ABSTRACT
BACKGROUND The correct interpretation of the ECG is pivotal for the accurate diagnosis of many cardiac abnormalities, and conventional computerized interpretation has not been able to reach physician-level accuracy in detecting (acute) cardiac abnormalities. This study aims to develop and validate a deep neural network for comprehensive automated ECG triage in daily practice. METHODS AND RESULTS We developed a 37-layer convolutional residual deep neural network on a data set of free-text physician-annotated 12-lead ECGs. The deep neural network was trained on a data set with 336.835 recordings from 142.040 patients and validated on an independent validation data set (n=984), annotated by a panel of 5 cardiologists electrophysiologists. The 12-lead ECGs were acquired in all noncardiology departments of the University Medical Center Utrecht. The algorithm learned to classify these ECGs into the following 4 triage categories: normal, abnormal not acute, subacute, and acute. Discriminative performance is presented with overall and category-specific concordance statistics, polytomous discrimination indexes, sensitivities, specificities, and positive and negative predictive values. The patients in the validation data set had a mean age of 60.4 years and 54.3% were men. The deep neural network showed excellent overall discrimination with an overall concordance statistic of 0.93 (95% CI, 0.92-0.95) and a polytomous discriminatory index of 0.83 (95% CI, 0.79-0.87). CONCLUSIONS This study demonstrates that an end-to-end deep neural network can be accurately trained on unstructured free-text physician annotations and used to consistently triage 12-lead ECGs. When further fine-tuned with other clinical outcomes and externally validated in clinical practice, the demonstrated deep learning-based ECG interpretation can potentially improve time to treatment and decrease healthcare burden.
