1
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Park H, Kwon OS, Shim J, Kim D, Park JW, Kim YG, Yu HT, Kim TH, Uhm JS, Choi JI, Joung B, Lee MH, Pak HN. Artificial intelligence estimated electrocardiographic age as a recurrence predictor after atrial fibrillation catheter ablation. NPJ Digit Med 2024; 7:234. [PMID: 39237703 PMCID: PMC11377779 DOI: 10.1038/s41746-024-01234-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Accepted: 08/22/2024] [Indexed: 09/07/2024] Open
Abstract
The application of artificial intelligence (AI) algorithms to 12-lead electrocardiogram (ECG) provides promising age prediction models. We explored whether the gap between the pre-procedural AI-ECG age and chronological age can predict atrial fibrillation (AF) recurrence after catheter ablation. We validated a pre-trained residual network-based model for age prediction on four multinational datasets. Then we estimated AI-ECG age using a pre-procedural sinus rhythm ECG among individuals on anti-arrhythmic drugs who underwent de-novo AF catheter ablation from two independent AF ablation cohorts. We categorized the AI-ECG age gap based on the mean absolute error of the AI-ECG age gap obtained from four model validation datasets; aged-ECG (≥10 years) and normal ECG age (<10 years) groups. In the two AF ablation cohorts, aged-ECG was associated with a significantly increased risk of AF recurrence compared to the normal ECG age group. These associations were independent of chronological age or left atrial diameter. In summary, a pre-procedural AI-ECG age has a prognostic value for AF recurrence after catheter ablation.
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Affiliation(s)
- Hanjin Park
- Yonsei University College of Medicine, Yonsei University Health System, Seoul, Republic of Korea
| | - Oh-Seok Kwon
- Yonsei University College of Medicine, Yonsei University Health System, Seoul, Republic of Korea
| | - Jaemin Shim
- Division of Cardiology, Department of Internal Medicine, Korea University Medical Center, Seoul, Republic of Korea.
| | - Daehoon Kim
- Yonsei University College of Medicine, Yonsei University Health System, Seoul, Republic of Korea
| | - Je-Wook Park
- Yonsei University College of Medicine, Yonsei University Health System, Seoul, Republic of Korea
| | - Yun-Gi Kim
- Division of Cardiology, Department of Internal Medicine, Korea University Medical Center, Seoul, Republic of Korea
| | - Hee Tae Yu
- Yonsei University College of Medicine, Yonsei University Health System, Seoul, Republic of Korea
| | - Tae-Hoon Kim
- Yonsei University College of Medicine, Yonsei University Health System, Seoul, Republic of Korea
| | - Jae-Sun Uhm
- Yonsei University College of Medicine, Yonsei University Health System, Seoul, Republic of Korea
| | - Jong-Il Choi
- Division of Cardiology, Department of Internal Medicine, Korea University Medical Center, Seoul, Republic of Korea
| | - Boyoung Joung
- Yonsei University College of Medicine, Yonsei University Health System, Seoul, Republic of Korea
| | - Moon-Hyoung Lee
- Yonsei University College of Medicine, Yonsei University Health System, Seoul, Republic of Korea
| | - Hui-Nam Pak
- Yonsei University College of Medicine, Yonsei University Health System, Seoul, Republic of Korea.
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2
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Takase B, Ikeda T, Shimizu W, Abe H, Aiba T, Chinushi M, Koba S, Kusano K, Niwano S, Takahashi N, Takatsuki S, Tanno K, Watanabe E, Yoshioka K, Amino M, Fujino T, Iwasaki YK, Kohno R, Kinoshita T, Kurita Y, Masaki N, Murata H, Shinohara T, Yada H, Yodogawa K, Kimura T, Kurita T, Nogami A, Sumitomo N. JCS/JHRS 2022 Guideline on Diagnosis and Risk Assessment of Arrhythmia. Circ J 2024; 88:1509-1595. [PMID: 37690816 DOI: 10.1253/circj.cj-22-0827] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/12/2023]
Affiliation(s)
| | - Takanori Ikeda
- Department of Cardiovascular Medicine, Toho University Faculty of Medicine
| | - Wataru Shimizu
- Department of Cardiovascular Medicine, Nippon Medical School
| | - Haruhiko Abe
- Department of Heart Rhythm Management, University of Occupational and Environmental Health, Japan
| | - Takeshi Aiba
- Department of Clinical Laboratory Medicine and Genetics, National Cerebral and Cardiovascular Center
| | - Masaomi Chinushi
- School of Health Sciences, Niigata University School of Medicine
| | - Shinji Koba
- Division of Cardiology, Department of Medicine, Showa University School of Medicine
| | - Kengo Kusano
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Shinichi Niwano
- Department of Cardiovascular Medicine, Kitasato University School of Medicine
| | - Naohiko Takahashi
- Department of Cardiology and Clinical Examination, Faculty of Medicine, Oita University
| | - Seiji Takatsuki
- Department of Cardiology, Keio University School of Medicine
| | - Kaoru Tanno
- Cardiology Division, Cardiovascular Center, Showa University Koto-Toyosu Hospital
| | - Eiichi Watanabe
- Division of Cardiology, Department of Internal Medicine, Fujita Health University Bantane Hospital
| | | | - Mari Amino
- Department of Cardiology, Tokai University School of Medicine
| | - Tadashi Fujino
- Department of Cardiovascular Medicine, Toho University Faculty of Medicine
| | - Yu-Ki Iwasaki
- Department of Cardiovascular Medicine, Nippon Medical School
| | - Ritsuko Kohno
- Department of Heart Rhythm Management, University of Occupational and Environmental Health, Japan
| | - Toshio Kinoshita
- Department of Cardiovascular Medicine, Toho University Faculty of Medicine
| | - Yasuo Kurita
- Cardiovascular Center, International University of Health and Welfare, Mita Hospital
| | - Nobuyuki Masaki
- Department of Intensive Care Medicine, National Defense Medical College
| | | | - Tetsuji Shinohara
- Department of Cardiology and Clinical Examination, Faculty of Medicine, Oita University
| | - Hirotaka Yada
- Department of Cardiology, International University of Health and Welfare, Mita Hospital
| | - Kenji Yodogawa
- Department of Cardiovascular Medicine, Nippon Medical School
| | - Takeshi Kimura
- Cardiovascular Medicine, Kyoto University Graduate School of Medicine
| | | | - Akihiko Nogami
- Department of Cardiology, Faculty of Medicine, University of Tsukuba
| | - Naokata Sumitomo
- Department of Pediatric Cardiology, Saitama Medical University International Medical Center
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3
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Liu L, Zhao B, Yu Y, Gao W, Liu W, Chen L, Xia Z, Cao Q. Vascular Aging in Ischemic Stroke. J Am Heart Assoc 2024; 13:e033341. [PMID: 39023057 DOI: 10.1161/jaha.123.033341] [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] [Indexed: 07/20/2024]
Abstract
Cellular senescence, a permanent halt in cell division due to stress, spurs functional and structural changes, contributing to vascular aging characterized by endothelial dysfunction and vascular remodeling. This process raises the risk of ischemic stroke (IS) in older individuals, with its mechanisms still not completely understood despite ongoing research efforts. In this review, we have analyzed the impact of vascular aging on increasing susceptibility and exacerbating the pathology of IS. We have emphasized the detrimental effects of endothelial dysfunction and vascular remodeling influenced by oxidative stress and inflammatory response on vascular aging and IS. Our goal is to aid the understanding of vascular aging and IS pathogenesis, particularly benefiting older adults with high risk of IS.
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Affiliation(s)
- Lian Liu
- Department of Anesthesiology Renmin Hospital of Wuhan University Wuhan China
| | - Bo Zhao
- Department of Anesthesiology Renmin Hospital of Wuhan University Wuhan China
| | - Yueyang Yu
- Taikang Medical School, School of Basic Medical Sciences Wuhan University Wuhan China
| | - Wenwei Gao
- Department of Critical Care Medicine Renmin Hospital of Wuhan University Wuhan China
| | - Weitu Liu
- Department of Pathology Hubei Provincial Hospital of Traditional Chinese Medicine Wuhan China
| | - Lili Chen
- Department of Anesthesiology Renmin Hospital of Wuhan University Wuhan China
| | - Zhongyuan Xia
- Department of Anesthesiology Renmin Hospital of Wuhan University Wuhan China
| | - Quan Cao
- Department of Nephrology Zhongnan Hospital of Wuhan University Wuhan China
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4
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Ricci CA, Crysup B, Phillips NR, Ray WC, Santillan MK, Trask AJ, Woerner AE, Goulopoulou S. Machine learning: a new era for cardiovascular pregnancy physiology and cardio-obstetrics research. Am J Physiol Heart Circ Physiol 2024; 327:H417-H432. [PMID: 38847756 PMCID: PMC11442027 DOI: 10.1152/ajpheart.00149.2024] [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: 03/11/2024] [Revised: 05/31/2024] [Accepted: 05/31/2024] [Indexed: 06/10/2024]
Abstract
The maternal cardiovascular system undergoes functional and structural adaptations during pregnancy and postpartum to support increased metabolic demands of offspring and placental growth, labor, and delivery, as well as recovery from childbirth. Thus, pregnancy imposes physiological stress upon the maternal cardiovascular system, and in the absence of an appropriate response it imparts potential risks for cardiovascular complications and adverse outcomes. The proportion of pregnancy-related maternal deaths from cardiovascular events has been steadily increasing, contributing to high rates of maternal mortality. Despite advances in cardiovascular physiology research, there is still no comprehensive understanding of maternal cardiovascular adaptations in healthy pregnancies. Furthermore, current approaches for the prognosis of cardiovascular complications during pregnancy are limited. Machine learning (ML) offers new and effective tools for investigating mechanisms involved in pregnancy-related cardiovascular complications as well as the development of potential therapies. The main goal of this review is to summarize existing research that uses ML to understand mechanisms of cardiovascular physiology during pregnancy and develop prediction models for clinical application in pregnant patients. We also provide an overview of ML platforms that can be used to comprehensively understand cardiovascular adaptations to pregnancy and discuss the interpretability of ML outcomes, the consequences of model bias, and the importance of ethical consideration in ML use.
