Chinese Medical Sciences Journal ›› 2020, Vol. 35 ›› Issue (4): 297-305.doi: 10.24920/003703

• Original Article • Previous Articles     Next Articles

Detection of Asymptomatic Carotid Artery Stenosis in High-Risk Individuals of Stroke Using a Machine-Learning Algorithm

Junxiong Yin1, Cheng Yu2, Lixia Wei2, Chuanyong Yu1, Hongxing Liu1, Mingyang Du1, Feng Sun1, Chongjun Wang2, Xiaoshan Wang1, *()   

  1. 1Department of Neurology, Brain Hospital Affiliated to Nanjing Medical University, Nanjing 210029, China
    2Department of Computer Science and Technology,Nanjing University, Nanjing 210093, China
  • Received:2019-12-16 Accepted:2020-03-24 Published:2020-12-31 Online:2020-09-28
  • Contact: Xiaoshan Wang
This study investigated the validity of a machine learning algorithm in predicting asymptomatic carotid stenosis (ACS) with 2841 high risk individuals of stroke and yield a promising result. Besides, family history of dyslipidemia was found to be an important risk factor for ACS that deserved more attention clinically.

Objective Asymptomatic carotid stenosis (ACS) is closely associated to the incidence of severe cerebrovascular diseases. Early identifying the individuals with ACS and its associated risk factors could be beneficial for primary prevention of stroke. This study aimed to investigate a machine-learning algorithm for the detection of ACS among high-risk population of stroke based on the associated risk factors.
Methods A novel model of machine learning was utilized to screen the associated predictors of ACS based on 30 potential risk factors. The algorithm of this model adopted a random forest pattern based on the training data and then was verified using the testing data. All of the original data were retrieved from the China National Stroke Screening and Prevention Project (CNSSPP), including demographic, clinical and laboratory characteristics. The individuals with high risk of stroke were enrolled and randomly divided into a training group and a testing group at a ratio of 4:1. The identification of carotid stenosis by carotid artery duplex scans was set as the golden standard. The receiver operating characteristic (ROC) curve and the area under the curve (AUC) was used to evaluate the efficacy of the model in detecting ACS.
Results Of 2841 high risk individual of stroke enrolled, 326 (11.6%) were diagnosed as ACS by ultrasonography. The top five risk factors contributing to ACS in this model were identified as family history of dyslipidemia, high level of low-density lipoprotein cholesterol (LDL-c), low level of high-density lipoprotein cholesterol (HDL-c), aging, and low body mass index (BMI). Their weights were 11.8%, 7.6%, 7.1%, 6.1%, and 6.1%, respectively. The total weight of the top 15 risk factors was 85.5%. The AUC values of the model for detecting ACS with training dataset and testing dataset were 0.927 and 0.888, respectively.
Conclusions This study demonstrated that the machine-learning algorithm could be used to identify the risk factors for ACS among high risk population of stroke. Family history of dyslipidemia may be the most important risk factor for ACS. This model could be a suitable tool to optimize the clinical approach for the primary prevention of stroke.

Key words: high-risk population, stroke, asymptomatic carotid stenosis, risk factors, machine learning

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