{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"institution":[{"name":"medRxiv"}],"indexed":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T21:19:23Z","timestamp":1792790363518,"version":"4.5.0"},"posted":{"date-parts":[[2026,9,15]]},"group-title":"Cardiovascular Medicine","reference-count":37,"publisher":"openRxiv","license":[{"start":{"date-parts":[[2026,9,15]],"date-time":"2026-09-15T00:00:00Z","timestamp":1789430400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"funder":[{"award":["R01HL167858"],"award-info":[{"award-number":["R01HL167858"]}],"id":[{"id":"https:\/\/ror.org\/012pb6c26","id-type":"ROR","asserted-by":"publisher"}]},{"award":["K23HL153775"],"award-info":[{"award-number":["K23HL153775"]}],"id":[{"id":"https:\/\/ror.org\/012pb6c26","id-type":"ROR","asserted-by":"publisher"}]},{"name":"National Institute on Aging","award":["R01AG089981"],"award-info":[{"award-number":["R01AG089981"]}],"id":[{"id":"https:\/\/ror.org\/049v75w11","id-type":"ROR","asserted-by":"crossref"}]},{"award":["26CDA1612298"],"award-info":[{"award-number":["26CDA1612298"]}],"id":[{"id":"https:\/\/ror.org\/013kjyp64","id-type":"ROR","asserted-by":"publisher"}]},{"award":["P30AG021342"],"award-info":[{"award-number":["P30AG021342"]}],"id":[{"id":"https:\/\/ror.org\/03pnmqc26","id-type":"ROR","asserted-by":"publisher"}]},{"name":"National Center for Advancing Translational Sciences","award":["UL1 TR001863"],"award-info":[{"award-number":["UL1 TR001863"]}],"id":[{"id":"https:\/\/ror.org\/04pw6fb54","id-type":"ROR","asserted-by":"crossref"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"accepted":{"date-parts":[[2026,9,15]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                <jats:sec>\n                  <jats:title>Aims<\/jats:title>\n                  <jats:p>Structural heart disease (SHD) often remains undetected until symptoms develop. Portable 1-lead ECG devices return an automated rhythm-based interpretation, but whether AI-ECG adds diagnostic value beyond this interpretation is unknown. We prospectively evaluated a noise-adapted 1-lead AI-ECG algorithm for detecting severe SHD from portable KardiaMobile 6L recordings, and its relative diagnostic value beyond the device\u2019s rhythm interpretation.<\/jats:p>\n                <\/jats:sec>\n                <jats:sec>\n                  <jats:title>Methods and Results<\/jats:title>\n                  <jats:p>Adults undergoing outpatient echocardiography between June 2024 and January 2025 recorded a 30-second, 1-lead ECG with real-time AI-ECG inference. The primary endpoint was discrimination for echocardiography-defined severe SHD. Secondary analyses assessed net reclassification improvement (NRI) versus the native interpretation and the number needed to test (NNT). Among 597 participants (median age 61.7 years; 51.4% women), 30 (5.1%) had severe SHD. AI-ECG achieved an AUROC of 0.872 (95% CI: 0.806\u2013 0.938), meeting the prespecified endpoint, with 86.7% (70.3\u201394.7) sensitivity, 72.5% (68.7\u2013 76.0) specificity, 99.0% (97.5\u201399.6) negative predictive value, and 14.4% (10.1\u201320.3) positive predictive value, with comparable performance across subgroups. AI-ECG increased sensitivity by 34.6 percentage points (95% CI: 13.0\u201356.0) over the native interpretation and yielded a categorical NRI of 24.3% (95% CI: 2.8\u201345.9), with 76.9% sensitivity and 80.0% specificity among tracings the device read as normal. An AI-ECG-guided strategy for detecting severe SHD reduced the NNT from 19.7 to 6.9 (a 64.8% reduction).<\/jats:p>\n                <\/jats:sec>\n                <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>A noise-adapted AI-ECG algorithm detected severe SHD from real-world portable 1-lead ECGs and substantially improved case finding beyond the device\u2019s rhythm interpretation, supporting AI-ECG-guided triage as a potential scalable screening strategy.<\/jats:p>\n                <\/jats:sec>","DOI":"10.64898\/2026.09.14.26361683","type":"posted-content","created":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T00:55:22Z","timestamp":1789520122000},"source":"Crossref","is-referenced-by-count":0,"title":["Detection of Severe Structural Heart Disease Using an AI-Enhanced Portable 1-Lead ECG: The ACCESS-SHD 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