Left ventricular systolic dysfunction predicted by artificial intelligence using the electrocardiogram in Chagas disease patients–The SaMi-Trop cohort

Left ventricular systolic dysfunction (LVSD) in Chagas disease (ChD) is relatively common and its treatment using low-cost drugs can improve symptoms and reduce mortality. Recently, an artificial intelligence (AI)-enabled ECG algorithm showed excellent accuracy to detect LVSD in a general population...

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Published inPLoS neglected tropical diseases Vol. 15; no. 12; p. e0009974
Main Authors Brito, Bruno Oliveira de Figueiredo, Attia, Zachi I., Martins, Larissa Natany A., Perel, Pablo, Nunes, Maria Carmo P., Sabino, Ester Cerdeira, Cardoso, Clareci Silva, Ferreira, Ariela Mota, Gomes, Paulo R., Luiz Pinho Ribeiro, Antonio, Lopez-Jimenez, Francisco
Format Journal Article
LanguageEnglish
Published United States Public Library of Science 01.12.2021
Public Library of Science (PLoS)
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Online AccessGet full text
ISSN1935-2735
1935-2727
1935-2735
DOI10.1371/journal.pntd.0009974

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Abstract Left ventricular systolic dysfunction (LVSD) in Chagas disease (ChD) is relatively common and its treatment using low-cost drugs can improve symptoms and reduce mortality. Recently, an artificial intelligence (AI)-enabled ECG algorithm showed excellent accuracy to detect LVSD in a general population, but its accuracy in ChD has not been tested. To analyze the ability of AI to recognize LVSD in patients with ChD, defined as a left ventricular ejection fraction determined by the Echocardiogram ≤ 40%. This is a cross-sectional study of ECG obtained from a large cohort of patients with ChD named São Paulo-Minas Gerais Tropical Medicine Research Center (SaMi-Trop) Study. The digital ECGs of the participants were submitted to the analysis of the trained machine to detect LVSD. The diagnostic performance of the AI-enabled ECG to detect LVSD was tested using an echocardiogram as the gold standard to detect LVSD, defined as an ejection fraction <40%. The model was enriched with NT-proBNP plasma levels, male sex, and QRS ≥ 120ms. Among the 1,304 participants of this study, 67% were women, median age of 60; there were 93 (7.1%) individuals with LVSD. Most patients had major ECG abnormalities (59.5%). The AI algorithm identified LVSD among ChD patients with an odds ratio of 63.3 (95% CI 32.3-128.9), a sensitivity of 73%, a specificity of 83%, an overall accuracy of 83%, and a negative predictive value of 97%; the AUC was 0.839. The model adjusted for the male sex and QRS ≥ 120ms improved the AUC to 0.859. The model adjusted for the male sex and elevated NT-proBNP had a higher accuracy of 0.89 and an AUC of 0.874. The AI analysis of the ECG of Chagas disease patients can be transformed into a powerful tool for the recognition of LVSD.
AbstractList Background Left ventricular systolic dysfunction (LVSD) in Chagas disease (ChD) is relatively common and its treatment using low-cost drugs can improve symptoms and reduce mortality. Recently, an artificial intelligence (AI)-enabled ECG algorithm showed excellent accuracy to detect LVSD in a general population, but its accuracy in ChD has not been tested. Objective To analyze the ability of AI to recognize LVSD in patients with ChD, defined as a left ventricular ejection fraction determined by the Echocardiogram [less than or equal to] 40%. Methodology/principal findings This is a cross-sectional study of ECG obtained from a large cohort of patients with ChD named São Paulo-Minas Gerais Tropical Medicine Research Center (SaMi-Trop) Study. The digital ECGs of the participants were submitted to the analysis of the trained machine to detect LVSD. The diagnostic performance of the AI-enabled ECG to detect LVSD was tested using an echocardiogram as the gold standard to detect LVSD, defined as an ejection fraction <40%. The model was enriched with NT-proBNP plasma levels, male sex, and QRS [greater than or equal to] 120ms. Among the 1,304 participants of this study, 67% were women, median age of 60; there were 93 (7.1%) individuals with LVSD. Most patients had major ECG abnormalities (59.5%). The AI algorithm identified LVSD among ChD patients with an odds ratio of 63.3 (95% CI 32.3-128.9), a sensitivity of 73%, a specificity of 83%, an overall accuracy of 83%, and a negative predictive value of 97%; the AUC was 0.839. The model adjusted for the male sex and QRS [greater than or equal to] 120ms improved the AUC to 0.859. The model adjusted for the male sex and elevated NT-proBNP had a higher accuracy of 0.89 and an AUC of 0.874. Conclusion The AI analysis of the ECG of Chagas disease patients can be transformed into a powerful tool for the recognition of LVSD.
