TY - JOUR
T1 - Detection of left atrial myopathy using artificial intelligence–enabled electrocardiography
AU - Verbrugge, Frederik H.
AU - Reddy, Yogesh N.V.
AU - Attia, Zachi I.
AU - Friedman, Paul A.
AU - Noseworthy, Peter A.
AU - Lopez-Jimenez, Francisco
AU - Kapa, Suraj
AU - Borlaug, Barry A.
N1 - Publisher Copyright:
© 2021 American Heart Association, Inc.
PY - 2022/1/1
Y1 - 2022/1/1
N2 - BACKGROUND: Left atrial (LA) myopathy is common in patients with heart failure and preserved ejection fraction and leads to the development of atrial fibrillation (AF). We investigated whether the likelihood of LA remodeling, LA dysfunction, altered hemodynamics, and risk for incident AF could be identified from a single 12-lead ECG using a novel artificial intelligence (AI)-enabled ECG analysis. METHODS: Patients with heart failure and preserved ejection fraction (n=613) underwent AI-enabled ECG analysis, echocardiography, and cardiac catheterization. Individuals were grouped by AI-enabled ECG probability of contemporaneous AF, taken as an indicator of underlying LA myopathy. RESULTS: Structural heart disease was more severe in patients with higher AI-probability of AF, with more left ventricular hypertrophy, larger LA volumes, and lower LA reservoir and booster strain. Cardiac filling pressures and pulmonary artery pressures were higher in patients with higher AI-probability, while cardiac output reserve was more impaired during exercise. Among patients with sinus rhythm and no prior AF, each 10% increase in AI-probability was associated with a 31% greater risk of developing new-onset AF (hazard ratio, 1.31 [95% CI, 1.20–1.42]; P<0.001). In the population as a whole, each 10% increase in AI-probability was associated with a 12% greater risk of death (hazard ratio, 1.12 [95% CI, 1.08–1.17]; P<0.001) during long-term follow-up, which was no longer significant after adjustments for baseline characteristics. CONCLUSIONS: A novel AI-enabled score derived from a single 12-lead ECG identifies the presence of underlying LA myopathy in patients with heart failure and preserved ejection fraction as evidenced by structural, functional, and hemodynamic abnormalities, as well as long-term risk for incident AF. Further research is required to determine the role of the AI-enabled ECG in the evaluation and care of patients with heart failure and preserved ejection fraction.
AB - BACKGROUND: Left atrial (LA) myopathy is common in patients with heart failure and preserved ejection fraction and leads to the development of atrial fibrillation (AF). We investigated whether the likelihood of LA remodeling, LA dysfunction, altered hemodynamics, and risk for incident AF could be identified from a single 12-lead ECG using a novel artificial intelligence (AI)-enabled ECG analysis. METHODS: Patients with heart failure and preserved ejection fraction (n=613) underwent AI-enabled ECG analysis, echocardiography, and cardiac catheterization. Individuals were grouped by AI-enabled ECG probability of contemporaneous AF, taken as an indicator of underlying LA myopathy. RESULTS: Structural heart disease was more severe in patients with higher AI-probability of AF, with more left ventricular hypertrophy, larger LA volumes, and lower LA reservoir and booster strain. Cardiac filling pressures and pulmonary artery pressures were higher in patients with higher AI-probability, while cardiac output reserve was more impaired during exercise. Among patients with sinus rhythm and no prior AF, each 10% increase in AI-probability was associated with a 31% greater risk of developing new-onset AF (hazard ratio, 1.31 [95% CI, 1.20–1.42]; P<0.001). In the population as a whole, each 10% increase in AI-probability was associated with a 12% greater risk of death (hazard ratio, 1.12 [95% CI, 1.08–1.17]; P<0.001) during long-term follow-up, which was no longer significant after adjustments for baseline characteristics. CONCLUSIONS: A novel AI-enabled score derived from a single 12-lead ECG identifies the presence of underlying LA myopathy in patients with heart failure and preserved ejection fraction as evidenced by structural, functional, and hemodynamic abnormalities, as well as long-term risk for incident AF. Further research is required to determine the role of the AI-enabled ECG in the evaluation and care of patients with heart failure and preserved ejection fraction.
KW - Atrial fibrillation
KW - Echocardiography
KW - Exercise
KW - Heart failure
KW - Probability
UR - http://www.scopus.com/inward/record.url?scp=85123812577&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85123812577&partnerID=8YFLogxK
U2 - 10.1161/CIRCHEARTFAILURE.120.008176
DO - 10.1161/CIRCHEARTFAILURE.120.008176
M3 - Article
C2 - 34911362
AN - SCOPUS:85123812577
SN - 1941-3289
VL - 15
SP - E008176
JO - Circulation: Heart Failure
JF - Circulation: Heart Failure
IS - 1
ER -