Detecting structural heart disease from electrocardiograms using AI.

Journal: Nature
Published Date: Jul 16, 2025

Abstract

Early detection of structural heart disease is critical to improving outcomes, but widespread screening remains limited by the cost and accessibility of imaging tools such as echocardiography. Recent advances in machine learning applied to heart rhythm recordings have shown promise in identifying disease, although previous work has been limited by development in narrow populations or targeting only select heart conditions. Here we introduce a deep learning model, EchoNext, trained on more than 1 million heart rhythm and imaging records across a large and diverse health system to detect many forms of structural heart disease. The model demonstrated high diagnostic accuracy in internal and external validation, outperforming cardiologists in a controlled evaluation and showing consistent performance across different care settings and racial and/or ethnic groups. The models were prospectively evaluated in a clinical trial of patients without previous cardiac imaging, successfully identifying previously undiagnosed heart disease. These findings support the potential of artificial intelligence to expand access to heart disease screening at scale. To enable further development and transparency, we have publicly released model weights and a large, annotated dataset linking heart rhythm data to imaging-based diagnoses.

Authors

  • Timothy J Poterucha
    Seymour, Paul, and Gloria Milstein Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center and NewYork-Presbyterian Hospital, New York, New York, USA.
  • Linyuan Jing
    Department of Imaging Science and Innovation, Geisinger, Danville, Pennsylvania.
  • Ramon Pimentel Ricart
    Seymour, Paul, and Gloria Milstein Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York, NY, USA.
  • Michael Adjei-Mosi
    Brown Center for Biomedical Informatics, Brown University, Providence, RI, USA.
  • Joshua Finer
    NewYork-Presbyterian Hospital, New York, New York, USA.
  • Dustin Hartzel
    Department of Imaging Science and Innovation, Geisinger, Danville, Pennsylvania.
  • Christopher Kelsey
    Information Technology Data Science, New York-Presbyterian Hospital, NY (C.M.H., J.F., D.H., L.J., A.K., C.K., D.R., J.R., D.v.M., P.E.).
  • Aaron Long
    Seymour, Paul, and Gloria Milstein Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center/New York-Presbyterian Hospital, NY (A.L., G.M., E.D., T.M., M.M., A.J.E., D.K., S.H., Q.L., V.A., M. Lebehn, M. Leon, R.H., P.E., T.J.P.).
  • Daniel Rocha
    Information Technology Data Science, New York-Presbyterian Hospital, NY (C.M.H., J.F., D.H., L.J., A.K., C.K., D.R., J.R., D.v.M., P.E.).
  • Jeffrey A Ruhl
    Department of Translational Data Science and Informatics (A.E.U-C., L.J., J.M.P., S.R., J.A.R., C.W.G., C.M.H., B.K.F., R.C.); Geisinger, Danville, PA.
  • David vanMaanen
    Information Technology Data Science, New York-Presbyterian Hospital, NY (C.M.H., J.F., D.H., L.J., A.K., C.K., D.R., J.R., D.v.M., P.E.).
  • Marc A Probst
    Department of Emergency Medicine, Columbia University Irving Medical Center, New York, New York, USA.
  • Brock Daniels
    Departments of Emergency Medicine and Population Health Sciences, Weill Cornell Medicine, New York, NY, USA.
  • Shalmali D Joshi
    Department of Biomedical Informatics, Columbia University, New York, NY, USA.
  • Olivier Tastet
    Department of Medicine, Montreal Heart Institute, Montreal, Quebec, Canada.
  • Denis Corbin
    Laboratoire d'Imagerie optique et Moléculaire, Polytechnique Montréal, 2500 Chemin de Polytechnique Montréal, Montreal, QC, H3T 1J4, Canada. denis.corbin@hotmail.com.
  • Robert Avram
    Division of Cardiology, Department of Medicine, Montreal Heart Institute, University of Montreal, Montreal, QC H1T 1C8, Canada. Electronic address: robert.avram.md@gmail.com.
  • Joshua P Barrios
    Department of Medicine, Division of Cardiology, University of California, San Francisco, 555 Mission Bay Blvd South Box 3120, San Francisco, CA 94158, USA.
  • Geoffrey H Tison
    Department of Medicine (G.H.T., M.H.L., E.F., M.A.A., C.J., K.E.F., R.C.D.).
  • I-Min Chiu
