Artificial intelligence electrocardiogram as a novel screening tool to detect a newly abnormal left ventricular ejection fraction after anthracycline-based cancer therapy
Open accessAbstract
Aims: Cardiotoxicity is a serious side effect of anthracycline treatment, most commonly manifesting as a reduction in left ventricular ejection fraction (EF). Early recognition and treatment have been advocated, but robust, convenient, and cost-effective alternatives to cardiac imaging are missing. Recent developments in artificial intelligence (AI) techniques applied to electrocardiograms (ECGs) may fill this gap, but no study so far has demonstrated its merit for the detection of an abnormal EF after anthracycline therapy. Methods and results: Single centre consecutive cohort study of all breast cancer patients with ECG and transthoracic echocardiography (TTE) evaluation before and after (neo)adjuvant anthracycline chemotherapy. Patients with HER2-directed therapy, metastatic disease, second primary malignancy, or pre-existing cardiovascular disease were excluded from the analyses as were patients with EF decline for reasons other than anthracycline-induced cardiotoxicity. Primary readout was the diagnostic performance of AI-ECG by area under the curve (AUC) for EFs < 50%. Of 989 consecutive female breast cancer patients, 22 developed a decline in EF attributed to anthracycline therapy over a follow-up time of 9.8 ± 4.2 years. After exclusion of patients who did not have ECGs within 90 days of a TTE, 20 cases and 683 controls remained. The AI-ECG model detected an EF < 50% and ≤ 35% after anthracycline therapy with an AUC of 0.93 and 0.94, respectively. Conclusion: These data support the use of AI-ECG for cardiotoxicity screening after anthracycline-based chemotherapy. This technology could serve as a gatekeeper to more costly cardiac imaging and could enable patients to monitor themselves over long periods of time.
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
In cardio-oncology, AI-ECG has shown promise for detecting newly abnormal LVEF after anthracycline therapy.
“in cardio-oncology, AI-ECG has shown promise for detecting newly abnormal LVEF after anthracycline therapy.18”
From AI-ECG for Echocardiography Triage in Structural Heart Disease: Evidence, Implementation, and Future Directions (2026) · cites this paper as [18]
Emerging evidence supports longitudinal risk tracking in aortic stenosis and surveillance for treatment-related left ventricular dysfunction in cardio-oncology.
“with emerging evidence supporting longitudinal risk tracking in aortic stenosis23 and surveillance for treatment-related left ventricular dysfunction in cardio-oncology.18”
From AI-ECG for Echocardiography Triage in Structural Heart Disease: Evidence, Implementation, and Future Directions (2026) · cites this paper as [18]
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
The self-check needs the paper’s full text.
Cites
No references could be resolved yet.
Research works printed but not linked: 21
- Herrmann J. Adverse cardiac effects of cancer therapies: cardiotoxicity and arrhythmia. Nat Rev Cardiol 2020;17:474-502.
- Sawicki KT, Sala V, Prever L, Hirsch E, Ardehali H, Ghigo A. Preventing and treating an- thracycline cardiotoxicity: new insights. Annu Rev Pharmacol Toxicol 2021;61:309-332.
- Narezkina A, Narayan HK, Zemljic-Harpf AE. Molecular mechanisms of anthracycline cardiovascular toxicity. Clin Sci (Lond 2021;135:1311-1332.
- Cardinale D, Iacopo F, Cipolla CM. Cardiotoxicity of anthracyclines. Front Cardiovasc Med 2020;7:26.
- Cardinale D, Sandri MT. Role of biomarkers in chemotherapy-induced cardiotoxicity. Prog Cardiovasc Dis 2010;53:121-129.
- Lyon AR, López-Fernández T, Couch LS, Asteggiano R, Aznar MC, Bergler-Klein J, et al. 2022 ESC guidelines on cardio-oncology developed in collaboration with the European Hematology Association (EHA), the European Society for Therapeutic Radiology and Oncology (ESTRO) and the International Cardio-Oncology Society (IC-OS). Eur Heart J 2022;43:4229-4361.
- Siontis KC, Noseworthy PA, Attia ZI, Friedman PA. Artificial intelligence-enhanced elec- trocardiography in cardiovascular disease management. Nat Rev Cardiol 2021;18: 465-478.
- Attia ZI, Harmon DM, Dugan J, Manka L, Lopez-Jimenez F, Lerman A, et al. Prospective evaluation of smartwatch-enabled detection of left ventricular dysfunction. Nat Med 2022;28:2497-2503.
- Vulsteke C, Pfeil AM, Maggen C, Schwenkglenks M, Pettengell R, Szucs TD, et al. Clinical and genetic risk factors for epirubicin-induced cardiac toxicity in early breast cancer pa- tients. Breast Cancer Res Treat 2015;152:67-76.
- Guglin M, Krischer J, Tamura R, Fink A, Bello-Matricaria L, McCaskill-Stevens W, et al. Randomized trial of lisinopril versus carvedilol to prevent trastuzumab cardiotoxicity in patients with breast cancer. J Am Coll Cardiol 2019;73:2859-2868.
- Attia ZI, Kapa S, Lopez-Jimenez F, McKie PM, Ladewig DJ, Satam G, et al. Screening for cardiac contractile dysfunction using an artificial intelligence-enabled electrocardiogram. Nat Med 2019;25:70-74.
