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PROGNOSIS OF CORONARY ARTERY DISEASE

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 PROGNOSIS OF CORONARY ARTERY DISEASE
DEPENDING ON SOFT SETS
1
Ramdhan A. Mohammed, 2Tahir H. Ismail, 3Ahmed A. Allam, 4Mahmoud Ahmed Abd Elbaset
1
Dept. of Mathematics, Faculty of Science, University of Duhok, Kurdistan-Region, Iraq.
1
E-mail: ramadhan.hajani@uod.ac2Dept. of Mathematics, College of com. Sci. and math., University of Mosul, Mosul-Iraq.
2
E-mail: tahir_hs@yahoo.com3Dept. of Mathematics, Faculty of Science, University of Assiut, Assiut-Egypt.
2
E-mail: tahir_hs@yahoo.com
4
Dept. of Heart, Faculty of Medicine, University of Al-Azhar, Assiut-Egypt.
4
E-mail: Elhaycardio@yahoo.com

ABSTRACT

This aim this paper the concept of soft set theory is extended to develop a knowledge-based system in medicine and
devise a prediction system named soft expert system. Also, soft expert system helps the expert doctor to decide whether a
patient needs to be given investigation or drug therapy. A soft expert system is a rule-based system that uses fuzzy set and
soft set. Its basic structure includes four main components as follows: A fuzzication, which translates inputs (real-valued) into
fuzzy values, From fuzzication of data set to obtain soft sets, Using conjunction parameter to get on soft rules, Analyze the soft
rules to get the output data. The present study used only 70 numbers of patients in the Cardiology Unit, Department of Heart,
Faculty of Medicine, Al-Azhar University (Assiut branch) in Egypt and the laboratory data belongs to 40 males and 30 females
of patients.The developed soft expert system is then used in predicting of coronary artery disease using Systolic Blood
Pressure (SBP), Low Density Lipoprotein Cholesterol (LDL-C), Glycosylated hemoglobin (HbA1C) and age of patients. We can
use a soft expert system based on fuzzy sets and soft sets was developed by Matlab program in order to classify artery
disease.

KEYWORDS: Soft set, soft expert system, coronary artery disease, glycosated hemoglobin, systolic blood pressure.

 Corresponding author: Ramdhan A. Mohammed (E-mail: ramadhan.hajani@uod.ac)

 Ramdhan A. Mohammed et al.

