用多模态融合方法,让6导联心电图提前识别肺动脉高压。
Multimodal Latent Fusion of ECG Leads for Early Assessment of Pulmonary Hypertension
- 设计分导联变分自编码器,融合不同心电图导联的特征。
- 在两个数据集上验证,对肺动脉高压检测准确率超基线模型。
- 适合临床场景中数据少时的智能诊断,可解释性强。
近年来,肺动脉高压(PH)的早期评估多聚焦于12导联心电图(12L-ECG)的机器学习应用。然而,在基层医疗等去中心化场景中,便携式6导联心电图(6L-ECG)更具实用性,但受限于标注数据稀缺,模型可靠性不足。为此,我们提出一种分导联心电图多模态变分自编码器(LS-EMVAE),结合分层模态专家(HiME)融合机制与潜在表示对齐损失。HiME融合混合专家与乘积专家思想,实现灵活自适应的潜在空间融合;对齐损失增强导联特异性与共享表示间的一致性。为缓解数据稀缺问题,采用迁移学习策略:先在大规模无标签12L-ECG数据集上预训练,再在小规模有标签6L-ECG数据集上微调。我们在两个回顾性队列中验证了该方法:来自ASPIRE注册库的892名受试者用于(1)PH检测和(2)前/后毛细血管性PH表型分类;来自UK Biobank的16,416名受试者用于(3)预测肺毛细血管楔压升高。结果表明,LS-EMVAE持续优于单模态及多模态基线方法,在泛化性和可解释性方面表现突出。代码已开源。
原文摘要 · Abstract (English)
Recent advancements in early assessment of pulmonary hypertension (PH) primarily focus on applying machine learning methods to centralized diagnostic modalities, such as 12-lead electrocardiogram (12L-ECG). Despite their potential, these approaches fall short in decentralized clinical settings, e.g., point-of-care and general practice, where handheld 6-lead ECG (6L-ECG) can offer an alternative but is limited by the scarcity of labeled data for developing reliable models. To address this, we propose a lead-specific electrocardiogram multimodal variational autoencoder (\textsc{LS-EMVAE}), which incorporates a hierarchical modality expert (HiME) fusion mechanism and a latent representation alignment loss. HiME combines mixture-of-experts and product-of-experts to enable flexible, adaptive latent fusion, while the alignment loss improves coherence among lead-specific and shared representations. To alleviate data scarcity and enhance representation learning, we adopt a transfer learning strategy: the model is first pre-trained on a large unlabeled 12L-ECG dataset and then fine-tuned on smaller task-specific labeled 6L-ECG datasets. We validate \textsc{LS-EMVAE} across two retrospective cohorts in a 6L-ECG setting: 892 subjects from the ASPIRE registry for (1) PH detection and (2) phenotyping pre-/post-capillary PH, and 16,416 subjects from UK Biobank for (3) predicting elevated pulmonary atrial wedge pressure, where it consistently outperforms unimodal and multimodal baseline methods and demonstrates strong generalizability and interpretability. The code is available at https://github.com/Shef-AIRE/LS-EMVAE.
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