• Abdulah A Mahayni, Zachi I Attia, Jose R Medina-Inojosa, Mohamed F A Elsisy, Peter A Noseworthy, Francisco Lopez-Jimenez, Suraj Kapa, Samuel J Asirvatham, Paul A Friedman, Juan A Crestenallo, and Mohamad Alkhouli.
• Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN.
• Mayo Clin. Proc. 2021 Dec 1; 96 (12): 3062-3070.

ObjectiveTo assess whether an electrocardiography-based artificial intelligence (AI) algorithm developed to detect severe ventricular dysfunction (left ventricular ejection fraction [LVEF] of 35% or below) independently predicts long-term mortality after cardiac surgery among patients without severe ventricular dysfunction (LVEF>35%).MethodsPatients who underwent valve or coronary bypass surgery at Mayo Clinic (1993-2019) and had documented LVEF above 35% on baseline electrocardiography were included. We compared patients with an abnormal vs a normal AI-enhanced electrocardiogram (AI-ECG) screen for LVEF of 35% or below on preoperative electrocardiography. The primary end point was all-cause mortality.ResultsA total of 20,627 patients were included, of whom 17,125 (83.0%) had a normal AI-ECG screen and 3502 (17.0%) had an abnormal AI-ECG screen. Patients with an abnormal AI-ECG screen were older and had more comorbidities. Probability of survival at 5 and 10 years was 86.2% and 68.2% in patients with a normal AI-ECG screen vs 71.4% and 45.1% in those with an abnormal screen (log-rank, P<.01). In the multivariate Cox survival analysis, the abnormal AI-ECG screen was independently associated with a higher all-cause mortality overall (hazard ratio [HR], 1.31; 95% CI, 1.24 to 1.37) and in subgroups of isolated valve surgery (HR, 1.30; 95% CI, 1.18 to 1.42), isolated coronary artery bypass grafting (HR, 1.29; 95% CI, 1.20 to 1.39), and combined coronary artery bypass grafting and valve surgery (HR, 1.19; 95% CI, 1.08 to 1.32). In a subgroup analysis, the association between abnormal AI-ECG screen and mortality was consistent in patients with LVEF of 35% to 55% and among those with LVEF above 55%.ConclusionA novel electrocardiography-based AI algorithm that predicts severe ventricular dysfunction can predict long-term mortality among patients with LVEF above 35% undergoing valve and/or coronary bypass surgery.Copyright © 2021 Mayo Foundation for Medical Education and Research. Published by Elsevier Inc. All rights reserved.

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