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The aim of this work is to present the HEARTEN Knowledge Management System, one of the core modules of the HEARTEN platform. The HEARTEN platform is an mHealth collaborative environment enabling the Heart Failure patients to self-manage the disease and remain adherent, while allowing the other ecosystem actors (healthcare professionals, caregivers, nutritionists, physical activity experts, psychologists) to monitor the patient's health progress and offer personalized, predictive and preventive disease management. The HEARTEN Knowledge Management System is a tool which provides multiple functionalities to the ecosystem actors for the assessment of the patient's condition, the estimation of the patient's adherence, the prediction of potential adverse events, the calculation of Heart Failure related scores, the extraction of statistics, the association of patient clinical and non-clinical data and the provision of alerts and suggestions. The innovation of this tool lays in the analysis of multi-parametric personal data coming from different sources, including for the first time breath and saliva biomarkers, and the use of machine learning techniques. The HEARTEN Knowledge Management System consists of nine modules. The accuracy of the KMS modules ranges from 78% to 95% depending on the module/functionality.
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Insuficiência Cardíaca/terapia , Gestão do Conhecimento , Biomarcadores/metabolismo , Testes Respiratórios , Dieta , Exercício Físico , Insuficiência Cardíaca/metabolismo , Insuficiência Cardíaca/fisiopatologia , Humanos , Aprendizado de Máquina , Monitorização Fisiológica/métodos , Cooperação do Paciente , Saliva/metabolismo , AutogestãoRESUMO
BACKGROUND: Serum natriuretic peptides (NPs) have an established role in heart failure (HF) diagnosis. Saliva NT-proBNP that may be easily acquired has been studied little. METHODS: Ninety-nine subjects were enrolled; thirty-six obese or hypertensive with dyspnoea but no echocardiographic HF findings or raised NPs served as controls, thirteen chronic HF (CHF) patients and fifty patients with acute decompensated HF (ADHF) requiring hospital admission. Electrocardiogram, echocardiogram, 6 min walking distance (6MWD), blood and saliva samples, were acquired in all participants. RESULTS: Serum NT-proBNP ranged from 60-9000 pg/mL and saliva NT-proBNP from 0.64-93.32 pg/mL. Serum NT-proBNP was significantly higher in ADHF compared to CHF (p = 0.007) and in CHF compared to controls (p < 0.05). There was no significant difference in saliva values between ADHF and CHF, or between CHF and controls. Saliva and serum levels were positively associated only in ADHF patients (R = 0.352, p = 0.012). Serum NT-proBNP was positively associated with NYHA class (R = 0.506, p < 0.001) and inversely with 6MWD (R = -0.401, p = 0.004) in ADHF. Saliva NT-proBNP only correlated with age in ADHF patients. CONCLUSIONS: In the current study, saliva NT-proBNP correlated with serum values in ADHF patients, but could not discriminate between HF and other causes of dyspnoea. Further research is needed to explore the value of saliva NT-proBNP.
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BACKGROUND: In this work, we propose a multilevel and multiparametric approach in order to model the growth and progression of oral squamous cell carcinoma (OSCC) after remission. OSCC constitutes the major neoplasm of the head and neck region, exhibiting a quite aggressive nature, often leading to unfavorable prognosis. METHODS: We formulate a Decision Support System assembling a multitude of heterogeneous data sources (clinical, imaging tissue and blood genomic), aiming to capture all manifestations of the disease. Our primary aim is to identify the factors that dictate OSCC progression and subsequently predict potential relapses of the disease. The discrimination potential of each source of data is initially explored separately, and afterwards the individual predictions are combined to yield a consensus decision achieving complete discrimination between patients with and without a disease relapse. Moreover, we collect and analyze gene expression data from circulating blood cells throughout the follow-up period in consecutive time-slices, in order to model the temporal dimension of the disease. For this purpose a Dynamic Bayesian Network (DBN) is employed which is able to capture in a transparent manner the underlying mechanism dictating the disease evolvement, and employ it for monitoring the status and prognosis of the patients after remission. RESULTS: By feeding as input to the DBN data from the baseline visit we achieve accuracy of 86%, which is further improved to complete discrimination when data from the first follow-up visit are also employed. CONCLUSIONS: Knowing in advance the progression of the disease, i.e. identifying groups of patients with higher/lower risk of reoccurrence, we are able to determine the subsequent treatment protocol in a more personalized manner.
