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Heart Disease Diagnosis by Artificial Neural Networks
Heart Disease Diagnosis by Artificial Neural Networks
Heart Disease Diagnosis by Artificial Neural Networks
Original article
KEYWORDS
Coronary heart
disease;
Risk factors;
Articial neural
networks
Summary The aim of this study was to develop an articial neural networks-based (ANNs)
diagnostic model for coronary heart disease (CHD) using a complex of traditional and genetic
factors of this disease. The original database for ANNs included clinical, laboratory, functional,
coronary angiographic, and genetic [single nucleotide polymorphisms (SNPs)] characteristics of
487 patients (327 with CHD caused by coronary atherosclerosis, 160 without CHD). By changing
the types of ANN and the number of input factors applied, we created models that demonstrated
6494% accuracy. The best accuracy was obtained with a neural networks topology of multilayer
perceptron with two hidden layers for models included by both genetic and non-genetic CHD
risk factors.
2011 Japanese College of Cardiology. Published by Elsevier Ltd. All rights reserved.
Introduction
0914-5087/$ see front matter 2011 Japanese College of Cardiology. Published by Elsevier Ltd. All rights reserved.
doi:10.1016/j.jjcc.2011.11.005
191
Risk factors
CHD risk factors included in the analysis were: age,
gender, total cholesterol, high-density lipoprotein (HDL)
cholesterol, low-density lipoprotein (LDL) cholesterol, verylow-density lipoprotein (VLDL) cholesterol, triglycerides,
cholesterol ratio, fasting plasma glucose, arterial hypertension, diabetes mellitus, current tobacco smoking status,
obesity (Quetelet index, body mass index BMI > 30), and a
family history of CHD. Additional factors taken into account
were profession (locomotive driving), risk of fatal cardiovascular disease according to the European SCORE project
scale (SCORE index) [1], left ventricular ejection fraction,
and coronary angiography data.
Genotyping
Genotyping was performed by an allele-specic primer
extension of multiplex amplied products and detection
with a matrix-assisted laser desorption/ionization time-ofight mass spectroscopy on an AutoPhlex II MALDI-TOF MS
(Bruker Daltonics, Billerica, MA, USA). The analyzed panel
includes 14 SNPs localized in genes involved in CHD pathogenesis: lipoprotein lipase [LIPC 250G/A (rs2070895) and
LIPC 514C/T (rs1800588)], nitric oxide synthase [NOS E298D
(rs1799983)], methylenetetrahydrofolate reductase [MTHFR
A223V (rs1801133)], angiotensin-converting enzyme [ACE
Alu Ins/Del I>D (rs4646994)], angiotensinogen [AGT M235T
(rs699)], and AGT T174M (rs4762) variants, angiotensin
II type 1 receptor [AGTR A1166C (rs5186)], plasminogen
activator inhibitor-1 [PAI-1 5G/4G (rs1799889)], and Creactive protein [CRP-1 (rs1800947)], CRP-2 (rs1417938),
CRP-3 (rs1205), CRP-4 (rs3093068), and CRP-5 (rs1130864)].
Results
Based on the results of the clinical instrumental research,
CHD caused by coronary atherosclerosis was diagnosed in
192
Table 1
Model
Factors
Accuracy (%)
64
II
III
IV
V
VI
VII
VIII
IX
X
77
83
91
90
83
89
93
90
88
CHD, coronary heart disease; HDL, high-density lipoprotein cholesterol; LDL, low-density lipoprotein cholesterol; VLDL, very-low-density
lipoprotein cholesterol; SNP, single nucleotide polymorphisms.
a In all cases, the multilayer perceptron neuronal network topology with two buried 4-neuron layers was used.
Discussion
One of the modern approaches to the solution of classication problems is intelligent data processing based on
resolving optimization tasks using ANNs. Our results suggest
that ANNs may also be used to create a highly accurate and
effective model for CHD prediction.
