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Cardiac imaging studies encompass a wide range of noninvasive and minimally invasive techniques designed to visualize the heart's structure and function in detail. One such technique is echocardiography, which uses high-frequency ultrasound waves to produce detailed images of the heart, known as echocardiograms.
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Performance of off-the-shelf machine learning architectures and biases in low left ventricular ejection fraction

Jake A Bergquist^1,2,3, Brian Zenger⁴, James Brundage⁴

¹Scientific Computing and Imaging Institute, University of Utah, Salt Lake City, Utah.

Heart Rhythm O2

|November 4, 2024

Summary

This summary is machine-generated.

Off-the-shelf artificial intelligence-machine learning (AI-ML) models can effectively detect low left ventricular ejection fraction (LVEF) from electrocardiograms (ECGs). However, patient characteristics like race and sex may impact AI-ML prediction accuracy, highlighting potential biases.

Keywords:

Artificial intelligence Electrocardiogram Explainability Heart failure Machine learning

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Last Updated: Jun 7, 2026

Ultrasonic Assessment of Myocardial Microstructure

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Published on: January 14, 2014

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Published on: October 28, 2020

Area of Science:

Cardiology
Artificial Intelligence
Machine Learning
Medical Informatics

Background:

Artificial intelligence-machine learning (AI-ML) offers novel methods for extracting clinical insights from electrocardiograms (ECGs).
Numerous open-source AI-ML architectures exist, adaptable for various applications.
Limited research has explored the utility and limitations of these "off-the-shelf" AI-ML models in ECG analysis.

Purpose of the Study:

To evaluate the effectiveness of readily available AI-ML architectures for ECG analysis.
To identify which "off-the-shelf" AI-ML models are suitable for ECG interpretation.
To understand the failure modes and potential biases of AI-ML approaches in ECG-based LVEF detection.

Main Methods:

Applied six "off-the-shelf" AI-ML architectures to a large cohort of 24,868 ECGs.
Assessed the performance of these models in detecting low left ventricular ejection fraction (LVEF).
Investigated patient characteristics associated with inaccurate LVEF predictions (false positives/negatives).

Main Results:

All tested architectures achieved an area under the receiver-operating characteristic curve (AUC) above 0.9 for LVEF detection.
The ResNet 18 architecture demonstrated the highest performance with an average AUC of 0.917.
Patient factors including race, sex, and comorbidities were linked to reduced LVEF prediction accuracy.

Conclusions:

"Off-the-shelf" AI-ML architectures can achieve performance comparable to custom-built models for ECG analysis.
The study identified potential biases related to patient characteristics in AI-ML ECG interpretation.
Findings emphasize the need for careful consideration of efficiency and equity in AI-ML deployment for healthcare.