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Progressão da Doença , Modelos Biológicos , Neoplasias Bucais/patologia , Neoplasias de Células Escamosas/patologia , Teorema de Bayes , Sistemas de Apoio a Decisões Clínicas , Feminino , Expressão Gênica , Humanos , Masculino , Neoplasias Bucais/genética , Recidiva Local de Neoplasia , Neoplasias de Células Escamosas/genética , Indução de RemissãoRESUMO
Early prediction of cancer reoccurrence constitutes a challenge for oncologists and surgeons. This chapter describes one ongoing experience, the EU-Project NeoMark, where scientists from different medical and biology research fields joined efforts with Information Technology experts to identify methods and algorithms that are able to early predict the reoccurrence risk for one of the most devastating tumors, the oral cavity squamous cell carcinoma (OSCC). The challenge of NeoMark is to develop algorithms able to identify a "signature" or bio-profile of the disease, by integrating multiscale and multivariate data from medical images, genomic profile from tissue and circulating cells RNA, and other medical parameters collected from patients before and after treatment. A limited number of relevant biomarkers will be identified and used in a real-time PCR device for early detection of disease reoccurrence.
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Diagnóstico por Computador/estatística & dados numéricos , Recidiva Local de Neoplasia/diagnóstico , Algoritmos , Biomarcadores Tumorais/genética , Carcinoma de Células Escamosas/diagnóstico , Carcinoma de Células Escamosas/genética , Carcinoma de Células Escamosas/terapia , Biologia Computacional , Interpretação Estatística de Dados , Mineração de Dados , Genômica/estatística & dados numéricos , Humanos , Interpretação de Imagem Assistida por Computador , Bases de Conhecimento , Neoplasias Bucais/diagnóstico , Neoplasias Bucais/genética , Neoplasias Bucais/terapia , Recidiva Local de Neoplasia/genética , Recidiva Local de Neoplasia/prevenção & controle , Reação em Cadeia da Polimerase , Medição de RiscoRESUMO
The aim of the study is to address the heart failure (HF) diagnosis with the application of deep learning approaches. Seven deep learning architectures are implemented, where stacked Restricted Boltzman Machines (RBMs) and stacked Autoencoders (AEs) are used to pre-train Deep Belief Networks (DBN) and Deep Neural Networks (DNN). The data is provided by the University College Dublin and the 2nd Department of Cardiology from the University Hospital of Ioannina. The features recorded are grouped into: general demographic information, physical examination, classical cardiovascular risk factors, personal history of cardiovascular disease, symptoms, medications, echocardiographic features, laboratory findings, lifestyle/habits and other diseases. The total number of subjects utilized is 422. The deep learning methods provide quite high results with the Autoencoder plus DNN approach to demonstrate accuracy 91.71%, sensitivity 90.74%, specificity 92.31% and f-score 89.36%.