In this research we have examined the inuence of different parameters, teaching methods, and neural network
topologies on the accuracy of CHD diagnosis. We revealed
that the optimal topology to resolve this classication task
is a MLP with two buried layers. The optimal input parameters are 810 of the most signicant factors: the use of all
factors seems to excessively complicate the model, while,
at the same time, smaller numbers do not provide essential
information for resolving this problem. It is of interest to
note that, in some models, the accuracy of CHD diagnosis
was lower than 90% in spite of including coronary arteriography data, which are considered the gold standard for
CHD diagnosis in clinical practice.
Publications on the possibilities of cardiologic application of articial intelligence, ANN, rst of all, are usually
limited to different combinations of traditional laboratory
and instrumental methods [2225]. Therefore, the novelty
of our study is the inclusion of genes as risk factors in order to
estimate capabilities of CHD prediction. In this connection,
Conclusion
The purpose of this study was to create CHD diagnostic models with appropriate analytical characteristics using
MLP ANNs. The best accuracy was obtained in models that
included both genetic and non-genetic factors associated
with the disease. The models of >90% accuracy may serve as
the basis for the development of software tools for diagnosis
and prediction of CHD.
References
[1] Graham I, Atar D, Borch-Johnsen K, Boysen G, Burell G,
Cifkova R, Dallongeville J, De Backer G, Ebrahim S, Gjelsvik
B, Herrmann-Lingen C, Hoes A, Humphries S, Knapton M, Perk
J, et al. European guidelines on cardiovascular disease prevention in clinical practice: executive summary. Fourth Joint Task
Force of the European Society of Cardiology and other societies on cardiovascular disease prevention in clinical practice
(constituted by representatives of nine societies and by invited
experts). Eur Heart J 2007;28:2375414.
[2] Rosamond W, Flegal K, Friday G, Furie K, Go A, Greenlund K,
Haase N, Ho M, Howard V, Kissela B, Kittner S, Lloyd-Jones
D, McDermott M, Meigs J, Moy C, et al. Heart disease and
stroke statistics 2007 update: a report from the American
Heart Association Statistics Committee and Stroke Statistics
Subcommittee. Circulation 2007;115:e69171.
[3] Li C, Balluz LS, Okoro CA, Strine TW, Lin JM, Town M, Garvin
W, Murphy W, Bartoli W, Valluru B. Centers for Disease Control
and Prevention (CDC). Division of Behavioral Surveillance, Public Health Surveillance Program Ofce, Ofce of Surveillance,
Epidemiology, and Laboratory Services. Surveillance of certain
health behaviors and conditions among States and selected
local areas behavioral risk factor surveillance system, United
States, 2009. MMWR Surveill Summ 2011;60:1250.
193
[4] Ford ES, Capewell S. Coronary heart disease mortality among
young adults in the U.S. from 1980 through 2002: concealed
leveling of mortality rates. J Am Coll Cardiol 2007;50:212832.
[5] Rumana N, Kita Y, Turin TC, Murakami Y, Sugihara H, Morita
Y, Tomioka N, Okayama A, Nakamura Y, Abbott RD, Ueshima
H. Trend of increase in the incidence of acute myocardial
infarction in a Japanese population: Takashima AMI Registry,
19902001. Am J Epidemiol 2008;167:135864.
[6] Pogosova GV, Oganov RG, Koltunov IE, Sokolova OIu, Pozdniakov IuM, Vygodin VA, Sapunova ID, Ryzhikova IB, Karpova AV,
Eliseeva NA. Monitoring of secondary prevention of ischemic
heart disease in Russia and European countries: results of
international multicenter study EUROASPIRE III. Kardiologiia
2011;51:3440.
[7] Assmann G, Cullen P, Schulte H. Simple scoring scheme for calculating the risk of acute coronary events based on the 10-year
follow-up of the prospective cardiovascular Munster (PROCAM)
study. Circulation 2002;105:3105.
