Ozcan Ilke, Toya Takumi, Cohen-Shelly Michal, Park Hyun Woong, Ahmad Ali, Ozcan Alp, Noseworthy Peter A, Kapa Suraj, Lerman Lilach O, Attia Zachi I, Kushwaha Sudhir S, Friedman Paul A, Lerman Amir
Department of Cardiovascular Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55902, USA.
Division of Cardiology, National Defense Medical College, Tokorozawa, Namiki, 3 Chome-2 Saitama, Japan.
Eur Heart J Digit Health. 2022 Sep 16;3(4):516-524. doi: 10.1093/ehjdh/ztac051. eCollection 2022 Dec.
An artificial intelligence algorithm detecting age from 12-lead electrocardiogram (ECG) has been suggested to reflect 'physiological age'. An increased physiological age has been associated with a higher risk of cardiac mortality in the non-transplant population. We aimed to investigate the utility of this algorithm in patients who underwent heart transplantation (HTx).
A total of 540 patients were studied. The average ECG ages within 1 year before and after HTx were used to represent pre- and post-HTx ECG ages. Major adverse cardiovascular event (MACE) was defined as any coronary revascularization, heart failure hospitalization, re-transplantation, and mortality. Recipient pre-transplant ECG age (mean 63 ± 11 years) correlated significantly with recipient chronological age (mean 49 ± 14 years, = 0.63, < 0.0001), while post-transplant ECG age (mean 54 ± 10 years) correlated with both the donor (mean 32 ± 13 years, = 0.45, < 0.0001) and the recipient ages ( = 0.38, < 0.0001). During a median follow-up of 8.8 years, 307 patients experienced MACE. Patients with an increase in ECG age post-transplant showed an increased risk of MACE [hazard ratio (HR): 1.58, 95% confidence interval (CI): (1.24, 2.01), = 0.0002], even after adjusting for potential confounders [HR: 1.58, 95% CI: (1.19, 2.10), = 0.002].
Electrocardiogram age-derived cardiac ageing after transplantation is associated with a higher risk of MACE. This study suggests that physiological age change of the heart might be an important determinant of MACE risk post-HTx.
一种可从12导联心电图（ECG）检测年龄的人工智能算法被认为可反映“生理年龄”。在非移植人群中，生理年龄增加与心脏死亡风险升高相关。我们旨在研究该算法在接受心脏移植（HTx）患者中的效用。
共研究了540例患者。HTx前后1年内的平均心电图年龄用于代表HTx前后的心电图年龄。主要不良心血管事件（MACE）定义为任何冠状动脉血运重建、心力衰竭住院、再次移植和死亡。受者移植前心电图年龄（平均63±11岁）与受者实际年龄（平均49±14岁，r = 0.63，P < 0.0001）显著相关，而移植后心电图年龄（平均54±10岁）与供者年龄（平均32±13岁，r = 0.45，P < 0.0001）和受者年龄（r = 0.38，P < 0.0001）均相关。在中位随访8.8年期间，307例患者发生MACE。移植后心电图年龄增加的患者发生MACE的风险增加[风险比（HR）：1.58，95%置信区间（CI）：（1.24，2.01），P = 0.0002]，即使在调整潜在混杂因素后[HR：1.58，95% CI：（1.19，2.10），P = 0.002]。
移植后基于心电图年龄得出的心脏老化与MACE风险较高相关。本研究表明，心脏的生理年龄变化可能是HTx后MACE风险的重要决定因素。