Background Left ventricular systolic dysfunction (LVSD) in Chagas disease (ChD) is relatively common and its treatment using low-cost drugs can improve symptoms and reduce mortality. Recently, an artificial intelligence (AI)-enabled ECG algorithm showed excellent accuracy to detect LVSD in a general population, but its accuracy in ChD has not been tested. Objective To analyze the ability of AI to recognize LVSD in patients with ChD, defined as a left ventricular ejection fraction determined by the Echocardiogram ≤ 40%. Methodology/principal findings This is a cross-sectional study of ECG obtained from a large cohort of patients with ChD named São Paulo-Minas Gerais Tropical Medicine Research Center (SaMi-Trop) Study. The digital ECGs of the participants were submitted to the analysis of the trained machine to detect LVSD. The diagnostic performance of the AI-enabled ECG to detect LVSD was tested using an echocardiogram as the gold standard to detect LVSD, defined as an ejection fraction <40%. The model was enriched with NT-proBNP plasma levels, male sex, and QRS ≥ 120ms. Among the 1,304 participants of this study, 67% were women, median age of 60; there were 93 (7.1%) individuals with LVSD. Most patients had major ECG abnormalities (59.5%). The AI algorithm identified LVSD among ChD patients with an odds ratio of 63.3 (95% CI 32.3–128.9), a sensitivity of 73%, a specificity of 83%, an overall accuracy of 83%, and a negative predictive value of 97%; the AUC was 0.839. The model adjusted for the male sex and QRS ≥ 120ms improved the AUC to 0.859. The model adjusted for the male sex and elevated NT-proBNP had a higher accuracy of 0.89 and an AUC of 0.874. Conclusion The AI analysis of the ECG of Chagas disease patients can be transformed into a powerful tool for the recognition of LVSD.
Left ventricular systolic dysfunction (LVSD) in Chagas disease (ChD) is relatively common and its treatment using low-cost drugs can improve symptoms and reduce mortality. Recently, an artificial intelligence (AI)-enabled ECG algorithm showed excellent accuracy to detect LVSD in a general population, but its accuracy in ChD has not been tested.BACKGROUNDLeft ventricular systolic dysfunction (LVSD) in Chagas disease (ChD) is relatively common and its treatment using low-cost drugs can improve symptoms and reduce mortality. Recently, an artificial intelligence (AI)-enabled ECG algorithm showed excellent accuracy to detect LVSD in a general population, but its accuracy in ChD has not been tested.To analyze the ability of AI to recognize LVSD in patients with ChD, defined as a left ventricular ejection fraction determined by the Echocardiogram ≤ 40%.OBJECTIVETo analyze the ability of AI to recognize LVSD in patients with ChD, defined as a left ventricular ejection fraction determined by the Echocardiogram ≤ 40%.This is a cross-sectional study of ECG obtained from a large cohort of patients with ChD named São Paulo-Minas Gerais Tropical Medicine Research Center (SaMi-Trop) Study. The digital ECGs of the participants were submitted to the analysis of the trained machine to detect LVSD. The diagnostic performance of the AI-enabled ECG to detect LVSD was tested using an echocardiogram as the gold standard to detect LVSD, defined as an ejection fraction <40%. The model was enriched with NT-proBNP plasma levels, male sex, and QRS ≥ 120ms. Among the 1,304 participants of this study, 67% were women, median age of 60; there were 93 (7.1%) individuals with LVSD. Most patients had major ECG abnormalities (59.5%). The AI algorithm identified LVSD among ChD patients with an odds ratio of 63.3 (95% CI 32.3-128.9), a sensitivity of 73%, a specificity of 83%, an overall accuracy of 83%, and a negative predictive value of 97%; the AUC was 0.839. The model adjusted for the male sex and QRS ≥ 120ms improved the AUC to 0.859. The model adjusted for the male sex and elevated NT-proBNP had a higher accuracy of 0.89 and an AUC of 0.874.METHODOLOGY/PRINCIPAL FINDINGSThis is a cross-sectional study of ECG obtained from a large cohort of patients with ChD named São Paulo-Minas Gerais Tropical Medicine Research Center (SaMi-Trop) Study. The digital ECGs of the participants were submitted to the analysis of the trained machine to detect LVSD. The diagnostic performance of the AI-enabled ECG to detect LVSD was tested using an echocardiogram as the gold standard to detect LVSD, defined as an ejection fraction <40%. The model was enriched with NT-proBNP plasma levels, male sex, and QRS ≥ 120ms. Among the 1,304 participants of this study, 67% were women, median age of 60; there were 93 (7.1%) individuals with LVSD. Most patients had major ECG abnormalities (59.5%). The AI algorithm identified LVSD among ChD patients with an odds ratio of 63.3 (95% CI 32.3-128.9), a sensitivity of 73%, a specificity of 83%, an overall accuracy of 83%, and a negative predictive value of 97%; the AUC was 0.839. The model adjusted for the male sex and QRS ≥ 120ms improved the AUC to 0.859. The model adjusted for the male sex and elevated NT-proBNP had a higher accuracy of 0.89 and an AUC of 0.874.The AI analysis of the ECG of Chagas disease patients can be transformed into a powerful tool for the recognition of LVSD.CONCLUSIONThe AI analysis of the ECG of Chagas disease patients can be transformed into a powerful tool for the recognition of LVSD.
