Datasheet1_Artificial intelligence-estimated biological heart age using a 12-lead electrocardiogram predicts mortality and cardiovascular outcomes.docx

BackgroundThere is a paucity of data on artificial intelligence-estimated biological electrocardiography (ECG) heart age (AI ECG-heart age) for predicting cardiovascular outcomes, distinct from the chronological age (CA). We developed a deep learning-based algorithm to estimate the AI ECG-heart age using standard 12-lead ECGs and evaluated whether it predicted mortality and cardiovascular outcomes.MethodsWe trained and validated a deep neural network using the raw ECG digital data from 425,051 12-lead ECGs acquired between January 2006 and December 2021. The network performed a holdout test using a separate set of 97,058 ECGs. The deep neural network was trained to estimate the AI ECG-heart age [mean absolute error, 5.8 ± 3.9 years; R-squared, 0.7 (r = 0.84, p FindingsIn the Cox proportional hazards models, after adjusting for relevant comorbidity factors, the patients with an AI ECG-heart age of 6 years older than the CA had higher all-cause mortality (hazard ratio (HR) 1.60 [1.42–1.79]) and more major adverse cardiovascular events (MACEs) [HR: 1.91 (1.66–2.21)], whereas those under 6 years had an inverse relationship (HR: 0.82 [0.75–0.91] for all-cause mortality; HR: 0.78 [0.68–0.89] for MACEs). Additionally, the analysis of ECG features showed notable alterations in the PR interval, QRS duration, QT interval and corrected QT Interval (QTc) as the AI ECG-heart age increased.ConclusionBiological heart age estimated by AI had a significant impact on mortality and MACEs, suggesting that the AI ECG-heart age facilitates primary prevention and health care for cardiovascular outcomes.</p

Inclusion criteria.

Inclusion criteria.</p

SPIRIT checklist.

(DOC)</p

Baseline characteristics.

<p>Baseline characteristics.</p

Non-vitamin K antagonist oral anticoagulants versus warfarin for the prevention of spontaneous echo-contrast and thrombus in patients with atrial fibrillation or flutter undergoing cardioversion: A trans-esophageal echocardiography study

<div><p>Spontaneous echo-contrast (SEC) and thrombus observed in trans-esophageal echocardiography (TEE) is known as a strong surrogate marker for future risk of ischemic stroke in patients with atrial fibrillation (AF) or atrial flutter (AFL). The efficacy of non-vitamin K antagonist oral anticoagulants (NOAC) compared to warfarin to prevent SEC or thrombus in patients with AF or AFL is currently unknown. AF or AFL patients who underwent direct current cardioversion (DCCV) and pre-DCCV TEE evaluation from January 2014 to October 2016 in a single center were analyzed. The prevalence of SEC and thrombus were compared between patients who received NOAC and those who took warfarin. NOAC included direct thrombin inhibitor and factor Xa inhibitors. Among 1,050 patients who were considered for DCCV, 424 patients anticoagulated with warfarin or NOAC underwent TEE prior to DCCV. Eighty patients who were anticoagulated for less than 21 days were excluded. Finally, 344 patients were included for the analysis (180 warfarin users vs. 164 NOAC users). No significant difference in the prevalence of SEC (44.4% vs. 43.9%; <i>p</i> = 0.919), dense SEC (13.9% vs. 15.2%; <i>p</i> = 0.722), or thrombus (2.2% vs. 4.3%; <i>p</i> = 0.281) was observed between the warfarin group and the NOAC group. In multivariate analysis, there was no association between NOAC and risk of SEC (odds ratio [OR]: 1.4, 95% CI: 0.796–2.297, <i>p</i> = 0.265) or thrombus (OR: 3.4, 95% CI: 0.726–16.039, <i>p</i> = 0.120). In conclusion, effectiveness of NOAC is comparable to warfarin in preventing SEC and thrombus in patients with AF or AFL undergoing DCCV. However, numerical increase in the prevalence of thrombus in NOAC group warrants further evaluation.</p></div

Prevalence rates of SEC and thrombus in therapeutic anticoagulation and reduced dose NOAC groups.

<p>The prevalence rate of SEC was significantly higher in the reduced dose NOAC group <b>(A)</b>. Prevalence rates of dense SEC <b>(B)</b> and thrombus <b>(C)</b> were not significantly different between warfarin and reduced dose NOAC groups.</p> <p>NOAC: non-vitamin K oral anticoagulant; SEC: spontaneous echo-contrast.</p

Prevalence rates of SEC, dense SEC, and thrombus among rivaroxaban, apixaban, and dabigatran groups.

<p>Prevalence rates of SEC <b>(A)</b>, dense SEC <b>(B)</b>, and thrombus <b>(C)</b> were not significantly different among full dose rivaroxaban, apixaban, and dabigatran groups.</p> <p>NOAC: non-vitamin K oral anticoagulant; SEC: spontaneous echo-contrast.</p

Prevalence rates of SEC and thrombus in warfarin and full dose NOAC groups.

<p>Prevalence rates of SEC <b>(A)</b>, dense SEC <b>(B)</b>, and thrombus <b>(C)</b> were not significantly different between warfarin and full dose NOAC groups.</p> <p>NOAC: non-vitamin K oral anticoagulant; SEC: spontaneous echo-contrast.</p

Multivariate analysis: Warfarin vs. full dose NOAC.

<p>Multivariate analysis: Warfarin vs. full dose NOAC.</p

Prevalence rates of SEC and thrombus in therapeutic anticoagulation and reduced dose NOAC groups.

<p>The prevalence rate of SEC was significantly higher in the reduced dose NOAC group <b>(A)</b>. Prevalence rates of dense SEC <b>(B)</b> and thrombus <b>(C)</b> were not significantly different between warfarin and reduced dose NOAC groups.</p> <p>NOAC: non-vitamin K oral anticoagulant; SEC: spontaneous echo-contrast.</p