Table 1.
Summary of artificial intelligence electrocardiogram algorithms and their performance and characteristics
| Model | Author/Group | Test geography hospital vs. development | Prospective or retrospective | Number of patients tested | Disease prevalence (%) | Description of controls | Hardware specification (12 lead vs. other; specify manufactures/performance of 12 lead) | Bias analysis: population reporting (age, sex, race, other) | AUC | Sensitivity (%) | Specificity (%) |
|---|---|---|---|---|---|---|---|---|---|---|---|
| LVSD/HF |
Attia et al.2 Mayo |
All Mayo Clinic Sites | Retrospective | 52 870 | 7.8 | Low EF confirmed by TTE | 12 Lead ECG (GE-Marquette) | No formal analysis | 0.93 | 86.3 | 85.7 |
| LVSD/HF |
Attia et al.18 Mayo |
All Mayo Clinic Sites | Prospective | 3874 | 7.0 | Low EF confirmed by TTE or HF prediction by NT-proBNP | 12 Lead ECG (GE-Marquette) | No formal analysis | 0.918 | 82.5 | 86.8 |
| LVSD/HF |
Adedinsewo et al.19 Mayo |
All Mayo Clinic Sites | Retrospective | 1606 | 10.2 | Low EF confirmed by TTE | 12 Lead ECG (GE-Marquette) | Age, Sex | 0.89 | 73.8 | 87.3 |
| LVSD/HF |
Noseworthy et al.20 Mayo |
All Mayo Clinic Sites | Retrospective | 52 870 | 7.8 | Low EF confirmed by TTE | 12 Lead ECG (GE-Marquette) | Race | >0.93 in all groups tested | — | — |
| LVSD/HF |
Attia et al.21 Mayo |
Mayo Rochester | Prospective | 100 | 7 | Low EF confirmed by TTE | AI-enhanced ECG-enabled stethoscope (Eko); single lead | No formal analysis | 0.906 | — | — |
| LVSD/HF |
Attia et al.22 Mayo/Multi-Institution |
Know Your Heart Sites (Russia) |
Retrospective | 4277 | 0.6 | Low EF confirmed by TTE | 12 Lead ECG (Cardiax; IMED Ltd, Hungary) | Age, sex | 0.82 | 26.9 | 97.4 |
| LVSD/HF |
Cho et al.23 Sejong/Korea |
Mediplex/Sejong (Korea) | Retrospective |
IV-2908 EV-4176 |
6.8 | Low EF confirmed by echo | 12 Lead ECG (Page Writer Cardiograph; Philips, Netherlands) | Age, sex, obesity |
IV-0.913 EV-0.961 |
IV-90.5 EV-91.5 |
IV-75.6 EV-91.1 |
| LVSD/HF |
Cho et al.23 Sejong/Korea |
Mediplex/Sejong (Korea) | Retrospective |
IV-2908 EV-4176 |
6.8 | Low EF confirmed by echo | Single lead (LI) from 12 lead ECG (Page Writer Cardiograph; Philips, Netherlands) | Performance of all single leads |
IV-0.874 EV-0.929 |
IV-93.2 EV-92.1 |
IV-63.2 EV-82.1 |
| LVSD/HF |
Kwon et al.24 Sejong/Korea |
Mediplex/Sejong (Korea) | Retrospective |
IV-3378 EV-5901 |
IV-9.7 EV-4.2 |
Low EF confirmed by echo | 12 Lead ECG (Page Writer Cardiograph; Philips, Netherlands) | No formal analysis |
IV-0.843 EV-0.889 |
IV-n/a EV-90 |
IV-n/a EV-60.4 |
| HCM |
Ko et al.13 Mayo |
All Mayo Clinic Sites | Retrospective | 13 400 | 4.6 | Sex/age matched | 12 Lead ECG (GE-Marquette) | Age, sex, ECG finding | 0.96 | 87 | 90 |
| HCM |
Rahman et al.25 Hopkins Queens (CA) |
Hopkins Baltimore |
Retrospective | 762 | 29.0 | Patients with ICD and CM diagnosis | 12 Lead ECG (unspecified) | No formal analysis |
RF-0.94 SVM-0.94 |
RF-87 SVM-0.91 |
RF-92 SVF-0.91 |
| Hyperkalaemia |
Galloway et al.26 Mayo |
All Mayo Clinic Sites | Retrospective |
MN-50 099 AZ-5855 FL-6011 |
MN-2.6 AZ-4.6 FL-4.8 |
Confirmation by serum potassium | 12 Lead ECG (GE-Marquette); 2 Lead evaluation LI/LII | No formal analysis |
MN-0.883 AZ-0.853 FL-0.860 |
MN-90.2 AZ-88.9 FL-91.3 |
MN-54.7 AZ-55.0 FL-54.7 |
| Sex and age >40 years |
Attia et al.1 Mayo |
All Mayo Clinic Sites | Retrospective | 275 056 | n/a | Confirmed age/sex in medical record | 12 Lead ECG (GE-Marquette) | Co-morbidity impact on ECG age |
Sex-0.968 Age-0.94 |
Sex-n/a Age-87.8 |
Sex-n/a Age-86.8 |
| Afib |
Attia et al.3 Mayo |
All Mayo Clinic Sites | Retrospective | 36 280 | 8.4 | Patients without Afib on prior EKG | 12 Lead ECG (GE-Marquette) | Analysis with ‘window of interest’ | 0.87 | 79.0 | 79.5 |