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Aprendizado Profundo , Insuficiência Cardíaca , Algoritmos , Insuficiência Cardíaca/diagnóstico , Humanos , Redes Neurais de ComputaçãoRESUMO
The aim of this study was to perform a systematic review on the potential value of saliva biomarkers in the diagnosis, management and prognosis of heart failure (HF). The correlation between saliva and plasma values of these biomarkers was also studied. PubMed was searched to collect relevant literature, i.e., case-control, cross-sectional studies that either compared the values of salivary biomarkers among healthy subjects and HF patients, or investigated their role in risk stratification and prognosis in HF patients. No randomized control trials were included. The search ended on 31st of December 2020. A total of 15 studies met the inclusion criteria. 18 salivary biomarkers were analyzed and the levels of all biomarkers studied were found to be higher in HF patients compared to controls, except for amylase, sodium, and chloride that had smaller saliva concentrations in HF patients. Natriuretic peptides are the most commonly used plasma biomarkers in the management of HF. Their saliva levels show promising results, although the correlation of saliva to plasma values is weakened in higher plasma values. In most of the publications, differences in biomarker levels between HF patients and controls were found to be statistically significant. Due to the small number of patients included, larger studies need to be conducted in order to facilitate the use of saliva biomarkers in clinical practice.
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The aim of this study was to address chronic heart failure (HF) diagnosis with the application of machine learning (ML) approaches. In the present study, we simulated the procedure that is followed in clinical practice, as the models we built are based on various combinations of feature categories, e.g., clinical features, echocardiogram, and laboratory findings. We also investigated the incremental value of each feature type. The total number of subjects utilized was 422. An ML approach is proposed, comprising of feature selection, handling class imbalance, and classification steps. The results for HF diagnosis were quite satisfactory with a high accuracy (91.23%), sensitivity (93.83%), and specificity (89.62%) when features from all categories were utilized. The results remained quite high, even in cases where single feature types were employed.
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Heart failure (HF) is the most rapidly growing cardiovascular condition with an estimated prevalence of >37.7 million individuals globally. HF is associated with increased mortality and morbidity and confers a substantial burden, in terms of cost and quality of life, for the individuals and the healthcare systems, highlighting thus the need for early and accurate diagnosis of HF. The accuracy of HF diagnosis, severity estimation, and prediction of adverse events has improved by the utilization of blood tests measuring biomarkers. The contribution of biomarkers for HF management is intensified by the fact that they can be measured in short time at the point-of-care. This is allowed by the development of portable analytical devices, commonly known as point-of-care testing (POCT) devices, which exploit the advancements in the area of microfluidics and nanotechnology. The aim of this review paper is to present a review of POCT devices used for the measurement of biomarkers facilitating decision making when managing HF patients. The devices are either commercially available or in the form of prototypes under development. Both blood and saliva samples are considered. The challenges concerning the implementation of POCT devices and the barriers for their adoption in clinical practice are discussed.
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Insuficiência Cardíaca , Testes Imediatos/normas , Saliva/química , Idoso , Biomarcadores/análise , Biomarcadores/sangue , Insuficiência Cardíaca/sangue , Insuficiência Cardíaca/diagnóstico , Insuficiência Cardíaca/metabolismo , Humanos , Pessoa de Meia-Idade , Peptídeo Natriurético Encefálico/análise , Peptídeo Natriurético Encefálico/sangue , Fragmentos de Peptídeos/análise , Fragmentos de Peptídeos/sangue , Qualidade de VidaRESUMO
The aim of this work is to present the architecture of the KardiaSoft software, a clinical decision support tool allowing the healthcare professionals to monitor patients with heart failure by providing useful information and suggestions in terms of the estimation of the presence of heart failure (heart failure diagnosis), stratification-patient profiling, long term patient condition evaluation and therapy response monitoring. KardiaSoft is based on predictive modeling techniques that analyze data that correspond to four saliva biomarkers, measured by a point-of-care device, along with other patient's data. The KardiaSoft is designed based on the results of a user requirements elicitation process. A small clinical scale study with 135 subjects and an early clinical study with 90 subjects will take place in order to build and validate the predictive models, respectively.
