Multi-branch myocardial infarction detection and localization framework based on multi-instance learning and domain knowledge

Objective. Myocardial infarction (MI) is a serious cardiovascular disease that can cause irreversible damage to the heart, making early identification and treatment crucial. However, automatic MI detection and localization from an electrocardiogram (ECG) remain challenging. In this study, we propose two models, MFB-SENET and MFB-DMIL, for MI detection and localization, respectively. Approach. The MFB-SENET model is designed to detect MI, while the MFB-DMIL model is designed to localize MI. The MI localization model employs a specialized attention mechanism to integrate multi-instance learning with domain knowledge. This approach incorporates handcrafted features and introduces a new loss function called lead-loss, to improve MI localization. Grad-CAM is employed to visualize the decision-making process. Main Results. The proposed method was evaluated on the PTB and PTB-XL databases. Under the inter-patient scheme, the accuracy of MI detection and localization on the PTB database reached 93.88% and 67.17%, respectively. The accuracy of MI detection and localization on the PTB-XL database were 94.89% and 85.83%, respectively. Significance. Our method achieved comparable or better performance than other state-of-the-art algorithms. The proposed method combined deep learning and medical domain knowledge, demonstrates effectiveness and reliability, holding promise as an efficient MI diagnostic tool to assist physicians in formulating accurate diagnoses.