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Med."],"abstract":"<jats:title>Abstract<\/jats:title><jats:p>Assessment of left ventricular diastolic function plays a major role in the diagnosis and prognosis of cardiac diseases, including heart failure with preserved ejection fraction. We aimed to develop an artificial intelligence (AI)-enabled electrocardiogram (ECG) model to identify echocardiographically determined diastolic dysfunction and increased filling pressure. We trained, validated, and tested an AI-enabled ECG in 98,736, 21,963, and 98,763 patients, respectively, who had an ECG and echocardiographic diastolic function assessment within 14 days with no exclusion criteria. It was also tested in 55,248 patients with indeterminate diastolic function by echocardiography. The model was evaluated using the area under the curve (AUC) of the receiver operating characteristic curve, and its prognostic performance was compared to echocardiography. The AUC for detecting increased filling pressure was 0.911. The AUCs to identify diastolic dysfunction grades \u22651, \u22652, and 3 were 0.847, 0.911, and 0.943, respectively. During a median follow-up of 5.9 years, 20,223 (20.5%) died. Patients with increased filling pressure predicted by AI-ECG had higher mortality than those with normal filling pressure, after adjusting for age, sex, and comorbidities in the test group (hazard ratio (HR) 1.7, 95% CI 1.645\u20131.757) similar to echocardiography and in the indeterminate group (HR 1.34, 95% CI 1.298\u20131.383). An AI-enabled ECG identifies increased filling pressure and diastolic function grades with a good prognostic value similar to echocardiography. AI-ECG is a simple and promising tool to enhance the detection of diseases associated with diastolic dysfunction and increased diastolic filling pressure.<\/jats:p>","DOI":"10.1038\/s41746-023-00993-7","type":"journal-article","created":{"date-parts":[[2024,1,6]],"date-time":"2024-01-06T02:03:04Z","timestamp":1704506584000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":79,"title":["Artificial intelligence-enabled ECG for left ventricular diastolic function and filling pressure"],"prefix":"10.1038","volume":"7","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6476-9527","authenticated-orcid":false,"given":"Eunjung","family":"Lee","sequence":"first","affiliation":[]},{"given":"Saki","family":"Ito","sequence":"additional","affiliation":[]},{"given":"William R.","family":"Miranda","sequence":"additional","affiliation":[]},{"given":"Francisco","family":"Lopez-Jimenez","sequence":"additional","affiliation":[]},{"given":"Garvan C.","family":"Kane","sequence":"additional","affiliation":[]},{"given":"Samuel J.","family":"Asirvatham","sequence":"additional","affiliation":[]},{"given":"Peter A.","family":"Noseworthy","sequence":"additional","affiliation":[]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5052-2948","authenticated-orcid":false,"given":"Paul A.","family":"Friedman","sequence":"additional","affiliation":[]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0818-273X","authenticated-orcid":false,"given":"Rickey E.","family":"Carter","sequence":"additional","affiliation":[]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9375-0596","authenticated-orcid":false,"given":"Barry A.","family":"Borlaug","sequence":"additional","affiliation":[]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9706-7900","authenticated-orcid":false,"given":"Zachi I.","family":"Attia","sequence":"additional","affiliation":[]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8303-5780","authenticated-orcid":false,"given":"Jae K.","family":"Oh","sequence":"additional","affiliation":[]}],"member":"297","published-online":{"date-parts":[[2024,1,6]]},"reference":[{"key":"993_CR1","doi-asserted-by":"publisher","first-page":"507","DOI":"10.1038\/nrcardio.2014.83","volume":"11","author":"BA Borlaug","year":"2014","unstructured":"Borlaug, B. 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P.A.F., Z.I.A., E.L., P.A.N., F.L.-J., S.J.A., and J.K.O. have invented algorithms licensed to ANUMANA and may benefit from algorithm commercialization via Mayo Clinic. P.A.F., Z.I.A., F.L.-J., S.J.A., and R.E.C. are members of the scientific advisory board to ANUMANA. B.A.B. receives research support from the National Institutes of Health (NIH) and the United States Department of Defense, as well as research grant funding from AstraZeneca, Axon, GlaxoSmithKline, Medtronic, Mesoblast, Novo Nordisk, Rivus, and Tenax Therapeutics. Dr. Borlaug has served as a consultant for Actelion, Amgen, Aria, Axon Therapies, BD, Boehringer Ingelheim, Cytokinetics, Edwards Lifesciences, Eli Lilly, Imbria, Janssen, Merck, Novo Nordisk, NGM, NXT, and VADovations, and is named inventor (US Patent no. 10,307,179) for the tools and approach for a minimally invasive pericardial modification procedure to treat heart failure. Other authors declare no competing interests.","order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"4"}}