CarDS-Plus ECG Platform: Development and Feasibility Evaluation of a Multiplatform Artificial Intelligence Toolkit for Portable and Wearable Device Electrocardiograms

In the rapidly evolving landscape of modern healthcare, the integration of wearable & portable technology provides a unique opportunity for personalized health monitoring in the community. Devices like the Apple Watch, FitBit, and AliveCor KardiaMobile have revolutionized the acquisition and processing of intricate health data streams. Amidst the variety of data collected by these gadgets, single-lead electrocardiogram (ECG) recordings have emerged as a crucial source of information for monitoring cardiovascular health. There has been significant advances in artificial intelligence capable of interpreting these 1-lead ECGs, facilitating clinical diagnosis as well as the detection of rare cardiac disorders. This design study describes the development of an innovative multiplatform system aimed at the rapid deployment of AI-based ECG solutions for clinical investigation & care delivery. The study examines design considerations, aligning them with specific applications, develops data flows to maximize efficiency for research & clinical use. This process encompasses the reception of single-lead ECGs from diverse wearable devices, channeling this data into a centralized data lake & facilitating real-time inference through AI models for ECG interpretation. An evaluation of the platform demonstrates a mean duration from acquisition to reporting of results of 33.0 to 35.7 seconds, after a standard 30 second acquisition. There were no substantial differences in acquisition to reporting across two commercially available devices (Apple Watch and KardiaMobile). These results demonstrate the succcessful translation of design principles into a fully integrated & efficient strategy for leveraging 1-lead ECGs across platforms & interpretation by AI-ECG algorithms. Such a platform is critical to translating AI discoveries for wearable and portable ECG devices to clinical impact through rapid deployment.

Self-Supervised Learning of Echocardiogram Videos Enables Data-Efficient Clinical Diagnosis

Given the difficulty of obtaining high-quality labels for medical image recognition tasks, there is a need for deep learning techniques that can be adequately fine-tuned on small labeled data sets. Recent advances in self-supervised learning techniques have shown that such an in-domain representation learning approach can provide a strong initialization for supervised fine-tuning, proving much more data-efficient than standard transfer learning from a supervised pretraining task. However, these applications are not adapted to applications to medical diagnostics captured in a video format. With this progress in mind, we developed a self-supervised learning approach catered to echocardiogram videos with the goal of learning strong representations for downstream fine-tuning on the task of diagnosing aortic stenosis (AS), a common and dangerous disease of the aortic valve. When fine-tuned on 1% of the training data, our best self-supervised learning model achieves 0.818 AUC (95% CI: 0.794, 0.840), while the standard transfer learning approach reaches 0.644 AUC (95% CI: 0.610, 0.677). We also find that our self-supervised model attends more closely to the aortic valve when predicting severe AS as demonstrated by saliency map visualizations.