Collin Stultz

Abinitha Gourabathina, Hyewon Jeong, Teya Bergamaschi et al. · mit

Deep learning models trained to optimize average accuracy often exhibit systematic failures on particular subpopulations. In real world settings, the subpopulations most affected by such disparities are frequently unlabeled or unknown, thereby motivating the development of methods that are performant on sensitive subgroups without being pre-specified. However, existing group-robust methods typically assume prior knowledge of relevant subgroups, using group annotations for training or model selection. We propose Low-rank Error Informed Adaptation (LEIA), a simple two-stage method that improves group robustness by identifying a low-dimensional subspace in the representation space where model errors concentrate. LEIA restricts adaptation to this error-informed subspace via a low-rank adjustment to the classifier logits, directly targeting latent failure modes without modifying the backbone or requiring group labels. Using five real-world datasets, we analyze group robustness under three settings: (1) truly no knowledge of subgroup relevance, (2) partial knowledge of subgroup relevance, and (3) full knowledge of subgroup relevance. Across all settings, LEIA consistently improves worst-group performance while remaining fast, parameter-efficient, and robust to hyperparameter choice.

Ridwan Alam, Collin Stultz

The diagnosis, prognosis, and treatment of a number of cardiovascular disorders rely on ECG interval measurements, including the PR, QRS, and QT intervals. These quantities are measured from the 12-lead ECG, either manually or using automated algorithms, which are readily available in clinical settings. A number of wearable devices, however, can acquire the lead-I ECG in an outpatient setting, thereby raising the potential for out-of-hospital monitoring for disorders that involve clinically significant changes in ECG intervals. In this work, we therefore developed a series of deep learning models for estimating the PR, QRS, and QT intervals using lead-I ECG. From a corpus of 4.2 million ECGs from patients at the Massachusetts General Hospital, we train and validate each of the models. At internal holdout validation, we achieve mean absolute errors (MAE) of 6.3 ms for QRS durations and 11.9 ms for QT intervals, and an MAE of 9.2 ms for estimating PR intervals. Moreover, as a well-defined P-wave does not always exist in ECG tracings - for example, when there is atrial fibrillation - we trained a model that can identify when there is a P-wave, and consequently, a measurable PR interval. We validate our models on three large external healthcare datasets without any finetuning or retraining - 3.2 million ECG from the Brigham and Womens Hospital, 668 thousand from MIMIC-IV, and 20 thousand from PTB-XL - and achieve similar performance. Also, our models significantly outperform two publicly available baseline algorithms. This work demonstrates that ECG intervals can be tracked from only lead-I ECG using deep learning, and highlights the potential for out-of-hospital applications.

Nathaniel Diamant, Erik Reinertsen, Steven Song et al.

Supervised machine learning applications in health care are often limited due to a scarcity of labeled training data. To mitigate this effect of small sample size, we introduce a pre-training approach, Patient Contrastive Learning of Representations (PCLR), which creates latent representations of ECGs from a large number of unlabeled examples. The resulting representations are expressive, performant, and practical across a wide spectrum of clinical tasks. We develop PCLR using a large health care system with over 3.2 million 12-lead ECGs, and demonstrate substantial improvements across multiple new tasks when there are fewer than 5,000 labels. We release our model to extract ECG representations at https://github.com/broadinstitute/ml4h/tree/master/model_zoo/PCLR.

Hyewon Jeong, Nassim Oufattole, Matthew Mcdermott et al.

In clinical practice, one often needs to identify whether a patient is at high risk of adverse outcomes after some key medical event. For example, quantifying the risk of adverse outcomes after an acute cardiovascular event helps healthcare providers identify those patients at the highest risk of poor outcomes; i.e., patients who benefit from invasive therapies that can lower their risk. Assessing the risk of adverse outcomes, however, is challenging due to the complexity, variability, and heterogeneity of longitudinal medical data, especially for individuals suffering from chronic diseases like heart failure. In this paper, we introduce Event-Based Contrastive Learning (EBCL) - a method for learning embeddings of heterogeneous patient data that preserves temporal information before and after key index events. We demonstrate that EBCL can be used to construct models that yield improved performance on important downstream tasks relative to other pretraining methods. We develop and test the method using a cohort of heart failure patients obtained from a large hospital network and the publicly available MIMIC-IV dataset consisting of patients in an intensive care unit at a large tertiary care center. On both cohorts, EBCL pretraining yields models that are performant with respect to a number of downstream tasks, including mortality, hospital readmission, and length of stay. In addition, unsupervised EBCL embeddings effectively cluster heart failure patients into subgroups with distinct outcomes, thereby providing information that helps identify new heart failure phenotypes. The contrastive framework around the index event can be adapted to a wide array of time-series datasets and provides information that can be used to guide personalized care.

Ridwan Alam, Aaron Aguirre, Collin Stultz

For a number of antiarrhythmics, drug loading requires a 3 day hospitalization with monitoring for QT prolongation. Automated QT monitoring with wearable ECG monitors would facilitate out-of-hospital care. We develop a deep learning model that infers QT intervals from ECG lead-I - the lead most often acquired from ambulatory ECG monitors - and to use this model to detect clinically meaningful QT-prolongation episodes during Dofetilide drug loading. Using 4.22 million 12-lead ECG recordings from 903.6 thousand patients at the Massachusetts General Hospital, we develop a deep learning model, QTNet, that infers QT intervals from lead-I. Over 3 million ECGs from 653 thousand patients are used to train the model and an internal-test set containing 633 thousand ECGs from 135 thousand patients was used for testing. QTNet is further evaluated on an external-validation set containing 3.1 million ECGs from 667 thousand patients at another institution. QTNet was used to detect Dofetilide-induced QT prolongation in a publicly available database (ECGRDVQ-dataset) containing ECGs from subjects enrolled in a clinical trial evaluating the effects of antiarrhythmic drugs. QTNet achieves mean absolute errors of 12.63ms (internal-test) and 12.30ms (external-validation) for estimating absolute QT intervals. The associated Pearson correlation coefficients are 0.91 (internal-test) and 0.92 (external-validation). For the ECGRDVQ-dataset, QTNet detects Dofetilide-induced QTc prolongation with 87% sensitivity and 77% specificity. The negative predictive value of the model is greater than 95% when the pre-test probability of drug-induced QTc prolongation is below 25%. Drug-induced QT prolongation risk can be tracked from ECG lead-I using deep learning.