[8] Wilson PWF, Castelli WP, Kannel WB. Coronary risk prediction in adults (the Framingham Heart Study). Am J Cardiol
1987;59:914.
[9] Conroy RM, Pyrl K, Fitzgerald AP, Sans S, Menotti A, De
Backer G, De Bacquer D, Ducimetire P, Jousilahti P, Keil U,
Njlstad I, Oganov RG, Thomsen T, Tunstall-Pedoe H, Tverdal A,
et al. Estimation of ten-year risk of fatal cardiovascular disease
in Europe: the SCORE project. Eur Heart J 2003;24:9871003.
[10] Hippisley-Cox J, Coupland C, Vinogradova Y, Robson J, May M,
Brindle P. Derivation and validation of QRISK, a new cardiovascular disease risk score for the United Kingdom: prospective
open cohort study. BMJ 2007;335:136.
[11] Ridker PM, Buring JE, Rifai N, Cook NR. Development and validation of improved algorithms for the assessment of global
cardiovascular risk in women: the Reynolds Risk Score. JAMA
2007;297:6119.
[12] Brindle P, Beswick A, Fahey T, Ebrahim S. Accuracy and impact
of risk assessment in the primary prevention of cardiovascular
disease: a systematic review. Heart 2006;92:17529.
[13] Yamamoto H, Ohashi N, Ishibashi K, Utsunomiya H, Kunita E,
Oka T, Horiguchi J, Kihara Y. Coronary calcium score as a predictor for coronary artery disease and cardiac events in Japanese
high-risk patients. Circ J 2011;75:242431.
[14] Williams M, Shaw LJ, Raggi P, Morris D, Vaccarino V, Liu ST,
Weinstein SR, Mosler TP, Tseng PH, Flores FR, Nasir K, Budoff
M. Prognostic value of number and site of calcied coronary
lesions compared with the total score. JACC Cardiovasc Imaging 2008;1:619.
[15] Tedeschi-Reiner E, Strozzi M, Skoric B, Reiner Z. Relation of
atherosclerotic changes in retinal arteries to the extent of
coronary artery disease. Am J Cardiol 2005;96:11079.
[16] Casas J, Cooper J, Miller GJ, Hingorani AD, Humphries SE.
Investigating the genetic determinants of cardiovascular disease using candidate genes and meta-analysis of association
studies. Ann Hum Genet 2006;70:14569.
[17] Brautbar A, Ballantyne CM, Lawson K, Nambi V, Chambless
L, Folsom AR, Willerson JT, Boerwinkle E. Impact of adding
a single allele in the 9p21 locus to traditional risk factors
on reclassication of coronary heart disease risk and implications for lipid-modifying therapy in the Atherosclerosis Risk
in Communities (ARIC) study. Circ Cardiovasc Genet 2009;2:
27985.
[18] Kullo IJ, Cooper LT. Early identication of cardiovascular risk using genomics and proteomics. Nat Rev Cardiol
2010;7:30917.
[19] Ding K, Kullo IJ. Genome-wide association studies for
atherosclerotic vascular disease and its risk factors. Circ Cardiovasc Genet 2009;2:6372.
[20] Haykin S. Neural networks: a comprehensive foundation. New
York: Macmillan College Publishing Company; 1994.
194
[21] Obenshain MK. Application of data mining techniques to healthcare data. Infect Control Hosp Epidemiol 2004;25:6905.
[22] Allison JS, Heo J, Iskandrian AE. Articial neural network modeling of stress single-photon emission computed tomographic
imaging for detecting extensive coronary artery disease. Am J
Cardiol 2005;95:17881.
giro
glu S, Barutc
u I.
[23] Colak MC, Colak C, Kocatrk H, Sa
Predicting coronary artery disease using different articial neural network models. Anadolu Kardiyol Derg 2008;8:
24954.
[24] Papaloukas C, Fotiadis DI, Likas A, Michalis LK. An ischemia
detection method based on articial neural networks. Artif
Intell Med 2002;24:16778.