The objective of this study was to classify 27 cardiac abnormalities based on a data set of 43 101 ECG recordings. A hybrid model combining a rule-based algorithm with different deep learning architectures was developed. We compared two different Convolutional Neural Networks; a Fully Convolutional Neural Network and an Encoder Network, a combination of both, and with the addition of another neural network using age and gender as input. Two of these combinations were finally combined with a rule-based model using derived ECG features. The performance of the models was evaluated on validation data during model development using hold-out validation. Finally, the models were deployed to a Docker image, trained on the provided development data, and tested on the Challenge validation set. The model that performed best on the Challenge validation set was then deployed and tested on the full Challenge test set. The performance was evaluated based on a particular Challenge score. Our team, TeamUIO, achieved a Challenge validation score of 0.377, and a full test score of 0.206 for our best model. The score on the full test set placed us at 20th out of 41 teams in the official ranking.
Supervised deep learning has been widely used in the studies of automatic ECG classification, which largely benefits from sufficient annotation of large datasets. However, most of the existing large ECG datasets are roughly annotated, so the classification model trained on them can only detect the existence of abnormalities in a whole recording, but cannot determine their exact occurrence time. In addition, it may take huge time and economic cost to construct a fine-annotated ECG dataset. Therefore, this study proposes weakly supervised deep learning models for detecting abnormal ECG events and their occurrence time. The available supervision information for the models is limited to the event types in an ECG record, excluding the specific occurring time of each event. By leverage of feature locality of deep convolution neural network, the models first make predictions based on the local features, and then aggregate the local predictions to infer the existence of each event during the whole record. Through training, the local predictions are expected to reflect the specific occurring time of each event. To test their potentials, we apply the models for detecting cardiac rhythmic and morphological arrhythmias by using the AFDB and MITDB datasets, respectively. The results show that the models achieve beat-level accuracies of 99.09% in detecting atrial fibrillation, and 99.13% in detecting morphological arrhythmias, which are comparable to that of fully supervised learning models, demonstrating their effectiveness. The local prediction maps revealed by this method are also helpful to analyze and diagnose the decision logic of record-level classification models.
In the time-series analysis, the time series motifs and the order patterns in time series can reveal general temporal patterns and dynamic features. Triadic Motif Field (TMF) is a simple and effective time-series image encoding method based on triadic time series motifs. Electrocardiography (ECG) signals are time-series data widely used to diagnose various cardiac anomalies. The TMF images contain the features characterizing the normal and Atrial Fibrillation (AF) ECG signals. Considering the quasi-periodic characteristics of ECG signals, the dynamic features can be extracted from the TMF images with the transfer learning pre-trained convolutional neural network (CNN) models. With the extracted features, the simple classifiers, such as the Multi-Layer Perceptron (MLP), the logistic regression, and the random forest, can be applied for accurate anomaly detection. With the test dataset of the PhysioNet Challenge 2017 database, the TMF classification model with the VGG16 transfer learning model and MLP classifier demonstrates the best performance with the 95.50% ROC-AUC and 88.43% F1 score in the AF classification. Besides, the TMF classification model can identify AF patients in the test dataset with high precision. The feature vectors extracted from the TMF images show clear patient-wise clustering with the t-distributed Stochastic Neighbor Embedding technique. Above all, the TMF classification model has very good clinical interpretability. The patterns revealed by symmetrized Gradient-weighted Class Activation Mapping have a clear clinical interpretation at the beat and rhythm levels.
The recent advances in ECG sensor devices provide opportunities for user self-managed auto-diagnosis and monitoring services over the internet. This imposes the requirements for generic ECG classification methods that are inter-patient and device independent. In this paper, we present our work on using the densely connected convolutional neural network (DenseNet) and gated recurrent unit network (GRU) for addressing the inter-patient ECG classification problem. A deep learning model architecture is proposed and is evaluated using the MIT-BIH Arrhythmia and Supraventricular Databases. The results obtained show that without applying any complicated data pre-processing or feature engineering methods, both of our models have considerably outperformed the state-of-the-art performance for supraventricular (SVEB) and ventricular (VEB) arrhythmia classifications on the unseen testing dataset (with the F1 score improved from 51.08 to 61.25 for SVEB detection and from 88.59 to 89.75 for VEB detection respectively). As no patient-specific or device-specific information is used at the training stage in this work, it can be considered as a more generic approach for dealing with scenarios in which varieties of ECG signals are collected from different patients using different types of sensor devices.
