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    An explainable algorithm for detecting drug-induced QT-prolongation at risk of torsades de pointes (TdP) regardless of heart rate and T-wave morphology

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    Authors
    Alahmadi, A.
    Davies, A.
    Royle, Jennifer
    Goodwin, Leanna
    Cresswell, K.
    Arain, Z.
    Vigo, M.
    Jay, C.
    Affiliation
    Department of Computer Science, The University of Manchester, Manchester, UK
    Issue Date
    2021
    
    Metadata
    Show full item record
    Abstract
    Torsade de points (TdP), a life-threatening arrhythmia that can increase the risk of sudden cardiac death, is associated with drug-induced QT-interval prolongation on the electrocardiogram (ECG). While many modern ECG machines provide automated measurements of the QT-interval, these automated QT values are usually correct only for a noise-free normal sinus rhythm, in which the T-wave morphology is well defined. As QT-prolonging drugs often affect the morphology of the T-wave, automated QT measurements taken under these circumstances are easily invalidated. An additional challenge is that the QT-value at risk of TdP varies with heart rate, with the slower the heart rate, the greater the risk of TdP. This paper presents an explainable algorithm that uses an understanding of human visual perception and expert ECG interpretation to automate the detection of QT-prolongation at risk of TdP regardless of heart rate and T-wave morphology. It was tested on a large number of ECGs (n=5050) with variable QT-intervals at varying heart rates, acquired from a clinical trial that assessed the effect of four known QT-prolonging drugs versus placebo on healthy subjects. The algorithm yielded a balanced accuracy of 0.97, sensitivity of 0.94, specificity of 0.99, F1-score of 0.88, ROC (AUC) of 0.98, precision-recall (AUC) of 0.88, and Matthews correlation coefficient (MCC) of 0.88. The results indicate that a prolonged ventricular repolarisation area can be a significant risk predictor of TdP, and detection of this is potentially easier and more reliable to automate than measuring the QT-interval distance directly. The proposed algorithm can be visualised using pseudo-colour on the ECG trace, thus intuitively 'explaining' how its decision was made, which results of a focus group show may help people to self-monitor QT-prolongation, as well as ensuring clinicians can validate its results.
    Citation
    Alahmadi A, Davies A, Royle J, Goodwin L, Cresswell K, Arain Z, et al. An explainable algorithm for detecting drug-induced QT-prolongation at risk of torsades de pointes (TdP) regardless of heart rate and T-wave morphology. Comput Biol Med. 2021;131:104281.
    Journal
    Computers in Biology and Medicine
    URI
    http://hdl.handle.net/10541/623823
    DOI
    10.1016/j.compbiomed.2021.104281
    PubMed ID
    33636421
    Additional Links
    https://dx.doi.org/10.1016/j.compbiomed.2021.104281
    Type
    Article
    Language
    en
    ae974a485f413a2113503eed53cd6c53
    10.1016/j.compbiomed.2021.104281
    Scopus Count
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    All Paterson Institute for Cancer Research

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