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Josemans SH, Lindeboom L, Gerritsen KGF, Wieringa FP, Kooman JP, Rotmans JI. Home monitoring of patients with chronic kidney disease. Nat Rev Nephrol 2024:10.1038/s41581-024-00858-6. [PMID: 38834826 DOI: 10.1038/s41581-024-00858-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2024]
Affiliation(s)
- Sabine H Josemans
- Department of Internal Medicine, Leiden University Medical Center, Leiden, The Netherlands
| | - Lucas Lindeboom
- Imec, R&D and innovation hub in nanoelectronics and digital technologies, Imec, Eindhoven, The Netherlands
| | - Karin G F Gerritsen
- Department of Nephrology University Medical Center Utrecht, Utrecht, The Netherlands
| | - Fokko P Wieringa
- Imec, R&D and innovation hub in nanoelectronics and digital technologies, Imec, Eindhoven, The Netherlands
| | - Jeroen P Kooman
- Department of Nephrology, University Medical Center Maastricht, Maastricht, The Netherlands
| | - Joris I Rotmans
- Department of Internal Medicine, Leiden University Medical Center, Leiden, The Netherlands.
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2
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Hashimoto K, Fujii K, Ueda D, Sumiyoshi A, Hasegawa K, Fukuhara R, Otagaki M, Okamura A, Yamamoto W, Kawano N, Yamamoto A, Miki Y, Shiojima I. Development and Validation of Artificial Intelligence-Based Algorithms for Predicting the Segments Debulked by Rotational Atherectomy Using Intravascular Ultrasound Images. Am J Cardiol 2024; 223:S0002-9149(24)00394-1. [PMID: 38782227 DOI: 10.1016/j.amjcard.2024.05.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Revised: 04/22/2024] [Accepted: 05/17/2024] [Indexed: 05/25/2024]
Abstract
We develop and evaluate an artificial intelligence (AI)-based algorithm that uses pre-rotation atherectomy (RA) intravascular ultrasound (IVUS) images to automatically predict regions debulked by RA. A total of 2106 IVUS cross-sections from 60 patients with de novo severely calcified coronary lesions who underwent IVUS-guided RA were consecutively collected. The 2 identical IVUS images of pre- and post-RA were merged, and the orientations of the debulked segments identified in the merged images were marked on the outer circle of each IVUS image. The AI model was developed based on ResNet (deep residual learning for image recognition). The architecture connected 36 fully connected layers, each corresponding to 1 of the 36 orientations segmented every 10°, to a single feature extractor. In each cross-sectional analysis, our AI model achieved an average sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of 81%, 72%, 46%, 90%, and 75%, respectively. In conclusion, the AI-based algorithm can use information from pre-RA IVUS images to accurately predict regions debulked by RA and will assist interventional cardiologists in determining the treatment strategies for severely calcified coronary lesions.
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Affiliation(s)
- Kenta Hashimoto
- Division of Cardiology, Department of Medicine II, Kansai Medical University, Hirakata, Japan
| | - Kenichi Fujii
- Division of Cardiology, Department of Medicine II, Kansai Medical University, Hirakata, Japan.
| | - Daiju Ueda
- Department of Diagnostic and Interventional Radiology, Graduate School of Medicine, Osaka Metropolitan University, Osaka, Japan
| | - Akinori Sumiyoshi
- Cardiovascular Vascular Center, Sakurabashi Watanabe Hospital, Osaka, Japan
| | - Katsuyuki Hasegawa
- Department of Cardiology, Higashi Takarazuka Satoh Hospital, Takarazuka, Japan
| | - Rei Fukuhara
- Department of Cardiovascular Medicine, Hyogo Prefectural Amagasaki General Medical Center, Amagasaki, Japan
| | - Munemitsu Otagaki
- Department of Cardiology, Kansai Medical University Medical Center, Moriguchi, Japan
| | - Atsunori Okamura
- Cardiovascular Vascular Center, Sakurabashi Watanabe Hospital, Osaka, Japan
| | - Wataru Yamamoto
- Department of Cardiology, Higashi Takarazuka Satoh Hospital, Takarazuka, Japan
| | - Naoki Kawano
- Department of Cardiovascular Medicine, Hyogo Prefectural Amagasaki General Medical Center, Amagasaki, Japan
| | - Akira Yamamoto
- Department of Diagnostic and Interventional Radiology, Graduate School of Medicine, Osaka Metropolitan University, Osaka, Japan
| | - Yukio Miki
- Department of Diagnostic and Interventional Radiology, Graduate School of Medicine, Osaka Metropolitan University, Osaka, Japan
| | - Iichiro Shiojima
- Division of Cardiology, Department of Medicine II, Kansai Medical University, Hirakata, Japan
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Riaz Gondal MU, Atta Mehdi H, Khenhrani RR, Kumari N, Ali MF, Kumar S, Faraz M, Malik J. Role of Machine Learning and Artificial Intelligence in Arrhythmias and Electrophysiology. Cardiol Rev 2024:00045415-990000000-00270. [PMID: 38761137 DOI: 10.1097/crd.0000000000000715] [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] [Indexed: 05/20/2024]
Abstract
Machine learning (ML), a subset of artificial intelligence (AI) centered on machines learning from extensive datasets, stands at the forefront of a technological revolution shaping various facets of society. Cardiovascular medicine has emerged as a key domain for ML applications, with considerable efforts to integrate these innovations into routine clinical practice. Within cardiac electrophysiology, ML applications, especially in the automated interpretation of electrocardiograms, have garnered substantial attention in existing literature. However, less recognized are the diverse applications of ML in cardiac electrophysiology and arrhythmias, spanning basic science research on arrhythmia mechanisms, both experimental and computational, as well as contributions to enhanced techniques for mapping cardiac electrical function and translational research related to arrhythmia management. This comprehensive review delves into various ML applications within the scope of this journal, organized into 3 parts. The first section provides a fundamental understanding of general ML principles and methodologies, serving as a foundational resource for readers interested in exploring ML applications in arrhythmia research. The second part offers an in-depth review of studies in arrhythmia and electrophysiology that leverage ML methodologies, showcasing the broad potential of ML approaches. Each subject is thoroughly outlined, accompanied by a review of notable ML research advancements. Finally, the review delves into the primary challenges and future perspectives surrounding ML-driven cardiac electrophysiology and arrhythmias research.
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Affiliation(s)
| | - Hassan Atta Mehdi
- Department of Medicine, Jinnah Postgraduate Medical Centre, Karachi, Pakistan
| | - Raja Ram Khenhrani
- Department of Medicine, Internal Medicine Fellow, Shaheed Mohtarma Benazir Bhutto Medical College and Lyari General Hospital, Karachi, Pakistan
| | - Neha Kumari
- Department of Medicine, Jinnah Postgraduate Medical Centre, Karachi, Pakistan
| | - Muhammad Faizan Ali
- Department of Medicine, Jinnah Postgraduate Medical Centre, Karachi, Pakistan
| | - Sooraj Kumar
- Department of Medicine, Jinnah Sindh Medical University, Karachi, Pakistan; and
| | - Maria Faraz
- Department of Cardiovascular Medicine, Cardiovascular Analytics Group, Rawalpindi, Pakistan
| | - Jahanzeb Malik
- Department of Cardiovascular Medicine, Cardiovascular Analytics Group, Rawalpindi, Pakistan
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Zhang H, Tarabanis C, Jethani N, Goldstein M, Smith S, Chinitz L, Ranganath R, Aphinyanaphongs Y, Jankelson L. QTNet: Predicting Drug-Induced QT Prolongation With Artificial Intelligence-Enabled Electrocardiograms. JACC Clin Electrophysiol 2024; 10:956-966. [PMID: 38703162 DOI: 10.1016/j.jacep.2024.01.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 01/19/2024] [Accepted: 01/31/2024] [Indexed: 05/06/2024]
Abstract
BACKGROUND Prediction of drug-induced long QT syndrome (diLQTS) is of critical importance given its association with torsades de pointes. There is no reliable method for the outpatient prediction of diLQTS. OBJECTIVES This study sought to evaluate the use of a convolutional neural network (CNN) applied to electrocardiograms (ECGs) to predict diLQTS in an outpatient population. METHODS We identified all adult outpatients newly prescribed a QT-prolonging medication between January 1, 2003, and March 31, 2022, who had a 12-lead sinus ECG in the preceding 6 months. Using risk factor data and the ECG signal as inputs, the CNN QTNet was implemented in TensorFlow to predict diLQTS. RESULTS Models were evaluated in a held-out test dataset of 44,386 patients (57% female) with a median age of 62 years. Compared with 3 other models relying on risk factors or ECG signal or baseline QTc alone, QTNet achieved the best (P < 0.001) performance with a mean area under the curve of 0.802 (95% CI: 0.786-0.818). In a survival analysis, QTNet also had the highest inverse probability of censorship-weighted area under the receiver-operating characteristic curve at day 2 (0.875; 95% CI: 0.848-0.904) and up to 6 months. In a subgroup analysis, QTNet performed best among males and patients ≤50 years or with baseline QTc <450 ms. In an external validation cohort of solely suburban outpatient practices, QTNet similarly maintained the highest predictive performance. CONCLUSIONS An ECG-based CNN can accurately predict diLQTS in the outpatient setting while maintaining its predictive performance over time. In the outpatient setting, our model could identify higher-risk individuals who would benefit from closer monitoring.
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Affiliation(s)
- Hao Zhang
- Department of Population Health, NYU Langone Health, New York University School of Medicine, New York, New York, USA.
| | - Constantine Tarabanis
- Leon H. Charney Division of Cardiology, Cardiac Electrophysiology, NYU Langone Health, New York University School of Medicine, New York, New York, USA
| | - Neil Jethani
- Department of Population Health, NYU Langone Health, New York University School of Medicine, New York, New York, USA; Courant Institute of Mathematical Sciences, New York University, New York, New York, USA
| | - Mark Goldstein
- Courant Institute of Mathematical Sciences, New York University, New York, New York, USA
| | - Silas Smith
- Ronald O. Perelman Department of Emergency Medicine, NYU Langone Health, New York, New York, USA
| | - Larry Chinitz
- Leon H. Charney Division of Cardiology, Cardiac Electrophysiology, NYU Langone Health, New York University School of Medicine, New York, New York, USA
| | - Rajesh Ranganath
- Department of Population Health, NYU Langone Health, New York University School of Medicine, New York, New York, USA; Courant Institute of Mathematical Sciences, New York University, New York, New York, USA
| | - Yindalon Aphinyanaphongs
- Department of Population Health, NYU Langone Health, New York University School of Medicine, New York, New York, USA
| | - Lior Jankelson
- Leon H. Charney Division of Cardiology, Cardiac Electrophysiology, NYU Langone Health, New York University School of Medicine, New York, New York, USA.
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Lopez-Jimenez F, Kapa S, Friedman PA, LeBrasseur NK, Klavetter E, Mangold KE, Attia ZI. Assessing Biological Age: The Potential of ECG Evaluation Using Artificial Intelligence: JACC Family Series. JACC Clin Electrophysiol 2024; 10:775-789. [PMID: 38597855 DOI: 10.1016/j.jacep.2024.02.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Revised: 02/08/2024] [Accepted: 02/11/2024] [Indexed: 04/11/2024]
Abstract
Biological age may be a more valuable predictor of morbidity and mortality than a person's chronological age. Mathematical models have been used for decades to predict biological age, but recent developments in artificial intelligence (AI) have led to new capabilities in age estimation. Using deep learning methods to train AI models on hundreds of thousands of electrocardiograms (ECGs) to predict age results in a good, but imperfect, age prediction. The error predicting age using ECG, or the difference between AI-ECG-derived age and chronological age (delta age), may be a surrogate measurement of biological age, as the delta age relates to survival, even after adjusting for chronological age and other covariates associated with total and cardiovascular mortality. The relative affordability, noninvasiveness, and ubiquity of ECGs, combined with ease of access and potential to be integrated with smartphone or wearable technology, presents a potential paradigm shift in assessment of biological age.
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Affiliation(s)
- Francisco Lopez-Jimenez
- Department of Cardiovascular Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota, USA.
| | - Suraj Kapa
- Department of Cardiovascular Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
| | - Paul A Friedman
- Department of Cardiovascular Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
| | - Nathan K LeBrasseur
- Robert and Arlene Kogod Center on Aging, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
| | - Eric Klavetter
- Department of Cardiovascular Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
| | - Kathryn E Mangold
- Department of Cardiovascular Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
| | - Zachi I Attia
- Department of Cardiovascular Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
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Dzikowicz DJ. A Scoping Review of Varying Mobile Electrocardiographic Devices. Biol Res Nurs 2024; 26:303-314. [PMID: 38029286 DOI: 10.1177/10998004231216923] [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] [Indexed: 12/01/2023]
Abstract
The electrocardiogram (ECG) can now be measured using mobile devices. Mobile ECG devices, which are defined as devices capable of recording and transmitting non-standard ECGs, offer numerous advantages such as cost-effectiveness and being user-friendly. Mobile ECG can also extend recording lengths (e.g., 2 days, 14 days), which is necessary to capture important intermittent events (e.g., cardiac arrhythmias) and evaluate prognostic risk markers (e.g., prolonged corrected QT (QTc) interval). Some mobile ECG devices can even connect to broadband networks allowing patients to remotely transmit their ECG to a clinician. This article systematically examines different mobile ECG devices used in prior studies and provides a detailed assessment of five diverse yet commonly used mobile ECG devices: AliveCor KardiaMobile; AliveCor KardiaMobile 6L; iRhythm ZioPatch; Apple Smartwatch ECG; and CardioSecur System. These mobile ECG devices are diverse in the number of leads measured and the duration of monitoring. Similar to their diversity, there has been a wide range of clinical applications of mobile ECG devices. Despite significant progress, questions regarding data quality, and clinican and patient acceptance and compliance persist.
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Affiliation(s)
- Dillon J Dzikowicz
- University of Rochester School of Nursing, Rochester, NY, USA
- Clinical Cardiovascular Research Center, University of Rochester, Rochester, NY, USA
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Makimoto H, Kohro T. Adopting artificial intelligence in cardiovascular medicine: a scoping review. Hypertens Res 2024; 47:685-699. [PMID: 37907600 DOI: 10.1038/s41440-023-01469-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Revised: 09/03/2023] [Accepted: 09/26/2023] [Indexed: 11/02/2023]
Abstract
Recent years have witnessed significant transformations in cardiovascular medicine, driven by the rapid evolution of artificial intelligence (AI). This scoping review was conducted to capture the breadth of AI applications within cardiovascular science. Employing a structured approach, we sourced relevant articles from PubMed, with an emphasis on journals encompassing general cardiology and digital medicine. We applied filters to highlight cardiovascular articles published in journals focusing on general internal medicine, cardiology and digital medicine, thereby identifying the prevailing trends in the field. Following a comprehensive full-text screening, a total of 140 studies were identified. Over the preceding 5 years, cardiovascular medicine's interplay with AI has seen an over tenfold augmentation. This expansive growth encompasses multiple cardiovascular subspecialties, including but not limited to, general cardiology, ischemic heart disease, heart failure, and arrhythmia. Deep learning emerged as the predominant methodology. The majority of AI endeavors in this domain have been channeled toward enhancing diagnostic and prognostic capabilities, utilizing resources such as hospital datasets, electrocardiograms, and echocardiography. A significant uptrend was observed in AI's application for omics data analysis. However, a clear gap persists in AI's full-scale integration into the clinical decision-making framework. AI, particularly deep learning, has demonstrated robust applications across cardiovascular subspecialties, indicating its transformative potential in this field. As we continue on this trajectory, ensuring the alignment of technological progress with medical ethics becomes crucial. The abundant digital health data today further accentuates the need for meticulous systematic reviews, tailoring them to each cardiovascular subspecialty.
