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Dhingra LS, Aminorroaya A, Sangha V, Camargos AP, Asselbergs FW, Brant LCC, Barreto SM, Ribeiro ALP, Krumholz HM, Oikonomou EK, Khera R. Scalable Risk Stratification for Heart Failure Using Artificial Intelligence applied to 12-lead Electrocardiographic Images: A Multinational Study. medRxiv 2024:2024.04.02.24305232. [PMID: 38633808 PMCID: PMC11023679 DOI: 10.1101/2024.04.02.24305232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/19/2024]
Abstract
Background Current risk stratification strategies for heart failure (HF) risk require either specific blood-based biomarkers or comprehensive clinical evaluation. In this study, we evaluated the use of artificial intelligence (AI) applied to images of electrocardiograms (ECGs) to predict HF risk. Methods Across multinational longitudinal cohorts in the integrated Yale New Haven Health System (YNHHS) and in population-based UK Biobank (UKB) and Brazilian Longitudinal Study of Adult Health (ELSA-Brasil), we identified individuals without HF at baseline. Incident HF was defined based on the first occurrence of an HF hospitalization. We evaluated an AI-ECG model that defines the cross-sectional probability of left ventricular dysfunction from a single image of a 12-lead ECG and its association with incident HF. We accounted for the competing risk of death using the Fine-Gray subdistribution model and evaluated the discrimination using Harrel's c-statistic. The pooled cohort equations to prevent HF (PCP-HF) were used as a comparator for estimating incident HF risk. Results Among 231,285 individuals at YNHHS, 4472 had a primary HF hospitalization over 4.5 years (IQR 2.5-6.6) of follow-up. In UKB and ELSA-Brasil, among 42,741 and 13,454 people, 46 and 31 developed HF over a follow-up of 3.1 (2.1-4.5) and 4.2 (3.7-4.5) years, respectively. A positive AI-ECG screen portended a 4-fold higher risk of incident HF among YNHHS patients (age-, sex-adjusted HR [aHR] 3.88 [95% CI, 3.63-4.14]). In UKB and ELSA-Brasil, a positive-screen ECG portended 13- and 24-fold higher hazard of incident HF, respectively (aHR: UKBB, 12.85 [6.87-24.02]; ELSA-Brasil, 23.50 [11.09-49.81]). The association was consistent after accounting for comorbidities and the competing risk of death. Higher model output probabilities were progressively associated with a higher risk for HF. The model's discrimination for incident HF was 0.718 in YNHHS, 0.769 in UKB, and 0.810 in ELSA-Brasil. Across cohorts, incorporating model probability with PCP-HF yielded a significant improvement in discrimination over PCP-HF alone. Conclusions An AI model applied to images of 12-lead ECGs can identify those at elevated risk of HF across multinational cohorts. As a digital biomarker of HF risk that requires just an ECG image, this AI-ECG approach can enable scalable and efficient screening for HF risk.
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Affiliation(s)
- Lovedeep S Dhingra
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Arya Aminorroaya
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Veer Sangha
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
- Department of Engineering Science, University of Oxford, Oxford, UK
| | - Aline Pedroso Camargos
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Folkert W Asselbergs
- Department of Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam University Medical Centre, University of Amsterdam, Amsterdam, Netherlands
- Institute of Health Informatics, University College London, London, UK
- The National Institute for Health Research University College London Hospitals Biomedical Research Centre, University College London, London, UK
| | - Luisa CC Brant
- Department of Internal Medicine, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
- Telehealth Center and Cardiology Service, Hospital das Clínicas, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Sandhi M Barreto
- Department of Preventive Medicine, School of Medicine, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Antonio Luiz P Ribeiro
- Department of Internal Medicine, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
- Telehealth Center and Cardiology Service, Hospital das Clínicas, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Harlan M Krumholz
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
- Center for Outcomes Research and Evaluation (CORE), Yale New Haven Hospital, New Haven, CT, USA
- Department of Health Policy and Management, Yale School of Public Health, New Haven, CT, USA
| | - Evangelos K Oikonomou
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Rohan Khera
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
- Center for Outcomes Research and Evaluation (CORE), Yale New Haven Hospital, New Haven, CT, USA
- Section of Biomedical Informatics and Data Science, Yale School of Medicine, New Haven, CT, USA
- Section of Health Informatics, Department of Biostatistics, Yale School of Public Health, New Haven, CT, USA
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2
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Chorney W, Wang H. Towards federated transfer learning in electrocardiogram signal analysis. Comput Biol Med 2024; 170:107984. [PMID: 38244469 DOI: 10.1016/j.compbiomed.2024.107984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Revised: 12/17/2023] [Accepted: 01/13/2024] [Indexed: 01/22/2024]
Abstract
Modern methods in artificial intelligence perform very well on many healthcare datasets, at times outperforming trained doctors. However, many assumptions made in model training are not justifiable in clinical settings. In this work, we propose a method to train classifiers for electrocardiograms, able to deal with data of disparate input dimensions, distributed across different institutions, and able to protect patient privacy. In addition, we propose a simple method for creating federated datasets from any centralized dataset. We use autoencoders in conjunction with federated learning to model a highly heterogeneous modeling problem using the Massachusetts Institute of Technology Beth Israel Hospital Arrhythmia dataset, the Computing in Cardiology 2017 challenge dataset, and the PTB-XL dataset. For an encoding dimension of 1000, our federated classifier achieves an accuracy, precision, recall, and F1 score of 73.0%, 66.6%, 73.0%, and 69.7%, respectively. Our results suggest that dropping commonly made assumptions significantly complicate training and that as a result, estimates of performance of many machine learning models may overestimate performance when adopted for clinical settings.
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Affiliation(s)
- Wesley Chorney
- Computational Engineering, Mississippi State University, Mississippi State, 39762, USA.
| | - Haifeng Wang
- Industrial and Systems Engineering, Mississippi State University, Mississippi State, 39762, USA.
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3
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Safdar MF, Nowak RM, Pałka P. Pre-Processing techniques and artificial intelligence algorithms for electrocardiogram (ECG) signals analysis: A comprehensive review. Comput Biol Med 2024; 170:107908. [PMID: 38217973 DOI: 10.1016/j.compbiomed.2023.107908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 12/19/2023] [Accepted: 12/24/2023] [Indexed: 01/15/2024]
Abstract
Electrocardiogram (ECG) are the physiological signals and a standard test to measure the heart's electrical activity that depicts the movement of cardiac muscles. A review study has been conducted on ECG signals analysis with the help of artificial intelligence (AI) methods over the last ten years i.e., 2012-22. Primarily, the method of ECG analysis by software systems was divided into classical signal processing (e.g. spectrograms or filters), machine learning (ML) and deep learning (DL), including recursive models, transformers and hybrid. Secondly, the data sources and benchmark datasets were depicted. Authors grouped resources by ECG acquisition methods into hospital-based portable machines and wearable devices. Authors also included new trends like advanced pre-processing, data augmentation, simulations and agent-based modeling. The study found improvement in ECG examination perfection made each year through ML, DL, hybrid models, and transformers. Convolutional neural networks and hybrid models were more targeted and proved efficient. The transformer model extended the accuracy from 90% to 98%. The Physio-Net library helps acquire ECG signals, including the popular benchmark databases such as MIT-BIH, PTB, and challenging datasets. Similarly, wearable devices have been established as a appropriate option for monitoring patient health without the time and place limitations and are also helpful for AI model calibration with so far accuracy of 82%-83% on Samsung smartwatch. In the pre-processing signals, spectrogram generation through Fourier and wavelet transformations are erected leading approaches promoting on average accuracy of 90%-95%. Likewise, data enhancement using geometrical techniques is well-considered; however, extraction and concatenation-based methods need attention. As the what-if analysis in healthcare or cardiac issues can be performed using a complex simulation, the study reviews agent-based modeling and simulation approaches for cardiovascular risk event assessment.
