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Machine learning models for automated interpretation of 12-lead electrocardiographic signals: a narrative review of techniques, challenges, achievements and clinical relevance
Stockholm University, Faculty of Social Sciences, Department of Computer and Systems Sciences. 3rd Department of Cardiology, Thoracic Diseases General Hospital “Sotiria”, National and Kapodistrian University of Athens, Athens, Greece.ORCID iD: 0000-0001-5394-832x
Stockholm University, Faculty of Social Sciences, Department of Computer and Systems Sciences.
3rd Department of Cardiology, Thoracic Diseases General Hospital “Sotiria”, National and Kapodistrian University of Athens, Athens, Greece.ORCID iD: 0000-0001-8079-059
Stockholm University, Faculty of Social Sciences, Department of Computer and Systems Sciences.ORCID iD: 0000-0002-4632-4815
Number of Authors: 42023 (English)In: Journal of medical artificial intelligence, E-ISSN 2617-2496, Vol. 6, article id 6Article in journal (Refereed) Published
Abstract [en]

Background and Objective: Novel advances in machine learning (ML) and its subfield, deep learning (DL), as well as the recent release of large-scale electrocardiogram (ECG) databases, have driven a sharp increase in research related to automated ECG interpretation. This review aims to summarize the recent ML approaches for automatically interpreting standard 12-lead ECG signals.

Methods: We searched 10 indexing databases, for original research in English, referring to the application of ML/DL techniques in 12-lead, raw ECG signal analysis. The retrieved titles were filtered based on their relevance. The results were summarized and reported.

Key Content and Findings: More than 80% of studies integrated a DL approach, while fewer attempts applied a feature extraction method to obtain inputs for training a simple ML classifier. The average diagnostic accuracy was as high as 90%, while several other performance metrics, such as the area under the curve (AUC), F1-score, sensitivity and specificity, were also employed. DL models generally demanded 10-time more samples for training but were capable of better handling multi-class problems. The most frequently involved disease (49% of studies) was myocardial infarction (MI), while atrial fibrillation (AF) was encountered in more than one-third of studies. Various datasets were used for training and testing, constituting either private collections or publicly available databanks [such as the “Physikalisch-Technische Bundesanstalt” (PTB) dataset and datasets derived from the “China Physiological Signal Challenge” and the “Computing in Cardiology Challenge”]. Overall, DL and simpler ML approaches for automated ECG interpretation display unprecedented growth, reaching remarkably high performances.

Conclusions: While such novel tools can support clinicians in reaching reliable diagnoses for life-threatening conditions on the spot, concerns regarding their accountability do exist. Generalizability of the developed approaches is still an issue, possibly mitigable with the extensive deployment of developed models, so as to become massively accessible and validatable. Finally, the observed heterogeneity of the various attempts underlines the need for transparency and reproducibility in the development processes.

Place, publisher, year, edition, pages
2023. Vol. 6, article id 6
Keywords [en]
ECG, electrocardiogram, machine learning (ML), deep learning (DL)
National Category
Computer Sciences
Research subject
Computer and Systems Sciences
Identifiers
URN: urn:nbn:se:su:diva-224559DOI: 10.21037/jmai-22-94Scopus ID: 2-s2.0-85166205680OAI: oai:DiVA.org:su-224559DiVA, id: diva2:1820428
Available from: 2023-12-18 Created: 2023-12-18 Last updated: 2024-06-18Bibliographically approved
In thesis
1. Data-Driven AI for Patient and Public Health: On the Use of Multisource and Multimodal Data in Machine Learning to Improve Healthcare
Open this publication in new window or tab >>Data-Driven AI for Patient and Public Health: On the Use of Multisource and Multimodal Data in Machine Learning to Improve Healthcare
2024 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The integration of artificial intelligence in healthcare has created a new era of advancements, reshaping patient care and revolutionizing public health interventions. Through artificial intelligence, healthcare providers and public health authorities can optimize interventions, leading to more precise and efficient responses that enhance patient outcomes and address public health challenges effectively. The past decade has witnessed a rapid digital transformation across industries, and healthcare is no exception. This evolution is evident in the widespread adoption of electronic health records and healthcare information systems and the integration of diverse technologies, including handheld, wearable, and smart devices.

A central challenge in this digital shift lies in representing data from multiple sources and modalities for downstream machine learning tasks. This complexity stems from the varied longitudinal or contextual events in patients' historical records, encompassing lab tests, vital signs, diagnoses, and drug administration. Additionally, the challenge extends to predictive modeling and constructing robust models that accurately classify future health events, taking into consideration heterogeneous health-related data. Electronic phenotyping, crucial for identifying fine-grained disease/patient clusters, is also a central problem when utilizing multisource and multimodal information effectively to create meaningful patient profiles. In the context of public health interventions, exemplified by crises like the COVID-19 pandemic, decision-making requires a delicate balance between optimizing intervention effectiveness and considering economic and societal well-being.

This Ph.D. thesis seeks to unravel the potential of multisource and multimodal health observational data in generating patient phenotypes and predictions for both individual health and public health surveillance. It addresses the following central question: How can multisource and multimodal observational health data be effectively harnessed, using machine learning, to enhance patient and public health? Comprising five studies, the thesis confronts challenges posed by diverse data sources and modalities, exploring strategies for creating comprehensive patient profiles, developing robust classification models, and employing clustering methods tailored to observational health data. The research seeks to provide valuable insights into integrating AI in healthcare, with a specific emphasis on the complexities of multisource and multimodal data integration. It underscores the importance of exploring heterogeneous health observational data to deepen our understanding of patient health and optimize machine learning applications. Emphasizing the intricate nature of health data, the thesis discusses careful data handling and innovative methodologies to maximize its potential impact on improving patient outcomes and informing public health strategies. The effective management of heterogeneous observational health data requires thoughtful consideration due to their varied sources and inherent complexities.

Place, publisher, year, edition, pages
Stockholm: Department of Computer and Systems Sciences, Stockholm University, 2024. p. 86
Series
Report Series / Department of Computer & Systems Sciences, ISSN 1101-8526 ; 24-009
Keywords
Machine Learning; Artificial Intelligence; Healthcare; Multimodal Data; Complex Data
National Category
Computer Sciences
Research subject
Computer and Systems Sciences
Identifiers
urn:nbn:se:su:diva-231336 (URN)978-91-8014-847-4 (ISBN)978-91-8014-848-1 (ISBN)
Public defence
2024-09-06, L30, NOD-huset, Borgarfjordsgatan 12, Kista, 09:00 (English)
Opponent
Supervisors
Available from: 2024-08-14 Created: 2024-06-18 Last updated: 2024-08-19Bibliographically approved

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Pantelidis, PanteleimonBampa, MariaPapapetrou, Panagiotis

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