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Gaussian process-based kernel as a diagnostic model for prediction of type 2 diabetes mellitus risk using non-linear heart rate variability features

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Abstract

The main objective of the study was to develop a low-cost, non-invasive diagnostic model for the early prediction of T2DM risk and validation of this model on patients. The model was designed based on the machine learning classification technique using non-linear Heart rate variability (HRV) features. The electrocardiogram of the healthy subjects (n = 35) and T2DM subjects (n = 100) were recorded in the supine position for 15 min, and HRV features were extracted. The significant non-linear HRV features were identified through statistical analysis. It was found that Poincare plot features (SD1 and SD2) can differentiate the T2DM subject data from healthy subject data. Several machine learning classifiers, such as Linear Discriminant Analysis (LDA), Quadratic Discriminant Analysis, Naïve Bayes, and Gaussian Process Classifier (GPC), have classified the data based on the cross-validation approach. A GP classifier was implemented using three kernels, namely radial basis, linear, and polynomial kernel, considering the ability to handle the non-linear data. The classifier performance was evaluated and compared using performance metrics such as accuracy(AC), sensitivity(SN), specificity(SP), precision(PR), F1 score, and area under the receiver operating characteristic curve(AUC). Initially, all non-linear HRV features were selected for classification, but the specificity of the model was the limitation. Thus, only two Poincare plot features were used to design the diagnostic model. Our diagnostic model shows the performance using GPC based linear kernel as AC of 92.59%, SN of 96.07%, SP of 81.81%, PR of 94.23%, F1 score of 0.95, and AUC of 0.89, which are more extensive compared to other classification models. Further, the diagnostic model was deployed on the hardware module. Its performance on unknown/test data was validated on 65 subjects (healthy n = 15 and T2DM n = 50). Considering the desirable performance of the diagnostic model, it can be used as an initial screening test tool for a healthcare practitioner to predict T2DM risk.

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References

  1. Acharya UR, Joseph KP, Kannathal N, Lim CM, Suri JS. Heart rate variability: a review. Med Biol Eng Compu. 2006;44(12):1031–51.

    Article  Google Scholar 

  2. Williams SM, Eleftheriadou A, Alam U, Cuthbertson DJ, Wilding JP. Cardiac autonomic neuropathy in obesity, the metabolic syndrome, and prediabetes: a narrative review. Diabetes Therapy. 2019;1:1–27.

    Google Scholar 

  3. Spallone V. Update on the impact, diagnosis, and management of cardiovascular autonomic neuropathy in diabetes: what is defined, what is new, and what is unmet. Diabetes Metab J. 2019;43(1):3–30.

    Article  MathSciNet  Google Scholar 

  4. Sardu C, De Lucia C, Wallner M, Santulli G. Diabetes mellitus and its cardiovascular complications: new insights into an old disease. 2019;1:1–2.

  5. Rydén L, Grant PJ, Anker SD, Berne C, Cosentino F, Danchin N, Deaton C, Escaned J, Hammes HP, Huikuri H. ESC Guidelines on diabetes, pre-diabetes, and cardiovascular diseases developed in collaboration with the EASD: the Task Force on diabetes, pre-diabetes, and cardiovascular diseases of the European Society of Cardiology (ESC) and developed in collaboration with the European Association for the Study of Diabetes (EASD). Eur Heart J. 2013;34(39):3035–87.

    Article  Google Scholar 

  6. Dunlay SM, Givertz MM, Aguilar D, Allen LA, Chan M, Desai AS, Deswal A, Dickson VV, Kosiborod MN, Lekavich CL, McCoy RG. Type 2 Diabetes Mellitus and Heart Failure: A Scientific Statement from the American Heart Association and the Heart Failure Society of America: This statement does not represent an update of the 2017 ACC/AHA/HFSA heart failure guideline update. Circulation. 2019;140(7):e294-324.

