End-to-end risk prediction of atrial fibrillation from the 12-Lead ECG by deep neural networks.

BACKGROUND: Atrial fibrillation (AF) is one of the most common cardiac arrhythmias that affects millions of people each year worldwide and it is closely linked to increased risk of cardiovas- cular diseases such as stroke and heart failure. Machine learning methods have shown promising results in evaluating the risk of developing atrial fibrillation from the electrocardiogram. We aim to develop and evaluate one such algorithm on a large CODE dataset collected in Brazil. METHODS: We used the CODE cohort to develop and test a model for AF risk prediction for individual patients from the raw ECG recordings without the use of additional digital biomarkers. The cohort is a collection of ECG recordings and annotations by the Telehealth Network of Minas Gerais, in Brazil. A convolutional neural network based on a residual network architecture was implemented to produce class probabilities for the classification of AF. The probabilities were used to develop a Cox proportional hazards model and a Kaplan-Meier model to carry out survival analysis. Hence, our model is able to perform risk prediction for the development of AF in patients without the condition. RESULTS: The deep neural network model identified patients without indication of AF in the presented ECG but who will develop AF in the future with an AUC score of 0.845. From our survival model, we obtain that patients in the high-risk group (i.e. with the probability of a future AF case being >0.7) are 50% more likely to develop AF within 40 weeks, while patients belonging to the minimal-risk group (i.e. with the probability of a future AF case being less than or equal to 0.1) have >85% chance of remaining AF free up until after seven years. CONCLUSION: We developed and validated a model for AF risk prediction. If applied in clinical practice, the model possesses the potential of providing valuable and useful information in decision- making and patient management processes.

Screening for Chagas disease from the electrocardiogram using a deep neural network.

BACKGROUND: Worldwide, it is estimated that over 6 million people are infected with Chagas disease (ChD). It is a neglected disease that can lead to severe heart conditions in its chronic phase. While early treatment can avoid complications, the early-stage detection rate is low. We explore the use of deep neural networks to detect ChD from electrocardiograms (ECGs) to aid in the early detection of the disease. METHODS: We employ a convolutional neural network model that uses 12-lead ECG data to compute the probability of a ChD diagnosis. Our model is developed using two datasets which jointly comprise over two million entries from Brazilian patients: The SaMi-Trop study focusing on ChD patients, enriched with data from the CODE study from the general population. The model's performance is evaluated on two external datasets: the REDS-II, a study focused on ChD with 631 patients, and the ELSA-Brasil study, with 13,739 civil servant patients. FINDINGS: Evaluating our model, we obtain an AUC-ROC of 0.80 (CI 95% 0.79-0.82) for the validation set (samples from CODE and SaMi-Trop), and in external validation datasets: 0.68 (CI 95% 0.63-0.71) for REDS-II and 0.59 (CI 95% 0.56-0.63) for ELSA-Brasil. In the latter, we report a sensitivity of 0.52 (CI 95% 0.47-0.57) and 0.36 (CI 95% 0.30-0.42) and a specificity of 0.77 (CI 95% 0.72-0.81) and 0.76 (CI 95% 0.75-0.77), respectively. Additionally, when considering only patients with Chagas cardiomyopathy as positive, the model achieved an AUC-ROC of 0.82 (CI 95% 0.77-0.86) for REDS-II and 0.77 (CI 95% 0.68-0.85) for ELSA-Brasil. INTERPRETATION: The neural network detects chronic Chagas cardiomyopathy (CCC) from ECG-with weaker performance for early-stage cases. Future work should focus on curating large higher-quality datasets. The CODE dataset, our largest development dataset includes self-reported and therefore less reliable labels, limiting performance for non-CCC patients. Our findings can improve ChD detection and treatment, particularly in high-prevalence areas.

Development and validation of deep learning ECG-based prediction of myocardial infarction in emergency department patients.

Myocardial infarction diagnosis is a common challenge in the emergency department. In managed settings, deep learning-based models and especially convolutional deep models have shown promise in electrocardiogram (ECG) classification, but there is a lack of high-performing models for the diagnosis of myocardial infarction in real-world scenarios. We aimed to train and validate a deep learning model using ECGs to predict myocardial infarction in real-world emergency department patients. We studied emergency department patients in the Stockholm region between 2007 and 2016 that had an ECG obtained because of their presenting complaint. We developed a deep neural network based on convolutional layers similar to a residual network. Inputs to the model were ECG tracing, age, and sex; and outputs were the probabilities of three mutually exclusive classes: non-ST-elevation myocardial infarction (NSTEMI), ST-elevation myocardial infarction (STEMI), and control status, as registered in the SWEDEHEART and other registries. We used an ensemble of five models. Among 492,226 ECGs in 214,250 patients, 5,416 were recorded with an NSTEMI, 1,818 a STEMI, and 485,207 without a myocardial infarction. In a random test set, our model could discriminate STEMIs/NSTEMIs from controls with a C-statistic of 0.991/0.832 and had a Brier score of 0.001/0.008. The model obtained a similar performance in a temporally separated test set of the study sample, and achieved a C-statistic of 0.985 and a Brier score of 0.002 in discriminating STEMIs from controls in an external test set. We developed and validated a deep learning model with excellent performance in discriminating between control, STEMI, and NSTEMI on the presenting ECG of a real-world sample of the important population of all-comers to the emergency department. Hence, deep learning models for ECG decision support could be valuable in the emergency department.

