{
  "abstract": "Background\n\nCardiomyopathy significantly impacts maternal health worldwide. Artificial intelligence-enabled electrocardiograms (AI-ECG) have shown effectiveness in detecting left ventricular systolic dysfunction (LVSD) in adults and limited obstetric cohorts; however, broad validation in diverse obstetric populations remains unexplored.Objectives\n\nOur primary objective was to validate the performance of 2 versions of an AI-ECG model for detecting cardiomyopathy in an international obstetric cohort.Methods\n\nWe conducted a retrospective, multisite study of pregnant or postpartum women (≤12 months) across 11 institutions in 4 countries (Israel, Nigeria, Pakistan, and the United States). Two AI-ECG models (Food and Drug Administration-cleared v2.5.0 and refined v3.0.0) were evaluated against echocardiography. LVSD was defined as left ventricular ejection fraction ≤40% in keeping with the model's training target. Model performance was assessed by area under the receiver-operating characteristic curve (AUROC).Results\n\nWe included 1,820 women with paired ECG-echocardiogram data, of whom 7.3% had LVSD. Model 1 (v2.5.0) demonstrated strong discriminative performance with an AUROC of 0.865, sensitivity of 46.1%, and negative predictive value of 95.8%. Model 2 (v3.0.0) showed significantly improved performance, with an AUROC of 0.925, sensitivity of 64.1%, and negative predictive value of 97.2% (P < 0.001) for LVSD detection.Conclusions\n\nAI-ECG models demonstrated strong external validity in a global obstetric cohort, with significantly improved performance in the refined model trained on expanded data. These findings support the potential role of AI-ECG for a scalable LVSD screening tool in obstetric populations, while underscoring the importance of population-specific validation prior to clinical implementation.",
  "abstract_shown": true,
  "affiliations": [
    "Department of Cardiovascular Medicine, Mayo Clinic, Jacksonville, Florida, USA. Electronic address: adedinsewo.demilade@mayo.edu.",
    "Department of Quantitative Health Sciences, Mayo Clinic, Jacksonville, Florida, USA.",
    "Department of Radiology, Emory University School of Medicine, Atlanta, Georgia, USA.",
    "Department of Cardiovascular Medicine, Mayo Clinic, Jacksonville, Florida, USA.",
    "Leviev Heart Center, Sheba Medical Center, Ramat Gan, Israel; ARC Innovation Center, Sagol AI Hub, Sheba Medical Center, Ramat Gan, Israel.",
    "Leviev Heart Center, Sheba Medical Center, Ramat Gan, Israel; ARC Innovation Center, Sagol AI Hub, Sheba Medical Center, Ramat Gan, Israel; Gray Faculty of Medical and Health Sciences, Tel Aviv University, Ramat Aviv, Tel Aviv, Israel.",
    "Leviev Heart Center, Sheba Medical Center, Ramat Gan, Israel; Department of Military Medicine, Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel.",
    "Department of Obstetrics and Gynecology, The Sheba Medical Center, Tel Hashomer, Israel; The Dina Recanati School of Medicine, Reichman University, Herzliya, Israel.",
    "ARC Innovation Center, Sagol AI Hub, Sheba Medical Center, Ramat Gan, Israel; Department of Obstetrics and Gynecology, The Sheba Medical Center, Tel Hashomer, Israel.",
    "Department of Medicine, Aminu Kanu Teaching Hospital and Bayero University, Kano, Nigeria.",
    "Department of Obstetrics and Gynecology, College of Medicine, University of Lagos, Idi-Araba, Lagos, Nigeria; Centre for Clinical Trials, Research and Implementation Science, University of Lagos College of Medicine, Idi-Araba, Lagos, Nigeria.",
    "Department of Obstetrics and Gynecology, Olabisi Onabanjo University Teaching Hospital, Sagamu, Ogun, Nigeria.",
    "Department of Medicine, Rasheed Shekoni Federal University Teaching Hospital, Dutse, Jigawa, Nigeria.",
    "Department of Obstetrics and Gynecology, University of Ilorin Teaching Hospital, Ilorin, Nigeria.",
    "Cardiology Unit, Department of Medicine, University of Ibadan, Ibadan, Oyo, Nigeria.",
    "Department of Adult Cardiology, National Institute of Cardiovascular Diseases (NICVD), Karachi, Pakistan; Department of Cardiology, Rutgers Robert Wood Johnson University Hospital, New Brunswick, New Jersey, USA.",
    "Department of Adult Cardiology, National Institute of Cardiovascular Diseases (NICVD), Karachi, Pakistan.",
    "Department of Obstetrics and Gynecology, Jinnah Postgraduate Medical Centre (JPMC), Jinnah Sindh Medical University, Karachi, Pakistan.",
    "Baptist Beaches Cardiology Center, Baptist Health, Jacksonville, Florida, USA.",
    "Department of Transplant, Mayo Clinic, Jacksonville, Florida, USA.",
    "Department of Cardiology, University of Florida College of Medicine, Jacksonville, Florida, USA.",
    "Department of Obstetrics and Gynecology, University of Florida College of Medicine, Jacksonville, Florida, USA.",
    "Department of Cardiology, Morehouse School of Medicine, Atlanta, Georgia, USA.",
    "Department of Cardiology, West Georgia Cardiology, Carrollton, Georgia, USA.",
    "Department of Obstetrics and Gynecology, Morehouse School of Medicine, Atlanta, Georgia, USA; Center for Maternal Health Equity, Department of Community Health and Preventive Medicine, Morehouse School of Medicine, Atlanta, Georgia, USA.",
    "Department of Cardiology, Essentia Health Heart and Vascular Center, Fargo, North Dakota, USA.",
    "Department of Obstetrics and Gynecology, Essentia Health, Fargo, North Dakota, USA.",
    "Anumana Inc, Cambridge, Massachusetts, USA; Nference Inc, Cambridge, Massachusetts, USA.",
    "Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, Minnesota, USA.",
    "Department of Cardiology, Mayo Clinic, Rochester, Minnesota, USA."
