Artificial intelligence-derived cardiac ageing is associated with cardiac events post-heart transplantation

Ilke Ozcan, Takumi Toya, Michal Cohen-Shelly, Hyun Woong Park, Ali Ahmad, Alp Ozcan, Peter A. Noseworthy, Suraj Kapa, Lilach O. Lerman, Zachi I. Attia, Sudhir S. Kushwaha, Paul A. Friedman, Amir Lerman

Research output: Contribution to journalArticlepeer-review


Aims: An artificial intelligence algorithm detecting age from 12-lead electrocardiogram (ECG) has been suggested to reflect 'physiological age'. An increased physiological age has been associated with a higher risk of cardiac mortality in the non-transplant population. We aimed to investigate the utility of this algorithm in patients who underwent heart transplantation (HTx). Methods and results: A total of 540 patients were studied. The average ECG ages within 1 year before and after HTx were used to represent pre- and post-HTx ECG ages. Major adverse cardiovascular event (MACE) was defined as any coronary revascularization, heart failure hospitalization, re-transplantation, and mortality. Recipient pre-transplant ECG age (mean 63 ± 11 years) correlated significantly with recipient chronological age (mean 49 ± 14 years, R = 0.63, P < 0.0001), while post-transplant ECG age (mean 54 ± 10 years) correlated with both the donor (mean 32 ± 13 years, R = 0.45, P < 0.0001) and the recipient ages (R = 0.38, P < 0.0001). During a median follow-up of 8.8 years, 307 patients experienced MACE. Patients with an increase in ECG age post-transplant showed an increased risk of MACE [hazard ratio (HR): 1.58, 95% confidence interval (CI): (1.24, 2.01), P = 0.0002], even after adjusting for potential confounders [HR: 1.58, 95% CI: (1.19, 2.10), P = 0.002]. Conclusion: Electrocardiogram age-derived cardiac ageing after transplantation is associated with a higher risk of MACE. This study suggests that physiological age change of the heart might be an important determinant of MACE risk post-HTx.

Original languageEnglish (US)
Pages (from-to)516-524
Number of pages9
JournalEuropean Heart Journal - Digital Health
Issue number4
StatePublished - Dec 1 2022


  • Artificial intelligence
  • Cardiac allograft vasculopathy
  • Electrocardiogram
  • Heart transplantation

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine


Dive into the research topics of 'Artificial intelligence-derived cardiac ageing is associated with cardiac events post-heart transplantation'. Together they form a unique fingerprint.

Cite this