Heart rate variability features from nonlinear cardiac dynamics in identification of diabetes using artificial neural network and support vector machine

Development of Enhanced Machine Learning Models for Predicting Type 2 Diabetes Mellitus Using Heart Rate Variability: A Retrospective Study

INTRODUCTION

With its rising prevalence and serious complications, type 2 diabetes mellitus (T2DM) is a major worldwide health burden that calls for early detection using non-invasive screening techniques. Existing screening techniques, including OGTT, HbA1c, and fasting plasma glucose, have drawbacks in terms of accessibility, expense, and invasiveness. Recent developments in heart rate variability (HRV) analysis and machine learning (ML) offer a possible non-invasive substitute for diabetes screening. Previous research on HRV-based ML models in the classification of diabetes has issues with generalizability. The objective of this study is to develop and validate ML models using HRV features: time-domain, frequency-domain, and nonlinear HRV, to improve the prediction of T2DM. The study also evaluates the developed ML model's effectiveness against existing ML models.

METHOD

A retrospective dataset comprising 519 individuals (261 T2DM patients and 258 non-diabetic controls) was collected from the Autonomic Function Testing (AFT) laboratory repositories. To ensure comparability of age, gender, height, and weight among groups, post-hoc matching was used. HRV features were extracted from five-minute ECG recordings using the PowerLab data acquisition system and LabChart HRV module (ADInstruments, Sydney, Australia), following the European Society of Cardiology Task Force guidelines. An 80:20 train-test split was used to train and assess ML models, such as Logistic Regression, K-Nearest Neighbors (KNNs), Random Forest, Gradient Boosting, XGBoost, LightGBM, CatBoost, and AdaBoost. Accuracy, precision, recall, F1-score, area under the curve (AUC) for the receiver operating characteristic (ROC), sensitivity, and specificity were among the performance indicators. GridSearchCV was used for hyperparameter adjustment to maximize model performance.

RESULTS

The baseline characteristics of the non-diabetic and T2DM groups were similar (p>0.05). HRV analysis showed substantial decreases in the diabetic group's time-domain (SDNN - SD of Normal-to-Normal Intervals/RMSSD - RMS of Successive Differences), frequency-domain (Low/High Frequency - LF/HF), and nonlinear (SD2 - SD of Poincaré Plot/CVRR - Coefficient of Variation of R-R Intervals) parameters (p<0.001). With a 91.2% accuracy rate and an AUC of 0.91, CatBoost outperformed other ML models in terms of prediction. LightGBM and Random Forest, which demonstrated high sensitivity and specificity, trailed closely behind. KNN achieved the highest accuracy (98.2%) and AUC (0.99), followed by Random Forest (96.4%) and CatBoost (94.5%), while hyperparameter modification further enhanced performance. CatBoost demonstrated the highest predictive performance, with an accuracy of 91.2% and an AUC of 0.91. According to correlation analysis, the most important HRV characteristics for diabetes prediction were SD2, SDRR (SD of R-R Intervals), and CVRR.

CONCLUSION

This study validates the utility of HRV-based ML models for non-invasive T2DM prediction, with ensemble models like CatBoost and LightGBM demonstrating superior performance when compared to the results of prior ML models. The optimized ML model, integrated with wearable medical technology for real-time monitoring, offers a scalable, affordable, and non-invasive alternative for diabetes screening. To improve generalizability and clinical use, future studies should investigate wearable-based HRV monitoring, multimodal AI models, and longitudinal validation.

An Artificial Intelligence-Based Non-Invasive Approach for Cardiovascular Disease Risk Stratification in Obstructive Sleep Apnea Patients: A Narrative Review

Background

Obstructive sleep apnea (OSA) is a severe condition associated with numerous cardiovascular complications, including heart failure. The complex biological and morphological relationship between OSA and atherosclerotic cardiovascular disease (ASCVD) poses challenges in predicting adverse cardiovascular outcomes. While artificial intelligence (AI) has shown potential for predicting cardiovascular disease (CVD) and stroke risks in other conditions, there is a lack of detailed, bias-free, and compressed AI models for ASCVD and stroke risk stratification in OSA patients. This study aimed to address this gap by proposing three hypotheses: (i) a strong relationship exists between OSA and ASCVD/stroke, (ii) deep learning (DL) can stratify ASCVD/stroke risk in OSA patients using surrogate carotid imaging, and (iii) including OSA risk as a covariate with cardiovascular risk factors can improve CVD risk stratification.