BackgroundLeft ventricular systolic dysfunction (LVSD) in Chagas disease (ChD) is relatively common and its treatment using low-cost drugs can improve symptoms and reduce mortality. Recently, an artificial intelligence (AI)-enabled ECG algorithm showed excellent accuracy to detect LVSD in a general population, but its accuracy in ChD has not been tested.ObjectiveTo analyze the ability of AI to recognize LVSD in patients with ChD, defined as a left ventricular ejection fraction determined by the Echocardiogram ≤ 40%.Methodology/principal findingsThis is a cross-sectional study of ECG obtained from a large cohort of patients with ChD named São Paulo-Minas Gerais Tropical Medicine Research Center (SaMi-Trop) Study. The digital ECGs of the participants were submitted to the analysis of the trained machine to detect LVSD. The diagnostic performance of the AI-enabled ECG to detect LVSD was tested using an echocardiogram as the gold standard to detect LVSD, defined as an ejection fraction <40%. The model was enriched with NT-proBNP plasma levels, male sex, and QRS ≥ 120ms. Among the 1,304 participants of this study, 67% were women, median age of 60; there were 93 (7.1%) individuals with LVSD. Most patients had major ECG abnormalities (59.5%). The AI algorithm identified LVSD among ChD patients with an odds ratio of 63.3 (95% CI 32.3-128.9), a sensitivity of 73%, a specificity of 83%, an overall accuracy of 83%, and a negative predictive value of 97%; the AUC was 0.839. The model adjusted for the male sex and QRS ≥ 120ms improved the AUC to 0.859. The model adjusted for the male sex and elevated NT-proBNP had a higher accuracy of 0.89 and an AUC of 0.874.ConclusionThe AI analysis of the ECG of Chagas disease patients can be transformed into a powerful tool for the recognition of LVSD.
Background Left ventricular systolic dysfunction (LVSD) in Chagas disease (ChD) is relatively common and its treatment using low-cost drugs can improve symptoms and reduce mortality. Recently, an artificial intelligence (AI)-enabled ECG algorithm showed excellent accuracy to detect LVSD in a general population, but its accuracy in ChD has not been tested. Objective To analyze the ability of AI to recognize LVSD in patients with ChD, defined as a left ventricular ejection fraction determined by the Echocardiogram ≤ 40%. Methodology/principal findings This is a cross-sectional study of ECG obtained from a large cohort of patients with ChD named São Paulo-Minas Gerais Tropical Medicine Research Center (SaMi-Trop) Study. The digital ECGs of the participants were submitted to the analysis of the trained machine to detect LVSD. The diagnostic performance of the AI-enabled ECG to detect LVSD was tested using an echocardiogram as the gold standard to detect LVSD, defined as an ejection fraction <40%. The model was enriched with NT-proBNP plasma levels, male sex, and QRS ≥ 120ms. Among the 1,304 participants of this study, 67% were women, median age of 60; there were 93 (7.1%) individuals with LVSD. Most patients had major ECG abnormalities (59.5%). The AI algorithm identified LVSD among ChD patients with an odds ratio of 63.3 (95% CI 32.3–128.9), a sensitivity of 73%, a specificity of 83%, an overall accuracy of 83%, and a negative predictive value of 97%; the AUC was 0.839. The model adjusted for the male sex and QRS ≥ 120ms improved the AUC to 0.859. The model adjusted for the male sex and elevated NT-proBNP had a higher accuracy of 0.89 and an AUC of 0.874. Conclusion The AI analysis of the ECG of Chagas disease patients can be transformed into a powerful tool for the recognition of LVSD.
