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rECHOmmend:基于心电图的机器学习方法用于识别通过心电图检测到未被诊断的结构性心脏病风险增加的患者
Alvaro E Ulloa-Cerna1, Linyuan Jing1, John M Pfeifer1,2,3
1Department of Translational Data Science and Informatics (A.E.U-C., L.J., J.M.P., S.R., J.A.R., C.W.G., C.M.H., B.K.F., R.C.); Geisinger, Danville, PA.
使用心电图 (ECG) 的新型机器学习模型可以预测多种结构性心脏病,改善早期检测并针对患者进行心电图. 这种方法有助于诊断诊断不足的疾病,改善患者的治疗结果.
科学领域:
- 心脏病学
- 人工智能
- 医疗诊断
背景情况:
- 结构性心脏病 (SHD) 诊断对于患者的结果至关重要,但往往会延迟.
- 对SHD进行全民心声学查是不切实际的.
- 基于心电图 (ECG) 的预测模型为识别高风险个体提供了可扩展的解决方案.
研究的目的:
- 开发和验证基于心电图的新型机器学习模型,用于预测多种结构性心脏病.
- 假设复合预测模型将改善针对性回声心脏学的流行率和积极预测值.
- 提高心电图在识别未诊断的SHD患者中的实用性.
主要方法:
- 在超过220万名成年人心电图上训练机器学习模型 (1984-2021年).
- 使用复合标签,包括中度/重度的膜疾病,减少排泄分数 (< 50%),或增加隔膜厚度 (> 15 mm).
- 通过交叉验证,多站点验证 (10个独立站点) 和模拟后期部署来评估模型.
主要成果:
- 综合RECHOmmend模型 (年龄,性别,心电图痕迹) 的AUC值为0.91,预测值为42%且灵敏度为90%.
- 个体疾病模型显示AUC为0. 86- 0. 93,但具有较低的积极预测值 (1-31%).
- 多地验证证实了模型的概括性 (AUC为0. 91);回顾性部署确定了4. 5%的患者是后来发展SHD的高风险患者.
结论:
- 基于心电图的机器学习模型具有复合终点,有效地识别未诊断的SHD高风险患者.
- 这种复合模型的性能优于单一疾病模型,并为实际查提供更高的积极预测值.
- 这种方法有助于针对性回声心脏学,解决结构性心脏病的不足诊断问题.
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