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Affiliation(s)
- Hisaki Makimoto
- Data Science Center/Cardiovascular Center, Jichi Medical University, Shimotsuke, Japan.
| | - Takahide Kohro
- Data Science Center/Cardiovascular Center, Jichi Medical University, Shimotsuke, Japan
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Holmstrom L, Chugh H, Nakamura K, Bhanji Z, Seifer M, Uy-Evanado A, Reinier K, Ouyang D, Chugh SS. An ECG-based artificial intelligence model for assessment of sudden cardiac death risk. COMMUNICATIONS MEDICINE 2024; 4:17. [PMID: 38413711 PMCID: PMC10899257 DOI: 10.1038/s43856-024-00451-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2023] [Accepted: 02/02/2024] [Indexed: 02/29/2024] Open
Abstract
BACKGROUND Conventional ECG-based algorithms could contribute to sudden cardiac death (SCD) risk stratification but demonstrate moderate predictive capabilities. Deep learning (DL) models use the entire digital signal and could potentially improve predictive power. We aimed to train and validate a 12 lead ECG-based DL algorithm for SCD risk assessment. METHODS Out-of-hospital SCD cases were prospectively ascertained in the Portland, Oregon, metro area. A total of 1,827 pre- cardiac arrest 12 lead ECGs from 1,796 SCD cases were retrospectively collected and analyzed to develop an ECG-based DL model. External validation was performed in 714 ECGs from 714 SCD cases from Ventura County, CA. Two separate control group samples were obtained from 1342 ECGs taken from 1325 individuals of which at least 50% had established coronary artery disease. The DL model was compared with a previously validated conventional 6 variable ECG risk model. RESULTS The DL model achieves an AUROC of 0.889 (95% CI 0.861-0.917) for the detection of SCD cases vs. controls in the internal held-out test dataset, and is successfully validated in external SCD cases with an AUROC of 0.820 (0.794-0.847). The DL model performs significantly better than the conventional ECG model that achieves an AUROC of 0.712 (0.668-0.756) in the internal and 0.743 (0.711-0.775) in the external cohort. CONCLUSIONS An ECG-based DL model distinguishes SCD cases from controls with improved accuracy and performs better than a conventional ECG risk model. Further detailed investigation is warranted to evaluate how the DL model could contribute to improved SCD risk stratification.
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Affiliation(s)
- Lauri Holmstrom
- Center for Cardiac Arrest Prevention, Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Harpriya Chugh
- Center for Cardiac Arrest Prevention, Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Kotoka Nakamura
- Center for Cardiac Arrest Prevention, Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Ziana Bhanji
- Center for Cardiac Arrest Prevention, Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Madison Seifer
- Center for Cardiac Arrest Prevention, Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Audrey Uy-Evanado
- Center for Cardiac Arrest Prevention, Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Kyndaron Reinier
- Center for Cardiac Arrest Prevention, Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - David Ouyang
- Center for Cardiac Arrest Prevention, Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
- Division of Artificial Intelligence in Medicine, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Sumeet S Chugh
- Center for Cardiac Arrest Prevention, Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
- Division of Artificial Intelligence in Medicine, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
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Di Costanzo A, Spaccarotella CAM, Esposito G, Indolfi C. An Artificial Intelligence Analysis of Electrocardiograms for the Clinical Diagnosis of Cardiovascular Diseases: A Narrative Review. J Clin Med 2024; 13:1033. [PMID: 38398346 PMCID: PMC10889404 DOI: 10.3390/jcm13041033] [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: 12/25/2023] [Revised: 02/04/2024] [Accepted: 02/08/2024] [Indexed: 02/25/2024] Open
Abstract
Artificial intelligence (AI) applied to cardiovascular disease (CVD) is enjoying great success in the field of scientific research. Electrocardiograms (ECGs) are the cornerstone form of examination in cardiology and are the most widely used diagnostic tool because they are widely available, inexpensive, and fast. Applications of AI to ECGs, especially deep learning (DL) methods using convolutional neural networks (CNNs), have been developed in many fields of cardiology in recent years. Deep learning methods provide valuable support for rapid ECG interpretation, demonstrating a diagnostic capability overlapping with specialists in the diagnosis of CVD by a classical analysis of macroscopic changes in the ECG trace. Through photoplethysmography, wearable devices can obtain single-derivative ECGs for the recognition of AI-diagnosed arrhythmias. In addition, CNNs have been developed that recognize no macroscopic electrocardiographic changes and can predict, from a 12-lead ECG, atrial fibrillation, even from sinus rhythm; left and right ventricular function; hypertrophic cardiomyopathy; acute coronary syndromes; or aortic stenosis. The fields of application are many, but numerous are the limitations, mainly associated with the reliability of the acquired data, an inability to verify black box processes, and medico-legal and ethical problems. The challenge of modern medicine is to recognize the limitations of AI and overcome them.
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Affiliation(s)
- Assunta Di Costanzo
- Division of Cardiology, Cardiovascular Research Center, University Magna Graecia Catanzaro, 88100 Catanzaro, Italy
| | - Carmen Anna Maria Spaccarotella
- Division of Cardiology, Department of Advanced Biomedical Sciences, University of Naples Federico II, 80126 Naples, Italy; (C.A.M.S.)
| | - Giovanni Esposito
- Division of Cardiology, Department of Advanced Biomedical Sciences, University of Naples Federico II, 80126 Naples, Italy; (C.A.M.S.)
| | - Ciro Indolfi
- Division of Cardiology, Cardiovascular Research Center, University Magna Graecia Catanzaro, 88100 Catanzaro, Italy
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10
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Ouyang D, Theurer J, Stein NR, Hughes JW, Elias P, He B, Yuan N, Duffy G, Sandhu RK, Ebinger J, Botting P, Jujjavarapu M, Claggett B, Tooley JE, Poterucha T, Chen JH, Nurok M, Perez M, Perotte A, Zou JY, Cook NR, Chugh SS, Cheng S, Albert CM. Electrocardiographic deep learning for predicting post-procedural mortality: a model development and validation study. Lancet Digit Health 2024; 6:e70-e78. [PMID: 38065778 DOI: 10.1016/s2589-7500(23)00220-0] [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: 09/15/2022] [Revised: 10/01/2023] [Accepted: 10/18/2023] [Indexed: 12/22/2023]
Abstract
BACKGROUND Preoperative risk assessments used in clinical practice are insufficient in their ability to identify risk for postoperative mortality. Deep-learning analysis of electrocardiography can identify hidden risk markers that can help to prognosticate postoperative mortality. We aimed to develop a prognostic model that accurately predicts postoperative mortality in patients undergoing medical procedures and who had received preoperative electrocardiographic diagnostic testing. METHODS In a derivation cohort of preoperative patients with available electrocardiograms (ECGs) from Cedars-Sinai Medical Center (Los Angeles, CA, USA) between Jan 1, 2015 and Dec 31, 2019, a deep-learning algorithm was developed to leverage waveform signals to discriminate postoperative mortality. We randomly split patients (8:1:1) into subsets for training, internal validation, and final algorithm test analyses. Model performance was assessed using area under the receiver operating characteristic curve (AUC) values in the hold-out test dataset and in two external hospital cohorts and compared with the established Revised Cardiac Risk Index (RCRI) score. The primary outcome was post-procedural mortality across three health-care systems. FINDINGS 45 969 patients had a complete ECG waveform image available for at least one 12-lead ECG performed within the 30 days before the procedure date (59 975 inpatient procedures and 112 794 ECGs): 36 839 patients in the training dataset, 4549 in the internal validation dataset, and 4581 in the internal test dataset. In the held-out internal test cohort, the algorithm discriminates mortality with an AUC value of 0·83 (95% CI 0·79-0·87), surpassing the discrimination of the RCRI score with an AUC of 0·67 (0·61-0·72). The algorithm similarly discriminated risk for mortality in two independent US health-care systems, with AUCs of 0·79 (0·75-0·83) and 0·75 (0·74-0·76), respectively. Patients determined to be high risk by the deep-learning model had an unadjusted odds ratio (OR) of 8·83 (5·57-13·20) for postoperative mortality compared with an unadjusted OR of 2·08 (0·77-3·50) for postoperative mortality for RCRI scores of more than 2. The deep-learning algorithm performed similarly for patients undergoing cardiac surgery (AUC 0·85 [0·77-0·92]), non-cardiac surgery (AUC 0·83 [0·79-0·88]), and catheterisation or endoscopy suite procedures (AUC 0·76 [0·72-0·81]). INTERPRETATION A deep-learning algorithm interpreting preoperative ECGs can improve discrimination of postoperative mortality. The deep-learning algorithm worked equally well for risk stratification of cardiac surgeries, non-cardiac surgeries, and catheterisation laboratory procedures, and was validated in three independent health-care systems. This algorithm can provide additional information to clinicians making the decision to perform medical procedures and stratify the risk of future complications. FUNDING National Heart, Lung, and Blood Institute.
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Affiliation(s)
- David Ouyang
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA; Division of Artificial Intelligence in Medicine, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
| | - John Theurer
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Nathan R Stein
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - J Weston Hughes
- Department of Computer Science, Stanford University, Palo Alto, CA, USA
| | - Pierre Elias
- Milstein Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York, NY, USA; Department of Biomedical Informatics, Columbia University Irving Medical Center, New York, NY, USA
| | - Bryan He
- Department of Computer Science, Stanford University, Palo Alto, CA, USA
| | - Neal Yuan
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Grant Duffy
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Roopinder K Sandhu
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Joseph Ebinger
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Patrick Botting
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Melvin Jujjavarapu
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Brian Claggett
- Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - James E Tooley
- Division of Cardiology, Stanford University, Palo Alto, CA, USA
| | - Tim Poterucha
- Milstein Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York, NY, USA
| | - Jonathan H Chen
- Division of Bioinformatics Research, Stanford University, Palo Alto, CA, USA
| | - Michael Nurok
- Division of Anesthesia, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Marco Perez
- Division of Cardiology, Stanford University, Palo Alto, CA, USA
| | - Adler Perotte
- Milstein Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York, NY, USA
| | - James Y Zou
- Department of Computer Science, Stanford University, Palo Alto, CA, USA; Department of Medicine, and Department of Biomedical Data Science, Stanford University, Palo Alto, CA, USA
| | - Nancy R Cook
- Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Sumeet S Chugh
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA; Division of Artificial Intelligence in Medicine, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Susan Cheng
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Christine M Albert
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
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11
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Raileanu G, de Jong JSSG. Electrocardiogram Interpretation Using Artificial Intelligence: Diagnosis of Cardiac and Extracardiac Pathologic Conditions. How Far Has Machine Learning Reached? Curr Probl Cardiol 2024; 49:102097. [PMID: 37739276 DOI: 10.1016/j.cpcardiol.2023.102097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 09/18/2023] [Indexed: 09/24/2023]
Abstract
Artificial intelligence (AI) is already widely used in different fields of medicine, making possible the integration of the paraclinical exams with the clinical findings in patients, for a more accurate and rapid diagnosis and treatment decision. The electrocardiogram remains one of the most important, fastest, cheapest, and noninvasive methods of diagnosis in cardiology, despite the rapid development and progression of the technology. Even if studied a long time ago, it still has a lot of less understood features that, with a better understanding, can give more clues to a correct and prompt diagnosis in a short time. The use of AI in the interpretation of the ECG improved the accuracy and the time to diagnosis in different cardiovascular diseases, and more than this, explaining the decision to make AI diagnosis improved the human understanding of the different features of the ECG that might be considered for a more accurate diagnosis. The purpose of this article is to provide an overview of the most recently published articles about the use of AI in ECG interpretation.
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Affiliation(s)
- Gabriela Raileanu
- Department of Cardiology, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands.
| | - Jonas S S G de Jong
- Department of Cardiology, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands
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12
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Regolisti G, Rossi GM, Genovesi S. Can we trust ECG for diagnosing hyperkalemia? A challenging question for clinicians and bioengineers. Int J Cardiol 2023; 393:131380. [PMID: 37741347 DOI: 10.1016/j.ijcard.2023.131380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2023] [Accepted: 09/18/2023] [Indexed: 09/25/2023]
Affiliation(s)
- Giuseppe Regolisti
- UO Clinica e Immunologia Medica, Università di Parma e Azienda Ospedaliero-Universitaria di Parma, Parma, Italy.
| | - Giovanni Maria Rossi
- UO Nefrologia, Università di Parma e Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
| | - Simonetta Genovesi
- School of Medicine and Surgery, Nephrology Clinic, Milano-Bicocca University, Milan, Italy; Istituto Auxologico Italiano, IRCCS, Milan, Italy
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13
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Maursetter L. Will ChatGPT Be the Next Nephrologist? Clin J Am Soc Nephrol 2023; 19:01277230-990000000-00301. [PMID: 38048210 PMCID: PMC10843331 DOI: 10.2215/cjn.0000000000000378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/06/2023]
Affiliation(s)
- Laura Maursetter
- University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wisconsin
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14
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Avula V, Wu KC, Carrick RT. Clinical Applications, Methodology, and Scientific Reporting of Electrocardiogram Deep-Learning Models: A Systematic Review. JACC. ADVANCES 2023; 2:100686. [PMID: 38288263 PMCID: PMC10824530 DOI: 10.1016/j.jacadv.2023.100686] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/31/2024]
Abstract
BACKGROUND The electrocardiogram (ECG) is one of the most common diagnostic tools available to assess cardio-vascular health. The advent of advanced computational techniques such as deep learning has dramatically expanded the breadth of clinical problems that can be addressed using ECG data, leading to increasing popularity of ECG deep-learning models aimed at predicting clinical endpoints. OBJECTIVES The purpose of this study was to define the current landscape of clinically relevant ECG deep-learning models and examine practices in the scientific reporting of these studies. METHODS We performed a systematic review of PubMed and EMBASE databases to identify clinically relevant ECG deep-learning models published through July 1, 2022. RESULTS We identified 44 manuscripts including 53 unique, clinically relevant ECG deep-learning models. The rate of publication of ECG deep-learning models is increasing rapidly. The most common clinical applications of ECG deep learning were identification of cardiomyopathy (14/53 [26%]), followed by arrhythmia detection (9/53 [17%]). Methodologic reporting varied; while 33/44 (75%) publications included model architecture diagrams, complete information required to reproduce these models was provided in only 10/44 (23%). Saliency analysis was performed in 20/44 (46%) of publications. Only 18/53 (34%) models were tested within external validation cohorts. Model code or resources allowing for model implementation by external groups were available for only 5/44 (11%) publications. CONCLUSIONS While ECG deep-learning models are increasingly clinically relevant, their reporting is highly variable, and few publications provide sufficient detail for methodologic reproduction or model validation by external groups. The field of ECG deep learning would benefit from adherence to a set of standardized scientific reporting guidelines.