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Affiliation(s)
- Contessa A Ricci
- College of Nursing, Washington State University, Spokane, Washington, United States
- IREACH: Institute for Research and Education to Advance Community Health, Washington State University, Seattle, Washington, United States
- Elson S. Floyd College of Medicine, Washington State University, Spokane, Washington, United States
| | - Benjamin Crysup
- Department of Microbiology, Immunology and Genetics, University of North Texas Health Science, Fort Worth, Texas, United States
- Center for Human Identification, University of North Texas Health Science Center, Fort Worth, Texas, United States
| | - Nicole R Phillips
- Department of Microbiology, Immunology and Genetics, University of North Texas Health Science, Fort Worth, Texas, United States
| | - William C Ray
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, Ohio, United States
| | - Mark K Santillan
- Department of Obstetrics and Gynecology, University of Iowa Carver College of Medicine, Iowa City, Iowa, United States
| | - Aaron J Trask
- Center for Cardiovascular Research, The Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, Ohio, United States
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, Ohio, United States
| | - August E Woerner
- Department of Microbiology, Immunology and Genetics, University of North Texas Health Science, Fort Worth, Texas, United States
- Center for Human Identification, University of North Texas Health Science Center, Fort Worth, Texas, United States
| | - Styliani Goulopoulou
- Lawrence D. Longo Center for Perinatal Biology, Departments of Basic Sciences, Gynecology and Obstetrics, Loma Linda University, Loma Linda, California, United States
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5
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Takase B, Ikeda T, Shimizu W, Abe H, Aiba T, Chinushi M, Koba S, Kusano K, Niwano S, Takahashi N, Takatsuki S, Tanno K, Watanabe E, Yoshioka K, Amino M, Fujino T, Iwasaki Y, Kohno R, Kinoshita T, Kurita Y, Masaki N, Murata H, Shinohara T, Yada H, Yodogawa K, Kimura T, Kurita T, Nogami A, Sumitomo N. JCS/JHRS 2022 Guideline on Diagnosis and Risk Assessment of Arrhythmia. J Arrhythm 2024; 40:655-752. [PMID: 39139890 PMCID: PMC11317726 DOI: 10.1002/joa3.13052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2024] [Accepted: 04/22/2024] [Indexed: 08/15/2024] Open
Affiliation(s)
| | - Takanori Ikeda
- Department of Cardiovascular MedicineToho University Faculty of Medicine
| | - Wataru Shimizu
- Department of Cardiovascular MedicineNippon Medical School
| | - Haruhiko Abe
- Department of Heart Rhythm ManagementUniversity of Occupational and Environmental HealthJapan
| | - Takeshi Aiba
- Department of Clinical Laboratory Medicine and GeneticsNational Cerebral and Cardiovascular Center
| | | | - Shinji Koba
- Division of Cardiology, Department of MedicineShowa University School of Medicine
| | - Kengo Kusano
- Department of Cardiovascular MedicineNational Cerebral and Cardiovascular Center
| | - Shinichi Niwano
- Department of Cardiovascular MedicineKitasato University School of Medicine
| | - Naohiko Takahashi
- Department of Cardiology and Clinical Examination, Faculty of MedicineOita University
| | | | - Kaoru Tanno
- Cardiovascular Center, Cardiology DivisionShowa University Koto‐Toyosu Hospital
| | - Eiichi Watanabe
- Division of Cardiology, Department of Internal MedicineFujita Health University Bantane Hospital
| | | | - Mari Amino
- Department of CardiologyTokai University School of Medicine
| | - Tadashi Fujino
- Department of Cardiovascular MedicineToho University Faculty of Medicine
| | - Yu‐ki Iwasaki
- Department of Cardiovascular MedicineNippon Medical School
| | - Ritsuko Kohno
- Department of Heart Rhythm ManagementUniversity of Occupational and Environmental HealthJapan
| | - Toshio Kinoshita
- Department of Cardiovascular MedicineToho University Faculty of Medicine
| | - Yasuo Kurita
- Cardiovascular Center, Mita HospitalInternational University of Health and Welfare
| | - Nobuyuki Masaki
- Department of Intensive Care MedicineNational Defense Medical College
| | | | - Tetsuji Shinohara
- Department of Cardiology and Clinical Examination, Faculty of MedicineOita University
| | - Hirotaka Yada
- Department of CardiologyInternational University of Health and Welfare Mita Hospital
| | - Kenji Yodogawa
- Department of Cardiovascular MedicineNippon Medical School
| | - Takeshi Kimura
- Cardiovascular MedicineKyoto University Graduate School of Medicine
| | | | - Akihiko Nogami
- Department of Cardiology, Faculty of MedicineUniversity of Tsukuba
| | - Naokata Sumitomo
- Department of Pediatric CardiologySaitama Medical University International Medical Center
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6
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Ansari MY, Qaraqe M, Righetti R, Serpedin E, Qaraqe K. Enhancing ECG-based heart age: impact of acquisition parameters and generalization strategies for varying signal morphologies and corruptions. Front Cardiovasc Med 2024; 11:1424585. [PMID: 39027006 PMCID: PMC11254851 DOI: 10.3389/fcvm.2024.1424585] [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: 04/28/2024] [Accepted: 06/04/2024] [Indexed: 07/20/2024] Open
Abstract
Electrocardiogram (ECG) is a non-invasive approach to capture the overall electrical activity produced by the contraction and relaxation of the cardiac muscles. It has been established in the literature that the difference between ECG-derived age and chronological age represents a general measure of cardiovascular health. Elevated ECG-derived age strongly correlates with cardiovascular conditions (e.g., atherosclerotic cardiovascular disease). However, the neural networks for ECG age estimation are yet to be thoroughly evaluated from the perspective of ECG acquisition parameters. Additionally, deep learning systems for ECG analysis encounter challenges in generalizing across diverse ECG morphologies in various ethnic groups and are susceptible to errors with signals that exhibit random or systematic distortions To address these challenges, we perform a comprehensive empirical study to determine the threshold for the sampling rate and duration of ECG signals while considering their impact on the computational cost of the neural networks. To tackle the concern of ECG waveform variability in different populations, we evaluate the feasibility of utilizing pre-trained and fine-tuned networks to estimate ECG age in different ethnic groups. Additionally, we empirically demonstrate that finetuning is an environmentally sustainable way to train neural networks, and it significantly decreases the ECG instances required (by more than 100 × ) for attaining performance similar to the networks trained from random weight initialization on a complete dataset. Finally, we systematically evaluate augmentation schemes for ECG signals in the context of age estimation and introduce a random cropping scheme that provides best-in-class performance while using shorter-duration ECG signals. The results also show that random cropping enables the networks to perform well with systematic and random ECG signal corruptions.
