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<article xmlns:xlink="http://www.w3.org/1999/xlink">
  <front>
    <journal-meta />
    <article-meta>
      <title-group>
        <article-title>Calculation Method for a Computer's Diagnostics of Cardiovascular Diseases Based on Canonical Decompositions of Random Sequences</article-title>
      </title-group>
      <contrib-group>
        <contrib contrib-type="author">
          <string-name>Igor P. Atamanyuk</string-name>
          <email>atamanyukip@mnau.edu.ua</email>
          <xref ref-type="aff" rid="aff0">0</xref>
        </contrib>
        <contrib contrib-type="author">
          <string-name>Yuriy P. Kondratenko</string-name>
          <email>yuriy.kondratenko@chdu.edu.ua</email>
          <xref ref-type="aff" rid="aff1">1</xref>
        </contrib>
        <aff id="aff0">
          <label>0</label>
          <institution>Mykolaiv National Agrarian University, Commune of Paris str.</institution>
          <addr-line>9, 54010 Mykolaiv</addr-line>
          ,
          <country country="UA">Ukraine</country>
        </aff>
        <aff id="aff1">
          <label>1</label>
          <institution>Petro Mohyla Black Sea State University</institution>
          ,
          <addr-line>68</addr-line>
        </aff>
      </contrib-group>
      <abstract>
        <p>The canonical decomposition of sequence describing the change of cardiograms is put in the basis of the method for a computer system of disease diagnostics. Obtained criterion of the solution of the problem of electrocardiograms classification is considerably simpler than the known criterion of making decision on the basis of the criterion of the maximum of density of distribution. The transition from multi-dimension density distribution to producing of unidimensional densities that allows to use random number of parameters of electrocardiograms for diagnostics is offered to carry out. The results of numerical experiment confirm the effectiveness of the offered method and high reliability of the processes of identification of cardiovascular diseases identification on the basis of its usage.</p>
      </abstract>
      <kwd-group>
        <kwd>calculation method</kwd>
        <kwd>medical diagnostics</kwd>
        <kwd>electrocardiogram</kwd>
        <kwd>random sequence</kwd>
        <kwd>canonical decomposition</kwd>
      </kwd-group>
    </article-meta>
  </front>
  <body>
    <sec id="sec-1">
      <title>-</title>
      <p>
        At present, cardiovascular diseases head the list among the most widespread and
dangerous diseases of modernity [
        <xref ref-type="bibr" rid="ref1">1</xref>
        ]. According to the data of the world Health
Organization the death rate because of heart diseases in Ukraine reaches 64%, in the USA heart
disease affects more than 800 000 people annually. At present the number of heart
diseases among capable of working population sharply increased (quite often the age
of the sick person with cardiac infarction doesn’t exceed 23-25 years).
      </p>
      <p>
        As heart diseases belong to the diseases which course and results of treatment
directly depend on timely detection and elimination of pathological deviations the
reliable diagnostics is the most important and primary task in the problem of
cardiovascular diseases. As of today a great number of approaches [
        <xref ref-type="bibr" rid="ref10 ref11 ref12 ref2 ref3 ref4 ref5 ref6 ref7 ref8 ref9">2-12</xref>
        ] for the solving of the
given task with the usage of different mathematical methods including statistical
methods, methods of computational intelligence, fuzzy logic, neural network
modeling algorithms and others are worked out.
      </p>
      <p>
        Let us consider some related works concerning the methods for analysis of
electrocardiograms using automated techniques, modern information technologies and
computer systems. For example, such investigations were started at the University of
Glasgow (Uni-G), United Kingdom more than 40 years ago and are continuing as
Uni-G ECG Analysis Program [
        <xref ref-type="bibr" rid="ref13">13</xref>
        ] based on development of different approaches, in
particular: methods for processing waveforms recorded in groups of three leads
simultaneously, 12-lead ECG analysis program, optional approaches to computing the
average QRS cycle including a simple mean, a weighted mean and a median beat,
rhythm analysis, Brugada pattern, neural networks, rule based criteria, software
diagnostic criteria based on age, sex, race, clinical classification, drug therapy and so on.