INTRODUCTION

Coronary artery disease (CAD) has become one of the mostly occurring diseases in the world and has increasing trend in
its incidence in future. It is the cause of 20-30% of deaths in most industrialized countries (Park, 2015).
CAD is the leading cause of death worldwide for both men and women and occurs when the arteries that supply blood to
the heart muscle stiffened and become narrowed. This is due to the accumulation of fat, calcium, cholesterol and other
substances found in blood which form the so-called plaque. Plaque sticks to the soles of the walls of the arteries. Over time,
this plaque hardens and leads to arterial stenosis which reduces blood flow to the heart muscle. When the growing plaque
ruptures, it blocks the blood flow in the arteries. This blockage prevents the blood to flow to parts of the heart muscle which
will then leads to angina or a heart attack. Furthermore, cholesterol has been identified as one of the main risk factor for
myocardial infarction and subsequent sudden death (Schuster, Adamson, & Bell, 1999). In order to circumvent such a life
threatening problem, one of the possible solutions is to make people aware of their respective CAD risks in advance and take
preventive measures accordingly. It is only possible when an early detection of CAD occurs. According to medical experts, an
early detection at the stage of angina may prevent the death due to CAD if proper medication is given thereafter.
In view of this, we will develop a CAD soft expert system based on soft sets. This system which can mimic the reasoning
of doctors, shall be called as expert system. Till date many medical expert systems have been developed, such as INTERNIST
(Miller, Pople Jr, & Myers, 1982) and CADIAG-2 (Adlassnig & Kolarz, 1982). However, these are multiple disease expert
systems. Research on risk factor analysis has been conducted (Chirinos et al., 2007; Gamberger, Lavrač, & Krstačić, 2003;
Genest et al., 1991; Vaisi-Raygani et al., 2010; Wung & Drew, 1999). Studies on 18-lead electro cardiogram (ECG) analysis
(Wung & Drew, 1999), wavelet transformed (ECG) analysis(Ranjith, Baby, & Joseph, 2003), heart valve disease analysis(Ge,
Sun, Zhou, & Shao, 2009; Turkoglu, Arslan, & Ilkay, 2002) have been done extensively for detection of cardiovascular diseases.
Artificial immune recognition system (AIRS) were used to detect heart diseases(Polat, Şahan, & Güneş, 2006, 2007), while
single lead ECG classification methodology were proposed using time domain principal components(Martis & Chakraborty,
2011; Martis, Chakraborty, & Ray, 2009; Martis et al., 2012) after a methodology for CAD diagnosis based on neuro-fuzzy
model was suggested (Kochurani, Aji, & Kaimal, 2007). In another study, decision tree was used to find preliminary rules
based on the extracted rules of a fuzzy model developed for CAD detection (Tsipouras et al., 2008).
A comparative study of logistic regression, classification and regression tree, neural network, radial basis function and
self-organizing feature maps were parameterized in a model to predict the absence or presence of CAD (Kurt, Ture, & Kurum,
2008). This was followed by a methodology which uses SAS base software 9.1.3 for diagnosing of the heart disease(Das,
Turkoglu, & Sengur, 2009). A neural networks ensemble method is incorporated into the proposed system. A fuzzy expert
system (FES) includes a set of fuzzy rules and membership functions, i.e., knowledge acquisition, considered to be the most
important issue in the design of fuzzy expert system. Generally, knowledge could be obtained from experts in the particular
area. However, experts might find it difficult to define the complete rule set if there are too many possible rules. A fuzzy expert
system (Adeli & Neshat, 2010) for heart disease diagnosis was designed based on the V. A. Medical Center, Long Beach and
Cleveland Clinic Foundation data base. The system has 13 input fields and one output field. Input fields are chest pain type,
blood pressure, cholesterol, resting blood sugar, maximum heart rate, resting electrocardiography (ECG), exercise, old peak
(ST depression induced by exercise relative to rest), thallium scan, sex and age. Computational intelligence combines fuzzy
systems, neural network and evolutionary computing, where neuro fuzzy integrated system for coronary heart disease is
presented. In order to show the effectiveness of the proposed system, simulation for automated diagnosis is performed by
using realistic causes of coronary heart disease. The performance of the system can be increased by tuning of membership
function using optimization algorithms (Kumar, Victoire, Renukadevi, & Devaraj, 2012).
A hybrid particle swarm optimization based fuzzy expert system for the diagnosis of coronary artery disease was
proposed(Muthukaruppan & Er, 2012). Association rule mining using a computational intelligence approach, is used to identify
these factors and the UCI Cleveland data set, a biological database, is considered along with the three rule generation
algorithms - Apriori, Predictive Apriori and Tertius(Nahar, Imam, Tickle, & Chen, 2013).Current research indicates the
accuracy of fuzzy rule-based classification that could noninvasively predict CAD based on myocardialperfusion scan test and
clinical-epidemiological variables (Mohammad pour, Abedi, Bagheri, & Ghaemian, 2015). CAD detection using a fuzzy-boosting
PSO approach has also been proposed (Hedeshi & Abadeh, 2014). Automated diagnosis of CAD using tunable-Q wavelet
transform applied on heart rate signals has been presented (Patidar, Pachori, & Acharya, 2015), along with CAD diagnosis
using supervised fuzzy C-means with differential search algorithm based on the generalized Minkowski metrics (Negahbani,
Joulazadeh, Marateb, & Mansourian, 2015).
The rest of the paper is organized as follows. Section2 introduces the soft sets and database description. In Section 3,
methodology and implementation of the proposed system are presented. Details of the experimental results are discussed in
Section 4. Finally, conclusions are given in Section 5.

BACKGROUND

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 Ramdhan A. Mohammed et al.

SOFT SETS

DEFINITION
(Zadeh, 1965) A fuzzy subset of a universal set is defined by a membership function , where
is interpreted as a grade in which an element has a property or a grade in which is consistent to The closer the
value of is to 1, the more belongs to . is completely characterized by the set of pairs
and .

DEFINITION
(Molodtsov, 1999) Let refers to an initial universe and is a set of parameters. Let denote the power set of
and . A pair is called a soft set over , where is a mapping given by . In other words, a soft set
over is a parameterized family of subsets of the universe , For may be considered as the set of
approximate elements of the soft set .

DEFINITION
(Maji, Biswas, & Roy, 2003) For two soft sets and over a common universe . We say that is a soft
subset of if
(1)
(2) for are identical approximations. We write .

DEFINITION
(Min, 2012) Let be a set of parameters and For and is called the conjunction
parameter of ordered pair parameter . The conjunction parameter ( and ) of ordered pair parameter is denoted
by . For every we will denote the set of all as the following:

DEFINITION
(Min, 2012) Let and be soft sets over a common universe set . Then is a soft set
defined by where is a mapping given by
for any , where is the intersection operation of sets.

DATABASE DESCRIPTION
Data for our present work is obtained from the Cardiology Unit, Department of Heart, Faculty of Medicine, University of
Al-Azhar, Assiut-Egypt. This database collected from 70 patients contains 15 attributes, but we used only 6 of them which are
relevant to coronary artery disease. The attributes that we considered in this work are:
(1) Systolic Blood Pressure.
(2) Low Density Lipoprotein Cholesterol.
(3) Glycosylated hemoglobin.
(4) Age.