    Article  Google Scholar 

  7. Prasad VC, Savery DM, Prasad VR. Cardiac autonomic dysfunction and ECG abnormalities in patients with type 2 diabetes mellitus-a comparative cross-sectional study. Natl J Physiol Pharm Pharmacol. 2016;6(3):178–81.

    Article  Google Scholar 

  8. Roy B, Ghatak S. Non-linear methods to assess changes in heart rate variability in type 2 diabetic patients. Arq Bras Cardiol. 2013;101(4):317–27.

    Google Scholar 

  9. De Souza AC, Cisternas JR, De Abreu LC, Roque AL, Monteiro CB, Adami F, Vanderlei LC, Sousa FH, Ferreira LL, Valenti VE. Fractal correlation property of heart rate variability in response to the postural change maneuver in healthy women. Int Arch Med. 2014;7(1):25–30.

    Article  Google Scholar 

  10. Yeh RG, Chen GY, Shieh JS, Kuo CD. Parameter investigation of detrended fluctuation analysis for short-term human heart rate variability. J Med Biol Eng. 2010;30(5):277–82.

    Article  Google Scholar 

  11. Shukla RS, Aggarwal Y. Nonlinear heart rate variability-based analysis and prediction of performance status in pulmonary metastases patients. Biomed Eng Appl Basis Commun. 2018;30(06):1850043–8.

    Article  Google Scholar 

  12. Khandoker AH, Jelinek HF, Palaniswami M. Identifying diabetic patients with cardiac autonomic neuropathy by heart rate complexity analysis. Biomed Eng Online. 2009;8(1):3.

    Article  Google Scholar 

  13. Nunan D, Sandercock GR, Brodie DA. A quantitative systematic review of normal values for short-term heart rate variability in healthy adults. Pacing Clin Electrophysiol. 2010;33(11):1407–17.

    Article  Google Scholar 

  14. American Diabetes Association. 2. Classification and diagnosis of diabetes. Diabetes Care. 2015; 38(Supplement 1):8–16.

  15. Electrophysiology TF. Heart rate variability: standards of measurement, physiological interpretation, and clinical use. Circulation. 1996;93(5):1043–65.

    Article  Google Scholar 

  16. Faust O, Acharya UR, Molinari F, Chattopadhyay S, Tamura T. Linear and non-linear analysis of cardiac health in diabetic subjects. Biomed Signal Process Control. 2012;7(3):295–302.

    Article  Google Scholar 

  17. Brennan M, Palaniswami M, Kamen P. Do existing measures of Poincare plot geometry reflect non-linear features of heart rate variability? IEEE Trans Biomed Eng. 2001;48(11):1342–7.

    Article  Google Scholar 

  18. Peng CK, Havlin S, Hausdorff JM, Mietus JE, Stanley HE, Goldberger AL. Fractal mechanisms and heart rate dynamics: long-range correlations and their breakdown with disease. J Electrocardiol. 1995;28:59–65.

    Article  Google Scholar 

  19. Fusheng Y, Bo H, Qingyu T. Approximate entropy and its application in biosignal analysis. Non-linear Biomed Signal Process Dyn Anal Model. 2001;2:72–91.

    Google Scholar 

  20. Richman JS, Moorman JR. Physiological time-series analysis using approximate entropy and sample entropy. Am J Physiol Heart Circ Physiol. 2000;278(6):2039–49.

    Article  Google Scholar 

  21. Xie L, Li Z, Zhou Y, He Y, Zhu J. Computational diagnostic techniques for electrocardiogram signal analysis. Sensors. 2020;20(21):6318.

    Article  Google Scholar 

  22. Gupta V, Mittal M. Efficient R-peak detection in electrocardiogram signal based on features extracted using Hilbert transform and Burg method. J Inst Eng India Ser B. 2020;101:1–2.

    Article  Google Scholar 

  23. Patro S, Sahu KK. Normalization: A preprocessing stage. arXiv preprint http://arxiv.org/abs/1503.06462. 2015.

  24. Jain AK, Duin RP, Mao J. Statistical pattern recognition: A review. IEEE Trans Pattern Anal Mach Intell. 2000;22(1):4–37.