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Affiliation(s)
- Muhammad Farhan Safdar
- Institute of Computer Science, Faculty of Electronics and Information Technology, Warsaw University of Technology, 00-665 Warsaw, Poland.
| | - Robert Marek Nowak
- Institute of Computer Science, Faculty of Electronics and Information Technology, Warsaw University of Technology, 00-665 Warsaw, Poland
| | - Piotr Pałka
- Institute of Control and Computation Engineering, Faculty of Electronics and Information Technology, Warsaw University of Technology, 00-665 Warsaw, Poland
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Nyström A, Olsson de Capretz P, Björkelund A, Lundager Forberg J, Ohlsson M, Björk J, Ekelund U. Prior electrocardiograms not useful for machine learning predictions of major adverse cardiac events in emergency department chest pain patients. J Electrocardiol 2024; 82:42-51. [PMID: 38006763 DOI: 10.1016/j.jelectrocard.2023.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 09/07/2023] [Accepted: 11/02/2023] [Indexed: 11/27/2023]
Abstract
At the emergency department (ED), it is important to quickly and accurately determine which patients are likely to have a major adverse cardiac event (MACE). Machine learning (ML) models can be used to aid physicians in detecting MACE, and improving the performance of such models is an active area of research. In this study, we sought to determine if ML models can be improved by including a prior electrocardiogram (ECG) from each patient. To that end, we trained several models to predict MACE within 30 days, both with and without prior ECGs, using data collected from 19,499 consecutive patients with chest pain, from five EDs in southern Sweden, between the years 2017 and 2018. Our results indicate no improvement in AUC from prior ECGs. This was consistent across models, both with and without additional clinical input variables, for different patient subgroups, and for different subsets of the outcome. While contradicting current best practices for manual ECG analysis, the results are positive in the sense that ML models with fewer inputs are more easily and widely applicable in practice.
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Affiliation(s)
- Axel Nyström
- Lund University, Department of Laboratory Medicine, Lund, Sweden.
| | - Pontus Olsson de Capretz
- Skåne University Hospital, Department of Internal and Emergency Medicine, Lund, Sweden; Lund University, Department of Clinical Sciences, Lund, Sweden
| | - Anders Björkelund
- Lund University, Center for Environmental and Climate Science, Lund, Sweden
| | - Jakob Lundager Forberg
- Lund University, Department of Clinical Sciences, Lund, Sweden; Helsingborg Hospital, Department of Emergency Medicine, Helsingborg, Sweden
| | - Mattias Ohlsson
- Lund University, Center for Environmental and Climate Science, Lund, Sweden; Halmstad University, Center for Applied Intelligent Systems Research (CAISR), Halmstad, Sweden
| | - Jonas Björk
- Lund University, Department of Laboratory Medicine, Lund, Sweden; Clinical Studies Sweden, Forum South, Skåne University Hospital, Lund, Sweden
| | - Ulf Ekelund
- Skåne University Hospital, Department of Internal and Emergency Medicine, Lund, Sweden; Lund University, Department of Clinical Sciences, Lund, Sweden
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Chorney W, Wang H, Fan LW. AttentionCovidNet: Efficient ECG-based diagnosis of COVID-19. Comput Biol Med 2024; 168:107743. [PMID: 38000247 DOI: 10.1016/j.compbiomed.2023.107743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2023] [Revised: 10/24/2023] [Accepted: 11/20/2023] [Indexed: 11/26/2023]
Abstract
The novel coronavirus caused a worldwide pandemic. Rapid detection of COVID-19 can help reduce the spread of the novel coronavirus as well as the burden on healthcare systems worldwide. The current method of detecting COVID-19 suffers from low sensitivity, with estimates of 50%-70% in clinical settings. Therefore, in this study, we propose AttentionCovidNet, an efficient model for the detection of COVID-19 based on a channel attention convolutional neural network for electrocardiograms. The electrocardiogram is a non-invasive test, and so can be more easily obtained from a patient. We show that the proposed model achieves state-of-the-art results compared to recent models in the field, achieving metrics of 0.993, 0.997, 0.993, and 0.995 for accuracy, precision, recall, and F1 score, respectively. These results indicate both the promise of the proposed model as an alternative test for COVID-19, as well as the potential of ECG data as a diagnostic tool for COVID-19.
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Affiliation(s)
- Wesley Chorney
- Computational Engineering, Mississippi State University, Mississippi State, 39762, USA.
| | - Haifeng Wang
- Industrial and Systems Engineering, Mississippi State University, Mississippi State, 39762, USA.
| | - Lir-Wan Fan
- Pediatrics/Newborn Medicine, University of Mississippi Medical Center, Mississippi State, 39216, USA.
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Kinoshita T, Onda N, Ohno R, Ikeda T, Sugizaki Y, Ohara H, Nakagami T, Yuzawa H, Shimada H, Shimizu K, Ikeda T. Activation recovery interval as an electrocardiographic repolarization index to detect doxorubicin-induced cardiotoxicity. J Cardiol 2023; 82:473-480. [PMID: 37506822 DOI: 10.1016/j.jjcc.2023.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 05/12/2023] [Accepted: 07/21/2023] [Indexed: 07/30/2023]
Abstract
BACKGROUND It has been reported that early detection and treatment of cancer therapy- related cardiac dysfunction (CTRCD) improves its prognosis. The detailed relationships between electrocardiographic repolarization indices and decreased left ventricular function in CTRCD have not been elucidated. We closely assessed such relationships in patients with doxorubicin (DOX)-induced CTRCD. METHODS This retrospective, single-center, cohort study included 471 consecutive patients with malignant lymphoma who received chemotherapy including DOX. Of them, 17 patients with CTRCD and 68 patients without CTRCD who underwent 12‑lead electrocardiogram and an echocardiogram before and after chemotherapy were eventually analyzed. The fluctuations of the following electrocardiographic repolarization indices were evaluated in lead V5: QT, JT, T peak to T end interval (Tp-e), and activation recovery interval (ARI). These indices were corrected by heart rate with the Fridericia formula. RESULTS The median period from the end of chemotherapy to the diagnosis of the CTRCD group was 346 days (IQR 170-1283 days). After chemotherapy, the QT interval was significantly prolonged in both with and without CTRCD groups compared with that before chemotherapy (pre QTc vs. post QTc in CTRCD group, 386 ± 27 ms vs. 411 ± 37 ms, p = 0.03, pre QTc vs. post QTc in non-CTRCD group, 388 ± 24 ms vs. 395 ± 25 ms, p = 0.04, respectively). ARIc after chemotherapy was characteristically observed only in the CTRCD group (pre ARIc vs. post ARIc in CTRCD group, 258 ± 53 ms vs. 211 ± 28 ms, p = 0.03, pre ARIc vs. post ARIc in non-CTRCD group, 221 ± 19 ms vs. 225 ± 23 ms, NS, respectively) and had negative correlations with left ventricular ejection fraction (r = -0.56, p < 0.001). Using the receiver-operating characteristic curve, the relationship between ARIc and CTRCD morbidity was examined. The optimal cut-off point of ARIc prolongation between before and after chemotherapy was 18 ms (sensitivity 75 %, specificity 79 %, area under the curve 0.76). CONCLUSIONS ARIc prolongation may be useful in the early detection of developing late-onset chronic DOX-induced CTRCD and lead to early treatment for cardiac protection.
