A machine learning framework for risk prediction of multi-label cardiovascular events based on focused carotid plaque B-Mode ultrasound: A Canadian study

• Published in: Computers in biology and medicine Vol. 140; p. 105102
• Main Authors: Jamthikar, Ankush, Gupta, Deep, Johri, Amer M., Mantella, Laura E., Saba, Luca, Suri, Jasjit S.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Ltd 01.01.2022; Elsevier Limited
• Subjects: Accuracy; Acute coronary syndrome; Acute coronary syndromes; Algorithms; Angina; Angiography; Artificial intelligence; Biomarkers; Canada; Cardiac arrhythmia; Cardiovascular disease; Cardiovascular diseases; Cardiovascular events; Carotid arteries; Carotid ultrasound; Cerebral infarction; Classification; Congestive heart failure; Coronary artery; Coronary artery disease; Coronary Artery Disease - diagnostic imaging; Coronary Artery Disease - epidemiology; Coronary vessels; Datasets; Demography; Ethnicity; Heart attacks; Heart failure; Humans; Image classification; Internal Medicine; Ischemia; Learning algorithms; Machine Learning; Medical imaging; Multi-label classification; Myocardial infarction; Other; Patients; Performance evaluation; Phenotypes; Plaque, Atherosclerotic - diagnostic imaging; Predictions; Risk Assessment; Risk Factors; Sensitivity analysis; Stroke; Transient ischemic attack; Ultrasonic imaging; Ultrasound; Vein & artery diseases; Canada; Ontario Canada; Cardiovascular events; Acute coronary syndrome; Multi-label classification; Coronary artery disease; Carotid ultrasound; Machine learning
• ISSN: 0010-4825; 1879-0534; 1879-0534
• DOI: 10.1016/j.compbiomed.2021.105102

Machine learning (ML) algorithms can provide better cardiovascular event (CVE) prediction. However, ML algorithms are mostly explored for predicting a single CVE at a time. The objective of this study is to design and develop an ML-based system to predict multi-label CVEs, such as (i) coronary artery disease, (ii) acute coronary syndrome, and (iii) a composite CVE—a class of AtheroEdge 3.0 (ML) system. Focused carotid B-mode ultrasound and coronary angiography are performed on a group of 459 participants consisting of three cardiovascular labels. Initially, 23 risk predictors comprising (i) patients’ demographics, (ii) clinical blood-biomarkers, and (iii) carotid ultrasound image-based phenotypes are collected. Six types of classification techniques comprising (a) four problem transformation methods (PTM) and (b) two algorithm adaptation methods (AAM) are used for multi-label CVE prediction. The performance of the proposed system is evaluated for accuracy, sensitivity, specificity, F1-score, and area-under-the-curve (AUC) using 10-fold cross-validation. The proposed system is also verified using another database of 522 participants. For the primary database, PTM demonstrated a better multi-label CVE prediction than AAM (mean accuracy: 80.89% vs. 62.83%, mean AUC: 0.89 vs. 0.63), validating our hypothesis. The PTM-based binary relevance (BR) technique provided optimal performance in multi-label CVE prediction. The overall multi-label classification accuracy, sensitivity, specificity, F1-score, and AUC using BR are 81.2 ± 3.01%, 76.5 ± 8.8%, 83.8 ± 3.8%, 75.37 ± 5.8%, and 0.89 ± 0.02 (p < 0.0001), respectively. When used on the second Canadian database with seven cardiovascular events (acute coronary syndrome, myocardial infarction, angina, stroke, transient ischemic attack, heart failure, and death), the proposed system showed an accuracy of 96.36 ± 0.87% (AUC: 0.61 ± 0.06, p < 0.0001). ML-based multi-label classification algorithms, such as binary relevance, yielded the best predictions for three cardiovascular endpoints. •The first study, which predicts multi-label cardiovascular events using the machine learning (ML) paradigm.•Carotid ultrasound imaging and conventional risk predictors are used for ML-based multi-label cardiovascular event prediction.•This study compares the performance of six types of ML-based multi-label classification algorithms.•ML-based multi-label cardiovascular event prediction system is validated on an external cohort with the same ethnicity.