    Article  Google Scholar 

  25. Fisher RA. The use of multiple measurements in taxonomic problems. Ann Eugen. 1936;7(2):179–88.

    Article  Google Scholar 

  26. Tharwat A, Gaber T, Ibrahim A, Hassanien AE. Linear discriminant analysis: A detailed tutorial. AI Commun. 2017;30(2):169–90.

    Article  MathSciNet  Google Scholar 

  27. Smith CA. Some examples of discrimination. Ann Eugen. 1946;13(1):272–82.

    Article  MathSciNet  Google Scholar 

  28. Pérez A, Larrañaga P, Inza I. Bayesian classifiers based on kernel density estimation: Flexible classifiers. Int J Approximate Reasoning. 2009;50(2):341–62.

    Article  Google Scholar 

  29. Rasmussen CE, Williams CK. Gaussian processes for machine learning. 2006; 38:715–719.

  30. Nickisch H, Rasmussen CE. Approximations for binary Gaussian process classification. J Mach Learn Res. 2008;9:2035–78.

    MathSciNet  MATH  Google Scholar 

  31. Opper M, Winther O. Gaussian processes for classification: Mean-field algorithms. Neural Comput. 2000;12(11):2655–84.

    Article  Google Scholar 

  32. Hajian-Tilaki K. Receiver operating characteristic (ROC) curve analysis for medical diagnostic test evaluation. Caspian J Intern Med. 2013;4(2):627–35.

    Google Scholar 

  33. Burlutskiy N, Petridis M, Fish A, Chernov A, Ali N. An investigation on online versus batch learning in predicting user behaviour. In: International Conference on Innovative Techniques and Applications of Artificial Intelligence. 2016;135–49.

  34. Demšar J. Statistical comparisons of classifiers over multiple data sets. J Mach Learn Res. 2006;7:1–30.

    MathSciNet  MATH  Google Scholar 

  35. Acharya UR, Faust O, Sree SV, Ghista DN, Dua S, Joseph P, Ahamed VT, Janarthanan N, Tamura T. An integrated diabetic index using heart rate variability signal features for diagnosis of diabetes. Comput Methods Biomech Biomed Eng. 2013;16(2):222–34.

    Article  Google Scholar 

  36. Acharya UR, Faust O, Kadri NA, Suri JS, Yu W. Automated identification of normal and diabetes heart rate signals using non-linear measures. Comput Biol Med. 2013;43(10):1523–9.

    Article  Google Scholar 

  37. Benichou T, Pereira B, Mermillod M, Tauveron I, Pfabigan D, Maqdasy S, Dutheil F. Heart rate variability in type 2 diabetes mellitus: A systematic review and meta-analysis. PLoS ONE. 2018;13(4):1–19.

    Article  Google Scholar 

  38. Kumari VA, Chitra R. Classification of diabetes disease using support vector machine. Int J Eng Res Appl. 2013;3(2):1797–801.

    Google Scholar 

  39. Osman AH, Aljahdali HM. Diabetes disease diagnosis method based on feature extraction using K-SVM. Int J Adv Comput Sci Appl. 2017;8(1):236–44.

    Google Scholar 

  40. Chawla NV, Bowyer KW, Hall LO, Kegelmeyer WP. SMOTE: synthetic minority over-sampling technique. J Artif Intell Res. 2002;16:321–57.

    Article  Google Scholar 

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Correspondence to R. Shashikant.

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The study was approved by the Institutional Ethics Committee of Smt. Kashibai Navale Medical College and General Hospital Pune India.

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Shashikant, R., Chaskar, U., Phadke, L. et al. Gaussian process-based kernel as a diagnostic model for prediction of type 2 diabetes mellitus risk using non-linear heart rate variability features. Biomed. Eng. Lett. 11, 273–286 (2021). https://doi.org/10.1007/s13534-021-00196-7

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