022] [Indexed: 01/04/2023] Open
Abstract
Electronic health record (EHR) datasets are statistically powerful but are subject to ascertainment bias and missingness. Using the Mass General Brigham multi-institutional EHR, we approximated a community-based cohort by sampling patients receiving longitudinal primary care between 2001-2018 (Community Care Cohort Project [C3PO], n = 520,868). We utilized natural language processing (NLP) to recover vital signs from unstructured notes. We assessed the validity of C3PO by deploying established risk models for myocardial infarction/stroke and atrial fibrillation. We then compared C3PO to Convenience Samples including all individuals from the same EHR with complete data, but without a longitudinal primary care requirement. NLP reduced the missingness of vital signs by 31%. NLP-recovered vital signs were highly correlated with values derived from structured fields (Pearson r range 0.95-0.99). Atrial fibrillation and myocardial infarction/stroke incidence were lower and risk models were better calibrated in C3PO as opposed to the Convenience Samples (calibration error range for myocardial infarction/stroke: 0.012-0.030 in C3PO vs. 0.028-0.046 in Convenience Samples; calibration error for atrial fibrillation 0.028 in C3PO vs. 0.036 in Convenience Samples). Sampling patients receiving regular primary care and using NLP to recover missing data may reduce bias and maximize generalizability of EHR research.
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Affiliation(s)
- Shaan Khurshid
- Division of Cardiology, Massachusetts General Hospital, Boston, MA, USA
- Cardiovascular Research Center, Massachusetts General Hospital, Boston, MA, USA
- Cardiovascular Disease Initiative, Broad Institute of Harvard and the Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Christopher Reeder
- Data Sciences Platform, Broad Institute of Harvard and the Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Lia X Harrington
- Cardiovascular Research Center, Massachusetts General Hospital, Boston, MA, USA
- Cardiovascular Disease Initiative, Broad Institute of Harvard and the Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Pulkit Singh
- Data Sciences Platform, Broad Institute of Harvard and the Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Gopal Sarma
- Data Sciences Platform, Broad Institute of Harvard and the Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Samuel F Friedman
- Data Sciences Platform, Broad Institute of Harvard and the Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Paolo Di Achille
- Data Sciences Platform, Broad Institute of Harvard and the Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Nathaniel Diamant
- Data Sciences Platform, Broad Institute of Harvard and the Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Jonathan W Cunningham
- Cardiovascular Disease Initiative, Broad Institute of Harvard and the Massachusetts Institute of Technology, Cambridge, MA, USA
- Division of Cardiology, Brigham and Women's Hospital, Boston, MA, USA
| | - Ashby C Turner
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
- Henry and Allison McCance Center for Brain Health, Massachusetts General Hospital, Boston, MA, USA
| | - Emily S Lau
- Division of Cardiology, Massachusetts General Hospital, Boston, MA, USA
- Cardiovascular Research Center, Massachusetts General Hospital, Boston, MA, USA
- Cardiovascular Disease Initiative, Broad Institute of Harvard and the Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Julian S Haimovich
- Cardiovascular Research Center, Massachusetts General Hospital, Boston, MA, USA
- Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Mostafa A Al-Alusi
- Division of Cardiology, Massachusetts General Hospital, Boston, MA, USA
- Cardiovascular Research Center, Massachusetts General Hospital, Boston, MA, USA
| | - Xin Wang
- Cardiovascular Research Center, Massachusetts General Hospital, Boston, MA, USA
- Cardiovascular Disease Initiative, Broad Institute of Harvard and the Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Marcus D R Klarqvist
- Data Sciences Platform, Broad Institute of Harvard and the Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Jeffrey M Ashburner
- Harvard Medical School, Boston, MA, USA
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Christian Diedrich
- Bayer AG, Research and Development, Pharmaceuticals, Leverkusen, Germany
| | - Mercedeh Ghadessi
- Bayer AG, Research and Development, Pharmaceuticals, Leverkusen, Germany
| | - Johanna Mielke
- Bayer AG, Research and Development, Pharmaceuticals, Leverkusen, Germany
| | - Hanna M Eilken
- Bayer AG, Research and Development, Pharmaceuticals, Leverkusen, Germany
| | - Alice McElhinney
- Cardiovascular Disease Initiative, Broad Institute of Harvard and the Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Andrea Derix
- Bayer AG, Research and Development, Pharmaceuticals, Leverkusen, Germany
| | - Steven J Atlas
- Harvard Medical School, Boston, MA, USA
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Patrick T Ellinor
- Cardiovascular Research Center, Massachusetts General Hospital, Boston, MA, USA
- Cardiovascular Disease Initiative, Broad Institute of Harvard and the Massachusetts Institute of Technology, Cambridge, MA, USA
- Demoulas Center for Cardiac Arrhythmias, Massachusetts General Hospital, Boston, MA, USA
| | - Anthony A Philippakis
- Data Sciences Platform, Broad Institute of Harvard and the Massachusetts Institute of Technology, Cambridge, MA, USA
- Eric and Wendy Schmidt Center, Broad Institute of Harvard and the Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Christopher D Anderson
- Cardiovascular Research Center, Massachusetts General Hospital, Boston, MA, USA
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
- Henry and Allison McCance Center for Brain Health, Massachusetts General Hospital, Boston, MA, USA
- Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, USA
- Department of Neurology, Brigham and Women's Hospital, Boston, MA, USA
| | - Jennifer E Ho
- Division of Cardiology, Massachusetts General Hospital, Boston, MA, USA
- Cardiovascular Research Center, Massachusetts General Hospital, Boston, MA, USA
- Cardiovascular Disease Initiative, Broad Institute of Harvard and the Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Puneet Batra
- Data Sciences Platform, Broad Institute of Harvard and the Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Steven A Lubitz
- Cardiovascular Research Center, Massachusetts General Hospital, Boston, MA, USA.
- Cardiovascular Disease Initiative, Broad Institute of Harvard and the Massachusetts Institute of Technology, Cambridge, MA, USA.
- Demoulas Center for Cardiac Arrhythmias, Massachusetts General Hospital, Boston, MA, USA.
