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Alam R, Aguirre A, Stultz CM. Detecting QT prolongation from a single-lead ECG with deep learning. PLOS DIGITAL HEALTH 2024; 3:e0000539. [PMID: 38917157 PMCID: PMC11198807 DOI: 10.1371/journal.pdig.0000539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Accepted: 05/17/2024] [Indexed: 06/27/2024]
Abstract
For a number of antiarrhythmics, drug loading requires a 3-day hospitalization with continuous monitoring for QT-prolongation. Automated QT monitoring with wearable ECG monitors would enable out-of-hospital care. We therefore develop a deep learning model that infers QT intervals from ECG Lead-I-the lead that is often available in ambulatory ECG monitors-and use this model to detect clinically meaningful QT-prolongation episodes during Dofetilide drug loading. QTNet-a deep neural network that infers QT intervals from Lead-I ECG-was trained using over 3 million ECGs from 653 thousand patients at the Massachusetts General Hospital and tested on an internal-test set consisting of 633 thousand ECGs from 135 thousand patients. QTNet is further evaluated on an external-validation set containing 3.1 million ECGs from 667 thousand patients at another healthcare institution. On both evaluations, the model achieves mean absolute errors of 12.63ms (internal-test) and 12.30ms (external-validation) for estimating absolute QT intervals. The associated Pearson correlation coefficients are 0.91 (internal-test) and 0.92 (external-validation). Finally, QTNet was used to detect Dofetilide-induced QT prolongation in a publicly available database (ECGRDVQ-dataset) containing ECGs from subjects enrolled in a clinical trial evaluating the effects of antiarrhythmic drugs. QTNet detects Dofetilide-induced QTc prolongation with 87% sensitivity and 77% specificity. The negative predictive value of the model is greater than 95% when the pre-test probability of drug-induced QTc prolongation is below 25%. These results show that drug-induced QT prolongation risk can be tracked from ECG Lead-I using deep learning.
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Affiliation(s)
- Ridwan Alam
- Research Laboratory of Electronics, Massachusetts Institute of Technology, Cambridge, Massachusetts, United States of America
- Computer Science & Artificial Intelligence Laboratory, Massachusetts Institute of Technology, Cambridge, Massachusetts, United States of America
- Department of Electrical Engineering and Computer Science, Massachusetts Institute of Technology, Cambridge, Massachusetts, United States of America
| | - Aaron Aguirre
- Wellman Center for Photomedicine, Massachusetts General Hospital, Boston, Massachusetts, United States of America
- Division of Cardiology, Massachusetts General Hospital, Boston, Massachusetts, United States of America
- Harvard Medical School, Boston, Massachusetts, United States of America
- Harvard-MIT Program in Health Sciences and Technology, Cambridge, Massachusetts, United States of America
| | - Collin M. Stultz
- Research Laboratory of Electronics, Massachusetts Institute of Technology, Cambridge, Massachusetts, United States of America
- Computer Science & Artificial Intelligence Laboratory, Massachusetts Institute of Technology, Cambridge, Massachusetts, United States of America
- Department of Electrical Engineering and Computer Science, Massachusetts Institute of Technology, Cambridge, Massachusetts, United States of America
- Division of Cardiology, Massachusetts General Hospital, Boston, Massachusetts, United States of America
- Harvard-MIT Program in Health Sciences and Technology, Cambridge, Massachusetts, United States of America
- Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, Massachusetts, United States of America
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Doumparatzi M, Sotiriou P, Deligiannis A, Kouidi E. Electrocardiographic characteristics of pediatric and adolescent football players. SPORTS MEDICINE AND HEALTH SCIENCE 2024; 6:179-184. [PMID: 38708327 PMCID: PMC11067734 DOI: 10.1016/j.smhs.2023.12.004] [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: 06/17/2023] [Revised: 11/25/2023] [Accepted: 12/11/2023] [Indexed: 05/07/2024] Open