| Afib |
Tison et al.27 UCSF |
Remote study; UCSF | Prospective | 9750 | 3.4 | 12 lead EKG diagnosis of Afib | Apple Watch photoplethysmography (Apple Inc.) | No formal analysis | 0.97 | 98.0 | 90.2 |
| Afib |
Hill et al.28 UK-Multi-institution |
UK | Retrospective | 2 994 837 | 3.2 | CHARGE-AF score | Time-varying neural network; based on clinic data and risk scores | No formal analysis | 0.827 | 75.0 | 74.9 |
| Afib |
Jo et al.29 Sejong/Korea |
Multiple sites (Korea) | Retrospective |
IV-6287 EV-38 018 |
IV-13 EV-6.0 |
Patients without afib | 12 lead, 6 lead, and single lead ECG (unspecified) | No formal analysis | IV/EV for 12, 6, single lead all >0.95 | All >98% | All >99% |
| Afib |
Poh et al.30 Boston |
Hong Kong | Retrospective | 1013 | 2.8 | Patients without afib | Photoplethysmographic pulse waveform | No formal analysis | 0.997 | 97.6 | 96.5 |
| Afib | Raghunath et al.31 | Geisinger Clinic, PA, USA | Retrospective | 1.6M | Patients without afib | 12 lead ECG | Age, sex, race analysed | 0.85 | 69 | 81 | |
| Long QT (>500 ms) |
Giudicessi et al.32 Mayo |
Mayo Clinic Rochester | Both; prospective data reported | 686 | 3.6 | QT expert/lab over-read of 12 lead ECGs | 6 lead smartphone-enabled ECG (AliveCor Kardia Mobile 6L) | No formal analysis | 0.97 | 80.0 | 94.4 |
| Long QT |
Bos et al.33 Mayo |
Mayo Clinic Rochester | Retrospective | 2059 | 47 | Patients without LQTS | 12 Lead ECG (GE-Marquette) | LQTS genotype subgroup analysis | 0.900 | 83.7 | 80.6 |
| Multiple Pathologies |
Tison et al.34 UCSF |
UCSF | Retrospective | 36 816 (ECGs) |
HCM-27.4 PAH-29.8 Amyloid-28.3 MVP-21.0 |
Individual pathologies determined by standard care (i.e. echo, biopsy) | 12 Lead ECG (GE-Marquette) | No formal analysis |
HCM-0.91 PAH-0.94 Amyloid-0.86 MVP-0.77 |
— | — |
| Mod-Sev AS |
Cohen-Shelly et al.6 Mayo |
All Mayo Clinic Sites | Retrospective | 102 926 | 3.7 | Mod-Sev AS confirmed by TTE | 12 Lead ECG (GE-Marquette) | Age, sex | 0.85 | 78 | 74 |
| Significant AS |
Kwon et al.7 Sejong/Korea |
Mediplex/Sejong (Korea) | Retrospective |
IV-6453 EV-10 865 |
IV-3.8 EV-1.7 |
Significant AS confirmed by echo | 12 Lead ECG (Unspecified) | No formal analysis |
IV-0.884 EV-0.861 |
IV-80.0 EV-80.0 |
IV-81.4 EV-78.3 |
| Significant AS |
Kwon et al.7 Sejong/Korea |
Mediplex/Sejong (Korea) | Retrospective |
IV-6453 EV-10 865 |
IV-3.8 EV-1.7 |
Significant AS confirmed by echo | Single lead (L2) from 12 lead ECG (unspecified) | No formal analysis |
IV-0.845 EV-0.821 |
— | — |
| Mod-Sev MR |
Kwon et al.35 Sejong/Korea |
Mediplex/Sejong (Korea) | Retrospective |
IV-3174 EV-10 865 |
IV-n/a EV-3.9 |
Mod-Sev MR confirmed by echo | 12 Lead ECG (Unspecified) | No formal analysis |
IV 0.816 EV 0.877 |
IV 0.900 EV 0.901 |
IV 0.533 EV 0.699 |
| Mod-Sev MR |
Kwon et al.35 Sejong/Korea |
Mediplex/Sejong (Korea) | Retrospective |
IV-3174 EV-10 865 |
IV-n/a EV 3.9 |
Mod-Sev MR confirmed by echo | Single lead (aVR) from 12 lead ECG (unspecified) | No formal analysis |
IV 0.758 EV 0.850 |
IV 0.900 EV 0.901 |
IV 0.408 EV 0.560 |
Afib, atrial fibrillation; AI, artificial intelligence; AUC, area under the curve; AZ, Arizona; CA, Canada; ECG, electrocardiogram; echo, echocardiography; EV, external validation; FL, Florida; HCM, hypertrophic cardiomyopathy; HF, heart failure; ICD, implantable cardiac defibrillator; IV, internal validation; LVSD, left ventricular systolic dysfunction; LQTS, long QT syndrome; MN, Minnesota; mod-sev AS, moderate to severe aortic stenosis; mod-sev MR, moderate to severe mitral regurgitation; MVP, mitral valve prolapse; NT-proBNP, N-terminus of brain natriuretic peptide; PAH, pulmonary arterial hypertension; RF, random forest classifier; SVM, support vector machine classifier; TTE, transthoracic echocardiogram.