Methods

The study employed the Preferred Reporting Items for Systematic reviews and Meta-analyses (PRISMA) search strategy, yielding 191 studies that link OSA with coronary, carotid, and aortic atherosclerotic vascular diseases. This research investigated the link between OSA and CVD, explored DL solutions for OSA detection, and examined the role of DL in utilizing carotid surrogate biomarkers by saving costs. Lastly, we benchmark our strategy against previous studies.

Results

(i) This study found that CVD and OSA are indirectly or directly related. (ii) DL models demonstrated significant potential in improving OSA detection and proved effective in CVD risk stratification using carotid ultrasound as a biomarker. (iii) Additionally, DL was shown to be useful for CVD risk stratification in OSA patients; (iv) There are important AI attributes such as AI-bias, AI-explainability, AI-pruning, and AI-cloud, which play an important role in CVD risk for OSA patients.

Conclusions

DL provides a powerful tool for CVD risk stratification in OSA patients. These results can promote several recommendations for developing unique, bias-free, and explainable AI algorithms for predicting ASCVD and stroke risks in patients with OSA.

Advances in artificial intelligence-based technologies for increasing the quality of medical products

Artificial intelligence (AI) is a technology that combines machine learning (ML) and deep learning. It has numerous usages in the domains of medicine and other sciences. Artificial intelligence can forecast the behavior of a drug's target protein and predict its desired physicochemical qualities. AI's potential to enhance healthcare services offerings formerly unheard-of opportunities for cost reserves, enhanced overall clinical and patient outcomes. The recent development of research in the biomedical field, encompassing fields such as genomics, computational medicine, AI, and algorithms for learning, has led to the demand for novel technology, a fresh workforce, and new standards of practice set the stage for the revolution in healthcare. By connecting these health statistics with cutting-edge AI technologies, precise insights into patient treatment can be obtained. Moreover, AI can aid in the search for new drugs by foretelling the target protein's two-dimensional structure. In the current review, an overview of the latest AI-based technologies and how they may be employed to reduce product development time to market and snowballing product quality, cost-effectiveness, as well as security throughout the manufacturing process is detailed.

Time-domain heart rate dynamics in the prognosis of progressive atherosclerosis

BACKGROUND AND AIM

The regular uptake of a high-fat diet (HFD) with changing lifestyle causes atherosclerosis leading to cardiovascular diseases and autonomic dysfunction. Therefore, the current study aimed to investigate the correlation of autonomic activity to lipid and atherosclerosis markers. Further, the study proposes a support vector machine (SVM) based model in the prediction of atherosclerosis severity.

METHODS AND RESULTS

The Lead-II electrocardiogram and blood markers were measured from both the control and the experiment subjects each week for nine consecutive weeks. The time-domain heart rate variability (HRV) parameters were derived, and the significance level was tested using a one-way Analysis of Variance. The correlation analysis was performed to determine the relation between autonomic parameters and lipid and atherosclerosis markers. The statistically significant time-domain values were used as features of the SVM. The observed results demonstrated the reduced time domain HRV parameters with the increase in lipid and atherosclerosis index markers with the progressive atherosclerosis severity. The correlation analysis revealed a negative association between time-domain HRV parameters with lipid and atherosclerosis parameters. The percentage accuracy increases from 86.58% to 98.71% with the increase in atherosclerosis severity with regular consumption of HFD.

CONCLUSIONS

Atherosclerosis causes autonomic dysfunction with reduced HRV. The negative correlation between autonomic parameters and lipid profile and atherosclerosis indexes marker revealed the potential role of vagal activity in the prognosis of atherosclerosis progression. The support vector machine presented a respectable accuracy in the prediction of atherosclerosis severity from the control group.

