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Differentiating HFmr/rEF from HFpEF using standard 12-lead ECG measurements: an interpretable machine learning study.

📚 期刊: Open heart 📅 发表: 0000-00-00 🔬 PMID: 42463275 🔗 DOI: 10.1136/openhrt-2026-004127 👁️ 浏览: 11

👤 作者: Zhao C, Chan PJ, Dougherty S, Fan Y, Lee APW

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APA Vancouver 国标 GB/T 7714 BibTeX RIS
Zhao C, Chan PJ, Dougherty S, Fan Y, Lee APW (0000). Differentiating HFmr/rEF from HFpEF using standard 12-lead ECG measurements: an interpretable machine learning study.. Open heart. https://doi.org/10.1136/openhrt-2026-004127

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📝 摘要

BACKGROUND: Differentiating heart failure (HF) with mildly reduced/reduced ejection fraction (HFmr/rEF) from HF with preserved ejection fraction (HFpEF) guides therapy but echocardiography may be delayed or unavailable. We developed and validated machine learning models using routine 12-lead ECG data to classify HF phenotypes. METHODS: In this retrospective cohort of hospitalised patients with HF, predictors available at or before the index ECG were used. HFmrEF was pooled with HFrEF (left ventricular ejection fraction <50%) for model development. Data were split 70/30 into training and held-out test sets. Random forest (RF), Extreme Gradient Boosting and support vector machine models were trained and tuned using fivefold cross-validation in the training set. Boruta was used to select key ECG features. Test-set performance was evaluated by area under the curve (AUC) and accuracy; AUCs were compared using DeLong's test. RESULTS: Overall, 495 patients were included (254 HFmr/rEF; 241 HFpEF). RF consistently performed best. Using ECG features alone, RF achieved an AUC of 0.821 (95% CI 0.752 to 0.890) and accuracy of 75.7%. A parsimonious RF model using 12 Boruta-selected ECG variables achieved an AUC of 0.832 (95% CI 0.766 to 0.899) and accuracy of 76.4%, with no significant AUC difference versus a comprehensive RF model using clinical/laboratory/ECG predictors (AUC 0.804, 95% CI 0.734 to 0.875; p=0.288) or the model using all ECG features (p=0.092). Adding X-ray cardiomegaly did not improve performance. CONCLUSION: A parsimonious RF model based on a small set of standard ECG measurements differentiates HFmr/rEF from HFpEF with good discrimination, supporting ECG as an adjunct for phenotyping when echocardiography is not immediately available.

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