{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,10]],"date-time":"2026-09-10T04:08:25Z","timestamp":1789013305223,"version":"build-2803163510"},"reference-count":38,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"15","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"published-print":{"date-parts":[[2026,8,4]]},"abstract":"<jats:sec xml:lang=\"en\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p xml:lang=\"en\">Left ventricular (LV) dysfunction and heart failure with preserved ejection fraction (HFpEF) often present with early signs that are frequently overlooked or attributed to other conditions. This study proposes a novel, externally validated artificial intelligence (AI) tool using ECG data (ECG\u2010AI) for the simultaneous detection of subtypes of LV dysfunction and HFpEF.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec xml:lang=\"en\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p xml:lang=\"en\">Two ECG\u2010AI models, using 12\u2010lead or single\u2010lead ECG, were developed using data from Atrium Health Wake Forest Baptist and University of Tennessee Health Science Center (UTHSC) to classify ECGs into 4 categories: reduced LV ejection fraction (rEF; EF&lt;40), midrange EF (mEF; 40\u2264mEF&lt;50), HFpEF, and controls (no LV dysfunction or HFpEF). Next, a boosting algorithm was used to incorporate clinical risk factors. Finally, the models were independently validated on pediatric data from UTHSC.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec xml:lang=\"en\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p xml:lang=\"en\">The Atrium Health Wake Forest Baptist cohort included 1\u2009078\u2009198 digital ECGs from 165\u2009243 patients (5% rEF, 8% mEF, 2% HFpEF), and the UTHSC external validation cohort comprised 72\u2009832 ECGs from 42\u2009880 patients (1% rEF, 1% mEF, 1% HFpEF). For the 12\u2010lead (Lead\u2010I) ECG\u2010AI model, areas under the curve for rEF\/mEF\/HFpEF were 0.90\/0.81\/0.80 (0.89\/0.78\/0.75) in the Atrium Health Wake Forest Baptist holdout data and 0.92\/0.76\/0.73 (0.90\/0.75\/0.74) in the UTHSC data. Clinical data\u2010only machine\u2010learning models lacked generalizability; clinical + ECG\u2010AI models did not show any significant improvement compared with ECG\u2010alone models. With 8418 ECGs (142 cases, 8276 controls) from UTHSC pediatric data, the 12\u2010lead model achieved areas under the curve of 0.97\/0.71\/0.64 for rEF\/mEF\/HFpEF, and the Lead I model had areas under the curve of 0.94\/0.77\/0.67.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec xml:lang=\"en\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p xml:lang=\"en\">ECG\u2010AI can accurately detect LV dysfunction and HFpEF even from single\u2010lead ECG, enabling potential low\u2010cost screening.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1161\/jaha.124.041948","type":"journal-article","created":{"date-parts":[[2026,7,28]],"date-time":"2026-07-28T12:08:35Z","timestamp":1785240515000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":1,"title":["ECG\u2010Based Artificial Intelligence for Classifying Left Ventricular Dysfunction and Heart Failure With Preserved Ejection Fraction"],"prefix":"10.1161","volume":"15","author":[{"given":"Ibrahim","family":"Karabayir","sequence":"first","affiliation":[{"name":"Wake Forest School of Medicine","place":["Winston\u2010Salem, USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Olivia","family":"Gilbert","sequence":"additional","affiliation":[{"name":"Wake Forest School of Medicine","place":["Winston\u2010Salem, USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5923-814X","authenticated-orcid":false,"given":"Ali","family":"Valika","sequence":"additional","affiliation":[{"name":"Advocate Good Samaritan Hospital","place":["Downers