{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,14]],"date-time":"2026-09-14T14:54:43Z","timestamp":1789397683198,"version":"build-2803163510"},"reference-count":50,"publisher":"Oxford University Press (OUP)","issue":"2","license":[{"start":{"date-parts":[[2026,2,2]],"date-time":"2026-02-02T00:00:00Z","timestamp":1769990400000},"content-version":"vor","delay-in-days":6,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/100003608","name":"ASE Foundation","doi-asserted-by":"publisher","award":["R01HL167050"],"award-info":[{"award-number":["R01HL167050"]}],"id":[{"id":"10.13039\/100003608","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100012774","name":"Kostin Innovation Fund","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100012774","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100005627","name":"Thrasher Research Fund","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100005627","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000050","name":"NHLBI","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000050","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,1,27]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Aims<\/jats:title>\n                    <jats:p>Periodic cardiac MRI (CMR) is recommended to identify adverse ventricular remodelling in repaired tetralogy of Fallot (TOF), but access to CMR is uneven, and compliance is poor. We developed a 12-lead electrocardiogram (ECG) artificial intelligence (AI) biomarker to identify CMR-quantified adverse biventricular remodelling in repaired TOF.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and results<\/jats:title>\n                    <jats:p>Six (1 train\/5 external test) North American retrospective cohorts with paired ECG and CMR were included. The main outcome was a composite of \u22652 TOF-specific CMR abnormalities: right ventricular (RV) end-diastolic volume \u2265 160\u2005mL\/m2, RV end-systolic volume \u2265 80\u2005mL\/m2, RV ejection fraction (EF) &amp;lt;47%, and left ventricular EF &amp;lt;55%. Model discrimination, calibration, and net benefit as a screening test to rule out ventricular remodelling were assessed. Nine hundred and eight patients (2552 ECGs) were included in training, and 782 patients (1795 ECGs) in external validation (outcome prevalence 57%). The area under the receiver-operating curve (AUROC) was 0.85 (95% confidence interval 0.83\u20130.87), and average precision was 0.88. At a screening risk-threshold of 0.25, there was 92% sensitivity, 41% specificity, 87% negative predictive value, and 55% positive predictive value for ventricular remodelling, which yielded a 13% net reduction in CMR use on net benefit analysis. There was no difference by sex or race\/ethnicity, but there were differences by age and site, with two of five sites with lower AUROC than the others, and three of five sites met criteria for miscalibration, which improved after centre-specific calibration.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>An artificial intelligence analysis of electrocardiogram (AI-ECG) biomarker in repaired TOF effectively identifies ventricular remodelling to inform timing of advanced imaging. Extensive external validation revealed variation in discrimination and calibration that are important considerations for clinical implementation and regulatory approval pathways of AI-ECG in congenital heart disease.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/ehjdh\/ztag015","type":"journal-article","created":{"date-parts":[[2026,1,30]],"date-time":"2026-01-30T12:42:48Z","timestamp":1769776968000},"source":"Crossref","is-referenced-by-count":2,"title":["Development and multicentre validation of an artificial intelligence electrocardiogram model for ventricular remodeling in repaired tetralogy of Fallot"],"prefix":"10.1093","volume":"7","author":[{"given":"Son Q","family":"Duong","sequence":"first","affiliation":[{"name":"Department of Pediatrics (Cardiology), Icahn School of Medicine at Mount Sinai , 1468 Madison Ave, Annenberg 3rd Fl, New York, NY 10029 ,","place":["USA"]},{"name":"Windreich Department of Artificial Intelligence and Human Health, Icahn School of Medicine at Mount Sinai , New York, NY 10029 ,","place":["USA"]},{"name":"Center for Artificial Intelligence in Children\u2019s Health, Mindich Child Health and Development Institute, Icahn School of Medicine at Mount Sinai , New York, NY 10029 ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3343-744X","authenticated-orcid":false,"given":"Akhil","family":"Vaid","sequence":"additional","affiliation":[{"name":"Windreich Department of Artificial Intelligence and Human Health, Icahn School of Medicine at Mount Sinai , New York, NY 10029 ,","place":["USA"]},{"name":"The Hasso Plattner Institute for Digital Health at Mount Sinai , New York, NY 10029 ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pengfei","family":"Jiang","sequence":"additional","affiliation":[{"name":"Center for Child Health Services Research, Mindich Child Health and Development Institute, Icahn School of Medicine at Mount Sinai , New York, NY 10029 ,","place":["USA"]},{"name":"Department of Population Health Sciences and Policy, Icahn School of Medicine at Mount Sinai , New York, NY 10029 ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuval","family":"Bitterman","sequence":"additional","affiliation":[{"name":"Department of Paediatrics, Labatt Family Heart Centre, Hospital for Sick Children (SickKids) , Toronto M5G 1X8 ,","place":["Canada"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yamini","family":"Krishnamurthy","sequence":"additional","affiliation":[{"name":"Department of Medicine (Cardiology), Columbia University Medical Center , New York, NY 10032 ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"I Min","family":"Chiu","sequence":"additional","affiliation":[{"name":"Department of Medicine (Cardiology), Cedars-Sinai Medical Center , Los Angeles, CA 90048 ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joshua","family":"Finer","sequence":"additional","affiliation":[{"name":"Department of Medicine (Cardiology), Columbia University Medical Center , New York, NY 10032 ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brian","family":"Cleary","sequence":"additional","affiliation":[{"name":"Department of Pediatrics (Cardiology), Northwestern Feinberg School of Medicine , Chicago, IL 60611 ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4515-8090","authenticated-orcid":false,"given":"Benjamin S","family":"Glicksberg","sequence":"additional","affiliation":[{"name":"Windreich Department of Artificial Intelligence and Human Health, Icahn School of Medicine at Mount Sinai , New York, NY 10029 ,","place":["USA"]},{"name":"Center for Artificial Intelligence in Children\u2019s Health, Mindich Child Health and Development Institute, Icahn School of Medicine at Mount Sinai , New York, NY 10029 ,","place":["USA"]},{"name":"The Hasso Plattner Institute for Digital Health at Mount Sinai , New York, NY 10029 ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ruchira","family":"Garg","sequence":"additional","affiliation":[{"name":"Department of Pediatrics (Cardiology), Cedars-Sinai Medical Center , Los Angeles, CA 90048 ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"DiLorenzo","sequence":"additional","affiliation":[{"name":"Department of Pediatrics (Cardiology), Columbia University College of Physicians and Surgeons , New York, NY 10032 ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mark","family":"Friedberg","sequence":"additional","affiliation":[{"name":"Department of Paediatrics, Labatt Family Heart Centre, Hospital for Sick Children (SickKids) , Toronto M5G 1X8 ,","place":["Canada"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Evan","family":"Zahn","sequence":"additional","affiliation":[{"name":"Department of Pediatrics (Cardiology), Cedars-Sinai Medical Center , Los Angeles, CA 90048 ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthew","family":"Lewis","sequence":"additional","affiliation":[{"name":"Department of Medicine (Cardiology), Columbia University Medical Center , New York, NY 10032 ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Satzer","sequence":"additional","affiliation":[{"name":"Department of Pediatrics (Cardiology), Northwestern Feinberg School of Medicine , Chicago, IL 60611 ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3813-7518","authenticated-orcid":false,"given":"David","family":"Ouyang","sequence":"additional","affiliation":[{"name":"Department of Medicine (Cardiology), Cedars-Sinai Medical Center , Los Angeles, CA 90048 ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9643-3024","authenticated-orcid":false,"given":"Pierre","family":"Elias","sequence":"additional","affiliation":[{"name":"Department of Medicine (Cardiology), Columbia University Medical Center , New York, NY 10032 ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tal","family":"Geva","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Boston Children\u2019s Hospital , Boston, MA 02115 ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4227-8823","authenticated-orcid":false,"given":"Sunil","family":"Ghelani","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Boston Children\u2019s Hospital , Boston, MA 02115 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Icahn School of Medicine at Mount Sinai , New York, NY 10029 ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rachel M","family":"Wald","sequence":"additional","affiliation":[{"name":"Department of Paediatrics, Labatt Family Heart Centre, Hospital for Sick Children (SickKids) , Toronto M5G 1X8 ,","place":["Canada"]},{"name":"Peter Munk Cardiac Centre, Toronto Adult Congenital Heart Disease Program, University of Toronto , Toronto M5G 2C4, Ontario ,","place":["Canada"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Girish N","family":"Nadkarni","sequence":"additional","affiliation":[{"name":"Windreich Department of Artificial Intelligence and Human Health, Icahn School of Medicine at Mount Sinai , New York, NY 10029 ,","place":["USA"]},{"name":"The Hasso Plattner Institute for Digital Health at Mount Sinai , New York, NY 10029 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