- Herrmann J, Lenihan D, Armenian S, Barac A, Blaes A, Cardinale D, et al. Defining car- diovascular toxicities of cancer therapies: an International Cardio-Oncology Society (IC-OS) consensus statement. Eur Heart J 2022;43:280-299.
- Cardinale D, Colombo A, Bacchiani G, Tedeschi I, Meroni CA, Veglia F, et al. Early de- tection of anthracycline cardiotoxicity and improvement with heart failure therapy. Circulation 2015;131:1981-1988.
- Lyon AR, López-Fernández T, Couch LS, Asteggiano R, Aznar MC, Bergler-Klein J, et al. 2022 ESC guidelines on cardio-oncology developed in collaboration with the European Hematology Association (EHA), the European Society for Therapeutic Radiology and Oncology (ESTRO) and the International Cardio-Oncology Society (IC-OS). Eur Heart J Cardiovasc Imaging 2022;23:e333-e465.
- Zamorano JL, Lancellotti P, Rodriguez Muñoz D, Aboyans V, Asteggiano R, Galderisi M, et al. 2016 ESC position paper on cancer treatments and cardiovascular toxicity devel- oped under the auspices of the ESC Committee for Practice Guidelines: the task force for cancer treatments and cardiovascular toxicity of the European Society of Cardiology (ESC). Eur J Heart Fail 2017;19:9-42.
- Thavendiranathan P, Negishi T, Somerset E, Negishi K, Penicka M, Lemieux J, et al. Strain-guided management of potentially cardiotoxic cancer therapy. J Am Coll Cardiol 2021;77:392-401.
- Guerra F, Marchesini M, Contadini D, Menditto A, Morelli M, Piccolo E, et al. Speckle-tracking global longitudinal strain as an early predictor of cardiotoxicity in breast carcinoma. Support Care Cancer 2016;24:3139-3145.
- López-Sendón J, Álvarez-Ortega C, Zamora Auñon P, Buño Soto A, Lyon AR, Farmakis D, et al. Classification, prevalence, and outcomes of anticancer therapy-induced cardi- otoxicity: the CARDIOTOX registry. Eur Heart J 2020;41:1720-1729.
- Noseworthy PA, Attia ZI, Brewer LC, Hayes SN, Yao X, Kapa S, et al. Assessing and mitigating bias in medical artificial intelligence: the effects of race and ethnicity on a deep learning model for ECG analysis. Circ Arrhythm Electrophysiol 2020;13:e007988.
- Harmon DM, Carter RE, Cohen-Shelly M, Svatikova A, Adedinsewo DA, Noseworthy PA, et al. Real-world performance, long-term efficacy, and absence of bias in the artificial intelligence enhanced electrocardiogram to detect left ventricular systolic dysfunction. Eur Heart J Digit Health 2022;3:238-244.
- Lu X, Zhao Y, Chen C, Han C, Xue L, Xing D, et al. BNP as a marker for early prediction of anthracycline-induced cardiotoxicity in patients with breast cancer. Oncol Lett 2019; 18:4992-5001.
Cited by
Sorted by citations
Tang, Q., Deng, K., Cui, Y., Liu, H., & Qian, B. (2026) · International Journal of General Medicine · doi:10.2147/ijgm.s610298
- Authors
- Jacobs, J. E. J., Greason, G., Mangold, K. E., Wildiers, H., Willems, R., Janssens, S., Noseworthy, P., Lopez-Jimenez, F., Voigt, J.-U., Friedman, P., Van Aelst, L., Vandenberk, B., Attia, Z. I., & Herrmann, J.
- Affiliations
- Mayo Clinic (US)
- Universitair Ziekenhuis Leuven (BE)
- KU Leuven (BE)
- Department of Cardiovascular Medicine, Mayo Clinic , 200 First St. SW, Rochester, MN 55905 , USA
- Department of Cardiovascular Sciences, KU Leuven , Leuven , Belgium
- Corresponding author
- Herrmann, Joerg
- ORCID
- Venue
- European Journal of Preventive Cardiology
- Publisher
- Oxford University Press (OUP)
- Published
- 2023-11-07
- Volume
- 31
- Issue
- 5
- Pages
- 560-566
- ISSN
- 2047-4873 (ISSN-L)
- 2047-4881
- PMC
- PMC10972628
- OpenAlex
- W4388515883
- Cited by
- 49
- References
- 0
- Citations by year
- 2026: 19 · 2025: 21 · 2024: 8 · 2023: 1
- FWCI
- 9.64
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- European Journal of Preventive Cardiology (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Lirias (submittedVersion, other-oa)
- Funders
- Belgian American Education Foundation
- National Institutes of Health
- National Cancer Institute (R01CA233610)
- Miami Heart Research Institute
- Mayo Center for Biomedical Discovery
- Department of Cardiovascular Diseases
- Research Foundation Flanders
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Chemotherapy-induced cardiotoxicity and mitigation
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › ECG Monitoring and Analysis
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac pacing and defibrillation studies
- Keywords
- anthracycline cardiotoxicity, left ventricular ejection fraction, cardiotoxicity screening, breast cancer, anthracycline chemotherapy, transthoracic echocardiography, early detection of cardiac dysfunction
- MeSH terms
- Antibiotics, Antineoplastic, Artificial Intelligence, Breast Neoplasms, Electrocardiography, Female, Humans, Stroke Volume, Cohort Studies, Ventricular Function, Left, Anthracyclines, Early Detection of Cancer, Cardiotoxicity
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