It is challenging to visually detect heart disease from the electrocardiographic (ECG) signals. Implementing an automated ECG signal detection system can help diagnosis arrhythmia in order to improve the accuracy of diagnosis. In this paper, we proposed, implemented, and compared an automated system using two different frameworks of the combination of convolutional neural network (CNN) and long-short term memory (LSTM) for classifying normal sinus signals, atrial fibrillation, and other noisy signals. The dataset we used is from the MIT-BIT Arrhythmia Physionet. Our approach demonstrated that the cascade of two deep learning network has higher performance than the concatenation of them, achieving a weighted f1 score of 0.82. The experimental results have successfully validated that the cascade of CNN and LSTM can achieve satisfactory performance on discriminating ECG signals.
An essential part for the accurate classification of electrocardiogram (ECG) signals is the extraction of informative yet general features, which are able to discriminate diseases. Cardiovascular abnormalities manifest themselves in features on different time scales: small scale morphological features, such as missing P-waves, as well as rhythmical features apparent on heart rate scales. For this reason we incorporate a variant of the complex wavelet transform, called a scatter transform, in a deep residual neural network (ResNet). The former has the advantage of being derived from theory, making it well behaved under certain transformations of the input. The latter has proven useful in ECG classification, allowing feature extraction and classification to be learned in an end-to-end manner. Through the incorporation of trainable layers in between scatter transforms, the model gains the ability to combine information from different channels, yielding more informative features for the classification task and adapting them to the specific domain. For evaluation, we submitted our model in the official phase in the PhysioNet/Computing in Cardiology Challenge 2020. Our (Team Triage) approach achieved a challenge validation score of 0.640, and full test score of 0.485, placing us 4th out of 41 in the official ranking.
This paper proposes piece-wise matching layer as a novel layer in representation learning methods for electrocardiogram (ECG) classification. Despite the remarkable performance of representation learning methods in the analysis of time series, there are still several challenges associated with these methods ranging from the complex structures of methods, the lack of generality of solutions, the need for expert knowledge, and large-scale training datasets. We introduce the piece-wise matching layer that works based on two levels to address some of the aforementioned challenges. At the first level, a set of morphological, statistical, and frequency features and comparative forms of them are computed based on each periodic part and its neighbors. At the second level, these features are modified by predefined transformation functions based on a receptive field scenario. Several scenarios of offline processing, incremental processing, fixed sliding receptive field, and event-based triggering receptive field can be implemented based on the choice of length and mechanism of indicating the receptive field. We propose dynamic time wrapping as a mechanism that indicates a receptive field based on event triggering tactics. To evaluate the performance of this method in time series analysis, we applied the proposed layer in two publicly available datasets of PhysioNet competitions in 2015 and 2017 where the input data is ECG signal. We compared the performance of our method against a variety of known tuned methods from expert knowledge, machine learning, deep learning methods, and the combination of them. The proposed approach improves the state of the art in two known completions 2015 and 2017 around 4% and 7% correspondingly while it does not rely on in advance knowledge of the classes or the possible places of arrhythmia.
We developed a convolutional recurrent neural network to classify 12-lead ECG signals for the challenge of PhysioNet/ Computing in Cardiology 2020 as team Pink Irish Hat. The model combines convolutional and recurrent layers, takes sliding windows of ECG signals as input and yields the probability of each class as output. The convolutional part extracts features from each sliding window. The bi-directional gated recurrent unit (GRU) layer and an attention layer aggregate these features from all windows into a single feature vector. Finally, a dense layer outputs class probabilities. The final decision is made using test time augmentation (TTA) and an optimized decision threshold. Several hyperparameters of our architecture were optimized, the most important of which turned out to be the choice of optimizer and the number of filters per convolutional layer. Our network achieved a challenge score of 0.511 on the hidden validation set and 0.167 on the full hidden test set, ranking us 23rd out of 41 in the official ranking.
