ECG based Prediction Model for Cardiac-Related Diseases using Machine Learning Techniques

This dissertation presents research on the construction of predictive models for health conditions through the application of Artificial Intelligence methods. The work is thus focused on the prediction, in the short and long term, of Atrial Fibrillation conditions through the analysis of Electrocardiography exams, with the use of several techniques to reduce noise and interference, as well as their representation through spectrograms and their application in Artificial Intelligence models, specifically Deep Learning. The training and testing processes of the models made use of a publicly available database. In its two approaches, predictive algorithms were obtained with an accuracy of 96.73% for a short horizon prediction and 96.52% for long Atrial Fibrillation prediction horizon. The main objectives of this dissertation are thus the study of works already carried out in the area during the last decade, to present a new methodology of prediction of the presented condition, as well as to present and discuss its results, including suggestions for improvement for future development.Esta dissertação descreve a construção de modelos preditivos de condições de saúde através de aplicação de métodos de Inteligência Artificial. O trabalho é assim focado na predição, a curto e longo prazo, de condições de Fibrilhação Auricular através da análise de exames de Eletrocardiografia, com a utilização de diversas técnicas de redução de ruído e de interferência, bem como a sua representação através de espectrogramas e sua aplicação em modelos de Inteligência Artificial, concretamente de Aprendizagem Profunda (Deep Learning na língua inglesa). Os processos de treino e teste dos modelos obtidos recorreram a uma base de dados publicamente disponível. Nas suas duas abordagens, foram obtidos algoritmos preditivos com uma precisão de 96.73% para uma predição de curto horizonte e 96.52% para longo horizonte de predição de Fibrilhação Auricular. Os objetivos principais da presente dissertação são assim o estudo de trabalhos já realizados na área durante a última década, apresentar uma nova metodologia de predição da condição apresentada, bem como apresentar e discutir os seus resultados, incluindo sugestões de melhoria para futuro desenvolvimento

Perspectives on Sex- and Gender-Specific Prediction of New-Onset Atrial Fibrillation by Leveraging Big Data

Atrial fibrillation (AF), the most common sustained cardiac arrhythmia, has a large impact on quality of life and is associated with increased risk of hospitalization, morbidity, and mortality. Over the past two decades advances regarding the clinical epidemiology and management of AF have been established. Moreover, sex differences in the prevalence, incidence, prediction, pathophysiology, and prognosis of AF have been identified. Nevertheless, AF remains to be a complex and heterogeneous disorder and a comprehensive sex- and gender-specific approach to predict new-onset AF is lacking. The exponential growth in various sources of big data such as electrocardiograms, electronic health records, and wearable devices, carries the potential to improve AF risk prediction. Leveraging these big data sources by artificial intelligence (AI)-enabled approaches, in particular in a sex- and gender-specific manner, could lead to substantial advancements in AF prediction and ultimately prevention. We highlight the current status, premise, and potential of big data to improve sex- and gender-specific prediction of new-onset AF

Atrial Fibrillation Prediction from Critically Ill Sepsis Patients

Sepsis is defined by life-threatening organ dysfunction during infection and is the leading cause of death in hospitals. During sepsis, there is a high risk that new onset of atrial fibrillation (AF) can occur, which is associated with significant morbidity and mortality. Consequently, early prediction of AF during sepsis would allow testing of interventions in the intensive care unit (ICU) to prevent AF and its severe complications. In this paper, we present a novel automated AF prediction algorithm for critically ill sepsis patients using electrocardiogram (ECG) signals. From the heart rate signal collected from 5-min ECG, feature extraction is performed using the traditional time, frequency, and nonlinear domain methods. Moreover, variable frequency complex demodulation and tunable Q-factor wavelet-transform-based time-frequency methods are applied to extract novel features from the heart rate signal. Using a selected feature subset, several machine learning classifiers, including support vector machine (SVM) and random forest (RF), were trained using only the 2001 Computers in Cardiology data set. For testing the proposed method, 50 critically ill ICU subjects from the Medical Information Mart for Intensive Care (MIMIC) III database were used in this study. Using distinct and independent testing data from MIMIC III, the SVM achieved 80% sensitivity, 100% specificity, 90% accuracy, 100% positive predictive value, and 83.33% negative predictive value for predicting AF immediately prior to the onset of AF, while the RF achieved 88% AF prediction accuracy. When we analyzed how much in advance we can predict AF events in critically ill sepsis patients, the algorithm achieved 80% accuracy for predicting AF events 10 min early. Our algorithm outperformed a state-of-the-art method for predicting AF in ICU patients, further demonstrating the efficacy of our proposed method. The annotations of patients\u27 AF transition information will be made publicly available for other investigators. Our algorithm to predict AF onset is applicable for any ECG modality including patch electrodes and wearables, including Holter, loop recorder, and implantable devices

