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      Bimodal CNN for cardiovascular disease classification by co-training ECG grayscale images and scalograms

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      Scientific Reports
      Nature Publishing Group UK
      Biomedical engineering, Arrhythmias

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          Abstract

          This study aimed to develop a bimodal convolutional neural network (CNN) by co-training grayscale images and scalograms of ECG for cardiovascular disease classification. The bimodal CNN model was developed using a 12-lead ECG database collected from Chapman University and Shaoxing People's Hospital. The preprocessed database contains 10,588 ECG data and 11 heart rhythms labeled by a specialist physician. The preprocessed one-dimensional ECG signals were converted into two-dimensional grayscale images and scalograms, which are fed simultaneously to the bimodal CNN model as dual input images. The proposed model aims to improve the performance of CVDs classification by making use of ECG grayscale images and scalograms. The bimodal CNN model consists of two identical Inception-v3 backbone models, which were pre-trained on the ImageNet database. The proposed model was fine-tuned with 6780 dual-input images, validated with 1694 dual-input images, and tested on 2114 dual-input images. The bimodal CNN model using two identical Inception-v3 backbones achieved best AUC (0.992), accuracy (95.08%), sensitivity (0.942), precision (0.946) and F1-score (0.944) in lead II. Ensemble model of all leads obtained AUC (0.994), accuracy (95.74%), sensitivity (0.950), precision (0.953), and F1-score (0.952). The bimodal CNN model showed better diagnostic performance than logistic regression, XGBoost, LSTM, single CNN model training with grayscale images alone or with scalograms alone. The proposed bimodal CNN model would be of great help in diagnosing cardiovascular diseases.

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          Most cited references34

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          Long Short-Term Memory

          Learning to store information over extended time intervals by recurrent backpropagation takes a very long time, mostly because of insufficient, decaying error backflow. We briefly review Hochreiter's (1991) analysis of this problem, then address it by introducing a novel, efficient, gradient-based method called long short-term memory (LSTM). Truncating the gradient where this does not do harm, LSTM can learn to bridge minimal time lags in excess of 1000 discrete-time steps by enforcing constant error flow through constant error carousels within special units. Multiplicative gate units learn to open and close access to the constant error flow. LSTM is local in space and time; its computational complexity per time step and weight is O(1). Our experiments with artificial data involve local, distributed, real-valued, and noisy pattern representations. In comparisons with real-time recurrent learning, back propagation through time, recurrent cascade correlation, Elman nets, and neural sequence chunking, LSTM leads to many more successful runs, and learns much faster. LSTM also solves complex, artificial long-time-lag tasks that have never been solved by previous recurrent network algorithms.
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            Cardiologist-level arrhythmia detection and classification in ambulatory electrocardiograms using a deep neural network

            Computerized electrocardiogram (ECG) interpretation plays a critical role in the clinical ECG workflow1. Widely available digital ECG data and the algorithmic paradigm of deep learning2 present an opportunity to substantially improve the accuracy and scalability of automated ECG analysis. However, a comprehensive evaluation of an end-to-end deep learning approach for ECG analysis across a wide variety of diagnostic classes has not been previously reported. Here, we develop a deep neural network (DNN) to classify 12 rhythm classes using 91,232 single-lead ECGs from 53,549 patients who used a single-lead ambulatory ECG monitoring device. When validated against an independent test dataset annotated by a consensus committee of board-certified practicing cardiologists, the DNN achieved an average area under the receiver operating characteristic curve (ROC) of 0.97. The average F1 score, which is the harmonic mean of the positive predictive value and sensitivity, for the DNN (0.837) exceeded that of average cardiologists (0.780). With specificity fixed at the average specificity achieved by cardiologists, the sensitivity of the DNN exceeded the average cardiologist sensitivity for all rhythm classes. These findings demonstrate that an end-to-end deep learning approach can classify a broad range of distinct arrhythmias from single-lead ECGs with high diagnostic performance similar to that of cardiologists. If confirmed in clinical settings, this approach could reduce the rate of misdiagnosed computerized ECG interpretations and improve the efficiency of expert human ECG interpretation by accurately triaging or prioritizing the most urgent conditions.
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              Convolutional Neural Networks for Medical Image Analysis: Full Training or Fine Tuning?

              Training a deep convolutional neural network (CNN) from scratch is difficult because it requires a large amount of labeled training data and a great deal of expertise to ensure proper convergence. A promising alternative is to fine-tune a CNN that has been pre-trained using, for instance, a large set of labeled natural images. However, the substantial differences between natural and medical images may advise against such knowledge transfer. In this paper, we seek to answer the following central question in the context of medical image analysis: Can the use of pre-trained deep CNNs with sufficient fine-tuning eliminate the need for training a deep CNN from scratch? To address this question, we considered four distinct medical imaging applications in three specialties (radiology, cardiology, and gastroenterology) involving classification, detection, and segmentation from three different imaging modalities, and investigated how the performance of deep CNNs trained from scratch compared with the pre-trained CNNs fine-tuned in a layer-wise manner. Our experiments consistently demonstrated that 1) the use of a pre-trained CNN with adequate fine-tuning outperformed or, in the worst case, performed as well as a CNN trained from scratch; 2) fine-tuned CNNs were more robust to the size of training sets than CNNs trained from scratch; 3) neither shallow tuning nor deep tuning was the optimal choice for a particular application; and 4) our layer-wise fine-tuning scheme could offer a practical way to reach the best performance for the application at hand based on the amount of available data.
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                Author and article information

                Contributors
                danniskang@gmail.com
                Journal
                Sci Rep
                Sci Rep
                Scientific Reports
                Nature Publishing Group UK (London )
                2045-2322
                20 February 2023
                20 February 2023
                2023
                : 13
                : 2937
                Affiliations
                GRID grid.411612.1, ISNI 0000 0004 0470 5112, Department of Healthcare Information Technology, , Inje University, ; Inje-ro, Gimhae-si, 50834 Republic of Korea
                Article
                30208
                10.1038/s41598-023-30208-8
                9941114
                36804469
                50312aad-53e1-4ac8-a3da-d65ba9c03d7f
                © The Author(s) 2023

                Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.

                History
                : 3 August 2022
                : 17 February 2023
                Funding
                Funded by: National Research Foundation of Korea (NRF) grant funded by the Korean government (MSIT)
                Award ID: No. 2020R1G1A1102881
                Award Recipient :
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                © The Author(s) 2023

                Uncategorized
                biomedical engineering,arrhythmias
                Uncategorized
                biomedical engineering, arrhythmias

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