Biosignal data captured by patient monitoring systems could provide key evidence for detecting or predicting critical clinical events; however, noise in these data hinders their use. Because deep learning algorithms can extract features without human annotation, this study hypothesized that they could be used to screen unacceptable electrocardiograms (ECGs) that include noise. To test that, a deep learning-based model for unacceptable ECG screening was developed, and its screening results were compared with the interpretations of a medical expert. To develop and apply the screening model, we used a biosignal database comprising 165,142,920 ECG II (10-second lead II electrocardiogram) data gathered between August 31, 2016 and September 30, 2018 from a trauma intensive-care unit. Then, 2,700 and 300 ECGs (ratio of 9:1) were reviewed by a medical expert and used for 9-fold cross-validation (training and validation) and test datasets. A convolutional neural network-based model for unacceptable ECG screening was developed based on the training and validation datasets. The model exhibiting the lowest cross-validation loss was subsequently selected as the final model. Its performance was evaluated through comparison with a test dataset. When the screening results of the proposed model were compared to the test dataset, the area under the receiver operating characteristic curve and the F1-score of the model were 0.93 and 0.80 (sensitivity = 0.88, specificity = 0.89, positive predictive value = 0.74, and negative predictive value = 0.96). The deep learning-based model developed in this study is capable of detecting and screening unacceptable ECGs efficiently.

X: original ECG data;

Background: Data collected by an actigraphy device worn on the wrist or waist can provide objective measurements for studies related to physical activity; however, some data may contain intervals where values are missing. In previous studies, statistical methods have been applied to impute missing values on the basis of statistical assumptions. Deep learning algorithms, however, can learn features from the data without any such assumptions and may outperform previous approaches in imputation tasks. Objective: The aim of this study was to impute missing values in data using a deep learning approach. Methods: To develop an imputation model for missing values in accelerometer-based actigraphy data, a denoising convolutional autoencoder was adopted. We trained and tested our deep learning–based imputation model with the National Health and Nutrition Examination Survey data set and validated it with the external Korea National Health and Nutrition Examination Survey and the Korean Chronic Cerebrovascular Disease Oriented Biobank data sets which consist of daily records measuring activity counts. The partial root mean square error and partial mean absolute error of the imputed intervals (partial RMSE and partial MAE, respectively) were calculated using our deep learning–based imputation model (zero-inflated denoising convolutional autoencoder) as well as using other approaches (mean imputation, zero-inflated Poisson regression, and Bayesian regression). Results: The zero-inflated denoising convolutional autoencoder exhibited a partial RMSE of 839.3 counts and partial MAE of 431.1 counts, whereas mean imputation achieved a partial RMSE of 1053.2 counts and partial MAE of 545.4 counts, the zero-inflated Poisson regression model achieved a partial RMSE of 1255.6 counts and partial MAE of 508.6 counts, and Bayesian regression achieved a partial RMSE of 924.5 counts and partial MAE of 605.8 counts. Conclusions: Our deep learning–based imputation model performed better than the other methods when imputing missing values in actigraphy data.

Biosignals such as electrocardiogram or photoplethysmogram are widely used for determining and monitoring the medical condition of patients. It was recently discovered that more information could be gathered from biosignals by applying artificial intelligence (AI). At present, one of the most impactful advancements in AI is deep learning. Deep learning-based models can extract important features from raw data without feature engineering by humans, provided the amount of data is sufficient. This AI-enabled feature presents opportunities to obtain latent information that may be used as a digital biomarker for detecting or predicting a clinical outcome or event without further invasive evaluation. However, the black box model of deep learning is difficult to understand for clinicians familiar with a conventional method of analysis of biosignals. A basic knowledge of AI and machine learning is required for the clinicians to properly interpret the extracted information and to adopt it in clinical practice. This review covers the basics of AI and machine learning, and the feasibility of their application to real-life situations by clinicians in the near future.

Background. Proper management of hyperkalemia that leads to fatal cardiac arrhythmia has become more important because of the increased prevalence of hyperkalemia-prone diseases. Although T-wave changes in hyperkalemia are well known, their usefulness is debatable. We evaluated how well T-wave-based features of electrocardiograms (ECGs) are correlated with estimated serum potassium levels using ECG data from real-world clinical practice.Methods. We collected ECGs from a local ECG repository (MUSE™) from 1994 to 2017 and extracted the ECG waveforms. Of about 1 million reports, 124,238 were conducted within 5 minutes before or after blood collection for serum potassium estimation. We randomly selected 500 ECGs and two evaluators measured the amplitude (T-amp) and right slope of the T-wave (T-right slope) on five lead waveforms (V3, V4, V5, V6, and II). Linear correlations of T-amp, T-right slope, and their normalized feature (T-norm) with serum potassium levels were evaluated using Pearson correlation coefficient analysis.Results. Pearson correlation coefficients for T-wave-based features with serum potassium between the two evaluators were 0.99 for T-amp and 0.97 for T-right slope. The coefficient for the association between T-amp, T-right slope, and T-norm, and serum potassium ranged from -0.22 to 0.02. In the normal ECG subgroup (normal ECG or otherwise normal ECG), there was no correlation between T-wave-based features and serum potassium level.Conclusions. T-wave-based features were not correlated with serum potassium level, and their use in real clinical practice is currently limited.

We evaluated new features from biosignals comprising diverse physiological response information to predict the outcome of weaning from mechanical ventilation (MV). We enrolled 89 patients who were candidates for weaning from MV in the intensive care unit and collected continuous biosignal data: electrocardiogram (ECG), respiratory impedance, photoplethysmogram (PPG), arterial blood pressure, and ventilator parameters during a spontaneous breathing trial (SBT). We compared the collected biosignal data’s variability between patients who successfully discontinued MV (n = 67) and patients who did not (n = 22). To evaluate the usefulness of the identified factors for predicting weaning success, we developed a machine learning model and evaluated its performance by bootstrapping. The following markers were different between the weaning success and failure groups: the ratio of standard deviations between the short-term and long-term heart rate variability in a Poincaré plot, sample entropy of ECG and PPG, α values of ECG, and respiratory impedance in the detrended fluctuation analysis. The area under the receiver operating characteristic curve of the model was 0.81 (95% confidence interval: 0.70–0.92). This combination of the biosignal data-based markers obtained during SBTs provides a promising tool to assist clinicians in determining the optimal extubation time.