Evidence mapPaperPMID 41406930Full record

ArticleJACC. Advances2026

Artificial Intelligence-Enabled ECG for Diastolic Dysfunction in Congenital Heart Disease: A Novel Risk Stratification Tool.

Donnchadh O'Sullivan, Malini Madhavan, Sahar Samimi, Scott Anjewierdan, William R Miranda, Zachi I Attia, Heidi M Connolly, Katia Bravo-Jaimes, C Charles Jain, Paul A Friedman and 4 more

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Article in JACC. Advances, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

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5 · Who and what money

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14 authors.

Donnchadh O'SullivanDepartment of Pediatric Cardiology, Texas Children's Hospital, Houston, Texas, USA; Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA; Baylor College of Medicine, Houston, Texas, USA.
Malini MadhavanDepartment of Pediatric Cardiology, Texas Children's Hospital, Houston, Texas, USA.
Sahar SamimiBaylor College of Medicine, Houston, Texas, USA.
Scott AnjewierdanDepartment of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA.
William R MirandaDepartment of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA.
Zachi I AttiaDepartment of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA.
Heidi M ConnollyDepartment of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA.
Katia Bravo-JaimesDepartment of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA.
C Charles JainDepartment of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA.
Paul A FriedmanDepartment of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA.
C Alexander EgbeDepartment of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA.
Francisco Lopez-JimenezDepartment of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA.
Jae K OhDepartment of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA.
Luke J BurchillDepartment of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA. Electronic address: Burchill.luke@mayo.edu.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundEchocardiography-based assessment of diastolic function in adult congenital heart disease (ACHD) is challenging owing to complex anatomy and heterogenous physiology.

objectivesThe objectives of the study was to evaluate an artificial intelligence (AI)-enabled electrocardiogram (ECG) (AI-ECG) model for grading diastolic dysfunction in patients with ACHD and assess its correlation with echocardiographic, invasive hemodynamic, and clinical outcomes.

methodsIn this single-center retrospective study, we analyzed 6,741 patients from the Mayo Clinic ACHD Registry (median age 37 years, 49% female) followed from 2000 to 2023. The median follow-up was 10 (5-15) years. Using a validated deep neural network (trained on 98,736 ECG-echocardiogram pairs), we assigned an AI-ECG diastolic grade (0-3) to the earliest ECG within 12 months of the index visit. We evaluated associations with echocardiography, hemodynamics, and mortality using nonparametric tests, correlation, Kaplan-Meier curves, Cox regression, and model performance for detecting elevated pulmonary artery wedge pressure (PAWP).

resultsThe AI-ECG classified diastolic function as grade 0 in 65.8%, grade 1 in 4.0%, grade 2 in 19.7%, and grade 3 in 10.5%. Higher grades were associated with older age, greater CHD complexity, and more comorbidities including heart failure (6.7% vs 24.8%), diabetes, and cirrhosis (all P < 0.001). N-terminal pro-B-type natriuretic peptide rose with each grade (129 [60-304] to 763 [311-1,915] pg/mL; P < 0.001). AI-ECG pressure estimates correlated with left atrial strain (ρ = -0.52) and right ventricular strain (ρ = -0.50). Invasive hemodynamics followed similar patterns; right atrial pressure rose from 8 (6-11) to 13 (10-18) mm Hg, and wedge pressure from 11 (8-14) to 16 (12-21) mm Hg (P < 0.001). Survival differed by grade (log-rank P < 0.0001); grades 2 and 3 independently predicted mortality (HR: 1.38; 95% CI: 1.09-1.75; HR: 1.63; 95% CI: 1.27-2.08). The model discriminated pulmonary artery wedge pressure ≥20 mm Hg with an area under the receiver operating characteristic curve of 0.74 (95% CI: 0.70-0.78).

conclusionsAI-ECG diastolic grading correlates with echocardiographic and invasive measures of cardiac filling pressures and independently predicts mortality in ACHD. These findings support its utility as a scalable, noninvasive risk stratification tool.

Indexed as

adult congenital heart diseaseartificial intelligencediastolic dysfunctioninvasive hemodynamics

Identifiers

PMID41406930
PMCPMC12869886

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.