用AI模型+可解释算法,提前预测心梗患者室速室颤风险。
Combining ECG Foundation Model and XGBoost to Predict In-Hospital Malignant Ventricular Arrhythmias in AMI Patients
- 用ECG基础模型提取特征,再用XGBoost分类提升可解释性。
- 在6634例数据上达到AUC 0.801,优于传统方法。
- 识别出临床公认的危险和保护因素,适合临床部署。
急性心肌梗死(AMI)后恶性室性心律失常(VT/VF)是院内死亡的主要原因,但早期识别仍具挑战。传统风险评分性能有限,端到端深度学习模型又缺乏临床可解释性。本研究提出一种混合预测框架,将大规模心电图(ECG)基础模型ECGFounder与可解释的XGBoost分类器结合,以兼顾准确性和可解释性。分析了6,634例AMI患者的ECG记录,其中175例发生院内VT/VF。ECGFounder提取150维诊断概率特征,经特征选择后用于训练XGBoost分类器。模型性能通过AUC和F1-score评估,采用SHAP方法进行可解释性分析。结果表明,ECGFounder + XGBoost混合模型达到AUC 0.801,显著优于KNN(AUC 0.677)、RNN(AUC 0.676)和端到端1D-CNN(AUC 0.720)。SHAP分析显示,模型识别的关键特征如“室性早搏”(风险因子)和“窦性心律”(保护因子)与临床知识高度一致。结论:该混合框架为VT/VF风险预测提供了新范式,验证了基础模型输出作为自动化特征工程的有效性,助力构建可信、可解释的AI临床决策支持系统。
原文摘要 · Abstract (English)
Malignant ventricular arrhythmias (VT/VF) following acute myocardial infarction (AMI) are a major cause of in-hospital death, yet early identification remains a clinical challenge. While traditional risk scores have limited performance, end-to-end deep learning models often lack the interpretability needed for clinical trust. This study aimed to develop a hybrid predictive framework that integrates a large-scale electrocardiogram (ECG) foundation model (ECGFounder) with an interpretable XGBoost classifier to improve both accuracy and interpretability. We analyzed 6,634 ECG recordings from AMI patients, among whom 175 experienced in-hospital VT/VF. The ECGFounder model was used to extract 150-dimensional diagnostic probability features , which were then refined through feature selection to train the XGBoost classifier. Model performance was evaluated using AUC and F1-score , and the SHAP method was used for interpretability. The ECGFounder + XGBoost hybrid model achieved an AUC of 0.801 , outperforming KNN (AUC 0.677), RNN (AUC 0.676), and an end-to-end 1D-CNN (AUC 0.720). SHAP analysis revealed that model-identified key features, such as "premature ventricular complexes" (risk predictor) and "normal sinus rhythm" (protective factor), were highly consistent with clinical knowledge. We conclude that this hybrid framework provides a novel paradigm for VT/VF risk prediction by validating the use of foundation model outputs as effective, automated feature engineering for building trustworthy, explainable AI-based clinical decision support systems.
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