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Affiliation(s)
- Toshio Kinoshita
- Division of Cardiovascular Medicine, Department of Internal Medicine, Toho University Sakura Medical Center, Chiba, Japan.
| | - Naoki Onda
- Division of Hematology and Oncology, Department of Medicine, Toho University Omori Medical Center, Tokyo, Japan
| | - Ruiko Ohno
- Division of Cardiovascular Medicine, Department of Internal Medicine, Toho University Sakura Medical Center, Chiba, Japan
| | - Takushi Ikeda
- Division of Cardiovascular Medicine, Department of Internal Medicine, Toho University Sakura Medical Center, Chiba, Japan
| | - Yuta Sugizaki
- Division of Cardiovascular Medicine, Department of Internal Medicine, Toho University Sakura Medical Center, Chiba, Japan
| | - Hiroshi Ohara
- Department of Cardiovascular Medicine, Toho University Faculty of Medicine, Tokyo, Japan
| | - Takahiro Nakagami
- Division of Cardiovascular Medicine, Department of Internal Medicine, Toho University Sakura Medical Center, Chiba, Japan
| | - Hitomi Yuzawa
- Division of Cardiology, Mitsui Memorial Hospital, Tokyo, Japan
| | - Hideaki Shimada
- Department of Gastroenterological Surgery and Clinical Oncology, Toho University Graduate School of Medicine, Tokyo, Japan
| | - Kazuhiro Shimizu
- Division of Cardiovascular Medicine, Department of Internal Medicine, Toho University Sakura Medical Center, Chiba, Japan
| | - Takanori Ikeda
- Department of Cardiovascular Medicine, Toho University Faculty of Medicine, Tokyo, Japan
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7
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Zhao H, Li T, Yang J, Pang C. An error-bounded median filter for correcting ECG baseline wander. Health Inf Sci Syst 2023; 11:45. [PMID: 37771394 PMCID: PMC10522562 DOI: 10.1007/s13755-023-00235-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 07/17/2023] [Indexed: 09/30/2023] Open
Abstract
The baseline wander (BLW) in electrocardiogram (ECG) is a common disturbance that has a significant influence on the ECG wave pattern recognition. Many methods, such as IIR filter, mean filter, etc., can be used to correct BLW; However, most of them work on the original ECG signals. Compressed ECG data are economic for data storage and transmission, and if the baseline correction can be processed on them, it will be more efficient than we decompress them first and then do such correction. In this paper, we propose a new type of median filter CM_Filter, which works on the synopses of straight lines achieved from ECG by piecewise linear approximation (PLA) under maximum error bound. In CM_Filter, a heuristic strategy "Quick-Finding" is deduced by a property of straight lines in order to get the quality-assured median values from the synopses. The extended experimental tests demonstrate that the proposed filter is very efficient in execution time, and effective for correcting both slow and abrupt ECG baseline wander.
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Affiliation(s)
- Huanyu Zhao
- The School of Computer Science and Technology, Donghua University, Shanghai, China
- The Institute of Applied Mathematics, Hebei Academy of Sciences, Shijiazhuang, China
- Hebei Authentication Technology Engineering Research Center, Shijiazhuang, China
| | - Tongliang Li
- The Institute of Applied Mathematics, Hebei Academy of Sciences, Shijiazhuang, China
| | - Jian Yang
- The School of Computer Science and Technology, Donghua University, Shanghai, China
| | - Chaoyi Pang
- The School of Computer Science & Data Engineering, NingboTech University, Ningbo, China
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Shankar SV, Oikonomou EK, Khera R. CarDS-Plus ECG Platform: Development and Feasibility Evaluation of a Multiplatform Artificial Intelligence Toolkit for Portable and Wearable Device Electrocardiograms. medRxiv 2023:2023.10.02.23296404. [PMID: 37873174 PMCID: PMC10593062 DOI: 10.1101/2023.10.02.23296404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2023]
Abstract
In the rapidly evolving landscape of modern healthcare, the integration of wearable and portable technology provides a unique opportunity for personalized health monitoring in the community. Devices like the Apple Watch, FitBit, and AliveCor KardiaMobile have revolutionized the acquisition and processing of intricate health data streams that were previously accessible only through devices only available to healthcare providers. Amidst the variety of data collected by these gadgets, single-lead electrocardiogram (ECG) recordings have emerged as a crucial source of information for monitoring cardiovascular health. Notably, there has been significant advances in artificial intelligence capable of interpreting these 1-lead ECGs, facilitating clinical diagnosis as well as the detection of rare cardiac disorders. This design study describes the development of an innovative multi-platform system aimed at the rapid deployment of AI-based ECG solutions for clinical investigation and care delivery. The study examines various design considerations, aligning them with specific applications, and develops data flows to maximize efficiency for research and clinical use. This process encompasses the reception of single-lead ECGs from diverse wearable devices, channeling this data into a centralized data lake, and facilitating real-time inference through AI models for ECG interpretation. An evaluation of the platform demonstrates a mean duration from acquisition to reporting of results of 33.0 to 35.7 seconds, after a standard 30 second acquisition, allowing the complete process to be completed in 63.0 to 65.7 seconds. There were no substantial differences in acquisition to reporting across two commercially available devices (Apple Watch and KardiaMobile). These results demonstrate the succcessful translation of design principles into a fully integrated and efficient strategy for leveraging 1-lead ECGs across platforms and interpretation by AI-ECG algorithms. Such a platform is critical to translating AI discoveries for wearable and portable ECG devices to clinical impact through rapid deployment.
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Affiliation(s)
- Sumukh Vasisht Shankar
- Cardiovascular Data Science (CarDS) Lab, Yale School of Medicine, New Haven, CT
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, CT
| | - Evangelos K Oikonomou
- Cardiovascular Data Science (CarDS) Lab, Yale School of Medicine, New Haven, CT
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, CT
| | - Rohan Khera
- Cardiovascular Data Science (CarDS) Lab, Yale School of Medicine, New Haven, CT
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, CT
- Center for Outcomes Research and Evaluation (CORE), Yale New Haven Hospital, New Haven, CT, USA
- Section of Health Informatics, Department of Biostatistics, Yale School of Public Health, New Haven, CT, USA
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9
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Yoo H, Yum Y, Park SW, Lee JM, Jang M, Kim Y, Kim JH, Park HJ, Han KS, Park JH, Joo HJ. Standardized Database of 12-Lead Electrocardiograms with a Common Standard for the Promotion of Cardiovascular Research: KURIAS-ECG. Healthc Inform Res 2023; 29:132-144. [PMID: 37190737 PMCID: PMC10209728 DOI: 10.4258/hir.2023.29.2.132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Revised: 02/22/2023] [Accepted: 03/10/2023] [Indexed: 05/17/2023] Open
Abstract
OBJECTIVES Electrocardiography (ECG)-based diagnosis by experts cannot maintain uniform quality because individual differences may occur. Previous public databases can be used for clinical studies, but there is no common standard that would allow databases to be combined. For this reason, it is difficult to conduct research that derives results by combining databases. Recent commercial ECG machines offer diagnoses similar to those of a physician. Therefore, the purpose of this study was to construct a standardized ECG database using computerized diagnoses. METHODS The constructed database was standardized using Systematized Nomenclature of Medicine Clinical Terms (SNOMED CT) and Observational Medical Outcomes Partnership-common data model (OMOP-CDM), and data were then categorized into 10 groups based on the Minnesota classification. In addition, to extract high-quality waveforms, poor-quality ECGs were removed, and database bias was minimized by extracting at least 2,000 cases for each group. To check database quality, the difference in baseline displacement according to whether poor ECGs were removed was analyzed, and the usefulness of the database was verified with seven classification models using waveforms. RESULTS The standardized KURIAS-ECG database consists of high-quality ECGs from 13,862 patients, with about 20,000 data points, making it possible to obtain more than 2,000 for each Minnesota classification. An artificial intelligence classification model using the data extracted through SNOMED-CT showed an average accuracy of 88.03%. CONCLUSIONS The KURIAS-ECG database contains standardized ECG data extracted from various machines. The proposed protocol should promote cardiovascular disease research using big data and artificial intelligence.
