Attia ZI, Kapa S, Dugan J, Pereira N, Noseworthy PA, Jimenez FL, Cruz J, Carter RE, DeSimone DC, Signorino J, Halamka J, Chennaiah Gari NR, Madathala RS, Platonov PG, Gul F, Janssens SP, Narayan S, Upadhyay GA, Alenghat FJ, Lahiri MK, Dujardin K, Hermel M, Dominic P, Turk-Adawi K, Asaad N, Svensson A, Fernandez-Aviles F, Esakof DD, Bartunek J, Noheria A, Sridhar AR, Lanza GA, Cohoon K, Padmanabhan D, Pardo Gutierrez JA, Sinagra G, Merlo M, Zagari D, Rodriguez Escenaro BD, Pahlajani DB, Loncar G, Vukomanovic V, Jensen HK, Farkouh ME, Luescher TF, Su Ping CL, Peters NS, Friedman PA, Discover Consortium (Digital and Noninvasive Screening for COVID-19 with AI ECG Repository)
Mayo Clin Proc 96 (8) 2081-2094 [2021-08-00; online 2021-08-07]
To rapidly exclude severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection using artificial intelligence applied to the electrocardiogram (ECG). A global, volunteer consortium from 4 continents identified patients with ECGs obtained around the time of polymerase chain reaction-confirmed COVID-19 diagnosis and age- and sex-matched controls from the same sites. Clinical characteristics, polymerase chain reaction results, and raw electrocardiographic data were collected. A convolutional neural network was trained using 26,153 ECGs (33.2% COVID positive), validated with 3826 ECGs (33.3% positive), and tested on 7870 ECGs not included in other sets (32.7% positive). Performance under different prevalence values was tested by adding control ECGs from a single high-volume site. The area under the curve for detection of acute COVID-19 infection in the test group was 0.767 (95% CI, 0.756 to 0.778; sensitivity, 98%; specificity, 10%; positive predictive value, 37%; negative predictive value, 91%). To more accurately reflect a real-world population, 50,905 normal controls were added to adjust the COVID prevalence to approximately 5% (2657/58,555), resulting in an area under the curve of 0.780 (95% CI, 0.771 to 0.790) with a specificity of 12.1% and a negative predictive value of 99.2%. Infection with SARS-CoV-2 results in electrocardiographic changes that permit the artificial intelligence-enhanced ECG to be used as a rapid screening test with a high negative predictive value (99.2%). This may permit the development of electrocardiography-based tools to rapidly screen individuals for pandemic control.