Algorithms for automated diagnosis of cardiovascular diseases based on ECG data: A comprehensive systematic review

The prevalence of cardiovascular diseases is increasing around the world. However, the technology is evolving and can be monitored with low-cost sensors anywhere at any time. This subject is being researched, and different methods can automatically identify these diseases, helping patients and healthcare professionals with the treatments. This paper presents a systematic review of disease identification, classification, and recognition with ECG sensors. The review was focused on studies published between 2017 and 2022 in different scientific databases, including PubMed Central, Springer, Elsevier, Multidisciplinary Digital Publishing Institute (MDPI), IEEE Xplore, and Frontiers. It results in the quantitative and qualitative analysis of 103 scientific papers. The study demonstrated that different datasets are available online with data related to various diseases. Several ML/DP-based models were identified in the research, where Convolutional Neural Network and Support Vector Machine were the most applied algorithms. This review can allow us to identify the techniques that can be used in a system that promotes the patient’s autonomy.N/

Electrocardiogram Monitoring Wearable Devices and Artificial-Intelligence-Enabled Diagnostic Capabilities: A Review

Worldwide, population aging and unhealthy lifestyles have increased the incidence of high-risk health conditions such as cardiovascular diseases, sleep apnea, and other conditions. Recently, to facilitate early identification and diagnosis, efforts have been made in the research and development of new wearable devices to make them smaller, more comfortable, more accurate, and increasingly compatible with artificial intelligence technologies. These efforts can pave the way to the longer and continuous health monitoring of different biosignals, including the real-time detection of diseases, thus providing more timely and accurate predictions of health events that can drastically improve the healthcare management of patients. Most recent reviews focus on a specific category of disease, the use of artificial intelligence in 12-lead electrocardiograms, or on wearable technology. However, we present recent advances in the use of electrocardiogram signals acquired with wearable devices or from publicly available databases and the analysis of such signals with artificial intelligence methods to detect and predict diseases. As expected, most of the available research focuses on heart diseases, sleep apnea, and other emerging areas, such as mental stress. From a methodological point of view, although traditional statistical methods and machine learning are still widely used, we observe an increasing use of more advanced deep learning methods, specifically architectures that can handle the complexity of biosignal data. These deep learning methods typically include convolutional and recurrent neural networks. Moreover, when proposing new artificial intelligence methods, we observe that the prevalent choice is to use publicly available databases rather than collecting new data

A Compact LSTM-SVM Fusion Model for Long-Duration Cardiovascular Diseases Detection

Globally, cardiovascular diseases (CVDs) are the leading cause of mortality, accounting for an estimated 17.9 million deaths annually. One critical clinical objective is the early detection of CVDs using electrocardiogram (ECG) data, an area that has received significant attention from the research community. Recent advancements based on machine learning and deep learning have achieved great progress in this domain. However, existing methodologies exhibit inherent limitations, including inappropriate model evaluations and instances of data leakage. In this study, we present a streamlined workflow paradigm for preprocessing ECG signals into consistent 10-second durations, eliminating the need for manual feature extraction/beat detection. We also propose a hybrid model of Long Short-Term Memory (LSTM) with Support Vector Machine (SVM) for fraud detection. This architecture consists of two LSTM layers and an SVM classifier, which achieves a SOTA results with an Average precision score of 0.9402 on the MIT-BIH arrhythmia dataset and 0.9563 on the MIT-BIH atrial fibrillation dataset. Based on the results, we believe our method can significantly benefit the early detection and management of CVDs

Synergy of Physics-based Reasoning and Machine Learning in Biomedical Applications: Towards Unlimited Deep Learning with Limited Data

Technological advancements enable collecting vast data, i.e., Big Data, in science and industry including biomedical field. Increased computational power allows expedient analysis of collected data using statistical and machine-learning approaches. Historical data incompleteness problem and curse of dimensionality diminish practical value of pure data-driven approaches, especially in biomedicine. Advancements in deep learning (DL) frameworks based on deep neural networks (DNN) improved accuracy in image recognition, natural language processing, and other applications yet severe data limitations and/or absence of transfer-learning-relevant problems drastically reduce advantages of DNN-based DL. Our earlier works demonstrate that hierarchical data representation can be alternatively implemented without NN, using boosting-like algorithms for utilization of existing domain knowledge, tolerating significant data incompleteness, and boosting accuracy of low-complexity models within the classifier ensemble, as illustrated in physiological-data analysis. Beyond obvious use in initial-factor selection, existing simplified models are effectively employed for generation of realistic synthetic data for later DNN pre-training. We review existing machine learning approaches, focusing on limitations caused by training-data incompleteness. We outline our hybrid framework that leverages existing domain-expert models/knowledge, boosting-like model combination, DNN-based DL and other machine learning algorithms for drastic reduction of training-data requirements. Applying this framework is illustrated in context of analyzing physiological data