A biosensing system employing nonlinear dynamic analysis-assisted neural network for drug-induced cardiotoxicity assessment

Preclinical investigation of drug-induced cardiotoxicity is of importance for drug development. To evaluate such cardiotoxicity, in vitro high-throughput interdigitated electrode-based recording of cardiomyocytes mechanical beating is widely used. To automatically analyze the features from the beating signals for drug-induced cardiotoxicity assessment, artificial neural network analysis is conventionally employed and signals are segmented into cycles and feature points are located in the cycles. However, signal segmentation and location of feature points for different signal shapes require design of specific algorithms. Consequently, this may lower the efficiency of research and the applications of such algorithms in signals with different morphologies are limited. Here, we present a biosensing system that employs nonlinear dynamic analysis-assisted neural network (NDANN) to avoid the signal segmentation process and directly extract features from beating signal time series. By processing beating time series with fixed time duration to avoid the signal segmentation process, this NDANN-based biosensing system can identify drug-induced cardiotoxicity with accuracy over 0.99. The individual drugs were classified with high accuracies over 0.94 and drug-induced cardiotoxicity levels were accurately predicted. We also evaluated the generalization performance of the NDANN-based biosensing system in assessing drug-induced cardiotoxicity through an independent dataset. This system achieved accuracy of 0.85-0.95 for different drug concentrations in identification of drug-induced cardiotoxicity. This result demonstrates that our NDANN-based biosensing system has the capacity of screening newly developed drugs, which is crucial in practical applications. This NDANN-based biosensing system can work as a new screening platform for drug-induced cardiotoxicity and improve the efficiency of bio-signal processing.

Cardiovascular/Stroke Risk Stratification in Diabetic Foot Infection Patients Using Deep Learning-Based Artificial Intelligence: An Investigative Study

A diabetic foot infection (DFI) is among the most serious, incurable, and costly to treat conditions. The presence of a DFI renders machine learning (ML) systems extremely nonlinear, posing difficulties in CVD/stroke risk stratification. In addition, there is a limited number of well-explained ML paradigms due to comorbidity, sample size limits, and weak scientific and clinical validation methodologies. Deep neural networks (DNN) are potent machines for learning that generalize nonlinear situations. The objective of this article is to propose a novel investigation of deep learning (DL) solutions for predicting CVD/stroke risk in DFI patients. The Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) search strategy was used for the selection of 207 studies. We hypothesize that a DFI is responsible for increased morbidity and mortality due to the worsening of atherosclerotic disease and affecting coronary artery disease (CAD). Since surrogate biomarkers for CAD, such as carotid artery disease, can be used for monitoring CVD, we can thus use a DL-based model, namely, Long Short-Term Memory (LSTM) and Recurrent Neural Networks (RNN) for CVD/stroke risk prediction in DFI patients, which combines covariates such as office and laboratory-based biomarkers, carotid ultrasound image phenotype (CUSIP) lesions, along with the DFI severity. We confirmed the viability of CVD/stroke risk stratification in the DFI patients. Strong designs were found in the research of the DL architectures for CVD/stroke risk stratification. Finally, we analyzed the AI bias and proposed strategies for the early diagnosis of CVD/stroke in DFI patients. Since DFI patients have an aggressive atherosclerotic disease, leading to prominent CVD/stroke risk, we, therefore, conclude that the DL paradigm is very effective for predicting the risk of CVD/stroke in DFI patients.

