Paulo R. Gomes

Petrus E. O. G. B. Abreu, Gabriela M. M. Paixão, Jiawei Li et al.

Data-driven methods for electrocardiogram (ECG) interpretation are rapidly progressing. Large datasets have enabled advances in artificial intelligence (AI) based ECG analysis, yet limitations in annotation quality, size, and scope remain major challenges. Here we present CODE-II, a large-scale real-world dataset of 2,735,269 12-lead ECGs from 2,093,807 adult patients collected by the Telehealth Network of Minas Gerais (TNMG), Brazil. Each exam was annotated using standardized diagnostic criteria and reviewed by cardiologists. A defining feature of CODE-II is a set of 66 clinically meaningful diagnostic classes, developed with cardiologist input and routinely used in telehealth practice. We additionally provide an open available subset: CODE-II-open, a public subset of 15,000 patients, and the CODE-II-test, a non-overlapping set of 8,475 exams reviewed by multiple cardiologists for blinded evaluation. A neural network pre-trained on CODE-II achieved superior transfer performance on external benchmarks (PTB-XL and CPSC 2018) and outperformed alternatives trained on larger datasets.

Antônio H. Ribeiro, Manoel Horta Ribeiro, Gabriela M. M. Paixão et al.

The role of automatic electrocardiogram (ECG) analysis in clinical practice is limited by the accuracy of existing models. Deep Neural Networks (DNNs) are models composed of stacked transformations that learn tasks by examples. This technology has recently achieved striking success in a variety of task and there are great expectations on how it might improve clinical practice. Here we present a DNN model trained in a dataset with more than 2 million labeled exams analyzed by the Telehealth Network of Minas Gerais and collected under the scope of the CODE (Clinical Outcomes in Digital Electrocardiology) study. The DNN outperform cardiology resident medical doctors in recognizing 6 types of abnormalities in 12-lead ECG recordings, with F1 scores above 80% and specificity over 99%. These results indicate ECG analysis based on DNNs, previously studied in a single-lead setup, generalizes well to 12-lead exams, taking the technology closer to the standard clinical practice.

Antônio H. Ribeiro, Manoel Horta Ribeiro, Gabriela Paixão et al.

We present a model for predicting electrocardiogram (ECG) abnormalities in short-duration 12-lead ECG signals which outperformed medical doctors on the 4th year of their cardiology residency. Such exams can provide a full evaluation of heart activity and have not been studied in previous end-to-end machine learning papers. Using the database of a large telehealth network, we built a novel dataset with more than 2 million ECG tracings, orders of magnitude larger than those used in previous studies. Moreover, our dataset is more realistic, as it consist of 12-lead ECGs recorded during standard in-clinics exams. Using this data, we trained a residual neural network with 9 convolutional layers to map 7 to 10 second ECG signals to 6 classes of ECG abnormalities. Future work should extend these results to cover a large range of ECG abnormalities, which could improve the accessibility of this diagnostic tool and avoid wrong diagnosis from medical doctors.