Dataset Information

A Deep-Learning Algorithm (ECG12Net) for Detecting Hypokalemia and Hyperkalemia by Electrocardiography: Algorithm Development.

ABSTRACT: BACKGROUND:The detection of dyskalemias-hypokalemia and hyperkalemia-currently depends on laboratory tests. Since cardiac tissue is very sensitive to dyskalemia, electrocardiography (ECG) may be able to uncover clinically important dyskalemias before laboratory results. OBJECTIVE:Our study aimed to develop a deep-learning model, ECG12Net, to detect dyskalemias based on ECG presentations and to evaluate the logic and performance of this model. METHODS:Spanning from May 2011 to December 2016, 66,321 ECG records with corresponding serum potassium (K+) concentrations were obtained from 40,180 patients admitted to the emergency department. ECG12Net is an 82-layer convolutional neural network that estimates serum K+ concentration. Six clinicians-three emergency physicians and three cardiologists-participated in human-machine competition. Sensitivity, specificity, and balance accuracy were used to evaluate the performance of ECG12Net with that of these physicians. RESULTS:In a human-machine competition including 300 ECGs of different serum K+ concentrations, the area under the curve for detecting hypokalemia and hyperkalemia with ECG12Net was 0.926 and 0.958, respectively, which was significantly better than that of our best clinicians. Moreover, in detecting hypokalemia and hyperkalemia, the sensitivities were 96.7% and 83.3%, respectively, and the specificities were 93.3% and 97.8%, respectively. In a test set including 13,222 ECGs, ECG12Net had a similar performance in terms of sensitivity for severe hypokalemia (95.6%) and severe hyperkalemia (84.5%), with a mean absolute error of 0.531. The specificities for detecting hypokalemia and hyperkalemia were 81.6% and 96.0%, respectively. CONCLUSIONS:A deep-learning model based on a 12-lead ECG may help physicians promptly recognize severe dyskalemias and thereby potentially reduce cardiac events.

SUBMITTER: Lin CS

PROVIDER: S-EPMC7082733 | biostudies-literature | 2020 Mar

REPOSITORIES: biostudies-literature

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A Deep-Learning Algorithm (ECG12Net) for Detecting Hypokalemia and Hyperkalemia by Electrocardiography: Algorithm Development.

Lin Chin-Sheng CS Lin Chin C Fang Wen-Hui WH Hsu Chia-Jung CJ Chen Sy-Jou SJ Huang Kuo-Hua KH Lin Wei-Shiang WS Tsai Chien-Sung CS Kuo Chih-Chun CC Chau Tom T Yang Stephen Jh SJ Lin Shih-Hua SH

JMIR medical informatics 20200305 3

<h4>Background</h4>The detection of dyskalemias-hypokalemia and hyperkalemia-currently depends on laboratory tests. Since cardiac tissue is very sensitive to dyskalemia, electrocardiography (ECG) may be able to uncover clinically important dyskalemias before laboratory results.<h4>Objective</h4>Our study aimed to develop a deep-learning model, ECG12Net, to detect dyskalemias based on ECG presentations and to evaluate the logic and performance of this model.<h4>Methods</h4>Spanning from May 2011 ...[more]

PMID: 32134388

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Project description:(1) Background: Acute pericarditis is often confused with ST-segment elevation myocardial infarction (STEMI) among patients presenting with acute chest pain in the emergency department (ED). Since a deep learning model (DLM) has been validated to accurately identify STEMI cases via 12-lead electrocardiogram (ECG), this study aimed to develop another DLM for the detection of acute pericarditis in the ED. (2) Methods: This study included 128 ECGs from patients with acute pericarditis and 66,633 ECGs from patients visiting the ED between 1 January 2010 and 31 December 2020. The ECGs were randomly allocated based on patients to the training, tuning, and validation sets, at a 3:1:1 ratio. We used raw ECG signals to train a pericarditis-DLM and used traditional ECG features to train a machine learning model. A human-machine competition was conducted using a subset of the validation set, and the performance of the Philips automatic algorithm was also compared. STEMI cases in the validation set were extracted to analyze the DLM ability of differential diagnosis between acute pericarditis and STEMI using ECG. We also followed the hospitalization events in non-pericarditis cases to explore the meaning of false-positive predictions. (3) Results: The pericarditis-DLM exceeded the performance of all participating human experts and algorithms based on traditional ECG features in the human-machine competition. In the validation set, the pericarditis-DLM could detect acute pericarditis with an area under the receiver operating characteristic curve (AUC) of 0.954, a sensitivity of 78.9%, and a specificity of 97.7%. However, our pericarditis-DLM also misinterpreted 10.2% of STEMI ECGs as pericarditis cases. Therefore, we generated an integrating strategy combining pericarditis-DLM and a previously developed STEMI-DLM, which provided a sensitivity of 73.7% and specificity of 99.4%, to identify acute pericarditis in patients with chest pains. Compared to the true-negative cases, patients with false-positive results using this strategy were associated with higher risk of hospitalization within 3 days due to cardiac disorders (hazard ratio (HR): 8.09; 95% confidence interval (CI): 3.99 to 16.39). (4) Conclusions: The AI-enhanced algorithm may be a powerful tool to assist clinicians in the early detection of acute pericarditis and differentiate it from STEMI using 12-lead ECGs.

