Correlation between artificial intelligence-enabled electrocardiogram and echocardiographic features in aortic stenosis

AIMS: An artificial intelligence-enabled electrocardiogram (AI-ECG) is a promising tool to detect patients with aortic stenosis (AS) before developing symptoms. However, functional, structural, or haemodynamic components reflected in AI-ECG responsible for its detection are unknown. METHODS AND RESULTS: The AI-ECG model that was developed at Mayo Clinic using a convolutional neural network to identify patients with moderate–severe AS was applied. In patients used as the testing group, the correlation between the AI-ECG probability of AS and echocardiographic parameters was investigated. This study included 102 926 patients (63.0 ± 16.3 years, 52% male), and 28 464 (27.7%) were identified as AS positive by AI-ECG. Older age, atrial fibrillation, hypertension, diabetes, coronary artery disease, and heart failure were more common in the positive AI-ECG group than in the negative group (P < 0.001). The AI-ECG was correlated with aortic valve area (ρ = −0.48, R(2) = 0.20), peak velocity (ρ = 0.22, R(2) = 0.08), and mean pressure gradient (ρ = 0.35, R(2) = 0.08). The AI-ECG also correlated with left ventricular (LV) mass index (ρ = 0.36, R(2) = 0.13), E/e′ (ρ = 0.36, R(2) = 0.12), and left atrium volume index (ρ = 0.42, R(2) = 0.12). Neither LV ejection fraction nor stroke volume index had a significant correlation with the AI-ECG. Age correlated with the AI-ECG (ρ = 0.46, R(2) = 0.22) and its correlation with echocardiography parameters was similar to that of the AI-ECG. CONCLUSION: A combination of AS severity, diastolic dysfunction, and LV hypertrophy is reflected in the AI-ECG to detect AS. There seems to be a gradation of the cardiac anatomical/functional features in the model and its identification process of AS is multifactorial.