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Accurate diagnosis of apical hypertrophic cardiomyopathy using explainable advanced ECG analysis

Hughes, Rebecca K; Thornton, George D; Malcolmson, James W; Pierce, Iain; Khoury, Shafik; Hornell, Amanda; Knott, Kristopher; ... Ugander, Martin; + view all (2024) Accurate diagnosis of apical hypertrophic cardiomyopathy using explainable advanced ECG analysis. EP Europace , 26 (4) , Article euae093. 10.1093/europace/euae093. Green open access

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Abstract

BACKGROUND AND AIMS: Typical electrocardiogram (ECG) features of apical hypertrophic cardiomyopathy (ApHCM) include tall R waves and deep or giant T-wave inversion in the precordial leads, but these features are not always present. The ECG is used as the gatekeeper to cardiac imaging for diagnosis. We tested whether explainable advanced ECG (A-ECG) could accurately diagnose ApHCM. METHODS: A-ECG analysis was performed on standard resting 12-lead ECGs in patients with ApHCM (n = 75 overt, n = 32 relative [<15mm hypertrophy]), a subgroup of which underwent cardiovascular magnetic resonance, n = 92), and comparator subjects (n = 2449), including healthy volunteers (n = 1672), patients with coronary artery disease (n = 372), left ventricular electrical remodelling (n = 108), ischemic (n = 114) or non-ischemic cardiomyopathy (n = 57), and asymmetrical septal hypertrophy (ASH) HCM (n = 126). RESULTS: Multivariable logistic regression identified four A-ECG measures that together discriminated ApHCM from other diseases with high accuracy (area under the receiver operating characteristics curve (AUC) [bootstrapped 95% confidence interval] 0.982 [0.965-0.993]. Linear discriminant analysis also diagnosed ApHCM with high accuracy (AUC 0.989 [0.986-0.991]). CONCLUSION: Explainable A-ECG has excellent diagnostic accuracy for ApHCM, even when the hypertrophy is relative, with A-ECG analysis providing incremental diagnostic value over imaging alone. The electrical (ECG) and anatomical (wall thickness) disease features do not completely align, suggesting future diagnostic and management strategies may incorporate both features.

Type: Article
Title: Accurate diagnosis of apical hypertrophic cardiomyopathy using explainable advanced ECG analysis
Location: England
Open access status: An open access version is available from UCL Discovery
DOI: 10.1093/europace/euae093
Publisher version: http://dx.doi.org/10.1093/europace/euae093
Language: English
Additional information: Copyright © The Author(s) 2024. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/).
Keywords: Electrocardiography, Vectorcardiography, Apical Hypertrophic Cardiomyopathy, Hypertrophic Cardiomyopathy
UCL classification: UCL
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Institute of Cardiovascular Science
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Institute of Cardiovascular Science > Clinical Science
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Institute of Cardiovascular Science > Population Science and Experimental Medicine
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Institute of Cardiovascular Science > Population Science and Experimental Medicine > MRC Unit for Lifelong Hlth and Ageing
URI: https://discovery.ucl.ac.uk/id/eprint/10190934
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