Complexity Analysis in the PR, QT, RR and ST Segments of ECG for Early Assessment of Severity in Cardiac Autonomic Neuropathy

Early-stage detection of cardiac autonomic neuropathy (CAN) is important for better management of the disease and prevents hospitalization. This study has investigated the complex nature of PR, QT, RR, and ST time segments of ECG signals by computing the fractal dimension (FD) of all segments from 20 min ECG recordings of people with different severity of the disease and healthy individuals. The mean computed for each ECG time segment to distinguish between subjects was insufficient for an early diagnosis. Statistical analysis shows that the change of FD in various time segments of ECG throughout the recording was most suitable to assess the steps for severity in symptoms of CAN between the healthy and the subjects with early symptoms of CAN. The complexity of ECG features was evaluated using various classifier models, namely, support vector machine (SVM), naïve Bayes, random forest, K-nearest neighbor (KNN), AdaBoost, and neural networks. Performance measures were computed on all models, with a maximum neural network classifier having an accuracy of 96.9%. Feature ranking results show that fractal features have more significance than the time segments of ECG in differentiating the subjects. The results of statistical validation show that all the selected features based on ECG physiology proved to have an evident complexity change between normal and severity stages of CAN. Thus, this work reports the complexity analysis in all the selected time segments of ECG that can be an effective tool for early diagnostics for CAN.

Heart rate dynamics in the prediction of coronary artery disease and myocardial infarction using artificial neural network and support vector machine

BACKGROUND

Atherosclerosis leads to coronary artery disease (CAD) and myocardial infarction (MI), a major cause of morbidity and mortality worldwide. The computer-aided prognosis of atherosclerotic events with the electrocardiogram (ECG) derived heart rate variability (HRV) can be a robust method in the prognosis of atherosclerosis events.

METHODS

A total of 70 male subjects aged 55 ± 5 years participated in the study. The lead-II ECG was recorded and sampled at 200 Hz. The tachogram was obtained from the ECG signal and used to extract twenty-five HRV features. The one-way Analysis of variance (ANOVA) test was performed to find the significant differences between the CAD, MI, and control subjects. Features were used in the training and testing of a two-class artificial neural network (ANN) and support vector machine (SVM).

RESULTS

The obtained results revealed depressed HRV under atherosclerosis. Accuracy of 100% was obtained in classifying CAD and MI subjects from the controls using ANN. Accuracy was 99.6% with SVM, and in the classification of CAD from MI subjects using SVM and ANN, 99.3% and 99.0% accuracy was obtained respectively.

CONCLUSIONS

Depressed HRV has been suggested to be a marker in the identification of atherosclerotic events. The good accuracy observed in classification between control, CAD, and MI subjects, revealed it to be a non-invasive cost-effective approach in the prognosis of atherosclerotic events.

Artificial intelligence in disease diagnosis: a systematic literature review, synthesizing framework and future research agenda

Artificial intelligence can assist providers in a variety of patient care and intelligent health systems. Artificial intelligence techniques ranging from machine learning to deep learning are prevalent in healthcare for disease diagnosis, drug discovery, and patient risk identification. Numerous medical data sources are required to perfectly diagnose diseases using artificial intelligence techniques, such as ultrasound, magnetic resonance imaging, mammography, genomics, computed tomography scan, etc. Furthermore, artificial intelligence primarily enhanced the infirmary experience and sped up preparing patients to continue their rehabilitation at home. This article covers the comprehensive survey based on artificial intelligence techniques to diagnose numerous diseases such as Alzheimer, cancer, diabetes, chronic heart disease, tuberculosis, stroke and cerebrovascular, hypertension, skin, and liver disease. We conducted an extensive survey including the used medical imaging dataset and their feature extraction and classification process for predictions. Preferred reporting items for systematic reviews and Meta-Analysis guidelines are used to select the articles published up to October 2020 on the Web of Science, Scopus, Google Scholar, PubMed, Excerpta Medical Database, and Psychology Information for early prediction of distinct kinds of diseases using artificial intelligence-based techniques. Based on the study of different articles on disease diagnosis, the results are also compared using various quality parameters such as prediction rate, accuracy, sensitivity, specificity, the area under curve precision, recall, and F1-score.