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Affiliation(s)
- Hakje Yoo
- Korea University Research Institute for Medical Bigdata Science, Korea University College of Medicine, Seoul,
Korea
| | - Yunjin Yum
- Department of Biostatistics, Korea University College of Medicine, Seoul,
Korea
| | - Soo Wan Park
- Korea University Research Institute for Medical Bigdata Science, Korea University College of Medicine, Seoul,
Korea
| | - Jeong Moon Lee
- Korea University Research Institute for Medical Bigdata Science, Korea University College of Medicine, Seoul,
Korea
| | - Moonjoung Jang
- Korea University Research Institute for Medical Bigdata Science, Korea University College of Medicine, Seoul,
Korea
| | - Yoojoong Kim
- School of Computer Science and Information Engineering, The Catholic University of Korea, Bucheon,
Korea
| | - Jong-Ho Kim
- Department of Cardiology, Cardiovascular Center, Korea University College of Medicine, Seoul,
Korea
| | - Hyun-Joon Park
- Korea University Research Institute for Healthcare Service Innovation, Korea University College of Medicine, Seoul,
Korea
| | - Kap Su Han
- Department of Emergency Medicine, Korea University Anam Hospital, Korea University College of Medicine, Seoul,
Korea
| | - Jae Hyoung Park
- Department of Cardiology, Cardiovascular Center, Korea University College of Medicine, Seoul,
Korea
| | - Hyung Joon Joo
- Korea University Research Institute for Medical Bigdata Science, Korea University College of Medicine, Seoul,
Korea
- Department of Cardiology, Cardiovascular Center, Korea University College of Medicine, Seoul,
Korea
- Department of Medical Informatics, Korea University College of Medicine, Seoul,
Korea
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Jasaui Y, Mortazhejri S, Dowling S, Duquette D, L’Heureux G, Linklater S, Mrklas KJ, Wilkinson G, Beesoon S, Patey AM, Ruzycki SM, Grimshaw JM. Beyond guideline knowledge: a theory-based qualitative study of low-value preoperative testing. Perioper Med (Lond) 2023; 12:3. [PMID: 36864470 PMCID: PMC9979452 DOI: 10.1186/s13741-023-00292-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Accepted: 02/12/2023] [Indexed: 03/04/2023] Open
Abstract
BACKGROUND Choosing Wisely Canada and most major anesthesia and preoperative guidelines recommend against obtaining preoperative tests before low-risk procedures. However, these recommendations alone have not reduced low-value test ordering. In this study, the theoretical domains framework (TDF) was used to understand the drivers of preoperative electrocardiogram (ECG) and chest X-ray (CXR) ordering for patients undergoing low-risk surgery ('low-value preoperative testing') among anesthesiologists, internal medicine specialists, nurses, and surgeons. METHODS Using snowball sampling, preoperative clinicians working in a single health system in Canada were recruited for semi-structured interviews about low-value preoperative testing. The interview guide was developed using the TDF to identify the factors that influence preoperative ECG and CXR ordering. Interview content was deductively coded using TDF domains and specific beliefs were identified by grouping similar utterances. Domain relevance was established based on belief statement frequency, presence of conflicting beliefs, and perceived influence over preoperative test ordering practices. RESULTS Sixteen clinicians (7 anesthesiologists, 4 internists, 1 nurse, and 4 surgeons) participated. Eight of the 12 TDF domains were identified as the drivers of preoperative test ordering. While most participants agreed that the guidelines were helpful, they also expressed distrust in the evidence behind them (knowledge). Both a lack of clarity about the responsibilities of the specialties involved in the preoperative process and the ease by which any clinician could order, but not cancel tests, were drivers of low-value preoperative test ordering (social/professional role and identity, social influences, belief about capabilities). Additionally, low-value tests could also be ordered by nurses or the surgeon and may be completed before the anesthesia or internal medicine preoperative assessment appointment (environmental context and resources, beliefs about capabilities). Finally, while participants agreed that they did not intend to routinely order low-value tests and understood that these would not benefit patient outcomes, they also reported ordering tests to prevent surgery cancellations and problems during surgery (motivation and goals, beliefs about consequences, social influences). CONCLUSIONS We identified key factors that anesthesiologists, internists, nurses, and surgeons believe influence preoperative test ordering for patients undergoing low-risk surgeries. These beliefs highlight the need to shift away from knowledge-based interventions and focus instead on understanding local drivers of behaviour and target change at the individual, team, and institutional levels.