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Petmezas G, Stefanopoulos L, Kilintzis V, Tzavelis A, Rogers JA, Katsaggelos AK, Maglaveras N. State-of-the-art Deep Learning Methods on Electrocardiogram Data: A Systematic Review (Preprint). JMIR Med Inform 2022; 10:e38454. [PMID: 35969441 PMCID: PMC9425174 DOI: 10.2196/38454] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Revised: 06/03/2022] [Accepted: 07/03/2022] [Indexed: 11/13/2022] Open
Abstract
Background Electrocardiogram (ECG) is one of the most common noninvasive diagnostic tools that can provide useful information regarding a patient’s health status. Deep learning (DL) is an area of intense exploration that leads the way in most attempts to create powerful diagnostic models based on physiological signals. Objective This study aimed to provide a systematic review of DL methods applied to ECG data for various clinical applications. Methods The PubMed search engine was systematically searched by combining “deep learning” and keywords such as “ecg,” “ekg,” “electrocardiogram,” “electrocardiography,” and “electrocardiology.” Irrelevant articles were excluded from the study after screening titles and abstracts, and the remaining articles were further reviewed. The reasons for article exclusion were manuscripts written in any language other than English, absence of ECG data or DL methods involved in the study, and absence of a quantitative evaluation of the proposed approaches. Results We identified 230 relevant articles published between January 2020 and December 2021 and grouped them into 6 distinct medical applications, namely, blood pressure estimation, cardiovascular disease diagnosis, ECG analysis, biometric recognition, sleep analysis, and other clinical analyses. We provide a complete account of the state-of-the-art DL strategies per the field of application, as well as major ECG data sources. We also present open research problems, such as the lack of attempts to address the issue of blood pressure variability in training data sets, and point out potential gaps in the design and implementation of DL models. Conclusions We expect that this review will provide insights into state-of-the-art DL methods applied to ECG data and point to future directions for research on DL to create robust models that can assist medical experts in clinical decision-making.
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Affiliation(s)
- Georgios Petmezas
- Lab of Computing, Medical Informatics and Biomedical-Imaging Technologies, The Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Leandros Stefanopoulos
- Lab of Computing, Medical Informatics and Biomedical-Imaging Technologies, The Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Vassilis Kilintzis
- Lab of Computing, Medical Informatics and Biomedical-Imaging Technologies, The Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Andreas Tzavelis
- Department of Biomedical Engineering, Northwestern University, Evanston, IL, United States
| | - John A Rogers
- Department of Material Science, Northwestern University, Evanston, IL, United States
| | - Aggelos K Katsaggelos
- Department of Electrical and Computer Engineering, Northwestern University, Evanston, IL, United States
| | - Nicos Maglaveras
- Lab of Computing, Medical Informatics and Biomedical-Imaging Technologies, The Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
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Yu X, Yao X, Wu B, Zhou H, Xia S, Su W, Wu Y, Zheng X. Using deep learning method to identify left ventricular hypertrophy on echocardiography. Int J Cardiovasc Imaging 2022; 38:759-769. [PMID: 34757566 PMCID: PMC11130004 DOI: 10.1007/s10554-021-02461-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Accepted: 10/25/2021] [Indexed: 01/19/2023]
Abstract
BACKGROUND Left ventricular hypertrophy (LVH) is an independent prognostic factor for cardiovascular events and it can be detected by echocardiography in the early stage. In this study, we aim to develop a semi-automatic diagnostic network based on deep learning algorithms to detect LVH. METHODS We retrospectively collected 1610 transthoracic echocardiograms, included 724 patients [189 hypertensive heart disease (HHD), 218 hypertrophic cardiomyopathy (HCM), and 58 cardiac amyloidosis (CA), along with 259 controls]. The diagnosis of LVH was defined by two experienced clinicians. For the deep learning architecture, we introduced ResNet and U-net++ to complete classification and segmentation tasks respectively. The models were trained and validated independently. Then, we connected the best-performing models to form the final framework and tested its capabilities. RESULTS In terms of individual networks, the view classification model produced AUC = 1.0. The AUC of the LVH detection model was 0.98 (95% CI 0.94-0.99), with corresponding sensitivity and specificity of 94.0% (95% CI 85.3-98.7%) and 91.6% (95% CI 84.6-96.1%) respectively. For etiology identification, the independent model yielded good results with AUC = 0.90 (95% CI 0.82-0.95) for HCM, AUC = 0.94 (95% CI 0.88-0.98) for CA, and AUC = 0.88 (95% CI 0.80-0.93) for HHD. Finally, our final integrated framework automatically classified four conditions (Normal, HCM, CA, and HHD), which achieved an average of AUC 0.91, with an average sensitivity and specificity of 83.7% and 90.0%. CONCLUSION Deep learning architecture has the ability to detect LVH and even distinguish the latent etiology of LVH.
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Affiliation(s)
- Xiang Yu
- Department of Cardiology, The Fourth Affiliated Hospital, School of Medicine, Zhejiang University, N1 Shangcheng Avenue, Yiwu, 322000, China
| | - Xinxia Yao
- Key Laboratory for Biomedical Engineering of Ministry of Education, Zhejiang University, Zheda Avenue, Hangzhou, 310027, China
| | - Bifeng Wu
- Department of Cardiology, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, 310006, China
| | - Hong Zhou
- Key Laboratory for Biomedical Engineering of Ministry of Education, Zhejiang University, Zheda Avenue, Hangzhou, 310027, China.
| | - Shudong Xia
- Department of Cardiology, The Fourth Affiliated Hospital, School of Medicine, Zhejiang University, N1 Shangcheng Avenue, Yiwu, 322000, China.
