Predicting Tolerance to Anthracycline Chemotherapy Using Electrocardiogram-Based Artificial Intelligence in Sarcoma

Objective

The objective of this study was to understand the utility of artificial intelligence-enabled electrocardiogram (AI-ECG) to assess the tolerability of anthracycline chemotherapy.

Patients and Methods

From December 18, 2006 to October 15, 2020, we identified adults with sarcoma who were treated with anthracycline chemotherapy at our institution who had an ECG within 1 year prior to treatment initiation. Utilizing previously defined AI-ECG nomograms, we obtained age and ejection fraction (EF) predictions. Changes in AI-ECG age were correlated with chemotherapy tolerance (the rates of dose reductions, treatment delays, and early discontinuation). We measured the sensitivity and specificity of the ECG to predict an EF of less than 50% or 35% prior to treatment and compared how changes in the AI-ECG EF prediction related to changes in echocardiography-based EF.

Results

Forty patients met the eligibility criteria. Sixty-eight percent of the patients were men. The median age was 56.5 years (18-76 years). We did not find differences in chemotherapy tolerance between patients who had an elevated or decreased ECG age. There was a trend `toward higher rates of dose reductions in patients with high ECG aging (odds ratio, 5.13; P=.32). The AI-ECG low EF prediction had a sensitivity of 100% and a specificity of 94% to isolate patients with an EF of less than 50% prior to treatment. Two patients’ EF decreased more than 10% after treatment, and both cases showed significant increases in the low EF prediction.

Conclusion

Overall, AI-based predictions on ECG tracings could be a way to monitor for decreases in EF during treatment with anthracycline chemotherapy. We recommend further studies to evaluate AI-ECG aging as a marker for chemotherapy tolerance.