Artificial intelligence for detecting mitral regurgitation using electrocardiography

Background: Screening and early diagnosis of mitral regurgitation (MR) are crucial for preventing irreversible progression of MR. In this study, we developed and validated an artificial intelligence (AI) algorithm for detecting MR using electrocardiography (ECG). Methods: This retrospective cohort study included data from two hospital. An AI algorithm was trained using 56,670 ECGs from 24,202 patients. Internal validation of the algorithm was performed with 3174 ECGs of 3174 patients from one hospital, while external validation was performed with 10,865 ECGs of 10,865 patients from another hospital. The endpoint was the diagnosis of significant MR, moderate to severe, confirmed by echocardiography. We used 500 Hz ECG raw data as predictive variables. Additionally, we showed regions of ECG that have the most significant impact on the decision-making of the AI algorithm using a sensitivity map. Results: During the internal and external validation, the area under the receiver operating characteristic curve of the AI algorithm using a 12-lead ECG for detecting MR was 0.816 and 0.877, respectively, while that using a single-lead ECG was 0.758 and 0.850, respectively. In the 3157 non-MR individuals, those patients that the AI defined as high risk had a significantly higher chance of development of MR than the low risk group (13.9% vs. 2.6%, p < 0.001) during the follow-up period. The sensitivity map showed the AI algorithm focused on the P-wave and T-wave for MR patients and QRS complex for non-MR patients. Conclusions: The proposed AI algorithm demonstrated promising results for MR detecting using 12-lead and single-lead ECGs.