An ECG-based AI index combined with classical guidelines significantly improved the prediction of sudden cardiac death in heart failure patients (ROC-AUC 0.66 vs 0.59; P=0.017).
Observational (n=2,559)
Yes
Does an ECG-based artificial intelligence index improve the prediction of sudden cardiac death in patients discharged after acute decompensated heart failure?
An ECG-based AI index significantly improves risk stratification for sudden cardiac death when added to conventional predictors in patients with heart failure.
Effect estimate: adjusted sub-distributional HR 1.25 (95% CI 1.04-1.49)
p-value: p=0.015
AIMS: Available predictive models for sudden cardiac death (SCD) in heart failure (HF) patients remain suboptimal. We assessed whether the electrocardiography (ECG)-based artificial intelligence (AI) could better predict SCD, and also whether the combination of the ECG-AI index and conventional predictors of SCD would improve the SCD stratification among HF patients. METHODS AND RESULTS: In a prospective observational study, 4 tertiary care hospitals in Tokyo enrolled 2559 patients hospitalized for HF who were successfully discharged after acute decompensation. The ECG data during the index hospitalization were extracted from the hospitals' electronic medical record systems. The association of the ECG-AI index and SCD was evaluated with adjustment for left ventricular ejection fraction (LVEF), New York Heart Association (NYHA) class, and competing risk of non-SCD. The ECG-AI index plus classical predictive guidelines (i.e. LVEF ≤35%, NYHA Class II and III) significantly improved the discriminative value of SCD receiver operating characteristic area under the curve (ROC-AUC), 0.66 vs. 0.59; P = 0.017; Delong's test with good calibration (P = 0.11; Hosmer-Lemeshow test) and improved net reclassification 36%; 95% confidence interval (CI), 9-64%; P = 0.009. The Fine-Gray model considering the competing risk of non-SCD demonstrated that the ECG-AI index was independently associated with SCD (adjusted sub-distributional hazard ratio, 1.25; 95% CI, 1.04-1.49; P = 0.015). An increased proportional risk of SCD vs. non-SCD with an increasing ECG-AI index was also observed (low, 16.7%; intermediate, 18.5%; high, 28.7%; P for trend = 0.023). Similar findings were observed in patients aged ≤75 years with a non-ischaemic aetiology and an LVEF of >35%. CONCLUSION: To improve risk stratification of SCD, ECG-based AI may provide additional values in the management of patients with HF.
Shiraishi et al. (Wed,) conducted a observational in Heart failure (n=2,559). ECG-based artificial intelligence (AI) index vs. Classical predictive guidelines (LVEF ≤35%, NYHA Class II and III) was evaluated on Sudden cardiac death (SCD) (adjusted sub-distributional HR 1.25, 95% CI 1.04-1.49, p=0.015). An ECG-based AI index combined with classical guidelines significantly improved the prediction of sudden cardiac death in heart failure patients (ROC-AUC 0.66 vs 0.59; P=0.017).