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

Mobile Personal Healthcare System for Non-Invasive, Pervasive and Continuous Blood Pressure Monitoring: A Feasibility Study

Background: Smartphone-based blood pressure (BP) monitor using photoplethysmogram (PPG) technology has emerged as a promising approach to empower users with self-monitoring for effective diagnosis and control ofhypertension (HT). Objective: This study aimed to develop a mobile personal healthcare system for non-invasive, pervasive, and continuous estimation of BP level and variability to be user-friendly to elderly. Methods: The proposed approach was integrated by a self-designed cuffless, calibration-free, wireless and wearable PPG-only sensor, and a native purposely-designed smartphone application using multilayer perceptron machine learning techniques from raw signals. We performed a pilot study with three elder adults (mean age 61.3 ± 1.5 years; 66% women) to test usability and accuracy of the smartphone-based BP monitor. Results: The employed artificial neural network (ANN) model performed with high accuracy in terms of predicting the reference BP values of our validation sample (n=150). On average, our approach predicted BP measures with accuracy \u3e90% and correlations \u3e0.90 (P \u3c .0001). Bland-Altman plots showed that most of the errors for BP prediction were less than 10 mmHg. Conclusions: With further development and validation, the proposed system could provide a cost-effective strategy to improve the quality and coverage of healthcare, particularly in rural zones, areas lacking physicians, and solitary elderly populations

A Novel Deep Learning based Automatic Auscultatory Method to Measure Blood Pressure

Background: It is clinically important to develop innovative techniques that can accurately measure blood pressures (BP) automatically. Objectives: This study aimed to present and evaluate a novel automatic BP measurement method based on deep learning method, and to confirm the effects on measured BPs of the position and contact pressure of stethoscope. Methods: 30 healthy subjects were recruited. 9 BP measurements (from three different stethoscope contact pressures and three repeats) were performed on each subject. The convolutional neural network (CNN) was designed and trained to identify the Korotkoff sounds at a beat-by-beat level. Next, a mapping algorithm was developed to relate the identified Korotkoff beats to the corresponding cuff pressures for systolic and diastolic BP (SBP and DBP) determinations. Its performance was evaluated by investigating the effects of the position and contact pressure of stethoscope on measured BPs in comparison with reference manual auscultatory method. Results: The overall measurement errors of the proposed method were 1.4 ± 2.4 mmHg for SBP and 3.3 ± 2.9 mmHg for DBP from all the measurements. In addition, the method demonstrated that there were small SBP differences between the 2 stethoscope positions, respectively at the 3 stethoscope contact pressures, and that DBP from the stethoscope under the cuff was significantly lower than that from outside the cuff by 2.0 mmHg (P < 0.01). Conclusion: Our findings suggested that the deep learning based method was an effective technique to measure BP, and could be developed further to replace the current oscillometric based automatic blood pressure measurement method

Blood Pressure Estimation from Electrocardiogram and Photoplethysmography Signals Using Continuous Wavelet Transform and Convolutional Neural Network

Cuff-less and continuous blood pressure (BP) measurement has recently become an active research area in the field of remote healthcare monitoring. There is a growing demand for automated BP estimation and monitoring for various long-term and chronic conditions. Automated BP monitoring can produce a good amount of rich health data, which increases the chance of early diagnosis and treatments that are critical for a long-term condition such as hypertension and Cardiovascular diseases (CVDs). However, mining and processing this vast amount of data is challenging, which is aimed to address in this research. We employed a continuous wavelet transform (CWT) and a deep convolutional neural network (CNN) to estimate the BP. The electrocardiogram (ECG), photoplethysmography (PPG) and arterial blood pressure (ABP) signals were extracted from the online Medical Information Mart for Intensive Care (MIMIC III) database. The scalogram of each signal was created and used for training and testing our proposed CNN model that can implicitly learn to extract the descriptive features from the training data. This study achieved a promising BP estimation approach has been achieved without employing engineered feature extraction that is comparable with previous works. Experimental results demonstrated a low root mean squere error (RMSE) rate of 3.36 mmHg and a high accuracy of 86.3% for BP estimations. The proposed CNN-based model can be considered as a reliable and feasible approach to estimate BP for continuous remote healthcare monitoring