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Sistemas de Apoio a Decisões Clínicas , Insuficiência Cardíaca , Biomarcadores , Humanos , Saliva , SoftwareRESUMO
The aim of this work is to present KardiaTool platform, an integrated Point of Care (POC) solution for noninvasive diagnosis and therapy monitoring of Heart Failure (HF) patients. The KardiaTool platform consists of two components, KardiaPOC and KardiaSoft. KardiaPOC is an easy to use portable device with a disposable Lab-on-Chip (LOC) for the rapid, accurate, non-invasive and simultaneous quantitative assessment of four HF related biomarkers, from saliva samples. KardiaSoft is a decision support software based on predictive modeling techniques that analyzes the POC data and other patient's data, and delivers information related to HF diagnosis and therapy monitoring. It is expected that identifying a source comparable to blood, for biomarker information extraction, such as saliva, that is cost-effective, less invasive, more convenient and acceptable for both patients and healthcare professionals would be beneficial for the healthcare community. In this work the architecture and the functionalities of the KardiaTool platform are presented.
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Insuficiência Cardíaca , Sistemas Automatizados de Assistência Junto ao Leito , Biomarcadores , Humanos , Dispositivos Lab-On-A-Chip , SalivaRESUMO
A method for the extraction and classification of individual motor unit action potentials (MUAPs) from needle electromyographic signals is presented. The proposed method automatically decomposes MUAPs and classifies them into normal, neuropathic or myopathic using a two-stage feature-based classifier. The method consists of four steps: (i) preprocessing of EMG recordings, (ii) MUAP clustering and detection of superimposed MUAPs, (iii) feature extraction and (iv) MUAP classification using a two-stage classifier. The proposed method employs Radial Basis Function Artificial Neural Networks and decision trees. It requires minimal use of tuned parameters and is able to provide interpretation for the classification decisions. The approach has been validated on real EMG recordings and an annotated collection of MUAPs. The success rate for MUAP clustering is 96%, while the accuracy for MUAP classification is about 89%.
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Potenciais de Ação/fisiologia , Doenças Neuromusculares/diagnóstico , Processamento de Sinais Assistido por Computador , Algoritmos , Árvores de Decisões , Eletromiografia/métodos , Humanos , Contração Muscular/fisiologia , Redes Neurais de Computação , Doenças Neuromusculares/fisiopatologiaRESUMO
The aim of this work is to present a computational approach for the estimation of the severity of heart failure (HF) in terms of New York Heart Association (NYHA) class and the characterization of the status of the HF patients, during hospitalization, as acute, progressive or stable. The proposed method employs feature selection and classification techniques. However, it is differentiated from the methods reported in the literature since it exploits information that biomarkers fetch. The method is evaluated on a dataset of 29 patients, through a 10-fold-cross-validation approach. The accuracy is 94 and 77% for the estimation of HF severity and the status of HF patients during hospitalization, respectively.
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Insuficiência Cardíaca , Biomarcadores , Hospitalização , Humanos , SalivaRESUMO
Heart failure is one of the most common diseases worldwide. In recent years, Ventricular Assist Devices (VADs) have become a valuable option for patients with advanced HF. Although it has been shown that VADs improve patient survival rates, several complications persist during left VAD (LVAD) support. The stratification scores currently employed are mostly generic, i.e. not specifically built for LVAD patients, and are based on pre-implantation patient data. In this work we apply data mining approaches for the prediction of time dependent survival in patients after LVAD implantation. Moreover, the predictions acquired with the use of pre-implantation data are enriched by employing post-implantation data, i.e. follow-up data. Different clinical scenarios have been depicted and the subsequent conditions are tested in order to identify the optimal set of pre- and post-implant features, as well as the most suitable algorithms for feature selection and prediction. The proposed approach is applied to a real dataset of 71 patients, reporting an accuracy of 84.5%, sensitivity of 87% and specificity of 82%. Based on the reported results, expert cardio-surgeons can be supported in planning the treatment of VAD patients.