Recently, the Bag-Of-Word (BOW) algorithm provides efficient features and promotes the accuracy of the ECG classification system. However, BOW algorithm has two shortcomings: (1). it has large quantization errors and poor reconstruction performance; (2). it loses heart beat's time information, and may provide confusing features for different kinds of heart beats. Furthermore, ECG classification system can be used for long time monitoring and analysis of cardiovascular patients, while a huge amount of data will be produced, so we urgently need an efficient compression algorithm. In view of the above problems, we use the wavelet feature to construct the sparse dictionary, which lower the quantization error to a minimum. In order to reduce the complexity of our algorithm and adapt to large-scale heart beats operation, we combine the Online Dictionary Learning with Feature-sign algorithm to update the dictionary and coefficients. Coefficients matrix is used to represent ECG beats, which greatly reduces the memory consumption, and solve the problem of quantitative error simultaneously. Finally, we construct the pyramid to match coefficients of each ECG beat. Thus, we obtain the features that contain the beat time information by time stochastic pooling. It is efficient to solve the problem of losing time information. The experimental results show that: on the one hand, the proposed algorithm has advantages of high reconstruction performance for BOW, this storage method is high fidelity and low memory consumption; on the other hand, our algorithm yields highest accuracy in ECG beats classification; so this method is more suitable for large-scale heart beats data storage and classification.
Electrocardiogram (ECG) is the most widely used diagnostic tool to monitor the condition of the cardiovascular system. Deep neural networks (DNNs), have been developed in many research labs for automatic interpretation of ECG signals to identify potential abnormalities in patient hearts. Studies have shown that given a sufficiently large amount of data, the classification accuracy of DNNs could reach human-expert cardiologist level. However, despite of the excellent performance in classification accuracy, it has been shown that DNNs are highly vulnerable to adversarial noises which are subtle changes in input of a DNN and lead to a wrong class-label prediction with a high confidence. Thus, it is challenging and essential to improve robustness of DNNs against adversarial noises for ECG signal classification, a life-critical application. In this work, we designed a CNN for classification of 12-lead ECG signals with variable length, and we applied three defense methods to improve robustness of this CNN for this classification task. The ECG data in this study is very challenging because the sample size is limited, and the length of each ECG recording varies in a large range. The evaluation results show that our customized CNN reached satisfying F1 score and average accuracy, comparable to the top-6 entries in the CPSC2018 ECG classification challenge, and the defense methods enhanced robustness of our CNN against adversarial noises and white noises, with a minimal reduction in accuracy on clean data.
Generating training examples for supervised tasks is a long sought after goal in AI. We study the problem of heart signal electrocardiogram (ECG) synthesis for improved heartbeat classification. ECG synthesis is challenging: the generation of training examples for such biological-physiological systems is not straightforward, due to their dynamic nature in which the various parts of the system interact in complex ways. However, an understanding of these dynamics has been developed for years in the form of mathematical process simulators. We study how to incorporate this knowledge into the generative process by leveraging a biological simulator for the task of ECG classification. Specifically, we use a system of ordinary differential equations representing heart dynamics, and incorporate this ODE system into the optimization process of a generative adversarial network to create biologically plausible ECG training examples. We perform empirical evaluation and show that heart simulation knowledge during the generation process improves ECG classification.
Electrocardiography is a very common, non-invasive diagnostic procedure and its interpretation is increasingly supported by automatic interpretation algorithms. The progress in the field of automatic ECG interpretation has up to now been hampered by a lack of appropriate datasets for training as well as a lack of well-defined evaluation procedures to ensure comparability of different algorithms. To alleviate these issues, we put forward first benchmarking results for the recently published, freely accessible PTB-XL dataset, covering a variety of tasks from different ECG statement prediction tasks over age and gender prediction to signal quality assessment. We find that convolutional neural networks, in particular resnet- and inception-based architectures, show the strongest performance across all tasks outperforming feature-based algorithms by a large margin. These results are complemented by deeper insights into the classification algorithm in terms of hidden stratification, model uncertainty and an exploratory interpretability analysis. We also put forward benchmarking results for the ICBEB2018 challenge ECG dataset and discuss prospects of transfer learning using classifiers pretrained on PTB-XL. With this resource, we aim to establish the PTB-XL dataset as a resource for structured benchmarking of ECG analysis algorithms and encourage other researchers in the field to join these efforts.