Deep Learning in Cardiology

The medical field is creating large amount of data that physicians are unable to decipher and use efficiently. Moreover, rule-based expert systems are inefficient in solving complicated medical tasks or for creating insights using big data. Deep learning has emerged as a more accurate and effective technology in a wide range of medical problems such as diagnosis, prediction and intervention. Deep learning is a representation learning method that consists of layers that transform the data non-linearly, thus, revealing hierarchical relationships and structures. In this review we survey deep learning application papers that use structured data, signal and imaging modalities from cardiology. We discuss the advantages and limitations of applying deep learning in cardiology that also apply in medicine in general, while proposing certain directions as the most viable for clinical use.Comment: 27 pages, 2 figures, 10 table

Automatic analysis and classification of cardiac acoustic signals for long term monitoring

Objective: Cardiovascular diseases are the leading cause of death worldwide resulting in over 17.9 million deaths each year. Most of these diseases are preventable and treatable, but their progression and outcomes are significantly more positive with early-stage diagnosis and proper disease management. Among the approaches available to assist with the task of early-stage diagnosis and management of cardiac conditions, automatic analysis of auscultatory recordings is one of the most promising ones, since it could be particularly suitable for ambulatory/wearable monitoring. Thus, proper investigation of abnormalities present in cardiac acoustic signals can provide vital clinical information to assist long term monitoring. Cardiac acoustic signals, however, are very susceptible to noise and artifacts, and their characteristics vary largely with the recording conditions which makes the analysis challenging. Additionally, there are challenges in the steps used for automatic analysis and classification of cardiac acoustic signals. Broadly, these steps are the segmentation, feature extraction and subsequent classification of recorded signals using selected features. This thesis presents approaches using novel features with the aim to assist the automatic early-stage detection of cardiovascular diseases with improved performance, using cardiac acoustic signals collected in real-world conditions. Methods: Cardiac auscultatory recordings were studied to identify potential features to help in the classification of recordings from subjects with and without cardiac diseases. The diseases considered in this study for the identification of the symptoms and characteristics are the valvular heart diseases due to stenosis and regurgitation, atrial fibrillation, and splitting of fundamental heart sounds leading to additional lub/dub sounds in the systole or diastole interval of a cardiac cycle. The localisation of cardiac sounds of interest was performed using an adaptive wavelet-based filtering in combination with the Shannon energy envelope and prior information of fundamental heart sounds. This is a prerequisite step for the feature extraction and subsequent classification of recordings, leading to a more precise diagnosis. Localised segments of S1 and S2 sounds, and artifacts, were used to extract a set of perceptual and statistical features using wavelet transform, homomorphic filtering, Hilbert transform and mel-scale filtering, which were then fed to train an ensemble classifier to interpret S1 and S2 sounds. Once sound peaks of interest were identified, features extracted from these peaks, together with the features used for the identification of S1 and S2 sounds, were used to develop an algorithm to classify recorded signals. Overall, 99 features were extracted and statistically analysed using neighborhood component analysis (NCA) to identify the features which showed the greatest ability in classifying recordings. Selected features were then fed to train an ensemble classifier to classify abnormal recordings, and hyperparameters were optimized to evaluate the performance of the trained classifier. Thus, a machine learning-based approach for the automatic identification and classification of S1 and S2, and normal and abnormal recordings, in real-world noisy recordings using a novel feature set is presented. The validity of the proposed algorithm was tested using acoustic signals recorded in real-world, non-controlled environments at four auscultation sites (aortic valve, tricuspid valve, mitral valve, and pulmonary valve), from the subjects with and without cardiac diseases; together with recordings from the three large public databases. The performance metrics of the methodology in relation to classification accuracy (CA), sensitivity (SE), precision (P+), and F1 score, were evaluated. Results: This thesis proposes four different algorithms to automatically classify fundamental heart sounds – S1 and S2; normal fundamental sounds and abnormal additional lub/dub sounds recordings; normal and abnormal recordings; and recordings with heart valve disorders, namely the mitral stenosis (MS), mitral regurgitation (MR), mitral valve prolapse (MVP), aortic stenosis (AS) and murmurs, using cardiac acoustic signals. The results obtained from these algorithms were as follows: • The algorithm to classify S1 and S2 sounds achieved an average SE of 91.59% and 89.78%, and F1 score of 90.65% and 89.42%, in classifying S1 and S2, respectively. 87 features were extracted and statistically studied to identify the top 14 features which showed the best capabilities in classifying S1 and S2, and artifacts. The analysis showed that the most relevant features were those extracted using Maximum Overlap Discrete Wavelet Transform (MODWT) and Hilbert transform. • The algorithm to classify normal fundamental heart sounds and abnormal additional lub/dub sounds in the systole or diastole intervals of a cardiac cycle, achieved an average SE of 89.15%, P+ of 89.71%, F1 of 89.41%, and CA of 95.11% using the test dataset from the PASCAL database. The top 10 features that achieved the highest weights in classifying these recordings were also identified. • Normal and abnormal classification of recordings using the proposed algorithm achieved a mean CA of 94.172%, and SE of 92.38%, in classifying recordings from the different databases. Among the top 10 acoustic features identified, the deterministic energy of the sound peaks of interest and the instantaneous frequency extracted using the Hilbert Huang-transform, achieved the highest weights. • The machine learning-based approach proposed to classify recordings of heart valve disorders (AS, MS, MR, and MVP) achieved an average CA of 98.26% and SE of 95.83%. 99 acoustic features were extracted and their abilities to differentiate these abnormalities were examined using weights obtained from the neighborhood component analysis (NCA). The top 10 features which showed the greatest abilities in classifying these abnormalities using recordings from the different databases were also identified. The achieved results demonstrate the ability of the algorithms to automatically identify and classify cardiac sounds. This work provides the basis for measurements of many useful clinical attributes of cardiac acoustic signals and can potentially help in monitoring the overall cardiac health for longer duration. The work presented in this thesis is the first-of-its-kind to validate the results using both, normal and pathological cardiac acoustic signals, recorded for a long continuous duration of 5 minutes at four different auscultation sites in non-controlled real-world conditions.Open Acces

