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O'Sullivan D, Anjewierden S, Greason G, Attia IZ, Lopez-Jimenez F, Friedman PA, Noseworthy P, Anderson J, Kashou A, Asirvatham SJ, Eidem BW, Johnson JN, Niaz T, Madhavan M. Pediatric sex estimation using AI-enabled ECG analysis: influence of pubertal development. NPJ Digit Med 2024; 7:176. [PMID: 38956410 PMCID: PMC11220019 DOI: 10.1038/s41746-024-01165-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Accepted: 06/12/2024] [Indexed: 07/04/2024] Open
Abstract
AI-enabled ECGs have previously been shown to accurately predict patient sex in adults and correlate with sex hormone levels. We aimed to test the ability of AI-enabled ECGs to predict sex in the pediatric population and study the influence of pubertal development. AI-enabled ECG models were created using a convolutional neural network trained on pediatric 10-second, 12-lead ECGs. The first model was trained de novo using pediatric data. The second model used transfer learning from a previously validated adult data-derived algorithm. We analyzed the first ECG from 90,133 unique pediatric patients (aged ≤18 years) recorded between 1987-2022, and divided the cohort into training, validation, and testing datasets. Subgroup analysis was performed on prepubertal (0-7 years), peripubertal (8-14 years), and postpubertal (15-18 years) patients. The cohort was 46.7% male, with 21,678 prepubertal, 26,740 peripubertal, and 41,715 postpubertal children. The de novo pediatric model demonstrated 81% accuracy and an area under the curve (AUC) of 0.91. Model sensitivity was 0.79, specificity was 0.83, positive predicted value was 0.84, and the negative predicted value was 0.78, for the entire test cohort. The model's discriminatory ability was highest in postpubertal (AUC = 0.98), lower in the peripubertal age group (AUC = 0.91), and poor in the prepubertal age group (AUC = 0.67). There was no significant performance difference observed between the transfer learning and de novo models. AI-enabled interpretation of ECG can estimate sex in peripubertal and postpubertal children with high accuracy.
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Affiliation(s)
- Donnchadh O'Sullivan
- Department of Pediatric and Adolescent Medicine, Division of Pediatric Cardiology, Mayo Clinic, Rochester, MN, USA.
| | - Scott Anjewierden
- Department of Pediatric and Adolescent Medicine, Division of Pediatric Cardiology, Mayo Clinic, Rochester, MN, USA
| | - Grace Greason
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | | | | | - Paul A Friedman
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | - Peter Noseworthy
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | - Jason Anderson
- Department of Pediatric and Adolescent Medicine, Division of Pediatric Cardiology, Mayo Clinic, Rochester, MN, USA
| | - Anthony Kashou
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | | | - Benjamin W Eidem
- Department of Pediatric and Adolescent Medicine, Division of Pediatric Cardiology, Mayo Clinic, Rochester, MN, USA
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | - Jonathan N Johnson
- Department of Pediatric and Adolescent Medicine, Division of Pediatric Cardiology, Mayo Clinic, Rochester, MN, USA
| | - Talha Niaz
- Department of Pediatric and Adolescent Medicine, Division of Pediatric Cardiology, Mayo Clinic, Rochester, MN, USA
| | - Malini Madhavan
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
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Burton S, Reynolds AC, King N, Modi A, Asopa S. Midterm Clinical Outcomes of Reimplantation Versus Remodeling Valve-Sparing Aortic Root Replacement in Patients With Connective Tissue Disorders: A Meta-Analysis. Am J Cardiol 2024; 213:28-35. [PMID: 38104753 DOI: 10.1016/j.amjcard.2023.11.066] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 11/13/2023] [Accepted: 11/29/2023] [Indexed: 12/19/2023]
Abstract
This meta-analysis aimed to compare the midterm clinical outcomes of reimplantation versus remodeling techniques for valve-sparing aortic root replacement (VSARR) in patients with connective tissue disorders (CTDs). Studies were screened and identified after the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines from the PubMed, Web of Science, and Embase databases. Forest plots were produced using Review Manager 5.3 (Cochrane, UK). Studies comparing early and midterm clinical outcomes of reimplantation versus remodeling VSARR in patients with CTD with a mean age ≥18 years were included. The sensitivity analysis excluded studies and subgroups of patients that received ring or suture annuloplasty in addition to remodeling surgery. The study selection identified 9 eligible studies. After analysis of the study period and location for patient crossover, 7 retrospective studies consisting of 597 patients (301 reimplantation and 296 remodeling) were pooled. The pooling revealed no significant difference in postoperative mortality (estimated mean follow-up of 10.5 years) (odds ratio [OR] 0.66, 95% confidence interval [CI] 0.30 to 1.48, I2 = 30%, p = 0.32), reoperation (OR 0.35, CI 0.04 to 3.30, I2 = 81%, p = 0.36), or occurrence of postoperative aortic regurgitation of ≥2 (OR 0.56, CI 0.31 to 1.02, I2 = 47%, p = 0.06). The sensitivity analysis excluding annuloplasty demonstrated improved mortality (OR 0.19, CI 0.06 to 0.64, I2 = 0%, p = 0.007) and decreased aortic regurgitation of ≥2 (OR 0.23, CI 0.10 to 0.53, I2 = 47%, p = 0.0005) in reimplantation VSARR. The rates of reoperation remained insignificant in the sensitivity analysis (OR 0.43, CI 0.05 to 3.53, I2 = 71%, p = 0.43). In conclusion, this meta-analysis has demonstrated no significant difference in the midterm clinical outcomes of reimplantation versus remodeling techniques of VSARR. The sensitivity analysis excluding studies and patient subgroups that received remodeling and annuloplasty suggests remodeling alone to be inferior to reimplantation in patients with CTDs. Further research is required to assess remodeling and annuloplasty against reimplantation in patients of this demographic because the current body of knowledge does not allow sufficient analysis.