딥러닝 기반 혈압 예측 기법

학위논문 (박사) -- 서울대학교 대학원 : 공과대학 전기·정보공학부, 2020. 8. 윤성로.While COVID-19 is changing the world's social profile, it is expected that the telemedicine sector, which has not been activated due to low regulation and reliability, will also undergo a major change. As COVID-19 spreads in the United States, the US Department of Health \& Human Services temporarily loosens the standards for telemedicine, while enabling telemedicine using Facebook, Facebook Messenger-based video chat, Hangouts, and Skype. The expansion of the telemedicine market is expected to quickly transform the existing treatment-oriented hospital-led medical market into a digital healthcare service market focused on prevention and management through wearables, big data, and health records analysis. In this prevention and management-oriented digital healthcare service, it is very important to develop a technology that can easily monitor a person's health status. One of the vital signs that can be used for personal health monitoring is blood pressure. High BP is a common and dangerous condition. About 1 out of 3 adults in the U.S. (about 75 million people) have high BP. This common condition increases the risk of heart disease and stroke, two of the leading causes of death for Americans. High BP is called the silent killer because it often has no warning signs or symptoms, and many people are not aware they have it. For these reasons, it is important to develop a technology that can easily and conveniently check BP regularly. In biomedical data analysis, various studies are being attempted to effectively analyze by applying machine learning to biomedical big data accumulated in large quantities. However, collecting blood pressure-related data at the level of big data is very difficult and very expensive because it takes a lot of manpower and time. So in this dissertation, we proposed a three-step strategy to overcome these issues. First, we describe a BP prediction model with extraction and concentration CNN architecture, to process publicly disclosed sequential ECG and PPG dataset. Second, we evaluate the performance of the developed model by applying the developed model to privately measured data. To address the third issue, we propose the knowledge distillation method and input pre-processing method to improve the accuracy of the blood pressure prediction model. All the methods proposed in this dissertation are based on a deep convolutional neural network (CNN). Unlike other studies based on manual recognition of the features, by utilizing the advantage of deep learning which automatically extracts features, raw biomedical signals are used intact to reflect the inherent characteristics of the signals themselves.코로나 19에 의한 전 세계의 사회적 프로필 변화로, 규제와 신뢰성이 낮기 때문에 활성화 되지 않은 원격 의료 분야도 큰 변화를 겪을 것으로 예상됩니다. 코로나 19가 미국에 퍼짐에 따라 미국 보건복지부는 원격 진료의 표준을 일시적으로 완화하면서 페이스북, 페이스북 메신저 기반 화상 채팅, 행아웃, 스카이프를 사용한 원격 진료를 가능하게 했습니다. 원격의료 시장의 확장은 기존의 치료중심 병원주도의 의료시장을 웨어러블, 빅 데이터 및 건강기록 분석을 통한 예방 및 관리에 중점을 둔 디지털 의료 서비스 시장으로 빠르게 변화시킬 것으로 예상됩니다. 이러한 예방 및 관리 중심의 디지털 헬스케어 서비스에서는 사람의 건강 상태를 쉽게 모니터링 할 수 있는 기술 개발이 매우 중요한데 혈압은 개인 건강 모니터링에 사용될 수 있는 필수 징후 중 하나 입니다. 고혈압은 아주 흔하고 위험한 질환입니다. 미국 성인 3명중 1명(약 7,500만명)이 고혈압을 가지고 있습니다. 이는 미국인의 주요 사망 원인 중 두가지인 심장질환과 뇌졸중의 위험을 증가 시킵니다. 고혈압은 신체에 경고 신호나 자각 증상이 없어 많은 사람들이 자신이 고혈압인 것을 인지하지 못하기 때문에 "사일런트 킬러"라 불리웁니다. 이러한 이유로 정기적으로 쉽고 편리하게 혈압을 확인할 수 있는 기술의 개발이 매우 중요합니다. 생체의학 데이터 분석 분야에서는 머신 러닝을 대량으로 수집된 생체의학 빅 데이터에 적용하는 다양한 연구가 효과적으로 이루어지고 있습니다. 그러나 빅 데이터 수준으로 다량의 혈압 관련 데이터를 수집하는 것은 많은 전문적인 인력들이 오랜시간을 필요로 하기 때문에 매우 어렵고 비용 또한 많이 필요합니다. 따라서 본 학위논문에서는 이러한 문제를 극복하기 위한 3단계 전략을 제안했습니다. 먼저 누구나 시용할 수 있도록 공개되어 있는 심전도, 광용적맥파 데이터셋을 이용, 순차적인 심전도, 광용적맥파 신호에서 혈압을 잘 예측하도록 고안된 추출 및 농축 작업을 반복하는 함성곱 신경망 구조를 제안했습니다. 두번째로 제안된 합성곱 신경망 모델을 개인에게서 측정한 광용적맥파 신호를 이용해 제안된 함성곱 신경망 모델의 성능을 평가했습니다. 세번째로 혈압예측 모델의 정확성을 높이기 위해 지식 증류법과 입력신호 전처리 방법을 제안했습니다. 이 논문에서 제안된 모든 혈압예측 방법은 합성곱 신경망을 기반으로 합니다. 혈압 예측에 필요한 특징들을 수동으로 추출해야 하는 다른 연구들과 다르게 특징을 자동으로 추출하는 딥러닝의 장점을 활용, 아무런 처리도 하지 않은 원래 그대로의 생체 신호에서 신호 자체의 고유한 특징을 반영할 수 있습니다.1 Introduction 1 2 Background 5 2.1 Cuff-based BP measurement methods 9 2.1.1 Auscultatory method 9 2.1.2 Oscillometric method 10 2.1.3 Tonometric method 11 2.2 Biomedical signals used in cuffless BP prediction methods 13 2.2.1 Electrocardiography (ECG) 13 2.2.2 Photoplethysmography (PPG) 20 2.3 Cuffless BP measurement methods 21 2.3.1 PWV based BP prediction methods 25 2.3.2 Machine learning based pulse wave analysis methods 26 2.4 Deep learning for sequential biomedical data 30 2.4.1 Convolutional neural networks 31 2.4.2 Recurrent neural networks 32 3 End-to-end blood pressure prediction via fully convolutional networks 33 3.1 Introduction 35 3.2 Method 38 3.2.1 Data preparation 38 3.2.2 CNN based prediction model 41 3.2.3 Detailed architecture 45 3.3 Experimental results 47 3.3.1 Setup 47 3.3.2 Model evaluation & selection 48 3.3.3 Calibration-based method 51 3.3.4 Performance comparison 52 3.3.5 Verification using international standards for BP measurement grading criteria 54 3.3.6 Performance comparison by the input signal combinations 56 3.3.7 An ablation study of each architectural component of extraction-concentration blocks 58 3.3.8 Preprocessing of input signal to improve blood pressure prediction performance 59 3.4 Discussion 61 3.5 Summary 63 4 Blood pressure prediction by a smartphone sensor using fully convolutional networks 64 4.1 Introduction 66 4.2 Method 69 4.2.1 Data acquisition 71 4.2.2 Preprocessing of the PPG signals 71 4.2.3 PPG signal selection 71 4.2.4 Data preparation for CNN model training 72 4.2.5 Network architectures 72 4.3 Experimental results 75 4.3.1 Implementation details 75 4.3.2 Effect of PPG combination on BP prediction 75 4.3.3 Performance comparison with other related works 76 4.3.4 Verification using international standards for BP measurement grading criteria 77 4.3.5 Preprocessing of input signal to improve blood pressure prediction performance 79 4.4 Discussion 81 4.5 Summary 83 5 Improving accuracy of blood pressure prediction by distilling the knowledge of neural networks 84 5.1 Introduction 85 5.2 Methods 87 5.3 Experimental results 88 5.4 Discussion & Summary 89 6 Conclusion 90 6.1 Future work 92 Bibliography 93 Abstract (In Korean) 106Docto