Left ventricular systolic dysfunction (LVSD) in Chagas disease (ChD) is relatively common and its treatment using low-cost drugs can improve symptoms and reduce mortality. Recently, an artificial intelligence (AI)-enabled ECG algorithm showed excellent accuracy to detect LVSD in a general population, but its accuracy in ChD has not been tested. To analyze the ability of AI to recognize LVSD in patients with ChD, defined as a left ventricular ejection fraction determined by the Echocardiogram [less than or equal to] 40%. This is a cross-sectional study of ECG obtained from a large cohort of patients with ChD named São Paulo-Minas Gerais Tropical Medicine Research Center (SaMi-Trop) Study. The digital ECGs of the participants were submitted to the analysis of the trained machine to detect LVSD. The diagnostic performance of the AI-enabled ECG to detect LVSD was tested using an echocardiogram as the gold standard to detect LVSD, defined as an ejection fraction <40%. The model was enriched with NT-proBNP plasma levels, male sex, and QRS [greater than or equal to] 120ms. The AI analysis of the ECG of Chagas disease patients can be transformed into a powerful tool for the recognition of LVSD.
Left ventricular systolic dysfunction (LVSD) in Chagas disease (ChD) is relatively common and its treatment using low-cost drugs can improve symptoms and reduce mortality. Recently, an artificial intelligence (AI)-enabled ECG algorithm showed excellent accuracy to detect LVSD in a general population, but its accuracy in ChD has not been tested. To analyze the ability of AI to recognize LVSD in patients with ChD, defined as a left ventricular ejection fraction determined by the Echocardiogram ≤ 40%. This is a cross-sectional study of ECG obtained from a large cohort of patients with ChD named São Paulo-Minas Gerais Tropical Medicine Research Center (SaMi-Trop) Study. The digital ECGs of the participants were submitted to the analysis of the trained machine to detect LVSD. The diagnostic performance of the AI-enabled ECG to detect LVSD was tested using an echocardiogram as the gold standard to detect LVSD, defined as an ejection fraction <40%. The model was enriched with NT-proBNP plasma levels, male sex, and QRS ≥ 120ms. Among the 1,304 participants of this study, 67% were women, median age of 60; there were 93 (7.1%) individuals with LVSD. Most patients had major ECG abnormalities (59.5%). The AI algorithm identified LVSD among ChD patients with an odds ratio of 63.3 (95% CI 32.3-128.9), a sensitivity of 73%, a specificity of 83%, an overall accuracy of 83%, and a negative predictive value of 97%; the AUC was 0.839. The model adjusted for the male sex and QRS ≥ 120ms improved the AUC to 0.859. The model adjusted for the male sex and elevated NT-proBNP had a higher accuracy of 0.89 and an AUC of 0.874. The AI analysis of the ECG of Chagas disease patients can be transformed into a powerful tool for the recognition of LVSD.
Chagas disease (ChD) is caused by the protozoan parasite Trypanosoma cruzi and continues to be a health problem despite the control of its transmission. ChD is a heterogeneous condition with a wide variation in its clinical course and prognosis. The majority (60%–70%) of infected individuals remain asymptomatic throughout life. Although some develop only conduction defects and mild segmental wall motion abnormalities, others develop severe symptoms of heart failure (HF), thromboembolic phenomena, and life threatening ventricular arrhythmias. HF is one of major causes of the death of patients with ChD. There is some evidence on effective drugs against the parasite in the chronic form of the disease capable of preventing long-term adverse outcomes, but it is still limited. However low-cost medications are able to reduce mortality and improve the quality of life of patients with HF. Because of the lack of tertiary care facilities outside urban centers, an automatic diagnostic tool based on the ECG, which is a relatively simple exam without requiring human interpretation, would improve the capacity to recognize HF. Recently, digital signals of the electrocardiogram were recognized by Artificial Intelligence (AI) and associated with an excellent accuracy for HF in the general population. Our results demonstrate that AI-ECG could ensure a rapid recognition of HF in patients who require a referral to a cardiologist and the use of disease-modifying drugs. AI can be used as a powerful public heath tool, it can transform the lives of 6 million patients with ChD worldwide, and it may well have a formidable impact on patient management and prognosis.
