Multimodal wearable EEG, EMG and accelerometry measurements improve the accuracy of tonic-clonic seizure detection in-hospital

Objective: Most current wearable tonic-clonic seizure (TCS) detection systems are based on extra-cerebral signals, such as electromyography (EMG) or accelerometry (ACC). Although many of these devices show good sensitivity in seizure detection, their false positive rates (FPR) are still relatively high. Wearable EEG may improve performance; however, studies investigating this remain scarce. This paper aims 1) to investigate the possibility of detecting TCSs with a behind-the-ear, two-channel wearable EEG, and 2) to evaluate the added value of wearable EEG to other non-EEG modalities in multimodal TCS detection. Method: We included 27 participants with a total of 44 TCSs from the European multicenter study SeizeIT2. The multimodal wearable detection system Sensor Dot (Byteflies) was used to measure two-channel, behind-the-ear EEG, EMG, electrocardiography (ECG), ACC and gyroscope (GYR). First, we evaluated automatic unimodal detection of TCSs, using performance metrics such as sensitivity, precision, FPR and F1-score. Secondly, we fused the different modalities and again assessed performance. Algorithm-labeled segments were then provided to a neurologist and a wearable data expert, who reviewed and annotated the true positive TCSs, and discarded false positives (FPs). Results: Wearable EEG outperformed the other modalities in unimodal TCS detection by achieving a sensitivity of 100.0% and a FPR of 10.3/24h (compared to 97.7% sensitivity and 30.9/24h FPR for EMG; 95.5% sensitivity and 13.9 FPR for ACC). The combination of wearable EEG and EMG achieved overall the most clinically useful performance in offline TCS detection with a sensitivity of 97.7%, a FPR of 0.4/24 h, a precision of 43.0%, and a F1-score of 59.7%. Subsequent visual review of the automated detections resulted in maximal sensitivity and zero FPs.

Cardiac and extracardiac discharge diagnosis prediction from emergency department ECGs using deep learning

Current deep learning algorithms designed for automatic ECG analysis have exhibited notable accuracy. However, akin to traditional electrocardiography, they tend to be narrowly focused and typically address a singular diagnostic condition. In this study, we specifically demonstrate the capability of a single model to predict a diverse range of both cardiac and non-cardiac discharge diagnoses based on a sole ECG collected in the emergency department. Among the 1,076 hierarchically structured ICD codes considered, our model achieves an AUROC exceeding 0.8 in 439 of them. This underscores the models proficiency in handling a wide array of diagnostic scenarios. We emphasize the potential of utilizing this model as a screening tool, potentially integrated into a holistic clinical decision support system for efficiently triaging patients in the emergency department. This research underscores the remarkable capabilities of comprehensive ECG analysis algorithms and the extensive range of possibilities facilitated by the open MIMIC-IV-ECG dataset. Finally, our data may play a pivotal role in revolutionizing the way ECG analysis is performed, marking a significant advancement in the field.

Region-Disentangled Diffusion Model for High-Fidelity PPG-to-ECG Translation

The high prevalence of cardiovascular diseases (CVDs) calls for accessible and cost-effective continuous cardiac monitoring tools. Despite Electrocardiography (ECG) being the gold standard, continuous monitoring remains a challenge, leading to the exploration of Photoplethysmography (PPG), a promising but more basic alternative available in consumer wearables. This notion has recently spurred interest in translating PPG to ECG signals. In this work, we introduce Region-Disentangled Diffusion Model (RDDM), a novel diffusion model designed to capture the complex temporal dynamics of ECG. Traditional Diffusion models like Denoising Diffusion Probabilistic Models (DDPM) face challenges in capturing such nuances due to the indiscriminate noise addition process across the entire signal. Our proposed RDDM overcomes such limitations by incorporating a novel forward process that selectively adds noise to specific regions of interest (ROI) such as QRS complex in ECG signals, and a reverse process that disentangles the denoising of ROI and non-ROI regions. Quantitative experiments demonstrate that RDDM can generate high-fidelity ECG from PPG in as few as 10 diffusion steps, making it highly effective and computationally efficient. Additionally, to rigorously validate the usefulness of the generated ECG signals, we introduce CardioBench, a comprehensive evaluation benchmark for a variety of cardiac-related tasks including heart rate and blood pressure estimation, stress classification, and the detection of atrial fibrillation and diabetes. Our thorough experiments show that RDDM achieves state-of-the-art performance on CardioBench. To the best of our knowledge, RDDM is the first diffusion model for cross-modal signal-to-signal translation in the bio-signal domain.

