In European heart journal. Acute cardiovascular care
BACKGROUND AND AIMS : Our goal was to evaluate a previously validated artificial intelligence-augmented electrocardiography (AI-ECG) screening tool for left ventricular systolic dysfunction (LVSD) in patients undergoing high-sensitivity cardiac troponin T (hs-cTnT).
METHODS : Retrospective application of AI-ECG for LVSD in emergency department (ED) patients undergoing hs-cTnT. AI-ECG scores (0-1) for probability of LVSD (left ventricular ejection fraction ≤ 35%) were obtained. An AI-ECG score ≥0.256 indicates a positive screen. The primary endpoint was a composite of post-discharge major adverse cardiovascular events (MACE) at 2-years follow-up.
RESULTS : Among 1977 patients, 248 (13%) had a positive AI-ECG. As compared to patients with a negative AI-ECG, those with a positive AI-ECG had a higher risk for MACE (48% vs. 21%, p < 0.0001, adjusted HR 1.39, 95% CI 1.11-1.75). This was largely because of a higher rate of deaths (32 vs. 14%, p < 0.0001; adjusted HR 1.26, 95% 0.95-1.66) and heart failure hospitalizations (26% vs. 6.1%, p < 0.001; adjusted HR 1.75, 95% CI 1.25-2.45). Together, hs-cTnT and AI-ECG resulted in the following MACE rates and adjusted HRs: hs-cTnT < 99th percentile and negative AI-ECG: 116/1176 (11%) (reference), hs-cTnT < 99th percentile and positive AI-ECG: 28/107 (26%) (adjusted HR 1.54, 95% CI 1.01-2.36), hs-cTnT > 99th percentile and negative AI-ECG: 233/553 (42%) (adjusted HR 2.12, 95% CI 1.66, 2.70), and hs-cTnT > 99th percentile and positive AI-ECG: 91/141 (65%) (adjusted HR 2.83, 95% CI 2.06, 3.87).
CONCLUSIONS : Among ED patients evaluated with hs-cTnT, a positive AI-ECG for LVSD identifies patients at high risk for MACE. The conjoint use of hs-cTnT and AI-ECG facilitates risk-stratification.
De Michieli Laura, Knott Jonathan D, Attia Zachi I, Ola Olatunde, Mehta Ramila A, Akula Ashok, Hodge David O, Gulati Rajiv, Friedman Paul A, Jaffe Allan S, Sandoval Yader
2022-Dec-20
Artificial intelligence, Electrocardiogram, High-sensitivity cardiac troponin, Myocardial infarction, Myocardial injury