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Affiliation(s)
- Mohammed Yusuf Ansari
- Electrical and Computer Engineering, Texas A&M University, College Station, TX, United States
- Electrical and Computer Engineering, Texas A&M University at Qatar, Doha, Qatar
| | - Marwa Qaraqe
- Electrical and Computer Engineering, Texas A&M University at Qatar, Doha, Qatar
- Division of Information and Computing Technology, College of Science and Engineering, Hamad Bin Khalifa University, Qatar Foundation, Doha, Qatar
| | - Raffaella Righetti
- Electrical and Computer Engineering, Texas A&M University, College Station, TX, United States
| | - Erchin Serpedin
- Electrical and Computer Engineering, Texas A&M University, College Station, TX, United States
| | - Khalid Qaraqe
- Electrical and Computer Engineering, Texas A&M University at Qatar, Doha, Qatar
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7
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Mangold KE, Carter RE, Siontis KC, Noseworthy PA, Lopez-Jimenez F, Asirvatham SJ, Friedman PA, Attia ZI. Unlocking the potential of artificial intelligence in electrocardiogram biometrics: age-related changes, anomaly detection, and data authenticity in mobile health platforms. EUROPEAN HEART JOURNAL. DIGITAL HEALTH 2024; 5:314-323. [PMID: 38774362 PMCID: PMC11104462 DOI: 10.1093/ehjdh/ztae024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 03/05/2024] [Accepted: 03/12/2024] [Indexed: 05/24/2024]
Abstract
Aims Mobile devices such as smartphones and watches can now record single-lead electrocardiograms (ECGs), making wearables a potential screening tool for cardiac and wellness monitoring outside of healthcare settings. Because friends and family often share their smart phones and devices, confirmation that a sample is from a given patient is important before it is added to the electronic health record. Methods and results We sought to determine whether the application of Siamese neural network would permit the diagnostic ECG sample to serve as both a medical test and biometric identifier. When using similarity scores to discriminate whether a pair of ECGs came from the same patient or different patients, inputs of single-lead and 12-lead medians produced an area under the curve of 0.94 and 0.97, respectively. Conclusion The similar performance of the single-lead and 12-lead configurations underscores the potential use of mobile devices to monitor cardiac health.
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Affiliation(s)
- Kathryn E Mangold
- Department of Cardiology, Mayo Clinic, 200 1st Street SW, Rochester, MN 55905, USA
| | - Rickey E Carter
- Department of Quantitative Health Sciences, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL 32224, USA
| | | | - Peter A Noseworthy
- Department of Cardiology, Mayo Clinic, 200 1st Street SW, Rochester, MN 55905, USA
| | | | - Samuel J Asirvatham
- Department of Cardiology, Mayo Clinic, 200 1st Street SW, Rochester, MN 55905, USA
| | - Paul A Friedman
- Department of Cardiology, Mayo Clinic, 200 1st Street SW, Rochester, MN 55905, USA
| | - Zachi I Attia
- Department of Cardiology, Mayo Clinic, 200 1st Street SW, Rochester, MN 55905, USA
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8
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Kanaji Y, Ozcan I, Tryon DN, Ahmad A, Sara JDS, Lewis B, Friedman P, Noseworthy PA, Lerman LO, Kakuta T, Attia ZI, Lerman A. Predictive Value of Artificial Intelligence-Enabled Electrocardiography in Patients With Takotsubo Cardiomyopathy. J Am Heart Assoc 2024; 13:e031859. [PMID: 38390798 PMCID: PMC10944041 DOI: 10.1161/jaha.123.031859] [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: 07/19/2023] [Accepted: 12/29/2023] [Indexed: 02/24/2024]
Abstract
BACKGROUND Recent studies have indicated high rates of future major adverse cardiovascular events in patients with Takotsubo cardiomyopathy (TC), but there is no well-established tool for risk stratification. This study sought to evaluate the prognostic value of several artificial intelligence-augmented ECG (AI-ECG) algorithms in patients with TC. METHODS AND RESULTS This study examined consecutive patients in the prospective and observational Mayo Clinic Takotsubo syndrome registry. Several previously validated AI-ECG algorithms were used for the estimation of ECG- age, probability of low ejection fraction, and probability of atrial fibrillation. Multivariable models were constructed to evaluate the association of AI-ECG and other clinical characteristics with major adverse cardiac events, defined as cardiovascular death, recurrence of TC, nonfatal myocardial infarction, hospitalization for congestive heart failure, and stroke. In the final analysis, 305 patients with TC were studied over a median follow-up of 4.8 years. Patients with future major adverse cardiac events were more likely to be older, have a history of hypertension, congestive heart failure, worse renal function, as well as high-risk AI-ECG findings compared with those without. Multivariable Cox proportional hazards analysis indicated that the presence of 2 or 3 high-risk findings detected by AI-ECG remained a significant predictor of major adverse cardiac events in patients with TC after adjustment by conventional risk factors (hazard ratio, 4.419 [95% CI, 1.833-10.66], P=0.001). CONCLUSIONS The combined use of AI-ECG algorithms derived from a single 12-lead ECG might detect subtle underlying patterns associated with worse outcomes in patients with TC. This approach might be beneficial for stratifying high-risk patients with TC.
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Affiliation(s)
- Yoshihisa Kanaji
- Department of Cardiovascular MedicineMayo ClinicRochesterMNUSA
- Division of Cardiovascular MedicineTsuchiura Kyodo General HospitalIbarakiJapan
| | - Ilke Ozcan
- Department of Cardiovascular MedicineMayo ClinicRochesterMNUSA
| | - David N. Tryon
- Department of Cardiovascular MedicineMayo ClinicRochesterMNUSA
| | - Ali Ahmad
- Department of Cardiovascular MedicineMayo ClinicRochesterMNUSA
| | | | - Brad Lewis
- Division of Clinical Trials and BiostatisticsMayo ClinicRochesterMNUSA
| | - Paul Friedman
- Department of Cardiovascular MedicineMayo ClinicRochesterMNUSA
| | | | - Lilach O. Lerman
- Division of Nephrology and HypertensionMayo ClinicRochesterMNUSA
| | - Tsunekazu Kakuta
- Division of Cardiovascular MedicineTsuchiura Kyodo General HospitalIbarakiJapan
| | - Zachi I. Attia
- Department of Cardiovascular MedicineMayo ClinicRochesterMNUSA
| | - Amir Lerman
- Department of Cardiovascular MedicineMayo ClinicRochesterMNUSA
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9
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Tang Q, Liu S, Tao C, Wang J, Zhao H, Wang G, Zhao X, Ren Q, Zhang L, Su B, Xu J, An H. A new method for vascular age estimation based on relative risk difference in vascular aging. Comput Biol Med 2024; 171:108155. [PMID: 38430740 DOI: 10.1016/j.compbiomed.2024.108155] [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: 11/24/2023] [Revised: 01/26/2024] [Accepted: 02/12/2024] [Indexed: 03/05/2024]
Abstract
OBJECTIVE The current models of estimating vascular age (VA) primarily rely on the regression label expressed with chronological age (CA), which does not account individual differences in vascular aging (IDVA) that are difficult to describe by CA. This may lead to inaccuracies in assessing the risk of cardiovascular disease based on VA. To address this limitation, this work aims to develop a new method for estimating VA by considering IDVA. This method will provide a more accurate assessment of cardiovascular disease risk. METHODS Relative risk difference in vascular aging (RRDVA) is proposed to replace IDVA, which is represented as the numerical difference between individual predicted age (PA) and the corresponding mean PA of healthy population. RRDVA and CA are regard as the influence factors to acquire VA. In order to acquire PA of all samples, this work takes CA as the dependent variable, and mines the two most representative indicators from arteriosclerosis data as the independent variables, to establish a regression model for obtaining PA. RESULTS The proposed VA based on RRDVA is significantly correlated with 27 indirect indicators for vascular aging evaluation. Moreover, VA is better than CA by comparing the correlation coefficients between VA, CA and 27 indirect indicators, and RRDVA greater than zero presents a higher risk of disease. CONCLUSION The proposed VA overcomes the limitation of CA in characterizing IDVA, which may help young groups with high disease risk to promote healthy behaviors.
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Affiliation(s)
- Qingfeng Tang
- School of Traditional Chinese Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai 201203, China; The University Key Laboratory of Intelligent Perception and Computing of Anhui Province, Anqing Normal University, Anqing 246133, China; Anhui Engineering Research Center of Intelligent Perception and Elderly Care, Chuzhou University, Chuzhou 239000, China.
| | - Shiping Liu
- The University Key Laboratory of Intelligent Perception and Computing of Anhui Province, Anqing Normal University, Anqing 246133, China.
| | - Chao Tao
- The University Key Laboratory of Intelligent Perception and Computing of Anhui Province, Anqing Normal University, Anqing 246133, China.
| | - Jue Wang
- School of Traditional Chinese Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai 201203, China.
| | - Huanhuan Zhao
- Anhui Engineering Research Center of Intelligent Perception and Elderly Care, Chuzhou University, Chuzhou 239000, China; School of Computer and Information Engineering, Chuzhou University, Chuzhou 239000, China.
| | - Guangjun Wang
- The University Key Laboratory of Intelligent Perception and Computing of Anhui Province, Anqing Normal University, Anqing 246133, China.
| | - Xu Zhao
- Health Management & Physical Examination Center, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Xiangyang 441021, China.
| | - Qun Ren
- Health Management & Physical Examination Center, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Xiangyang 441021, China.
| | - Liangliang Zhang
- The University Key Laboratory of Intelligent Perception and Computing of Anhui Province, Anqing Normal University, Anqing 246133, China.
| | - Benyue Su
- The University Key Laboratory of Intelligent Perception and Computing of Anhui Province, Anqing Normal University, Anqing 246133, China; School of Mathematics and Computer Science, Tongling University, Tongling 244061, China.
| | - Jiatuo Xu
- School of Traditional Chinese Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai 201203, China.
| | - Hui An
- Health Management & Physical Examination Center, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Xiangyang 441021, China.
