{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,6]],"date-time":"2026-11-06T01:19:37Z","timestamp":1793927977106,"version":"4.8.0"},"reference-count":42,"publisher":"Oxford University Press (OUP)","issue":"44","license":[{"start":{"date-parts":[[2025,7,16]],"date-time":"2025-07-16T00:00:00Z","timestamp":1752624000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Shanghai Municipal Key Clinical Specialty","award":["shslczdzk01701"],"award-info":[{"award-number":["shslczdzk01701"]}]},{"name":"Fudan University AI4S Project","award":["FudanX24AI056"],"award-info":[{"award-number":["FudanX24AI056"]}]},{"DOI":"10.13039\/501100000274","name":"British Heart Foundation","doi-asserted-by":"publisher","award":["FS\/CRTF\/21\/24183"],"award-info":[{"award-number":["FS\/CRTF\/21\/24183"]}],"id":[{"id":"10.13039\/501100000274","id-type":"DOI","asserted-by":"publisher"}]},{"name":"NIHR Academic Clinical Lectureship"},{"DOI":"10.13039\/501100007155","name":"Medical Research Council","doi-asserted-by":"publisher","award":["MR\/Y000803\/1"],"award-info":[{"award-number":["MR\/Y000803\/1"]}],"id":[{"id":"10.13039\/501100007155","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100019573","name":"BHF","doi-asserted-by":"publisher","award":["RG\/F\/22\/110078"],"award-info":[{"award-number":["RG\/F\/22\/110078"]}],"id":[{"id":"10.13039\/501100019573","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100019573","name":"BHF","doi-asserted-by":"publisher","award":["RG\/F\/22\/110078"],"award-info":[{"award-number":["RG\/F\/22\/110078"]}],"id":[{"id":"10.13039\/501100019573","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100019573","name":"BHF","doi-asserted-by":"publisher","award":["RE\/18\/4\/34215"],"award-info":[{"award-number":["RE\/18\/4\/34215"]}],"id":[{"id":"10.13039\/501100019573","id-type":"DOI","asserted-by":"publisher"}]},{"name":"EJP RD Research Mobility Fellowship"},{"name":"National Institute for Health Research Imperial Biomedical Research Centre"},{"name":"Imperial\u2019s BHF Centre","award":["RE\/18\/4\/34215"],"award-info":[{"award-number":["RE\/18\/4\/34215"]}]},{"name":"Imperial\u2019s BHF Centre","award":["RE\/24\/130023"],"award-info":[{"award-number":["RE\/24\/130023"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,11,21]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background and Aims<\/jats:title>\n                    <jats:p>Valvular heart disease (VHD) is a significant source of morbidity and mortality, though early intervention can improve outcomes. This study aims to develop artificial intelligence-enhanced electrocardiography (AI-ECG) models to diagnose and predict future moderate or severe regurgitant VHDs (rVHDs), including mitral regurgitation (MR), tricuspid regurgitation (TR), and aortic regurgitation (AR).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>The AI-ECG models were developed in a data set of 988 618 ECG and transthoracic echocardiogram pairs from 400 882 patients from Zhongshan Hospital, Shanghai, China. The AI-ECG models used a residual convolutional neural network with a discrete-time survival loss function. External evaluation was performed in outpatients from a secondary care data set from Beth Israel Deaconess Medical Center, Boston, USA, consisting of 34 214 patients with linked echocardiography.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>In the internal test set, the AI-ECG models accurately predicted future significant MR [C-index 0.774, 95% confidence interval (CI) 0.753\u20130.792], AR (0.691, 95% CI 0.657\u20130.720), and TR (0.793, 95% CI 0.777\u20130.808). In age- and sex-adjusted Cox models, the highest risk quartile had a hazard ratio (HR) of 7.6 (95% CI 5.8\u20139.9, P &amp;lt; .0001) for risk of future significant MR, compared with the lowest risk quartile. For future AR and TR, the equivalent HRs were 3.8 (95% CI 2.7\u20135.5) and 9.9 (95% CI 7.5\u201313.0), respectively. These findings were confirmed in the transnational external test set. Imaging association analyses demonstrated AI-ECG predictions were associated with subclinical chamber remodelling.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>This study developed AI-ECG models to diagnose and predict rVHDs and validated the models in a transnational and ethnically distinct cohort. The AI-ECG models could be utilized to guide surveillance echocardiography in patients at risk of future rVHDs, to facilitate early detection and intervention.