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Artificial Intelligence–Enhanced Electrocardiogram for the Early Detection of Cardiac Amyloidosis

      Abstract

      Objective

      To develop an artificial intelligence (AI)–based tool to detect cardiac amyloidosis (CA) from a standard 12-lead electrocardiogram (ECG).

      Methods

      We collected 12-lead ECG data from 2541 patients with light chain or transthyretin CA seen at Mayo Clinic between 2000 and 2019. Cases were nearest neighbor matched for age and sex, with 2454 controls. A subset of 2997 (60%) cases and controls were used to train a deep neural network to predict the presence of CA with an internal validation set (n=999; 20%) and a randomly selected holdout testing set (n=999; 20%). We performed experiments using single-lead and 6-lead ECG subsets.

      Results

      The area under the receiver operating characteristic curve (AUC) was 0.91 (CI, 0.90 to 0.93), with a positive predictive value for detecting either type of CA of 0.86. By use of a cutoff probability of 0.485 determined by the Youden index, 426 (84%) of the holdout patients with CA were detected by the model. Of the patients with CA and prediagnosis electrocardiographic studies, the AI model successfully predicted the presence of CA more than 6 months before the clinical diagnosis in 59%. The best single-lead model was V5 with an AUC of 0.86 and a precision of 0.78, with other single leads performing similarly. The 6-lead (bipolar leads) model had an AUC of 0.90 and a precision of 0.85.

      Conclusion

      An AI-driven ECG model effectively detects CA and may promote early diagnosis of this life-threatening disease.

      Abbreviations and Acronyms:

      AI (artificial intelligence), AL (light chain amyloid), ATTR (transthyretin amyloid), ATTRv (variant (hereditary) transthyretin amyloidosis), ATTRwt (wild-type transthyretin amyloidosis), AUC (area under the receiver operating characteristic curve), CA (cardiac amyloidosis), ECG (electrocardiogram), LVH (left ventricular hypertrophy)
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      • Correction
        Mayo Clinic ProceedingsVol. 98Issue 1
        • Preview
          Corrigendum to ‘Artificial Intelligence–Enhanced Electrocardiogram for the Early Detection of Cardiac Amyloidosis’ [Mayo Clinic Proceedings 96 (2021) 2768–2778]
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