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Comparison of Artificial Intelligence-Derived Heart Age with Chronological Age Using Normal Sinus Electrocardiograms

Myoung Jung Kim1, Sung-Hee Song2, Young Jun Park3

  • 1Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Republic of Korea.

Journal of Clinical Medicine
|August 14, 2025
PubMed

Insights

Artificial intelligence can estimate heart age from ECGs, offering a new biomarker for biological aging. This AI model accurately predicts heart age in individuals without heart disease, aiding risk assessment.

Area of Science:

  • Cardiology
  • Artificial Intelligence
  • Biomarkers

Background:

  • Chronological age may not reflect true biological aging.
  • Electrocardiogram (ECG)-derived heart age is a potential non-invasive biomarker.
  • AI advancements enable accurate estimation of heart age from ECGs.

Purpose of the Study:

  • Develop and validate a deep learning model for ECG-heart age prediction.
  • Assess the model's accuracy in individuals without structural heart disease.
  • Evaluate ECG-heart age as a biomarker for physiological aging.

Main Methods:

  • A convolutional neural network (DenseNet-121) was trained on 292,484 12-lead ECGs.
  • Exclusion criteria included age <18 or >90 years and structural abnormalities.
  • Model performance was assessed using R², PCC, MAE, and RMSE, with external validation.

Main Results:

  • The AI model showed strong predictive performance (R² = 0.783, PCC = 0.885).
  • ECG-heart age was overestimated in younger adults and underestimated in older adults.
  • External validation confirmed consistent performance (R² = 0.703, PCC = 0.846).

Conclusions:

  • An AI model can accurately estimate ECG-heart age in individuals with normal heart structure.
  • ECG-derived heart age shows promise as a reliable biomarker for biological aging.
  • This approach may enhance future cardiovascular risk stratification strategies.

Keywords:
artificial intelligencebiological agechronological ageelectrocardiogram

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