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10
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Ansari MY, Qaraqe M, Charafeddine F, Serpedin E, Righetti R, Qaraqe K. Estimating age and gender from electrocardiogram signals: A comprehensive review of the past decade. Artif Intell Med 2023; 146:102690. [PMID: 38042607 DOI: 10.1016/j.artmed.2023.102690] [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: 05/05/2023] [Revised: 10/13/2023] [Accepted: 10/18/2023] [Indexed: 12/04/2023]
Abstract
Twelve lead electrocardiogram signals capture unique fingerprints about the body's biological processes and electrical activity of heart muscles. Machine learning and deep learning-based models can learn the embedded patterns in the electrocardiogram to estimate complex metrics such as age and gender that depend on multiple aspects of human physiology. ECG estimated age with respect to the chronological age reflects the overall well-being of the cardiovascular system, with significant positive deviations indicating an aged cardiovascular system and a higher likelihood of cardiovascular mortality. Several conventional, machine learning, and deep learning-based methods have been proposed to estimate age from electronic health records, health surveys, and ECG data. This manuscript comprehensively reviews the methodologies proposed for ECG-based age and gender estimation over the last decade. Specifically, the review highlights that elevated ECG age is associated with atherosclerotic cardiovascular disease, abnormal peripheral endothelial dysfunction, and high mortality, among many other cardiovascular disorders. Furthermore, the survey presents overarching observations and insights across methods for age and gender estimation. This paper also presents several essential methodological improvements and clinical applications of ECG-estimated age and gender to encourage further improvements of the state-of-the-art methodologies.
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Affiliation(s)
- Mohammed Yusuf Ansari
- Texas A&M University, College Station, TX, USA; Texas A&M University at Qatar, Doha, Qatar.
| | - Marwa Qaraqe
- Division of Information and Computing Technology, Hamad Bin Khalifa University, Doha, Qatar; Texas A&M University at Qatar, Doha, Qatar
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Zaidan AM. The leading global health challenges in the artificial intelligence era. Front Public Health 2023; 11:1328918. [PMID: 38089037 PMCID: PMC10711066 DOI: 10.3389/fpubh.2023.1328918] [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: 10/27/2023] [Accepted: 11/13/2023] [Indexed: 12/18/2023] Open
Abstract
Millions of people's health is at risk because of several factors and multiple overlapping crises, all of which hit the vulnerable the most. These challenges are dynamic and evolve in response to emerging health challenges and concerns, which need effective collaboration among countries working toward achieving Sustainable Development Goals (SDGs) and securing global health. Mental Health, the Impact of climate change, cardiovascular diseases (CVDs), diabetes, Infectious diseases, health system, and population aging are examples of challenges known to pose a vast burden worldwide. We are at a point known as the "digital revolution," characterized by the expansion of artificial intelligence (AI) and a fusion of technology types. AI has emerged as a powerful tool for addressing various health challenges, and the last ten years have been influential due to the rapid expansion in the production and accessibility of health-related data. The computational models and algorithms can understand complicated health and medical data to perform various functions and deep-learning strategies. This narrative mini-review summarizes the most current AI applications to address the leading global health challenges. Harnessing its capabilities can ultimately mitigate the Impact of these challenges and revolutionize the field. It has the ability to strengthen global health through personalized health care and improved preparedness and response to future challenges. However, ethical and legal concerns about individual or community privacy and autonomy must be addressed for effective implementation.
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Affiliation(s)
- Amal Mousa Zaidan
- King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center (KAIMRC), Riyadh, Saudi Arabia
- Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
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12
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Tahsin CT, Michopoulos V, Powers A, Park J, Ahmed Z, Cullen K, Jenkins NDM, Keller-Ross M, Fonkoue IT. Sleep efficiency and PTSD symptom severity predict microvascular endothelial function and arterial stiffness in young, trauma-exposed women. Am J Physiol Heart Circ Physiol 2023; 325:H739-H750. [PMID: 37505472 PMCID: PMC10642999 DOI: 10.1152/ajpheart.00169.2023] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 07/13/2023] [Accepted: 07/28/2023] [Indexed: 07/29/2023]
Abstract
Posttraumatic stress disorder (PTSD) is linked to sleep disturbances and significantly higher risk of developing cardiovascular disease (CVD). Furthermore, vascular dysfunction and sleep are independently associated with CVD. Uncovering the link between PTSD symptom severity, sleep disturbances, and vascular function could shine a light on mechanisms of CVD risk in trauma-exposed young women. The purpose of the present study was to investigate the individual and combined effects of sleep efficiency and PTSD symptom severity on vascular function. We recruited 60 otherwise healthy women [age, 26 ± 7 yr and body mass index (BMI), 27.7 ± 6.5 kg/m2] who had been exposed to trauma. We objectively quantified sleep efficiency (SE) using actigraphy, microvascular endothelial function via Framingham reactive hyperemia index (fRHI), and arterial stiffness via pulse-wave velocity (PWV). PTSD symptom severity was assessed using the PTSD checklist for fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) (PCL5). PWV was correlated with age (r = 0.490, P < 0.001) and BMI (r = 0.484, P < 0.001). In addition, fRHI was positively correlated with SE (r = 0.409, P = 0.001) and negatively correlated with PTSD symptoms (r = -0.382, P = 0.002). To explore the predictive value of SE and PTSD symptoms on PWV and fRHI, we conducted two multivariate linear regression models. The model predicting PWV was significant (R2 = 0.584, P < 0.001) with age, BMI, blood pressure, and SE emerging as predictors. Likewise, the model predicting fRHI was significant (R2 = 0.360, P < 0.001) with both PTSD symptoms and SE as significant predictors. Our results suggest that although PTSD symptoms mainly impact microvascular endothelial function, sleep efficiency is additionally associated with arterial stiffness in young trauma-exposed women, after controlling for age and BMI.NEW & NOTEWORTHY This is the first study to investigate the individual and combined impacts of objective sleep and PTSD symptoms severity on arterial stiffness and microvascular endothelial function in young premenopausal women. We report that in young trauma-exposed women, although low sleep efficiency is associated with overall vascular function (i.e., microvascular endothelial function and arterial stiffness), the severity of PTSD symptoms is specifically associated with microvascular endothelial function, after accounting for age and body mass index.
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Affiliation(s)
- Chowdhury Tasnova Tahsin
- Division of Physical Therapy, Department of Rehabilitation Medicine, University of Minnesota Medical School, Minneapolis, Minnesota, United States
- Division of Rehabilitation Science, Department of Rehabilitation Medicine, University of Minnesota Medical School, Minneapolis, Minnesota, United States
| | - Vasiliki Michopoulos
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, Georgia, United States
| | - Abigail Powers
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, Georgia, United States
| | - Jeanie Park
- Division of Renal Medicine, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, United States
- Department of Veterans Affairs, Research Service Line, Atlanta Veterans Affairs Healthcare Systems, Decatur, Georgia, United States
| | - Zynab Ahmed
- Division of Physical Therapy, Department of Rehabilitation Medicine, University of Minnesota Medical School, Minneapolis, Minnesota, United States
- Division of Rehabilitation Science, Department of Rehabilitation Medicine, University of Minnesota Medical School, Minneapolis, Minnesota, United States
| | - Kathryn Cullen
- Department of Psychiatry, University of Minnesota Medical School, Minneapolis, Minnesota, United States
| | - Nathaniel D M Jenkins
- Department of Health and Human Physiology, University of Iowa, Iowa City, Iowa, United States
- Abboud Cardiovascular Research Center, University of Iowa, Iowa City, Iowa, United States
| | - Manda Keller-Ross
- Division of Physical Therapy, Department of Rehabilitation Medicine, University of Minnesota Medical School, Minneapolis, Minnesota, United States
- Division of Rehabilitation Science, Department of Rehabilitation Medicine, University of Minnesota Medical School, Minneapolis, Minnesota, United States
| | - Ida T Fonkoue
- Division of Physical Therapy, Department of Rehabilitation Medicine, University of Minnesota Medical School, Minneapolis, Minnesota, United States
- Division of Rehabilitation Science, Department of Rehabilitation Medicine, University of Minnesota Medical School, Minneapolis, Minnesota, United States
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13
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Iakunchykova O, Schirmer H, Vangberg T, Wang Y, Benavente ED, van Es R, van de Leur RR, Lindekleiv H, Attia ZI, Lopez-Jimenez F, Leon DA, Wilsgaard T. Machine-learning-derived heart and brain age are independently associated with cognition. Eur J Neurol 2023; 30:2611-2619. [PMID: 37254942 DOI: 10.1111/ene.15902] [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: 02/13/2023] [Revised: 05/03/2023] [Accepted: 05/28/2023] [Indexed: 06/01/2023]
Abstract
BACKGROUND AND PURPOSE A heart age biomarker has been developed using deep neural networks applied to electrocardiograms. Whether this biomarker is associated with cognitive function was investigated. METHODS Using 12-lead electrocardiograms, heart age was estimated for a population-based sample (N = 7779, age 40-85 years, 45.3% men). Associations between heart delta age (HDA) and cognitive test scores were studied adjusted for cardiovascular risk factors. In addition, the relationship between HDA, brain delta age (BDA) and cognitive test scores was investigated in mediation analysis. RESULTS Significant associations between HDA and the Word test, Digit Symbol Coding Test and tapping test scores were found. HDA was correlated with BDA (Pearson's r = 0.12, p = 0.0001). Moreover, 13% (95% confidence interval 3-36) of the HDA effect on the tapping test score was mediated through BDA. DISCUSSION Heart delta age, representing the cumulative effects of life-long exposures, was associated with brain age. HDA was associated with cognitive function that was minimally explained through BDA.