Cancer classification using machine learning and HRV analysis: preliminary evidence from a pilot study

Most cancer patients exhibit autonomic dysfunction with attenuated heart rate variability (HRV) levels compared to healthy controls. This research aimed to create and evaluate a machine learning (ML) model enabling discrimination between cancer patients and healthy controls based on 5-min-ECG recordings. We selected 12 HRV features based on previous research and compared the results between cancer patients and healthy individuals using Wilcoxon sum-rank test. Recursive Feature Elimination (RFE) identified the top five features, averaged over 5 min and employed them as input to three different ML. Next, we created an ensemble model based on a stacking method that aggregated the predictions from all three base classifiers. All HRV features were significantly different between the two groups. SDNN, RMSSD, pNN50%, HRV triangular index, and SD1 were selected by RFE and used as an input to three different ML. All three base-classifiers performed above chance level, RF being the most efficient with a testing accuracy of 83%. The ensemble model showed a classification accuracy of 86% and an AUC of 0.95. The results obtained by ML algorithms suggest HRV parameters could be a reliable input for differentiating between cancer patients and healthy controls. Results should be interpreted in light of some limitations that call for replication studies with larger sample sizes.

Application and Clinical Analysis of Remote Fetal Heart Rate Monitoring Platform in Continuous Fetal Heart Rate Monitoring Images

Fetal heart sound is an important part of fetal monitoring and has attracted extensive research and attention from scholars at home and abroad in recent years. The fetal heart rate, extracted from the fetal heart sound signal, is one of the important indicators that reflect the health of the fetus in the womb. In this study, a maternal-fetal Holter monitor based on f ECG technology was used to collect maternal heart rate, fetal heart rate, and uterine contractions signals, isolate the fetal heart rate, and design an algorithm to extract the fetal heart rate baseline, acceleration, variation, wake-up cycle, and nonlinear parameters. Using statistical methods to analyze the average value and range of various characteristic parameters of fetal heart rate under continuous long-term monitoring, the results show that the baseline has a downward trend from 10 o'clock in the night to 4 o'clock in the morning and is the lowest around 2 o'clock in the morning. The area and acceleration time were significantly higher than those in the suspicious group. However, there was no significant difference in the number of acceleration values between the two groups; the proportion of small mutations in the normal group was lower than that of the suspicious group and the proportion of medium mutations was higher than that of the suspicious group. There is no statistically significant difference in maternal age, gestational age at childbirth, pregnancy comorbidities, and complication rates in the five-level interpretation system of ACOG (2009), RCOG (2007), SOGC (2007), and the United States (2007). The difference of pregnancy and parity in various images was statistically significant, P < 0.05. The second type of fetal heart rate monitoring images appeared in the highest among the diagnostic standards, and the difference in the second type of fetal heart rate monitoring images between the various diagnostic standards was statistically significant, P ≤ 0.001.

Heart rate variability time domain features in automated prediction of diabetes in rat

Diabetes is a very common occurring disease, diagnosed by hyperglycemia. The established mode of diagnosis is the analysis of blood glucose level with the help of a hand-held glucometer. Nowadays, it is also known for affecting multi-organ functions, particularly the microvasculature of the cardiovascular system. In this work, an alternative diagnostic system based on the heart rate variability (HRV) analysis and artificial neural network (ANN) and support vector machine (SVM) have been proposed. The experiment and data recording has been performed on male Wister rats of 10-12 week of age and 200 ± 20 gm of weight. The digital lead-I electrocardiogram (ECG) data are recorded from control (n = 5) and Streptozotocin-induced diabetic rats (n = 5). Nine time-domain linear HRV parameters are computed from 60 s of ECG data epochs and used for the training and testing of backpropagation ANN and SVM. Total 526 (334 Control and 192 diabetics) such datasets are computed for the testing of ANN for the identification of the diabetic conditions. The ANN has been optimized for architecture 9:5:1 (Input: hidden: output neurons, respectively) with the optimized learning rate parameter at 0.02. With this network, a very good classification accuracy of 96.2% is achieved. While similar accuracy of 95.2% is attained using SVM. Owing to the successful implementation of HRV parameters based automated classifiers for diabetic conditions, a non-invasive, ECG based online prognostic system can be developed for accurate and non-invasive prediction of the diabetic condition.