Clinicians are increasingly looking towards machine learning to gain insights about patient evolutions. We propose a novel approach named Multi-Modal UMLS Graph Learning (MMUGL) for learning meaningful representations of medical concepts using graph neural networks over knowledge graphs based on the unified medical language system. These representations are aggregated to represent entire patient visits and then fed into a sequence model to perform predictions at the granularity of multiple hospital visits of a patient. We improve performance by incorporating prior medical knowledge and considering multiple modalities. We compare our method to existing architectures proposed to learn representations at different granularities on the MIMIC-III dataset and show that our approach outperforms these methods. The results demonstrate the significance of multi-modal medical concept representations based on prior medical knowledge.
Murmurs are sounds caused by turbulent blood flow that are often the first sign of structural heart disease. These sounds are detected by auscultating the heart using a stethoscope, or more recently by a phonocardiogram (PCG). We aim to identify the presence, absence, or unclear cases of murmurs, as well as predict normal or abnormal clinical outcome from PCG recordings using machine learning. We trained and tested two 1-dimensional convolutional neural networks (CNN) on a PCG data set from a pediatric population of 1568 individuals. One model predicted murmurs, while the other model predicted clinical outcomes. Both models were trained to give recording-wise predictions, while the final predictions were given for every patient (patient-wise predictions). This paper describes our participation in the George B. Moody PhysioNet Challenge 2022 whose objective was to identify heart murmurs and clinical outcome from PCGs. Our team, Simulab, trained a clinical outcome classifier that achieved a challenge cost score of 12419 (ranked 14th out of 39 teams) and the murmur classifier achieved a weighted accuracy of 0.593 (ranked 30th out of 40 teams) on the test set.
Cardiac auscultation is one of the most cost-effective techniques used to detect and identify many heart conditions. Computer-assisted decision systems based on auscultation can support physicians in their decisions. Unfortunately, the application of such systems in clinical trials is still minimal since most of them only aim to detect the presence of extra or abnormal waves in the phonocardiogram signal, i.e., only a binary ground truth variable (normal vs abnormal) is provided. This is mainly due to the lack of large publicly available datasets, where a more detailed description of such abnormal waves (e.g., cardiac murmurs) exists. To pave the way to more effective research on healthcare recommendation systems based on auscultation, our team has prepared the currently largest pediatric heart sound dataset. A total of 5282 recordings have been collected from the four main auscultation locations of 1568 patients, in the process, 215780 heart sounds have been manually annotated. Furthermore, and for the first time, each cardiac murmur has been manually annotated by an expert annotator according to its timing, shape, pitch, grading, and quality. In addition, the auscultation locations where the murmur is present were identified as well as the auscultation location where the murmur is detected more intensively. Such detailed description for a relatively large number of heart sounds may pave the way for new machine learning algorithms with a real-world application for the detection and analysis of murmur waves for diagnostic purposes.