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Affiliation(s)
- Vennela Avula
- Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Katherine C. Wu
- Division of Cardiology, Johns Hopkins University Department of Medicine, Baltimore, Maryland, USA
| | - Richard T. Carrick
- Division of Cardiology, Johns Hopkins University Department of Medicine, Baltimore, Maryland, USA
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15
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Kashani KB, Koyner JL. Digital health utilities in acute kidney injury management. Curr Opin Crit Care 2023; 29:542-550. [PMID: 37861196 DOI: 10.1097/mcc.0000000000001105] [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] [Indexed: 10/21/2023]
Abstract
PURPOSE OF REVIEW Acute kidney injury (AKI) is a highly prevalent clinical syndrome that substantially impacts patient outcomes. It is accepted by the clinical communities that the management of AKI is time-sensitive. Unfortunately, despite growing proof of its preventability, AKI management remains suboptimal in community, acute care, and postacute care settings. Digital health solutions comprise various tools and models to improve care processes and patient outcomes in multiple medical fields. AKI development, progression, recovery, or lack thereof, offers tremendous opportunities for developing, validating, and implementing digital health solutions in multiple settings. This article will review the definitions and components of digital health, the characteristics of AKI that allow digital health solutions to be considered, and the opportunities and threats in implementing these solutions. RECENT FINDINGS Over the past two decades, the academic output related to the use of digital health solutions in AKI has exponentially grown. While this indicates the growing interest in the topic, most topics are primarily related to clinical decision support by detecting AKI within hospitals or using artificial intelligence or machine learning technologies to predict AKI within acute care settings. However, recently, projects to assess the impact of digital health solutions in more complex scenarios, for example, managing nephrotoxins among adults of pediatric patients who already have AKI, is increasing. Depending on the type of patients, chosen digital health solution intervention, comparator groups, and selected outcomes, some of these studies showed benefits, while some did not indicate additional gain in care processes or clinical outcomes. SUMMARY Careful needs assessment, selection of the correct digital health solution, and appropriate clinical validation of the benefits while avoiding additional health disparities are moral, professional, and ethical obligations for all individuals using these healthcare tools, including clinicians, data scientists, and administrators.
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Affiliation(s)
- Kianoush B Kashani
- Division of Nephrology and Hypertension
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Mayo Clinic, Rochester, Minnesota
| | - Jay L Koyner
- Section of Nephrology, Department of Medicine, University of Chicago, Chicago, Illinois, USA
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16
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Kim D, Jeong J, Kim J, Cho Y, Park I, Lee SM, Oh YT, Baek S, Kang D, Lee E, Jeong B. Hyperkalemia Detection in Emergency Departments Using Initial ECGs: A Smartphone AI ECG Analyzer vs. Board-Certified Physicians. J Korean Med Sci 2023; 38:e322. [PMID: 37987103 PMCID: PMC10659922 DOI: 10.3346/jkms.2023.38.e322] [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: 06/01/2023] [Accepted: 08/22/2023] [Indexed: 11/22/2023] Open
Abstract
BACKGROUND Hyperkalemia is a potentially fatal condition that mandates rapid identification in emergency departments (EDs). Although a 12-lead electrocardiogram (ECG) can indicate hyperkalemia, subtle changes in the ECG often pose detection challenges. An artificial intelligence application that accurately assesses hyperkalemia risk from ECGs could revolutionize patient screening and treatment. We aimed to evaluate the efficacy and reliability of a smartphone application, which utilizes camera-captured ECG images, in quantifying hyperkalemia risk compared to human experts. METHODS We performed a retrospective analysis of ED hyperkalemic patients (serum potassium ≥ 6 mmol/L) and their age- and sex-matched non-hyperkalemic controls. The application was tested by five users and its performance was compared to five board-certified emergency physicians (EPs). RESULTS Our study included 125 patients. The area under the curve (AUC)-receiver operating characteristic of the application's output was nearly identical among the users, ranging from 0.898 to 0.904 (median: 0.902), indicating almost perfect interrater agreement (Fleiss' kappa 0.948). The application demonstrated high sensitivity (0.797), specificity (0.934), negative predictive value (NPV) (0.815), and positive predictive value (PPV) (0.927). In contrast, the EPs showed moderate interrater agreement (Fleiss' kappa 0.551), and their consensus score had a significantly lower AUC of 0.662. The physicians' consensus demonstrated a sensitivity of 0.203, specificity of 0.934, NPV of 0.527, and PPV of 0.765. Notably, this performance difference remained significant regardless of patients' sex and age (P < 0.001 for both). CONCLUSION Our findings suggest that a smartphone application can accurately and reliably quantify hyperkalemia risk using initial ECGs in the ED.
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Affiliation(s)
- Donghoon Kim
- Department of Emergency Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Joo Jeong
- Department of Emergency Medicine, Seoul National University Bundang Hospital, Seongnam, Korea.
| | - Joonghee Kim
- Department of Emergency Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
- Division of Data Science, Department of Emergency Medicine, Seoul National University College of Medicine, Seoul, Korea
- ARPI Inc., Seongnam, Korea.
| | - Youngjin Cho
- Division of Cardiology, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
- ARPI Inc., Seongnam, Korea
| | - Inwon Park
- Department of Emergency Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Sang-Min Lee
- Department of Emergency Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Young Taeck Oh
- Department of Emergency Medicine, Hallym University Dongtan Sacred Heart Hospital, Hwaseong, Korea
| | - Sumin Baek
- Department of Emergency Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
- Division of Data Science, Department of Emergency Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Dongin Kang
- Department of Emergency Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
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17
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Tsai C, Patel H, Horbal P, Dickey S, Peng Y, Nwankwo E, Hicks H, Chen G, Hussein A, Gopinathannair R, Mar PL. Comparison of quantifiable electrocardiographic changes associated with severe hyperkalemia. Int J Cardiol 2023; 391:131257. [PMID: 37574026 DOI: 10.1016/j.ijcard.2023.131257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 06/29/2023] [Accepted: 08/10/2023] [Indexed: 08/15/2023]
Abstract
BACKGROUND Hyperkalemia (HK) is a life-threatening condition that is frequently evaluated by electrocardiogram (ECG). ECG changes in severe HK (≥ 6.3 mEq/L) are not well-characterized. This study sought to compare and correlate ECG metrics in severe HK to baseline normokalemic ECGs and serum potassium. METHODS A retrospective analysis of 340 severe HK encounters with corresponding normokalemic ECGs was performed. RESULTS Various ECG metrics were analyzed. P wave amplitude in lead II, QRS duration, T wave slope, ratio of T wave amplitude: duration, and ratios of T wave: QRS amplitudes were significantly different between normokalemic and HK ECGs. P wave amplitude attenuation in lead II correlated better with serum potassium than in V1. T wave metrics that incorporated both T wave and QRS amplitudes correlated better than metrics utilizing T wave metrics alone. CONCLUSION Multiple statistically significant and quantifiable differences among ECG metrics were observed between normokalemic and HK ECGs and correlated with increasing degrees of serum potassium and along the continuum of serum potassium. When incorporated into a logistic regression model, the ability to distinguish HK versus normokalemia on ECG improved significantly. These findings could be integrated into an ECG acquisition system that can more accurately identify severe HK.
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Affiliation(s)
- Christina Tsai
- Department of Medicine, Saint Louis University, Saint Louis, MO, 1008 S. Spring Avenue, Suite 2113, Saint Louis, MO 63110, USA
| | - Hiren Patel
- Division of Cardiovascular Medicine, Saint Louis University, 1008 S. Spring Avenue, Suite 2113, Saint Louis, MO 63110, USA
| | - Piotr Horbal
- Department of Medicine, Saint Louis University, Saint Louis, MO, 1008 S. Spring Avenue, Suite 2113, Saint Louis, MO 63110, USA
| | - Sierra Dickey
- Department of Medicine, Saint Louis University, Saint Louis, MO, 1008 S. Spring Avenue, Suite 2113, Saint Louis, MO 63110, USA
| | - Yuanzun Peng
- Saint Louis University School of Medicine, 1008 S. Spring Avenue, Suite 2113, Saint Louis, MO 63110, USA
| | - Eugene Nwankwo
- Department of Medicine, Saint Louis University, Saint Louis, MO, 1008 S. Spring Avenue, Suite 2113, Saint Louis, MO 63110, USA
| | - Hunter Hicks
- Saint Louis University School of Medicine, 1008 S. Spring Avenue, Suite 2113, Saint Louis, MO 63110, USA
| | - Guanhua Chen
- Department of Biostatistics and Medical Informatics, University of Wisconsin, 610 Walnut Street, Room 207D, Madison, WI 53726, USA
| | - Ahmed Hussein
- Division of Cardiovascular Medicine, Saint Louis University, 1008 S. Spring Avenue, Suite 2113, Saint Louis, MO 63110, USA
| | - Rakesh Gopinathannair
- Kansas City Heart Rhythm Institute, Missouri, 2330 East Meyer Blvd, Suite 509, Kansas City, MO 64132, USA
| | - Philip L Mar
- Division of Cardiovascular Medicine, Saint Louis University, 1008 S. Spring Avenue, Suite 2113, Saint Louis, MO 63110, USA.
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18
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Pasero E, Gaita F, Randazzo V, Meynet P, Cannata S, Maury P, Giustetto C. Artificial Intelligence ECG Analysis in Patients with Short QT Syndrome to Predict Life-Threatening Arrhythmic Events. SENSORS (BASEL, SWITZERLAND) 2023; 23:8900. [PMID: 37960599 PMCID: PMC10649184 DOI: 10.3390/s23218900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 10/23/2023] [Accepted: 10/28/2023] [Indexed: 11/15/2023]
Abstract
Short QT syndrome (SQTS) is an inherited cardiac ion-channel disease related to an increased risk of sudden cardiac death (SCD) in young and otherwise healthy individuals. SCD is often the first clinical presentation in patients with SQTS. However, arrhythmia risk stratification is presently unsatisfactory in asymptomatic patients. In this context, artificial intelligence-based electrocardiogram (ECG) analysis has never been applied to refine risk stratification in patients with SQTS. The purpose of this study was to analyze ECGs from SQTS patients with the aid of different AI algorithms to evaluate their ability to discriminate between subjects with and without documented life-threatening arrhythmic events. The study group included 104 SQTS patients, 37 of whom had a documented major arrhythmic event at presentation and/or during follow-up. Thirteen ECG features were measured independently by three expert cardiologists; then, the dataset was randomly divided into three subsets (training, validation, and testing). Five shallow neural networks were trained, validated, and tested to predict subject-specific class (non-event/event) using different subsets of ECG features. Additionally, several deep learning and machine learning algorithms, such as Vision Transformer, Swin Transformer, MobileNetV3, EfficientNetV2, ConvNextTiny, Capsule Networks, and logistic regression were trained, validated, and tested directly on the scanned ECG images, without any manual feature extraction. Furthermore, a shallow neural network, a 1-D transformer classifier, and a 1-D CNN were trained, validated, and tested on ECG signals extracted from the aforementioned scanned images. Classification metrics were evaluated by means of sensitivity, specificity, positive and negative predictive values, accuracy, and area under the curve. Results prove that artificial intelligence can help clinicians in better stratifying risk of arrhythmia in patients with SQTS. In particular, shallow neural networks' processing features showed the best performance in identifying patients that will not suffer from a potentially lethal event. This could pave the way for refined ECG-based risk stratification in this group of patients, potentially helping in saving the lives of young and otherwise healthy individuals.
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Affiliation(s)
- Eros Pasero
- Department of Electronics and Telecommunications, Politecnico di Torino, 10129 Turin, Italy
| | - Fiorenzo Gaita
- Cardiology Unit, J Medical, 1015 Turin, Italy;
- Department of Medical Sciences, University of Turin, 10124 Turin, Italy;
| | - Vincenzo Randazzo
- Department of Electronics and Telecommunications, Politecnico di Torino, 10129 Turin, Italy
| | - Pierre Meynet
- Department of Medical Sciences, University of Turin, 10124 Turin, Italy;
- Division of Cardiology, Città della Salute e della Scienza Hospital, 10126 Turin, Italy
| | - Sergio Cannata
- Department of Electronics and Telecommunications, Politecnico di Torino, 10129 Turin, Italy
| | - Philippe Maury
- Department of Cardiology, University Hospital Rangueil, 31400 Toulouse, France;
| | - Carla Giustetto
- Department of Medical Sciences, University of Turin, 10124 Turin, Italy;
- Division of Cardiology, Città della Salute e della Scienza Hospital, 10126 Turin, Italy
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19
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Nadkarni GN, Sakhuja A. Clinical Informatics in Critical Care Medicine. THE YALE JOURNAL OF BIOLOGY AND MEDICINE 2023; 96:397-405. [PMID: 37780994 PMCID: PMC10524812 DOI: 10.59249/wttu3055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/03/2023]
Abstract
Continuous monitoring and treatment of patients in intensive care units generates vast amounts of data. Critical Care Medicine clinicians incorporate this continuously evolving data to make split-second, life or death decisions for management of these patients. Despite the abundance of data, it can be challenging to consider every accessible data point when making the quick decisions necessary at the point of care. Consequently, Clinical Informatics offers a natural partnership to improve the care for critically ill patients. The last two decades have seen a significant evolution in the role of Clinical Informatics in Critical Care Medicine. In this review, we will discuss how Clinical Informatics improves the care of critically ill patients by enhancing not only data collection and visualization but also bedside medical decision making. We will further discuss the evolving role of machine learning algorithms in Clinical Informatics as it pertains to Critical Care Medicine.
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Affiliation(s)
- Girish N. Nadkarni
- Division of Nephrology, Department of Medicine, Icahn
School of Medicine at Mount Sinai, New York, NY, USA
- The Charles Bronfman Institute for Personalized
Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Ankit Sakhuja
- Division of Cardiovascular Critical Care, Department of
Cardiovascular and Thoracic Surgery, West Virginia University, Morgantown, WV,
USA
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20
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Komuro J, Kusumoto D, Hashimoto H, Yuasa S. Machine learning in cardiology: Clinical application and basic research. J Cardiol 2023; 82:128-133. [PMID: 37141938 DOI: 10.1016/j.jjcc.2023.04.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 04/23/2023] [Accepted: 04/28/2023] [Indexed: 05/06/2023]
Abstract
Machine learning is a subfield of artificial intelligence. The quality and versatility of machine learning have been rapidly improving and playing a critical role in many aspects of social life. This trend is also observed in the medical field. Generally, there are three main types of machine learning: supervised, unsupervised, and reinforcement learning. Each type of learning is adequately selected for the purpose and type of data. In the field of medicine, various types of information are collected and used, and research using machine learning is becoming increasingly relevant. Many clinical studies are conducted using electronic health and medical records, including in the cardiovascular area. Machine learning has also been applied in basic research. Machine learning has been widely used for several types of data analysis, such as clustering of microarray analysis and RNA sequence analysis. Machine learning is essential for genome and multi-omics analyses. This review summarizes the recent advancements in the use of machine learning in clinical applications and basic cardiovascular research.
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Affiliation(s)
- Jin Komuro
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Dai Kusumoto
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Hisayuki Hashimoto
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Shinsuke Yuasa
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan.
