Artificial intelligence–enabled classification of hypertrophic heart diseases using electrocardiograms

Abstract

Background

Differentiating among cardiac diseases associated with left ventricular hypertrophy (LVH) informs diagnosis and clinical care.

Objective

To evaluate if artificial intelligence–enabled analysis of the 12-lead electrocardiogram (ECG) facilitates automated detection and classification of LVH.

Methods

We used a pretrained convolutional neural network to derive numerical representations of 12-lead ECG waveforms from patients in a multi-institutional healthcare system who had cardiac diseases associated with LVH (n = 50,709), including cardiac amyloidosis (n = 304), hypertrophic cardiomyopathy (n = 1056), hypertension (n = 20,802), aortic stenosis (n = 446), and other causes (n = 4766). We then regressed LVH etiologies relative to no LVH on age, sex, and the numerical 12-lead representations using logistic regression (“LVH-Net”). To assess deep learning model performance on single-lead data analogous to mobile ECGs, we also developed 2 single-lead deep learning models by training models on lead I (“LVH-Net Lead I”) or lead II (“LVH-Net Lead II”) from the 12-lead ECG. We compared the performance of the LVH-Net models to alternative models fit on (1) age, sex, and standard ECG measures, and (2) clinical ECG-based rules for diagnosing LVH.

Results

The areas under the receiver operator characteristic curve of LVH-Net by specific LVH etiology were cardiac amyloidosis 0.95 [95% CI, 0.93–0.97], hypertrophic cardiomyopathy 0.92 [95% CI, 0.90–0.94], aortic stenosis LVH 0.90 [95% CI, 0.88-0.92], hypertensive LVH 0.76 [95% CI, 0.76-0.77], and other LVH 0.69 [95% CI 0.68-0.71]. The single-lead models also discriminated LVH etiologies well.

Conclusion

An artificial intelligence–enabled ECG model is favorable for detection and classification of LVH and outperforms clinical ECG-based rules.