Grove, USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Turgay","family":"Celik","sequence":"additional","affiliation":[{"name":"Wake Forest School of Medicine","place":["Winston\u2010Salem, USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arunkumar","family":"Krishnan","sequence":"additional","affiliation":[{"name":"Wake Forest University School of Medicine","place":["Winston\u2010Salem, USA"]},{"name":"Atrium Health Levine Cancer","place":["Charlotte, USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1258-8353","authenticated-orcid":false,"given":"Lokesh","family":"Chinthala","sequence":"additional","affiliation":[{"name":"University of Tennessee Health Science Center","place":["Memphis, USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9651-3836","authenticated-orcid":false,"given":"Ambarish","family":"Pandey","sequence":"additional","affiliation":[{"name":"UT Southwestern Medical Center","place":["Dallas, USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5632-8150","authenticated-orcid":false,"given":"Elsayed Z.","family":"Soliman","sequence":"additional","affiliation":[{"name":"Wake Forest School of Medicine","place":["Winston\u2010Salem, USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4046-2352","authenticated-orcid":false,"given":"John L.","family":"Jefferies","sequence":"additional","affiliation":[{"name":"University of Memphis","place":["Memphis, USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-5274-0826","authenticated-orcid":false,"given":"Dalane","family":"Kitzman","sequence":"additional","affiliation":[{"name":"Wake Forest School of Medicine","place":["Winston\u2010Salem, USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7670-6400","authenticated-orcid":false,"given":"David","family":"Herrington","sequence":"additional","affiliation":[{"name":"Wake Forest School of Medicine","place":["Winston\u2010Salem, USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert L.","family":"Davis","sequence":"additional","affiliation":[{"name":"University of Tennessee Health Science Center","place":["Memphis, USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0313-9254","authenticated-orcid":false,"given":"Oguz","family":"Akbilgic","sequence":"additional","affiliation":[{"name":"Wake Forest School of Medicine","place":["Winston\u2010Salem, USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"e_1_3_1_2_2","doi-asserted-by":"publisher","DOI":"10.1016\/s0140-6736(18)32279-7"},{"key":"e_1_3_1_3_2","doi-asserted-by":"publisher","DOI":"10.1161\/cir.0000000000000757"},{"key":"e_1_3_1_4_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIR.0000000000001063"},{"key":"e_1_3_1_5_2","doi-asserted-by":"publisher","DOI":"10.1161\/cir.0000000000000950"},{"key":"e_1_3_1_6_2","first-page":"1","article-title":"Recent trends in heart failure\u2010related mortality: United States, 2000\u20132014","volume":"2015","author":"Ni H","year":"2015","unstructured":"Ni H, Xu J. Recent trends in heart failure\u2010related mortality: United States, 2000\u20132014. NCHS Data Brief. 2015;2015:1\u20138.","journal-title":"NCHS Data Brief"},{"key":"e_1_3_1_7_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jchf.2014.04.008"},{"key":"e_1_3_1_8_2","doi-asserted-by":"publisher","DOI":"10.1161\/circheartfailure.111.964841"},{"key":"e_1_3_1_9_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2013.7588"},{"key":"e_1_3_1_10_2","doi-asserted-by":"publisher","DOI":"10.1111\/anec.12591"},{"key":"e_1_3_1_11_2","doi-asserted-by":"publisher","DOI":"10.1111\/jce.13889"},{"key":"e_1_3_1_12_2","doi-asserted-by":"publisher","DOI":"10.1038\/s41598-021-81374-6"},{"key":"e_1_3_1_13_2","doi-asserted-by":"publisher","DOI":"10.1161\/circimaging.119.009303"},{"key":"e_1_3_1_14_2","doi-asserted-by":"publisher","DOI":"10.1093\/ehjdh\/ztaa015"},{"key":"e_1_3_1_15_2","doi-asserted-by":"publisher","DOI":"10.3390\/s22239190"},{"key":"e_1