Background: Cardiovascular waveforms contain information for clinical diagnosis. By "learning" and organizing the subtle change of waveform morphology from large amounts of raw waveform data, unsupervised manifold learning helps delineate a high-dimensional structure and display it as a novel three-dimensional (3D) image. We hypothesize that the shape of this structure conveys clinically relevant inner dynamics information.
Methods:To validate this hypothesis, we investigate the electrocardiography (ECG) waveform for ischemic heart disease and arterial blood pressure (ABP) waveform in dynamic vasoactive episodes. We model each beat or pulse to be a point lying on a manifold, like a surface, and use the diffusion map (DMap) to establish the relationship among those pulses. The output of the DMap is converted to a 3D image for visualization. For ECG datasets, first we analyzed the non-ST-elevation ECG waveform distribution from unstable angina to healthy control in the 3D image, and we investigated intraoperative ST-elevation ECG waveforms to show the dynamic ECG waveform changes. For ABP datasets, we analyzed waveforms collected under endotracheal intubation and administration of vasodilator. To quantify the dynamic separation, we applied the support vector machine (SVM) analysis and reported the total accuracy and macro F1 score. We further carried out the trajectory analysis and derived the moving direction of successive beats (or pulses) as vectors in the high-dimensional space.Results: For the non-ST-elevation ECG, a hierarchical tree structure comprising consecutive ECG waveforms spanning from unstable angina to healthy control is presented in the 3D image (accuracy = 97.6%, macro-F1=96.1%). The DMap helps quantify and visualize the evolving direction of intraoperative ST-elevation myocardial episode in a 1-hour period (accuracy=97.58%, macro-F1=96.06%). The ABP waveform analysis of Nicardipine administration shows inter-individual difference (accuracy=95.01%, macro-F1=96.9%) and their common directions from intra-individual moving trajectories. The dynamic change of the ABP waveform during endotracheal intubation shows a loop-like trajectory structure, which can be further divided using the manifold learning knowledge obtained from Nicardipine.
Conclusions:The DMap and the generated 3D image of ECG or ABP waveforms provides clinically relevant inner dynamics information. It provides clues of acute coronary syndrome diagnosis, shows clinical course in myocardial ischemic episode and reveals underneath physiological mechanism under stress or vasodilators.Keywords: manifold learning, diffusion map, electrocardiography, myocardial ischemia, arterial 10,583 ECG beats, including clinical unstable angina (red), ischemic ECG pattern (green), and healthy control (blue).
Video F3CCorresponding to Figure 3 panel C, it shows the 3D animation of 1-min ECG beats during the intra-operative ST-elevation event.
Video F3DCorresponding to Figure 3 panel D, it shows the 3D animation of 4,299 consecutive ECG 31 beats from the IS...