Artificial intelligence-augmented electrocardiography for left ventricular systolic dysfunction in patients undergoing high-sensitivity cardiac troponin T

• Published in: European heart journal. Acute cardiovascular care Vol. 12; no. 2; pp. 106 - 114
• Main Authors: 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
• Format: Journal Article
• Language: English
• Published: England 09.02.2023
• Subjects: Aftercare; Artificial Intelligence; Biomarkers; Electrocardiography; Humans; Patient Discharge; Retrospective Studies; Stroke Volume; Troponin T; Ventricular Dysfunction, Left - diagnosis; Ventricular Function, Left; Myocardial infarction; High-sensitivity-cardiac troponin; Artificial intelligence; Electrocardiogram; Myocardial injury
• ISSN: 2048-8726; 2048-8734
• DOI: 10.1093/ehjacc/zuac156

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). 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 (MACEs) at two years follow-up. Among 1977 patients, 248 (13%) had a positive AI-ECG. When compared with 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 hazard ratio (HR) 1.39, 95% confidence interval (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). 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.