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/eurheartj\/ehaf448","type":"journal-article","created":{"date-parts":[[2025,7,16]],"date-time":"2025-07-16T23:06:39Z","timestamp":1752707199000},"page":"4823-4837","source":"Crossref","is-referenced-by-count":29,"title":["Artificial intelligence-enhanced electrocardiography to predict regurgitant valvular heart diseases: an international study"],"prefix":"10.1093","volume":"46","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5467-8958","authenticated-orcid":false,"given":"Yixiu","family":"Liang","sequence":"first","affiliation":[{"name":"Department of Cardiology, Zhongshan Hospital of Fudan University, Shanghai, Institute of Cardiovascular Diseases, National Clinical Research Centre for Interventional Medicine , Shanghai 200032 ,","place":["China"]},{"name":"National Heart and Lung Institute, Imperial College London, Hammersmith Hospital , Du Cane Road, London W12 0NN ,","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0204-7078","authenticated-orcid":false,"given":"Arunashis","family":"Sau","sequence":"additional","affiliation":[{"name":"National Heart and Lung Institute, Imperial College London, Hammersmith Hospital , Du Cane Road, London W12 0NN ,","place":["UK"]},{"name":"Department of Cardiology, Imperial College Healthcare NHS Trust , London W12 0NN ,","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Boroumand","family":"Zeidaabadi","sequence":"additional","affiliation":[{"name":"National Heart and Lung Institute, Imperial College London, Hammersmith Hospital , Du Cane Road, London W12 0NN ,","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joseph","family":"Barker","sequence":"additional","affiliation":[{"name":"National Heart and Lung Institute, Imperial College London, Hammersmith Hospital , Du Cane Road, London W12 0NN ,","place":["UK"]},{"name":"Department of Cardiology, Imperial College Healthcare NHS Trust , London W12 0NN ,","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5888-8490","authenticated-orcid":false,"given":"Konstantinos","family":"Patlatzoglou","sequence":"additional","affiliation":[{"name":"National Heart and Lung Institute, Imperial College London, Hammersmith Hospital , Du Cane Road, London W12 0NN ,","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6892-6553","authenticated-orcid":false,"given":"Libor","family":"Pastika","sequence":"additional","affiliation":[{"name":"National Heart and Lung Institute, Imperial College London, Hammersmith Hospital , Du Cane Road, London W12 0NN ,","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8603-7044","authenticated-orcid":false,"given":"Ewa","family":"Sieliwonczyk","sequence":"additional","affiliation":[{"name":"National Heart and Lung Institute, Imperial College London, Hammersmith Hospital , Du Cane Road, London W12 0NN ,","place":["UK"]},{"name":"MRC Laboratory of Medical Sciences, Imperial College London , London ,","place":["UK"]},{"name":"University of Antwerp and Antwerp University Hospital , Antwerp ,","place":["Belgium"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zachary","family":"Whinnett","sequence":"additional","affiliation":[{"name":"National Heart and Lung Institute, Imperial College London, Hammersmith Hospital , Du Cane Road, London W12 0NN ,","place":["UK"]},{"name":"Department of Cardiology, Imperial College Healthcare NHS Trust , London W12 0NN ,","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicholas S","family":"Peters","sequence":"additional","affiliation":[{"name":"National Heart and Lung Institute, Imperial College London, Hammersmith Hospital , Du Cane Road, London W12 0NN ,","place":["UK"]},{"name":"Department of Cardiology, Imperial College Healthcare NHS Trust , London W12 0NN ,","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ziqing","family":"Yu","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Zhongshan Hospital of Fudan University, Shanghai, Institute of Cardiovascular Diseases, National Clinical Research Centre for Interventional Medicine , Shanghai 200032 ,","place":["China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xi","family":"Liu","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Zhongshan Hospital of Fudan University, Shanghai, Institute of Cardiovascular Diseases, National Clinical Research Centre for Interventional Medicine , Shanghai 200032 ,","place":["China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shuo","family":"Wang","sequence":"additional","affiliation":[{"name":"School of Basic Medical Sciences, Digital Medical Research Center, Fudan University , Shanghai ,","place":["China"]},{"name":"Imperial College London, Data Science Institute , London SW7 2AZ ,","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hongyang","family":"Lu","sequence":"additional","affiliation":[{"name":"Cardiac Rhythm Management, Medtronic Technology Center, Medtronic (Shanghai) Ltd , Shanghai ,","place":["China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4241-3586","authenticated-orcid":false,"given":"Daniel B","family":"Kramer","sequence":"additional","affiliation":[{"name":"Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Beth Israel Deaconess Medical Center, Harvard Medical School , Boston, MA ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5560-5638","authenticated-orcid":false,"given":"Jonathan W","family":"Waks","sequence":"additional","affiliation":[{"name":"Harvard Medical School, Beth Israel Deaconess Medical Center, Harvard-Thorndike Electrophysiology Institute , Boston, MA ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yangang","family":"Su","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Zhongshan Hospital of Fudan University, Shanghai, Institute of Cardiovascular Diseases, National Clinical Research Centre for Interventional Medicine , Shanghai 200032 ,","place":["China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Junbo","family":"Ge","sequence":"additional","affiliation":[{"name":"Department of 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