A Deep Learning Method for Beat-Level Risk Analysis and Interpretation of Atrial Fibrillation Patients during Sinus Rhythm

Atrial Fibrillation (AF) is a common cardiac arrhythmia. Many AF patients experience complications such as stroke and other cardiovascular issues. Early detection of AF is crucial. Existing algorithms can only distinguish ``AF rhythm in AF patients'' from ``sinus rhythm in normal individuals'' . However, AF patients do not always exhibit AF rhythm, posing a challenge for diagnosis when the AF rhythm is absent. To address this, this paper proposes a novel artificial intelligence (AI) algorithm to distinguish ``sinus rhythm in AF patients'' and ``sinus rhythm in normal individuals'' in beat-level. We introduce beat-level risk interpreters, trend risk interpreters, addressing the interpretability issues of deep learning models and the difficulty in explaining AF risk trends. Additionally, the beat-level information fusion decision is presented to enhance model accuracy. The experimental results demonstrate that the average AUC for single beats used as testing data from CPSC 2021 dataset is 0.7314. By employing 150 beats for information fusion decision algorithm, the average AUC can reach 0.7591. Compared to previous segment-level algorithms, we utilized beats as input, reducing data dimensionality and making the model more lightweight, facilitating deployment on portable medical devices. Furthermore, we draw new and interesting findings through average beat analysis and subgroup analysis, considering varying risk levels.

A Review of Deep Learning Methods for Photoplethysmography Data

Photoplethysmography (PPG) is a highly promising device due to its advantages in portability, user-friendly operation, and non-invasive capabilities to measure a wide range of physiological information. Recent advancements in deep learning have demonstrated remarkable outcomes by leveraging PPG signals for tasks related to personal health management and other multifaceted applications. In this review, we systematically reviewed papers that applied deep learning models to process PPG data between January 1st of 2017 and July 31st of 2023 from Google Scholar, PubMed and Dimensions. Each paper is analyzed from three key perspectives: tasks, models, and data. We finally extracted 193 papers where different deep learning frameworks were used to process PPG signals. Based on the tasks addressed in these papers, we categorized them into two major groups: medical-related, and non-medical-related. The medical-related tasks were further divided into seven subgroups, including blood pressure analysis, cardiovascular monitoring and diagnosis, sleep health, mental health, respiratory monitoring and analysis, blood glucose analysis, as well as others. The non-medical-related tasks were divided into four subgroups, which encompass signal processing, biometric identification, electrocardiogram reconstruction, and human activity recognition. In conclusion, significant progress has been made in the field of using deep learning methods to process PPG data recently. This allows for a more thorough exploration and utilization of the information contained in PPG signals. However, challenges remain, such as limited quantity and quality of publicly available databases, a lack of effective validation in real-world scenarios, and concerns about the interpretability, scalability, and complexity of deep learning models. Moreover, there are still emerging research areas that require further investigation.

Artificial Intelligence System for Detection and Screening of Cardiac Abnormalities using Electrocardiogram Images

The artificial intelligence (AI) system has achieved expert-level performance in electrocardiogram (ECG) signal analysis. However, in underdeveloped countries or regions where the healthcare information system is imperfect, only paper ECGs can be provided. Analysis of real-world ECG images (photos or scans of paper ECGs) remains challenging due to complex environments or interference. In this study, we present an AI system developed to detect and screen cardiac abnormalities (CAs) from real-world ECG images. The system was evaluated on a large dataset of 52,357 patients from multiple regions and populations across the world. On the detection task, the AI system obtained area under the receiver operating curve (AUC) of 0.996 (hold-out test), 0.994 (external test 1), 0.984 (external test 2), and 0.979 (external test 3), respectively. Meanwhile, the detection results of AI system showed a strong correlation with the diagnosis of cardiologists (cardiologist 1 (R=0.794, p<1e-3), cardiologist 2 (R=0.812, p<1e-3)). On the screening task, the AI system achieved AUCs of 0.894 (hold-out test) and 0.850 (external test). The screening performance of the AI system was better than that of the cardiologists (AI system (0.846) vs. cardiologist 1 (0.520) vs. cardiologist 2 (0.480)). Our study demonstrates the feasibility of an accurate, objective, easy-to-use, fast, and low-cost AI system for CA detection and screening. The system has the potential to be used by healthcare professionals, caregivers, and general users to assess CAs based on real-world ECG images.

Cross Reconstruction Transformer for Self-Supervised Time Series Representation Learning

Unsupervised/self-supervised representation learning in time series is critical since labeled samples are usually scarce in real-world scenarios. Existing approaches mainly leverage the contrastive learning framework, which automatically learns to understand the similar and dissimilar data pairs. Nevertheless, they are restricted to the prior knowledge of constructing pairs, cumbersome sampling policy, and unstable performances when encountering sampling bias. Also, few works have focused on effectively modeling across temporal-spectral relations to extend the capacity of representations. In this paper, we aim at learning representations for time series from a new perspective and propose Cross Reconstruction Transformer (CRT) to solve the aforementioned problems in a unified way. CRT achieves time series representation learning through a cross-domain dropping-reconstruction task. Specifically, we transform time series into the frequency domain and randomly drop certain parts in both time and frequency domains. Dropping can maximally preserve the global context compared to cropping and masking. Then a transformer architecture is utilized to adequately capture the cross-domain correlations between temporal and spectral information through reconstructing data in both domains, which is called Dropped Temporal-Spectral Modeling. To discriminate the representations in global latent space, we propose Instance Discrimination Constraint to reduce the mutual information between different time series and sharpen the decision boundaries. Additionally, we propose a specified curriculum learning strategy to optimize the CRT, which progressively increases the dropping ratio in the training process.

