Abstract
Objective
To assess whether an electrocardiography-based artificial intelligence (AI) algorithm
developed to detect severe ventricular dysfunction (left ventricular ejection fraction
[LVEF] of 35% or below) independently predicts long-term mortality after cardiac surgery
among patients without severe ventricular dysfunction (LVEF>35%).
Methods
Patients who underwent valve or coronary bypass surgery at Mayo Clinic (1993-2019)
and had documented LVEF above 35% on baseline electrocardiography were included. We
compared patients with an abnormal vs a normal AI-enhanced electrocardiogram (AI-ECG)
screen for LVEF of 35% or below on preoperative electrocardiography. The primary end
point was all-cause mortality.
Results
A total of 20,627 patients were included, of whom 17,125 (83.0%) had a normal AI-ECG
screen and 3502 (17.0%) had an abnormal AI-ECG screen. Patients with an abnormal AI-ECG
screen were older and had more comorbidities. Probability of survival at 5 and 10
years was 86.2% and 68.2% in patients with a normal AI-ECG screen vs 71.4% and 45.1%
in those with an abnormal screen (log-rank, P<.01). In the multivariate Cox survival analysis, the abnormal AI-ECG screen was independently
associated with a higher all-cause mortality overall (hazard ratio [HR], 1.31; 95%
CI, 1.24 to 1.37) and in subgroups of isolated valve surgery (HR, 1.30; 95% CI, 1.18
to 1.42), isolated coronary artery bypass grafting (HR, 1.29; 95% CI, 1.20 to 1.39),
and combined coronary artery bypass grafting and valve surgery (HR, 1.19; 95% CI,
1.08 to 1.32). In a subgroup analysis, the association between abnormal AI-ECG screen
and mortality was consistent in patients with LVEF of 35% to 55% and among those with
LVEF above 55%.
Conclusion
A novel electrocardiography-based AI algorithm that predicts severe ventricular dysfunction
can predict long-term mortality among patients with LVEF above 35% undergoing valve
and/or coronary bypass surgery.
Abbreviations and Acronyms:
AI (artificial intelligence), CABG (coronary artery bypass grafting), ECG (electrocardiogram), HR (hazard ratio), LVEF (left ventricular ejection fraction)To read this article in full you will need to make a payment
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Article info
Footnotes
Potential Competing Interests: The authors report no competing interests.
Identification
Copyright
© 2021 Mayo Foundation for Medical Education and Research. Published by Elsevier Inc. All rights reserved.