An optimization method based on genetic algorithm for heart rate variability analysis in the prediction of the onset of cardiac arrhythmia

Heart rate variability (HRV) is one of the common biological markers for developing a diagnostic system of cardiovascular disease. HRV analysis is used to extract statistical, geometrical, spectral and non-linear features in such diagnostic system. The diagnostic accuracy can be maximized by applying a feature selection step that selects an optimal feature subset from the extracted features. However, there are shortcomings in using only the feature selection for optimizing a diagnostic system that is based on HRV analysis. One of the main limitations is that the parameters of HRV feature extraction algorithms are not optimized for maximal performance. In addition, the feature selection process does not consider the feature cost and misclassification error of the selected optimal feature subset. Therefore, this thesis proposes a multi-objective optimization method that is based on the non-dominated sorting genetic algorithm to overcome these shortcomings in a cardiac arrhythmia prediction system. It optimizes the HRV feature extraction parameters, selects the best feature subset, and tunes the classifier parameters simultaneously for maximum prediction performance. The proposed optimization algorithm is applied in two cardiac arrhythmia cases, namely the prediction of the onsets of paroxysmal atrial fibrillation (PAF) and ventricular tachyarrhythmia (VTA). In the proposed approach, trade-off between multiple optimization objectives that contradict to each other are also analyzed. The optimization objectives include the feature count, measurement cost, prediction sensitivity, specificity and accuracy rate. The following results prove the effectiveness of the proposed optimization algorithm in the two arrhythmia cases. Firstly, the PAF onset prediction achieves an accuracy rate of 89.6%, which significantly outperforms most of the previous works. This accuracy rate is achieved even with the HRV signal length being reduced from the typical 30 minutes to just 5 minutes (a reduction of 83%). In the case of VTA onset prediction, the accuracy rate of 78.15% is achieved with 5-minute signal length. This result outperforms previous works. Another significant result is the sensitivity rate improvement with the tradeoff of lower specificity and accuracy rate for both PAF and VTA onset predictions. For instance, the sensitivity rate of the VTA onset prediction system improved from 81.48% to 92.59% while the accuracy rate reduced from 78.15% to 72.59%

Can heart rate variability parameters derived by a heart rate monitor differentiate between atrial fibrillation and sinus rhythm?

Background: Heart rate variability (HRV) parameters, and especially RMSSD (root mean squared successive differences in RR interval), could distinguish atrial fibrillation (AF) from sinus rhythm(SR) in horses, as was demonstrated in a previous study. If heart rate monitors (HRM) automatically calculating RMSSD could also distinguish AF from SR, they would be useful for the monitoring of AF recurrence. The objective of the study was to assess whether RMSSD values obtained from a HRM can differentiate AF from SR in horses. Furthermore, the impact of artifact correction algorithms, integrated in the analyses software for HRV analyses was evaluated. Fourteen horses presented for AF treatment were simultaneously equipped with a HRM and an electrocardiogram (ECG). A two-minute recording at rest, walk and trot, before and after cardioversion, was obtained. RR intervals used were those determined automatically by the HRM and by the equine ECG analysis software, and those obtained after manual correction of QRS detection within the ECG software. RMSSD was calculated by the HRM software and by dedicated HRV software, using six different artifact filters. Statistical analysis was performed using the Wilcoxon signed-rank test and receiver operating curves. Results: The HRM, which applies a low level filter, produced high area under the curve (AUC) (>0.9) and cut off values with high sensitivity and specificity. Similar results were obtained for the ECG, when low level artifact filtering was applied. When no artifact correction was used during trotting, an important decrease in AUC (0.75) occurred. Conclusion: In horses treated for AF, HRMs with automatic RMSSD calculations distinguish between AF and SR. Such devices might be a useful aid to monitor for AF recurrence in horses

