Artificial intelligence-enhanced six-lead portable electrocardiogram device for detecting left ventricular systolic dysfunction: a prospective single-centre cohort study.

Aims: The real-world effectiveness of the artificial intelligence model based on electrocardiogram (AI-ECG) signals from portable devices for detection of left ventricular systolic dysfunction (LVSD) requires further exploration.

Methods and results: In this prospective, single-centre study, we assessed the diagnostic performance of AI-ECG for detecting LVSD using a six-lead hand-held portable device (AliveCor KardiaMobile 6L). We retrained the AI-ECG model, previously validated with 12-lead ECG, to interpret the 6-lead ECG inputs. Patients aged 19 years or older underwent six-lead ECG recording during transthoracic echocardiography. The primary outcome was the area under the receiver operating characteristic curve (AUROC) for detecting LVSD, defined as an ejection fraction below 40%. Of the 1716 patients recruited prospectively, 1635 were included for the final analysis (mean age 60.6 years, 50% male), among whom 163 had LVSD on echocardiography. The AI-ECG model based on the six-lead portable device demonstrated an AUROC of 0.924 [95% confidence interval (CI) 0.903-0.944], with 83.4% sensitivity (95% CI 77.8-89.0%) and 88.7% specificity (95% CI 87.1-90.4%). Of the 1079 patients evaluated using the AI-ECG model based on the conventional 12-lead ECG, the AUROC was 0.962 (95% CI 0.947-0.977), with 90.1% sensitivity (95% CI 85.0-95.2%) and 91.1% specificity (95% CI 89.3-92.9%).

Conclusion: The AI-ECG model constructed with the six-lead hand-held portable ECG device effectively identifies LVSD, demonstrating comparable accuracy to that of the conventional 12-lead ECG. This highlights the potential of hand-held portable ECG devices leveraged with AI as efficient tools for early LVSD screening.