Cited by 38ECG Monitoring and AnalysisPulmonary Hypertension Research and TreatmentsArtificial Intelligence in Healthcare

An electrocardiogram-based AI algorithm for early detection of pulmonary hypertension

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DuBrock, Hilary M., Wagner, Tyler E., Carlson, Katherine, Carpenter, Corinne L., Awasthi, Samir, Attia, Zachi I., Frantz, Robert P., Friedman, Paul A. +16 more·2024·European Respiratory Journal

Abstract

Background: Early diagnosis of pulmonary hypertension (PH) is critical for effective treatment and management. We aimed to develop and externally validate an artificial intelligence algorithm that could serve as a PH screening tool, based on analysis of a standard 12-lead ECG. Methods: The PH Early Detection Algorithm (PH-EDA) is a convolutional neural network developed using retrospective ECG voltage–time data, with patients classified as “PH-likely” or “PH-unlikely” (controls) based on right heart catheterisation or echocardiography. In total, 39 823 PH-likely patients and 219 404 control patients from Mayo Clinic were randomly split into training (48%), validation (12%) and test (40%) sets. ECGs taken within 1 month of PH diagnosis (diagnostic dataset) were used to train the PH-EDA at Mayo Clinic. Performance was tested on diagnostic ECGs within the test sets from Mayo Clinic (n=16 175/87 998 PH-likely/controls) and Vanderbilt University Medical Center (VUMC; n=6045/24 256 PH-likely/controls). In addition, performance was tested on ECGs taken 6–18 months (pre-emptive dataset), and up to 5 years prior to a PH diagnosis at both sites. Results: Performance testing yielded an area under the receiver operating characteristic curve (AUC) of 0.92 and 0.88 in the diagnostic test sets at Mayo Clinic and VUMC, respectively, and 0.86 and 0.81, respectively, in the pre-emptive test sets. The AUC remained a minimum of 0.79 at Mayo Clinic and 0.73 at VUMC up to 5 years before diagnosis. Conclusion: The PH-EDA can detect PH at diagnosis and 6–18 months prior, demonstrating the potential to accelerate diagnosis and management of this debilitating disease.

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Crossref · 10.1183/13993003.00192-2024

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  • Hypertrophic cardiomyopathy, cardiac amyloidosis, and pulmonary hypertension AI-ECG applications remain earlier or pathway-incomplete.

    “hypertrophic cardiomyopathy, cardiac amyloidosis, and pulmonary hypertension remain earlier or pathway-incomplete applications.”

    From AI-ECG for Echocardiography Triage in Structural Heart Disease: Evidence, Implementation, and Future Directions (2026) · cites this paper as [32]

    The Methods describe the pulmonary-hypertension AI-ECG algorithm as investigational, and the Discussion says future studies will assess outcomes for patients it identifies. That supports describing the pulmonary-hypertension application as early or pathway-incomplete. The paper does not establish the same status for hypertrophic cardiomyopathy or cardiac amyloidosis; its Introduction and References mention prior hypertrophic-cardiomyopathy work but do not make that assessment (no page numbers provided). (LLM, conf=0.86)

    Experimental — accuracy not yet measured
  • Evidence for AI-ECG detection of pulmonary hypertension and right ventricular dysfunction remains comparatively early and predominantly retrospective, although reported discrimination has been encouraging with AUROCs of approximately 0.86-0.92 across internal and external validation cohorts.

    “Evidence for AI-ECG detection of PH and right ventricular dysfunction remains comparatively early. Published studies are still predominantly retrospective, although reported discrimination has been encouraging, with AUROCs of approximately 0.86–0.92 across internal and external validation cohorts.31–33”

    From AI-ECG for Echocardiography Triage in Structural Heart Disease: Evidence, Implementation, and Future Directions (2026) · cites this paper as [32]

    Split into 2 atoms — 1 confirmed, 1 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.

    Experimental — accuracy not yet measured
  • Earlier identification of PH may allow more timely echocardiography, specialist referral, and confirmatory hemodynamic testing when appropriate.

    “This finding is clinically important because delayed recognition of PH is common, and earlier identification may allow more timely echocardiography, specialist referral, and confirmatory hemodynamic testing when appropriate [37].”

    From Deep Learning Applied to 12-Lead ECGs for Detection of Structural, Metabolic and Systemic Disease (2026) · cites this paper as [37]

    The Discussion (page unavailable) says earlier suspicion of PH could prompt echocardiography and further diagnostic evaluation, potentially accelerating diagnosis. The Introduction (page unavailable) identifies right-heart catheterisation as the definitive diagnostic test. The paper does not specifically discuss specialist referral, so that part of the attributed pathway is unsupported. (LLM, conf=0.84)

    Experimental — accuracy not yet measured
  • PH-EDA achieved strong discrimination at the time of PH diagnosis.

    “PH-EDA achieved strong discrimination at the time of PH diagnosis and also demonstrated predictive ability when applied to ECGs obtained months to years before clinical diagnosis.”
  • PH-EDA demonstrated predictive ability when applied to ECGs obtained months to years before clinical diagnosis.

    “PH-EDA achieved strong discrimination at the time of PH diagnosis and also demonstrated predictive ability when applied to ECGs obtained months to years before clinical diagnosis.”

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Authors
DuBrock, H. M., Wagner, T. E., Carlson, K., Carpenter, C. L., Awasthi, S., Attia, Z. I., Frantz, R. P., Friedman, P. A., Kapa, S., Annis, J., Brittain, E. L., Hemnes, A. R., Asirvatham, S. J., Babu, M., Prasad, A., Yoo, U., Barve, R., Selej, M., Agron, P., Kogan, E., Quinn, D., Dunnmon, P., Khan, N., & Soundararajan, V.
Affiliations
  • Mayo Clinic (US)
  • Nference (United States) (US)
  • Vanderbilt University (US)
  • Vanderbilt University Medical Center (US)
  • Nference (India) (IN)
  • Janssen Research & Development (United States) (US)
Corresponding author
DuBrock, Hilary M.
Venue
European Respiratory Journal
Published
2024-06-27
Volume
64
Issue
1
Pages
2400192
ISSN
  • 0903-1936 (ISSN-L)
  • 1399-3003
OpenAlex
W4400083696
Cited by
38
References
36
Citations by year
2026: 18 · 2025: 17 · 2024: 3
FWCI
11.38
Type
journal article
Language
en
Open access
Locations
  • European Respiratory Journal (publishedVersion, cc-by-nc)
  • PubMed Central (publishedVersion, cc-by-nc)
  • PubMed (publishedVersion)
Funders
  • nference, Inc
  • Janssen Research and Development
Topics
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › ECG Monitoring and Analysis
  • Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Pulmonary Hypertension Research and Treatments
  • Health Sciences › Health Professions › Health Information Management › Artificial Intelligence in Healthcare
Keywords
pulmonary hypertension, early detection, electrocardiogram, artificial intelligence, convolutional neural networks, right heart catheterization, echocardiography, external validation
MeSH terms
Adult, Aged, Algorithms, Artificial Intelligence, Echocardiography, Electrocardiography, Female, Cardiac Catheterization, Humans, Hypertension, Pulmonary, Male, Middle Aged, Retrospective Studies, ROC Curve, Neural Networks, Computer, Early Diagnosis

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