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21
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Zhao Z, Li B, Xiao X, Liu J, Zheng W. Cell-free RNA and fully convolutional dense network-based early preeclampsia prediction. Clin Transl Med 2023; 13:e1371. [PMID: 37581567 PMCID: PMC10426394 DOI: 10.1002/ctm2.1371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 08/02/2023] [Accepted: 08/08/2023] [Indexed: 08/16/2023] Open
Affiliation(s)
- Zhuo Zhao
- Key Laboratory of Shaanxi Province for Craniofacial Precision Medicine Research, College of StomatologyXi'an Jiaotong UniversityXi'anP. R. China
- State Key Laboratory for Manufacturing System EngineeringXi'an Jiaotong UniversityXi'anP. R. China
| | - Bing Li
- State Key Laboratory for Manufacturing System EngineeringXi'an Jiaotong UniversityXi'anP. R. China
| | - Xia Xiao
- Clinical Research Center of Shaanxi Province for Dental and Maxillofacial Diseases, College of StomatologyXi'an Jiaotong UniversityXi'anP. R. China
- Yanan University Affiliated HospitalYananP. R. China
| | - Jinjun Liu
- Department of Physiology and Pathophysiology, School of Basic Medical SciencesXi'an Jiaotong UniversityXi'anP. R. China
| | - Wang Zheng
- Key Laboratory of Shaanxi Province for Craniofacial Precision Medicine Research, College of StomatologyXi'an Jiaotong UniversityXi'anP. R. China
- Department of Physiology and Pathophysiology, School of Basic Medical SciencesXi'an Jiaotong UniversityXi'anP. R. China
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22
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Chang HH, Chiang JH, Tsai CC, Chiu PF. Predicting hyperkalemia in patients with advanced chronic kidney disease using the XGBoost model. BMC Nephrol 2023; 24:169. [PMID: 37308844 DOI: 10.1186/s12882-023-03227-w] [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: 02/06/2023] [Accepted: 06/01/2023] [Indexed: 06/14/2023] Open
Abstract
BACKGROUND Hyperkalemia is a common complication of chronic kidney disease (CKD). Hyperkalemia is associated with mortality, CKD progression, hospitalization, and high healthcare costs in patients with CKD. We developed a machine learning model to predict hyperkalemia in patients with advanced CKD at an outpatient clinic. METHODS This retrospective study included 1,965 advanced CKD patients between January 1, 2010, and December 31, 2020 in Taiwan. We randomly divided all patients into the training (75%) and testing (25%) datasets. The primary outcome was to predict hyperkalemia (K+ > 5.5 mEq/L) in the next clinic vist. Two nephrologists were enrolled in a human-machine competition. The area under the receiver operating characteristic curves (AUCs), sensitivity, specificity, and accuracy were used to evaluate the performance of XGBoost and conventional logistic regression models with that of these physicians. RESULTS In a human-machine competition of hyperkalemia prediction, the AUC, PPV, and accuracy of the XGBoost model were 0.867 (95% confidence interval: 0.840-0.894), 0.700, and 0.933, which was significantly better than that of our clinicians. There were four variables that were chosen as high-ranking variables in XGBoost and logistic regression models, including hemoglobin, the serum potassium level in the previous visit, angiotensin receptor blocker use, and calcium polystyrene sulfonate use. CONCLUSIONS The XGBoost model provided better predictive performance for hyperkalemia than physicians at the outpatient clinic.
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Affiliation(s)
- Hsin-Hsiung Chang
- Division of Nephrology, Department of Internal Medicine, Antai Medical Care Corporation Antai Tian-Sheng Memorial Hospital, Pingtung County, Taiwan
- Department of Computer Science and Information Engineering, National Cheng Kung University, Tainan, Taiwan
| | - Jung-Hsien Chiang
- Department of Computer Science and Information Engineering, National Cheng Kung University, Tainan, Taiwan.
| | - Chun-Chieh Tsai
- Division of Nephrology, Department of Internal Medicine, Changhua Christian Hospital, Changhua, Taiwan
| | - Ping-Fang Chiu
- Division of Nephrology, Department of Internal Medicine, Changhua Christian Hospital, Changhua, Taiwan.
- Department of Post Baccalaureate, College of Medicine, National Chung Hsing University, Taichung, Taiwan.
- Department of Hospitality Management, MingDao University, Changhua, Taiwan.
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23
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Kooman JP. Detecting chronic kidney disease by electrocardiography. COMMUNICATIONS MEDICINE 2023; 3:74. [PMID: 37237030 DOI: 10.1038/s43856-023-00306-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 05/15/2023] [Indexed: 05/28/2023] Open
Affiliation(s)
- Jeroen P Kooman
- Department of Internal Medicine, Division of Nephrology, Maastricht University Medical Centre, Maastricht, The Netherlands.
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24
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Holmstrom L, Christensen M, Yuan N, Weston Hughes J, Theurer J, Jujjavarapu M, Fatehi P, Kwan A, Sandhu RK, Ebinger J, Cheng S, Zou J, Chugh SS, Ouyang D. Deep learning-based electrocardiographic screening for chronic kidney disease. COMMUNICATIONS MEDICINE 2023; 3:73. [PMID: 37237055 DOI: 10.1038/s43856-023-00278-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Accepted: 03/10/2023] [Indexed: 05/28/2023] Open
Abstract
BACKGROUND Undiagnosed chronic kidney disease (CKD) is a common and usually asymptomatic disorder that causes a high burden of morbidity and early mortality worldwide. We developed a deep learning model for CKD screening from routinely acquired ECGs. METHODS We collected data from a primary cohort with 111,370 patients which had 247,655 ECGs between 2005 and 2019. Using this data, we developed, trained, validated, and tested a deep learning model to predict whether an ECG was taken within one year of the patient receiving a CKD diagnosis. The model was additionally validated using an external cohort from another healthcare system which had 312,145 patients with 896,620 ECGs between 2005 and 2018. RESULTS Using 12-lead ECG waveforms, our deep learning algorithm achieves discrimination for CKD of any stage with an AUC of 0.767 (95% CI 0.760-0.773) in a held-out test set and an AUC of 0.709 (0.708-0.710) in the external cohort. Our 12-lead ECG-based model performance is consistent across the severity of CKD, with an AUC of 0.753 (0.735-0.770) for mild CKD, AUC of 0.759 (0.750-0.767) for moderate-severe CKD, and an AUC of 0.783 (0.773-0.793) for ESRD. In patients under 60 years old, our model achieves high performance in detecting any stage CKD with both 12-lead (AUC 0.843 [0.836-0.852]) and 1-lead ECG waveform (0.824 [0.815-0.832]). CONCLUSIONS Our deep learning algorithm is able to detect CKD using ECG waveforms, with stronger performance in younger patients and more severe CKD stages. This ECG algorithm has the potential to augment screening for CKD.
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Affiliation(s)
- Lauri Holmstrom
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
- Center for Cardiac Arrest Prevention, Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
- Research Unit of Internal Medicine, Medical Research Center Oulu, University of Oulu and Oulu University Hospital, Oulu, Finland
- Division of Artificial Intelligence in Medicine, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Matthew Christensen
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
- Division of Artificial Intelligence in Medicine, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Neal Yuan
- Department of Medicine, Division of Cardiology, San Francisco VA, UCSF, San Francisco, CA, USA
| | - J Weston Hughes
- Department of Computer Science, Stanford University, Palo Alto, CA, USA
| | - John Theurer
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
- Division of Artificial Intelligence in Medicine, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Melvin Jujjavarapu
- Enterprise Information Service, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Pedram Fatehi
- Division of Nephrology, Department of Medicine, Stanford University, Palo Alto, CA, USA
| | - Alan Kwan
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Roopinder K Sandhu
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Joseph Ebinger
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Susan Cheng
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - James Zou
- Department of Computer Science, Stanford University, Palo Alto, CA, USA
- Department of Biomedical Data Science, Stanford University, Palo Alto, CA, USA
| | - Sumeet S Chugh
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
- Center for Cardiac Arrest Prevention, Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
- Division of Artificial Intelligence in Medicine, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - David Ouyang
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
- Division of Artificial Intelligence in Medicine, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
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Ledziński Ł, Grześk G. Artificial Intelligence Technologies in Cardiology. J Cardiovasc Dev Dis 2023; 10:jcdd10050202. [PMID: 37233169 DOI: 10.3390/jcdd10050202] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 05/03/2023] [Accepted: 05/04/2023] [Indexed: 05/27/2023] Open
Abstract
As the world produces exabytes of data, there is a growing need to find new methods that are more suitable for dealing with complex datasets. Artificial intelligence (AI) has significant potential to impact the healthcare industry, which is already on the road to change with the digital transformation of vast quantities of information. The implementation of AI has already achieved success in the domains of molecular chemistry and drug discoveries. The reduction in costs and in the time needed for experiments to predict the pharmacological activities of new molecules is a milestone in science. These successful applications of AI algorithms provide hope for a revolution in healthcare systems. A significant part of artificial intelligence is machine learning (ML), of which there are three main types-supervised learning, unsupervised learning, and reinforcement learning. In this review, the full scope of the AI workflow is presented, with explanations of the most-often-used ML algorithms and descriptions of performance metrics for both regression and classification. A brief introduction to explainable artificial intelligence (XAI) is provided, with examples of technologies that have developed for XAI. We review important AI implementations in cardiology for supervised, unsupervised, and reinforcement learning and natural language processing, emphasizing the used algorithm. Finally, we discuss the need to establish legal, ethical, and methodical requirements for the deployment of AI models in medicine.
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Affiliation(s)
- Łukasz Ledziński
- Department of Cardiology and Clinical Pharmacology, Faculty of Health Sciences, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Toruń, Ujejskiego 75, 85-168 Bydgoszcz, Poland
| | - Grzegorz Grześk
- Department of Cardiology and Clinical Pharmacology, Faculty of Health Sciences, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Toruń, Ujejskiego 75, 85-168 Bydgoszcz, Poland
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Tang P, Wang Q, Ouyang H, Yang S, Hua P. The feasibility of early detecting coronary artery disease using deep learning-based algorithm based on electrocardiography. Aging (Albany NY) 2023; 15:3524-3537. [PMID: 37186897 PMCID: PMC10449295 DOI: 10.18632/aging.204688] [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: 03/18/2022] [Accepted: 04/13/2023] [Indexed: 05/17/2023]
Abstract
BACKGROUND Coronary Artery Disease (CAD) is a major cause of morbidity and mortality, yet it is frequently asymptomatic in the early stages and hence goes undetected. OBJECTIVE We aimed to develop a novel artificial intelligence-based approach for early detection of CAD patients based solely on electrocardiogram (ECG). METHODS This study included patients with suspected CAD who had standard 10-s resting 12-lead ECGs and coronary computed tomography angiography (cCTA) results within 4 weeks or less. The ECG and cCTA data from the same patient were matched based on their hospitalization or outpatient ID. All matched data pairs were then randomly divided into training, validation dataset for model development based on convolutional neural network (CNN) and test dataset for model evaluation. The accuracy (Acc), specificity (Spec), sensitivity (Sen), positive predictive value (PPV), negative predictive value (NPV) and area under the receiver operating characteristic curve (AUC) of the model were calculated by using the test dataset. RESULTS In the test dataset, the model for detecting CAD achieved an AUC of 0.75 (95% CI, 0.73 to 0.78) with an accuracy of 70.0%. Using the optimal cut-off point, the CAD detection model had sensitivity of 68.7%, specificity of 70.9%, positive predictive value (PPV) of 61.2%, and negative predictive value (NPV) of 77.2%. Our study demonstrates that a well-trained CNN model based solely on ECG could be considered an efficient, low-cost, and noninvasive method of assisting in CAD detection.
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Affiliation(s)
- Panli Tang
- Department of Cardiovascular Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, China
| | - Qi Wang
- Department of Cardiovascular Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, China
| | - Hua Ouyang
- Department of Cardiovascular Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, China
| | - Songran Yang
- The Biobank of Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, China
| | - Ping Hua
- Department of Cardiovascular Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, China
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Danilov A, Aronow WS. Artificial Intelligence in Cardiology: Applications and Obstacles. Curr Probl Cardiol 2023; 48:101750. [PMID: 37088174 DOI: 10.1016/j.cpcardiol.2023.101750] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Accepted: 04/17/2023] [Indexed: 04/25/2023]
Abstract
Artificial intelligence (AI) technology is poised to alter the flow of daily life, and in particular, medicine, where it may eventually complement the physician's work in diagnosing and treating disease. Despite the recent frenzy and uptick in AI research over the past decade, the integration of AI into medical practice is in its early stages. Cardiology stands to benefit due to its many diagnostic modalities and diverse treatments. AI methods have been applied to various domains within cardiology: imaging, electrocardiography, wearable devices, risk prediction, and disease classification. While many AI-based approaches have been developed that perform equal to or better than the state-of-the-art, few prospective randomized studies have evaluated their use. Furthermore, obstacles at the intersection of medicine and AI remain unsolved, including model understanding, bias, model evaluation, relevance and reproducibility, and legal and ethical dilemmas. We summarize recent and current applications of AI in cardiology, followed by a discussion of the aforementioned complications.
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Affiliation(s)
| | - Wilbert S Aronow
- New York Medical College, School of Medicine, Valhalla, New York; Department of Cardiology, Westchester Medical Center, Valhalla, NY
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28
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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: 0] [Impact Index Per Article: 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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29
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Lou YS, Lin CS, Fang WH, Lee CC, Lin C. Extensive deep learning model to enhance electrocardiogram application via latent cardiovascular feature extraction from identity identification. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2023; 231:107359. [PMID: 36738606 DOI: 10.1016/j.cmpb.2023.107359] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 12/22/2022] [Accepted: 01/17/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND AND OBJECTIVE Deep learning models (DLMs) have been successfully applied in biomedicine primarily using supervised learning with large, annotated databases. However, scarce training resources limit the potential of DLMs for electrocardiogram (ECG) analysis. METHODS We have developed a novel pre-training strategy for unsupervised identity identification with an area under the receiver operating characteristic curve (AUC) >0.98. Accordingly, a DLM pre-trained with identity identification can be applied to 70 patient characteristic predictions using transfer learning (TL). These ECG-based patient characteristics were then used for cardiovascular disease (CVD) risk prediction. The DLMs were trained using 507,729 ECGs from 222,473 patients and validated using two independent validation sets (n = 27,824/31,925). RESULTS The DLMs using our method exhibited better performance than directly trained DLMs. Additionally, our DLM performed better than those of previous studies in terms of gender (AUC [internal/external] = 0.982/0.968), age (correlation = 0.886/0.892), low ejection fraction (AUC = 0.942/0.951), and critical markers not addressed previously, including high B-type natriuretic peptide (AUC = 0.921/0.899). Additionally, approximately 50% of the ECG-based characteristics provided significantly more prediction information for cardiovascular risk than real characteristics. CONCLUSIONS This is the first study to use identity identification as a pre-training task for TL in ECG analysis. An extensive exploration of the relationship between ECG and 70 patient characteristics was conducted. Our DLM-enhanced ECG interpretation system extensively advanced ECG-related patient characteristic prediction and mortality risk management for cardiovascular diseases.
