Myocardial Infarction Severity Stages Classification From ECG Signals Using Attentional Recurrent Neural Network

Myocardial infarction (MI) is a lethal heart condition that occurs due to the lack of blood flow to the heart tissues. Based on the time from symptoms onset, it is categorized into three severity stages: early MI (EMI), acute MI (AMI), and chronic MI (CMI). Electrocardiogram (ECG) signals are often used to diagnose MI with pathological changes in its characteristics. In clinical practice, accurate diagnosis and risk-stratification are essential to optimize various treatment strategies, hence clinical outcome. However, most automated methods focus only on identifying MI patients from healthy controls (HC). Therefore, in this paper, we propose a novel multi-lead diagnostic attention-based recurrent neural network (MLDA-RNN) for automated diagnosis of the three MI severity stages from HC subjects. The method systematically processes the 12-lead ECGs to capture the multi-scale temporal dependencies from each ECG leads for improved classification. Specifically, we first employ the RNNs to encode the temporal variations in the 12-lead ECG signals. These encoded vectors are fed to the intra-lead attention module to summarize the within-lead discriminative vectors to obtain lead-attentive representations. Then, the inter-lead attention module aggregates these representative vectors based on their clinical relevance to obtain a high-level feature representation for a reliable diagnosis. Using 12-lead ECGs from the PTBDB and STAFF III datasets, we achieved an overall accuracy of 97.79% without compromising on the class-wise detection rates. With improved performance, the MLDA-RNN also shows promising results for model interpretability as the learned attention weights often correlate with clinicians’ way of diagnosing MI severity stages.

[1]  Samarendra Dandapat,et al.  Multiscale Energy and Eigenspace Approach to Detection and Localization of Myocardial Infarction , 2015, IEEE Transactions on Biomedical Engineering.

[2]  Robert A. O'Rourke,et al.  Hurst's The Heart: Manual of Cardiology , 2001 .

[3]  S. Brownlee,et al.  Evidence for overuse of medical services around the world , 2017, The Lancet.

[4]  Yufei Chen,et al.  Multi-Channel Lightweight Convolution Neural Network for Anterior Myocardial Infarction Detection , 2018, 2018 IEEE SmartWorld, Ubiquitous Intelligence & Computing, Advanced & Trusted Computing, Scalable Computing & Communications, Cloud & Big Data Computing, Internet of People and Smart City Innovation (SmartWorld/SCALCOM/UIC/ATC/CBDCom/IOP/SCI).

[5]  U. Rajendra Acharya,et al.  Classification of myocardial infarction with multi-lead ECG signals and deep CNN , 2019, Pattern Recognit. Lett..

[6]  N. Niles Pathologic Basis of Disease , 1974 .

[7]  Jane A. Linderbaum,et al.  2013 ACCF/AHA guideline for the management of ST-elevation myocardial infarction: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. , 2013, Journal of the American College of Cardiology.

[8]  Li Sun,et al.  ECG Analysis Using Multiple Instance Learning for Myocardial Infarction Detection , 2012, IEEE Transactions on Biomedical Engineering.

[9]  Fatemeh Afghah,et al.  Inter- and Intra- Patient ECG Heartbeat Classification for Arrhythmia Detection: A Sequence to Sequence Deep Learning Approach , 2018, ICASSP 2019 - 2019 IEEE International Conference on Acoustics, Speech and Signal Processing (ICASSP).

[10]  M. Sabarimalai Manikandan,et al.  A New Automated Signal Quality-Aware ECG Beat Classification Method for Unsupervised ECG Diagnosis Environments , 2019, IEEE Sensors Journal.

[11]  E. Antman Time is muscle: translation into practice. , 2008, Journal of the American College of Cardiology.

[12]  Guigang Zhang,et al.  Deep Learning , 2016, Int. J. Semantic Comput..

[13]  Celia Shahnaz,et al.  Detection of inferior myocardial infarction using shallow convolutional neural networks , 2017, 2017 IEEE Region 10 Humanitarian Technology Conference (R10-HTC).

[14]  L. Edenbrandt,et al.  Acute myocardial infarction detected in the 12-lead ECG by artificial neural networks. , 1997, Circulation.

[15]  Ram Bilas Pachori,et al.  A Novel Approach for Detection of Myocardial Infarction From ECG Signals of Multiple Electrodes , 2019, IEEE Sensors Journal.

[16]  Jin He,et al.  Real-Time Multilead Convolutional Neural Network for Myocardial Infarction Detection , 2018, IEEE Journal of Biomedical and Health Informatics.