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Affiliation(s)
- Samuel Burton
- Faculty of Health Sciences, University of Bristol, Bristol, United Kingdom.
| | | | - Nicola King
- Faculty of Health, University of Plymouth, Plymouth, United Kingdom
| | - Amit Modi
- Wessex Cardiac Centre, Southampton, United Kingdom
| | - Sanjay Asopa
- Southwest Cardiothoracic Centre, Plymouth, United Kingdom
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Iskandar Z, Dodd M, Huang J, Chin CWL, Stuart G, Caputo M, Clayton T, Child A, Jin XY, Aragon-Martin JA, Gibb J, Flather M, Choy AM. Exaggerated elastin turnover in young individuals with Marfan syndrome: new insights from the AIMS trial. EUROPEAN HEART JOURNAL OPEN 2023; 3:oead095. [PMID: 37829559 PMCID: PMC10567063 DOI: 10.1093/ehjopen/oead095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 09/08/2023] [Accepted: 09/14/2023] [Indexed: 10/14/2023]
Abstract
Aims The fragmentation and loss of elastic fibre in the tunica media of the aorta are pathological hallmarks of Marfan syndrome (MFS) but the dynamics of elastin degradation and its relationship to aortic size and physiological growth remain poorly understood. Methods and results In this post hoc analysis of the AIMS randomized controlled trial, the association of plasma desmosine (pDES)-a specific biomarker of mature elastin degradation-with age and aortic size was analysed in 113 patients with MFS and compared to 109 healthy controls. There was a strong association between age and pDES in both groups, with higher pDES levels in the lower age groups compared to adults. During childhood, pDES increased and peaked during early adolescence, and thereafter decreased to lower adult levels. This trend was exaggerated in young individuals with MFS but in those above 25 years of age, pDES levels were comparable to controls despite the presence of aortic root dilation. In MFS children, increased aortic diameter relative to controls was seen at an early age and although the increase in diameter was less after adolescence, aortic root size continued to increase steadily with age. In MFS participants, there was an indication of a positive association between baseline pDES levels and aortic root dilatation during up to 5 years of follow-up. Conclusion This study has shown that developmental age has a significant effect on levels of elastin turnover as measured by pDES in MFS individuals as well as healthy controls. This effect is exaggerated in those with MFS with increased levels seen during the period of physiologic development that plateaus towards adulthood. This suggests an early onset of pathophysiology that may present an important opportunity for disease-modifying intervention.
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Affiliation(s)
| | - Matthew Dodd
- Clinical Trials Unit, Department of Medical Statistics, London School of Hygiene & Tropical Medicine, London, UK
| | | | - Calvin W L Chin
- National Heart Center Singapore, Cardiovascular ACP, Duke-NUS Medical School, Singapore
| | - Graham Stuart
- University Hospitals Bristol NHS Foundation Trust/Bristol Heart Institute, University of Bristol, Bristol, UK
| | - Massimo Caputo
- Bristol Royal Hospital for Children/Bristol Heart Institute, University of Bristol, Bristol, UK
| | - Tim Clayton
- Clinical Trials Unit, Department of Medical Statistics, London School of Hygiene & Tropical Medicine, London, UK
| | - Anne Child
- Royal Brompton and Harefield Clinical Group, Guy’s and St Thomas’ Trust, King’s College, London, UK
| | - Xu Yu Jin
- Oxford Heart Centre, John Radcliffe Hospital, Oxford, UK
| | | | - Jack Gibb
- Bristol Royal Hospital for Children/Bristol Heart Institute, University of Bristol, Bristol, UK
| | - Marcus Flather
- Norwich Medical School, University of East Anglia, Norwich, UK
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