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Affiliation(s)
- Yu-Sheng Lou
- Graduate Institutes of Life Sciences, National Defense Medical Center, Taipei, Taiwan; School of Public Health, National Defense Medical Center, Taipei, Taiwan
| | - Chin-Sheng Lin
- Division of Cardiology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, R.O.C.; Medical Technology Education Center, School of Medicine, National Defense Medical Center, Taipei, Taiwan, R.O.C
| | - Wen-Hui Fang
- Department of Family and Community Medicine, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, R.O.C
| | - Chia-Cheng Lee
- Department of Medical Informatics, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, R.O.C.; Division of Colorectal Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, R.O.C
| | - Chin Lin
- Graduate Institutes of Life Sciences, National Defense Medical Center, Taipei, Taiwan; School of Public Health, National Defense Medical Center, Taipei, Taiwan; Medical Technology Education Center, School of Medicine, National Defense Medical Center, Taipei, Taiwan, R.O.C.; School of Medicine, National Defense Medical Center, Taipei, Taiwan, R.O.C..
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30
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Wen J, Liu D, Wu Q, Zhao L, Iao WC, Lin H. Retinal image‐based artificial intelligence in detecting and predicting kidney diseases: Current advances and future perspectives. VIEW 2023. [DOI: 10.1002/viw.20220070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/22/2023] Open
Affiliation(s)
- Jingyi Wen
- State Key Laboratory of OphthalmologyZhongshan Ophthalmic CenterSun Yat‐sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Disease GuangzhouChina
| | - Dong Liu
- State Key Laboratory of OphthalmologyZhongshan Ophthalmic CenterSun Yat‐sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Disease GuangzhouChina
| | - Qianni Wu
- State Key Laboratory of OphthalmologyZhongshan Ophthalmic CenterSun Yat‐sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Disease GuangzhouChina
| | - Lanqin Zhao
- State Key Laboratory of OphthalmologyZhongshan Ophthalmic CenterSun Yat‐sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Disease GuangzhouChina
| | - Wai Cheng Iao
- State Key Laboratory of OphthalmologyZhongshan Ophthalmic CenterSun Yat‐sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Disease GuangzhouChina
| | - Haotian Lin
- State Key Laboratory of OphthalmologyZhongshan Ophthalmic CenterSun Yat‐sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Disease GuangzhouChina
- Center for Precision Medicine and Department of Genetics and Biomedical Informatics Zhongshan School of Medicine Sun Yat‐sen University Guangzhou China
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Ginder C, Li J, Halperin JL, Akar JG, Martin DT, Chattopadhyay I, Upadhyay GA. Predicting Malignant Ventricular Arrhythmias Using Real-Time Remote Monitoring. J Am Coll Cardiol 2023; 81:949-961. [PMID: 36889873 DOI: 10.1016/j.jacc.2022.12.024] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 12/08/2022] [Accepted: 12/15/2022] [Indexed: 03/08/2023]
Abstract
BACKGROUND Although implantable cardioverter-defibrillator (ICD) therapies are associated with increased morbidity and mortality, the prediction of malignant ventricular arrhythmias has remained elusive. OBJECTIVES The purpose of this study was to evaluate whether daily remote-monitoring data may predict appropriate ICD therapies for ventricular tachycardia or ventricular fibrillation. METHODS This was a post hoc analysis of IMPACT (Randomized trial of atrial arrhythmia monitoring to guide anticoagulation in patients with implanted defibrillator and cardiac resynchronization devices), a multicenter, randomized, controlled trial of 2,718 patients evaluating atrial tachyarrhythmias and anticoagulation for patients with heart failure and ICD or cardiac resynchronization therapy with defibrillator devices. All device therapies were adjudicated as either appropriate (to treat ventricular tachycardia or ventricular fibrillation) or inappropriate (all others). Remote monitoring data in the 30 days before device therapy were utilized to develop separate multivariable logistic regression and neural network models to predict appropriate device therapies. RESULTS A total of 59,807 device transmissions were available for 2,413 patients (age 64 ± 11 years, 26% women, 64% ICD). Appropriate device therapies (141 shocks, 10 antitachycardia pacing) were delivered to 151 patients. Logistic regression identified shock lead impedance and ventricular ectopy as significantly associated with increased risk of appropriate device therapy (sensitivity 39%, specificity 91%, AUC: 0.72). Neural network modeling yielded significantly better (P < 0.01 for comparison) predictive performance (sensitivity 54%, specificity 96%, AUC: 0.90), and also identified patterns of change in atrial lead impedance, mean heart rate, and patient activity as predictors of appropriate therapies. CONCLUSIONS Daily remote monitoring data may be utilized to predict malignant ventricular arrhythmias in the 30 days before device therapies. Neural networks complement and enhance conventional approaches to risk stratification.
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Affiliation(s)
- Curtis Ginder
- Division of Cardiovascular Medicine, Department of Internal Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Jin Li
- Department of Computer Science, The University of Chicago, Chicago, Illinois, USA
| | - Jonathan L Halperin
- Cardiovascular Institute, Mount Sinai Medical Center, New York, New York, USA
| | - Joseph G Akar
- Cardiac Electrophysiology, Yale University School of Medicine, New Haven, Connecticut, USA
| | - David T Martin
- Division of Cardiovascular Medicine, Department of Internal Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Ishanu Chattopadhyay
- Department of Hospital Medicine, The University of Chicago Pritzker School of Medicine, Chicago, Illinois, USA
| | - Gaurav A Upadhyay
- Center for Arrhythmia Care, Heart and Vascular Institute, The University of Chicago Pritzker School of Medicine, Chicago, Illinois, USA. https://twitter.com/gauravaupadhyay
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Accurate Detection of Arrhythmias on Raw Electrocardiogram Images:An Aggregation Attention Multi-label Model for Diagnostic Assistance. Med Eng Phys 2023; 114:103964. [PMID: 37030892 DOI: 10.1016/j.medengphy.2023.103964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 12/24/2022] [Accepted: 02/23/2023] [Indexed: 03/06/2023]
Abstract
BACKGROUND The low rate of detection of abnormalities has been a major problem with current artificial intelligence-based electrocardiogram diagnostic algorithms, particularly when applied under real-world clinical scenarios. METHODS We proposed an aggregation attention multilabel electrocardiogram classification model (AA-ECG) that can be applied directly to raw images to identify cardiac abnormalities using image-level annotation only. To develop and validate the model, we conducted a prospective two-site study to build two large-scale real-world datasets of 12-lead electrocardiogram images, annotated by clinical experts in a multilabeled manner. We compared the proposed model with seven state-of-the-art classifiers on both datasets in 27 main categories. RESULTS In total, 47,733 electrocardiogram images from 37,442 consecutive patients were included in the development set, while 18,581 from 18,345 in the external set. The proposed model achieved better overall performance than the other seven models.The visualization of the attention maps provided an approach to build medical interpretability for machine intelligence. CONCLUSIONS The proposed model had high diagnostic accuracy in identifying cardiac abnormalities on two real-world datasets. It has the potential to help clinicians provide more efficient cardiac care with fewer medical resources.
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Prediction of postoperative infection in elderly using deep learning-based analysis: an observational cohort study. Aging Clin Exp Res 2023; 35:639-647. [PMID: 36598653 PMCID: PMC10014765 DOI: 10.1007/s40520-022-02325-3] [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: 09/06/2022] [Accepted: 12/09/2022] [Indexed: 01/05/2023]
Abstract
Elderly patients are susceptible to postoperative infections with increased mortality. Analyzing with a deep learning model, the perioperative factors that could predict and/or contribute to postoperative infections may improve the outcome in elderly. This was an observational cohort study with 2014 elderly patients who had elective surgery from 28 hospitals in China from April to June 2014. We aimed to develop and validate deep learning-based predictive models for postoperative infections in the elderly. 1510 patients were randomly assigned to be training dataset for establishing deep learning-based models, and 504 patients were used to validate the effectiveness of these models. The conventional model predicted postoperative infections was 0.728 (95% CI 0.688-0.768) with the sensitivity of 66.2% (95% CI 58.2-73.6) and specificity of 66.8% (95% CI 64.6-68.9). The deep learning model including risk factors relevant to baseline clinical characteristics predicted postoperative infections was 0.641 (95% CI 0.545-0.737), and sensitivity and specificity were 34.2% (95% CI 19.6-51.4) and 88.8% (95% CI 85.6-91.6), respectively. Including risk factors relevant to baseline variables and surgery, the deep learning model predicted postoperative infections was 0.763 (95% CI 0.681-0.844) with the sensitivity of 63.2% (95% CI 46-78.2) and specificity of 80.5% (95% CI 76.6-84). Our feasibility study indicated that a deep learning model including risk factors for the prediction of postoperative infections can be achieved in elderly. Further study is needed to assess whether this model can be used to guide clinical practice to improve surgical outcomes in elderly.
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Soundoulounaki S, Sylligardos E, Akoumianaki E, Sigalas M, Kondili E, Georgopoulos D, Trahanias P, Vaporidi K. Neural Network-Enabled Identification of Weak Inspiratory Efforts during Pressure Support Ventilation Using Ventilator Waveforms. J Pers Med 2023; 13:jpm13020347. [PMID: 36836581 PMCID: PMC9966968 DOI: 10.3390/jpm13020347] [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: 01/16/2023] [Revised: 02/10/2023] [Accepted: 02/15/2023] [Indexed: 02/19/2023] Open
Abstract
During pressure support ventilation (PSV), excessive assist results in weak inspiratory efforts and promotes diaphragm atrophy and delayed weaning. The aim of this study was to develop a classifier using a neural network to identify weak inspiratory efforts during PSV, based on the ventilator waveforms. Recordings of flow, airway, esophageal and gastric pressures from critically ill patients were used to create an annotated dataset, using data from 37 patients at 2-5 different levels of support, computing the inspiratory time and effort for every breath. The complete dataset was randomly split, and data from 22 patients (45,650 breaths) were used to develop the model. Using a One-Dimensional Convolutional Neural Network, a predictive model was developed to characterize the inspiratory effort of each breath as weak or not, using a threshold of 50 cmH2O*s/min. The following results were produced by implementing the model on data from 15 different patients (31,343 breaths). The model predicted weak inspiratory efforts with a sensitivity of 88%, specificity of 72%, positive predictive value of 40%, and negative predictive value of 96%. These results provide a 'proof-of-concept' for the ability of such a neural-network based predictive model to facilitate the implementation of personalized assisted ventilation.
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Affiliation(s)
- Stella Soundoulounaki
- Department of Intensive Care Medicine, School of Medicine, University of Crete, 71003 Heraklion, Greece
| | - Emmanouil Sylligardos
- Institute of Computer Science, Foundation for Research and Technology—Hellas (FORTH), 70013 Heraklion, Greece
- Department of Computer Science, University of Crete, 70013 Heraklion, Greece
| | - Evangelia Akoumianaki
- Department of Intensive Care Medicine, School of Medicine, University of Crete, 71003 Heraklion, Greece
| | - Markos Sigalas
- Institute of Computer Science, Foundation for Research and Technology—Hellas (FORTH), 70013 Heraklion, Greece
| | - Eumorfia Kondili
- Department of Intensive Care Medicine, School of Medicine, University of Crete, 71003 Heraklion, Greece
| | - Dimitrios Georgopoulos
- Department of Intensive Care Medicine, School of Medicine, University of Crete, 71003 Heraklion, Greece
| | - Panos Trahanias
- Institute of Computer Science, Foundation for Research and Technology—Hellas (FORTH), 70013 Heraklion, Greece
- Department of Computer Science, University of Crete, 70013 Heraklion, Greece
| | - Katerina Vaporidi
- Department of Intensive Care Medicine, School of Medicine, University of Crete, 71003 Heraklion, Greece
- Correspondence:
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Predict, diagnose, and treat chronic kidney disease with machine learning: a systematic literature review. J Nephrol 2023; 36:1101-1117. [PMID: 36786976 PMCID: PMC10227138 DOI: 10.1007/s40620-023-01573-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2022] [Accepted: 01/01/2023] [Indexed: 02/15/2023]
Abstract
OBJECTIVES In this systematic review we aimed at assessing how artificial intelligence (AI), including machine learning (ML) techniques have been deployed to predict, diagnose, and treat chronic kidney disease (CKD). We systematically reviewed the available evidence on these innovative techniques to improve CKD diagnosis and patient management. METHODS We included English language studies retrieved from PubMed. The review is therefore to be classified as a "rapid review", since it includes one database only, and has language restrictions; the novelty and importance of the issue make missing relevant papers unlikely. We extracted 16 variables, including: main aim, studied population, data source, sample size, problem type (regression, classification), predictors used, and performance metrics. We followed the Preferred Reporting Items for Systematic Reviews (PRISMA) approach; all main steps were done in duplicate. RESULTS From a total of 648 studies initially retrieved, 68 articles met the inclusion criteria. Models, as reported by authors, performed well, but the reported metrics were not homogeneous across articles and therefore direct comparison was not feasible. The most common aim was prediction of prognosis, followed by diagnosis of CKD. Algorithm generalizability, and testing on diverse populations was rarely taken into account. Furthermore, the clinical evaluation and validation of the models/algorithms was perused; only a fraction of the included studies, 6 out of 68, were performed in a clinical context. CONCLUSIONS Machine learning is a promising tool for the prediction of risk, diagnosis, and therapy management for CKD patients. Nonetheless, future work is needed to address the interpretability, generalizability, and fairness of the models to ensure the safe application of such technologies in routine clinical practice.
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Xue JB, Xia S, Wang X, Huang LL, Huang LY, Hao YW, Zhang LJ, Li SZ. Recognizing and monitoring infectious sources of schistosomiasis by developing deep learning models with high-resolution remote sensing images. Infect Dis Poverty 2023; 12:6. [PMID: 36747280 PMCID: PMC9903608 DOI: 10.1186/s40249-023-01060-9] [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: 10/08/2022] [Accepted: 01/28/2023] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND China is progressing towards the goal of schistosomiasis elimination, but there are still some problems, such as difficult management of infection source and snail control. This study aimed to develop deep learning models with high-resolution remote sensing images for recognizing and monitoring livestock bovine, which is an intermediate source of Schistosoma japonicum infection, and to evaluate the effectiveness of the models for real-world application. METHODS The dataset of livestock bovine's spatial distribution was collected from the Chinese National Platform for Common Geospatial Information Services. The high-resolution remote sensing images were further divided into training data, test data, and validation data for model development. Two recognition models based on deep learning methods (ENVINet5 and Mask R-CNN) were developed with reference to the training datasets. The performance of the developed models was evaluated by the performance metrics of precision, recall, and F1-score. RESULTS A total of 50 typical image areas were selected, 1125 bovine objectives were labeled by the ENVINet5 model and 1277 bovine objectives were labeled by the Mask R-CNN model. For the ENVINet5 model, a total of 1598 records of bovine distribution were recognized. The model precision and recall were 81.9% and 80.2%, respectively. The F1 score was 0.81. For the Mask R-CNN mode, 1679 records of bovine objectives were identified. The model precision and recall were 87.3% and 85.2%, respectively. The F1 score was 0.87. When applying the developed models to real-world schistosomiasis-endemic regions, there were 63 bovine objectives in the original image, 53 records were extracted using the ENVINet5 model, and 57 records were extracted using the Mask R-CNN model. The successful recognition ratios were 84.1% and 90.5% for the respectively developed models. CONCLUSION The ENVINet5 model is very feasible when the bovine distribution is low in structure with few samples. The Mask R-CNN model has a good framework design and runs highly efficiently. The livestock recognition models developed using deep learning methods with high-resolution remote sensing images accurately recognize the spatial distribution of livestock, which could enable precise control of schistosomiasis.
