{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,1]],"date-time":"2026-07-01T09:50:10Z","timestamp":1782899410545,"version":"3.54.5"},"reference-count":39,"publisher":"MDPI AG","issue":"13","license":[{"start":{"date-parts":[[2026,7,1]],"date-time":"2026-07-01T00:00:00Z","timestamp":1782864000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Health Institutes of T\u00fcrkiye","award":["16903"],"award-info":[{"award-number":["16903"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>Background\/Objectives: Electrocardiogram (ECG)-based myocardial infarction (MI) classifiers may achieve high internal validation performance but show reduced performance when applied to data from another source. The task is a controlled binary healthy-versus-MI benchmark and is not intended to represent real-world chest-pain triage or autonomous clinical deployment. This study evaluated the source-only transportability of engineered 12-lead ECG feature families for binary healthy-versus-MI classification across a cardiologist-annotated hospital dataset and PTB-XL. Methods: The hospital dataset contained 1749 usable recordings from 1434 patients after excluding 206 broken-data records, with 1550 Healthy and 199 MI recordings. The matched PTB-XL binary subset contained 14,982 recordings from 13,436 patients, with 9513 Healthy and 5469 MI recordings. Eleven engineered feature families and five classifier families were compared under preprocessing, patient-aware splitting, source-validation hyperparameter and threshold selection, and bootstrap uncertainty estimation. The reported leading rows are the highest observed configurations in a prespecified benchmark grid, not locked clinical models. Results: Internal performance was higher than strict source-only transfer performance. In the hospital dataset, fiducial interval descriptors with Extra Trees reached balanced accuracy 0.775 and receiver operating characteristic area under the curve (ROC-AUC) 0.855. In PTB-XL, a broad hybrid feature bank with ST-segment information and XGBoost reached a balanced accuracy of 0.898 and ROC-AUC of 0.965. Strict source-only transfer was weaker and asymmetric: the highest observed balanced accuracy was 0.580 for hospital-to-PTB-XL transfer and 0.632 for PTB-XL-to-hospital transfer. Ranking transportability and operating-threshold transportability diverged, most notably for hospital-to-PTB-XL transfer, where ROC-AUC was 0.774 but sensitivity at the source-selected threshold was only 0.164. A secondary target-threshold analysis improved balanced accuracy to 0.682 and 0.640, respectively, but this used target labels only to re-select the operating threshold and was not a strict source-only result. Conclusions: The findings indicate a transportability gap: PTB-XL-to-hospital transfer was more balanced than hospital-to-PTB-XL transfer, but neither direction achieved performance comparable to internal validation. The source-only operating-point results are not acceptable for clinical MI screening or decision support without additional calibration, target-setting validation, and prospective assessment.<\/jats:p>","DOI":"10.3390\/diagnostics16132061","type":"journal-article","created":{"date-parts":[[2026,7,1]],"date-time":"2026-07-01T08:19:02Z","timestamp":1782893942000},"page":"2061","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Source-Only Transportability of Engineered ECG Features for Healthy-Versus-Myocardial Infarction Classification"],"prefix":"10.3390","volume":"16","author":[{"given":"Fatih","family":"Ayd\u0131n","sequence":"first","affiliation":[{"name":"Department of Electrical and Electronics Engineering, Karadeniz Technical University, 61080 Trabzon, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sefer","family":"Usta","sequence":"additional","affiliation":[{"name":"Ahi Evren Thoracic and Cardiovascular Surgery Training and Research Hospital, Trabzon University, 61335 Trabzon, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ezgi","family":"Kalayc\u0131o\u011flu","sequence":"additional","affiliation":[{"name":"Ahi Evren Thoracic and Cardiovascular Surgery Training and Research Hospital, Trabzon University, 61335 Trabzon, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1177-8518","authenticated-orcid":false,"given":"Onder","family":"Aydemir","sequence":"additional","affiliation":[{"name":"Department of Electrical and Electronics Engineering, Karadeniz Technical University, 61080 Trabzon, T\u00fcrkiye"},{"name":"METAM (Medical Device Design and Production Application and Research Center), Karadeniz Technical University, 61080 Trabzon, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,7,1]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"e618","DOI":"10.1161\/CIR.0000000000000617","article-title":"Fourth universal definition of myocardial infarction (2018)","volume":"138","author":"Thygesen","year":"2018","journal-title":"Circulation"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"3720","DOI":"10.1093\/eurheartj\/ehad191","article-title":"2023 ESC Guidelines for the management of acute coronary syndromes","volume":"44","author":"Byrne","year":"2023","journal-title":"Eur. 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