      </p>
      <p>
        A dynamic hybrid architecture is descripted in [
        <xref ref-type="bibr" rid="ref14">14</xref>
        ] for ECG data analysis,
combining the fuzzy with the connectionist approach. The data abstraction is performed by a
layer of Radial Basis Function (RBF) units and the upcoming classification is carried
out by a classical two-layer feedforward neural network. For the evaluation a large
clinically validated ECG database is explored, but a more detailed description of the
input space using a larger number of RBF units does not grant sufficient
improvements.
      </p>
      <p>
        Leiden ECG Analysis and Decomposition Software (LEADS) was developed [
        <xref ref-type="bibr" rid="ref15">15</xref>
        ]
at the Leiden University Medical Center, The Netherlands as a MATLAB program for
research oriented ECG/VCG analysis. LEADS focuses on the determination of a
lownoise representative averaged beat (QRST complex), in which multiple parameters
can be measured, paying special attention to the T wave. LEADS generates a default
selection of beats for subsequent averaging.
      </p>
      <p>
        The paper [
        <xref ref-type="bibr" rid="ref16">16</xref>
        ] presents the current status of principal component analysis (PCA)
for ECG signal processing and describes the relationship between PCA and
Karhunen-Loeve transform.
      </p>
      <p>Several ECG applications based on PCA techniques have been successfully
employed, including data compression, ST-T segment analysis for the detection of
myocardial ischemia and abnormalities in ventricular repolarization, extraction of atrial
fibrillatory waves for detailed characterization of atrial fibrillation, and analysis of
body surface potential maps.</p>
      <p>
        Advances in sensor technology, personal mobile devices, wireless broadband
communications, and Cloud computing are enabling real-time collection and
dissemination of personal health data to patients and health-care professionals anytime. This
approach was proposed in [
        <xref ref-type="bibr" rid="ref17">17</xref>
        ] for creating an autonomic cloud environment for
hosting ECG data analysis services.
      </p>
      <p>
        A solution in [
        <xref ref-type="bibr" rid="ref18">18</xref>
        ] leverages the advance in multi-processor system-on-chip
architectures, and is centered on the parallelization of the ECG computation kernel.
      </p>
      <p>
        The article [
        <xref ref-type="bibr" rid="ref19">19</xref>
        ] reviewed time domain, frequency domain, premature complexes
detection, heart rate variability, and nonlinear ECG analysis based methods.
      </p>
      <p>
        Several different approaches for ECG analysis are based on a chaos theory [
        <xref ref-type="bibr" rid="ref20">20</xref>
        ], a
combination of statistical, geometric, and nonlinear heart rate variability features [
        <xref ref-type="bibr" rid="ref21">21</xref>
        ],
a semantic web ontology and heart failure expert system [
        <xref ref-type="bibr" rid="ref22">22</xref>
        ], learning system based
on support vector machines [
        <xref ref-type="bibr" rid="ref23">23</xref>
        ], signal averaging method, multivariate analysis [
        <xref ref-type="bibr" rid="ref24">24</xref>
        ],
RPCA - recursive principal component analysis [
        <xref ref-type="bibr" rid="ref25">25</xref>
        ], nonlinear PCA neural networks
[
        <xref ref-type="bibr" rid="ref26">26</xref>
        ], cluster analysis, SPSA - simultaneous perturbation stochastic approximation
method [
        <xref ref-type="bibr" rid="ref27">27</xref>
        ], ABT - Amplitude Based Technique, FDBT - First Derivative Based
Technique, SDBT - Second Derivative Based Technique [
        <xref ref-type="bibr" rid="ref28">28</xref>
        ], Hilbert transform [
        <xref ref-type="bibr" rid="ref29">29</xref>
        ]
and so on.