| | - Wenwen Su
- Department of Cardiology, The Fourth Affiliated Hospital, School of Medicine, Zhejiang University, N1 Shangcheng Avenue, Yiwu, 322000, China
| | - Yuanyuan Wu
- Department of Cardiology, The Fourth Affiliated Hospital, School of Medicine, Zhejiang University, N1 Shangcheng Avenue, Yiwu, 322000, China
| | - Xiaoye Zheng
- Department of Cardiology, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, 310006, China
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Artificial Intelligence-Enabled Electrocardiography Predicts Left Ventricular Dysfunction and Future Cardiovascular Outcomes: A Retrospective Analysis. J Pers Med 2022; 12:jpm12030455. [PMID: 35330455 PMCID: PMC8950054 DOI: 10.3390/jpm12030455] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 02/24/2022] [Accepted: 03/10/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND: The ejection fraction (EF) provides critical information about heart failure (HF) and its management. Electrocardiography (ECG) is a noninvasive screening tool for cardiac electrophysiological activities that has been used to detect patients with low EF based on a deep learning model (DLM) trained via large amounts of data. However, no studies have widely investigated its clinical impacts. OBJECTIVE: This study developed a DLM to estimate EF via ECG (ECG-EF). We further investigated the relationship between ECG-EF and echo-based EF (ECHO-EF) and explored their contributions to future cardiovascular adverse events. METHODS: There were 57,206 ECGs with corresponding echocardiograms used to train our DLM. We compared a series of training strategies and selected the best DLM. The architecture of the DLM was based on ECG12Net, developed previously. Next, 10,762 ECGs were used for validation, and another 20,629 ECGs were employed to conduct the accuracy test. The changes between ECG-EF and ECHO-EF were evaluated. The primary follow-up adverse events included future ECHO-EF changes and major adverse cardiovascular events (MACEs). RESULTS: The sex-/age-matching strategy-trained DLM achieved the best area under the curve (AUC) of 0.9472 with a sensitivity of 86.9% and specificity of 89.6% in the follow-up cohort, with a correlation of 0.603 and a mean absolute error of 7.436. In patients with accurate prediction (initial difference < 10%), the change traces of ECG-EF and ECHO-EF were more consistent (R-square = 0.351) than in all patients (R-square = 0.115). Patients with lower ECG-EF (≤35%) exhibited a greater risk of cardiovascular (CV) complications, delayed ECHO-EF recovery, and earlier ECHO-EF deterioration than patients with normal ECG-EF (>50%). Importantly, ECG-EF demonstrated an independent impact on MACEs and all CV adverse outcomes, with better prediction of CV outcomes than ECHO-EF. CONCLUSIONS: The ECG-EF could be used to initially screen asymptomatic left ventricular dysfunction (LVD) and it could also independently contribute to the predictions of future CV adverse events. Although further large-scale studies are warranted, DLM-based ECG-EF could serve as a promising diagnostic supportive and management-guided tool for CV disease prediction and the care of patients with LVD.
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38
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Thomas LB, Mastorides SM, Viswanadhan NA, Jakey CE, Borkowski AA. Artificial Intelligence: Review of Current and Future Applications in Medicine. Fed Pract 2022; 38:527-538. [PMID: 35136337 DOI: 10.12788/fp.0174] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Background The role of artificial intelligence (AI) in health care is expanding rapidly. Currently, there are at least 29 US Food and Drug Administration-approved AI health care devices that apply to numerous medical specialties and many more are in development. Observations With increasing expectations for all health care sectors to deliver timely, fiscally-responsible, high-quality health care, AI has potential utility in numerous areas, such as image analysis, improved workflow and efficiency, public health, and epidemiology, to aid in processing large volumes of patient and medical data. In this review, we describe basic terminology, principles, and general AI applications relating to health care. We then discuss current and future applications for a variety of medical specialties. Finally, we discuss the future potential of AI along with the potential risks and limitations of current AI technology. Conclusions AI can improve diagnostic accuracy, increase patient safety, assist with patient triage, monitor disease progression, and assist with treatment decisions.
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Affiliation(s)
- L Brannon Thomas
- James A. Haley Veterans' Hospital, Tampa, Florida.,University of South Florida, Morsani College of Medicine, Tampa
| | - Stephen M Mastorides
- James A. Haley Veterans' Hospital, Tampa, Florida.,University of South Florida, Morsani College of Medicine, Tampa
| | | | - Colleen E Jakey
- James A. Haley Veterans' Hospital, Tampa, Florida.,University of South Florida, Morsani College of Medicine, Tampa
| | - Andrew A Borkowski
- James A. Haley Veterans' Hospital, Tampa, Florida.,University of South Florida, Morsani College of Medicine, Tampa
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Darmawahyuni A, Nurmaini S, Rachmatullah MN, Tutuko B, Sapitri AI, Firdaus F, Fansyuri A, Predyansyah A. Deep learning-based electrocardiogram rhythm and beat features for heart abnormality classification. PeerJ Comput Sci 2022; 8:e825. [PMID: 35174263 PMCID: PMC8802771 DOI: 10.7717/peerj-cs.825] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 12/01/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Electrocardiogram (ECG) signal classification plays a critical role in the automatic diagnosis of heart abnormalities. While most ECG signal patterns cannot be recognized by a human interpreter, they can be detected with precision using artificial intelligence approaches, making the ECG a powerful non-invasive biomarker. However, performing rapid and accurate ECG signal classification is difficult due to the low amplitude, complexity, and non-linearity. The widely-available deep learning (DL) method we propose has presented an opportunity to substantially improve the accuracy of automated ECG classification analysis using rhythm or beat features. Unfortunately, a comprehensive and general evaluation of the specific DL architecture for ECG analysis across a wide variety of rhythm and beat features has not been previously reported. Some previous studies have been concerned with detecting ECG class abnormalities only through rhythm or beat features separately. METHODS This study proposes a single architecture based on the DL method with one-dimensional convolutional neural network (1D-CNN) architecture, to automatically classify 24 patterns of ECG signals through both rhythm and beat. To validate the proposed model, five databases which consisted of nine-class of ECG-base rhythm and 15-class of ECG-based beat were used in this study. The proposed DL network was applied and studied with varying datasets with different frequency samplings in intra and inter-patient scheme. RESULTS Using a 10-fold cross-validation scheme, the performance results had an accuracy of 99.98%, a sensitivity of 99.90%, a specificity of 99.89%, a precision of 99.90%, and an F1-score of 99.99% for ECG rhythm classification. Additionally, for ECG beat classification, the model obtained an accuracy of 99.87%, a sensitivity of 96.97%, a specificity of 99.89%, a precision of 92.23%, and an F1-score of 94.39%. In conclusion, this study provides clinicians with an advanced methodology for detecting and discriminating heart abnormalities between different ECG rhythm and beat assessments by using one outstanding proposed DL architecture.
