Deep cross-modal feature learning applied to predict acutely decompensated heart failure using in-home collected electrocardiography and transthoracic bioimpedance

Background Deep learning has been successfully applied to ECG data to aid in the accurate and more rapid diagnosis of acutely decompensated heart failure (ADHF). Previous applications focused primarily on classifying known ECG patterns in well-controlled clinical settings. However, this approach does not fully capitalize on the potential of deep learning, which directly learns important features without relying on a priori knowledge. In addition, deep learning applications to ECG data obtained from wearable devices have not been well studied, especially in the field of ADHF prediction. Methods We used ECG and transthoracic bioimpedance data from the SENTINEL-HF study, which enrolled patients (≥21 years) who were hospitalized with a primary diagnosis of heart failure or with ADHF symptoms. To build an ECG-based prediction model of ADHF, we developed a deep cross-modal feature learning pipeline, termed ECGX-Net, that utilizes raw ECG time series and transthoracic bioimpedance data from wearable devices. To extract rich features from ECG time series data, we first adopted a transfer learning approach in which ECG time series were transformed into 2D images, followed by feature extraction using ImageNet-pretrained DenseNet121/VGG19 models. After data filtering, we applied cross-modal feature learning in which a regressor was trained with ECG and transthoracic bioimpedance. Then, we concatenated the DenseNet121/VGG19 features with the regression features and used them to train a support vector machine (SVM) without bioimpedance information. Results The high-precision classifier using ECGX-Net predicted ADHF with a precision of 94 %, a recall of 79 %, and an F1-score of 0.85. The high-recall classifier with only DenseNet121 had a precision of 80 %, a recall of 98 %, and an F1-score of 0.88. We found that ECGX-Net was effective for high-precision classification, while DenseNet121 was effective for high-recall classification. Conclusion We show the potential for predicting ADHF from single-channel ECG recordings obtained from outpatients, enabling timely warning signs of heart failure. Our cross-modal feature learning pipeline is expected to improve ECG-based heart failure prediction by handling the unique requirements of medical scenarios and resource limitations. *Co-first authors: X. Pan and C. Wang. **Co-corresponding authors: K. Chon, Y. Mendelson, and K. Lee