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Affiliation(s)
- Yamile Jasaui
- grid.22072.350000 0004 1936 7697Continuing Medical Education, Cumming School of Medicine, University of Calgary, Alberta, Canada
| | - Sameh Mortazhejri
- grid.412687.e0000 0000 9606 5108Centre for Implementation Research, Ottawa Hospital Research Institute, Ottawa, ON Canada ,grid.28046.380000 0001 2182 2255School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON Canada
| | - Shawn Dowling
- grid.22072.350000 0004 1936 7697Department of Emergency Medicine, Cumming School of Medicine, University of Calgary, Alberta, Canada
| | - D’Arcy Duquette
- Patient Partner, De-Implementing Wisely Research Group, Edmonton, Canada
| | - Geralyn L’Heureux
- Patient Partner, De-Implementing Wisely Research Group, Edmonton, Canada
| | - Stefanie Linklater
- grid.412687.e0000 0000 9606 5108Centre for Implementation Research, Ottawa Hospital Research Institute, Ottawa, ON Canada
| | - Kelly J. Mrklas
- grid.413574.00000 0001 0693 8815Strategic Clinical Networks, Provincial Clinical Excellence, Alberta Health Services, Edmonton, AB Canada
| | - Gloria Wilkinson
- Patient Partner, De-Implementing Wisely Research Group, Edmonton, Canada
| | - Sanjay Beesoon
- grid.413574.00000 0001 0693 8815Surgery Strategic Clinical Network, Alberta Health Services, Edmonton, AB Canada
| | - Andrea M. Patey
- grid.412687.e0000 0000 9606 5108Centre for Implementation Research, Ottawa Hospital Research Institute, Ottawa, ON Canada
| | - Shannon M. Ruzycki
- grid.17089.370000 0001 2190 316XFaculty of Medicine and Dentistry, University of Alberta, Edmonton, AB Canada ,grid.22072.350000 0004 1936 7697Department of Medicine, Cumming School of Medicine, University of Calgary, Alberta, Canada
| | - Jeremy M. Grimshaw
- grid.412687.e0000 0000 9606 5108Centre for Implementation Research, Ottawa Hospital Research Institute, Ottawa, ON Canada ,grid.28046.380000 0001 2182 2255Department of Medicine, University of Ottawa, Ottawa, ON Canada
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11
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Singstad BJ. Norwegian Endurance Athlete ECG Database. IEEE Open J Eng Med Biol 2022; 3:162-166. [PMID: 36632091 PMCID: PMC9829117 DOI: 10.1109/ojemb.2022.3214719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 09/23/2022] [Accepted: 10/09/2022] [Indexed: 11/06/2022] Open
Abstract
Athletes often have training-induced remodeling of the heart, and this can sometimes be seen as abnormal but non-pathological changes in the electrocardiogram. However, these changes can be confused with severe cardiovascular diseases that, in some cases, can cause cardiovascular death. Electrocardiogram data from athletes is therefore important to learn more about the difference between normal athletic remodeling and pathological remodeling of the heart. This work provides a dataset of electrocardiograms from 28 Norwegian elite endurance athletes. The electrocardiograms are standard 12-lead resting ECGs, recorded for 10 seconds while the athlete's lay supine on a bench. The electrocardiograms were then interpreted by an interpretation algorithm and by a trained cardiologist. The electrocardiogram waveform data and the interpretations were stored in Python Waveform Database format and made publicly available through PhysioNet.
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Affiliation(s)
- Bjorn-Jostein Singstad
- Department of Computational PhysiologySimula Research Laboratory Kristian Augusts Gate 23,0164OsloNorway
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12
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Shi W, Chen C, Cui Q, Deng F, Yang B, Cao Y, Zhao F, Zhang Y, Du P, Wang J, Li T, Tang S, Shi X. Sleep disturbance exacerbates the cardiac conduction abnormalities induced by persistent heavy ambient fine particulate matter pollution: A multi-center cross-sectional study. Sci Total Environ 2022; 838:156472. [PMID: 35660605 DOI: 10.1016/j.scitotenv.2022.156472] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 05/30/2022] [Accepted: 05/31/2022] [Indexed: 06/15/2023]
Abstract
Fine particulate matter (PM2.5) exposure and sleep disturbance have been significantly associated with adverse cardiovascular outcomes, however, the combined effects of these two factors are still unclear. We conducted a multi-center cross-sectional study from November 2018 to May 2019 in the Beijing-Tianjin-Hebei region in China to investigate the potential modifying effects of sleep disturbance on associations between cardiac conduction abnormalities and PM2.5 exposure, as well as the combined effects of sleep disturbance and heavy pollution episodes, which were defined based on the PM2.5 mass concentration (≥75 μg/m3, falling in the 75th/90th percentile) and duration (1 day and ≥2 days). The sleep quality and sleep duration of all participants were evaluated using the Pittsburgh Sleep Quality Index. Standard 12-lead electrocardiogram (ECG) test was performed to measure the heart rate (HR), QRS duration (time taken for ventricular depolarization), HR corrected QT interval (time for ventricular depolarization and repolarization) and PR interval (time for atrioventricular conduction). Multivariable linear regression models were performed to evaluate the associations of PM2.5 and heavy pollution events on ECG parameters and the joint effects with sleep disturbance. We found PM2.5 exposure was independently associated with prolonged QRS and QTc intervals. Association between PM2.5 and the QTc interval was significantly stronger in participants with poor sleep quality. For each 10-μg/m3 increase in PM2.5 concentration, the QTc interval in the participants with poor sleep quality increased by 0.41 % (95 % confidence interval: 0.19, 0.64). In addition, heavy PM2.5 pollution episodes, especially extremely heavy pollution of long duration, were found to have synergistic effects with sleep disturbance on ECG parameters. Our findings provide evidence that PM2.5 exposure, especially heavy pollution episodes, may increase abnormal cardiac conduction and have a synergistic effect with sleep disturbance. Improving sleep hygiene is crucial to protect the heart health of the general population.
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Affiliation(s)
- Wanying Shi
- China CDC Key Laboratory of Environment and Population Health, National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Chen Chen
- China CDC Key Laboratory of Environment and Population Health, National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Qian Cui
- China CDC Key Laboratory of Environment and Population Health, National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, Beijing, China; School of Ecology and Environment, Inner Mongolia University, Hohhot, China
| | - Fuchang Deng
- China CDC Key Laboratory of Environment and Population Health, National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Bo Yang
- China CDC Key Laboratory of Environment and Population Health, National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, Beijing, China; School of Public Health, Baotou Medical College, Inner Mongolia University of Science and Technology, Baotou, China
| | - Yaqiang Cao
- China CDC Key Laboratory of Environment and Population Health, National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, Beijing, China; Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Feng Zhao
- China CDC Key Laboratory of Environment and Population Health, National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Yi Zhang
- China CDC Key Laboratory of Environment and Population Health, National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Peng Du
- China CDC Key Laboratory of Environment and Population Health, National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Jiaonan Wang
- China CDC Key Laboratory of Environment and Population Health, National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, Beijing, China; Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Tiantian Li
- China CDC Key Laboratory of Environment and Population Health, National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, Beijing, China; Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Song Tang
- China CDC Key Laboratory of Environment and Population Health, National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, Beijing, China; Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Xiaoming Shi
- China CDC Key Laboratory of Environment and Population Health, National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, Beijing, China; Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, Jiangsu, China.
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Henry C, Shipley L, Morgan S, Crowe JA, Carpenter J, Hayes-Gill B, Sharkey D. Feasibility of a Novel ECG Electrode Placement Method in Newborn Infants. Neonatology 2022; 119:264-267. [PMID: 35130540 PMCID: PMC9153365 DOI: 10.1159/000521530] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 12/07/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND International newborn resuscitation guidelines recommend electrocardiogram (ECG) heart rate (HR) monitoring at birth. We evaluated the application time of pre-set ECG electrodes fixed to a polyethene patch allowing adhesive-free attachment to the wet skin of the newborn chest. OBJECTIVES Using a three-electrode pre-set ECG patch configuration, application success was calculated using video analysis and measured at three time points, the time to (1) apply electrodes; (2) detect recognizable QRS complexes after application; and (3) display a HR after application. METHOD A prospective observational study in two UK tertiary maternity units was undertaken with 71 newborns including 23 who required resuscitation. RESULTS The median (IQR) time for ECG patch application was 8 (6-10) seconds, detection of recognizable QRS complexes 8 (2-12) seconds, and time to output HR was 23 (15-37) seconds. CONCLUSION Pre-set ECG chest electrodes allow rapid HR information at birth without electrode detachment or compromising skin integrity.