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Affiliation(s)
- Olena Iakunchykova
- Center for Lifespan Changes in Brain and Cognition, Department of Psychology, University of Oslo, Oslo, Norway
| | - Henrik Schirmer
- Akershus University Hospital, Lørenskog, Norway
- Institute of Clinical Medicine, Campus Ahus, University of Oslo, Oslo, Norway
| | - Torgil Vangberg
- Department of Clinical Medicine, UiT The Arctic University of Norway, Tromsø, Norway
- PET Imaging Center, University Hospital of North Norway, Tromsø, Norway
| | - Yunpeng Wang
- Center for Lifespan Changes in Brain and Cognition, Department of Psychology, University of Oslo, Oslo, Norway
| | - Ernest D Benavente
- Department of Experimental Cardiology, University Medical Center, Utrecht, The Netherlands
| | - René van Es
- Department of Cardiology, University Medical Center, Utrecht, The Netherlands
| | | | - Haakon Lindekleiv
- University Hospital of North Norway, Tromsø, Norway
- Department of Community Medicine, UiT The Arctic University of Norway, Tromsø, Norway
| | - Zachi I Attia
- Mayo Clinic College of Medicine, Rochester, Minnesota, USA
| | | | - David A Leon
- Department of Noncommunicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Tom Wilsgaard
- Department of Community Medicine, UiT The Arctic University of Norway, Tromsø, Norway
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14
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Sun X, Yin Y, Yang Q, Huo T. Artificial intelligence in cardiovascular diseases: diagnostic and therapeutic perspectives. Eur J Med Res 2023; 28:242. [PMID: 37475050 PMCID: PMC10360247 DOI: 10.1186/s40001-023-01065-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 02/15/2023] [Indexed: 07/22/2023] Open
Abstract
Artificial intelligence (AI), the technique of extracting information from complex database using sophisticated computer algorithms, has incorporated itself in medical field. AI techniques have shown the potential to accelerate the progression of diagnosis and treatment of cardiovascular diseases (CVDs), including heart failure, atrial fibrillation, valvular heart disease, hypertrophic cardiomyopathy, congenital heart disease and so on. In clinical scenario, AI have been proved to apply well in CVD diagnosis, enhance effectiveness of auxiliary tools, disease stratification and typing, and outcome prediction. Deeply developed to capture subtle connections from massive amounts of healthcare data, recent AI algorithms are expected to handle even more complex tasks than traditional methods. The aim of this review is to introduce current applications of AI in CVDs, which may allow clinicians who have limited expertise of computer science to better understand the frontier of the subject and put AI algorithms into clinical practice.
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Affiliation(s)
- Xiaoyu Sun
- National Institute of Hospital Administration, National Health Commission, Beijing, China
| | - Yuzhe Yin
- The Sixth Clinical Medical School, Capital Medical University, Beijing, China
| | - Qiwei Yang
- Department of Thorax, The First Hospital of China Medical University, Shenyang, Liaoning, China
| | - Tianqi Huo
- National Institute of Hospital Administration, National Health Commission, Beijing, China.
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15
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Toya T, Nagatomo Y, Ikegami Y, Masaki N, Adachi T. Coronary microvascular dysfunction in heart failure patients. Front Cardiovasc Med 2023; 10:1153994. [PMID: 37332583 PMCID: PMC10272355 DOI: 10.3389/fcvm.2023.1153994] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 05/23/2023] [Indexed: 06/20/2023] Open
Abstract
Coronary microcirculation has multiple layers of autoregulatory function to maintain resting flow and augment hyperemic flow in response to myocardial demands. Functional or structural alterations in the coronary microvascular function are frequently observed in patients with heart failure with preserved or reduced ejection fraction, which may lead to myocardial ischemic injury and resultant worsening of clinical outcomes. In this review, we describe our current understanding of coronary microvascular dysfunction in the pathogenesis of heart failure with preserved and reduced ejection fraction.
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16
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Suda M, Paul KH, Minamino T, Miller JD, Lerman A, Ellison-Hughes GM, Tchkonia T, Kirkland JL. Senescent Cells: A Therapeutic Target in Cardiovascular Diseases. Cells 2023; 12:1296. [PMID: 37174697 PMCID: PMC10177324 DOI: 10.3390/cells12091296] [Citation(s) in RCA: 20] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 04/27/2023] [Accepted: 04/29/2023] [Indexed: 05/15/2023] Open
Abstract
Senescent cell accumulation has been observed in age-associated diseases including cardiovascular diseases. Senescent cells lack proliferative capacity and secrete senescence-associated secretory phenotype (SASP) factors that may cause or worsen many cardiovascular diseases. Therapies targeting senescent cells, especially senolytic drugs that selectively induce senescent cell removal, have been shown to delay, prevent, alleviate, or treat multiple age-associated diseases in preclinical models. Some senolytic clinical trials have already been completed or are underway for a number of diseases and geriatric syndromes. Understanding how cellular senescence affects the various cell types in the cardiovascular system, such as endothelial cells, vascular smooth muscle cells, fibroblasts, immune cells, progenitor cells, and cardiomyocytes, is important to facilitate translation of senotherapeutics into clinical interventions. This review highlights: (1) the characteristics of senescent cells and their involvement in cardiovascular diseases, focusing on the aforementioned cardiovascular cell types, (2) evidence about senolytic drugs and other senotherapeutics, and (3) the future path and clinical potential of senotherapeutics for cardiovascular diseases.
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Affiliation(s)
- Masayoshi Suda
- Department of Physiology and Biomedical Engineering, Mayo Clinic, 200 First St., S.W., Rochester, MN 55905, USA
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, 3-1-3 Hongo, Bunkyo-ku, Tokyo 113-8421, Japan
| | - Karl H. Paul
- Department of Physiology and Biomedical Engineering, Mayo Clinic, 200 First St., S.W., Rochester, MN 55905, USA
- Department of Physiology and Pharmacology, Karolinska Institutet, Solnavägen 9, 171 65 Solna, Sweden
| | - Tohru Minamino
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, 3-1-3 Hongo, Bunkyo-ku, Tokyo 113-8421, Japan
- Japan Agency for Medical Research and Development-Core Research for Evolutionary Medical Science and Technology (AMED-CREST), Japan Agency for Medical Research and Development, Tokyo 100-0004, Japan
| | - Jordan D. Miller
- Division of Cardiovascular Surgery, Mayo Clinic College of Medicine, 200 First St., S.W., Rochester, MN 55905, USA
| | - Amir Lerman
- Department of Cardiovascular Medicine, Mayo Clinic, 200 First St., S.W., Rochester, MN 55905, USA
| | - Georgina M. Ellison-Hughes
- Centre for Human and Applied Physiological Sciences, School of Basic and Medical Biosciences, Faculty of Life Sciences & Medicine, Guy’s Campus, King’s College London, London SE1 1UL, UK
- Centre for Stem Cells and Regenerative Medicine, School of Basic and Medical Biosciences, Faculty of Life Sciences & Medicine, Guy’s Campus, King’s College London, London SE1 1UL, UK
| | - Tamar Tchkonia
- Department of Physiology and Biomedical Engineering, Mayo Clinic, 200 First St., S.W., Rochester, MN 55905, USA
| | - James L. Kirkland
- Department of Physiology and Biomedical Engineering, Mayo Clinic, 200 First St., S.W., Rochester, MN 55905, USA
- Division of General Internal Medicine, Department of Medicine, Mayo Clinic, 200 First St., S.W., Rochester, MN 55905, USA
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17
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Ryu JS, Lee S, Chu Y, Koh SB, Park YJ, Lee JY, Yang S. Deep Learning Algorithms for Estimation of Demographic and Anthropometric Features from Electrocardiograms. J Clin Med 2023; 12:jcm12082828. [PMID: 37109165 PMCID: PMC10146401 DOI: 10.3390/jcm12082828] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2023] [Revised: 04/02/2023] [Accepted: 04/06/2023] [Indexed: 04/29/2023] Open
Abstract
The electrocardiogram (ECG) has been known to be affected by demographic and anthropometric factors. This study aimed to develop deep learning models to predict the subject's age, sex, ABO blood type, and body mass index (BMI) based on ECGs. This retrospective study included individuals aged 18 years or older who visited a tertiary referral center with ECGs acquired from October 2010 to February 2020. Using convolutional neural networks (CNNs) with three convolutional layers, five kernel sizes, and two pooling sizes, we developed both classification and regression models. We verified a classification model to be applicable for age (<40 years vs. ≥40 years), sex (male vs. female), BMI (<25 kg/m2 vs. ≥25 kg/m2), and ABO blood type. A regression model was also developed and validated for age and BMI estimation. A total of 124,415 ECGs (1 ECG per subject) were included. The dataset was constructed by dividing the entire set of ECGs at a ratio of 4:3:3. In the classification task, the area under the receiver operating characteristic (AUROC), which represents a quantitative indicator of the judgment threshold, was used as the primary outcome. The mean absolute error (MAE), which represents the difference between the observed and estimated values, was used in the regression task. For age estimation, the CNN achieved an AUROC of 0.923 with an accuracy of 82.97%, and a MAE of 8.410. For sex estimation, the AUROC was 0.947 with an accuracy of 86.82%. For BMI estimation, the AUROC was 0.765 with an accuracy of 69.89%, and a MAE of 2.332. For ABO blood type estimation, the CNN showed an inferior performance, with a top-1 accuracy of 31.98%. For the ABO blood type estimation, the CNN showed an inferior performance, with a top-1 accuracy of 31.98% (95% CI, 31.98-31.98%). Our model could be adapted to estimate individuals' demographic and anthropometric features from their ECGs; this would enable the development of physiologic biomarkers that can better reflect their health status than chronological age.
