机器学习用于使用12导电心电图诊断急性冠状动脉综合征:系统性审查
Max Zworth1, Hashim Kareemi2, Suzanne Boroumand3
1Department of Emergency Medicine, University of Ottawa, Ottawa, ON, Canada. mzworth@toh.ca.
CJEM
|September 4, 2023
概括
机器学习 (ML) 模型显示出比临床医生更高的灵敏度,但比临床医生更低的特异性,用于通过心电图 (ECG) 诊断急性冠状动脉综合征 (ACS). 需要进一步的研究来确认MLML.
科学领域:
- 心脏病学 心脏病学
- 医疗信息学 医疗信息学
- 人工智能的人工智能
背景情况:
- 在紧急情况下,急性冠状动脉综合征 (ACS) 的及时诊断至关重要.
- 目前的计算机心电图 (ECG) 解释算法存在一些局限性.
- 机器学习 (ML) 模型在临床应用中显示出前景.
研究的目的:
- 系统地审查和比较基于ML的心电图分析对临床医生和非ML软件ACS的诊断性能.
- 在急诊室 (ED) 和医院前环境中评估ML模型.
主要方法:
- 在Medline,Embase,Cochrane Central和CINAHL数据库中进行系统搜索,截至2022年5月18日.
- 包括将ML算法与临床医生或非ML软件进行比较的研究,用于在成人患者中使用12心电图进行ACS诊断.
- 使用QUADAS-2进行偏差风险评估.
主要成果:
- 10项研究符合纳入标准,测试了5种ML模型类型.
- 与临床医生相比,ML模型显示出更高的灵敏度 (0.59-0.98),但较低的特异性 (0.44-0.95) (灵敏度0.22-0.93,特异性0.63-0.98).
- ML模型显示了比临床医生 (AUC 0.67-0.78) 更好的歧视 (AUC 0.79-0.98).
- 在几个研究中发现了显著的异质性和偏差风险.
结论:
- 在ACS诊断中,ML模型为ECG解释提供了更好的区分和灵敏度,但特异性较低.
- 基于ML的心电图分析可以作为安全网,用于识别错过的急性心肌梗塞 (MI).
- 需要更严格的研究来确定ML在心电图解释方面比临床医生优越.
相关概念视频
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Diagnosing acute coronary syndrome or ACS begins with a thorough patient history. Notable symptoms include central, crushing chest pain radiating to the left arm, neck, jaw, or back, along with shortness of breath, sweating (diaphoresis), nausea, vomiting, dizziness, and palpitations.It is crucial to note any history of cardiac illnesses and assess risk factors, including age, gender, smoking, hypertension, diabetes, hyperlipidemia, and a sedentary lifestyle.During physical examination, vital...
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01:19Acute Coronary Syndrome II: Pathophysiology and Clinical Manifestations
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The pathophysiology of Acute Coronary Syndrome [ACD] involves several key processes:The main underlying cause of ACD is atherosclerosis, a chronic inflammatory disease characterized by the buildup of lipid-laden plaques within the coronary arteries.As the atherosclerotic plaque grows in the coronary artery, it may become unstable due to the formation of a lipid-rich core and a thin fibrous cap. Inflammatory cells within the plaque, such as macrophages, secrete enzymes that degrade the...
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01:30Acute Coronary Syndrome I: Introduction
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Acute Coronary Syndrome (ACS) encompasses a spectrum of heart conditions caused by sudden obstruction of coronary arteries, typically resulting from the rupture of an atherosclerotic plaque and subsequent thrombus (blood clot) formation. This obstruction can lead to partial or complete blockage of blood flow, causing varying degrees of myocardial ischemia or infarction.ACS includes the following clinical entities:Unstable Angina (UA)Non-ST-Elevation Myocardial Infarction (NSTEMI)ST-Elevation...
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01:29Electrocardiogram
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An electrocardiogram (ECG or EKG) is a critical diagnostic tool that records the electrical signals produced by the heart during each heartbeat. This recording is achieved through electrodes placed strategically on the arms, legs, and chest. The electrocardiograph amplifies these signals and produces 12 distinct tracings, offering a comprehensive understanding of the heart's electrical activity.
Three major waveforms are present in a typical ECG recording: the P wave, the QRS complex, and...
Three major waveforms are present in a typical ECG recording: the P wave, the QRS complex, and...
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01:28Electrocardiogram Fundamentals
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Introduction
An electrocardiogram (ECG) is a diagnostic tool for identifying cardiac conditions such as arrhythmias, conduction abnormalities, and myocardial ischemia.
Definition
An electrocardiogram (ECG) visualizes the heart's electrical activity by tracing the electrical movement associated with each heartbeat on a graph or monitor. As the heart beats, an electrical wave passes through it, correlating with the cardiac cycle events.
Parts of an ECG
An ECG utilizes electrodes on the skin...
An electrocardiogram (ECG) is a diagnostic tool for identifying cardiac conditions such as arrhythmias, conduction abnormalities, and myocardial ischemia.
Definition
An electrocardiogram (ECG) visualizes the heart's electrical activity by tracing the electrical movement associated with each heartbeat on a graph or monitor. As the heart beats, an electrical wave passes through it, correlating with the cardiac cycle events.
Parts of an ECG
An ECG utilizes electrodes on the skin...
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01:25Imaging Studies for Cardiovascular System VI: Calcium -Scoring CT
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Calcium-Scoring CT ScanA calcium-scoring CT scan, also known as coronary artery calcium (CAC) scan, detects calcium deposits in the coronary arteries. This test assesses the risk of coronary artery disease (CAD), which can lead to cardiovascular events such as angina, heart failure, and sudden cardiac arrest.A calcium-scoring CT scan is generally recommended for individuals at intermediate risk of CAD without symptoms. It includes:Men aged 40-75 and women aged 50-75: Especially those with a...
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