Identifying heart failure dynamics using multi-point electrocardiograms and deep learning

Abstract Background Heart failure (HF) hospitalizations are related to poor survival outcomes, emphasizing the need for early detection and intervention. Recent studies have reported the potential of deep learning algorithms in identifying heart failure through electrocardiogram (ECG) with notable accuracy. However, evidence supporting their utility in the ongoing monitoring and follow-up of HF patients remains uncertain. Advanced diagnostic tools that can effectively track heart failure progression or improvement over time are needed. Purpose To address this challenge, we developed a deep learning model analyzing 12-lead ECG waveforms at two time points, aiming to detect HF deterioration or improvement, potentially revolutionizing HF management. Methods This study analyzed 32,045 ECGs from 6,892 unique adult patients (aged 18 years and older) visiting the Department of Cardiology at Kobe University Hospital. The participants were randomly assigned to training (4,284 patients), validation (1,034 patients), and test (1,034 patients) datasets. ElecTransformer was developed to classify HF status into deteriorated, improved, and no change classes based on ECG waveform signals at two different time points and to estimate brain natriuretic peptide (BNP) levels. Performance metrics, such as the area under the receiver operating characteristic curve (AUROC) and accuracy, were calculated, and attention mapping via gradient-weighted class activation mapping was utilized to interpret the model's decision-making ability. Results The patients had an average age of 65 years (±15.4 years) and BNP levels averaged 71.5 pg/mL (25.8 to 185.2 pg/mL). For HF status classification, ElecTransformer achieved an AUROC of 0.845 and an accuracy of 0.821, improving to an AUROC of 0.885 and an accuracy of 0.833 with baseline BNP integration. The ElecTransformer accurately estimated BNP levels from ECG data, evidenced by a correlation coefficient of 0.798. Averaged attention mapping showed that the QRS complex was the most important feature for determining model outputs with lesser effects seen for P waves and T waves variance Conclusions Harnessing a Transformer-based deep learning model to analyze multiple ECGs markedly improves the accuracy in detecting changes in heart failure status. This method offers a valuable non-invasive option for monitoring heart failure progression, potentially leading to better patient management and earlier intervention in heart failure treatment.Architecture and Performance of ModelsAveraged attention mapping