Comparison of HRV Indices of ECG and BCG Signals

Electrocardiography (ECG) plays a significant role in diagnosing heart-related issues, it provides, accurate, fast, and dependable insights into crucial parameters like QRS complex duration, the R-R interval, and the occurrence, amplitude, and duration of P, R, and T waves. However, utilizing ECG for prolonged monitoring poses challenges as it necessitates connecting multiple electrodes to the patient's body. This can be discomforting and disruptive, hampering the attainment of uninterrupted recordings. Ballistocardiography (BCG) emerges as a promising substitute for ECG, presenting a non-invasive technique for recording the heart's mechanical activity. BCG signals can be captured using sensors positioned beneath the bed, thereby providing enhanced comfort and convenience for long-term monitoring of the subject. In a recent study, researchers compared the heart rate variability (HRV) indices derived from simultaneously acquired ECG and BCG signals. Encouragingly, the BCG signal yielded satisfactory results similar to those obtained from ECG, implying that BCG holds potential as a viable alternative for prolonged monitoring. The findings of this study carry substantial implications for the advancement of innovative, non-invasive methods in monitoring heart health. BCG showcases the ability to offer a more comfortable and convenient alternative to ECG while retaining its capacity to deliver accurate and reliable cardiac information concerning a patient's condition.

Multimodal contrastive learning for diagnosing cardiovascular diseases from electrocardiography (ECG) signals and patient metadata

This work discusses the use of contrastive learning and deep learning for diagnosing cardiovascular diseases from electrocardiography (ECG) signals. While the ECG signals usually contain 12 leads (channels), many healthcare facilities and devices lack access to all these 12 leads. This raises the problem of how to use only fewer ECG leads to produce meaningful diagnoses with high performance. We introduce a simple experiment to test whether contrastive learning can be applied to this task. More specifically, we added the similarity between the embedding vectors when the 12 leads signal and the fewer leads ECG signal to the loss function to bring these representations closer together. Despite its simplicity, this has been shown to have improved the performance of diagnosing with all lead combinations, proving the potential of contrastive learning on this task.

Labour Monitoring in Pregnant Women Using Phonocardiography, Electrocardiography and Electromyography Technique

Continuous monitoring of fetal and maternal vital signs, particularly during labor, can be critical for the child and mother's health. We present a novel wearable electronic system that measures, in real-time, maternal heart rate using phonocardiography (PCG) and Electrocardiography (ECG). Uterine contractions using electromyography (EMG). When in later stages we employed ECG technique for maternal heart rate monitoring. The heart rate is determined using moving average filters to remove noises in the signal and ACF(Autocorrelation Function) for determining periodicity. For UC monitoring we stick to the same EMG technique. We also tried employing EMG technique to monitor the Fetal Heart Rate(FHR). But, in later stages of this design, this idea was aborted as we concluded that it needs further research on pregnancy stages and would require more intricate sensor integration that might not be in our reach at the moment. The system is accurate, low-cost, and portable, so it can be deployed at primary healthcare centers in low-income countries. The system can also be used by women in the comfort of their homes. At the same time, the data collected is transferred to their doctor for analysis and diagnosis, which can bring a revolutionary change in the continuous monitoring of fetal wellbeing during labor.

Automated Identication of Atrial Fibrillation from Single-lead ECGs Using Multi-branching ResNet

Atrial fibrillation (AF) is the most common cardiac arrhythmia, which is clinically identified with irregular and rapid heartbeat rhythm. AF puts a patient at risk of forming blood clots, which can eventually lead to heart failure, stroke, or even sudden death. It is of critical importance to develop an advanced analytical model that can effectively interpret the electrocardiography (ECG) signals and provide decision support for accurate AF diagnostics. In this paper, we propose an innovative deep-learning method for automated AF identification from single-lead ECGs. We first engage the continuous wavelet transform (CWT) to extract time-frequency features from ECG signals. Then, we develop a convolutional neural network (CNN) structure that incorporates ResNet for effective network training and multi-branching architectures for addressing the imbalanced data issue to process the 2D time-frequency features for AF classification. We evaluate the proposed methodology using two real-world ECG databases. The experimental results show a superior performance of our method compared with traditional deep learning models.

