Serial AI-Enabled Electrocardiogram Trajectories During Heart Failure Treatment

Figures

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  Visual Summary. Serial AI-ECG Changes During Heart Failure Treatment This visual summary illustrates the hypothesis-generating concept that serial AI-ECG LVSD and LVDD score changes may move in a direction broadly concordant with echocardiographic and biochemical changes during heart failure treatment, while also being influenced by rhythm, pacing, and conduction-related ECG changes. AI-ECG = artificial intelligence–enabled electrocardiography; AF = atrial fibrillation; AS = aortic stenosis; AVR = aortic valve replacement; CAD = coronary artery disease; CMP = cardiomyopathy; CRT-D = cardiac resynchronization therapy–defibrillator; DCMP = dilated cardiomyopathy; ECG = electrocardiogram; EF = ejection fraction; LAD = left anterior descending artery; LFLG = low-flow, low-gradient; LVDD = left ventricular diastolic dysfunction; LVSD = left ventricular systolic dysfunction OPCAB = off-pump coronary artery bypass grafting; PCI = percutaneous coronary intervention; PM = pacemaker; RFCA = radiofrequency catheter ablation.

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  Figure 1. Serial AI-ECG LVSD and LVDD Scores During Heart Failure Treatment in 4 Patients Each panel displays the serial AI-ECG LVSD score (blue) and LVDD score (green) over time (years from the first ECG), with corresponding ejection fraction and E/e′ values annotated below the x-axis. Dashed lines indicate predefined cutoffs for LVSD (9.7, blue) and LVDD (20.8, green), shown as visual references rather than decision thresholds. Vertical red dotted lines mark the timing of major procedural interventions. Marker shapes denote the rhythm and pacing state at each time point (circle = sinus rhythm; star = atrial fibrillation; triangle = paced rhythm). (A) Case 1: 78-year-old man with ischemic cardiomyopathy (left main, 3-vessel disease) treated with revascularization (OPCAB). (B) Case 2: 78-year-old man with low-flow, low-gradient aortic stenosis treated with valve replacement and subsequent device therapy (AVR, pacemaker, and CRT-D upgrade). (C) Case 3: 73-year-old man with coronary artery disease (2-vessel disease) treated with percutaneous coronary intervention. (D) Case 4: 66-year-old woman with dilated cardiomyopathy and atrial fibrillation treated with medical optimization and rhythm…

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  Figure 2. Representative 12-Lead ECGs Across Rhythm and Pacing Transitions in 2 Cases Twelve-lead ECGs are shown at paired time points from 2 patients in whom rhythm or pacing status changed substantially during follow-up. For each ECG, the rhythm and pacing state, QRS duration, ejection fraction, and AI-ECG LVSD and LVDD scores are annotated below the tracing. (A) Case 2 at baseline (pre-AVR): native sinus rhythm with a markedly widened QRS of 187 ms. (B) Case 2 at 1-year follow-up: atrioventricular dual-paced rhythm with a narrow QRS of 135 ms; despite substantial improvement in ejection fraction (18% → 36%), the AI-ECG LVSD score remained at 80.0 (vs 80.2 at baseline). The transition from a wide native QRS (A) to a narrower paced QRS (B) illustrates a substantial change in ECG morphology occurring independently of ventricular functional recovery. (C) Case 4 at baseline: atrial fibrillation with an irregular R-R interval and absent P waves, QRS 89 ms. (D) Case 4 after radiofrequency catheter ablation (∼70 months): restored sinus rhythm, QRS 111 ms; both AI-ECG scores normalized (LVSD: 1.7, LVDD: 3.8). Pacing spikes in (B) are indicated by arrowheads, and the rhythm state is labeled…