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Affiliation(s)
- Jing-Bo Xue
- grid.508378.1National Institute of Parasitic Diseases, Chinese Center for Disease Control and Prevention (Chinese Center for Tropical Diseases Research); NHC Key Laboratory of Parasite and Vector Biology; WHO Collaborating Centre for Tropical Diseases, National Center for International Research On Tropical Diseases, Shanghai, 200025 China ,grid.16821.3c0000 0004 0368 8293School of Global Health, Chinese Center for Tropical Diseases Research, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025 China
| | - Shang Xia
- grid.508378.1National Institute of Parasitic Diseases, Chinese Center for Disease Control and Prevention (Chinese Center for Tropical Diseases Research); NHC Key Laboratory of Parasite and Vector Biology; WHO Collaborating Centre for Tropical Diseases, National Center for International Research On Tropical Diseases, Shanghai, 200025 China ,grid.16821.3c0000 0004 0368 8293School of Global Health, Chinese Center for Tropical Diseases Research, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025 China
| | - Xin‑Yi Wang
- grid.508378.1National Institute of Parasitic Diseases, Chinese Center for Disease Control and Prevention (Chinese Center for Tropical Diseases Research); NHC Key Laboratory of Parasite and Vector Biology; WHO Collaborating Centre for Tropical Diseases, National Center for International Research On Tropical Diseases, Shanghai, 200025 China
| | - Lu-Lu Huang
- grid.508378.1National Institute of Parasitic Diseases, Chinese Center for Disease Control and Prevention (Chinese Center for Tropical Diseases Research); NHC Key Laboratory of Parasite and Vector Biology; WHO Collaborating Centre for Tropical Diseases, National Center for International Research On Tropical Diseases, Shanghai, 200025 China
| | - Liang-Yu Huang
- grid.508378.1National Institute of Parasitic Diseases, Chinese Center for Disease Control and Prevention (Chinese Center for Tropical Diseases Research); NHC Key Laboratory of Parasite and Vector Biology; WHO Collaborating Centre for Tropical Diseases, National Center for International Research On Tropical Diseases, Shanghai, 200025 China
| | - Yu-Wan Hao
- grid.508378.1National Institute of Parasitic Diseases, Chinese Center for Disease Control and Prevention (Chinese Center for Tropical Diseases Research); NHC Key Laboratory of Parasite and Vector Biology; WHO Collaborating Centre for Tropical Diseases, National Center for International Research On Tropical Diseases, Shanghai, 200025 China
| | - Li-Juan Zhang
- grid.508378.1National Institute of Parasitic Diseases, Chinese Center for Disease Control and Prevention (Chinese Center for Tropical Diseases Research); NHC Key Laboratory of Parasite and Vector Biology; WHO Collaborating Centre for Tropical Diseases, National Center for International Research On Tropical Diseases, Shanghai, 200025 China
| | - Shi-Zhu Li
- National Institute of Parasitic Diseases, Chinese Center for Disease Control and Prevention (Chinese Center for Tropical Diseases Research); NHC Key Laboratory of Parasite and Vector Biology; WHO Collaborating Centre for Tropical Diseases, National Center for International Research On Tropical Diseases, Shanghai, 200025, China. .,School of Global Health, Chinese Center for Tropical Diseases Research, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China.
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Stauss M, Htay H, Kooman JP, Lindsay T, Woywodt A. Wearables in Nephrology: Fanciful Gadgetry or Prêt-à-Porter? SENSORS (BASEL, SWITZERLAND) 2023; 23:1361. [PMID: 36772401 PMCID: PMC9919296 DOI: 10.3390/s23031361] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 01/20/2023] [Accepted: 01/24/2023] [Indexed: 06/18/2023]
Abstract
Telemedicine and digitalised healthcare have recently seen exponential growth, led, in part, by increasing efforts to improve patient flexibility and autonomy, as well as drivers from financial austerity and concerns over climate change. Nephrology is no exception, and daily innovations are underway to provide digitalised alternatives to current models of healthcare provision. Wearable technology already exists commercially, and advances in nanotechnology and miniaturisation mean interest is also garnering clinically. Here, we outline the current existing wearable technology pertaining to the diagnosis and monitoring of patients with a spectrum of kidney disease, give an overview of wearable dialysis technology, and explore wearables that do not yet exist but would be of great interest. Finally, we discuss challenges and potential pitfalls with utilising wearable technology and the factors associated with successful implementation.
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Affiliation(s)
- Madelena Stauss
- Department of Nephrology, Lancashire Teaching Hospitals NHS Foundation Trust, Preston PR2 9HT, UK
| | - Htay Htay
- Department of Renal Medicine, Singapore General Hospital, Singapore 169608, Singapore
| | - Jeroen P. Kooman
- Department of Internal Medicine, Division of Nephrology, Maastricht University, 6229 HX Maastricht, The Netherlands
| | - Thomas Lindsay
- Department of Nephrology, Lancashire Teaching Hospitals NHS Foundation Trust, Preston PR2 9HT, UK
| | - Alexander Woywodt
- Department of Nephrology, Lancashire Teaching Hospitals NHS Foundation Trust, Preston PR2 9HT, UK
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Monfredi OJ, Moore CC, Sullivan BA, Keim-Malpass J, Fairchild KD, Loftus TJ, Bihorac A, Krahn KN, Dubrawski A, Lake DE, Moorman JR, Clermont G. Continuous ECG monitoring should be the heart of bedside AI-based predictive analytics monitoring for early detection of clinical deterioration. J Electrocardiol 2023; 76:35-38. [PMID: 36434848 PMCID: PMC10061545 DOI: 10.1016/j.jelectrocard.2022.10.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 10/01/2022] [Accepted: 10/22/2022] [Indexed: 11/24/2022]
Abstract
The idea that we can detect subacute potentially catastrophic illness earlier by using statistical models trained on clinical data is now well-established. We review evidence that supports the role of continuous cardiorespiratory monitoring in these predictive analytics monitoring tools. In particular, we review how continuous ECG monitoring reflects the patient and not the clinician, is less likely to be biased, is unaffected by changes in practice patterns, captures signatures of illnesses that are interpretable by clinicians, and is an underappreciated and underutilized source of detailed information for new mathematical methods to reveal.
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Affiliation(s)
- Oliver J Monfredi
- Center for Advanced Medical Analytics, University of Virginia, United States of America; Department of Medicine, University of Virginia, United States of America
| | - Christopher C Moore
- Center for Advanced Medical Analytics, University of Virginia, United States of America; Department of Medicine, University of Virginia, United States of America
| | - Brynne A Sullivan
- Center for Advanced Medical Analytics, University of Virginia, United States of America; Department of Pediatrics, University of Virginia, United States of America
| | - Jessica Keim-Malpass
- Center for Advanced Medical Analytics, University of Virginia, United States of America; School of Nursing, University of Virginia, United States of America
| | - Karen D Fairchild
- Center for Advanced Medical Analytics, University of Virginia, United States of America; Department of Pediatrics, University of Virginia, United States of America
| | - Tyler J Loftus
- Department of Surgery, University of Florida, United States of America
| | - Azra Bihorac
- Department of Medicine, University of Florida, United States of America
| | - Katherine N Krahn
- Center for Advanced Medical Analytics, University of Virginia, United States of America; Department of Medicine, University of Virginia, United States of America
| | - Artur Dubrawski
- Robotics Institute, Carnegie Mellon University, United States of America
| | - Douglas E Lake
- Center for Advanced Medical Analytics, University of Virginia, United States of America; Department of Medicine, University of Virginia, United States of America
| | - J Randall Moorman
- Center for Advanced Medical Analytics, University of Virginia, United States of America; Department of Medicine, University of Virginia, United States of America.
| | - Gilles Clermont
- Department of Critical Care, University of Pittsburgh, United States of America
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Zheng Z, Soomro QH, Charytan DM. Deep Learning Using Electrocardiograms in Patients on Maintenance Dialysis. ADVANCES IN KIDNEY DISEASE AND HEALTH 2023; 30:61-68. [PMID: 36723284 DOI: 10.1053/j.akdh.2022.11.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Cardiovascular morbidity and mortality occur with an extraordinarily high incidence in the hemodialysis-dependent end-stage kidney disease population. There is a clear need to improve identification of those individuals at the highest risk of cardiovascular complications in order to better target them for preventative therapies. Twelve-lead electrocardiograms are ubiquitous and use inexpensive technology that can be administered with minimal inconvenience to patients and at a minimal burden to care providers. The embedded waveforms encode significant information on the cardiovascular structure and function that might be unlocked and used to identify at-risk individuals with the use of artificial intelligence techniques like deep learning. In this review, we discuss the experience with deep learning-based analysis of electrocardiograms to identify cardiovascular abnormalities or risk and the potential to extend this to the setting of dialysis-dependent end-stage kidney disease.
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Affiliation(s)
- Zhong Zheng
- Nephology Division, Department of Medicine, New York University Grossman School of Medicine, New York, NY
| | - Qandeel H Soomro
- Nephology Division, Department of Medicine, New York University Grossman School of Medicine, New York, NY
| | - David M Charytan
- Nephology Division, Department of Medicine, New York University Grossman School of Medicine, New York, NY.
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Chiu IM, Cheng CY, Chang PK, Li CJ, Cheng FJ, Lin CHR. Utilization of Personalized Machine-Learning to Screen for Dysglycemia from Ambulatory ECG, toward Noninvasive Blood Glucose Monitoring. BIOSENSORS 2022; 13:23. [PMID: 36671857 PMCID: PMC9855414 DOI: 10.3390/bios13010023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Revised: 12/16/2022] [Accepted: 12/21/2022] [Indexed: 06/17/2023]
Abstract
Blood glucose (BG) monitoring is important for critically ill patients, as poor sugar control has been associated with increased mortality in hospitalized patients. However, constant BG monitoring can be resource-intensive and pose a healthcare burden in clinical practice. In this study, we aimed to develop a personalized machine-learning model to predict dysglycemia from electrocardiogram (ECG) data. We used the Medical Information Mart for Intensive Care III database as our source of data and obtained more than 20 ECG records from each included patient during a single hospital admission. We focused on lead II recordings, along with corresponding blood sugar data. We processed the data and used ECG features from each heartbeat as inputs to develop a one-class support vector machine algorithm to predict dysglycemia. The model was able to predict dysglycemia using a single heartbeat with an AUC of 0.92 ± 0.09, a sensitivity of 0.92 ± 0.10, and specificity of 0.84 ± 0.04. After applying 10 s majority voting, the AUC of the model's dysglycemia prediction increased to 0.97 ± 0.06. This study showed that a personalized machine-learning algorithm can accurately detect dysglycemia from a single-lead ECG.
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Affiliation(s)
- I-Min Chiu
- Department of Computer Science and Engineering, National Sun Yat-Sen University, Kaohsiung 804, Taiwan
- Department of Emergency Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 833, Taiwan
| | - Chi-Yung Cheng
- Department of Computer Science and Engineering, National Sun Yat-Sen University, Kaohsiung 804, Taiwan
- Department of Emergency Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 833, Taiwan
| | - Po-Kai Chang
- Department of Computer Science and Engineering, National Sun Yat-Sen University, Kaohsiung 804, Taiwan
| | - Chao-Jui Li
- Department of Emergency Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 833, Taiwan
| | - Fu-Jen Cheng
- Department of Emergency Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 833, Taiwan
| | - Chun-Hung Richard Lin
- Department of Computer Science and Engineering, National Sun Yat-Sen University, Kaohsiung 804, Taiwan
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41
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Boonstra MJ, Oostendorp TF, Roudijk RW, Kloosterman M, Asselbergs FW, Loh P, Van Dam PM. Incorporating structural abnormalities in equivalent dipole layer based ECG simulations. Front Physiol 2022; 13:1089343. [PMID: 36620207 PMCID: PMC9814485 DOI: 10.3389/fphys.2022.1089343] [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: 11/04/2022] [Accepted: 12/12/2022] [Indexed: 12/24/2022] Open
Abstract
Introduction: Electrical activity of the myocardium is recorded with the 12-lead ECG. ECG simulations can improve our understanding of the relation between abnormal ventricular activation in diseased myocardium and body surface potentials (BSP). However, in equivalent dipole layer (EDL)-based ECG simulations, the presence of diseased myocardium breaks the equivalence of the dipole layer. To simulate diseased myocardium, patches with altered electrophysiological characteristics were incorporated within the model. The relation between diseased myocardium and corresponding BSP was investigated in a simulation study. Methods: Activation sequences in normal and diseased myocardium were simulated and corresponding 64-lead BSP were computed in four models with distinct patch locations. QRS-complexes were compared using correlation coefficient (CC). The effect of different types of patch activation was assessed. Of one patient, simulated electrograms were compared to electrograms recorded during invasive electro-anatomical mapping. Results: Hundred-fifty-three abnormal activation sequences were simulated. Median QRS-CC of delayed versus dyssynchronous were significantly different (1.00 vs. 0.97, p < 0.001). Depending on the location of the patch, BSP leads were affected differently. Within diseased regions, fragmentation, low bipolar voltages and late potentials were observed in both recorded and simulated electrograms. Discussion: A novel method to simulate cardiomyopathy in EDL-based ECG simulations was established and evaluated. The new patch-based approach created a realistic relation between ECG waveforms and underlying activation sequences. Findings in the simulated cases were in agreement with clinical observations. With this method, our understanding of disease progression in cardiomyopathies may be further improved and used in advanced inverse ECG procedures.
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Affiliation(s)
- Machteld J Boonstra
- Department of Cardiology, Division Heart and Lungs, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands,*Correspondence: Machteld J Boonstra,
| | - Thom F Oostendorp
- Radboud University Nijmegen Medical Centre, Donders Institute for Brain, Cognition and Behavior, Nijmegen, Netherlands
| | - Rob W Roudijk
- Department of Cardiology, Division Heart and Lungs, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | - Manon Kloosterman
- Department of Cardiology, Division Heart and Lungs, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | - Folkert W Asselbergs
- Department of Cardiology, Division Heart and Lungs, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands,Faculty of Population Health Sciences, Institute of Cardiovascular Science, University College London, London, United Kingdom,Health Data Research UK and Institute of Health Informatics, University College London, London, United Kingdom
| | - Peter Loh
- Department of Cardiology, Division Heart and Lungs, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | - Peter M Van Dam
- Department of Cardiology, Division Heart and Lungs, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands,ECG Excellence BV, Nieuwerbrug aan den Rijn, Weijland, Netherlands
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Barrios JP, Tison GH. Advancing cardiovascular medicine with machine learning: Progress, potential, and perspective. Cell Rep Med 2022; 3:100869. [PMID: 36543095 PMCID: PMC9798021 DOI: 10.1016/j.xcrm.2022.100869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 10/26/2022] [Accepted: 11/21/2022] [Indexed: 12/24/2022]
Abstract
Recent advances in machine learning (ML) have made it possible to analyze high-dimensional and complex data-such as free text, images, waveforms, videos, and sound-in an automated manner by successfully learning complex associations within these data. Cardiovascular medicine is particularly well poised to take advantage of these ML advances, due to the widespread digitization of medical data and the large number of diagnostic tests used to evaluate cardiovascular disease. Various ML approaches have successfully been applied to cardiovascular tests and diseases to automate interpretation, accurately perform measurements, and, in some cases, predict novel diagnoses from less invasive tests, effectively expanding the utility of more widely accessible diagnostic tests. Here, we present examples of some impactful advances in cardiovascular medicine using ML across a variety of modalities, with a focus on deep learning applications.
