Heart age gap estimated by explainable advanced electrocardiography is associated with cardiovascular risk factors and survival
(2023) In European Heart Journal - Digital Health 4(5). p.384-392- Abstract
Aims: Deep neural network artificial intelligence (DNN-AI)-based Heart Age estimations have been presented and used to show that the difference between an electrocardiogram (ECG)-estimated Heart Age and chronological age is associated with prognosis. An accurate ECG Heart Age, without DNNs, has been developed using explainable advanced ECG (A-ECG) methods. We aimed to evaluate the prognostic value of the explainable A-ECG Heart Age and compare its performance to a DNN-AI Heart Age. Methods and results: Both A-ECG and DNN-AI Heart Age were applied to patients who had undergone clinical cardiovascular magnetic resonance imaging. The association between A-ECG or DNN-AI Heart Age Gap and cardiovascular risk factors was evaluated using... (More)
Aims: Deep neural network artificial intelligence (DNN-AI)-based Heart Age estimations have been presented and used to show that the difference between an electrocardiogram (ECG)-estimated Heart Age and chronological age is associated with prognosis. An accurate ECG Heart Age, without DNNs, has been developed using explainable advanced ECG (A-ECG) methods. We aimed to evaluate the prognostic value of the explainable A-ECG Heart Age and compare its performance to a DNN-AI Heart Age. Methods and results: Both A-ECG and DNN-AI Heart Age were applied to patients who had undergone clinical cardiovascular magnetic resonance imaging. The association between A-ECG or DNN-AI Heart Age Gap and cardiovascular risk factors was evaluated using logistic regression. The association between Heart Age Gaps and death or heart failure (HF) hospitalization was evaluated using Cox regression adjusted for clinical covariates/comorbidities. Among patients [n=731, 103 (14.1%) deaths, 52 (7.1%) HF hospitalizations, median (interquartile range) follow-up 5.7 (4.7-6.7) years], A-ECG Heart Age Gap was associated with risk factors and outcomes [unadjusted hazard ratio (HR) (95% confidence interval) (5 year increments): 1.23 (1.13-1.34) and adjusted HR 1.11 (1.01-1.22)]. DNN-AI Heart Age Gap was associated with risk factors and outcomes after adjustments [HR (5 year increments): 1.11 (1.01-1.21)], but not in unadjusted analyses [HR 1.00 (0.93-1.08)], making it less easily applicable in clinical practice. Conclusion: A-ECG Heart Age Gap is associated with cardiovascular risk factors and HF hospitalization or death. Explainable A-ECG Heart Age Gap has the potential for improving clinical adoption and prognostic performance compared with existing DNN-AI-type methods.
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- author
- Lindow, Thomas LU ; Maanja, Maren ; Schelbert, Erik B. ; Ribeiro, Antônio H. ; Ribeiro, Antonio Luiz P. ; Schlegel, Todd T. and Ugander, Martin LU
- organization
- publishing date
- 2023-10
- type
- Contribution to journal
- publication status
- published
- subject
- keywords
- Cardiovascular disease, Heart age, Risk prediction, Vascular age
- in
- European Heart Journal - Digital Health
- volume
- 4
- issue
- 5
- pages
- 9 pages
- publisher
- Oxford University Press
- external identifiers
-
- pmid:37794867
- scopus:85174504439
- ISSN
- 2634-3916
- DOI
- 10.1093/ehjdh/ztad045
- language
- English
- LU publication?
- yes
- id
- 89bc2188-f281-4898-9f7c-102b304296cc
- date added to LUP
- 2023-12-15 10:11:14
- date last changed
- 2024-04-14 02:03:47
@article{89bc2188-f281-4898-9f7c-102b304296cc,
abstract = {{<p>Aims: Deep neural network artificial intelligence (DNN-AI)-based Heart Age estimations have been presented and used to show that the difference between an electrocardiogram (ECG)-estimated Heart Age and chronological age is associated with prognosis. An accurate ECG Heart Age, without DNNs, has been developed using explainable advanced ECG (A-ECG) methods. We aimed to evaluate the prognostic value of the explainable A-ECG Heart Age and compare its performance to a DNN-AI Heart Age. Methods and results: Both A-ECG and DNN-AI Heart Age were applied to patients who had undergone clinical cardiovascular magnetic resonance imaging. The association between A-ECG or DNN-AI Heart Age Gap and cardiovascular risk factors was evaluated using logistic regression. The association between Heart Age Gaps and death or heart failure (HF) hospitalization was evaluated using Cox regression adjusted for clinical covariates/comorbidities. Among patients [n=731, 103 (14.1%) deaths, 52 (7.1%) HF hospitalizations, median (interquartile range) follow-up 5.7 (4.7-6.7) years], A-ECG Heart Age Gap was associated with risk factors and outcomes [unadjusted hazard ratio (HR) (95% confidence interval) (5 year increments): 1.23 (1.13-1.34) and adjusted HR 1.11 (1.01-1.22)]. DNN-AI Heart Age Gap was associated with risk factors and outcomes after adjustments [HR (5 year increments): 1.11 (1.01-1.21)], but not in unadjusted analyses [HR 1.00 (0.93-1.08)], making it less easily applicable in clinical practice. Conclusion: A-ECG Heart Age Gap is associated with cardiovascular risk factors and HF hospitalization or death. Explainable A-ECG Heart Age Gap has the potential for improving clinical adoption and prognostic performance compared with existing DNN-AI-type methods.</p>}},
author = {{Lindow, Thomas and Maanja, Maren and Schelbert, Erik B. and Ribeiro, Antônio H. and Ribeiro, Antonio Luiz P. and Schlegel, Todd T. and Ugander, Martin}},
issn = {{2634-3916}},
keywords = {{Cardiovascular disease; Heart age; Risk prediction; Vascular age}},
language = {{eng}},
number = {{5}},
pages = {{384--392}},
publisher = {{Oxford University Press}},
series = {{European Heart Journal - Digital Health}},
title = {{Heart age gap estimated by explainable advanced electrocardiography is associated with cardiovascular risk factors and survival}},
url = {{http://dx.doi.org/10.1093/ehjdh/ztad045}},
doi = {{10.1093/ehjdh/ztad045}},
volume = {{4}},
year = {{2023}},
}