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Affiliation(s)
- Annisa Darmawahyuni
- Intelligent System Research Group, Faculty of Computer Science, Universitas Sriwijaya, Palembang, Indonesia
| | - Siti Nurmaini
- Intelligent System Research Group, Faculty of Computer Science, Universitas Sriwijaya, Palembang, Indonesia
| | | | - Bambang Tutuko
- Intelligent System Research Group, Faculty of Computer Science, Universitas Sriwijaya, Palembang, Indonesia
| | - Ade Iriani Sapitri
- Intelligent System Research Group, Faculty of Computer Science, Universitas Sriwijaya, Palembang, Indonesia
| | - Firdaus Firdaus
- Intelligent System Research Group, Faculty of Computer Science, Universitas Sriwijaya, Palembang, Indonesia
| | - Ahmad Fansyuri
- Intelligent System Research Group, Faculty of Computer Science, Universitas Sriwijaya, Palembang, Indonesia
| | - Aldi Predyansyah
- Intelligent System Research Group, Faculty of Computer Science, Universitas Sriwijaya, Palembang, Indonesia
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40
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Kumar Y, Koul A, Singla R, Ijaz MF. Artificial intelligence in disease diagnosis: a systematic literature review, synthesizing framework and future research agenda. JOURNAL OF AMBIENT INTELLIGENCE AND HUMANIZED COMPUTING 2022; 14:8459-8486. [PMID: 35039756 PMCID: PMC8754556 DOI: 10.1007/s12652-021-03612-z] [Citation(s) in RCA: 117] [Impact Index Per Article: 58.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Accepted: 11/18/2021] [Indexed: 05/03/2023]
Abstract
Artificial intelligence can assist providers in a variety of patient care and intelligent health systems. Artificial intelligence techniques ranging from machine learning to deep learning are prevalent in healthcare for disease diagnosis, drug discovery, and patient risk identification. Numerous medical data sources are required to perfectly diagnose diseases using artificial intelligence techniques, such as ultrasound, magnetic resonance imaging, mammography, genomics, computed tomography scan, etc. Furthermore, artificial intelligence primarily enhanced the infirmary experience and sped up preparing patients to continue their rehabilitation at home. This article covers the comprehensive survey based on artificial intelligence techniques to diagnose numerous diseases such as Alzheimer, cancer, diabetes, chronic heart disease, tuberculosis, stroke and cerebrovascular, hypertension, skin, and liver disease. We conducted an extensive survey including the used medical imaging dataset and their feature extraction and classification process for predictions. Preferred reporting items for systematic reviews and Meta-Analysis guidelines are used to select the articles published up to October 2020 on the Web of Science, Scopus, Google Scholar, PubMed, Excerpta Medical Database, and Psychology Information for early prediction of distinct kinds of diseases using artificial intelligence-based techniques. Based on the study of different articles on disease diagnosis, the results are also compared using various quality parameters such as prediction rate, accuracy, sensitivity, specificity, the area under curve precision, recall, and F1-score.
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Affiliation(s)
- Yogesh Kumar
- Department of Computer Engineering, Indus Institute of Technology and Engineering, Indus University, Ahmedabad, 382115 India
| | | | - Ruchi Singla
- Department of Research, Innovations, Sponsored Projects and Entrepreneurship, CGC Landran, Mohali, India
| | - Muhammad Fazal Ijaz
- Department of Intelligent Mechatronics Engineering, Sejong University, Seoul, 05006 South Korea
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41
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Vardas PE, Asselbergs FW, van Smeden M, Friedman P. The year in cardiovascular medicine 2021: digital health and innovation. Eur Heart J 2022; 43:271-279. [PMID: 34974610 DOI: 10.1093/eurheartj/ehab874] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 11/15/2021] [Accepted: 11/23/2021] [Indexed: 12/15/2022] Open
Abstract
This article presents some of the most important developments in the field of digital medicine that have appeared over the last 12 months and are related to cardiovascular medicine. The article consists of three main sections, as follows: (i) artificial intelligence-enabled cardiovascular diagnostic tools, techniques, and methodologies, (ii) big data and prognostic models for cardiovascular risk protection, and (iii) wearable devices in cardiovascular risk assessment, cardiovascular disease prevention, diagnosis, and management. To conclude the article, the authors present a brief further prospective on this new domain, highlighting existing gaps that are specifically related to artificial intelligence technologies, such as explainability, cost-effectiveness, and, of course, the importance of proper regulatory oversight for each clinical implementation.
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Affiliation(s)
- Panos E Vardas
- Heart Sector, Hygeia Hospitals Group, HHG, 5, Erithrou Stavrou, Marousi, Athens 15123, Greece.,European Heart Agency, ESC, Brussels, Belgium
| | - Folkert W Asselbergs
- Department of Cardiology, Division of Heart & Lungs, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.,Health Data Research UK and Institute of Health Informatics, University College London, London, UK
| | - Maarten van Smeden
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Paul Friedman
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
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42
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Lee CH, Liu WT, Lou YS, Lin CS, Fang WH, Lee CC, Ho CL, Wang CH, Lin C. Artificial intelligence-enabled electrocardiogram screens low left ventricular ejection fraction with a degree of confidence. Digit Health 2022; 8:20552076221143249. [DOI: 10.1177/20552076221143249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Accepted: 11/17/2022] [Indexed: 12/15/2022] Open
Abstract
Background Artificial intelligence-enabled electrocardiogram has become a substitute tool for echocardiography in left ventricular ejection fraction estimation. However, the direct use of artificial intelligence-enabled electrocardiogram may be not trustable due to the uncertainty of the prediction. Objective The study aimed to establish an artificial intelligence-enabled electrocardiogram with a degree of confidence to identify left ventricular dysfunction. Methods The study collected 76,081 and 11,771 electrocardiograms from an academic medical center and a community hospital to establish and validate the deep learning model, respectively. The proposed deep learning model provided the point estimation of the actual ejection fraction and its standard deviation derived from the maximum probability density function of a normal distribution. The primary analysis focused on the accuracy of identifying patients with left ventricular dysfunction (ejection fraction ≤ 40%). Since the standard deviation was an uncertainty indicator in a normal distribution, we used it as a degree of confidence in the artificial intelligence-enabled electrocardiogram. We further explored the clinical application of estimated standard deviation and followed up on the new-onset left ventricular dysfunction in patients with initially normal ejection fraction. Results The area under receiver operating characteristic curves (AUC) of detecting left ventricular dysfunction were 0.9549 and 0.9365 in internal and external validation sets. After excluding the cases with a lower degree of confidence, the artificial intelligence-enabled electrocardiogram performed better in the remaining cases in internal (AUC = 0.9759) and external (AUC = 0.9653) validation sets. For the application of future left ventricular dysfunction risk stratification in patients with initially normal ejection fraction, a 4.57-fold risk of future left ventricular dysfunction when the artificial intelligence-enabled electrocardiogram is positive in the internal validation set. The hazard ratio was increased to 8.67 after excluding the cases with a lower degree of confidence. This trend was also validated in the external validation set. Conclusion The deep learning model with a degree of confidence can provide advanced improvements in identifying left ventricular dysfunction and serve as a decision support and management-guided screening tool for prognosis.