_3_1_16_2","doi-asserted-by":"publisher","DOI":"10.3390\/diagnostics11122349"},{"key":"e_1_3_1_17_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2020.06.061"},{"key":"e_1_3_1_18_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijmedinf.2017.09.006"},{"key":"e_1_3_1_19_2","doi-asserted-by":"publisher","DOI":"10.1038\/s41591-018-0240-2"},{"key":"e_1_3_1_20_2","doi-asserted-by":"publisher","DOI":"10.1093\/ehjdh\/ztab080"},{"key":"e_1_3_1_21_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.cardfail.2019.04.006"},{"key":"e_1_3_1_22_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.cvdhj.2023.11.003"},{"key":"e_1_3_1_23_2","doi-asserted-by":"publisher","DOI":"10.21037\/atm.2019.06.79"},{"key":"e_1_3_1_24_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jclinepi.2007.11.008"},{"key":"e_1_3_1_25_2","unstructured":"He K Zhang X Ren S Sun J. Deep Residual Learning for Image Recognition. arXiv. 2015; e\u2010pring 1512.03385."},{"key":"e_1_3_1_26_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jelectrocard.2023.07.002"},{"key":"e_1_3_1_27_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.envsoft.2022.105447"},{"key":"e_1_3_1_28_2","doi-asserted-by":"publisher","DOI":"10.3390\/diagnostics11091714"},{"key":"e_1_3_1_29_2","doi-asserted-by":"publisher","DOI":"10.1155\/2022\/9517029"},{"key":"e_1_3_1_30_2","doi-asserted-by":"publisher","DOI":"10.3389\/fgene.2021.660275"},{"key":"e_1_3_1_31_2","doi-asserted-by":"publisher","DOI":"10.1186\/s12911-020-01250-7"},{"key":"e_1_3_1_32_2","first-page":"3149","volume-title":"Proceedings of the 31st International Conference on Neural Information Processing Systems","author":"Ke G","year":"2017","unstructured":"Ke G, Meng Q, Finley T, Wang T, Chen W, Ma W, Ye Q, Liu T\u2010Y. LightGBM: a highly efficient gradient boosting decision tree. Proceedings of the 31st International Conference on Neural Information Processing Systems. Long Beach, California, USA: Curran Associates Inc; 2017:3149\u20133157."},{"key":"e_1_3_1_33_2","volume-title":"Bayesian Optimization: Open Source Constrained Global Optimization Tool for Python","author":"Nogueira F","year":"2014","unstructured":"Nogueira F. Bayesian Optimization: Open Source Constrained Global Optimization Tool for Python. GitHub; 2014. https:\/\/github.com\/fmfn\/BayesianOptimization"},{"key":"e_1_3_1_34_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCHEARTFAILURE.121.008741"},{"key":"e_1_3_1_35_2","doi-asserted-by":"publisher","DOI":"10.1097\/hco.0000000000000855"},{"key":"e_1_3_1_36_2","doi-asserted-by":"publisher","DOI":"10.2307\/2531595"},{"key":"e_1_3_1_37_2","doi-asserted-by":"publisher","DOI":"10.1038\/s41746-023-00993-7"},{"key":"e_1_3_1_38_2","doi-asserted-by":"publisher","DOI":"10.1038\/s41591-022-02053-1"},{"key":"e_1_3_1_39_2","doi-asserted-by":"publisher","DOI":"10.1161\/circulationaha.123.067750"}],"container-title":["Journal of the American Heart Association"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ahajournals.org\/doi\/full\/10.1161\/JAHA.124.041948","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,10]],"date-time":"2026-09-10T03:40:53Z","timestamp":1789011653000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ahajournals.org\/doi\/10.1161\/JAHA.124.041948"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,4]]},"references-count":38,"journal-issue":{"issue":"15","published-print":{"date-parts":[[2026,8,4]]}},"alternative-id":["10.1161\/JAHA.124.041948"],"URL":"https:\/\/doi.org\/10.1161\/jaha.124.041948","relation":{},"ISSN":["2047-9980"],"issn-type":[{"value":"2047-9980","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,4]]},"assertion":[{"value":"2025-03-04","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-08-29","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-07-28","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e041948"}}