Abstract
Electrocardiographic characteristics of children and adolescents present differences compared to adults. The aim of our work was to study electrocardiograms (ECGs) of football male players from childhood to late adolescence and examine if the ECG parameters are influenced by systematic exercise. One thousand fifty-four football players participated and formed four groups. Group A included 89 players aged 5-7 years, group B 353 players aged 8-11 years, group C consisted of 355 football players 12-15 yearsold and group D of 257 players with 16-18 years of age. All participants underwent preparticipation screening, including 12-lead surface ECG. Heart rate (HR), PR, RR, QRS, QT, QTc intervals, QT dispersion (QTdisp) and QRS axis were calculated. All ECGs were evaluated according to the current preparticipation cardiac screening guidelines, that refer to athletes aged 12-35 years and do not include pediatric players. Eleven percent of the participants presented an ECG finding. Group D obtained the lowest values of HR, QTc and the highest of PR, RR, QRS, QT intervals and QTdisp, whereas no differences in QRS axis were reported. Incomplete Right Bandle Branch Block (RBBB) was the most frequent ECG peculiarity, detected in 7.3% of the participants. Years of training were statistically significantly correlated to HR, PR, RR, QRS and QT intervals. In conclusion, guidelines for ECG interpretation of athletes in childhood, early and late adolescence are needed.
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Affiliation(s)
- Maria Doumparatzi
- Sports Medicine Laboratory, School of Physical Education and Sports Science, Aristotle University of Thessaloniki, Thermi, GR, 57001, Greece
| | - Panagiota Sotiriou
- Sports Medicine Laboratory, School of Physical Education and Sports Science, Aristotle University of Thessaloniki, Thermi, GR, 57001, Greece
| | - Asterios Deligiannis
- Sports Medicine Laboratory, School of Physical Education and Sports Science, Aristotle University of Thessaloniki, Thermi, GR, 57001, Greece
| | - Evangelia Kouidi
- Sports Medicine Laboratory, School of Physical Education and Sports Science, Aristotle University of Thessaloniki, Thermi, GR, 57001, Greece
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Hsueh J, Fritz C, Thomas CE, Reimer AP, Reisner AT, Schoenfeld D, Haimovich A, Thomas SH. Applications of Artificial Intelligence in Helicopter Emergency Medical Services: A Scoping Review. Air Med J 2024; 43:90-95. [PMID: 38490791 DOI: 10.1016/j.amj.2023.11.012] [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: 09/24/2023] [Revised: 11/15/2023] [Accepted: 11/18/2023] [Indexed: 03/17/2024]
Abstract
OBJECTIVE Recent systematic reviews of acute care medicine applications of artificial intelligence (AI) have focused on hospital and general prehospital uses. The purpose of this scoping review was to identify and describe the literature on AI use with a focus on applications in helicopter emergency medical services (HEMS). METHODS A literature search was performed with specific inclusion and exclusion criteria. Articles were grouped by characteristics such as publication year and general subject matter with categoric and temporal trend analyses. RESULTS We identified 21 records focused on the use of AI in HEMS. These applications included both clinical and triage uses and nonclinical uses. The earliest study appeared in 2006, but over one third of the identified studies have been published in 2021 or later. The passage of time has seen an increased likelihood of HEMS AI studies focusing on nonclinical issues; for each year, the likelihood of a nonclinical focus had an odds ratio of 1.3. CONCLUSION This scoping review provides overview and hypothesis-generating information regarding AI applications specific to HEMS. HEMS AI may be ultimately deployed in nonclinical arenas as much as or more than for clinical decision support. Future studies will inform future decisions as to how AI may improve HEMS systems design, asset deployment, and clinical care.