Semi-Supervised Learning for Multi-Label Cardiovascular Diseases Prediction:A Multi-Dataset Study

Electrocardiography (ECG) is a non-invasive tool for predicting cardiovascular diseases (CVDs). Current ECG-based diagnosis systems show promising performance owing to the rapid development of deep learning techniques. However, the label scarcity problem, the co-occurrence of multiple CVDs and the poor performance on unseen datasets greatly hinder the widespread application of deep learning-based models. Addressing them in a unified framework remains a significant challenge. To this end, we propose a multi-label semi-supervised model (ECGMatch) to recognize multiple CVDs simultaneously with limited supervision. In the ECGMatch, an ECGAugment module is developed for weak and strong ECG data augmentation, which generates diverse samples for model training. Subsequently, a hyperparameter-efficient framework with neighbor agreement modeling and knowledge distillation is designed for pseudo-label generation and refinement, which mitigates the label scarcity problem. Finally, a label correlation alignment module is proposed to capture the co-occurrence information of different CVDs within labeled samples and propagate this information to unlabeled samples. Extensive experiments on four datasets and three protocols demonstrate the effectiveness and stability of the proposed model, especially on unseen datasets. As such, this model can pave the way for diagnostic systems that achieve robust performance on multi-label CVDs prediction with limited supervision.

Effect of Measurement Location on Cardiac Time Intervals Estimated by Seismocardiography

Cardiac time intervals (CTIs) are important parameters for assessing cardiac function and can be measured using non-invasive methods such as electrocardiography (ECG) and seismocardiography (SCG). It is widely accepted that SCG signals, when measured from various locations on the chest surface, exhibit distinct temporal and spectral characteristics. In that regard, the goal of this study was to determine the effect of the SCG measurement location on estimating SCG-based CTIs. For this purpose, ECG, SCG, and phonocardiography (PCG) signals were acquired from fourteen healthy adult subjects. For SCG, three tri-axial accelerometers were attached on the top, middle, and bottom of the sternum with double-sided tape. In this study, only the dorsoventral components of the SCG signals were analyzed. Using Pan-Tompkin's algorithm, ECG R peaks and their temporal indices were found. Then, a custom-built algorithm in MATLAB was developed to estimate heart rate (HR) from ECG and SCG signals. Furthermore, SCG fiducial points and CTIs were defined from the SCG signals recorded from different sternal locations. The average and correlation coefficient of the CTIs and HRs derived from all three locations were compared. Mean difference and standard deviation were analyzed for the CTIs and their respective sensor location. Results demonstrated that SCG-based CTIs varied with the SCG measurement locations. In conclusion, these results highlighted the importance of establishing consistent research and clinical protocols for reporting CTIs based on SCG. This work also calls for further investigation into comparing estimated CTIs with gold-standard methods such as echocardiography and 4D cardiac computed tomography.

Comparison of Different Segmentations in Automated Detection of Hypertension Using Electrocardiography with Empirical Mode Decomposition

Hypertension (HPT) refers to a condition where the pressure exerted on the walls of arteries by blood pumped from the heart to the body reaches levels that can lead to various ailments. Annually, a significant number of lives are lost globally due to diseases linked to HPT. Therefore, the early and accurate diagnosis of HPT is of utmost importance. This study aimed to automatically and with minimal error detect patients suffering from HPT by utilizing electrocardiogram (ECG) signals. The research involved the collection of ECG signals from two distinct groups. These groups consisted of ECG data of both five thousand and ten thousand data points in length, respectively. The performance in HPT detection was evaluated using entropy measurements derived from the 5-layer Intrinsic Mode Function(IMF) signals through the application of the Empirical Mode Decomposition method. The resulting performances were compared based on the nine features extracted from each IMF. To summarize, employing the 5-fold cross-validation technique, the most exceptional accuracy rates achieved were 99.9991% and 99.9989% for ECG data of lengths five thousand and ten thousand,respectively, using decision tree algorithms. These remarkable performance results indicate the potential usefulness of this method in assisting medical professionals to identify individuals with HPT.