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Affiliation(s)
- Chun-Ho Lee
- School of Public Health, National Defense Medical Center, Taipei
| | - Wei-Ting Liu
- Division of Cardiology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei
| | - Yu-Sheng Lou
- Graduate Institutes of Life Sciences, National Defense Medical Center, Taipei
| | - Chin-Sheng Lin
- Division of Cardiology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei
| | - Wen-Hui Fang
- Department of Family and Community Medicine, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei
| | - Chia-Cheng Lee
- Medical Informatics Office, Tri-Service General Hospital, National Defense Medical Center, Taipei
- Division of Colorectal Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei
| | - Ching-Liang Ho
- Division of Hematology and Oncology, Tri-Service General Hospital, National Defense Medical Center, Taipei
| | - Chih-Hung Wang
- Department of Otolaryngology-Head and Neck Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei
- Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei
| | - Chin Lin
- School of Public Health, National Defense Medical Center, Taipei
- Graduate Institutes of Life Sciences, National Defense Medical Center, Taipei
- Medical Technology Education Center, School of Medicine, National Defense Medical Center, Taipei
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De la Garza Salazar F, Romero Ibarguengoitia ME, Azpiri López JR, González Cantú A. Optimizing ECG to detect echocardiographic left ventricular hypertrophy with computer-based ECG data and machine learning. PLoS One 2021; 16:e0260661. [PMID: 34847202 PMCID: PMC8631676 DOI: 10.1371/journal.pone.0260661] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2021] [Accepted: 11/13/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Left ventricular hypertrophy detected by echocardiography (Echo-LVH) is an independent predictor of mortality. Integration of the Philips DXL-16 algorithm into the electrocardiogram (ECG) extensively analyses the electricity of the heart. Machine learning techniques such as the C5.0 could lead to a new decision tree criterion to detect Echo-LVH. OBJECTIVES To search for a new combination of ECG parameters predictive of Echo-LVH. The final model is called the Cardiac Hypertrophy Computer-based model (CHCM). METHODS We extracted the 458 ECG parameters provided by the Philips DXL-16 algorithm in patients with Echo-LVH and controls. We used the C5.0 ML algorithm to train, test, and validate the CHCM. We compared its diagnostic performance to validate state-of-the-art criteria in our patient cohort. RESULTS We included 439 patients and considered an alpha value of 0.05 and a power of 99%. The CHCM includes T voltage in I (≤0.055 mV), peak-to-peak QRS distance in aVL (>1.235 mV), and peak-to-peak QRS distance in aVF (>0.178 mV). The CHCM had an accuracy of 70.5% (CI95%, 65.2-75.5), a sensitivity of 74.3%, and a specificity of 68.7%. In the external validation cohort (n = 156), the CHCM had an accuracy of 63.5% (CI95%, 55.4-71), a sensitivity of 42%, and a specificity of 82.9%. The accuracies of the most relevant state-of-the-art criteria were: Romhilt-Estes (57.4%, CI95% 49-65.5), VDP Cornell (55.7%, CI95%47.6-63.7), Cornell (59%, CI95%50.8-66.8), Dalfó (62.9%, CI95%54.7-70.6), Sokolow Lyon (53.9%, CI95%45.7-61.9), and Philips DXL-16 algorithm (54.5%, CI95%46.3-62.5). CONCLUSION ECG computer-based data and the C5.0 determined a new set of ECG parameters to predict Echo-LVH. The CHCM classifies patients as Echo-LVH with repolarization abnormalities or LVH with increased voltage. The CHCM has a similar accuracy, and is slightly more sensitive than the state-of-the-art criteria.
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Affiliation(s)
- Fernando De la Garza Salazar
- School of Medicine, Medical Specialties, University of Monterrey, Monterrey, Nuevo León, Mexico
- Department of Internal Medicine, Hospital Christus Muguerza Alta Especialidad, Monterrey, Nuevo León, Mexico
| | - Maria Elena Romero Ibarguengoitia
- School of Medicine, Medical Specialties, University of Monterrey, Monterrey, Nuevo León, Mexico
- Department of Medical Education and Research in Health, Christus Muguerza Health Systems, Monterrey, Nuevo León, Mexico
| | - José Ramón Azpiri López
- Department of Cardiology, Hospital Christus Muguerza, Alta Especialidad, Monterrey, Nuevo León, Mexico
| | - Arnulfo González Cantú
- School of Medicine, Medical Specialties, University of Monterrey, Monterrey, Nuevo León, Mexico
- Department of Medical Education and Research in Health, Christus Muguerza Health Systems, Monterrey, Nuevo León, Mexico
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de Siqueira VS, Borges MM, Furtado RG, Dourado CN, da Costa RM. Artificial intelligence applied to support medical decisions for the automatic analysis of echocardiogram images: A systematic review. Artif Intell Med 2021; 120:102165. [PMID: 34629153 DOI: 10.1016/j.artmed.2021.102165] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 08/07/2021] [Accepted: 08/31/2021] [Indexed: 12/16/2022]
Abstract
The echocardiogram is a test that is widely used in Heart Disease Diagnoses. However, its analysis is largely dependent on the physician's experience. In this regard, artificial intelligence has become an essential technology to assist physicians. This study is a Systematic Literature Review (SLR) of primary state-of-the-art studies that used Artificial Intelligence (AI) techniques to automate echocardiogram analyses. Searches on the leading scientific article indexing platforms using a search string returned approximately 1400 articles. After applying the inclusion and exclusion criteria, 118 articles were selected to compose the detailed SLR. This SLR presents a thorough investigation of AI applied to support medical decisions for the main types of echocardiogram (Transthoracic, Transesophageal, Doppler, Stress, and Fetal). The article's data extraction indicated that the primary research interest of the studies comprised four groups: 1) Improvement of image quality; 2) identification of the cardiac window vision plane; 3) quantification and analysis of cardiac functions, and; 4) detection and classification of cardiac diseases. The articles were categorized and grouped to show the main contributions of the literature to each type of ECHO. The results indicate that the Deep Learning (DL) methods presented the best results for the detection and segmentation of the heart walls, right and left atrium and ventricles, and classification of heart diseases using images/videos obtained by echocardiography. The models that used Convolutional Neural Network (CNN) and its variations showed the best results for all groups. The evidence produced by the results presented in the tabulation of the studies indicates that the DL contributed significantly to advances in echocardiogram automated analysis processes. Although several solutions were presented regarding the automated analysis of ECHO, this area of research still has great potential for further studies to improve the accuracy of results already known in the literature.