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Affiliation(s)
- Ji Seung Ryu
- Department of Precision Medicine, Yonsei University Wonju College of Medicine, Wonju 26426, Republic of Korea
| | - Solam Lee
- Department of Preventive Medicine, Yonsei University Wonju College of Medicine, Wonju 26426, Republic of Korea
- Department of Dermatology, Yonsei University Wonju College of Medicine, Wonju 26426, Republic of Korea
| | - Yuseong Chu
- Department of Biomedical Engineering, Yonsei University, Wonju 26493, Republic of Korea
| | - Sang Baek Koh
- Department of Preventive Medicine, Yonsei University Wonju College of Medicine, Wonju 26426, Republic of Korea
| | - Young Jun Park
- Division of Cardiology, Department of Internal Medicine, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, Wonju 26426, Republic of Korea
| | - Ju Yeong Lee
- Department of Dermatology, Yonsei University Wonju College of Medicine, Wonju 26426, Republic of Korea
| | - Sejung Yang
- Department of Precision Medicine, Yonsei University Wonju College of Medicine, Wonju 26426, Republic of Korea
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18
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Hirota N, Suzuki S, Motogi J, Nakai H, Matsuzawa W, Takayanagi T, Umemoto T, Hyodo A, Satoh K, Arita T, Yagi N, Otsuka T, Yamashita T. Cardiovascular events and artificial intelligence-predicted age using 12-lead electrocardiograms. IJC HEART & VASCULATURE 2023; 44:101172. [PMID: 36654885 PMCID: PMC9841236 DOI: 10.1016/j.ijcha.2023.101172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 12/26/2022] [Accepted: 01/04/2023] [Indexed: 01/09/2023]
Abstract
Background There is increasing evidence that 12-lead electrocardiograms (ECG) can be used to predict biological age, which is associated with cardiovascular events. However, the utility of artificial intelligence (AI)-predicted age using ECGs remains unclear. Methods Using a single-center database, we developed an AI-enabled ECG using 17 042 sinus rhythm ECGs (SR-ECG) to predict chronological age (CA) with a convolutional neural network that yields AI-predicted age. Using the 5-fold cross validation method, AI-predicted age deriving from the test dataset was yielded for all ECGs. The incidence by AgeDiff and the areas under the curve by receiver operating characteristic curve with AI-predicted age for cardiovascular events were analyzed. Results During the mean follow-up period of 460.1 days, there were 543 cardiovascular events. The annualized incidence of cardiovascular events was 2.24 %, 2.44 %, and 3.01 %/year for patients with AgeDiff < -6, -6 to ≤6, and >6 years, respectively. The areas under the curve for cardiovascular events with CA and AI-predicted age, respectively, were 0.673 and 0.679 (Delong's test, P = 0.388) for all patients; 0.642 and 0.700 (P = 0.003) for younger patients (CA < 60 years); and 0.584 and 0.570 (P = 0.268) for older patients (CA ≥ 60 years). Conclusions AI-predicted age using 12-lead ECGs showed superiority in predicting cardiovascular events compared with CA in younger patients, but not in older patients.
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Affiliation(s)
- Naomi Hirota
- Department of Cardiovascular Medicine, The Cardiovascular Institute, Tokyo, Japan,Corresponding author at: The Cardiovascular Department of Cardiovascular MedicineInstitute, 3-2-19 Nishiazabu, Minato-Ku, Tokyo 106-0031, Japan.
| | - Shinya Suzuki
- Department of Cardiovascular Medicine, The Cardiovascular Institute, Tokyo, Japan
| | | | - Hiroshi Nakai
- Information System Division, The Cardiovascular Institute, Tokyo, Japan
| | | | | | | | | | | | - Takuto Arita
- Department of Cardiovascular Medicine, The Cardiovascular Institute, Tokyo, Japan
| | - Naoharu Yagi
- Department of Cardiovascular Medicine, The Cardiovascular Institute, Tokyo, Japan
| | - Takayuki Otsuka
- Department of Cardiovascular Medicine, The Cardiovascular Institute, Tokyo, Japan
| | - Takeshi Yamashita
- Department of Cardiovascular Medicine, The Cardiovascular Institute, Tokyo, Japan
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19
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Zhang C, Miao X, Wang B, Thomas RJ, Ribeiro AH, Brant LCC, Ribeiro ALP, Lin H. Association of lifestyle with deep learning predicted electrocardiographic age. Front Cardiovasc Med 2023; 10:1160091. [PMID: 37168659 PMCID: PMC10165078 DOI: 10.3389/fcvm.2023.1160091] [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: 02/06/2023] [Accepted: 04/04/2023] [Indexed: 05/13/2023] Open
Abstract
Background People age at different rates. Biological age is a risk factor for many chronic diseases independent of chronological age. A good lifestyle is known to improve overall health, but its association with biological age is unclear. Methods This study included participants from the UK Biobank who had undergone 12-lead resting electrocardiography (ECG). Biological age was estimated by a deep learning model (defined as ECG-age), and the difference between ECG-age and chronological age was defined as Δage. Participants were further categorized into an ideal (score 4), intermediate (scores 2 and 3) or unfavorable lifestyle (score 0 or 1). Four lifestyle factors were investigated, including diet, alcohol consumption, physical activity, and smoking. Linear regression models were used to examine the association between lifestyle factors and Δage, and the models were adjusted for sex and chronological age. Results This study included 44,094 individuals (mean age 64 ± 8, 51.4% females). A significant correlation was observed between predicted biological age and chronological age (correlation coefficient = 0.54, P < 0.001) and the mean Δage (absolute error of biological age and chronological age) was 9.8 ± 7.4 years. Δage was significantly associated with all of the four lifestyle factors, with the effect size ranging from 0.41 ± 0.11 for the healthy diet to 2.37 ± 0.30 for non-smoking. Compared with an ideal lifestyle, an unfavorable lifestyle was associated with an average of 2.50 ± 0.29 years of older predicted ECG-age. Conclusion In this large contemporary population, a strong association was observed between all four studied healthy lifestyle factors and deaccelerated aging. Our study underscores the importance of a healthy lifestyle to reduce the burden of aging-related diseases.
