Zero-Shot ECG Classification with Multimodal Learning and Test-time Clinical Knowledge Enhancement

Che Liu, Zhongwei Wan, Cheng Ouyang, Anand Shah, Wenjia Bai, Rossella Arcucci
Proceedings of the 41st International Conference on Machine Learning, PMLR 235:31949-31963, 2024.

Abstract

Electrocardiograms (ECGs) are non-invasive diagnostic tools crucial for detecting cardiac arrhythmic diseases in clinical practice. While ECG Self-supervised Learning (eSSL) methods show promise in representation learning from unannotated ECG data, they often overlook the clinical knowledge that can be found in reports. This oversight and the requirement for annotated samples for downstream tasks limit eSSL’s versatility. In this work, we address these issues with the Multimodal ECG Representation Learning (MERL) framework. Through multimodal learning on ECG records and associated reports, MERL is capable of performing zero-shot ECG classification with text prompts, eliminating the need for training data in downstream tasks. At test time, we propose the Clinical Knowledge Enhanced Prompt Engineering (CKEPE) approach, which uses Large Language Models (LLMs) to exploit external expert-verified clinical knowledge databases, generating more descriptive prompts and reducing hallucinations in LLM-generated content to boost zero-shot classification. Based on MERL, we perform the first benchmark across six public ECG datasets, showing the superior performance of MERL compared against eSSL methods. Notably, MERL achieves an average AUC score of 75.2% in zero-shot classification (without training data), 3.2% higher than linear probed eSSL methods with 10% annotated training data, averaged across all six datasets.

Cite this Paper

BibTeX
@InProceedings{pmlr-v235-liu24bg, title = {Zero-Shot {ECG} Classification with Multimodal Learning and Test-time Clinical Knowledge Enhancement}, author = {Liu, Che and Wan, Zhongwei and Ouyang, Cheng and Shah, Anand and Bai, Wenjia and Arcucci, Rossella}, booktitle = {Proceedings of the 41st International Conference on Machine Learning}, pages = {31949--31963}, year = {2024}, editor = {Salakhutdinov, Ruslan and Kolter, Zico and Heller, Katherine and Weller, Adrian and Oliver, Nuria and Scarlett, Jonathan and Berkenkamp, Felix}, volume = {235}, series = {Proceedings of Machine Learning Research}, month = {21--27 Jul}, publisher = {PMLR}, pdf = {https://raw.githubusercontent.com/mlresearch/v235/main/assets/liu24bg/liu24bg.pdf}, url = {https://proceedings.mlr.press/v235/liu24bg.html}, abstract = {Electrocardiograms (ECGs) are non-invasive diagnostic tools crucial for detecting cardiac arrhythmic diseases in clinical practice. While ECG Self-supervised Learning (eSSL) methods show promise in representation learning from unannotated ECG data, they often overlook the clinical knowledge that can be found in reports. This oversight and the requirement for annotated samples for downstream tasks limit eSSL’s versatility. In this work, we address these issues with the Multimodal ECG Representation Learning (MERL) framework. Through multimodal learning on ECG records and associated reports, MERL is capable of performing zero-shot ECG classification with text prompts, eliminating the need for training data in downstream tasks. At test time, we propose the Clinical Knowledge Enhanced Prompt Engineering (CKEPE) approach, which uses Large Language Models (LLMs) to exploit external expert-verified clinical knowledge databases, generating more descriptive prompts and reducing hallucinations in LLM-generated content to boost zero-shot classification. Based on MERL, we perform the first benchmark across six public ECG datasets, showing the superior performance of MERL compared against eSSL methods. Notably, MERL achieves an average AUC score of 75.2% in zero-shot classification (without training data), 3.2% higher than linear probed eSSL methods with 10% annotated training data, averaged across all six datasets.} }
Endnote
%0 Conference Paper %T Zero-Shot ECG Classification with Multimodal Learning and Test-time Clinical Knowledge Enhancement %A Che Liu %A Zhongwei Wan %A Cheng Ouyang %A Anand Shah %A Wenjia Bai %A Rossella Arcucci %B Proceedings of the 41st International Conference on Machine Learning %C Proceedings of Machine Learning Research %D 2024 %E Ruslan Salakhutdinov %E Zico Kolter %E Katherine Heller %E Adrian Weller %E Nuria Oliver %E Jonathan Scarlett %E Felix Berkenkamp %F pmlr-v235-liu24bg %I PMLR %P 31949--31963 %U https://proceedings.mlr.press/v235/liu24bg.html %V 235 %X Electrocardiograms (ECGs) are non-invasive diagnostic tools crucial for detecting cardiac arrhythmic diseases in clinical practice. While ECG Self-supervised Learning (eSSL) methods show promise in representation learning from unannotated ECG data, they often overlook the clinical knowledge that can be found in reports. This oversight and the requirement for annotated samples for downstream tasks limit eSSL’s versatility. In this work, we address these issues with the Multimodal ECG Representation Learning (MERL) framework. Through multimodal learning on ECG records and associated reports, MERL is capable of performing zero-shot ECG classification with text prompts, eliminating the need for training data in downstream tasks. At test time, we propose the Clinical Knowledge Enhanced Prompt Engineering (CKEPE) approach, which uses Large Language Models (LLMs) to exploit external expert-verified clinical knowledge databases, generating more descriptive prompts and reducing hallucinations in LLM-generated content to boost zero-shot classification. Based on MERL, we perform the first benchmark across six public ECG datasets, showing the superior performance of MERL compared against eSSL methods. Notably, MERL achieves an average AUC score of 75.2% in zero-shot classification (without training data), 3.2% higher than linear probed eSSL methods with 10% annotated training data, averaged across all six datasets.
APA
Liu, C., Wan, Z., Ouyang, C., Shah, A., Bai, W. & Arcucci, R.. (2024). Zero-Shot ECG Classification with Multimodal Learning and Test-time Clinical Knowledge Enhancement. Proceedings of the 41st International Conference on Machine Learning, in Proceedings of Machine Learning Research 235:31949-31963 Available from https://proceedings.mlr.press/v235/liu24bg.html.

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