An artificial intelligence algorithm for detection of severe aortic stenosis: A clinical cohort study
Publication Details
Strom, J.,
Playford, D.,
Stewart, S.,
&
Strange, G.
(2024).
An artificial intelligence algorithm for detection of severe aortic stenosis: A clinical cohort study.
JACC: Advances, 3 (9).
Abstract
Background: Identifying individuals with severe aortic stenosis (AS) at high risk of mortality remains challenging using current clinical imaging methods.
Objective: The purpose of this study was to evaluate an artificial intelligence decision support algorithm (AI-DSA) to augment the detection of severe AS within a well-resourced health care setting.
Methods: Agnostic to clinical information, an AI-DSA trained to identify echocardiographic phenotype associated with an aortic valve area (AVA)<1 cm2 using minimal input data (excluding left ventricular outflow tract measures) was applied to routine transthoracic echocardiograms (TTE) reports from 31,141 U.S. Medicare beneficiaries at an academic medical center (2003-2017).
Results: S Performance of AI-DSA to detect the phenotype associated with an AVA<1 cm2 was excellent (sensitivity 82.2%, specificity 98.1%, negative predictive value 9.2%, c-statistic ¼ 0.986). In addition to identifying clinical severe AS cases, AI-DSA identified an additional 1,034 (3.3%) individuals with guideline-defined moderate AS but with a similar clinical and TTE phenotype to those with severe AS with low rates of aortic valve replacement (6.6%). Five-year mortality was 75.9% in those with known severe AS, 73.5% in those with a similar phenotype to severe AS, and 44.6% in those without severe AS. The AI-DSA continued to perform well to identify severe AS among those with a depressed left ventricular ejection fraction. Overall rates of aortic valve replacement remained low, even in those with an AVA<1 cm2 (21.9%)
Conclusions: Without relying on left ventricular outflow tract measurements, an AI-DSA used echocardiographic reports to reliably identify the phenotype of severe AS. These results suggest possible utility for this AI-DSA to enhance detection of severe AS individuals at risk for adverse outcomes
Keywords
artificial intelligence, decision-support, echocardiography, aortic stenosis
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