A review of machine learning techniques in photoplethysmography for the non-invasive cuff-less measurement of blood pressure

Hypertension or high blood pressure is a leading cause of death throughout the world and a critical factor for increasing the risk of serious diseases, including cardiovascular diseases such as stroke and heart failure. Blood pressure is a primary vital sign that must be monitored regularly for the early detection, prevention and treatment of cardiovascular diseases. Traditional blood pressure measurement techniques are either invasive or cuff-based, which are impractical, intermittent, and uncomfortable for patients. Over the past few decades, several indirect approaches using photoplethysmogram (PPG) have been investigated, namely, pulse transit time, pulse wave velocity, pulse arrival time and pulse wave analysis, in an effort to utilise PPG for estimating blood pressure. Recent advancements in signal processing techniques, including machine learning and artificial intelligence, have also opened up exciting new horizons for PPG-based cuff less and continuous monitoring of blood pressure. Such a device will have a significant and transformative impact in monitoring patients’ vital signs, especially those at risk of cardiovascular disease. This paper provides a comprehensive review for non-invasive cuff-less blood pressure estimation using the PPG approach along with their challenges and limitations

Physics-informed neural networks for blood flow inverse problems

Physics-informed neural networks (PINNs) have emerged as a powerful tool for solving inverse problems, especially in cases where no complete information about the system is known and scatter measurements are available. This is especially useful in hemodynamics since the boundary information is often difficult to model, and high-quality blood flow measurements are generally hard to obtain. In this work, we use the PINNs methodology for estimating reduced-order model parameters and the full velocity field from scatter 2D noisy measurements in the ascending aorta. The results show stable and accurate parameter estimations when using the method with simulated data, while the velocity reconstruction shows dependence on the measurement quality and the flow pattern complexity. The method allows for solving clinical-relevant inverse problems in hemodynamics and complex coupled physical systems