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Affiliation(s)
- Jennifer Hsueh
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA.
| | - Christie Fritz
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | | | - Andrew P Reimer
- Case Western Reserve University Frances Payne Bolton School of Nursing, Cleveland, OH; Cleveland Clinic Critical Care Transport, Cleveland, OH
| | - Andrew T Reisner
- Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - David Schoenfeld
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Adrian Haimovich
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Stephen H Thomas
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; Blizard Institute, Barts and The London School of Medicine, London, United Kingdom
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Merdjanovska E, Rashkovska A. A framework for comparative study of databases and computational methods for arrhythmia detection from single-lead ECG. Sci Rep 2023; 13:11682. [PMID: 37468574 DOI: 10.1038/s41598-023-38532-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Accepted: 07/10/2023] [Indexed: 07/21/2023] Open
Abstract
Arrhythmia detection from ECG is an important area of computational ECG analysis. However, although a large number of public ECG recordings are available, most research uses only few datasets, making it difficult to estimate the generalizability of the plethora of ECG classification methods. Furthermore, there is a large variability in the evaluation procedures, as well as lack of insight into whether they could successfully perform in a real-world setup. To address these problems, we propose an open-source, flexible and configurable ECG classification codebase-ECGDL, as one of the first efforts that includes 9 arrhythmia datasets, covering a large number of both morphological and rhythmic arrhythmias, as well as 4 deep neural networks, 4 segmentation techniques and 4 evaluation schemes. We perform a comparative analysis along these framework components to provide a comprehensive perspective into arrhythmia classification, focusing on single-lead ECG as the most recent trend in wireless ECG monitoring. ECGDL unifies the class information representation in datasets by creating a label dictionary. Furthermore, it includes a set of the best-performing deep learning approaches with varying signal segmentation techniques and network architectures. A novel evaluation scheme, inter-patient cross-validation, has also been proposed to perform fair evaluation and comparison of results.
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Affiliation(s)
- Elena Merdjanovska
- Department of Communication Systems, Jožef Stefan Institute, 1000, Ljubljana, Slovenia
- Jožef Stefan International Postgraduate School, 1000, Ljubljana, Slovenia
| | - Aleksandra Rashkovska
- Department of Communication Systems, Jožef Stefan Institute, 1000, Ljubljana, Slovenia.
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Jidling C, Gedon D, Schön TB, Oliveira CDL, Cardoso CS, Ferreira AM, Giatti L, Barreto SM, Sabino EC, Ribeiro ALP, Ribeiro AH. Screening for Chagas disease from the electrocardiogram using a deep neural network. PLoS Negl Trop Dis 2023; 17:e0011118. [PMID: 37399207 PMCID: PMC10361500 DOI: 10.1371/journal.pntd.0011118] [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: 01/23/2023] [Revised: 07/21/2023] [Accepted: 05/25/2023] [Indexed: 07/05/2023] Open
Abstract
BACKGROUND Worldwide, it is estimated that over 6 million people are infected with Chagas disease (ChD). It is a neglected disease that can lead to severe heart conditions in its chronic phase. While early treatment can avoid complications, the early-stage detection rate is low. We explore the use of deep neural networks to detect ChD from electrocardiograms (ECGs) to aid in the early detection of the disease. METHODS We employ a convolutional neural network model that uses 12-lead ECG data to compute the probability of a ChD diagnosis. Our model is developed using two datasets which jointly comprise over two million entries from Brazilian patients: The SaMi-Trop study focusing on ChD patients, enriched with data from the CODE study from the general population. The model's performance is evaluated on two external datasets: the REDS-II, a study focused on ChD with 631 patients, and the ELSA-Brasil study, with 13,739 civil servant patients. FINDINGS Evaluating our model, we obtain an AUC-ROC of 0.80 (CI 95% 0.79-0.82) for the validation set (samples from CODE and SaMi-Trop), and in external validation datasets: 0.68 (CI 95% 0.63-0.71) for REDS-II and 0.59 (CI 95% 0.56-0.63) for ELSA-Brasil. In the latter, we report a sensitivity of 0.52 (CI 95% 0.47-0.57) and 0.36 (CI 95% 0.30-0.42) and a specificity of 0.77 (CI 95% 0.72-0.81) and 0.76 (CI 95% 0.75-0.77), respectively. Additionally, when considering only patients with Chagas cardiomyopathy as positive, the model achieved an AUC-ROC of 0.82 (CI 95% 0.77-0.86) for REDS-II and 0.77 (CI 95% 0.68-0.85) for ELSA-Brasil. INTERPRETATION The neural network detects chronic Chagas cardiomyopathy (CCC) from ECG-with weaker performance for early-stage cases. Future work should focus on curating large higher-quality datasets. The CODE dataset, our largest development dataset includes self-reported and therefore less reliable labels, limiting performance for non-CCC patients. Our findings can improve ChD detection and treatment, particularly in high-prevalence areas.