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Affiliation(s)
- Joshua P. Barrios
- Department of Medicine, Division of Cardiology, University of California, San Francisco, 555 Mission Bay Blvd South Box 3120, San Francisco, CA 94158, USA
| | - Geoffrey H. Tison
- Department of Medicine, Division of Cardiology, University of California, San Francisco, 555 Mission Bay Blvd South Box 3120, San Francisco, CA 94158, USA,Bakar Computational Health Sciences Institute, University of California, San Francisco, 555 Mission Bay Blvd South Box 3120, San Francisco, CA 94158, USA,Corresponding author
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Wu H, Patel KHK, Li X, Zhang B, Galazis C, Bajaj N, Sau A, Shi X, Sun L, Tao Y, Al-Qaysi H, Tarusan L, Yasmin N, Grewal N, Kapoor G, Waks JW, Kramer DB, Peters NS, Ng FS. A fully-automated paper ECG digitisation algorithm using deep learning. Sci Rep 2022; 12:20963. [PMID: 36471089 PMCID: PMC9722713 DOI: 10.1038/s41598-022-25284-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 11/28/2022] [Indexed: 12/12/2022] Open
Abstract
There is increasing focus on applying deep learning methods to electrocardiograms (ECGs), with recent studies showing that neural networks (NNs) can predict future heart failure or atrial fibrillation from the ECG alone. However, large numbers of ECGs are needed to train NNs, and many ECGs are currently only in paper format, which are not suitable for NN training. We developed a fully-automated online ECG digitisation tool to convert scanned paper ECGs into digital signals. Using automated horizontal and vertical anchor point detection, the algorithm automatically segments the ECG image into separate images for the 12 leads and a dynamical morphological algorithm is then applied to extract the signal of interest. We then validated the performance of the algorithm on 515 digital ECGs, of which 45 were printed, scanned and redigitised. The automated digitisation tool achieved 99.0% correlation between the digitised signals and the ground truth ECG (n = 515 standard 3-by-4 ECGs) after excluding ECGs with overlap of lead signals. Without exclusion, the performance of average correlation was from 90 to 97% across the leads on all 3-by-4 ECGs. There was a 97% correlation for 12-by-1 and 3-by-1 ECG formats after excluding ECGs with overlap of lead signals. Without exclusion, the average correlation of some leads in 12-by-1 ECGs was 60-70% and the average correlation of 3-by-1 ECGs achieved 80-90%. ECGs that were printed, scanned, and redigitised, our tool achieved 96% correlation with the original signals. We have developed and validated a fully-automated, user-friendly, online ECG digitisation tool. Unlike other available tools, this does not require any manual segmentation of ECG signals. Our tool can facilitate the rapid and automated digitisation of large repositories of paper ECGs to allow them to be used for deep learning projects.
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Affiliation(s)
- Huiyi Wu
- Imperial College London, National Heart & Lung Institute, London, W12 0NN, UK
| | | | - Xinyang Li
- Imperial College London, National Heart & Lung Institute, London, W12 0NN, UK
| | - Bowen Zhang
- National University of Singapore, Singapore, Singapore
| | | | - Nikesh Bajaj
- Imperial College London, National Heart & Lung Institute, London, W12 0NN, UK
| | - Arunashis Sau
- Imperial College London, National Heart & Lung Institute, London, W12 0NN, UK
- Department of Cardiology, Imperial College Healthcare NHS Trust, London, UK
| | - Xili Shi
- Imperial College London, National Heart & Lung Institute, London, W12 0NN, UK
| | - Lin Sun
- Imperial College London, National Heart & Lung Institute, London, W12 0NN, UK
| | | | - Harith Al-Qaysi
- Department of Cardiology, Imperial College Healthcare NHS Trust, London, UK
| | - Lawrence Tarusan
- Department of Cardiology, Imperial College Healthcare NHS Trust, London, UK
| | - Najira Yasmin
- Department of Cardiology, Imperial College Healthcare NHS Trust, London, UK
| | - Natasha Grewal
- Department of Cardiology, Imperial College Healthcare NHS Trust, London, UK
| | - Gaurika Kapoor
- Department of Cardiology, Imperial College Healthcare NHS Trust, London, UK
| | - Jonathan W Waks
- Harvard-Thorndike Electrophysiology Institute, Beth Israel Deaconess Medical Centre, Harvard Medical School, Boston, MA, USA
| | - Daniel B Kramer
- Imperial College London, National Heart & Lung Institute, London, W12 0NN, UK
- Harvard-Thorndike Electrophysiology Institute, Beth Israel Deaconess Medical Centre, Harvard Medical School, Boston, MA, USA
| | - Nicholas S Peters
- Imperial College London, National Heart & Lung Institute, London, W12 0NN, UK
| | - Fu Siong Ng
- Imperial College London, National Heart & Lung Institute, London, W12 0NN, UK.
- Department of Cardiology, Imperial College Healthcare NHS Trust, London, UK.
- Cardiac Electrophysiology, National Heart and Lung Institute, Imperial College London, 4th floor, Imperial Centre for Translational and Experimental Medicine, Hammersmith Campus, Du Cane Road, London, W12 0NN, UK.
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Chiu IM, Cheng JY, Chen TY, Wang YM, Cheng CY, Kung CT, Cheng FJ, Yau FFF, Lin CHR. Using Deep Transfer Learning to Detect Hyperkalemia From Ambulatory Electrocardiogram Monitors in Intensive Care Units: Personalized Medicine Approach. J Med Internet Res 2022; 24:e41163. [PMID: 36469396 DOI: 10.2196/41163] [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: 07/17/2022] [Revised: 11/07/2022] [Accepted: 11/17/2022] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Hyperkalemia is a critical condition, especially in intensive care units. So far, there have been no accurate and noninvasive methods for recognizing hyperkalemia events on ambulatory electrocardiogram monitors. OBJECTIVE This study aimed to improve the accuracy of hyperkalemia predictions from ambulatory electrocardiogram (ECG) monitors using a personalized transfer learning method; this would be done by training a generic model and refining it with personal data. METHODS This retrospective cohort study used open source data from the Waveform Database Matched Subset of the Medical Information Mart From Intensive Care III (MIMIC-III). We included patients with multiple serum potassium test results and matched ECG data from the MIMIC-III database. A 1D convolutional neural network-based deep learning model was first developed to predict hyperkalemia in a generic population. Once the model achieved a state-of-the-art performance, it was used in an active transfer learning process to perform patient-adaptive heartbeat classification tasks. RESULTS The results show that by acquiring data from each new patient, the personalized model can improve the accuracy of hyperkalemia detection significantly, from an average of 0.604 (SD 0.211) to 0.980 (SD 0.078), when compared with the generic model. Moreover, the area under the receiver operating characteristic curve level improved from 0.729 (SD 0.240) to 0.945 (SD 0.094). CONCLUSIONS By using the deep transfer learning method, we were able to build a clinical standard model for hyperkalemia detection using ambulatory ECG monitors. These findings could potentially be extended to applications that continuously monitor one's ECGs for early alerts of hyperkalemia and help avoid unnecessary blood tests.
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Affiliation(s)
- I-Min Chiu
- Department of Computer Science and Engineering, National Sun Yat-sen University, Kaohsiung City, Taiwan.,Department of Emergency Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung City, Taiwan
| | - Jhu-Yin Cheng
- Department of Emergency Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung City, Taiwan
| | - Tien-Yu Chen
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung City, Taiwan
| | - Yi-Min Wang
- Department of Emergency Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung City, Taiwan
| | - Chi-Yung Cheng
- Department of Computer Science and Engineering, National Sun Yat-sen University, Kaohsiung City, Taiwan.,Department of Emergency Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung City, Taiwan
| | - Chia-Te Kung
- Department of Emergency Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung City, Taiwan
| | - Fu-Jen Cheng
- Department of Emergency Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung City, Taiwan
| | - Fei-Fei Flora Yau
- Department of Emergency Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung City, Taiwan
| | - Chun-Hung Richard Lin
- Department of Computer Science and Engineering, National Sun Yat-sen University, Kaohsiung City, Taiwan
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Attia ZI, Harmon DM, Dugan J, Manka L, Lopez-Jimenez F, Lerman A, Siontis KC, Noseworthy PA, Yao X, Klavetter EW, Halamka JD, Asirvatham SJ, Khan R, Carter RE, Leibovich BC, Friedman PA. Prospective evaluation of smartwatch-enabled detection of left ventricular dysfunction. Nat Med 2022; 28:2497-2503. [PMID: 36376461 PMCID: PMC9805528 DOI: 10.1038/s41591-022-02053-1] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 09/23/2022] [Indexed: 11/16/2022]
Abstract
Although artificial intelligence (AI) algorithms have been shown to be capable of identifying cardiac dysfunction, defined as ejection fraction (EF) ≤ 40%, from 12-lead electrocardiograms (ECGs), identification of cardiac dysfunction using the single-lead ECG of a smartwatch has yet to be tested. In the present study, a prospective study in which patients of Mayo Clinic were invited by email to download a Mayo Clinic iPhone application that sends watch ECGs to a secure data platform, we examined patient engagement with the study app and the diagnostic utility of the ECGs. We digitally enrolled 2,454 unique patients (mean age 53 ± 15 years, 56% female) from 46 US states and 11 countries, who sent 125,610 ECGs to the data platform between August 2021 and February 2022; 421 participants had at least one watch-classified sinus rhythm ECG within 30 d of an echocardiogram, of whom 16 (3.8%) had an EF ≤ 40%. The AI algorithm detected patients with low EF with an area under the curve of 0.885 (95% confidence interval 0.823-0.946) and 0.881 (0.815-0.947), using the mean prediction within a 30-d window or the closest ECG relative to the echocardiogram that determined the EF, respectively. These findings indicate that consumer watch ECGs, acquired in nonclinical environments, can be used to identify patients with cardiac dysfunction, a potentially life-threatening and often asymptomatic condition.
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Affiliation(s)
- Zachi I. Attia
- Department of Cardiovascular Medicine, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - David M. Harmon
- Department of Cardiovascular Medicine, Mayo Clinic College of Medicine, Rochester, MN, USA.,Department of Internal Medicine, Mayo Clinic School of Graduate Medical Education, Rochester, MN, USA
| | - Jennifer Dugan
- Department of Cardiovascular Medicine, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - Lukas Manka
- Center for Digital Health, Mayo Clinic, Rochester, MN, USA
| | | | - Amir Lerman
- Department of Cardiovascular Medicine, Mayo Clinic College of Medicine, Rochester, MN, USA
| | | | - Peter A. Noseworthy
- Department of Cardiovascular Medicine, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - Xiaoxi Yao
- Department of Cardiovascular Medicine, Mayo Clinic College of Medicine, Rochester, MN, USA.,Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA
| | - Eric W. Klavetter
- Department of Cardiovascular Medicine, Mayo Clinic College of Medicine, Rochester, MN, USA
| | | | - Samuel J. Asirvatham
- Department of Cardiovascular Medicine, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - Rita Khan
- Center for Digital Health, Mayo Clinic, Rochester, MN, USA
| | - Rickey E. Carter
- Department of Quantitative Health Sciences, Jacksonville, FL, USA
| | - Bradley C. Leibovich
- Center for Digital Health, Mayo Clinic, Rochester, MN, USA.,Department of Urology, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - Paul A. Friedman
- Department of Cardiovascular Medicine, Mayo Clinic College of Medicine, Rochester, MN, USA.,Correspondence and requests for materials should be addressed to Paul A. Friedman.,
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Yoo J, Yoo I, Youn I, Kim SM, Yu R, Kim K, Kim K, Lee SB. Residual one-dimensional convolutional neural network for neuromuscular disorder classification from needle electromyography signals with explainability. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2022; 226:107079. [PMID: 36191354 DOI: 10.1016/j.cmpb.2022.107079] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 07/25/2022] [Accepted: 08/20/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND AND OBJECTIVE Neuromuscular disorders are diseases that damage our ability to control body movements. Needle electromyography (nEMG) is often used to diagnose neuromuscular disorders, which is an electrophysiological test measuring electric signals generated from a muscle using an invasive needle. Characteristics of nEMG signals are manually analyzed by an electromyographer to diagnose the types of neuromuscular disorders, and this process is highly dependent on the subjective experience of the electromyographer. Contemporary computer-aided methods utilized deep learning image classification models to classify nEMG signals which are not optimized for classifying signals. Additionally, model explainability was not addressed which is crucial in medical applications. This study aims to improve prediction accuracy, inference time, and explain model predictions in nEMG neuromuscular disorder classification. METHODS This study introduces the nEMGNet, a one-dimensional convolutional neural network with residual connections designed to extract features from raw signals with higher accuracy and faster speed compared to image classification models from previous works. Next, the divide-and-vote (DiVote) algorithm was designed to integrate each subject's heterogeneous nEMG signal data structures and to utilize muscle subtype information for higher accuracy. Finally, feature visualization was used to identify the causality of nEMGNet diagnosis predictions, to ensure that nEMGNet made predictions on valid features, not artifacts. RESULTS The proposed method was tested using 376 nEMG signals measured from 57 subjects between June 2015 to July 2020 in Seoul National University Hospital. The results from the three-class classification task demonstrated that nEMGNet's prediction accuracy of nEMG signal segments was 62.35%, and the subject diagnosis prediction accuracy of nEMGNet and the DiVote algorithm was 83.69 %, over 5-fold cross-validation. nEMGNet outperformed all models from previous works on nEMG diagnosis classification, and heuristic analysis of feature visualization results indicate that nEMGNet learned relevant nEMG signal characteristics. CONCLUSIONS This study introduced nEMGNet and DiVote algorithm which demonstrated fast and accurate performance in predicting neuromuscular disorders based on nEMG signals. The proposed method may be applied in medicine to support real-time electrophysiologic diagnosis.
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Affiliation(s)
- Jaesung Yoo
- School of Electrical Engineering, Korea University, Seoul, Republic of Korea
| | - Ilhan Yoo
- Department of Neurology, Nowon Eulji Medical Center, Eulji University School of Medicine, Seoul, Republic of Korea
| | - Ina Youn
- Department of Computer Science, New York University, NY, USA
| | - Sung-Min Kim
- Department of Neurology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Ri Yu
- Department of Software and Computer Engineering, Department of Artificial Intelligence, Ajou University
| | - Kwangsoo Kim
- Transdisciplinary Department of Medicine and Advanced Technology, Seoul National University Hospital, Seoul, Republic of Korea
| | - Keewon Kim
- Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul, Republic of Korea.
| | - Seung-Bo Lee
- Department of Medical Informatics: Keimyung University School of Medicine, Daegu, Republic of Korea.