MATERIALS AND METHODS

The present system provides diagnostic assistance concerned with artery diseases. The system output is compared to an
independent diagnosis given by physicians. The designed generic medical soft expert system has been tested and found to be
diagnosing the disease risk with accuracy. A soft expert system is a rule-based system that uses fuzzy set and soft set. Its
basic structure includes four main components, as depicted in Figure 1: The soft system design process includes the following
definitions:
(1) A fuzzication, which translates inputs (real-valued) into fuzzy values.
(2) From fuzzication of data set to obtain soft sets.

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(3) Using conjunction parameter to get on soft rules, and

(4) Analyze the soft rules to get the output data.

Input data Fuzzication

Output data Obtaining soft

sets

Analysis of Obtaining soft

soft rules rules
Fig. 1: Basic structure of soft expert system.

COMPUTING MEMBERSHIP FUNCTIONS OF DATA SET

The membership function editor in the fuzzy tool box is used to define the shapes of all membership functions associated
with each membership variable. For each of the input variable the membership functions are defined as following:

BLOOD PRESSURE
Different values of blood pressure may easily contribute a change to the results. In this blood pressure field, we use the
systolic blood pressure. This input variable is divided into four fuzzy sets. The four fuzzy sets are Low (L), Medium (M), High
(H) and Very high (VH). Membership functions of "Low" and "Very high" sets are trapezoidal while membership functions of
"medium" and "high" sets are triangular. We defined the fuzzy membership expressions for blood pressure input field as in
Table 1. The membership functions of blood pressure field are shown in Figure 2.

Fig. 2: Membership functions of systolic blood pressure.

Table 1: Classification of Systolic Blood Pressure.

Input field Range Fuzzy sets
Systolic Blood Pressure 134 > L
127-153 M
142-172 H
154 < VH

CHOLESTEROL
Cholesterol level has salient effect on the result and can change it easily. For this input field, we use the value of low
density lipoprotein cholesterol (LDL-C). The cholesterol field is categorized into four fuzzy sets (Low (L), Medium (M), High (H)
and Very high (VH)). These fuzzy sets are shown in Table 2. Membership functions of "Low" and "Very high" sets are
trapezoidal whereas membership functions of "medium" and "high" sets are triangular. Membership functions of cholesterol
field are shown in Figure 3.

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 Ramdhan A. Mohammed et al.

Table 2: Classification of LDL-C.

Input field Range Fuzzy sets
Cholesterol 197 > L
188-250 M
217-307 H
281 < VH

Fig. 3: Membership functions of cholesterol level.

GLYCOSYLATED HEMOGLOBIN
Glycosylated hemoglobin (HbA1C) field is one of the most important factors considered in this system. In this field, we
have 4 linguist variables (fuzzy sets) (Low (L), Medium (M), High (H) and Very high (VH)) which are classified accordingly as in
Table 3. Membership functions of "Low" and "High" fuzzy sets are trapezoidal while membership function of Medium "and "Very
high" fuzzy sets is triangular as shown in Figure 4.

Table 3: Classification of Glycosylated hemoglobin

Input field Range Fuzzy sets
Glycosylated hemoglobin 6.5 > L
6.5-7.2 M
7.3-8.4 H
8.4 < VH

Fig. 4: Membership functions of Glycosylated hemoglobin.

AGE
This input field divides the age group into four fuzzy sets (Young (Y), Mild (M), Old (O), Very old (VO)). These fuzzy sets
are classified as in Table 4. Membership functions of "Young" and "Very old" are trapezoidal while membership functions of
"Mild" and "Old" are triangular as shown in Figure 5.

Table 4: Classification of Age.

Input field Range Fuzzy sets
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 Ramdhan A. Mohammed et al.

Age 38 > L
33-45 M
40-58 H
52 < VH

Fig. 5: Membership functions of age.

RESULTS AND DISCUSSION

The present study used only 70 numbers of patients in the Cardiology Unit, Department of Heart, Faculty of Medicine, Al-
Azhar University (Assiut branch) in Egypt and the laboratory data belongs to 40 males and 30 females of patients. The input
values of these patients are shown in Table 5. The data in Table 5 is not convenient for applying to soft sets directly. For
reason, we are using Tables 1-4 to get patients values as shown in Table 6.

Table 5: The input values of some patients.

P SBP LDL - C HbA1C Age
p1 160 170 5.5 30
p8 140 190 9.0 40
p14 155 270 11 45
p20 140 250 8.2 66
p27 130 240 9.8 37
p33 150 170 8.5 34
p39 170 255 7.9 45
p45 120 150 4.9 37
p48 110 230 5.0 63
p58 155 130 8.8 56
p65 150 210 5.1 33
p70 130 140 3.5 40

Table 6: The membership functions of some patients.

