Screening for severe coronary stenosis in patients with apparently normal electrocardiograms based on deep learning

BACKGROUND: Patients with severe coronary arterystenosis may present with apparently normal electrocardiograms (ECGs), making it difficult to detect adverse health conditions during routine screenings or physical examinations. Consequently, these patients might miss the optimal window for treatment. METHODS: We aimed to develop an effective model to distinguish severe coronary stenosis from no or mild coronary stenosis in patients with apparently normal ECGs. A total of 392 patients, including 138 with severe stenosis, were selected for the study. Deep learning (DL) models were trained from scratch and using pre-trained parameters via transfer learning. These models were evaluated based on ECG data alone and in combination with clinical information, including age, sex, hypertension, diabetes, dyslipidemia and smoking status. RESULTS: We found that DL models trained from scratch using ECG data alone achieved a specificity of 74.6% but exhibited low sensitivity (54.5%), comparable to the performance of logistic regression using clinical data. Adding clinical information to the ECG DL model trained from scratch improved sensitivity (90.9%) but reduced specificity (42.3%). The best performance was achieved by combining clinical information with the ECG transfer learning model, resulting in an area under the receiver operating characteristic curve (AUC) of 0.847, with 84.8% sensitivity and 70.4% specificity. CONCLUSIONS: The findings demonstrate the effectiveness of DL models in identifying severe coronary stenosis in patients with apparently normal ECGs and validate an efficient approach utilizing existing ECG models. By employing transfer learning techniques, we can extract "deep features" that summarize the inherent information of ECGs with relatively low computational expense.