Objective: A novel structure based on channel-wise attention mechanism is presented in this paper. Embedding with the proposed structure, an efficient classification model that accepts multi-lead electrocardiogram (ECG) as input is constructed. Methods: One-dimensional convolutional neural networks (CNN) have proven to be effective in pervasive classification tasks, enabling the automatic extraction of features while classifying targets. We implement the Residual connection and design a structure which can learn the weights from the information contained in different channels in the input feature map during the training process. An indicator named mean square deviation is introduced to monitor the performance of a particular model segment in the classification task on the two out of the five ECG classes. The data in the MIT-BIH arrhythmia database is used and a series of control experiments is conducted. Results: Utilizing both leads of the ECG signals as input to the neural network classifier can achieve better classification results than those from using single channel inputs in different application scenarios. Models embedded with the channel-wise attention structure always achieve better scores on sensitivity and precision than the plain Resnet models. The proposed model exceeds the performance of most of the state-of-the-art models in ventricular ectopic beats (VEB) classification, and achieves competitive scores for supraventricular ectopic beats (SVEB). Conclusion: Adopting more lead ECG signals as input can increase the dimensions of the input feature maps, helping to improve both the performance and generalization of the network model. Significance: Due to its end-to-end characteristics, and the extensible intrinsic for multi-lead heart diseases diagnosing, the proposed model can be used for the real-time ECG tracking of ECG waveforms for Holter or wearable devices.
This paper presents a novel ECG classification algorithm for real-time cardiac monitoring on ultra low-power wearable devices. The proposed solution is based on spiking neural networks which are the third generation of neural networks. In specific, we employ spike-timing dependent plasticity (STDP), and reward-modulated STDP (R-STDP), in which the model weights are trained according to the timings of spike signals, and reward or punishment signals. Experiments show that the proposed solution is suitable for real-time operation, achieves comparable accuracy with respect to previous methods, and more importantly, its energy consumption is significantly smaller than previous neural network based solutions.
The reservoir computing paradigm is employed to classify heartbeat anomalies online based on electrocardiogram signals. Inspired by the principles of information processing in the brain, reservoir computing provides a framework to design, train, and analyze recurrent neural networks (RNNs) for processing time-dependent information. Due to its computational efficiency and the fact that training amounts to a simple linear regression, this supervised learning algorithm has been variously considered as a strategy to implement useful computations not only on digital computers but also on emerging unconventional hardware platforms such as neuromorphic microchips. Here, this biological-inspired learning framework is exploited to devise an accurate patient-adaptive model that has the potential to be integrated into wearable cardiac events monitoring devices. The proposed patient-customized model was trained and tested on ECG recordings selected from the MIT-BIH arrhythmia database. Restrictive inclusion criteria were used to conduct the study only on ECGs including, at least, two classes of heartbeats with highly unequal number of instances. The results of extensive simulations showed this model not only provides accurate, cheap and fast patient-customized heartbeat classifier but also circumvents the problem of "imbalanced classes" when the readout weights are trained using weighted ridge-regression.
In recent years, the electrocardiogram (ECG) has seen a large diffusion in both medical and commercial applications, fueled by the rise of single-lead versions. Single-lead ECG can be embedded in medical devices and wearable products such as the injectable Medtronic Linq monitor, the iRhythm Ziopatch wearable monitor, and the Apple Watch Series 4. Recently, deep neural networks have been used to automatically analyze ECG tracings, outperforming even physicians specialized in cardiac electrophysiology in detecting certain rhythm irregularities. However, deep learning classifiers have been shown to be brittle to adversarial examples, which are examples created to look incontrovertibly belonging to a certain class to a human eye but contain subtle features that fool the classifier into misclassifying them into the wrong class. Very recently, adversarial examples have also been created for medical-related tasks. Yet, traditional attack methods to create adversarial examples, such as projected gradient descent (PGD) do not extend directly to ECG signals, as they generate examples that introduce square wave artifacts that are not physiologically plausible. Here, we developed a method to construct smoothed adversarial examples for single-lead ECG. First, we implemented a neural network model achieving state-of-the-art performance on the data from the 2017 PhysioNet/Computing-in-Cardiology Challenge for arrhythmia detection from single lead ECG classification. For this model, we utilized a new technique to generate smoothed examples to produce signals that are 1) indistinguishable to cardiologists from the original examples and 2) incorrectly classified by the neural network. Finally, we show that adversarial examples are not unique and provide a general technique to collate and perturb known adversarial examples to create new ones.