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Affiliation(s)
- Caroline Henry
- Centre for Perinatal Research, School of Medicine, University of Nottingham, Nottingham, United Kingdom
| | - Lara Shipley
- Centre for Perinatal Research, School of Medicine, University of Nottingham, Nottingham, United Kingdom
| | - Stephen Morgan
- Faculty of Engineering, University of Nottingham, Nottingham, United Kingdom
| | - John A. Crowe
- Faculty of Engineering, University of Nottingham, Nottingham, United Kingdom
| | | | - Barrie Hayes-Gill
- Faculty of Engineering, University of Nottingham, Nottingham, United Kingdom
| | - Don Sharkey
- Centre for Perinatal Research, School of Medicine, University of Nottingham, Nottingham, United Kingdom
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Abstract
Artificial intelligence (AI) has given the electrocardiogram (ECG) and clinicians reading them super-human diagnostic abilities. Trained without hard-coded rules by finding often subclinical patterns in huge datasets, AI transforms the ECG, a ubiquitous, non-invasive cardiac test that is integrated into practice workflows, into a screening tool and predictor of cardiac and non-cardiac diseases, often in asymptomatic individuals. This review describes the mathematical background behind supervised AI algorithms, and discusses selected AI ECG cardiac screening algorithms including those for the detection of left ventricular dysfunction, episodic atrial fibrillation from a tracing recorded during normal sinus rhythm, and other structural and valvular diseases. The ability to learn from big data sets, without the need to understand the biological mechanism, has created opportunities for detecting non-cardiac diseases as COVID-19 and introduced challenges with regards to data privacy. Like all medical tests, the AI ECG must be carefully vetted and validated in real-world clinical environments. Finally, with mobile form factors that allow acquisition of medical-grade ECGs from smartphones and wearables, the use of AI may enable massive scalability to democratize healthcare.
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Affiliation(s)
- Zachi I Attia
- Department of Cardiovascular Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
| | - David M Harmon
- Department of Internal Medicine, Mayo Clinic School of Graduate Medical Education, 200 First Street SW, Rochester, MN 55905, USA
| | - Elijah R Behr
- Cardiology Research Center and Cardiovascular Clinical Academic Group, Molecular and Clinical Sciences Institute, St. George’s University of London and St. George’s University Hospitals NHS Foundation Trust, Blackshaw Rd, London SW17 0QT, UK
- Mayo Clinic Healthcare, 15 Portland Pl, London W1B 1PT, UK
| | - Paul A Friedman
- Department of Cardiovascular Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
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15
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Martin H, Morar U, Izquierdo W, Cabrerizo M, Cabrera A, Adjouadi M. Real-time frequency-independent single-Lead and single-beat myocardial infarction detection. Artif Intell Med 2021; 121:102179. [PMID: 34763801 DOI: 10.1016/j.artmed.2021.102179] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 07/29/2021] [Accepted: 09/21/2021] [Indexed: 11/26/2022]
Abstract
This study proposes a novel real-time frequency-independent myocardial infarction detector for Lead II electrocardiograms. The underlying Deep-LSTM network is trained using the PTB-XL database, the largest to date publicly available electrocardiography dataset, and is tested over the same and the older PTB database. By testing the model over distinct datasets, collected under different conditions and from different patients, a more realistic measure of the performance can be gauged from the deployed system. The detector is trained over 3589 myocardial infarction (MI) patients and 7115 healthy controls (HC) while it is evaluated on 1076 MIs and 1840 HCs. The proposed algorithm, achieved an accuracy of 77.12%, recall/sensitivity of 75.85%, and a specificity of 83.02% over the entire PTB database; 85.07%, 81.54%, 87.31% over the PTB-XL validation set (fold 9), and 84.17%, 78.37%, 87.55% over the PTB-XL test set (fold 10). The model also achieves stable performance metrics over the frequency range of 202 Hz to 2.8 kHz. The processing time is dependent on the sampling frequency, ranging from 130 ms at 202 Hz to 1.8 s at 2.8 kHz. Such outcome is within the time required for real-time processing (less than 300 ms for fast heartbeats), between 202 Hz and 500 Hz making the algorithm practically real-time. Therefore, the proposed MI detector could be readily deployed onto existing wearable and/or portable devices and test instruments; potentially having significant societal and clinical impact in the lives of patients at risk for myocardial infarction.
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Affiliation(s)
- Harold Martin
- CATE, Department of Electrical and Computer Engineering, Florida International University, Miami, FL, USA.
| | - Ulyana Morar
- CATE, Department of Electrical and Computer Engineering, Florida International University, Miami, FL, USA
| | - Walter Izquierdo
- CATE, Department of Electrical and Computer Engineering, Florida International University, Miami, FL, USA
| | - Mercedes Cabrerizo
- CATE, Department of Electrical and Computer Engineering, Florida International University, Miami, FL, USA
| | | | - Malek Adjouadi
- CATE, Department of Electrical and Computer Engineering, Florida International University, Miami, FL, USA
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16
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Reinstein I, Hill J, Cook DA, Lineberry M, Pusic MV. Multi-level longitudinal learning curve regression models integrated with item difficulty metrics for deliberate practice of visual diagnosis: groundwork for adaptive learning. Adv Health Sci Educ Theory Pract 2021; 26:881-912. [PMID: 33646468 DOI: 10.1007/s10459-021-10027-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Accepted: 01/07/2021] [Indexed: 06/12/2023]
Abstract
Visual diagnosis of radiographs, histology and electrocardiograms lends itself to deliberate practice, facilitated by large online banks of cases. Which cases to supply to which learners in which order is still to be worked out, with there being considerable potential for adapting the learning. Advances in statistical modeling, based on an accumulating learning curve, offer methods for more effectively pairing learners with cases of known calibrations. Using demonstration radiograph and electrocardiogram datasets, the advantages of moving from traditional regression to multilevel methods for modeling growth in ability or performance are demonstrated, with a final step of integrating case-level item-response information based on diagnostic grouping. This produces more precise individual-level estimates that can eventually support learner adaptive case selection. The progressive increase in model sophistication is not simply statistical but rather brings the models into alignment with core learning principles including the importance of taking into account individual differences in baseline skill and learning rate as well as the differential interaction with cases of varying diagnosis and difficulty. The developed approach can thus give researchers and educators a better basis on which to anticipate learners' pathways and individually adapt their future learning.
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Affiliation(s)
- Ilan Reinstein
- Institute for Innovations in Medical Education, NYU Grossman School of Medicine, 550 First Avenue, MSB G109, New York, NY, 10016, USA
| | - Jennifer Hill
- Department of Applied Statistics, Social Science, and the Humanities, New York University, New York, NY, USA
| | - David A Cook
- Department of Medicine, Office of Applied Scholarship and Education Science, School of Continuous Professional Development, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
| | - Matthew Lineberry
- Zamierowksi Institute for Experiential Learning, University of Kansas Medical Center, Kansas City, KS, USA
| | - Martin V Pusic
- Institute for Innovations in Medical Education, NYU Grossman School of Medicine, 550 First Avenue, MSB G109, New York, NY, 10016, USA.
- Department of Emergency Medicine, NYU Grossman School of Medicine, New York, NY, USA.