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Affiliation(s)
- Cuili Zhang
- Department of Cardiology, The First Affiliated Hospital of Harbin Medical University, Harbin, China
- Correspondence: Cuili Zhang ; Honghuang Lin
| | - Xiao Miao
- Innovation Research Institute of Traditional Chinese Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Biqi Wang
- Department of Medicine, University of Massachusetts Chan Medical School, Worcester, MA, United States
| | - Robert J. Thomas
- Department of Medicine, Division of Pulmonary, Critical Care & Sleep Medicine, Beth Israel DeaconessMedical Center, Boston, MA, United States
| | - Antônio H. Ribeiro
- Department of Information Technology, Uppsala University, Uppsala, Sweden
| | - Luisa C. C. Brant
- Faculty of Medicine and Telehealth Center, Hospital das Clínicas, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Antonio L. P. Ribeiro
- Faculty of Medicine and Telehealth Center, Hospital das Clínicas, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Honghuang Lin
- Department of Medicine, University of Massachusetts Chan Medical School, Worcester, MA, United States
- Correspondence: Cuili Zhang ; Honghuang Lin
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20
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Ozcan I, Toya T, Cohen-Shelly M, Park HW, Ahmad A, Ozcan A, Noseworthy PA, Kapa S, Lerman LO, Attia ZI, Kushwaha SS, Friedman PA, Lerman A. Artificial intelligence-derived cardiac ageing is associated with cardiac events post-heart transplantation. EUROPEAN HEART JOURNAL. DIGITAL HEALTH 2022; 3:516-524. [PMID: 36710906 PMCID: PMC9779895 DOI: 10.1093/ehjdh/ztac051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 09/08/2022] [Indexed: 02/01/2023]
Abstract
Aims An artificial intelligence algorithm detecting age from 12-lead electrocardiogram (ECG) has been suggested to reflect 'physiological age'. An increased physiological age has been associated with a higher risk of cardiac mortality in the non-transplant population. We aimed to investigate the utility of this algorithm in patients who underwent heart transplantation (HTx). Methods and results A total of 540 patients were studied. The average ECG ages within 1 year before and after HTx were used to represent pre- and post-HTx ECG ages. Major adverse cardiovascular event (MACE) was defined as any coronary revascularization, heart failure hospitalization, re-transplantation, and mortality. Recipient pre-transplant ECG age (mean 63 ± 11 years) correlated significantly with recipient chronological age (mean 49 ± 14 years, R = 0.63, P < 0.0001), while post-transplant ECG age (mean 54 ± 10 years) correlated with both the donor (mean 32 ± 13 years, R = 0.45, P < 0.0001) and the recipient ages (R = 0.38, P < 0.0001). During a median follow-up of 8.8 years, 307 patients experienced MACE. Patients with an increase in ECG age post-transplant showed an increased risk of MACE [hazard ratio (HR): 1.58, 95% confidence interval (CI): (1.24, 2.01), P = 0.0002], even after adjusting for potential confounders [HR: 1.58, 95% CI: (1.19, 2.10), P = 0.002]. Conclusion Electrocardiogram age-derived cardiac ageing after transplantation is associated with a higher risk of MACE. This study suggests that physiological age change of the heart might be an important determinant of MACE risk post-HTx.
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Affiliation(s)
- Ilke Ozcan
- Department of Cardiovascular Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55902, USA
| | - Takumi Toya
- Department of Cardiovascular Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55902, USA,Division of Cardiology, National Defense Medical College, Tokorozawa, Namiki, 3 Chome−2 Saitama, Japan
| | - Michal Cohen-Shelly
- Department of Cardiovascular Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55902, USA
| | - Hyun Woong Park
- Department of Cardiovascular Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55902, USA,Department of Internal Medicine, Gyeongsang National University School of Medicine and Gyeongsang National University Hospital, Jinju, Gyeongsangnam-do, 52727, South Korea
| | - Ali Ahmad
- Department of Cardiovascular Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55902, USA,Department of Internal Medicine, Saint Louis University School of Medicine, 1402 S Grand Blvd, St. Louis, MO 63104, USA
| | - Alp Ozcan
- Department of Cardiovascular Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55902, USA
| | - Peter A Noseworthy
- Department of Cardiovascular Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55902, USA
| | - Suraj Kapa
- Department of Cardiovascular Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55902, USA
| | - Lilach O Lerman
- Department of Cardiovascular Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55902, USA,Division of Nephrology and Hypertension, Mayo Clinic, 200 First Street SW, Rochester, MN 55902, USA
| | - Zachi I Attia
- Department of Cardiovascular Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55902, USA
| | - Sudhir S Kushwaha
- Department of Cardiovascular Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55902, USA
| | - Paul A Friedman
- Department of Cardiovascular Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55902, USA
| | - Amir Lerman
- Corresponding author. Tel: +1 507 255 4152, Fax: +1 507 255 7798,
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21
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Tricarico G, Travagli V. Approach to the management of COVID-19 patients: When home care can represent the best practice. INTERNATIONAL JOURNAL OF RISK & SAFETY IN MEDICINE 2022; 33:249-259. [PMID: 35786662 DOI: 10.3233/jrs-210064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND The pandemic that began around February 2020, caused by the viral pathogen SARS-CoV-2 (COVID-19), has still not completed its course at present in June 2022. OBJECTIVE The open research to date highlights just how varied and complex the outcome of the contagion can be. METHOD The clinical pictures observed following the contagion present variabilities that cannot be explained completely by the patient's age (which, with the new variants, is rapidly changing, increasingly affecting younger patients) nor by symptoms and concomitant pathologies (which are no longer proving to be decisive in recent cases) in relation to medium-to-long term sequelae. In particular, the functions of the vascular endothelium and vascular lesions at the pre-capillary level represent the source of tissue hypoxia and other damage, resulting in the clinical evolution of COVID-19. RESULTS Keeping the patient at home with targeted therapeutic support, aimed at not worsening vascular endothelium damage with early and appropriate stimulation of endothelial cells, ameliorates the glycocalyx function and improves the prognosis and, in some circumstances, could be the best practice suitable for certain patients. CONCLUSION Clinical information thus far collected may be of immense value in developing a better understanding of the present pandemic and future occurrences regarding patient safety, pharmaceutical care and therapy liability.
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Affiliation(s)
| | - Valter Travagli
- Dipartimento di Biotecnologie, Chimica e Farmacia, Università degli Studi di Siena, Siena, Italy.,Dipartimento di Eccellenza Nazionale, Università degli Studi di Siena, Siena, Italy
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22
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Girkantaite Z, Laucyte-Cibulskiene A, Ryliskyte L, Juceviciene A, Badariene J. Laser Doppler flowmetry evaluation of skin microvascular endothelial function in patients with metabolic syndrome. Microvasc Res 2022; 142:104373. [DOI: 10.1016/j.mvr.2022.104373] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Revised: 04/10/2022] [Accepted: 04/24/2022] [Indexed: 12/21/2022]
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23
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Mone P, Pansini A, Calabrò F, De Gennaro S, Esposito M, Rinaldi P, Colin A, Minicucci F, Coppola A, Frullone S, Santulli G. Global cognitive function correlates with P-wave dispersion in frail hypertensive older adults. J Clin Hypertens (Greenwich) 2022; 24:638-643. [PMID: 35229449 PMCID: PMC9106080 DOI: 10.1111/jch.14439] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 01/18/2022] [Accepted: 01/19/2022] [Indexed: 12/15/2022]
Abstract
P‐Wave Dispersion (PWD) is an ECG parameter defined as the difference between the longest and the shortest P‐Wave duration. PWD has been associated with hypertension, a leading cause of age‐related cognitive decline. Moreover, hypertension is associated with vascular dementia and Alzheimer's Disease. Based on these considerations, we evaluated PWD and global cognitive function in frail hypertensive older adults with a previous diagnosis of cognitive decline. We evaluated consecutive frail hypertensive patients ≥65‐year‐old with a Mini‐Mental State Examination (MMSE) score <26. Patients with evidence of secondary hypertension, history of stroke, myocardial infarction, or therapy with beta‐blockers or acetylcholinesterase inhibitors were excluded. Beta‐blocker therapy causes a significant decrease in PWD; patients treated with acetylcholinesterase inhibitors were not included to avoid confounding effects on cognitive function. By examining 180 patients, we found that PWD significantly correlated with MMSE score. Strikingly, these effects were confirmed in a linear multivariate analysis with a regression model. To our knowledge, this is the first study showing that PWD correlates with global cognitive function in frail hypertensive older adults.
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Affiliation(s)
- Pasquale Mone
- Department of Medicine, Division of Cardiology, Wilf Family Cardiovascular Research Institute, Einstein Institute for Aging Research, Albert Einstein College of Medicine, New York City, NY, USA.,University Campania "Luigi Vanvitelli", Naples, Italy.,ASL Avellino, Avellino, Italy
| | | | | | | | | | | | | | | | | | | | - Gaetano Santulli
- Department of Medicine, Division of Cardiology, Wilf Family Cardiovascular Research Institute, Einstein Institute for Aging Research, Albert Einstein College of Medicine, New York City, NY, USA.,University of Naples "Federico II", Naples, Italy.,International Translational Research and Medical Education (ITME) Consortium, Naples, Italy
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24
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Cardiac age detected by machine learning applied to the surface ECG of healthy subjects: Creation of a benchmark. J Electrocardiol 2022; 72:49-55. [DOI: 10.1016/j.jelectrocard.2022.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Revised: 02/10/2022] [Accepted: 03/06/2022] [Indexed: 11/22/2022]
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25
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Bio-Signals in Medical Applications and Challenges Using Artificial Intelligence. JOURNAL OF SENSOR AND ACTUATOR NETWORKS 2022. [DOI: 10.3390/jsan11010017] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Artificial Intelligence (AI) has broadly connected the medical field at various levels of diagnosis based on the congruous data generated. Different types of bio-signal can be used to monitor a patient’s condition and in decision making. Medical equipment uses signals to communicate information to care staff. AI algorithms and approaches will help to predict health problems and check the health status of organs, while AI prediction, classification, and regression algorithms are helping the medical industry to protect from health hazards. The early prediction and detection of health conditions will guide people to stay healthy. This paper represents the scope of bio-signals using AI in the medical area. It will illustrate possible case studies relevant to bio-signals generated through IoT sensors. The bio-signals that retrospectively occur are discussed, and the new challenges of medical diagnosis using bio-signals are identified.
