Identifying Hypertrophic or Dilated Cardiomyopathy: Development and Validation of a Fine-Tuned ResNet50 Model Based on Electrocardiogram Image

There is no established detecting tool for hypertrophic cardiomyopathy (HCM) and dilated cardiomyopathy (DCM). This study aimed to develop a deep-learning-based model for identifying HCM and DCM using standard 12-lead electrocardiogram (ECG) images. We obtained a cohort of patients with HCM (171 ECG images) or DCM (364 ECG images), confirmed by cardiovascular magnetic resonance (CMR) examinations, who underwent both ECG and CMR within 30 days at our institution. Age- and sex-matched healthy controls (2314 ECG images) were selected from our Health Check Center. A total of 2849 ECG images were processed via a fine-tuned ResNet50 architecture, with stratified five-fold cross-validation for model training, validation, and testing. The proposed model demonstrated strong performance in distinguishing DCM, achieving an area under the receiver operating curve (AUROC) of 0.996 and an area under the precision-recall curve (AUPRC) of 0.940. For the detection of HCM, the model also achieved an AUROC of 0.980 and an AUPRC of 0.953, respectively. The model prospectively exhibited stability in temporal validation. Furthermore, representative images of the Gradient-weighted Class Activation Mapping (Grad-CAM) technique analysis showed the regions corresponding to the anterior and anteroseptal leads were the most important areas for the prediction of HCM or DCM. This temporally validated fine-tuned ResNet50 model shows promise to inexpensively detect individuals with HCM or DCM.