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Affiliation(s)
- Vilson Soares de Siqueira
- Federal Institute of Tocantins, Av. Bernado Sayão, S/N, Santa Maria, Colinas do Tocantins, TO, Brazil; Federal University of Goias, Alameda Palmeiras, Quadra D, Câmpus Samambaia, Goiânia, GO, Brazil.
| | - Moisés Marcos Borges
- Diagnostic Imaging Center - CDI, Av. Portugal, 1155, St. Marista, Goiânia, GO, Brazil
| | - Rogério Gomes Furtado
- Diagnostic Imaging Center - CDI, Av. Portugal, 1155, St. Marista, Goiânia, GO, Brazil
| | - Colandy Nunes Dourado
- Diagnostic Imaging Center - CDI, Av. Portugal, 1155, St. Marista, Goiânia, GO, Brazil. http://www.cdigoias.com.br
| | - Ronaldo Martins da Costa
- Federal University of Goias, Alameda Palmeiras, Quadra D, Câmpus Samambaia, Goiânia, GO, Brazil.
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45
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Al Hinai G, Jammoul S, Vajihi Z, Afilalo J. Deep learning analysis of resting electrocardiograms for the detection of myocardial dysfunction, hypertrophy, and ischaemia: a systematic review. EUROPEAN HEART JOURNAL. DIGITAL HEALTH 2021; 2:416-423. [PMID: 34604757 PMCID: PMC8482047 DOI: 10.1093/ehjdh/ztab048] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Revised: 04/14/2021] [Indexed: 01/31/2023]
Abstract
The aim of this review was to assess the evidence for deep learning (DL) analysis of resting electrocardiograms (ECGs) to predict structural cardiac pathologies such as left ventricular (LV) systolic dysfunction, myocardial hypertrophy, and ischaemic heart disease. A systematic literature search was conducted to identify published original articles on end-to-end DL analysis of resting ECG signals for the detection of structural cardiac pathologies. Studies were excluded if the ECG was acquired by ambulatory, stress, intracardiac, or implantable devices, and if the pathology of interest was arrhythmic in nature. After duplicate reviewers screened search results, 12 articles met the inclusion criteria and were included. Three articles used DL to detect LV systolic dysfunction, achieving an area under the curve (AUC) of 0.89-0.93 and an accuracy of 98%. One study used DL to detect LV hypertrophy, achieving an AUC of 0.87 and an accuracy of 87%. Six articles used DL to detect acute myocardial infarction, achieving an AUC of 0.88-1.00 and an accuracy of 83-99.9%. Two articles used DL to detect stable ischaemic heart disease, achieving an accuracy of 95-99.9%. Deep learning models, particularly those that used convolutional neural networks, outperformed rules-based models and other machine learning models. Deep learning is a promising technique to analyse resting ECG signals for the detection of structural cardiac pathologies, which has clinical applicability for more effective screening of asymptomatic populations and expedited diagnostic work-up of symptomatic patients at risk for cardiovascular disease.
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Affiliation(s)
- Ghalib Al Hinai
- Division of Cardiology, Jewish General Hospital, McGill University, 3755 Cote Ste Catherine Rd, E-222, Montreal, QC H3T 1E2, Canada
| | - Samer Jammoul
- Division of Cardiology, Jewish General Hospital, McGill University, 3755 Cote Ste Catherine Rd, E-222, Montreal, QC H3T 1E2, Canada
| | - Zara Vajihi
- Department of Emergency Medicine, Jewish General Hospital, McGill University, 3755 Cote Ste Catherine Rd, H-126, Montreal, QC H3T 1E2, Canada
| | - Jonathan Afilalo
- Division of Cardiology, Jewish General Hospital, McGill University, 3755 Cote Ste Catherine Rd, E-222, Montreal, QC H3T 1E2, Canada,Centre for Clinical Epidemiology, Jewish General Hospital, 3755 Cote Ste Catherine Rd, H-411, Montreal, QC H3T 1E2, Canada,Corresponding author. Tel: (514) 340-7540, Fax: (514) 340-7534,
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Lin C, Lin CS, Lee DJ, Lee CC, Chen SJ, Tsai SH, Kuo FC, Chau T, Lin SH. Artificial Intelligence-Assisted Electrocardiography for Early Diagnosis of Thyrotoxic Periodic Paralysis. J Endocr Soc 2021; 5:bvab120. [PMID: 34308091 PMCID: PMC8294684 DOI: 10.1210/jendso/bvab120] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Indexed: 12/19/2022] Open
Abstract
Context Thyrotoxic periodic paralysis (TPP) characterized by acute weakness, hypokalemia, and hyperthyroidism is a medical emergency with a great challenge in early diagnosis since most TPP patients do not have overt symptoms. Objective This work aims to assess artificial intelligence (AI)-assisted electrocardiography (ECG) combined with routine laboratory data in the early diagnosis of TPP. Methods A deep learning model (DLM) based on ECG12Net, an 82-layer convolutional neural network, was constructed to detect hypokalemia and hyperthyroidism. The development cohort consisted of 39 ECGs from patients with TPP and 502 ECGs of hypokalemic controls; the validation cohort consisted of 11 ECGs of TPP patients and 36 ECGs of non-TPP individuals with weakness. The AI-ECG–based TPP diagnostic process was then consecutively evaluated in 22 male patients with TTP-like features. Results In the validation cohort, the DLM-based ECG system detected all cases of hypokalemia in TPP patients with a mean absolute error of 0.26 mEq/L and diagnosed TPP with an area under curve (AUC) of approximately 80%, surpassing the best standard ECG parameter (AUC = 0.7285 for the QR interval). Combining the AI predictions with the estimated glomerular filtration rate and serum chloride boosted the diagnostic accuracy of the algorithm to AUC 0.986. In the prospective study, the integrated AI and routine laboratory diagnostic system had a PPV of 100% and F-measure of 87.5%. Conclusion An AI-ECG system reliably identifies hypokalemia in patients with paralysis, and integration with routine blood chemistries provides valuable decision support for the early diagnosis of TPP.
