Central Illustration.

Artificial Intelligence–Enhanced Electrocardiogram Models for Detection of Left Ventricular Dysfunction - A Comparison Study

We propose a structured framework for the independent validation of AI-enhanced ECG models. Of the 51 published AI-enhanced ECG models for left ventricular systolic dysfunction, only 4 were available for true external validation. These models were evaluated in an independent cohort with paired electrocardiograms and cardiac magnetic resonance imaging as the reference standard. Despite differences in architecture and training cohorts, model performance remained high in this external setting. However, limited openness and accessibility of AI-enhanced ECG models constrain independent assessment and may impede broader clinical adoption. AI-ECG = AI-Enhanced ECG; ECG = electrocardiogram; LVSD = left ventricular systolic dysfunction; CGMH = Chang Gung Memorial Hospital; CMR = cardiac magnetic resonance; AUROC= area under the receiver-operating characteristic curve.