  ],
  "article_type": "research article",
  "arxiv": null,
  "author_total": 37,
  "authors": [
    {
      "affs": [
        0
      ],
      "name": "Demilade Adedinsewo",
      "orcid": "0000-0002-8629-2029"
    },
    {
      "affs": [
        1
      ],
      "name": "Patrick W Johnson"
    },
    {
      "affs": [
        2
      ],
      "name": "Carolina Morales-Lara"
    },
    {
      "affs": [
        3
      ],
      "name": "Maria Vitoria Coutinho"
    },
    {
      "affs": [
        3
      ],
      "name": "Sabrina D Phillips"
    },
    {
      "affs": [
        1
      ],
      "name": "Marc A Eidelhoch"
    },
    {
      "affs": [
        4
      ],
      "name": "Michal Cohen-Shelly"
    },
    {
      "affs": [
        5
      ],
      "name": "Elad Maor",
      "orcid": "0000-0002-5087-0464"
    },
    {
      "affs": [
        6
      ],
      "name": "Ariel Furer"
    },
    {
      "affs": [
        7
      ],
      "name": "Abraham Tsur"
    },
    {
      "affs": [
        8
      ],
      "name": "Shali Mazaki-Tovi"
    },
    {
      "affs": [
        9
      ],
      "name": "Kamilu M Karaye"
    },
    {
      "affs": [
        10
      ],
      "name": "Bosede Bukola Afolabi"
    },
    {
      "affs": [
        11
      ],
      "name": "Olusoji Edward Jagun"
    },
    {
      "affs": [
        12
      ],
      "name": "Sadiq Hassan Ringim"
    },
    {
      "affs": [
        13
      ],
      "name": "Kehinde Femi Ibiyemi",
      "orcid": "0000-0002-0125-7276"
    },
    {
      "affs": [
        14
      ],
      "name": "Okechukwu Samuel Ogah"
    },
    {
      "affs": [
        15
      ],
      "name": "Sabha Bhatti"
    },
    {
      "affs": [
        16
      ],
      "name": "Shakeela Naz"
    },
    {
      "affs": [
        17
      ],
      "name": "Haleema Yasmin"
    },
    {
      "affs": [
        18
      ],
      "name": "Maedeh Ganji"
    },
    {
      "affs": [
        19
      ],
      "name": "Jose Ruiz"
    },
    {
      "affs": [
        20
      ],
      "name": "Khadeeja Esmail"
    },
    {
      "affs": [
        21
      ],
      "name": "Jason Wheatley"
    },
    {
      "affs": [
        22
      ],
      "name": "Anekwe Onwuanyi"
    },
    {
      "affs": [
        23
      ],
      "name": "Eric Chang"
    },
    {
      "affs": [
        24
      ],
      "name": "Myah M Griffin"
    },
    {
      "affs": [
        25
      ],
      "name": "Oludamilola Oluleye"
    },
    {
      "affs": [
        26
      ],
      "name": "Stefanie Gefroh"
    },
    {
      "affs": [
        27
      ],
      "name": "Mohan Krishna Ranganathan"
    },
    {
      "affs": [
        27
      ],
      "name": "Samir Awasthi"
    },
    {
      "affs": [
        28
      ],
      "name": "Yvonne Butler Tobah"
    },
    {
      "affs": [
        29
      ],
      "name": "Francisco Lopez-Jimenez"
    },
    {
      "affs": [
        29
      ],
      "name": "Zachi I Attia"
    },
    {
      "affs": [
        29
      ],
      "name": "Paul A Friedman"
    },
    {
      "affs": [
        29
      ],
      "name": "Peter A Noseworthy"
    },
    {
      "affs": [
        1
      ],
      "name": "Rickey E Carter"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/08gk9zf2j8jd6.bib",
  "cited_by": 0,
  "doi": "10.1016/j.jacadv.2026.103321",
  "fulltext_url": "https://europepmc.org/articles/PMC13682377",
  "id": "08gk9zf2j8jd6",
  "issns": [
    "2772-963X"
  ],
  "landing_url": "https://europepmc.org/article/MED/42863355",
  "language": "eng",
  "licence": "CC-BY",
  "licence_label": "CC BY",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "openalex",
      "2705|ECG Monitoring and Analysis"
    ]
  ],
  "openalex": "W7214050982",
  "pdf_url": "https://europepmc.org/articles/PMC13682377?pdf=render",
  "pmcid": "PMC13682377",
  "pmid": "42863355",
  "published": "2026-09-22",
  "publisher": null,
  "ris": "https://research.draconitic.com/paper/08gk9zf2j8jd6.ris",
  "sources": [
    {
      "first_seen": "2026-10-30T12:19:16Z",
      "native_id": "MED:42863355",
      "source": "europepmc",
      "url": "https://europepmc.org/article/MED/42863355"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "openalex:2705|ECG Monitoring and Analysis",
      "subfield": "cardiovascular"
    }
  ],
  "title": "Validating ECG-Based Artificial Intelligence Models for Cardiomyopathy Detection in Obstetric Patients: A Multisite International Study.",
  "title_text": "Validating ECG-Based Artificial Intelligence Models for Cardiomyopathy Detection in Obstetric Patients: A Multisite International Study.",
  "type": "peer-reviewed",
  "updated_at": "2026-10-30T12:19:16Z",
  "url": "https://research.draconitic.com/paper/08gk9zf2j8jd6",
  "venue": "JACC. Advances",
  "versions": []
}