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Affiliation(s)
- Chin Lin
- Graduate Institute of Life Sciences, National Defense Medical Center, Taipei 114, Taiwan, R.O.C.,School of Medicine, National Defense Medical Center, Taipei 114, Taiwan, R.O.C.,School of Public Health, National Defense Medical Center, Taipei 114, Taiwan, R.O.C
| | - Chin-Sheng Lin
- Division of Cardiology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei 114, Taiwan, R.O.C
| | - Ding-Jie Lee
- Division of Nephrology, Department of Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei 114, Taiwan, R.O.C
| | - Chia-Cheng Lee
- Planning and Management Office, Tri-Service General Hospital, National Defense Medical Center, Taipei 114, Taiwan, R.O.C.,Division of Colorectal Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei 114, Taiwan, R.O.C
| | - Sy-Jou Chen
- Department of Emergency Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei 114, Taiwan, R.O.C.,Graduate Institute of Injury Prevention and Control, College of Public Health and Nutrition, Taipei Medical University, Taipei 114, Taiwan, R.O.C
| | - Shi-Hung Tsai
- Department of Emergency Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei 114, Taiwan, R.O.C
| | - Feng-Chih Kuo
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei 114, Taiwan, R.O.C
| | - Tom Chau
- Department of Medicine, Providence St. Vincent Medical Center, Portland, Oregon 97225,USA
| | - Shih-Hua Lin
- Division of Nephrology, Department of Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei 114, Taiwan, R.O.C
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Jo YY, Kwon JM, Jeon KH, Cho YH, Shin JH, Lee YJ, Jung MS, Ban JH, Kim KH, Lee SY, Park J, Oh BH. Detection and classification of arrhythmia using an explainable deep learning model. J Electrocardiol 2021; 67:124-132. [PMID: 34225095 DOI: 10.1016/j.jelectrocard.2021.06.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 04/24/2021] [Accepted: 06/25/2021] [Indexed: 01/02/2023]
Abstract
BACKGROUND Early detection and intervention is the cornerstone for appropriate treatment of arrhythmia and prevention of complications and mortality. Although diverse deep learning models have been developed to detect arrhythmia, they have been criticized due to their unexplainable nature. In this study, we developed an explainable deep learning model (XDM) to classify arrhythmia, and validated its performance using diverse external validation data. METHODS In this retrospective study, the Sejong dataset comprising 86,802 electrocardiograms (ECGs) was used to develop and internally variate the XDM. The XDM based on a neural network-backed ensemble tree was developed with six feature modules that are able to explain the reasons for its decisions. The model was externally validated using data from 36,961 ECGs from four non-restricted datasets. RESULTS During internal and external validation of the XDM, the average area under the receiver operating characteristic curves (AUCs) using a 12‑lead ECG for arrhythmia classification were 0.976 and 0.966, respectively. The XDM outperformed a previous simple multi-classification deep learning model that used the same method. During internal and external validation, the AUCs of explainability were 0.925-0.991. CONCLUSION Our XDM successfully classified arrhythmia using diverse formats of ECGs and could effectively describe the reason for the decisions. Therefore, an explainable deep learning methodology could improve accuracy compared to conventional deep learning methods, and that the transparency of XDM can be enhanced for its application in clinical practice.
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Affiliation(s)
- Yong-Yeon Jo
- Medical Research Team, Medical AI, Co., Seoul, South Korea
| | - Joon-Myoung Kwon
- Medical Research Team, Medical AI, Co., Seoul, South Korea; Artificial Intelligence and Big Data Research Center, Sejong Medical Research Institute, Bucheon, South Korea; Department of Critical Care and Emergency Medicine, Mediplex Sejong Hospital, Incheon, South Korea; Medical R&D Center, Body Friend, Co., Seoul, South Korea.
| | - Ki-Hyun Jeon
- Artificial Intelligence and Big Data Research Center, Sejong Medical Research Institute, Bucheon, South Korea; Division of Cardiology Cardiovascular Center, Mediplex Sejong Hospital, Incheon, South Korea
| | - Yong-Hyeon Cho
- Medical Research Team, Medical AI, Co., Seoul, South Korea
| | - Jae-Hyun Shin
- Medical Research Team, Medical AI, Co., Seoul, South Korea
| | - Yoon-Ji Lee
- Medical Research Team, Medical AI, Co., Seoul, South Korea
| | - Min-Seung Jung
- Medical Research Team, Medical AI, Co., Seoul, South Korea
| | - Jang-Hyeon Ban
- Medical R&D Center, Body Friend, Co., Seoul, South Korea
| | - Kyung-Hee Kim
- Artificial Intelligence and Big Data Research Center, Sejong Medical Research Institute, Bucheon, South Korea; Division of Cardiology Cardiovascular Center, Mediplex Sejong Hospital, Incheon, South Korea
| | - Soo Youn Lee
- Artificial Intelligence and Big Data Research Center, Sejong Medical Research Institute, Bucheon, South Korea; Division of Cardiology Cardiovascular Center, Mediplex Sejong Hospital, Incheon, South Korea
| | - Jinsik Park
- Division of Cardiology Cardiovascular Center, Mediplex Sejong Hospital, Incheon, South Korea
| | - Byung-Hee Oh
- Division of Cardiology Cardiovascular Center, Mediplex Sejong Hospital, Incheon, South Korea
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Farjo PD, Sengupta PP. ECG for Screening Cardiac Abnormalities: The Premise and Promise of Machine Learning. Circ Cardiovasc Imaging 2021; 14:e012837. [PMID: 34129345 DOI: 10.1161/circimaging.121.012837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Peter D Farjo
- Division of Cardiology, Department of Medicine, West Virginia University Heart and Vascular Institute, Morgantown, WV, USA
| | - Partho P Sengupta
- Division of Cardiology, Department of Medicine, West Virginia University Heart and Vascular Institute, Morgantown, WV, USA
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Haq IU, Haq I, Xu B. Artificial intelligence in personalized cardiovascular medicine and cardiovascular imaging. Cardiovasc Diagn Ther 2021; 11:911-923. [PMID: 34295713 DOI: 10.21037/cdt.2020.03.09] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Accepted: 03/05/2020] [Indexed: 12/27/2022]
Abstract
The collection of large, heterogeneous electronic datasets and imaging from patients with cardiovascular disease (CVD) has lent itself to the use of sophisticated analysis using artificial intelligence (AI). AI techniques such as machine learning (ML) are able to identify relationships between data points by linking input to output variables using a combination of different functions, such as neural networks. In cardiovascular medicine, this is especially pertinent for classification, diagnosis, risk prediction and treatment guidance. Common cardiovascular data sources from patients include genomic data, cardiovascular imaging, wearable sensors and electronic health records (EHR). Leveraging AI in analysing such data points: (I) for clinicians: more accurate and streamlined image interpretation and diagnosis; (II) for health systems: improved workflow and reductions in medical errors; (III) for patients: promoting health with further education and promoting primary and secondary cardiovascular health prevention. This review addresses the need for AI in cardiovascular medicine by reviewing recent literature in different cardiovascular imaging modalities: electrocardiography, echocardiography, cardiac computed tomography, cardiac nuclear imaging, and cardiac magnetic resonance (CMR) imaging as well as the role of EHR. This review aims to conceptulise these studies in relation to their clinical applications, potential limitations and future opportunities and directions.
