Abstract 4369244: AI-enabled ECG for Structural Heart Disease Diagnosis Improves Triage of Echocardiography Referral in a Low-Resource Setting: The PROVAR+ Study

作者：Aline F Pedroso, Lovedeep Singh Dhingra, Bruno Nascimento, Sumukh Vasisht Shankar, Craig Sable, Luísa Campos Caldeira Brant, Gabriela Paixão, Clara Oliveira, António Bettencourt Ribeiro, Rohan Khera · 发表于：Circulation · 年份：2025 · DOI：10.1161/circ.152.suppl_3.4369244 · 被引用次数：1 · 研究领域：Ultrasound in Clinical Applications、Artificial Intelligence in Healthcare and Education、COVID-19 diagnosis using AI

Background: Echocardiography is resource-intensive, limiting its use in screening for structural heart diseases (SHD). Broader use of point-of-care ultrasound (POCUS) by trained paramedical staff may improve early SHD detection, but effective patient selection is essential. ECGs may enable triage for POCUS use, with either traditional ECG interpretation for major abnormalities or the use of AI to detect subtle patterns of SHD from ECGs. Aim: To compare the performance of AI vs traditional ECG interpretation for detecting probable SHD on cardiac POCUS. Methods: PROVAR+ is an international collaborative study in Divinopolis, Brazil. In 2023-25, 6,488 consecutive patients who underwent clinical ECGs were centrally adjudicated for presence of major ECG abnormalities based on Minnesota Code criteria. Patients with major abnormalities, along with controls without these abnormalities at a 5:1 ratio, were prospectively enrolled for cardiac POCUS. We compared a validated SHD model (AUROC 0.91 against gold standard SHD diagnosis in multiple cohorts, including ELSA-Brasil) against traditional ECG interpretation for probable SHD on POCUS, defined as LVEF <40%, moderate-to-severe left-sided valve disease, or severe LV hypertrophy. We assessed the relative sensitivity and specificity of each approach, evaluated reclassification performance using net reclassification index (NRI), and examined clinical utility through decision curve analysis. Results: A total of 3,282 patients (67±40y; 48...