[17]  Satish T. S. Bukkapatnam,et al.  Topology and Random-Walk Network Representation of Cardiac Dynamics for Localization of Myocardial Infarction , 2013, IEEE Transactions on Biomedical Engineering.

[18]  Matin Hashemi,et al.  LSTM-Based ECG Classification for Continuous Monitoring on Personal Wearable Devices , 2018, IEEE Journal of Biomedical and Health Informatics.

[19]  U. Rajendra Acharya,et al.  Automated detection and localization of myocardial infarction using electrocardiogram: a comparative study of different leads , 2016, Knowl. Based Syst..

[20]  Yoshua Bengio,et al.  Empirical Evaluation of Gated Recurrent Neural Networks on Sequence Modeling , 2014, ArXiv.

[21]  Mary M. Maleckar,et al.  Simple T-Wave Metrics May Better Predict Early Ischemia as Compared to ST Segment , 2017, IEEE Transactions on Biomedical Engineering.

[22]  Fei Wang,et al.  MFB-CBRNN: A Hybrid Network for MI Detection Using 12-Lead ECGs , 2020, IEEE Journal of Biomedical and Health Informatics.

[23]  Yoshua Bengio,et al.  Show, Attend and Tell: Neural Image Caption Generation with Visual Attention , 2015, ICML.

[24]  U. Rajendra Acharya,et al.  Analysis of Myocardial Infarction Using Discrete Wavelet Transform , 2010, Journal of Medical Systems.

[25]  Yoshua Bengio,et al.  Neural Machine Translation by Jointly Learning to Align and Translate , 2014, ICLR.

[26]  Kurt S. Hoffmayer,et al.  Physician Accuracy in Interpreting Potential ST‐Segment Elevation Myocardial Infarction Electrocardiograms , 2013, Journal of the American Heart Association.

[27]  Navdeep Jaitly,et al.  Towards End-To-End Speech Recognition with Recurrent Neural Networks , 2014, ICML.

[28]  Ram Bilas Pachori,et al.  Localization of Myocardial Infarction From Multi-Lead ECG Signals Using Multiscale Analysis and Convolutional Neural Network , 2019, IEEE Sensors Journal.

[29]  Samarendra Dandapat,et al.  Automatic Quality Estimation of 12-lead ECG for Remote Healthcare Monitoring Systems , 2018, 2018 IEEE-EMBS Conference on Biomedical Engineering and Sciences (IECBES).

[30]  J. Rapin,et al.  A deep neural network learning algorithm outperforms a conventional algorithm for emergency department electrocardiogram interpretation. , 2019, Journal of electrocardiology.

[31]  Z. Goldberger,et al.  A Review of Automated Methods for Detection of Myocardial Ischemia and Infarction Using Electrocardiogram and Electronic Health Records , 2017, IEEE Reviews in Biomedical Engineering.

[32]  U. Rajendra Acharya,et al.  Application of deep convolutional neural network for automated detection of myocardial infarction using ECG signals , 2017, Inf. Sci..

[33]  Adrian D. C. Chan,et al.  Signal Quality Analysis of Ambulatory Electrocardiograms to Gate False Myocardial Ischemia Alarms , 2017, IEEE Transactions on Biomedical Engineering.

[34]  D. Yellon,et al.  Reducing myocardial infarct size: challenges and future opportunities , 2015, Heart.

[35]  Madhuchhanda Mitra,et al.  Automated Identification of Myocardial Infarction Using Harmonic Phase Distribution Pattern of ECG Data , 2018, IEEE Transactions on Instrumentation and Measurement.

[36]  Christian Schneider,et al.  Detection of (Reversible) Myocardial Ischemic Injury by Means of Electrical Bioimpedance , 2011, IEEE Transactions on Biomedical Engineering.

[37]  Hao Wang,et al.  Multiple-feature-branch convolutional neural network for myocardial infarction diagnosis using electrocardiogram , 2018, Biomed. Signal Process. Control..

[38]  Gerald Penn,et al.  Convolutional Neural Networks for Speech Recognition , 2014, IEEE/ACM Transactions on Audio, Speech, and Language Processing.

[39]  Mbbs Md FRCPath Donald N. Pritzker Vinay Kumar Robbins and Cotran pathologic basis of disease , 2015 .

[40]  Li Shi,et al.  Automated interpretable detection of myocardial infarction fusing energy entropy and morphological features , 2019, Comput. Methods Programs Biomed..