Artificial intelligence-enhanced electrocardiography to predict regurgitant valvular heart diseases: an international study

作者：Yixiu Liang, Arunashis Sau, Boroumand Zeidaabadi, Joseph Barker, Konstantinos Patlatzoglou, Libor Pastika, Ewa Sieliwończyk, Zachary I. Whinnett, Nicholas S. Peters, Ziqing Yu, Xi Liu, Shuo Wang, Hongyang Lu, Daniel B. Kramer, Jonathan W. Waks, Yangang Su, Junbo Ge, Fu Siong Ng · 发表于：European Heart Journal · 年份：2025 · DOI：10.1093/eurheartj/ehaf448 · 被引用次数：22 · 研究领域：Cardiac Valve Diseases and Treatments、Atrial Fibrillation Management and Outcomes、Cardiovascular Function and Risk Factors

BACKGROUND AND AIMS: Valvular heart disease (VHD) is a significant source of morbidity and mortality, though early intervention can improve outcomes. This study aims to develop artificial intelligence-enhanced electrocardiography (AI-ECG) models to diagnose and predict future moderate or severe regurgitant VHDs (rVHDs), including mitral regurgitation (MR), tricuspid regurgitation (TR), and aortic regurgitation (AR). METHODS: The AI-ECG models were developed in a data set of 988 618 ECG and transthoracic echocardiogram pairs from 400 882 patients from Zhongshan Hospital, Shanghai, China. The AI-ECG models used a residual convolutional neural network with a discrete-time survival loss function. External evaluation was performed in outpatients from a secondary care data set from Beth Israel Deaconess Medical Center, Boston, USA, consisting of 34 214 patients with linked echocardiography. RESULTS: In the internal test set, the AI-ECG models accurately predicted future significant MR [C-index 0.774, 95% confidence interval (CI) 0.753-0.792], AR (0.691, 95% CI 0.657-0.720), and TR (0.793, 95% CI 0.777-0.808). In age- and sex-adjusted Cox models, the highest risk quartile had a hazard ratio (HR) of 7.6 (95% CI 5.8-9.9, P < .0001) for risk of future significant MR, compared with the lowest risk quartile. For future AR and TR, the equivalent HRs were 3.8 (95% CI 2.7-5.5) and 9.9 (95% CI 7.5-13.0), respectively. These findings were confirmed in the transnational external test set. Imag...