      </p>
      <p>At the same time each from above-mentioned methods has its disadvantages and
limitations. Just therefore the necessity of the working out of new effective methods
of medical diagnostics didn’t lose its actuality.
2</p>
      <p>Statement of the problem
One of the most widespread methods of diagnostics and detection of cardiovascular
diseases is an electrocardiography, a method of graphic registration of the
characteristics of the electric field of a heart and their changes in the process of heart
contractions. Electrocardiogram is characterized with a set of teeth by time and amplitude
parameters of which the diagnosis is done. Taking into account that changing of the
parameters of electrocardiogram has accidental character the problem of the
classification of the realization of random sequence (some disease or absence of a disease
correspond to every class) is the mathematical content of heart diseases diagnostics.
For the purpose of the increase of the reliability of the diagnostics of cardiovascular
diseases it is necessary to work out on the basis of the theory of random sequences the
method of electrocardiogram recognition with taking complete account of their
stochastic qualities.
3</p>
      <p>Solution
The object of investigation is the random consequence
X   X 1 , X 2 ,..., X 12 with twelve elements each of which corresponds to
some the most informative parameter of the electrocardiogram Fig. 1 (as appropriate
the number of parameters can be increased): X 1 is the width of the tooth P; X 2
is the height of the tooth P; X 3 is the interval P–Q; X 4 is the height of the tooth
Q; X 5 is the interval QRS; X 6 is the height of the first tooth R; X 7 is the
height of the second tooth R; X 8 is the height of the tooth S; X 9 is the interval
Q-T; X 10 is the height of the tooth T; X 11 is the duration of the first cycle of
the cardiogram; X 12 is the duration of the second cycle of the cardiogram.</p>
      <p>As the result of electrocardiography conducting some sequence of values
x i, i  1,12 about which it is known a priori that it is generated by one of the
random sequences X ( j) i , i  1,12, j  1, J ( J 1 of diseases and normal state) is
obtained. It is necessary to define to which of these sequences exactly (to which of J
classes) relates to given realization. Formulated in such a way the problem of
recognition completely comes to standard Bayes approach but during the usage of Bayes
criterion improbable (and that is why especially dangerous) diseases can not be
recognized. Thereupon for solving of the problem of medical diagnostics the most
acceptable is the criterion of the maximum of probability according to which during the
observation of the realization x  x 1 , x 2 ,..., x 12 that hypothesis is taken
which meets the condition:
j*  arg max  f12  x / j ,
j
(1)
where</p>
      <p>f12  x / j , j  1, J is the relative density distribution of the symptoms x
provided that the realization belongs to the given class.</p>
      <p>The problem of the recognition of random sequence realization comes to the
determination of the belonging of the realization x to one of J given distributions
f12  x / j , j  1, J .</p>
      <p>
        Thus the following stage is the assessment of the unknown densities
f12  x / j  , j  1, J that in its turn taking into account the great number of the results
of x i  , i  1,12 observations is quite difficult and laborious procedure. Given
problem in the context of linear relations is essentially simplified [
        <xref ref-type="bibr" rid="ref30">30</xref>
        ] during the transition
from sequence x i  , i  1,12 to the analysis of the set of uncorrelated values
vi , i  1, I , which are determined from the canonical model of random sequence [
        <xref ref-type="bibr" rid="ref31">31</xref>