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Bases de Dados Factuais , Insuficiência Cardíaca , Coração Auxiliar , Modelos Biológicos , Adulto , Intervalo Livre de Doença , Feminino , Seguimentos , Insuficiência Cardíaca/mortalidade , Insuficiência Cardíaca/fisiopatologia , Insuficiência Cardíaca/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Taxa de SobrevidaRESUMO
Heart failure (HF) is a chronic disease characterised by poor quality of life, recurrent hospitalisation and high mortality. Adherence of patient to treatment suggested by the experts has been proven a significant deterrent of the above-mentioned serious consequences. However, the non-adherence rates are significantly high; a fact that highlights the importance of predicting the adherence of the patient and enabling experts to adjust accordingly patient monitoring and management. The aim of this work is to predict the adherence of patients with HF, through the application of machine learning techniques. Specifically, it aims to classify a patient not only as medication adherent or not, but also as adherent or not in terms of medication, nutrition and physical activity (global adherent). Two classification problems are addressed: (i) if the patient is global adherent or not and (ii) if the patient is medication adherent or not. About 11 classification algorithms are employed and combined with feature selection and resampling techniques. The classifiers are evaluated on a dataset of 90 patients. The patients are characterised as medication and global adherent, based on clinician estimation. The highest detection accuracy is 82 and 91% for the first and the second classification problem, respectively.
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Cardiac beat classification is a key process in the detection of myocardial ischemic episodes in the electrocardiographic signal. In the present study, we propose a multicriteria sorting method for classifying the cardiac beats as ischemic or not. Through a supervised learning procedure, each beat is compared to preclassified category prototypes under five criteria. These criteria refer to ST segment changes, T wave alterations, and the patient's age. The difficulty in applying the above criteria is the determination of the required method parameters, namely the thresholds and weight values. To overcome this problem, we employed a genetic algorithm, which, after proper training, automatically calculates the optimum values for the above parameters. A task-specific cardiac beat database was developed for training and testing the proposed method using data from the European Society of Cardiology ST-T database. Various experimental tests were carried out in order to adjust each module of the classification system. The obtained performance was 91% in terms of both sensitivity and specificity and compares favorably to other beat classification approaches proposed in the literature.
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Algoritmos , Arritmias Cardíacas/diagnóstico , Sistemas de Apoio a Decisões Clínicas , Diagnóstico por Computador/métodos , Eletrocardiografia/métodos , Isquemia Miocárdica/diagnóstico , Reconhecimento Automatizado de Padrão , Fatores Etários , Envelhecimento , Arritmias Cardíacas/complicações , Inteligência Artificial , Análise por Conglomerados , Frequência Cardíaca , Humanos , Isquemia Miocárdica/complicações , Reprodutibilidade dos Testes , Medição de Risco , Sensibilidade e EspecificidadeRESUMO
In this work we present a decision support tool for the calculation of time-dependent survival probability for patients after ventricular assist device implantation. Two different models have been developed, a short term one which predicts survival for the first three months and a long term one that predicts survival for one year after implantation. In order to model the time dependencies between the different time slices of the problem, a dynamic Bayesian network (DBN) approach has been employed. DBNs order to capture the temporal events of the patient disease and the temporal data availability. High accuracy results have been reported for both models. The short and long term DBNs reached an accuracy of 96.97% and 93.55% respectively.
