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Abstract AimsMyocardial infarction and heart failure are major cardiovascular diseases that affect millions of people in the USA with morbidity and mortality being highest among patients who develop cardiogenic shock. Early recognition of cardiogenic shock allows prompt implementation of treatment measures. Our objective is to develop a new dynamic risk score, called CShock, to improve early detection of cardiogenic shock in the cardiac intensive care unit (ICU). Methods and resultsWe developed and externally validated a deep learning-based risk stratification tool, called CShock, for patients admitted into the cardiac ICU with acute decompensated heart failure and/or myocardial infarction to predict the onset of cardiogenic shock. We prepared a cardiac ICU dataset using the Medical Information Mart for Intensive Care-III database by annotating with physician-adjudicated outcomes. This dataset which consisted of 1500 patients with 204 having cardiogenic/mixed shock was then used to train CShock. The features used to train the model for CShock included patient demographics, cardiac ICU admission diagnoses, routinely measured laboratory values and vital signs, and relevant features manually extracted from echocardiogram and left heart catheterization reports. We externally validated the risk model on the New York University (NYU) Langone Health cardiac ICU database which was also annotated with physician-adjudicated outcomes. The external validation cohort consisted of 131 patients with 25 patients experiencing cardiogenic/mixed shock. CShock achieved an area under the receiver operator characteristic curve (AUROC) of 0.821 (95% CI 0.792–0.850). CShock was externally validated in the more contemporary NYU cohort and achieved an AUROC of 0.800 (95% CI 0.717–0.884), demonstrating its generalizability in other cardiac ICUs. Having an elevated heart rate is most predictive of cardiogenic shock development based on Shapley values. The other top 10 predictors are having an admission diagnosis of myocardial infarction with ST-segment elevation, having an admission diagnosis of acute decompensated heart failure, Braden Scale, Glasgow Coma Scale, blood urea nitrogen, systolic blood pressure, serum chloride, serum sodium, and arterial blood pH. ConclusionThe novel CShock score has the potential to provide automated detection and early warning for cardiogenic shock and improve the outcomes for millions of patients who suffer from myocardial infarction and heart failure.
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A Fast and Accurate Myocardial Infarction Detector
We propose a novel pipeline for the real-time detection of myocardial infarction from a single heartbeat of a 12-lead electrocardiograms. We do so by merging a real-time R-spike detection algorithm with a deep learning Long-Short Term Memory (LSTM) network-based classifier. A comparative assessment of the classification performance of the resulting system is performed and provided. The proposed algorithm achieves an inter-patient classification accuracy of 95.76% (with a 95% Confidence Interval (CI) of ±2.4%), a recall of 96.67% (±2.4% 95% CI), specificity of 93.64% (±5.7% 95% CI), and the average J-Score is 90.31% (±6.2% 95% CI). These state-of-the-art myocardial infarction detection metrics are extremely promising and could pave the wave for the early detection of myocardial infarctions. This high accuracy is achieved with a processing time of 40 milliseconds, which is most appropriate for online classification as the time between fast heartbeats is around 300 milliseconds.
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- PAR ID:
- 10276281
- Date Published:
- Journal Name:
- 2020 International Conference on Computational Science and Computational Intelligence (CSCI)
- Page Range / eLocation ID:
- 782 to 787
- Format(s):
- Medium: X
- Sponsoring Org:
- National Science Foundation
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- Free Publicly Accessible Full Text
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Accepted Manuscript1.0
- Conference Paper:
- https://doi.org/10.1109/CSCI51800.2020.00147
