Prediction of biological age and all-cause mortality by 12-lead electrocardiogram in patients without structural heart disease

Abstract

Background There is a well-established relationship between 12-lead electrocardiogram (ECG) and age and mortality. Furthermore, there is increasing evidence that ECG can be used to predict biological age. However, the utility of biological age from ECG for predicting mortality remains unclear. Methods This was a single-center cohort study from a cardiology specialized hospital. A total of 19,170 patients registered in this study from February 2010 to March 2018. ECG was analyzed in a final 12,837 patients after excluding those with structural heart disease or with pacing beats, atrial or ventricular tachyarrhythmia, or an indeterminate axis (R axis > 180°) on index ECG. The models for biological age were developed by principal component analysis (BA) and the Klemera and Doubal’s method (not adjusted for age [BAE] and adjusted for age [BAEC]) using 438 ECG parameters. The predictive capability for all-cause death and cardiovascular death by chronological age (CA) and biological age using the three algorithms were evaluated by receiver operating characteristic analysis. Results During the mean follow-up period of 320.4 days, there were 55 all-cause deaths and 23 cardiovascular deaths. The predictive capabilities for all-cause death by BA, BAE, and BAEC using area under the curves were 0.731, 0.657, and 0.685, respectively, which were comparable to 0.725 for CA (p = 0.760, 0.141, and 0.308, respectively). The predictive capabilities for cardiovascular death by BA, BAE, and BAEC were 0.682, 0.685, and 0.692, respectively, which were also comparable to 0.674 for CA (p = 0.775, 0.839, and 0.706, respectively). In patients aged 60–74 years old, the area under the curves for all-cause death by BA, BAE, and BAEC were 0.619, 0.702, and 0.697, respectively, which tended to be or were significantly higher than 0.482 for CA (p = 0.064, 0.006, and 0.005, respectively). Conclusion Biological age by 12-lead ECG showed a similar predictive capability for mortality compared to CA among total patients, but partially showed a significant increase in predictive capability among patients aged 60–74 years old.

Electrocardiogram-Based Heart Age Estimation by a Deep Learning Model Provides More Information on the Incidence of Cardiovascular Disorders

“…In this study, we have achieved comparable accuracy to previous studies in age predictions (23)(24)(25)(26). The ECG-age is correlated with mortality which was known by many heuristic studies (24)(25)(26). Here, we demonstrated that ECG-age was not only correlated with mortality but also extensive CVD-related outcomes.…”

“…In this study, we have achieved comparable accuracy to previous studies in age predictions (23)(24)(25)(26). The ECG-age is correlated with mortality which was known by many heuristic studies (24)(25)(26).…”

“…The CVD guideline which published by the National Vascular Disease Prevention Alliance in Australia incorporates ECG and traditional CVD risk factors to achieve better CVD event risk prediction (31). Many studies were dedicated to obtaining more information from ECG, such as predicting serum potassium concentration (13), and the presence of AF in the future (21), or predicting mortality from a 12-lead ECG (24)(25)(26). Although current CVD risk prediction models and ECG abnormalities provide great information regarding CVD events and outcomes, they lack integration, which is not convenient for clinical use.…”

“…mortality and cardiovascular mortality (23). Currently, many research teams had pointed out the strength of mortality risk stratification using ECG-age (24)(25)(26). However, the application potential of ECG-age was not extensively explored.…”

Heart age estimated using explainable advanced electrocardiography

“…a “Heart Age Gap”. A Heart Age can either be determined by translating risk factor scores to what age a resultant score would represent in an individual with no risk factors, or it can be based on electrocardiographic changes 7 – 14 . Describing the risk to the patient using Heart Age has been reported to reduce metabolic risk factors and may have the advantage of being easily understood by the patient 11 , 15 .…”