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26
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Ahmad A, Shelly-Cohen M, Corban MT, Murphree Jr DH, Toya T, Sara JD, Ozcan I, Lerman LO, Friedman PA, Attia ZI, Lerman A. Machine learning aids clinical decision-making in patients presenting with angina and non-obstructive coronary artery disease. EUROPEAN HEART JOURNAL. DIGITAL HEALTH 2021; 2:597-605. [PMID: 36713103 PMCID: PMC9707870 DOI: 10.1093/ehjdh/ztab084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 09/14/2021] [Indexed: 02/01/2023]
Abstract
Aims The current gold standard comprehensive assessment of coronary microvascular dysfunction (CMD) is through a limited-access invasive catheterization lab procedure. We aimed to develop a point-of-care tool to assist clinical guidance in patients presenting with chest pain and/or an abnormal cardiac functional stress test and with non-obstructive coronary artery disease (NOCAD). Methods and results This study included 1893 NOCAD patients (<50% angiographic stenosis) who underwent CMD evaluation as well as an electrocardiogram (ECG) up to 1-year prior. Endothelial-independent CMD was defined by coronary flow reserve (CFR) ≤2.5 in response to intracoronary adenosine. Endothelial-dependent CMD was defined by a maximal percent increase in coronary blood flow (%ΔCBF) ≤50% in response to intracoronary acetylcholine infusion. We trained algorithms to distinguish between the following outcomes: CFR ≤2.5, %ΔCBF ≤50, and the combination of both. Two classes of algorithms were trained, one depending on ECG waveforms as input, and another using tabular clinical data. Mean age was 51 ± 12 years and 66% were females (n = 1257). Area under the curve values ranged from 0.49 to 0.67 for all the outcomes. The best performance in our analysis was for the outcome CFR ≤2.5 with clinical variables. Area under the curve and accuracy were 0.67% and 60%. When decreasing the threshold of positivity, sensitivity and negative predictive value increased to 92% and 90%, respectively, while specificity and positive predictive value decreased to 25% and 29%, respectively. Conclusion An artificial intelligence-enabled algorithm may be able to assist clinical guidance by ruling out CMD in patients presenting with chest pain and/or an abnormal functional stress test. This algorithm needs to be prospectively validated in different cohorts.
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Affiliation(s)
- Ali Ahmad
- Department of Cardiovascular Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55902, USA
| | - Michal Shelly-Cohen
- Department of Cardiovascular Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55902, USA
| | - Michel T Corban
- Department of Cardiovascular Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55902, USA
| | - Dennis H Murphree Jr
- Department of Cardiovascular Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55902, USA
| | - Takumi Toya
- Department of Cardiovascular Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55902, USA,Department of Medicine, Division of Cardiology, National Defense Medical College, Tokorozawa, Saitama, Japan
| | - Jaskanwal D Sara
- Department of Cardiovascular Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55902, USA
| | - Ilke Ozcan
- Department of Cardiovascular Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55902, USA
| | - Lilach O Lerman
- Department of Medicine, Division of Nephrology and Hypertension, Mayo Clinic, 200 First Street SW, Rochester, MN 55902, USA
| | - Paul A Friedman
- Department of Cardiovascular Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55902, USA
| | - Zachi I Attia
- Department of Cardiovascular Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55902, USA
| | - Amir Lerman
- Department of Cardiovascular Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55902, USA,Corresponding author. Tel: +1 507 255 4152, Fax: +1 507 255 7798,
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27
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Lima EM, Ribeiro AH, Paixão GMM, Ribeiro MH, Pinto-Filho MM, Gomes PR, Oliveira DM, Sabino EC, Duncan BB, Giatti L, Barreto SM, Meira W, Schön TB, Ribeiro ALP. Deep neural network-estimated electrocardiographic age as a mortality predictor. Nat Commun 2021; 12:5117. [PMID: 34433816 PMCID: PMC8387361 DOI: 10.1038/s41467-021-25351-7] [Citation(s) in RCA: 69] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 07/14/2021] [Indexed: 02/07/2023] Open
Abstract
The electrocardiogram (ECG) is the most commonly used exam for the evaluation of cardiovascular diseases. Here we propose that the age predicted by artificial intelligence (AI) from the raw ECG (ECG-age) can be a measure of cardiovascular health. A deep neural network is trained to predict a patient's age from the 12-lead ECG in the CODE study cohort (n = 1,558,415 patients). On a 15% hold-out split, patients with ECG-age more than 8 years greater than the chronological age have a higher mortality rate (hazard ratio (HR) 1.79, p < 0.001), whereas those with ECG-age more than 8 years smaller, have a lower mortality rate (HR 0.78, p < 0.001). Similar results are obtained in the external cohorts ELSA-Brasil (n = 14,236) and SaMi-Trop (n = 1,631). Moreover, even for apparent normal ECGs, the predicted ECG-age gap from the chronological age remains a statistically significant risk predictor. These results show that the AI-enabled analysis of the ECG can add prognostic information.
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Affiliation(s)
- Emilly M Lima
- Telehealth Center, Hospital das Clínicas, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil.,Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Antônio H Ribeiro
- Departamento de Ciência da Computação, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil.,Department of Information Technology, Uppsala University, Uppsala, Sweden
| | - Gabriela M M Paixão
- Telehealth Center, Hospital das Clínicas, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil.,Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | | | - Marcelo M Pinto-Filho
- Telehealth Center, Hospital das Clínicas, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil.,Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Paulo R Gomes
- Telehealth Center, Hospital das Clínicas, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil.,Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Derick M Oliveira
- Departamento de Ciência da Computação, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Ester C Sabino
- Instituto de Medicina Tropical da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Bruce B Duncan
- Programa de Pós-Graduação em Epidemiologia and Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Luana Giatti
- Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Sandhi M Barreto
- Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Wagner Meira
- Departamento de Ciência da Computação, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Thomas B Schön
- Department of Information Technology, Uppsala University, Uppsala, Sweden.
| | - Antonio Luiz P Ribeiro
- Telehealth Center, Hospital das Clínicas, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil. .,Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil.
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28
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Toya T, Ahmad A, Attia Z, Cohen-Shelly M, Ozcan I, Noseworthy PA, Lopez-Jimenez F, Kapa S, Lerman LO, Friedman PA, Lerman A. Vascular Aging Detected by Peripheral Endothelial Dysfunction Is Associated With ECG-Derived Physiological Aging. J Am Heart Assoc 2021; 10:e018656. [PMID: 33455414 PMCID: PMC7955452 DOI: 10.1161/jaha.120.018656] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Background An artificial intelligence algorithm that detects age using the 12-lead ECG has been suggested to signal "physiologic age." This study aimed to investigate the association of peripheral microvascular endothelial function (PMEF) as an index of vascular aging, with accelerated physiologic aging gauged by ECG-derived artificial intelligence-estimated age. Methods and Results This study included 531 patients who underwent ECG and a noninvasive PMEF assessment using reactive hyperemia peripheral arterial tonometry. Abnormal PMEF was defined as reactive hyperemia peripheral arterial tonometry index ≤2.0. Accelerated or delayed physiologic aging was calculated by the Δ age (ECG-derived artificial intelligence-estimated age minus chronological age), and the association between Δ age and PMEF as well as its impact on composite major adverse cardiovascular events were investigated. Δ age was higher in patients with abnormal PMEF than in patients with normal PMEF (2.3±7.8 versus 0.5±7.7 years; P=0.01). Reactive hyperemia peripheral arterial tonometry index was negatively associated with Δ age after adjustment for cardiovascular risk factors (standardized β coefficient, -0.08; P=0.048). The highest quartile of Δ age was associated with an increased risk of major adverse cardiovascular events compared with the first quartile of Δ age in patients with abnormal PMEF, even after adjustment for cardiovascular risk factors (hazard ratio, 4.72; 95% CI, 1.24-17.91; P=0.02). Conclusions Vascular aging detected by endothelial function is associated with accelerated physiologic aging, as assessed by the artificial intelligence-ECG Δ age. Patients with endothelial dysfunction and the highest quartile of accelerated physiologic aging have a marked increase in risk for cardiovascular events.
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Affiliation(s)
- Takumi Toya
- Department of Cardiovascular Medicine Mayo Clinic Rochester MN.,Division of Cardiology National Defense Medical College Tokorozawa Saitama Japan
| | | | - Zachi Attia
- Department of Cardiovascular Medicine Mayo Clinic Rochester MN
| | | | - Ilke Ozcan
- Department of Cardiovascular Medicine Mayo Clinic Rochester MN
| | | | | | - Suraj Kapa
- Department of Cardiovascular Medicine Mayo Clinic Rochester MN
| | - Lilach O Lerman
- Division of Nephrology and Hypertension Mayo Clinic Rochester MN
| | - Paul A Friedman
- Department of Cardiovascular Medicine Mayo Clinic Rochester MN
| | - Amir Lerman
- Department of Cardiovascular Medicine Mayo Clinic Rochester MN
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