A Heartbeat Classifier for Continuous Prediction Using a Wearable Device

Heartbeat monitoring may play an essential role in the early detection of cardiovascular disease. When using a traditional monitoring system, an abnormal heartbeat may not appear during a recording in a healthcare facility due to the limited time. Thus, continuous and long-term monitoring is needed. Moreover, the conventional equipment may not be portable and cannot be used at arbitrary times and locations. A wearable sensor device such as Polar H10 offers the same capability as an alternative. It has gold-standard heartbeat recording and communication ability but still lacks analytical processing of the recorded data. An automatic heartbeat classification system can play as an analyzer and is still an open problem in the development stage. This paper proposes a heartbeat classifier based on RR interval data for real-time and continuous heartbeat monitoring using the Polar H10 wearable device. Several machine learning and deep learning methods were used to train the classifier. In the training process, we also compare intra-patient and inter-patient paradigms on the original and oversampling datasets to achieve higher classification accuracy and the fastest computation speed. As a result, with a constrain in RR interval data as the feature, the random forest-based classifier implemented in the system achieved up to 99.67% for accuracy, precision, recall, and F1-score. We are also conducting experiments involving healthy people to evaluate the classifier in a real-time monitoring system

Automated Classification for Electrophysiological Data: Machine Learning Approaches for Disease Detection and Emotion Recognition

Smart healthcare is a health service system that utilizes technologies, e.g., artificial intelligence and big data, to alleviate the pressures on healthcare systems. Much recent research has focused on the automatic disease diagnosis and recognition and, typically, our research pays attention on automatic classifications for electrophysiological signals, which are measurements of the electrical activity. Specifically, for electrocardiogram (ECG) and electroencephalogram (EEG) data, we develop a series of algorithms for automatic cardiovascular disease (CVD) classification, emotion recognition and seizure detection. With the ECG signals obtained from wearable devices, the candidate developed novel signal processing and machine learning method for continuous monitoring of heart conditions. Compared to the traditional methods based on the devices at clinical settings, the developed method in this thesis is much more convenient to use. To identify arrhythmia patterns from the noisy ECG signals obtained through the wearable devices, CNN and LSTM are used, and a wavelet-based CNN is proposed to enhance the performance. An emotion recognition method with a single channel ECG is developed, where a novel exploitative and explorative GWO-SVM algorithm is proposed to achieve high performance emotion classification. The attractive part is that the proposed algorithm has the capability to learn the SVM hyperparameters automatically, and it can prevent the algorithm from falling into local solutions, thereby achieving better performance than existing algorithms. A novel EEG-signal based seizure detector is developed, where the EEG signals are transformed to the spectral-temporal domain, so that the dimension of the input features to the CNN can be significantly reduced, while the detector can still achieve superior detection performance