Audience Academic
Author Attia, Zachi I.
Martins, Larissa Natany A.
Lopez-Jimenez, Francisco
Sabino, Ester Cerdeira
Luiz Pinho Ribeiro, Antonio
Brito, Bruno Oliveira de Figueiredo
Ferreira, Ariela Mota
Gomes, Paulo R.
Nunes, Maria Carmo P.
Perel, Pablo
Cardoso, Clareci Silva
AuthorAffiliation 6 Instituto de Medicina Tropical da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
4 Department of Statistics, Instituto de Ciência Exatas, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
7 Federal University of São João del-Rei, Divinópolis, Brazil
8 Graduate Program in Health Sciences, State University of Montes Claros, Montes Claros, Minas Gerais, Brazil
2 Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, United States of America
5 London School of Hygiene and Tropical Medicine, London, United Kingdom
Baylor College of Medicine, UNITED STATES
1 Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
3 Telehealth Center, Hospital das Clínicas, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
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BackLink https://www.ncbi.nlm.nih.gov/pubmed/34871321$$D View this record in MEDLINE/PubMed
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Copyright_xml – notice: COPYRIGHT 2021 Public Library of Science
– notice: 2021 Brito et al. This is an open access article distributed under the terms of the Creative Commons Attribution License: http://creativecommons.org/licenses/by/4.0/ (the “License”), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.
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DocumentTitleAlternate Artificial intelligence and the electrocardiogram of Chagas disease
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I have read the journal’s policy and some authors of this manuscript have the following competing interests: Mayo Clinic has licensed the underlying technology to EKO, a maker of digital stethoscopes with embedded ECG electrodes. Mayo Clinic may receive financial benefit from the use of this technology, but at no point will Mayo Clinic benefit financially from its use for the care of patients at Mayo Clinic. F.L.J. and Z.I.A. may also receive financial benefit from this agreement. There is a patent filing covering some of the technology described in this manuscript (USPO application WO2019070978A1).
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SSID ssj0059581
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Snippet Left ventricular systolic dysfunction (LVSD) in Chagas disease (ChD) is relatively common and its treatment using low-cost drugs can improve symptoms and...
Background Left ventricular systolic dysfunction (LVSD) in Chagas disease (ChD) is relatively common and its treatment using low-cost drugs can improve...
Chagas disease (ChD) is caused by the protozoan parasite Trypanosoma cruzi and continues to be a health problem despite the control of its transmission. ChD is...
BackgroundLeft ventricular systolic dysfunction (LVSD) in Chagas disease (ChD) is relatively common and its treatment using low-cost drugs can improve symptoms...
Background Left ventricular systolic dysfunction (LVSD) in Chagas disease (ChD) is relatively common and its treatment using low-cost drugs can improve...
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SubjectTerms Abnormalities
Accuracy
Aged
Algorithms
Artificial Intelligence
Brazil
Chagas disease
Chagas Disease - complications
Chagas Disease - physiopathology
Cohorts
Complications and side effects
Computer and Information Sciences
Cross-Sectional Studies
Diagnosis
Diseases
Echocardiography
Ejection fraction
EKG
Electrocardiogram
Electrocardiography
Electrocardiography - instrumentation
Electrocardiography - methods
Enzymes
Female
Health aspects
Heart
Heart diseases
Heart rate
Humans
Immunoassay
Left ventricular function
Male
Males
Malformations
Medical prognosis
Medical sciences
Medicine
Medicine and Health Sciences
Middle Aged
Patients
Physical Sciences
Plasma levels
Primary care
Public health
Questionnaires
Research and Analysis Methods
Research facilities
Risk factors
Sex
Signs and symptoms
Specificity
Stroke Volume
Symptoms
Telemedicine
Tropical climate
Tropical diseases
Variables
Vector-borne diseases
Ventricle
Ventricular Dysfunction, Left - diagnosis
Ventricular Dysfunction, Left - etiology
Ventricular Dysfunction, Left - physiopathology
Ventricular Function, Left
Women
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Title Left ventricular systolic dysfunction predicted by artificial intelligence using the electrocardiogram in Chagas disease patients–The SaMi-Trop cohort
URI https://www.ncbi.nlm.nih.gov/pubmed/34871321
https://www.proquest.com/docview/2620112898
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https://pubmed.ncbi.nlm.nih.gov/PMC8675930
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