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Attia ZI, Dugan J, Rideout A, Maidens JN, Venkatraman S, Guo L, Noseworthy PA, Pellikka PA, Pham SL, Kapa S, Friedman PA, Lopez-Jimenez F. Automated detection of low ejection fraction from a one-lead electrocardiogram: application of an AI algorithm to an electrocardiogram-enabled Digital Stethoscope . EUROPEAN HEART JOURNAL. DIGITAL HEALTH 2022; 3:373-379. [PMID: 36712160 PMCID: PMC9708035 DOI: 10.1093/ehjdh/ztac030] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 04/21/2022] [Indexed: 06/18/2023]
Abstract
AIMS Electrocardiogram (ECG)-enabled stethoscope (ECG-Scope) acquires a single-lead ECGs during cardiac auscultation and may facilitate real-time screening for pathologies not routinely identified by cardiac auscultation alone. We previously demonstrated an artificial intelligence (AI) algorithm can identify left ventricular dysfunction (LVSD) [defined as ejection fraction (EF) ≤ 40%] with an area under the curve (AUC) of 0.91 using a 12-lead ECG. METHODS AND RESULTS One hundred patients referred for clinically indicated echocardiography were prospectively recruited. ECG-Scope recordings with the patient supine and sitting were obtained in multiple electrode locations at the time of the echocardiogram. The AI algorithm for the detection of LVSD was retrained using single leads from ECG-12 and validated against ECG-Scope to determine accuracy for low EF detection (≤35%, <40%, or <50%). We evaluated the algorithm with respect to body position and lead location. Amongst 100 patients (aged 61.3 ± 13.8; 61% male, BMI: 30.0 ± 5.4), eight had EF≤40%, and six had EF 40-50%. The best single recording position was V2 with the patient supine [AUC: 0.88 (CI: 0.80-0.97) for EF≤35%, 0.85 (CI: 0.75-0.95) for EF≤40%, and 0.81 (CI: 0.71-0.90) for EF < 50%]. When using an AI model to select the recording automatically, AUC was 0.91 (CI: 0.84-0.97) for EF≤35%, 0.89 (CI: 0.83-0.96) for EF≤40%, and 0.84 (CI: 0.73-0.94) for EF < 50%. CONCLUSION An AI algorithm applied to an ECG-enabled stethoscope recording in standard auscultation positions reliably detected the presence of a low EF in this prospective study of patients referred for echocardiography. The ability to screen patients with a possible low EF during routine physical examination may facilitate rapid detection of LVSD.
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Affiliation(s)
- Zachi I Attia
- Department of Cardiovascular Medicine, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - Jennifer Dugan
- Department of Cardiovascular Medicine, Mayo Clinic College of Medicine, Rochester, MN, USA
| | | | | | | | - Ling Guo
- Eko Devices, Inc., Berkeley, CA, USA
| | - Peter A Noseworthy
- Department of Cardiovascular Medicine, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - Patricia A Pellikka
- Department of Cardiovascular Medicine, Mayo Clinic College of Medicine, Rochester, MN, USA
| | | | - Suraj Kapa
- Department of Cardiovascular Medicine, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - Paul A Friedman
- Department of Cardiovascular Medicine, Mayo Clinic College of Medicine, Rochester, MN, USA
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Mulia EPB, Luke K, Yofrido FM, Julario R. Initial and terminal T wave angle as hyperkalemia indicator in chronic kidney disease. Postgrad Med 2022; 134:795-800. [PMID: 35916239 DOI: 10.1080/00325481.2022.2109336] [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: 10/16/2022]
Abstract
BACKGROUND Hyperkalemia is one prevalent complication in chronic kidney disease and is considered fatal since it potentially causes malignant arrhythmias and mortality. It is associated with electrocardiography (ECG) changes, such as peaked T wave in all ECG leads. However, the universal definition of the peaked T wave is still unclear, with low sensitivity and specificity. AIM : This study aims to determine the predictive value of initial and terminal T wave angle in detecting hyperkalemia among CKD patients. METHODS : A cross-sectional study was conducted at Dr. Soetomo General Hospital, including all adult hospitalized CKD patients. A caliper was used to measure T wave morphology. The initial deflection angle (Tia) and terminal deflection angle (Tta) were calculated from an arctan of T peak amplitude and the respective initial or terminal length. The receiver operating characteristics (ROC) curve was analyzed to determine the area under the curve (AUC) and optimal cut-off. RESULTS : A total of 220 CKD patients were enrolled in this study, with 98 patients with hyperkalemia (potassium >5.0). The majority of the patients were male, with a mean age of 51.12±12.58 years. Ti-Tp duration, Tp-Tt duration, Tia, Tta, and Tp amplitude were significantly higher in the hyperkalemia group (all p<0.05). A Spearman correlation analysis demonstrated a significant positive correlation of Tia (r=0.346 and p<0.001) and Tta (r=0.445 and p<0.001) with potassium levels in the participants. The optimal cut-off angle for Tta was 66.20o (sensitivity=67.3% and specificity=73.8%) and Tia was 61.07o (sensitivity=66.3% and specificity=69.7%). CONCLUSION : The terminal T wave angle outperformed the initial angle in predicting hyperkalemia in CKD patients.
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Affiliation(s)
- Eka Prasetya Budi Mulia
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Airlangga - Dr. Soetomo General Hospital, Surabaya, Indonesia
| | - Kevin Luke
- Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia
| | - Filipus Michael Yofrido
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Sam Ratulangi University - Prof. Dr. R. D. Kandou Central Hospital, Manado, Indonesia
| | - Rerdin Julario
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Airlangga - Dr. Soetomo General Hospital, Surabaya, Indonesia
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García-Escobar A, Vera-Vera S, Jurado-Román A, Jiménez-Valero S, Galeote G, Moreno R. Subtle QRS changes are associated with reduced ejection fraction, diastolic dysfunction, and heart failure development and therapy responsiveness: Applications for artificial intelligence to ECG. Ann Noninvasive Electrocardiol 2022; 27:e12998. [PMID: 35904538 DOI: 10.1111/anec.12998] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 06/28/2022] [Accepted: 07/03/2022] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Since the last century, the electrocardiogram (ECG) remains the non-invasive test, that is, most easily accessible, feasible, and inexpensive for cardiology assessment. In past years, many novel ECG indexes and patterns have been published that allow for a more advanced evaluation of what is currently being done, especially based on subtle QRS changes and patterns. OBJECTIVE The objective of the study was to provide an update on the evidence and clinical applications of these ECG subtle QRS changes and patterns associated with heart disease. METHODS Through the literature review, we will highlight the subtle QRS changes and patterns associated with heart disease, mainly focusing on QRS duration, voltage, morphology, axis, and QT interval. RESULTS Small increases in QRS duration are associated with a reduction in left ventricular ejection fraction (EF), increased cardiac chamber dimensions, and risk for incident heart failure (HF). Moreover, fragmentation of the QRS complex is associated with myocardial fibrosis and is a substrate for developing arrhythmic events. Besides, low amplitude QRS voltage is associated with congestive HF, and an increase in the voltage of the QRS complexes is associated with the effectiveness of diuresis treatment. Furthermore, small increases in QT interval are associated with diastolic dysfunction due to impaired sarcoplasmic reticulum calcium handling as occurs in myocardial ischemia, hypertension, or diabetes. On the other hand, in patients with left ventricular dysfunction, the QRS area is associated with clinical and echocardiographic response to cardiac resynchronization therapy regardless of the type of bundle branch block. In addition, subtle ECG changes and patterns in the left bundle branch block are associated with concomitant right ventricular dilation, mostly based on the QRS axis and voltage. Notwithstanding, to identify these subtle changes in QRS require exact manual measurements that can take time. In this regard, applying artificial intelligence (AI) to the ECG can make a quicker and more complete assessment, as well as provide a low cost when applied to large populations. CONCLUSION We provided an update on the evidence and clinical applications of these subtle QRS changes and patterns associated with diastolic dysfunction, reduced EF, and HF development and therapy responsiveness, as well as their applications for AI to ECG.
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Affiliation(s)
- Artemio García-Escobar
- Cardiology Department, Interventional Cardiology Section, La Paz University Hospital, Madrid, Spain.,Institute for Health Research La Paz University Hospital (IdiPAZ), Madrid, Spain.,Biomedical Research Network Center on Cardiovascular Disease, Institute of Health Carlos III, Madrid, Spain
| | - Silvio Vera-Vera
- Cardiology Department, Interventional Cardiology Section, La Paz University Hospital, Madrid, Spain.,Institute for Health Research La Paz University Hospital (IdiPAZ), Madrid, Spain.,Biomedical Research Network Center on Cardiovascular Disease, Institute of Health Carlos III, Madrid, Spain
| | - Alfonso Jurado-Román
- Cardiology Department, Interventional Cardiology Section, La Paz University Hospital, Madrid, Spain.,Institute for Health Research La Paz University Hospital (IdiPAZ), Madrid, Spain.,Biomedical Research Network Center on Cardiovascular Disease, Institute of Health Carlos III, Madrid, Spain
| | - Santiago Jiménez-Valero
- Cardiology Department, Interventional Cardiology Section, La Paz University Hospital, Madrid, Spain.,Institute for Health Research La Paz University Hospital (IdiPAZ), Madrid, Spain.,Biomedical Research Network Center on Cardiovascular Disease, Institute of Health Carlos III, Madrid, Spain
| | - Guillermo Galeote
- Cardiology Department, Interventional Cardiology Section, La Paz University Hospital, Madrid, Spain.,Institute for Health Research La Paz University Hospital (IdiPAZ), Madrid, Spain.,Biomedical Research Network Center on Cardiovascular Disease, Institute of Health Carlos III, Madrid, Spain
| | - Raúl Moreno
- Cardiology Department, Interventional Cardiology Section, La Paz University Hospital, Madrid, Spain.,Institute for Health Research La Paz University Hospital (IdiPAZ), Madrid, Spain.,Biomedical Research Network Center on Cardiovascular Disease, Institute of Health Carlos III, Madrid, Spain
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50
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Zhou W, Chan YE, Foo CS, Zhang J, Teo JX, Davila S, Huang W, Yap J, Cook S, Tan P, Chin CWL, Yeo KK, Lim WK, Krishnaswamy P. High-Resolution Digital Phenotypes From Consumer Wearables and Their Applications in Machine Learning of Cardiometabolic Risk Markers: Cohort Study. J Med Internet Res 2022; 24:e34669. [PMID: 35904853 PMCID: PMC9377462 DOI: 10.2196/34669] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 04/12/2022] [Accepted: 05/29/2022] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Consumer-grade wearable devices enable detailed recordings of heart rate and step counts in free-living conditions. Recent studies have shown that summary statistics from these wearable recordings have potential uses for longitudinal monitoring of health and disease states. However, the relationship between higher resolution physiological dynamics from wearables and known markers of health and disease remains largely uncharacterized. OBJECTIVE We aimed to derive high-resolution digital phenotypes from observational wearable recordings and to examine their associations with modifiable and inherent markers of cardiometabolic disease risk. METHODS We introduced a principled framework to extract interpretable high-resolution phenotypes from wearable data recorded in free-living conditions. The proposed framework standardizes the handling of data irregularities; encodes contextual information regarding the underlying physiological state at any given time; and generates a set of 66 minimally redundant features across active, sedentary, and sleep states. We applied our approach to a multimodal data set, from the SingHEART study (NCT02791152), which comprises heart rate and step count time series from wearables, clinical screening profiles, and whole genome sequences from 692 healthy volunteers. We used machine learning to model nonlinear relationships between the high-resolution phenotypes on the one hand and clinical or genomic risk markers for blood pressure, lipid, weight and sugar abnormalities on the other. For each risk type, we performed model comparisons based on Brier scores to assess the predictive value of high-resolution features over and beyond typical baselines. We also qualitatively characterized the wearable phenotypes for participants who had actualized clinical events. RESULTS We found that the high-resolution features have higher predictive value than typical baselines for clinical markers of cardiometabolic disease risk: the best models based on high-resolution features had 17.9% and 7.36% improvement in Brier score over baselines based on age and gender and resting heart rate, respectively (P<.001 in each case). Furthermore, heart rate dynamics from different activity states contain distinct information (maximum absolute correlation coefficient of 0.15). Heart rate dynamics in sedentary states are most predictive of lipid abnormalities and obesity, whereas patterns in active states are most predictive of blood pressure abnormalities (P<.001). Moreover, in comparison with standard measures, higher resolution patterns in wearable heart rate recordings are better able to represent subtle physiological dynamics related to genomic risk for cardiometabolic disease (improvement of 11.9%-22.0% in Brier scores; P<.001). Finally, illustrative case studies reveal connections between these high-resolution phenotypes and actualized clinical events, even for borderline profiles lacking apparent cardiometabolic risk markers. CONCLUSIONS High-resolution digital phenotypes recorded by consumer wearables in free-living states have the potential to enhance the prediction of cardiometabolic disease risk and could enable more proactive and personalized health management.
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Affiliation(s)
- Weizhuang Zhou
- Institute for Infocomm Research, Agency for Science Technology and Research (A*STAR), Singapore, Singapore
| | - Yu En Chan
- Institute for Infocomm Research, Agency for Science Technology and Research (A*STAR), Singapore, Singapore
| | - Chuan Sheng Foo
- Institute for Infocomm Research, Agency for Science Technology and Research (A*STAR), Singapore, Singapore
| | - Jingxian Zhang
- Institute for Infocomm Research, Agency for Science Technology and Research (A*STAR), Singapore, Singapore
| | - Jing Xian Teo
- SingHealth Duke-NUS Institute of Precision Medicine, Singapore, Singapore
| | - Sonia Davila
- SingHealth Duke-NUS Institute of Precision Medicine, Singapore, Singapore.,SingHealth Duke-NUS Genomic Medicine Centre, Singapore, Singapore.,Cardiovascular and Metabolic Disorders Program, Duke-NUS Medical School, Singapore, Singapore
| | - Weiting Huang
- Department of Cardiology, National Heart Centre Singapore, Singapore, Singapore
| | - Jonathan Yap
- Department of Cardiology, National Heart Centre Singapore, Singapore, Singapore.,Duke-NUS Medical School, Singapore, Singapore
| | - Stuart Cook
- Cardiovascular and Metabolic Disorders Program, Duke-NUS Medical School, Singapore, Singapore
| | - Patrick Tan
- SingHealth Duke-NUS Institute of Precision Medicine, Singapore, Singapore.,Cancer and Stem Biology Program, Duke-NUS Medical School, Singapore, Singapore.,Cancer Science Institute of Singapore, National University of Singapore, Singapore, Singapore.,Genome Institute of Singapore, Agency for Science Technology and Research (A*STAR), Singapore, Singapore
| | - Calvin Woon-Loong Chin
- Department of Cardiology, National Heart Centre Singapore, Singapore, Singapore.,Duke-NUS Medical School, Singapore, Singapore
| | - Khung Keong Yeo
- SingHealth Duke-NUS Institute of Precision Medicine, Singapore, Singapore.,Department of Cardiology, National Heart Centre Singapore, Singapore, Singapore.,Duke-NUS Medical School, Singapore, Singapore
| | - Weng Khong Lim
- SingHealth Duke-NUS Institute of Precision Medicine, Singapore, Singapore.,SingHealth Duke-NUS Genomic Medicine Centre, Singapore, Singapore.,Cancer and Stem Biology Program, Duke-NUS Medical School, Singapore, Singapore
| | - Pavitra Krishnaswamy
- Institute for Infocomm Research, Agency for Science Technology and Research (A*STAR), Singapore, Singapore
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