        ]
presentation:
      </p>
      <p>i
X i    V  i  , i  1,12,
 1</p>
      <p>i1
Vi  X i    V  i  , i  1,12,</p>
      <p> 1
 i  
1 M  X   X i  1 D j j   j i ,   1, I , i  , I.</p>
      <p>D  j1 </p>
      <p>i1
Di  M  X 2 i    D 2 i  , i  1,12 ,</p>
      <p>  1
where  i,  , i  1, I is nonrandom coordinate function:     1,  i   0 , if
  i .</p>
      <p>In this case the substitution of x for vector v taking into account
12
fI v / j    f1 vi / j , j  1, J allows to put down the criterion of decision making
i1
in the following form:</p>
      <p>12 
j*  arg max  f1 vi / j , j  1, J .</p>
      <p>j i1 </p>
      <p>
        The problem of recognition thus comes to consecutive approximation of twelve
one-dimensional densities of distribution. The stochastic algorithm of diagnostics
becomes simpler essentially but the transition from the vector x to the vector v is
possible provided that the random sequences  X i  / j, i  1,12, j  1, J have only
linear relations. Taking down of the limitations of the random sequences
X ( j) i  , i  1,12, j  1, J normal distribution is possible as a result of the usage of
the corresponding nonlinear canonical decomposition [
        <xref ref-type="bibr" rid="ref32 ref33 ref34 ref35">32-35</xref>
        ]:
      </p>
      <p>Vi( )  X  i  i11 jN1V( j)(j) i   j11Vi( j)( ij) i  , i  1,12;
(2)
(3)
(4)
(5)
(6)
(7)
 h( ) i </p>
      <p>D1   M  X    X h i  11 jN1 D j ( )(j)   h(j) i  </p>
      <p> 1 
  D j  (j)   h(j) i   ,   1, N ,  1, i.</p>
      <p>j1 </p>
      <p>Taking into account different qualities of random sequences
X i  / j, i  1,12, j  1, J parameters of the canonical decomposition (7)-(9) are
unique for each of the investigated sequences. The advantage of the decomposition
(7)-(9) usage is that their independence follows from noncorrelatedness Vi(N ) , i  1, I
as all stochastic relations of much lower order are removed from the given
coefficients. Thus the same as in the previous case the conversion of the problem of
recognition from twelve measured space of the characteristics X 1 ,..., X 12 into the
space of the characteristics V (N ) ,...,V (N ) of the same dimension simplifies the
1 12
procedure of the assessment of the densities of distribution
12
f12 v(N ) ,..., v(N ) / j    f1 vi(N ) / j , j  1, J that comes to the approximation of
1 I i1
twelve unidimensional densities of distribution. The criterion of making decision
takes the following form</p>
      <p>i1 N 2  1 2
D i  M  X 2 i   1 j1 D j  (j) i   j1 D j i (ij) i  , i  1,12; (8)
(9)
(10)
(11)
12 
j*  arg max  f1 vi(N ) / j , j  1, J .</p>
      <p>j i1 </p>
      <p>
        The absence of the assumptions about the kind of the density distribution of the
random values V (N ) ,...,V (N ) comes to the necessity of the usage of nonparametric
1 12
methods for their description. The simplest and the most effective approach under
given conditions is the usage of nonparametric assessments of Parzen-type [
        <xref ref-type="bibr" rid="ref36">36</xref>
        ]:
fL vi(N )  
1 L
      </p>
      <p> g ul ,
dL l1
where ul  d 1 vi(N )  vi(,Nl )  , vi(,Nl) , l  1, L are the realizations of the random value
V (N ) , g ul  is a certain weigh function (kernel); d is a constant (coefficient of
i
blurriness).</p>
      <p>The choice in the capacity of the function of the kernel of g u  of steady density
distribution allows to write down the expression for the assessment of the density
distribution of Vi(N ) in the following form:
where
fL vi(N )  
1 L</p>
      <p> gl vi(N ) ,
dL l1
0, 5, vi(,Nl )  d  vi(N )  vi(,Nl )  d ,
gl vi(N )   

 0, vi(N )  vi(,Nl )  d,</p>
      <p>l  1, L;
d  0,5sup vi(,Nl)  vi(,Nl)1 , vi(,Nl)  vi(,Nl)1, l  2, L.</p>
      <p>l</p>
      <p>The method of diagnostics of cardiovascular diseases on the basis of the offered
