Detection of Right and Left Ventricular Dysfunction in Pediatric Patients Using Artificial Intelligence–Enabled ECGs

Figures

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  Figure 1. Receiver operating characteristic curves for models for detection of LVSD. Receiver operating characteristic curves for adult cohort derived LVSD model applied to pediatric cohort (EF ≤35%), novel pediatric model for detection of severe LVSD (EF ≤35%), and novel pediatric model for detecting any LVSD (EF <50%). AUC indicates area under the curve; and EF, ejection fraction; and LVSD, left ventricular systolic dysfunction.

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  Figure 2. Cumulative incidence of LVSD among those with normal EF at the time of initial classification, stratified by AI model classification. The 5‐year cumulative incidence of LVEF <50% among those with normal EF at the time of initial classification, stratified by AI model classification as false positives or true negatives. Log‐rank test demonstrated a significant difference between the 2 groups (P<0.005). In a Cox proportional hazards model, there was a 3‐fold risk of future low LVEF for those who were initially categorized as false positives (age‐ and sex‐adjusted HR, 3.34 [95% CI,1.94–5.77]; P<0.005) compared with those who were classified as true positive. AI indicates artificial intelligence; EF, ejection fraction; LVEF, left ventricular ejection fraction; and LVSD, left ventricular systolic dysfunction.

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  Figure 3. Receiver operating characteristic curves for the RVSD model. Receiver operating characteristic curves for the RVSD model. Using the same test cohort, several conditions were assessed. First, the model was evaluated on its ability to identify only moderate or greater RVSD, which improved model performance. Next, the model was evaluated on any degree of RVSD, but with patients diagnosed with the Ebstein anomaly removed as this group was overrepresented in our cohort. Finally, the model was evaluated on its ability to identify moderate or greater RVSD in the cohort without the patients with the Ebstein anomaly. In both cases, removal of the patients with the Ebstein anomaly resulted in only a small drop in the AUC. AUC indicates area under the curve; and RVSD, right ventricular systolic dysfunction.