    Department of Emergency Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan.
  • David Ouyang
    Division of Artificial Intelligence, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California, USA.
  • Alexander Volodarskiy
    Department of Medicine, Division of Cardiology, NewYork-Presbyterian Hospital, New York, New York, USA.
  • Michelle Castillo
    Seymour, Paul, and Gloria Milstein Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York, NY, USA.
  • Francisco A Roedan Oliver
    Seymour, Paul, and Gloria Milstein Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York, NY, USA.
  • Paloma P Malta
    Seymour, Paul, and Gloria Milstein Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York, NY, USA.
  • Siqin Ye
    Seymour, Paul, and Gloria Milstein Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York, NY, USA.
  • Gregg F Rosner
    Seymour, Paul, and Gloria Milstein Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York, NY, USA.
  • Jose M Dizon
    Department of Medicine-Cardiology, Columbia University Irving Medical Center, New York (J.M.D.).
  • Shah R Ali
    From the Division of Cardiology; Department of Internal Medicine (S.R.A., H.A.S.), The University of Texas Southwestern Medical Center, Dallas.
  • Qi Liu
    National Institute of Traditional Chinese Medicine Constitution and Preventive Medicine, Beijing University of Chinese Medicine, Beijing, China.
  • Corey K Bradley
    Seymour, Paul, and Gloria Milstein Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York, NY, USA.
  • Prashant Vaishnava
    Seymour, Paul, and Gloria Milstein Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York, NY, USA.
  • Carol A Waksmonski
    Seymour, Paul, and Gloria Milstein Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York, NY, USA.
  • Ersilia M DeFilippis
    Seymour, Paul, and Gloria Milstein Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York, NY, USA.
  • Vratika Agarwal
    Seymour, Paul, and Gloria Milstein Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center/New York-Presbyterian Hospital, NY (A.L., G.M., E.D., T.M., M.M., A.J.E., D.K., S.H., Q.L., V.A., M. Lebehn, M. Leon, R.H., P.E., T.J.P.).
  • Mark Lebehn
    Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York, New York, USA.
  • Polydoros N Kampaktsis
  • Sofia Shames
    Seymour, Paul, and Gloria Milstein Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York, NY, USA.
  • Ashley N Beecy
  • Deepa Kumaraiah
    Seymour, Paul, and Gloria Milstein Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center and NewYork-Presbyterian Hospital, New York, New York, USA.
  • Shunichi Homma
    Department of Medicine, Columbia University, New York, NY, USA.
  • Allan Schwartz
    Seymour, Paul, and Gloria Milstein Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center and NewYork-Presbyterian Hospital, New York, New York, USA.
  • Rebecca T Hahn
    Seymour, Paul, and Gloria Milstein Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center and NewYork-Presbyterian Hospital, New York, New York, USA.
  • Martin Leon
    Seymour, Paul, and Gloria Milstein Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center/New York-Presbyterian Hospital, NY (A.L., G.M., E.D., T.M., M.M., A.J.E., D.K., S.H., Q.L., V.A., M. Lebehn, M. Leon, R.H., P.E., T.J.P.).
  • Andrew J Einstein
    Division of Cardiology, Department of Medicine, Columbia University Medical Center and New York-Presbyterian Hospital, New York, New York; Department of Radiology, Columbia University Medical Center and New York-Presbyterian Hospital, New York, New York.
  • Mathew S Maurer
    Division of Cardiology, Department of Medicine (L.W.L., M.S.M., M.P.R., Y.J.S.), Columbia University Irving Medical Center, New York, NY.
  • Heidi S Hartman
    Seymour, Paul, and Gloria Milstein Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York, NY, USA.
  • John Weston Hughes
    Electrical Engineering and Computer Science Department, University of California-Berkeley 465 Soda Hall, Berkeley, CA 94720-1776, USA.
  • Christopher M Haggerty
    IT Data Science, NewYork-Presbyterian Hospital, New York, New York, USA.
  • Pierre Elias
    Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York, NY.

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