algorithm and criterion of making decisions presupposes the fulfillment of the
following phases:</p>
      <p>Phase 1. Collection of statistic information about each investigated random
sequence X ( j) i , i=1, I , j=1, J ;</p>
      <p>Phase 2. Calculation on the basis of the accumulated realizations xl( j) i  , i  1, I ;
l  1, L j ; j  1, J for the investigated sequences X ( j) i , i=1, I , j=1, J discretized
moment functions M  Xl   X h i  ;</p>
      <p></p>
      <p>Phase 3. Forming for each sequence X ( j) i , i=1, I , j=1, J the canonical
decomposition (7);</p>
      <p>Phase 4. Obtaining on the basis of statistic information the assessments of
onedimensional densities of the distribution of the random coefficients of the canonical
decompositions of the random sequences X ( j) i , i=1, I , j=1, J ;</p>
      <p>Phase 5. Decomposition of the recognizable realization by canonical expressions;
calculation of the values of one-dimensional densities of distribution of coefficients
formed as a result of decompositions; determination of the belonging of the
realization of a certain random sequence X ( j*) i  , i=1, I (diagnostics of a disease) with the
help of a rule (10);</p>
      <p>Phase 6. Entry of the recognized realization x( j*) i  , i=1, I into the base of
statistical data of the corresponding random sequence X ( j*) i  , i=1, I .</p>
      <p>The scheme of the functioning of the system of cardiovascular diseases diagnostics
is represented in Fig. 2.</p>
      <p>
        In modern medicine more than one hundred different cardiovascular diseases are
classified [
        <xref ref-type="bibr" rid="ref1">1</xref>
        ]. Developed six-stage algorithm is tested on five the most widespread
diagnoses: “healthy heart” – is a random sequence X i  / 1, i  1,12 ; “hypertrophy
of myocardium” - X i  / 2, i  1,12 ; “severe arrhythmia” - X i  / 3, i  1,12 ;
“stenocardia of the 2d functional class” - X i  / 4, i  1,12 ; “neurocirculatory
dystonia of light degree” - X i  / 5, i  1,12 .The check of the statistical hypothesis
about the independence of random coefficients of the canonical decomposition (7) on
the basis of the criterion  2 showed the validity of the hypothesis by N  3 for all
three sequences with the probability not less than PD  0,98 . Thus the decomposition
(7) with the corresponding set of coordinate functions  h( ) i  , h,  1, 3,  , i  1,12
modifies into the adequate
model of the investigated
random
sequence
X i  / j, i  1,12, j  1, 3 . For example, in Table 1 values 1(1) i  ,  , i  1,12 for
X i  / 3, i  1,12 are represented.
      </p>
      <p>
        Recognition of the diagnoses was done on the basis of 200 different cardiograms
for each disease. Comparative results of recognition of the diagnoses (a) on the basis
of the developed by the authors calculating method, (b) on the basis of neuronic
network [
        <xref ref-type="bibr" rid="ref37">37</xref>
        ] synthesized with the usage of Daubechies wavelet function of the 4th
degree and Levenberg-Marquardt algorithm (for training) and (c) on the basis of the
usage of fuzzy logic in medical diagnostics [
        <xref ref-type="bibr" rid="ref3 ref4">3, 4</xref>
        ] during the realization of the systems
of fuzzy logic inference of Mamdani-type are presented in Table 2.
      </p>
      <p>Neuronic network that was used in calculating experiment (Table 2) has the
following pecularities.</p>
      <p>
        1. Expressions for the determination of approximation coefficients and detailing of
discrete wavelet transform are of the form [
        <xref ref-type="bibr" rid="ref37">37</xref>
        ]:
      </p>
      <p>W  j0 , k  
1</p>
      <p> f  x j0 ,k  x ,</p>
      <p>M x
W  j, k  
1</p>
      <p> f  x j,k  x ,</p>
      <p>M x
where  j,k  x ,  j,k  x is a family of basic functions.