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Klein AJ, Berlacher M, Doran JA, Corbelli J, Rothenberger SD, Berlacher K. A Resident-Authored, Case-Based Electrocardiogram Email Curriculum for Internal Medicine Residents. MedEdPORTAL 2020; 16:10927. [PMID: 32821805 PMCID: PMC7431182 DOI: 10.15766/mep_2374-8265.10927] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Accepted: 01/10/2020] [Indexed: 11/18/2022]
Abstract
Introduction The interpretation of electrocardiograms (ECGs) is a critical competency for internal medicine trainees, yet time and resources to foster proficiency are limited. Methods This resident-authored ECG email curriculum for first-year residents involved 129 first-year internal medicine residents at three major academic university hospitals. Residents either received the resident-authored ECG email curriculum (intervention group) or continued standard training (control group). The curriculum involved 10 multiple-choice ECG cases emailed biweekly over the 6-month study period. All participants were asked to complete a pre- and postintervention test to assess ECG interpretation competency and attitudes. The primary outcome was improvement in ECG test performance. Results Among the 129 first-year residents participating, 21 of the 65 (32%) randomized to the intervention group and 13 of the 64 (20%) randomized to the control group completed both the pre- and posttests for analysis. While all participants' ECG test scores improved over the study period (p < .001), improvement did not differ between groups (p = .860). We found that the effect of the intervention on ECG test performance varied significantly by the number of cardiology rotations an intern experienced (p = .031), benefiting naïve learners the most. All intervention group participants who completed the posttest reported they would recommend it to a colleague. Discussion While it did not improve resident performance on an ECG posttest, this resident-authored ECG email curriculum offers a scalable way to provide trainees additional practice with ECG interpretation, with particular benefit to trainees who have not yet rotated on cardiology.
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Affiliation(s)
- Andrew J. Klein
- Clinical Instructor, Division of General Internal Medicine, University of Pittsburgh School of Medicine
| | - Mark Berlacher
- Fellow, Department of Cardiology, University of Texas Southwestern Medical Center
| | - Jesse A. Doran
- Fellow, Division of Cardiology, University of Rochester Medical Center
| | - Jennifer Corbelli
- Associate Professor of Medicine, Division of General Internal Medicine, University of Pittsburgh School of Medicine
| | - Scott D. Rothenberger
- Assistant Professor of Medicine, Division of General Internal Medicine, University of Pittsburgh School of Medicine
| | - Kathryn Berlacher
- Assistant Professor of Medicine, Heart and Vascular Institute, University of Pittsburgh School of Medicine
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Desai L, Balmert L, Reichek J, Hauck A, Gambetta K, Webster G. Electrocardiograms for cardiomyopathy risk stratification in children with anthracycline exposure. Cardiooncology 2020; 5:10. [PMID: 32154016 PMCID: PMC7048097 DOI: 10.1186/s40959-019-0045-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Accepted: 06/28/2019] [Indexed: 11/18/2022]
Abstract
Background Early recognition of anthracycline-induced cardiomyopathy may reduce morbidity and mortality in children, but risk stratification tools are lacking. This study evaluates whether electrocardiogram (ECG) changes precede echocardiographic abnormalities in children with anthracycline-induced cardiomyopathy. Methods We performed a retrospective analysis of 589 pediatric cancer patients who received anthracyclines at a tertiary referral center. ECG endpoints were sum of absolute QRS amplitudes in the 6 limb leads (ΣQRS(6 L)) and corrected QT interval (QTc). Cardiomyopathy was defined by echocardiogram as ejection fraction < 50%, shortening fraction < 26%, or left ventricular end-diastolic diameter z-score > 2.5. Results Median age at start of therapy was 7.8 years (IQR 3.7–13.6); median follow-up time was 3.6 years (IQR 1.1–5.8). 19.5% of patients met criteria for cardiomyopathy. Male sex, race, older age at first dose, and larger body surface area were associated with development of cardiomyopathy. A 0.6 mV decrease in ΣQRS(6 L) and 10 ms increase in QTc were associated with an increased risk of developing cardiomyopathy with hazard ratios of 1.174 (95% CI = 1.057–1.304, p = 0.003) and 1.098 (95%CI = 1.027–1.173, p = 0.006) respectively. Kaplan-Meier estimates showed a lower chance of cardiomyopathy-free survival for QTc ≥ 440 ms and ΣQRS(6 L) ≤ 3.2 mV over time. After controlling for confounders, total anthracycline dose predicted a decrease in ΣQRS(6 L) and an increase in QTc independent of cardiomyopathy status (p = 0.01 and p < 0.001 respectively). Cardiotoxic radiation did not predict changes in ECG parameters. Cardiomyopathy was associated with increased mortality (34% versus 12%, p < 0.001). Conclusion In children receiving anthracyclines, decrease in ΣQRS(6 L) and QTc prolongation are associated with increased risk of developing cardiomyopathy. ECG is a potential non-invasive risk stratification tool for prediction of anthracycline-induced cardiomyopathy and requires prospective validation.
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Affiliation(s)
- Lajja Desai
- 1Division of Cardiology, Ann and Robert H. Lurie Children's Hospital of Chicago, 225 East Chicago Avenue, Box 21, Chicago, IL 60611 USA.,2Northwestern University Feinberg School of Medicine, 420 East Superior Street, Chicago, IL 60611 USA
| | - Lauren Balmert
- 2Northwestern University Feinberg School of Medicine, 420 East Superior Street, Chicago, IL 60611 USA
| | - Jennifer Reichek
- 2Northwestern University Feinberg School of Medicine, 420 East Superior Street, Chicago, IL 60611 USA.,3Division of Hematology/Oncology, Ann and Robert H. Lurie Children's Hospital of Chicago, 225 East Chicago Avenue, Box 30, Chicago, IL 60611 USA
| | - Amanda Hauck
- 1Division of Cardiology, Ann and Robert H. Lurie Children's Hospital of Chicago, 225 East Chicago Avenue, Box 21, Chicago, IL 60611 USA.,2Northwestern University Feinberg School of Medicine, 420 East Superior Street, Chicago, IL 60611 USA
| | - Katheryn Gambetta
- 1Division of Cardiology, Ann and Robert H. Lurie Children's Hospital of Chicago, 225 East Chicago Avenue, Box 21, Chicago, IL 60611 USA.,2Northwestern University Feinberg School of Medicine, 420 East Superior Street, Chicago, IL 60611 USA
| | - Gregory Webster
- 1Division of Cardiology, Ann and Robert H. Lurie Children's Hospital of Chicago, 225 East Chicago Avenue, Box 21, Chicago, IL 60611 USA.,2Northwestern University Feinberg School of Medicine, 420 East Superior Street, Chicago, IL 60611 USA
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Sato M, Matsumoto N, Noguchi A, Okonogi T, Sasaki T, Ikegaya Y. Simultaneous monitoring of mouse respiratory and cardiac rates through a single precordial electrode. J Pharmacol Sci 2018; 137:177-186. [PMID: 30042023 DOI: 10.1016/j.jphs.2018.06.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Revised: 05/23/2018] [Accepted: 05/28/2018] [Indexed: 10/28/2022] Open
Abstract
Normal respiratory and circulatory functions are crucial for survival. However, conventional methods of monitoring respiration, some of which use sensors inserted into the nasal cavity, may interfere with naïve respiratory rates. In this study, we conducted a single-point measurement of electrocardiograms (ECGs) from the pectoral muscles of anesthetized and waking mice and found low-frequency oscillations in the ECG baseline. Using the fast Fourier transform of simultaneously recorded respiratory signals, we demonstrated that the low-frequency oscillations corresponded to respiratory rhythms. Moreover, the baseline oscillations changed in parallel with the respiratory rhythm when the latter was altered by pharmacological manipulation. We also demonstrated that this method could be combined with in vivo whole-cell patch-clamp recordings from the hippocampus. Thus, we developed a non-invasive form of respirometry in mice. Our recording method using a simple derivation algorithm is applicable to a variety of physiological and pharmacological experiments, providing an experimental platform in studying the mechanisms underlying the interaction of the central nervous system and the peripheral functions.