P SBP LDL - C HbA1C Age
p1 H,VH L L Y
p8 M L,M VH M,O
p14 H,VH H VH M,O
p20 M M,H H VO
p27 L,M M,H VH Y,M
p33 M,H L VH Y,M
p39 H,VH H H M,O
p45 L L L M,O
p48 L M, H L VO
p58 H,VH L VH O,VO
p65 M,H M L Y,M
p70 L,M L L M,O

OBTAINING SOFT SETS

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 Ramdhan A. Mohammed et al.

We know that every fuzzy sets can be considered as soft sets [moneer].
Let and

. Suppose that where

Now, some soft sets of E as

OBTAINING AND ANALYSIS OF SOFT RULES

In this work, we can use a soft expert system based on fuzzy sets and soft sets was developed by Matlab program in
order to classify artery disease and healthy condition and was applied to seventy patients who came to Cardiology Unit,
Department of Heart, Faculty of Medicine, Al-Azhar University (Assiut branch) in Egypt for check up. Information based on
clinical risk factors was taken from the attributes ( , Age). Using conjunction parameter of the soft
sets we obtain 256 rules divided to 201 rules contain patients and 55 rules do not contain patients and in each rule we observe
how many of the patients in the set have coronary artery. If a patient's data is convenient to more than one rule, then we
accept the highest one. Some the soft rules as shown in Table 7.
From Table 7, we show that the patient are convenient to Rule 2, Rule 3, Rule 4 and Rule 9 and also, the patient p 56
are convenient to Rule 2, Rule 3, Rule 7 and Rule 9. Hence, the patients and are to probably coronary artery disease.
Finally, we write the soft expert system which calculates the coronary artery disease by Matlab program where the input
variables are and Age.

Table 7: Some soft rules.

Rule no. Soft rules Patients
R1 F(SBP)L ˄ F(LDL-C)L ˄ F(HbA1C)L ˄ F(Age)Y {p1}
R2 F(SBP)H ˄ F(LDL-C)H ˄ F(HbA1C)L ˄ F(Age)M {p37, p56, p55, p66}
R3 F(SBP)V H ˄ F(LDL-C)H ˄ F(HbA1C)L ˄ F(Age)M {p37, p56, p66}
R4 F(SBP)H ˄ F(LDL-C)M ˄ F(HbA1C)L ˄ F(Age)O {p37}
R5 F(SBP)M ˄ F(LDL-C)H ˄ F(HbA1C)L ˄ F(Age)V O {p11, p17, p20}
R6 F(SBP)M ˄ F(LDL-C)M ˄ F(HbA1C)M ˄ F(Age)Y {p2, p12, p27, p32, p65}
R7 F(SBP)V H ˄ F(LDL-C)H ˄ F(HbA1C)L ˄ F(Age)O {p37, p56g
R8 F(SBP)V H ˄ F(LDL-C)L ˄ F(HbA1C)M ˄ F(Age)O {p24, p58, p59, p68, p69}
R9 F(SBP)H ˄ F(LDL-C)H ˄ F(HbA1C)M ˄ F(Age)O {p14, p37, p38, p39, p56}
R10 F(SBP)V H ˄ F(LDL-C)H ˄ F(HbA1C)H ˄ F(Age)M {p13, p14, p38, p39}

CONCLUSIONS

In this study, we developed a soft expert system to predict those patients who may suffer coronary artery disease using
Systolic Blood Pressure Low Density Lipoprotein Cholesterol , Glycosated hemoglobin and
age of patients. It is a pioneering approach in applying soft sets to a medical diagnosis problem in the form of predicting
patients who may be suffering from coronary artery disease. This proposed methodology is a suitable tool to diagnose
coronary artery diseases, since it provides an interpretable system that can be easily comprehended by doctors. Table 8
shows the final score for these some patients and the corresponding action taken by the assigned specialist doctor.

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 Ramdhan A. Mohammed et al.

Table 8: Decision from specialist doctor.

P SBP LDL - C HbA1C Age
p1 160 170 5.5 30 Low possibility (Investigation)
p8 140 190 9.0 40 High possibility (Drug therapy)
p14 155 270 11 45 High possibility (Drug therapy)
p20 140 250 8.2 66 High possibility (Drug therapy)
p27 130 240 9.8 37 High possibility (Drug therapy)
p33 150 170 8.5 34 High possibility (Drug therapy)
p39 170 255 7.9 45 High possibility (Drug therapy)
p45 120 150 4.9 37 Low possibility (Investigation)
p48 110 230 5.0 63 Low possibility (Investigation)
p58 155 130 8.8 56 High possibility (Drug therapy)
p65 150 210 5.1 33 Low possibility (Investigation)
p70 130 140 3.5 40 Low possibility (Investigation)

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