Project description:Study designRetrospective diagnostic study.ObjectiveTo automatically detect osteolytic bone metastasis lesions in the thoracolumbar region using conventional computed tomography (CT) scans, we developed a new deep learning (DL)-based computer-aided detection model.Summary of background dataRadiographic detection of bone metastasis is often difficult, even for orthopedic surgeons and diagnostic radiologists, with a consequent risk for pathologic fracture or spinal cord injury. If we can improve detection rates, we will be able to prevent the deterioration of patients' quality of life at the end stage of cancer.Materials and methodsThis study included CT scans acquired at Tokyo Medical and Dental University (TMDU) Hospital between 2016 and 2022. A total of 263 positive CT scans that included at least one osteolytic bone metastasis lesion in the thoracolumbar spine and 172 negative CT scans without bone metastasis were collected for the datasets to train and validate the DL algorithm. As a test data set, 20 positive and 20 negative CT scans were separately collected from the training and validation datasets. To evaluate the performance of the established artificial intelligence (AI) model, sensitivity, precision, F1-score, and specificity were calculated. The clinical utility of our AI model was also evaluated through observer studies involving six orthopaedic surgeons and six radiologists.ResultsOur AI model showed a sensitivity, precision, and F1-score of 0.78, 0.68, and 0.72 (per slice) and 0.75, 0.36, and 0.48 (per lesion), respectively. The observer studies revealed that our AI model had comparable sensitivity to orthopaedic or radiology experts and improved the sensitivity and F1-score of residents.ConclusionWe developed a novel DL-based AI model for detecting osteolytic bone metastases in the thoracolumbar spine. Although further improvement in accuracy is needed, the current AI model may be applied to current clinical practice.Level of evidenceLevel III.

Project description:ImportanceFor patients with chronic kidney disease (CKD), hyperkalemia is common, associated with fatal arrhythmias, and often asymptomatic, while guideline-directed monitoring of serum potassium is underused. A deep-learning model that enables noninvasive hyperkalemia screening from the electrocardiogram (ECG) may improve detection of this life-threatening condition.ObjectiveTo evaluate the performance of a deep-learning model in detection of hyperkalemia from the ECG in patients with CKD.Design, setting, and participantsA deep convolutional neural network (DNN) was trained using 1 576 581 ECGs from 449 380 patients seen at Mayo Clinic, Rochester, Minnesota, from 1994 to 2017. The DNN was trained using 2 (leads I and II) or 4 (leads I, II, V3, and V5) ECG leads to detect serum potassium levels of 5.5 mEq/L or less (to convert to millimoles per liter, multiply by 1) and was validated using retrospective data from the Mayo Clinic in Minnesota, Florida, and Arizona. The validation included 61 965 patients with stage 3 or greater CKD. Each patient had a serum potassium count drawn within 4 hours after their ECG was recorded. Data were analyzed between April 12, 2018, and June 25, 2018.ExposuresUse of a deep-learning model.Main outcomes and measuresArea under the receiver operating characteristic curve (AUC) and sensitivity and specificity, with serum potassium level as the reference standard. The model was evaluated at 2 operating points, 1 for equal specificity and sensitivity and another for high (90%) sensitivity.ResultsOf the total 1 638 546 ECGs, 908 000 (55%) were from men. The prevalence of hyperkalemia in the 3 validation data sets ranged from 2.6% (n = 1282 of 50 099; Minnesota) to 4.8% (n = 287 of 6011; Florida). Using ECG leads I and II, the AUC of the deep-learning model was 0.883 (95% CI, 0.873-0.893) for Minnesota, 0.860 (95% CI, 0.837-0.883) for Florida, and 0.853 (95% CI, 0.830-0.877) for Arizona. Using a 90% sensitivity operating point, the sensitivity was 90.2% (95% CI, 88.4%-91.7%) and specificity was 63.2% (95% CI, 62.7%-63.6%) for Minnesota; the sensitivity was 91.3% (95% CI, 87.4%-94.3%) and specificity was 54.7% (95% CI, 53.4%-56.0%) for Florida; and the sensitivity was 88.9% (95% CI, 84.5%-92.4%) and specificity was 55.0% (95% CI, 53.7%-56.3%) for Arizona.Conclusions and relevanceIn this study, using only 2 ECG leads, a deep-learning model detected hyperkalemia in patients with renal disease with an AUC of 0.853 to 0.883. The application of artificial intelligence to the ECG may enable screening for hyperkalemia. Prospective studies are warranted.

Dataset Information

A Deep-Learning Algorithm (ECG12Net) for Detecting Hypokalemia and Hyperkalemia by Electrocardiography: Algorithm Development.

Publications

A Deep-Learning Algorithm (ECG12Net) for Detecting Hypokalemia and Hyperkalemia by Electrocardiography: Algorithm Development.

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