The role of automatic electrocardiogram (ECG) analysis in clinical practice is limited by the accuracy of existing models. Deep Neural Networks (DNNs) are models composed of stacked transformations that learn tasks by examples. This technology has recently achieved striking success in a variety of task and there are great expectations on how it might improve clinical practice. Here we present a DNN model trained in a dataset with more than 2 million labeled exams analyzed by the Telehealth Network of Minas Gerais and collected under the scope of the CODE (Clinical Outcomes in Digital Electrocardiology) study. The DNN outperform cardiology resident medical doctors in recognizing 6 types of abnormalities in 12-lead ECG recordings, with F1 scores above 80% and specificity over 99%. These results indicate ECG analysis based on DNNs, previously studied in a single-lead setup, generalizes well to 12-lead exams, taking the technology closer to the standard clinical practice.
Early recognition of abnormal rhythms in ECG signals is crucial for monitoring and diagnosing patients' cardiac conditions, increasing the success rate of the treatment. Classifying abnormal rhythms into exact categories is very challenging due to the broad taxonomy of rhythms, noises and lack of large-scale real-world annotated data. Different from previous methods that utilize hand-crafted features or learn features from the original signal domain, we propose a novel ECG classification method by learning deep time-frequency representation and progressive decision fusion at different temporal scales in an end-to-end manner. First, the ECG wave signal is transformed into the time-frequency domain by using the Short-Time Fourier Transform. Next, several scale-specific deep convolutional neural networks are trained on ECG samples of a specific length. Finally, a progressive online decision fusion method is proposed to fuse decisions from the scale-specific models into a more accurate and stable one. Extensive experiments on both synthetic and real-world ECG datasets demonstrate the effectiveness and efficiency of the proposed method.
In this article, we propose a novel ECG classification framework for atrial fibrillation (AF) detection using spectro-temporal representation (i.e., time varying spectrum) and deep convolutional networks. In the first step we use a Bayesian spectro-temporal representation based on the estimation of time-varying coefficients of Fourier series using Kalman filter and smoother. Next, we derive an alternative model based on a stochastic oscillator differential equation to accelerate the estimation of the spectro-temporal representation in lengthy signals. Finally, after comparative evaluations of different convolutional architectures, we propose an efficient deep convolutional neural network to classify the 2D spectro-temporal ECG data. The ECG spectro-temporal data are classified into four different classes: AF, non-AF normal rhythm (Normal), non-AF abnormal rhythm (Other), and noisy segments (Noisy). The performance of the proposed methods is evaluated and scored with the PhysioNet/Computing in Cardiology (CinC) 2017 dataset. The experimental results show that the proposed method achieves the overall F1 score of 80.2%, which is in line with the state-of-the-art algorithms.
Objective: A novel ECG classification algorithm is proposed for continuous cardiac monitoring on wearable devices with limited processing capacity. Methods: The proposed solution employs a novel architecture consisting of wavelet transform and multiple LSTM recurrent neural networks. Results: Experimental evaluations show superior ECG classification performance compared to previous works. Measurements on different hardware platforms show the proposed algorithm meets timing requirements for continuous and real-time execution on wearable devices. Conclusion: In contrast to many compute-intensive deep-learning based approaches, the proposed algorithm is lightweight, and therefore, brings continuous monitoring with accurate LSTM-based ECG classification to wearable devices. Significance: The proposed algorithm is both accurate and lightweight. The source code is available online [1].