Multinational Federated Learning Approach to Train ECG and Echocardiogram Models for Hypertrophic Cardiomyopathy Detection Article Swipe
Shinichi Goto
,
Divyarajsinhji Solanki
,
Jenine E. John
,
Ryuichiro Yagi
,
Max Homilius
,
Genki Ichihara
,
Yoshinori Katsumata
,
Hanna K. Gaggin
,
Yuji Itabashi
,
Calum A. MacRae
,
Rahul C. Deo
·
YOU?
·
· 2022
· Open Access
·
· DOI: https://doi.org/10.1161/circulationaha.121.058696
YOU?
·
· 2022
· Open Access
·
· DOI: https://doi.org/10.1161/circulationaha.121.058696
Background: Novel targeted treatments increase the need for prompt hypertrophic cardiomyopathy (HCM) detection. However, its low prevalence (0.5%) and resemblance to common diseases present challenges that may benefit from automated machine learning–based approaches. We aimed to develop machine learning models to detect HCM and to differentiate it from other cardiac conditions using ECGs and echocardiograms, with robust generalizability across multiple cohorts. Methods: Single-institution HCM ECG models were trained and validated on external data. Multi-institution models for ECG and echocardiogram were trained on data from 3 academic medical centers in the United States and Japan using a federated learning approach, which enables training on distributed data without data sharing. Models were validated on held-out test sets for each institution and from a fourth academic medical center and were further evaluated for discrimination of HCM from aortic stenosis, hypertension, and cardiac amyloidosis. Last, automated detection was compared with manual interpretation by 3 cardiologists on a data set with a realistic HCM prevalence. Results: We identified 74 376 ECGs for 56 129 patients and 8392 echocardiograms for 6825 patients at the 4 academic medical centers. Although ECG models trained on data from each institution displayed excellent discrimination of HCM on internal test data (C statistics, 0.88–0.93), the generalizability was limited, most notably for a model trained in Japan and tested in the United States (C statistic, 0.79–0.82). When trained in a federated manner, discrimination of HCM was excellent across all institutions (C statistics, 0.90–0.96 and 0.90–0.96 for ECG and echocardiogram model, respectively), including for phenotypic subgroups. The models further discriminated HCM from hypertension, aortic stenosis, and cardiac amyloidosis (C statistics, 0.84, 0.83, and 0.88, respectively, for ECG and 0.93, 0.94, 0.85, respectively, for echocardiogram). Analysis of electrocardiography-echocardiography paired data from 11 823 patients from an external institution indicated a higher sensitivity of automated HCM detection at a given positive predictive value compared with cardiologists (0.98 versus 0.81 at a positive predictive value of 0.01 for ECG and 0.78 versus 0.59 at a positive predictive value of 0.24 for echocardiogram). Conclusions: Federated learning improved the generalizability of models that use ECGs and echocardiograms to detect and differentiate HCM from other causes of hypertrophy compared with training within a single institution.
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- Type
- article
- Language
- en
- Landing Page
- https://doi.org/10.1161/circulationaha.121.058696
- https://www.ahajournals.org/doi/pdf/10.1161/CIRCULATIONAHA.121.058696
- OA Status
- hybrid
- Cited By
- 96
- References
- 28
- Related Works
- 10
- OpenAlex ID
- https://openalex.org/W4289525005
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- OpenAlex ID
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https://openalex.org/W4289525005Canonical identifier for this work in OpenAlex
- DOI
-
https://doi.org/10.1161/circulationaha.121.058696Digital Object Identifier
- Title
-
Multinational Federated Learning Approach to Train ECG and Echocardiogram Models for Hypertrophic Cardiomyopathy DetectionWork title
- Type
-
articleOpenAlex work type
- Language
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enPrimary language
- Publication year
-
2022Year of publication
- Publication date
-
2022-08-02Full publication date if available
- Authors
-
Shinichi Goto, Divyarajsinhji Solanki, Jenine E. John, Ryuichiro Yagi, Max Homilius, Genki Ichihara, Yoshinori Katsumata, Hanna K. Gaggin, Yuji Itabashi, Calum A. MacRae, Rahul C. DeoList of authors in order
- Landing page
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https://doi.org/10.1161/circulationaha.121.058696Publisher landing page
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https://www.ahajournals.org/doi/pdf/10.1161/CIRCULATIONAHA.121.058696Direct link to full text PDF
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YesWhether a free full text is available
- OA status
-
hybridOpen access status per OpenAlex
- OA URL
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https://www.ahajournals.org/doi/pdf/10.1161/CIRCULATIONAHA.121.058696Direct OA link when available
- Concepts
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Generalizability theory, Medicine, Hypertrophic cardiomyopathy, Artificial intelligence, Machine learning, Cardiology, Internal medicine, Academic institution, Computer science, Statistics, Library science, MathematicsTop concepts (fields/topics) attached by OpenAlex
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96Total citation count in OpenAlex
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2025: 45, 2024: 31, 2023: 19, 2022: 1Per-year citation counts (last 5 years)
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28Number of works referenced by this work
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10Other works algorithmically related by OpenAlex
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| primary_location.pdf_url | https://www.ahajournals.org/doi/pdf/10.1161/CIRCULATIONAHA.121.058696 |
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| publication_date | 2022-08-02 |
| publication_year | 2022 |
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