Great effort has been devoted in recent years to the development of sudden cardiac risk predictors as a function of electric cardiac signals, mainly obtained from the electrocardiogram (ECG) analysis. But these prediction techniques are still seldom used in clinical practice, partly due to its limited diagnostic accuracy and to the lack of consensus about the appropriate computational signal processing implementation. This paper addresses a three-fold approach, based on ECG indices, to structure this review on sudden cardiac risk stratification. First, throughout the computational techniques that had been widely proposed for obtaining these indices in technical literature. Second, over the scientific evidence, that although is supported by observational clinical studies, they are not always representative enough. And third, via the limited technology transfer of academy-accepted algorithms, requiring further meditation for future systems. We focus on three families of ECG derived indices which are tackled from the aforementioned viewpoints, namely, heart rate turbulence (HRT), heart rate variability (HRV), and T-wave alternans. In terms of computational algorithms, we still need clearer scientific evidence, standardizing, and benchmarking, siting on advanced algorithms applied over large and representative datasets. New scenarios like electronic health recordings, big data, long-term monitoring, and cloud databases, will eventually open new frameworks to foresee suitable new paradigms in the near future.

Noise and artifacts are inherent contaminating components and are particularly present in Holter electrocardiogram (ECG) monitoring. The presence of noise is even more significant in long-term monitoring (LTM) recordings, as these are collected for several days in patients following their daily activities; hence, strong artifact components can temporarily impair the clinical measurements from the LTM recordings. Traditionally, the noise presence has been dealt with as a problem of non-desirable component removal by means of several quantitative signal metrics such as the signal-to-noise ratio (SNR), but current systems do not provide any information about the true impact of noise on the ECG clinical evaluation. As a first step towards an alternative to classical approaches, this work assesses the ECG quality under the assumption that an ECG has good quality when it is clinically interpretable. Therefore, our hypotheses are that it is possible (a) to create a clinical severity score for the effect of the noise on the ECG, (b) to characterize its consistency in terms of its temporal and statistical distribution, and (c) to use it for signal quality evaluation in LTM scenarios. For this purpose, a database of external event recorder (EER) signals is assembled and labeled from a clinical point of view for its use as the gold standard of noise severity categorization. These devices are assumed to capture those signal segments more prone to be corrupted with noise during long-term periods. Then, the ECG noise is characterized through the comparison of these clinical severity criteria with conventional quantitative metrics taken from traditional noise-removal approaches, and noise maps are proposed as a novel representation tool to achieve this comparison. Our results showed that neither of the benchmarked quantitative noise measurement criteria represent an accurate enough estimation of the clinical severity of the noise. A case study of long-term ECG is reported, showing the statistical and temporal correspondences and properties with respect to EER signals used to create the gold standard for clinical noise. The proposed noise maps, together with the statistical consistency of the characterization of the noise clinical severity, paves the way towards forthcoming systems providing us with noise maps of the noise clinical severity, allowing the user to process different ECG segments with different techniques and in terms of different measured clinical parameters.

Despite the wide literature on R-wave detection algorithms for ECG Holter recordings, the long-term monitoring applications are bringing new requirements, and it is not clear that the existing methods can be straightforwardly used in those scenarios. Our aim in this work was twofold: First, we scrutinized the scope and limitations of existing methods for Holter monitoring when moving to long-term monitoring; Second, we proposed and benchmarked a beat detection method with adequate accuracy and usefulness in long-term scenarios. A longitudinal study was made with the most widely used waveform analysis algorithms, which allowed us to tune the free parameters of the required blocks, and a transversal study analyzed how these parameters change when moving to different databases. With all the above, the extension to long-term monitoring in a database of 7-day Holter monitoring was proposed and analyzed, by using an optimized simultaneous-multilead processing. We considered both own and public databases. In this new scenario, the noise-avoid mechanisms are more important due to the amount of noise that exists in these recordings, moreover, the computational efficiency is a key parameter in order to export the algorithm to the clinical practice. The method based on a Polling function outperformed the others in terms of accuracy and computational efficiency, yielding 99.48% sensitivity, 99.54% specificity, 99.69% positive predictive value, 99.46% accuracy, and 0.85% error for MIT-BIH arrhythmia database. We conclude that the method can be used in long-term Holter monitoring systems.

BACKGROUND Phospholamban (PLN) p.Arg14del mutation carriers are known to develop dilated and/or arrhythmogenic cardiomyopathy, and typical electrocardiographic (ECG) features have been identified for diagnosis. Machine learning is a powerful tool used in ECG analysis and has shown to outperform cardiologists.OBJECTIVES We aimed to develop machine learning and deep learning models to diagnose PLN p.Arg14del cardiomyopathy using ECGs and evaluate their accuracy compared to an expert cardiologist.METHODS We included 155 adult PLN mutation carriers and 155 age-and sex-matched control subjects. Twenty-one PLN mutation carriers (13.4%) were classified as symptomatic (symptoms of heart failure or malignant ventricular arrhythmias). The data set was split into training and testing sets using 4-fold cross-validation. Multiple models were developed to discriminate between PLN mutation carriers and control subjects. For comparison, expert cardiologists classified the same data set. The best performing models were validated using an external PLN p.Arg14del mutation carrier data set from Murcia, Spain (n 5 50). We applied occlusion maps to visualize the most contributing ECG regions. RESULTSIn terms of specificity, expert cardiologists (0.99) outperformed all models (range 0.53-0.81). In terms of accuracy and sensitivity, experts (0.28 and 0.64) were outperformed by all models (sensitivity range 0.65-0.81). T-wave morphology was most important for classification of PLN p.Arg14del carriers. External validation showed comparable results, with the best model outperforming experts.CONCLUSION This study shows that machine learning can outperform experienced cardiologists in the diagnosis of PLN p.Arg14del cardiomyopathy and suggests that the shape of the T wave is of added importance to this diagnosis.