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Affiliation(s)
- Ikram-Ul Haq
- Imperial College London Faculty of Medicine, London, UK
| | - Iqraa Haq
- Imperial College London Faculty of Medicine, London, UK
| | - Bo Xu
- Section of Cardiovascular Imaging, Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Sydell and Arnold Family Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
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50
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Khurshid S, Friedman S, Pirruccello JP, Achille PD, Diamant N, Anderson CD, Ellinor PT, Batra P, Ho JE, Philippakis AA, Lubitz SA. Deep Learning to Predict Cardiac Magnetic Resonance-Derived Left Ventricular Mass and Hypertrophy From 12-Lead ECGs. Circ Cardiovasc Imaging 2021; 14:e012281. [PMID: 34126762 PMCID: PMC8217289 DOI: 10.1161/circimaging.120.012281] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Classical methods for detecting left ventricular (LV) hypertrophy (LVH) using 12-lead ECGs are insensitive. Deep learning models using ECG to infer cardiac magnetic resonance (CMR)-derived LV mass may improve LVH detection. METHODS Within 32 239 individuals of the UK Biobank prospective cohort who underwent CMR and 12-lead ECG, we trained a convolutional neural network to predict CMR-derived LV mass using 12-lead ECGs (left ventricular mass-artificial intelligence [LVM-AI]). In independent test sets (UK Biobank [n=4903] and Mass General Brigham [MGB, n=1371]), we assessed correlation between LVM-AI predicted and CMR-derived LV mass and compared LVH discrimination using LVM-AI versus traditional ECG-based rules (ie, Sokolow-Lyon, Cornell, lead aVL rule, or any ECG rule). In the UK Biobank and an ambulatory MGB cohort (MGB outcomes, n=28 612), we assessed associations between LVM-AI predicted LVH and incident cardiovascular outcomes using age- and sex-adjusted Cox regression. RESULTS LVM-AI predicted LV mass correlated with CMR-derived LV mass in both test sets, although correlation was greater in the UK Biobank (r=0.79) versus MGB (r=0.60, P<0.001 for both). When compared with any ECG rule, LVM-AI demonstrated similar LVH discrimination in the UK Biobank (LVM-AI c-statistic 0.653 [95% CI, 0.608 -0.698] versus any ECG rule c-statistic 0.618 [95% CI, 0.574 -0.663], P=0.11) and superior discrimination in MGB (0.621; 95% CI, 0.592 -0.649 versus 0.588; 95% CI, 0.564 -0.611, P=0.02). LVM-AI-predicted LVH was associated with incident atrial fibrillation, myocardial infarction, heart failure, and ventricular arrhythmias. CONCLUSIONS Deep learning-inferred LV mass estimates from 12-lead ECGs correlate with CMR-derived LV mass, associate with incident cardiovascular disease, and may improve LVH discrimination compared to traditional ECG rules.
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Affiliation(s)
- Shaan Khurshid
- Division of Cardiology, Massachusetts General Hospital, Boston, Massachusetts, USA
- Cardiovascular Disease Initiative, Broad Institute of Harvard and the Massachusetts Institute of Technology, Cambridge, Massachusetts, USA
| | - Samuel Friedman
- Data Sciences Platform, Broad Institute of Harvard and the Massachusetts Institute of Technology, Cambridge, Massachusetts, USA
| | - James P. Pirruccello
- Division of Cardiology, Massachusetts General Hospital, Boston, Massachusetts, USA
- Cardiovascular Disease Initiative, Broad Institute of Harvard and the Massachusetts Institute of Technology, Cambridge, Massachusetts, USA
| | - Paolo Di Achille
- Data Sciences Platform, Broad Institute of Harvard and the Massachusetts Institute of Technology, Cambridge, Massachusetts, USA
| | - Nathaniel Diamant
- Data Sciences Platform, Broad Institute of Harvard and the Massachusetts Institute of Technology, Cambridge, Massachusetts, USA
| | - Christopher D. Anderson
- Cardiovascular Disease Initiative, Broad Institute of Harvard and the Massachusetts Institute of Technology, Cambridge, Massachusetts, USA
- Center for Genomic Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
- Henry and Allison McCance Center for Brain Health, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Patrick T. Ellinor
- Cardiovascular Disease Initiative, Broad Institute of Harvard and the Massachusetts Institute of Technology, Cambridge, Massachusetts, USA
- Cardiac Arrhythmia Service, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Puneet Batra
- Data Sciences Platform, Broad Institute of Harvard and the Massachusetts Institute of Technology, Cambridge, Massachusetts, USA
| | - Jennifer E. Ho
- Division of Cardiology, Massachusetts General Hospital, Boston, Massachusetts, USA
- Cardiovascular Disease Initiative, Broad Institute of Harvard and the Massachusetts Institute of Technology, Cambridge, Massachusetts, USA
| | - Anthony A. Philippakis
- Data Sciences Platform, Broad Institute of Harvard and the Massachusetts Institute of Technology, Cambridge, Massachusetts, USA
| | - Steven A. Lubitz
- Cardiovascular Disease Initiative, Broad Institute of Harvard and the Massachusetts Institute of Technology, Cambridge, Massachusetts, USA
- Cardiac Arrhythmia Service, Massachusetts General Hospital, Boston, Massachusetts, USA
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