Artificial intelligence enabled ECG screening for left ventricular systolic dysfunction: a systematic review
Open accessAbstract
Screening for left ventricular systolic dysfunction (LVSD), defined as reduced left ventricular ejection fraction (LVEF), deserves renewed interest as the medical treatment for the prevention and progression of heart failure improves. We aimed to review the updated literature to outline the potential and caveats of using artificial intelligence-enabled electrocardiography (AIeECG) as an opportunistic screening tool for LVSD.We searched PubMed and Cochrane for variations of the terms "ECG," "Heart Failure," "systolic dysfunction," and "Artificial Intelligence" from January 2010 to April 2022 and selected studies that reported the diagnostic accuracy and confounders of using AIeECG to detect LVSD.Out of 40 articles, we identified 15 relevant studies; eleven retrospective cohorts, three prospective cohorts, and one case series. Although various LVEF thresholds were used, AIeECG detected LVSD with a median AUC of 0.90 (IQR from 0.85 to 0.95), a sensitivity of 83.3% (IQR from 73 to 86.9%) and a specificity of 87% (IQR from 84.5 to 90.9%). AIeECG algorithms succeeded across a wide range of sex, age, and comorbidity and seemed especially useful in non-cardiology settings and when combined with natriuretic peptide testing. Furthermore, a false-positive AIeECG indicated a future development of LVSD. No studies investigated the effect on treatment or patient outcomes.This systematic review corroborates the arrival of a new generic biomarker, AIeECG, to improve the detection of LVSD. AIeECG, in addition to natriuretic peptides and echocardiograms, will improve screening for LVSD, but prospective randomized implementation trials with added therapy are needed to show cost-effectiveness and clinical significance.
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Previously, applications of artificial intelligence for electrocardiograms have shown potential to detect signatures of structural heart diseases.
“Previously applications of artificial intelligence for electrocardiograms (AI-ECG) have shown potential to detect signatures of SHDs.10-18”
From Ensemble Deep Learning Algorithm for Structural Heart Disease Screening Using Electrocardiographic Images (2025) · cites this paper as [13]
Prior studies have reported the use of deep learning on 12-lead ECGs to detect individual structural cardiovascular conditions, including LVSD, hypertrophic cardiomyopathy, cardiac amyloidosis, and aortic stenosis.
“Prior studies have reported the use of deep learning on 12-lead ECGs to detect individual structural cardiovascular conditions, including LVSD,10,11,13 hypertrophic cardiomyopathy,16,32,33 cardiac amyloidosis,34,35 aortic stenosis,12 among others.15,35-37”
From Ensemble Deep Learning Algorithm for Structural Heart Disease Screening Using Electrocardiographic Images (2025) · cites this paper as [13]
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- Authors
- Bjerkén, L. V., Rønborg, S. N., Jensen, M. T., Ørting, S. N., & Nielsen, O. W.
- Affiliations
- University of Copenhagen (DK)
- Bispebjerg Hospital (DK)
- Corresponding author
- Bjerkén, Laura Vindeløv
- ORCID
- Venue
- Heart Failure Reviews
- Published
- 2022-11-08
- Volume
- 28
- Issue
- 2
- Pages
- 419-430
- ISSN
- 1382-4147 (ISSN-L)
- 1573-7322
- PMC
- PMC9640840
- OpenAlex
- W4308590003
- Cited by
- 50
- References
- 36
- Citations by year
- 2026: 19 · 2025: 16 · 2024: 9 · 2023: 6
- FWCI
- 1.58
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- Heart Failure Reviews (publishedVersion, other-oa)
- PubMed Central (publishedVersion)
- Research at the University of Copenhagen (University of Copenhagen) (publishedVersion, other-oa)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › ECG Monitoring and Analysis
- Health Sciences › Health Professions › Health Information Management › Artificial Intelligence in Healthcare
- Health Sciences › Medicine › Health Informatics › Artificial Intelligence in Healthcare and Education
- Keywords
- left ventricular systolic dysfunction, heart failure screening, left ventricular ejection fraction, diagnostic accuracy, natriuretic peptides, opportunistic screening
- MeSH terms
- Electrocardiography, Heart Failure, Humans, Intelligence, Prospective Studies, Retrospective Studies, Stroke Volume, Ventricular Function, Left, Ventricular Dysfunction, Left
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