Memory efficient constrained optimization of scanning-beam lithography.

This article describes a memory efficient method for solving large-scale optimization problems that arise when planning scanning-beam lithography processes. These processes require the identification of an exposure pattern that minimizes the difference between a desired and predicted output image, subject to constraints. The number of free variables is equal to the number of pixels, which can be on the order of millions or billions in practical applications. The proposed method splits the problem domain into a number of smaller overlapping subdomains with constrained boundary conditions, which are then solved sequentially using a constrained gradient search method (L-BFGS-B). Computational time is reduced by exploiting natural sparsity in the problem and employing the fast Fourier transform for efficient gradient calculation. When it comes to the trade-off between memory usage and computational time we can make a different trade-off compared to previous methods, where the required memory is reduced by approximately the number of subdomains at the cost of more computations. In an example problem with 30 million variables, the proposed method reduces memory requirements by 67% but increases computation time by 27%. Variations of the proposed method are expected to find applications in the planning of processes such as scanning laser lithography, scanning electron beam lithography, and focused ion beam deposition, for example.

Direct Transmittance Estimation in Heterogeneous Participating Media Using Approximated Taylor Expansions.

Evaluating the transmittance between two points along a ray is a key component in solving the light transport through heterogeneous participating media and entails computing an intractable exponential of the integrated medium's extinction coefficient. While algorithms for estimating this transmittance exist, there is a lack of theoretical knowledge about their behaviour, which also prevent new theoretically sound algorithms from being developed. For this purpose, we introduce a new class of unbiased transmittance estimators based on random sampling or truncation of a Taylor expansion of the exponential function. In contrast to classical tracking algorithms, these estimators are non-analogous to the physical light transport process and directly sample the underlying extinction function without performing incremental advancement. We present several versions of the new class of estimators, based on either importance sampling or Russian roulette to provide finite unbiased estimators of the infinite Taylor series expansion. We also show that the well known ratio tracking algorithm can be seen as a special case of the new class of estimators. Lastly, we conduct performance evaluations on both the central processing unit (CPU) and the graphics processing unit (GPU), and the results demonstrate that the new algorithms outperform traditional algorithms for heterogeneous mediums.

Deep neural network-estimated electrocardiographic age as a mortality predictor.

The electrocardiogram (ECG) is the most commonly used exam for the evaluation of cardiovascular diseases. Here we propose that the age predicted by artificial intelligence (AI) from the raw ECG (ECG-age) can be a measure of cardiovascular health. A deep neural network is trained to predict a patient's age from the 12-lead ECG in the CODE study cohort (n = 1,558,415 patients). On a 15% hold-out split, patients with ECG-age more than 8 years greater than the chronological age have a higher mortality rate (hazard ratio (HR) 1.79, p < 0.001), whereas those with ECG-age more than 8 years smaller, have a lower mortality rate (HR 0.78, p < 0.001). Similar results are obtained in the external cohorts ELSA-Brasil (n = 14,236) and SaMi-Trop (n = 1,631). Moreover, even for apparent normal ECGs, the predicted ECG-age gap from the chronological age remains a statistically significant risk predictor. These results show that the AI-enabled analysis of the ECG can add prognostic information.

Universal probabilistic programming offers a powerful approach to statistical phylogenetics.

Statistical phylogenetic analysis currently relies on complex, dedicated software packages, making it difficult for evolutionary biologists to explore new models and inference strategies. Recent years have seen more generic solutions based on probabilistic graphical models, but this formalism can only partly express phylogenetic problems. Here, we show that universal probabilistic programming languages (PPLs) solve the expressivity problem, while still supporting automated generation of efficient inference algorithms. To prove the latter point, we develop automated generation of sequential Monte Carlo (SMC) algorithms for PPL descriptions of arbitrary biological diversification (birth-death) models. SMC is a new inference strategy for these problems, supporting both parameter inference and efficient estimation of Bayes factors that are used in model testing. We take advantage of this in automatically generating SMC algorithms for several recent diversification models that have been difficult or impossible to tackle previously. Finally, applying these algorithms to 40 bird phylogenies, we show that models with slowing diversification, constant turnover and many small shifts generally explain the data best. Our work opens up several related problem domains to PPL approaches, and shows that few hurdles remain before these techniques can be effectively applied to the full range of phylogenetic models.

Author Correction: Automatic diagnosis of the 12-lead ECG using a deep neural network.

An amendment to this paper has been published and can be accessed via a link at the top of the paper.

Automatic diagnosis of the 12-lead ECG using a deep neural network.

The role of automatic electrocardiogram (ECG) analysis in clinical practice is limited by the accuracy of existing models. Deep Neural Networks (DNNs) are models composed of stacked transformations that learn tasks by examples. This technology has recently achieved striking success in a variety of task and there are great expectations on how it might improve clinical practice. Here we present a DNN model trained in a dataset with more than 2 million labeled exams analyzed by the Telehealth Network of Minas Gerais and collected under the scope of the CODE (Clinical Outcomes in Digital Electrocardiology) study. The DNN outperform cardiology resident medical doctors in recognizing 6 types of abnormalities in 12-lead ECG recordings, with F1 scores above 80% and specificity over 99%. These results indicate ECG analysis based on DNNs, previously studied in a single-lead setup, generalizes well to 12-lead exams, taking the technology closer to the standard clinical practice.