Defending Against Adversarial Attack in ECG Classification with Adversarial Distillation Training

In clinics, doctors rely on electrocardiograms (ECGs) to assess severe cardiac disorders. Owing to the development of technology and the increase in health awareness, ECG signals are currently obtained by using medical and commercial devices. Deep neural networks (DNNs) can be used to analyze these signals because of their high accuracy rate. However, researchers have found that adversarial attacks can significantly reduce the accuracy of DNNs. Studies have been conducted to defend ECG-based DNNs against traditional adversarial attacks, such as projected gradient descent (PGD), and smooth adversarial perturbation (SAP) which targets ECG classification; however, to the best of our knowledge, no study has completely explored the defense against adversarial attacks targeting ECG classification. Thus, we did different experiments to explore the effects of defense methods against white-box adversarial attack and black-box adversarial attack targeting ECG classification, and we found that some common defense methods performed well against these attacks. Besides, we proposed a new defense method called Adversarial Distillation Training (ADT) which comes from defensive distillation and can effectively improve the generalization performance of DNNs. The results show that our method performed more effectively against adversarial attacks targeting on ECG classification than the other baseline methods, namely, adversarial training, defensive distillation, Jacob regularization, and noise-to-signal ratio regularization. Furthermore, we found that our method performed better against PGD attacks with low noise levels, which means that our method has stronger robustness.

MetaVA: Curriculum Meta-learning and Pre-fine-tuning of Deep Neural Networks for Detecting Ventricular Arrhythmias based on ECGs

Ventricular arrhythmias (VA) are the main causes of sudden cardiac death. Developing machine learning methods for detecting VA based on electrocardiograms (ECGs) can help save people's lives. However, developing such machine learning models for ECGs is challenging because of the following: 1) group-level diversity from different subjects and 2) individual-level diversity from different moments of a single subject. In this study, we aim to solve these problems in the pre-training and fine-tuning stages. For the pre-training stage, we propose a novel model agnostic meta-learning (MAML) with curriculum learning (CL) method to solve group-level diversity. MAML is expected to better transfer the knowledge from a large dataset and use only a few recordings to quickly adapt the model to a new person. CL is supposed to further improve MAML by meta-learning from easy to difficult tasks. For the fine-tuning stage, we propose improved pre-fine-tuning to solve individual-level diversity. We conduct experiments using a combination of three publicly available ECG datasets. The results show that our method outperforms the compared methods in terms of all evaluation metrics. Ablation studies show that MAML and CL could help perform more evenly, and pre-fine-tuning could better fit the model to training data.

A Deep Bayesian Neural Network for Cardiac Arrhythmia Classification with Rejection from ECG Recordings

With the development of deep learning-based methods, automated classification of electrocardiograms (ECGs) has recently gained much attention. Although the effectiveness of deep neural networks has been encouraging, the lack of information given by the outputs restricts clinicians' reexamination. If the uncertainty estimation comes along with the classification results, cardiologists can pay more attention to "uncertain" cases. Our study aims to classify ECGs with rejection based on data uncertainty and model uncertainty. We perform experiments on a real-world 12-lead ECG dataset. First, we estimate uncertainties using the Monte Carlo dropout for each classification prediction, based on our Bayesian neural network. Then, we accept predictions with uncertainty under a given threshold and provide "uncertain" cases for clinicians. Furthermore, we perform a simulation experiment using varying thresholds. Finally, with the help of a clinician, we conduct case studies to explain the results of large uncertainties and incorrect predictions with small uncertainties. The results show that correct predictions are more likely to have smaller uncertainties, and the performance on accepted predictions improves as the accepting ratio decreases (i.e. more rejections). Case studies also help explain why rejection can improve the performance. Our study helps neural networks produce more accurate results and provide information on uncertainties to better assist clinicians in the diagnosis process. It can also enable deep-learning-based ECG interpretation in clinical implementation.

Learning ECG Representations based on Manipulated Temporal-Spatial Reverse Detection

Learning representations from electrocardiogram (ECG) serves as a fundamental step for many downstream machine learning-based ECG analysis tasks. However, the learning process is always restricted by lack of high-quality labeled data in reality. Existing methods addressing data deficiency either cannot provide satisfied representations for downstream tasks or require too much effort to construct similar and dissimilar pairs to learn informative representations. In this paper, we propose a straightforward but effective approach to learn ECG representations. Inspired by the temporal and spatial characteristics of ECG, we flip the original signals horizontally, vertically, and both horizontally and vertically. The learning is then done by classifying the four types of signals including the original one. To verify the effectiveness of the proposed temporal-spatial (T-S) reverse detection method, we conduct a downstream task to detect atrial fibrillation (AF) which is one of the most common ECG tasks. The results show that the ECG representations learned with our method lead to remarkable performances on the downstream task. In addition, after exploring the representational feature space and investigating which parts of the ECG signal contribute to the representations, we conclude that the temporal reverse is more effective than the spatial reverse for learning ECG representations.