Despite the broad interest and use of sentiment analysis nowadays, most of the conclusions in current literature are driven by simple statistical representations of sentiment scores. On that basis, the generated sentiment evaluation consists nowadays of encoding and aggregating emotional information from a number of individuals and their populational trends. We hypothesized that the stochastic processes aimed to be measured by sentiment analysis systems will exhibit nontrivial statistical and temporal properties. We established an experimental setup consisting of analyzing the short text messages (tweets) of 6 user groups with different nature (universities, politics, musicians, communication media, technological companies, and financial companies), including in each group ten high-intensity users in their regular generation of traffic on social networks. Statistical descriptors were checked to converge at about 2000 messages for each user, for which messages from the last two weeks were compiled using a custom-made tool. The messages were subsequently processed for sentiment scoring in terms of different lexicons currently available and widely used. Not only the temporal dynamics of the resulting score time series per user was scrutinized, but also its statistical description as given by the score histogram, the temporal autocorrelation, the entropy, and the mutual information. Our results showed that the actual dynamic range of lexicons is in general moderate, and hence not much resolution is given within their end-of-scales. We found that seasonal patterns were more present in the time evolution of the number of tweets, but to a much lesser extent in the sentiment intensity. Additionally, we found that the presence of retweets added negligible effects over standard statistical modes, while it hindered informational and temporal patterns. The innovative Compounded Aggregated Positivity Index developed in this work proved to be characteristic for industries and at the same time an interesting way to identify singularities among peers. We conclude that temporal properties of messages provide with information about the sentiment dynamics, which is different in terms of lexicons and users, but commonalities can be exploited in this field using appropriate temporal digital processing tools.

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Objective noise metrics such as the signal to noise ratio and the root mean squared value, are not always related to the actual impact that noise can have on the clinical evaluation of cardiac signals. This work is intended to design a database along with a set of criteria to be used as an initial solid gold-standard of noise severity within a scale created from the clinical point of view. Different from previous approaches, we used recordings from external cardiac event recorders, which have a signal morphology and characteristics typical for the usual Holter monitoring devices. These recorded events often correspond to noise segments, which makes simpler the retrieval of a variety of signal segments with real noise examples. We generated a database recordings from 8 patients (4 female and 4 male with a clinical indication for long-term monitoring, 64.75±25.44 years old). In a first attempt, a set of rules for clinical quality recording were initially defined by a cardiologist, so segments with clear clinical description were categorized into free, low, moderate, hard, or other noise. Segments with unclear description are set apart for revision. This process was iterated until convergence of expert opinion and labels. A specific software tool was created and modified for supporting the process for each iteration. The relative duration of the different kinds of noise in both leads according to their clinical severity was: 4h 14m 15s (free, 37.32%), 2h 54m 52s (moderated, 25.67%), 2h 21m 46s (hard, 20.81%), 1h 43m 13s (low, 15.15%) and 07m 07s -other-(1.05%). The generated database and criteria represent a valuable gold standard for clinical quality evaluation of noise impact on ECG signals.

Recent research has proven the existence of statistical relation among fragmented QRS and several highly prevalence diseases, such as cardiac sarcoidosis, acute coronary syndrome, arrythmogenic cardiomyopathies, Brugada syndrome, and hypertrophic cardiomyopathy. One out of five hundred people suffer from hypertrophic cardiomyopathies. The relation among the fragmentation and arrhythmias drives the objective of this work, which is to propose a valid method for QRS fragmentation detection. With that aim, we followed a two-stage approach. First, we identified the features that better characterize the fragmentation by analyzing the physiological interpretation of multivariate approaches, such as principal component analysis (PCA) and independent component analysis (ICA). Second, we created an invariant transformation method for the multilead electrocardiogram (ECG), by scrutinizing the statistical distributions of the PCA eigenvectors and of the ICA transformation arrays, in order to anchor the desired elements in the suitable leads in the feature space. A complete database was compounded incorporating real fragmented ECGs, surrogate registers by synthetically adding fragmented activity to real non-fragmented ECG registers, and standard clean ECGs. Results showed that the creation of beat templates together with the application of PCA over eight independent leads achieves 0.995 fragmentation enhancement ratio and 0.07 dispersion coefficient. In the case of ICA over twelve leads, the results were 0.995 fragmentation enhancement ratio and 0.70 dispersion coefficient. We conclude that the algorithm presented in this work constructs a new paradigm, by creating a systematic and powerful tool for clinical anamnesis and evaluation based on multilead ECG. This approach consistently consolidates the inconspicuous elements present in multiple leads onto designated variables in the output space, hence offering additional and valid visual and non-visual information to standard clinical review, and opening the door to a more accurate automatic detection and statistically valid systematic approach for a wide number of applications. In this direction and within the companion paper, further developments are presented applying this technique to fragmentation detection.