Evolutionary Optimization of Atrial Fibrillation Diagnostic Algorithms

The goal of this research is to introduce an improved method for detecting atrial fibrillation (AF). The foundation of our algorithm is the irregularity of the RR intervals in the electrocardiogram (ECG) signal, and their correlation with AF. Three statistical techniques, including root mean squares of successive differences (RMSSD), turning points ratio (TPR), and Shannon entropy (SE), are used to detect RR interval irregularity. We use the Massachusetts Institution of Technology / Beth Israel Hospital (MIT-BIH) atrial fibrillation databases and their annotations to tune the parameters of the statistical methods by biogeography-based optimization (BBO), which is an evolutionary optimization algorithm. We trained each statistical method to diagnose AF on each database. Then each trained method was tested on the rest of the databases. We were able to obtain accuracy levels as high as 99 for the detection of AF in the trained databases. We obtained accuracy levels of up to 75 in the tested database

Evolutionary Optimization of Atrial Fibrillation Diagnostic Algorithms

The goal of this research is to introduce an improved method for detecting atrial fibrillation (AF). The foundation of our algorithm is the irregularity of the RR intervals in the electrocardiogram (ECG) signal, and their correlation with AF. Three statistical techniques, including root mean squares of successive differences (RMSSD), turning points ratio (TPR), and Shannon entropy (SE), are used to detect RR interval irregularity. We use the Massachusetts Institution of Technology / Beth Israel Hospital (MIT-BIH) atrial fibrillation databases and their annotations to tune the parameters of the statistical methods by biogeography-based optimization (BBO), which is an evolutionary optimization algorithm. We trained each statistical method to diagnose AF on each database. Then each trained method was tested on the rest of the databases. We were able to obtain accuracy levels as high as 99 for the detection of AF in the trained databases. We obtained accuracy levels of up to 75 in the tested database

Interventional techniques in the management of persistent atrial fibrillation

Atrial fibrillation (AF) is a common cardiac rhythm problem experienced by patients and comprises an increasing demand on healthcare systems. AF is characterised by advanced neurohormonal remodelling in the atria resulting in dilation and variable degree of atrial fibrosis that can be measured by imaging techniques with difficulty in developing methods of identifying and quantifying left atrial (LA) fibrosis. LA fibrosis can be estimated by measuring LA scar using non-invasive imaging methods such as strain imaging in advanced echocardiography and in cardiac magnetic resonance (CMR) imaging. Achieving rhythm control strategy utilising catheter ablation (CA) has shown to be advantageous in improving quality of life (QOL) in patients with paroxysmal AF. The most effective method in management of AF has remained elusive in non-paroxysmal AF. Thoracoscopic surgical ablation (TSA) has been developed over the last decade by experienced surgeons with some promising early results but has not been investigated in long-standing persistent AF (LSPAF). I have attempted to answer some of the relevant questions that have remained in management of LSPAF by conducting a multicentre randomised control trial comparing efficacy between CA and TSA (CASA-AF RCT) and improvements in quality of life indices. In a sub-study, I measured LA volumes using echocardiography and CMR to determine reverse remodelling and LA function using tissue Doppler imaging and strain imaging to predict AF recurrence. In a CMR sub-study, a novel automatic LA segmentation algorithm was used to quantify LA fibrosis before and after ablation. I was able to quantify the response of the autonomic nervous system to targeted ganglionic plexi (GP) ablation as part of TSA compared to CA by measuring heart rate variability. I am hopeful that the knowledge gained from this thesis will help with an appropriate selection that will improve the management of patients with LSPAF.Open Acces