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Affiliation(s)
- Motoshige Sato
- Graduate School of Pharmaceutical Sciences, The University of Tokyo, Tokyo, 113-0033, Japan
| | - Nobuyoshi Matsumoto
- Graduate School of Pharmaceutical Sciences, The University of Tokyo, Tokyo, 113-0033, Japan.
| | - Asako Noguchi
- Graduate School of Pharmaceutical Sciences, The University of Tokyo, Tokyo, 113-0033, Japan
| | - Toya Okonogi
- Graduate School of Pharmaceutical Sciences, The University of Tokyo, Tokyo, 113-0033, Japan
| | - Takuya Sasaki
- Graduate School of Pharmaceutical Sciences, The University of Tokyo, Tokyo, 113-0033, Japan; Precursory Research for Embryonic Science and Technology, Japan Science and Technology Agency, 4-1-8 Honcho, Kawaguchi, Saitama, 332-0012, Japan
| | - Yuji Ikegaya
- Graduate School of Pharmaceutical Sciences, The University of Tokyo, Tokyo, 113-0033, Japan; Center for Information and Neural Networks, National Institute of Information and Communications Technology, Suita City, Osaka, 565-0871, Japan
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Paratz ED, Zhao J, Sherwen AK, Scarlato RM, MacIsaac AI. Is an Abnormal ECG Just the Tip of the ICE-berg? Examining the Utility of Electrocardiography in Detecting Methamphetamine-Induced Cardiac Pathology. Heart Lung Circ 2016; 26:684-689. [PMID: 28110851 DOI: 10.1016/j.hlc.2016.11.005] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2016] [Revised: 11/02/2016] [Accepted: 11/09/2016] [Indexed: 11/28/2022]
Abstract
BACKGROUND Methamphetamine use is escalating in Australia and New Zealand, with increasing emergency department attendance and mortality. Cardiac complications play a large role in methamphetamine-related mortality, and it would be informative to assess the frequency of abnormal electrocardiograms (ECGs) amongst methamphetamine users. OBJECTIVE To determine the frequency and severity of ECG abnormalities amongst methamphetamine users compared to a control group. METHODS We conducted a retrospective cohort analysis on 212 patients admitted to a tertiary hospital (106 patients with methamphetamine use, 106 age and gender-matched control patients). Electrocardiograms were analysed according to American College of Cardiology guidelines. RESULTS Mean age was 33.4 years, with 73.6% male gender, with no significant differences between groups in smoking status, ECG indication, or coronary angiography rates. Methamphetamine users were more likely to have psychiatric admissions (22.6% vs 1.9%, p<0.0001). Overall, ECG abnormalities were significantly more common (71.7% vs 32.1%, p<0.0001) in methamphetamine users, particularly tachyarrhythmias (38.7% vs 26.4%, p<0.0001), right axis deviation (7.5% vs 0.0%, p=0.004), left ventricular hypertrophy (26.4% vs 4.7%, p<0.0001), P pulmonale pattern (7.5% vs 0.9%, p=0.017), inferior Q waves (10.4% vs 0.0%, p=0.001), lateral T wave inversion (3.8% vs 0.0%, p=0.043), and longer QTc interval (436.41±31.61ms vs 407.28±24.38ms, p<0.0001). Transthoracic echocardiogram (n=24) demonstrated left ventricular dysfunction (38%), thrombus (8%), valvular lesions (17%), infective endocarditis (17%), and pulmonary hypertension (13%). Electrocardiograms were only moderately sensitive at predicting abnormal TTE. CONCLUSION Electrocardiographic abnormalities are more common in methamphetamine users than age and gender-matched controls. Due to the high frequency of abnormalities, ECGs should be performed in all methamphetamine users who present to hospital. Methamphetamine users with abnormal ECGs should undergo further cardiac investigations.
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Affiliation(s)
- Elizabeth D Paratz
- Department of Cardiology, St Vincent's Hospital Melbourne, Vic, Australia.
| | - Jessie Zhao
- Department of Cardiology, St Vincent's Hospital Melbourne, Vic, Australia
| | - Amanda K Sherwen
- Department of Cardiology, St Vincent's Hospital Melbourne, Vic, Australia
| | | | - Andrew I MacIsaac
- Department of Cardiology, St Vincent's Hospital Melbourne, Vic, Australia
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Abstract
Routine preoperative testing is not cost-effective, because it is unlikely to identify significant abnormalities. Abnormal findings from routine testing are more likely to be false positive, are costly to pursue, introduce a new risk, increase the patient's anxiety, and are inconvenient to the patient. Abnormal findings rarely alter the surgical or anesthetic plan, and there is usually no association between perioperative complications and abnormal laboratory results. Incidental findings and false positive results may lead to increased hospital visits and admissions. Preoperative testing needs to be done based on a targeted history and physical examination and the type of surgery.
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Affiliation(s)
- Matthias Bock
- Department of Anesthesia and Intensive Care Medicine, Central Hospital, Via Lorenz Boehler 5, Bolzano 39100, Italy; Department of Anesthesiology, Perioperative Medicine and Intensive Care, Paracelsus Medical University, Muellner Hauptrstrasse 48, Salzburg 5020, Austria
| | - Gerhard Fritsch
- Department of Anesthesiology, Perioperative Medicine and Intensive Care, Paracelsus Medical University, Muellner Hauptrstrasse 48, Salzburg 5020, Austria; Department of Anesthesiology and Intensive Care, UKH Lorenz Boehler, Donaueschingerstrasse 3, Vienna 1220, Austria
| | - David L Hepner
- Department of Anesthesiology, Perioperative, and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02459, USA.
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Rastogi U, Kumars N. Lyme Arrhythmia in an Avid Golfer: A Diagnostic Challenge and a Therapeutic Dilemma. J Atr Fibrillation 2016; 8:1378. [PMID: 27909484 PMCID: PMC5089497 DOI: 10.4022/jafib.1378] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2016] [Revised: 02/02/2016] [Accepted: 02/19/2016] [Indexed: 05/28/2023]
Abstract
Lyme disease is a multisystem disorder affecting dermatologic, cardiac, nervous and musculoskeletal systems. Cardiac manifestations occur in about 5% of Lyme infections and stem from the involvement of the cardiac conduction system, resulting in varying degrees of sino-atrioventricular block. Occasionally, Lyme infection may also present with myopericarditis. Unlike isolated conduction node disease, myocardial involvement presents a great diagnostic and therapeutic dilemma for the physician. We report the case of a 68 year-old male cardiologist who presented with new onset exertional dyspnea and palpitations. Electrocardiograms revealed intermittent Wenckebach with markedly prolonged PR interval varying between 290-350ms. During his hospitalization, he also had a transient episode of atrial fibrillation/flutter with AV block. The patient was promptly treated with intravenous Ceftriaxone. He remained hemodynamically stable, and within 48 hours of antibiotic treatment, the patient's arrhythmias began to resolve, and the PR interval had shortened to 230ms. He was discharged on oral Doxycyline for three weeks.
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Affiliation(s)
- Ujjwal Rastogi
- James J. Peter VA Medical Center/The Mount Sinai Hospital
| | - Nidhi Kumars
- James J. Peter VA Medical Center/The Mount Sinai Hospital
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