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Affiliation(s)
- Carl Jidling
- Department of Information Technology, Uppsala University, Uppsala, Sweden
| | - Daniel Gedon
- Department of Information Technology, Uppsala University, Uppsala, Sweden
| | - Thomas B. Schön
- Department of Information Technology, Uppsala University, Uppsala, Sweden
| | | | - Clareci Silva Cardoso
- Preventive Medicine, School of Medicine, Universidade Federal de São João del-Rei, Divinópolis, Brazil
| | - Ariela Mota Ferreira
- Graduate Program in Health Sciences, Universidade Estadual de Montes Claros, Montes Claros, Brazil
| | - Luana Giatti
- Preventive Medicine, School of Medicine, Clinical Hospital/EBSERH, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Sandhi Maria Barreto
- Preventive Medicine, School of Medicine, Clinical Hospital/EBSERH, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Ester C. Sabino
- Instituto de Medicina Tropical da Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Antonio L. P. Ribeiro
- Department of Internal Medicine, Faculdade de Medicina, Telehealth Center, Hospital das Clínicas, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Antônio H. Ribeiro
- Department of Information Technology, Uppsala University, Uppsala, Sweden
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Artificial intelligence-driven wearable technologies for neonatal cardiorespiratory monitoring. Part 2: artificial intelligence. Pediatr Res 2023; 93:426-436. [PMID: 36513806 DOI: 10.1038/s41390-022-02417-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 10/21/2022] [Accepted: 11/29/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND With the development of Artificial Intelligence (AI) techniques, smart health monitoring, particularly neonatal cardiorespiratory monitoring with wearable devices, is becoming more popular. To this end, it is crucial to investigate the trend of AI and wearable sensors being developed in this domain. METHODS We performed a review of papers published in IEEE Xplore, Scopus, and PubMed from the year 2000 onwards, to understand the use of AI for neonatal cardiorespiratory monitoring with wearable technologies. We reviewed the advances in AI development for this application and potential future directions. For this review, we assimilated machine learning (ML) algorithms developed for neonatal cardiorespiratory monitoring, designed a taxonomy, and categorised the methods based on their learning capabilities and performance. RESULTS For AI related to wearable technologies for neonatal cardio-respiratory monitoring, 63% of studies utilised traditional ML techniques and 35% utilised deep learning techniques, including 6% that applied transfer learning on pre-trained models. CONCLUSIONS A detailed review of AI methods for neonatal cardiorespiratory wearable sensors is presented along with their advantages and disadvantages. Hierarchical models and suggestions for future developments are highlighted to translate these AI technologies into patient benefit. IMPACT State-of-the-art review in artificial intelligence used for wearable neonatal cardiorespiratory monitoring. Taxonomy design for artificial intelligence methods. Comparative study of AI methods based on their advantages and disadvantages.
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The Application of Computer Techniques to ECG Interpretation. HEARTS 2022. [DOI: 10.3390/hearts3010001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
It is over 120 years since Einthoven introduced the electrocardiogram [...]
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