Artificial intelligence assessment for early detection of heart failure with preserved ejection fraction based on electrocardiographic features

AIMS: Although heart failure with preserved ejection fraction (HFpEF) is a rapidly emerging global health problem, an adequate tool to screen it reliably and economically does not exist. We developed an interpretable deep learning model (DLM) using electrocardiography (ECG) and validated its performance. METHODS AND RESULTS: This retrospective cohort study included two hospitals. 34 103 patients who underwent echocardiography and ECG within 1 week and indicated normal left ventricular systolic function were included in this study. A DLM based on an ensemble neural network was developed using 32 671 ECGs of 20 169 patients. The internal validation included 1979 ECGs of 1979 patients. Furthermore, we conducted an external validation with 11 955 ECGs of 11 955 patients from another hospital. The endpoint was to detect HFpEF. During the internal and external validation, the area under the receiver operating characteristic curves of a DLM using 12-lead ECG for detecting HFpEF were 0.866 (95% confidence interval 0.850–0.883) and 0.869 (0.860–0.877), respectively. In the 1412 individuals without HFpEF at initial echocardiography, patients whose DLM was defined as having a higher risk had a significantly higher chance of developing HFpEF than those in the low-risk group (33.6% vs. 8.4%, P < 0.001). Sensitivity map showed that the DLM focused on the QRS complex and T-wave. CONCLUSION: The DLM demonstrated high performance for HFpEF detection using not only a 12-lead ECG but also 6- single-lead ECG. These results suggest that HFpEF can be screened using conventional ECG devices and diverse life-type ECG machines employing the DLM, thereby preventing disease progression.