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Teorema de Bayes , Sistemas de Apoio a Decisões Clínicas , Insuficiência Cardíaca/terapia , Coração Auxiliar , Procedimentos Cirúrgicos Torácicos/métodos , Adulto , Algoritmos , Cardiologia/métodos , Feminino , Insuficiência Cardíaca/mortalidade , Humanos , Masculino , Pessoa de Meia-Idade , Modelos Estatísticos , Probabilidade , Modelos de Riscos Proporcionais , Reprodutibilidade dos Testes , Fatores de TempoRESUMO
The control problem for LVADs is to set pump speed such that cardiac output and pressure perfusion are within acceptable physiological ranges. However, current technology of LVADs cannot provide for a closed-loop control scheme that can make adjustments based on the patient's level of activity. In this context, the SensorART Speed Selection Module (SSM) integrates various hardware and software components in order to improve the quality of the patients' treatment and the workflow of the specialists. It enables specialists to better understand the patient-device interactions, and improve their knowledge. The SensorART SSM includes two tools of the Specialist Decision Support System (SDSS); namely the Suction Detection Tool and the Speed Selection Tool. A VAD Heart Simulation Platform (VHSP) is also part of the system. The VHSP enables specialists to simulate the behavior of a patient׳s circulatory system, using different LVAD types and functional parameters. The SDSS is a web-based application that offers specialists with a plethora of tools for monitoring, designing the best therapy plan, analyzing data, extracting new knowledge and making informative decisions. In this paper, two of these tools, the Suction Detection Tool and Speed Selection Tool are presented. The former allows the analysis of the simulations sessions from the VHSP and the identification of issues related to suction phenomenon with high accuracy 93%. The latter provides the specialists with a powerful support in their attempt to effectively plan the treatment strategy. It allows them to draw conclusions about the most appropriate pump speed settings. Preliminary assessments connecting the Suction Detection Tool to the VHSP are presented in this paper.
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Simulação por Computador , Ventrículos do Coração/fisiopatologia , Coração Auxiliar , Modelos Cardiovasculares , Desenho de Prótese , HumanosRESUMO
In this paper, we propose a method to estimate the density of a data space represented by a geometric transformation of an initial Gaussian mixture model. The geometric transformation is hierarchical, and it is decomposed into two steps. At first, the initial model is assumed to undergo a global similarity transformation modeled by translation, rotation, and scaling of the model components. Then, to increase the degrees of freedom of the model and allow it to capture fine data structures, each individual mixture component may be transformed by another, local similarity transformation, whose parameters are distinct for each component of the mixture. In addition, to constrain the order of magnitude of the local transformation (LT) with respect to the global transformation (GT), zero-mean Gaussian priors are imposed onto the local parameters. The estimation of both GT and LT parameters is obtained through the expectation maximization framework. Experiments on artificial data are conducted to evaluate the proposed model, with varying data dimensionality, number of model components, and transformation parameters. In addition, the method is evaluated using real data from a speech recognition task. The obtained results show a high model accuracy and demonstrate the potential application of the proposed method to similar classification problems.
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This work presents the Treatment Tool, which is a component of the Specialist's Decision Support Framework (SDSS) of the SensorART platform. The SensorART platform focuses on the management of heart failure (HF) patients, which are treated with implantable, left ventricular assist devices (LVADs). SDSS supports the specialists on various decisions regarding patients with LVADs including decisions on the best treatment strategy, suggestion of the most appropriate candidates for LVAD weaning, configuration of the pump speed settings, while also provides data analysis tools for new knowledge extraction. The Treatment Tool is a web-based component and its functionality includes the calculation of several acknowledged risk scores along with the adverse events appearance prediction for treatment assessment.
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Insuficiência Cardíaca/prevenção & controle , Coração Auxiliar/efeitos adversos , Sistemas de Apoio a Decisões Clínicas , Gerenciamento Clínico , Insuficiência Cardíaca/epidemiologia , Insuficiência Cardíaca/mortalidade , Ventrículos do Coração , Humanos , Internet , Valor Preditivo dos Testes , Interface Usuário-ComputadorRESUMO
Oral squamous cell carcinoma (OSCC) constitutes the predominant neoplasm of the head and neck region, featuring particularly aggressive nature, associated with quite unfavorable prognosis. In this work we formulate a Decision Support System (DSS) which integrates a multitude of heterogeneous data (clinical, imaging and genomic), thus, framing all manifestations of the disease. Our primary aim is to identify the factors that dictate OSCC progression and subsequently predict potential relapses (local or metastatic) of the disease. The discrimination potential of each source of data is initially explored separately, and afterwards the individual predictions are combined to yield a consensus decision achieving complete discrimination between patients with and without a disease relapse.