arXiv:2412.11839eess.SPcs.LG2024-12

用心电图特征提升三甲医院心脏病患者分诊准确率

Evaluating the Efficacy of Vectocardiographic and ECG Parameters for Efficient Tertiary Cardiology Care Allocation Using Decision Tree Analysis

  • 结合心电图、风险因素与向量心电图参数构建决策树模型
  • 引入GEH参数后模型预测性能显著提升,尤其QRST角和SVG关键
  • 模型透明可解释,适合临床实际应用,优化医疗资源分配

利用真实世界数据,评估向量心电图(VCG)中的全局电不均性(GEH)参数作为机器学习模型特征的效能,与标准心电图特征及风险因素联合预测患者在转诊至三级心血管专科医院后的预后。接受评估的患者完成心电图检查和风险因素访谈,随后在6、12和15个月进行随访,通过电话随访确认心血管事件(死亡或新发非致命事件,如中风、心梗、支架植入、心脏手术)。首次随访的心电图由专科医生测量,并使用Kors矩阵计算GEH参数。将ECG测量值、GEH参数与风险因素结合,训练多个XGBoost决策树模型,每个模型分别针对AUCPR优化,最终选择表现最优的模型为代表。分析显示,该模型在预测能力上达到最佳,其中几何异质性参数(特别是QRS-T角和矢量面积变异性,SVG)具有统计学意义。结果表明,引入向量心电图特征有助于更精准识别需三级治疗的患者,从而优化资源配置并改善预后;同时,决策树模型的可解释性使其契合临床实践,助力临床决策。

原文摘要 · Abstract (English)

Use real word data to evaluate the performance of the electrocardiographic markers of GEH as features in a machine learning model with Standard ECG features and Risk Factors in Predicting Outcome of patients in a population referred to a tertiary cardiology hospital. Patients forwarded to specific evaluation in a cardiology specialized hospital performed an ECG and a risk factor anamnesis. A series of follow up attendances occurred in periods of 6 months, 12 months and 15 months to check for cardiovascular related events (mortality or new nonfatal cardiovascular events (Stroke, MI, PCI, CS), as identified during 1-year phone follow-ups. The first attendance ECG was measured by a specialist and processed in order to obtain the global electric heterogeneity (GEH) using the Kors Matriz. The ECG measurements, GEH parameters and risk factors were combined for training multiple instances of XGBoost decision trees models. Each instance were optmized for the AUCPR and the instance with higher AUC is chosen as representative to the model. The importance of each parameter for the winner tree model was compared to better understand the improvement from using GEH parameters. The GEH parameters turned out to have statistical significance for this population specially the QRST angle and the SVG. The combined model with the tree parameters class had the best performance. The findings suggest that using VCG features can facilitate more accurate identification of patients who require tertiary care, thereby optimizing resource allocation and improving patient outcomes. Moreover, the decision tree model's transparency and ability to pinpoint critical features make it a valuable tool for clinical decision-making and align well with existing clinical practices.

心电图分诊模型决策树医疗资源

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