y  k   M1 f  iK0 wki f  jN0 wij x  .</p>
      <p>3. As activation function of each separate neuron continuous sigmoid bipolar
function f  x  th  x was being used.</p>
      <p>
        In calculating experiment of the diagnostics of cardiovascular diseases on the basis
of the realization of the mechanism of fuzzy logic inference [
        <xref ref-type="bibr" rid="ref3 ref4">3,4</xref>
        ] the following input
parameters were used: x1 - age of the sick; x2 - double product of pulse on arterial
tension; x3 - tolerance to physical activity; x4 - increase of double product per one
kilogram of the body weight of the sick; x5 - increase of double product per one
kilogram of physical exertion; x6 - adenosinetriphosphoric acid; x7 - adenosine
diphosphoric acid; x8 - adenylic acid; x9 - coefficient of phosphorilation; x10 - maximal
consumption of oxygen per one kilogram of the body weight of the sick; x11 -
increase of double product in the response for submaximal physical exertion; x12
coefficient of the ratio of lactic and pyruvic acid content.
      </p>
      <p>Expressions for the determination of the diagnosis are of the form:</p>
      <p>d  fd  x1, y, z ,
y  f y  x2, x3, x4, x5, x10, x11 ,</p>
      <p>
        z  f y  x6 , x7 , x8, x9, x12 ,
where values d (diagnosis), y , z are determined with the help of the knowledge
base mentioned in the works of professor A. P. Rotstein [
        <xref ref-type="bibr" rid="ref3 ref4">3,4</xref>
        ].
      </p>
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      <p>bcaasilseoxfpcaannsioonni- 100%</p>
    </sec>
    <sec id="sec-3">
      <title>Method on the</title>
      <p>basis of neural</p>
      <p>network
Method on the
basis of fuzzy
logic
89%
91%
100%</p>
      <p>100%
92%
90%
94%
93%
98%
86%
91%
97%
83%
89%</p>
      <p>The results of numerical experiment confirm high effectiveness of the developed
calculating method in the comparison to the methods of artificial intelligence at the
expense of the usage of optimal parameters during the formation of the criterion of
making decision.</p>
      <p>
        The choice of Daubechies function of the 4th degree from the existing limited set
of wavelet functions in the capacity of the parameter of neural network is not optimal
for solving of the problem of cardiovascular diseases diagnostics (usage of other
functions leads to the worsening of quality of problem solution [
        <xref ref-type="bibr" rid="ref37">37</xref>
        ]).
      </p>
      <p>
        The results of the experiment on the basis of A. P. Rotstein’s approach [
        <xref ref-type="bibr" rid="ref3 ref4">3, 4</xref>
        ]
indicate that the absence of strict mathematical apparatus of fuzzy equation analysis
doesn’t allow to form optimal structure of fuzzy rules that naturally restricts the
accuracy of cardiovascular diseases classification.
      </p>
      <p>On the whole the basis of statistic data can be expanded by the way of the
introduction of cardiogram information about wider class or about all existing types of
cardiovascular diseases. This will allow to form on the basis of developed calculating
method highly efficient information systems of cardiovascular diseases diagnostics for
their actual usage in medical cardiologic centers, clinics and diagnostic
establishments.
4</p>
      <p>Conclusions
Therefore in the work the calculation method for a computer system of
cardiovascular diseases diagnostics on the basis of the canonical decomposition of the random
sequence of electrocardiogram change is offered. The use of the mechanism of
canonical decompositions allowed to formulate the decisive rule of the maximum of the
combined density distribution in the form of the production of one-dimensional
densities of distribution that gives the possibility to use for diagnostics random quantity of
electrocardiogram parameters. Besides canonical decomposition doesn’t impose any
essential limitations (linearity, stationarity, Markovian property etc.) on the class of
investigated random sequences. Thereby the offered approach to the solution of the
problem of cardiovascular diseases diagnostics allows to take into account the
maximum stochastic characteristics of the electrocardiograms belonging to different
cardiovascular diseases. The given results of modeling show the high reliability of
cardiovascular diseases diagnostics on the basis of the offered method.
5</p>
    </sec>
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