The concepts of artificial intelligence (AI) was firstly reported in a publication of Alan Turing in 1937 (1). The term AI was used for the first time at the Dartmouth Conference in 1956 (2). AI is the product of the combination of sophisticated mathematical models and computation, which allows the development of complex algorithms capable of emulating human intelligence. The recent advances in computing power and the improvement of the quality of data allowed the expansion of Machine Learning (ML) algorithms. In cardiology, ML algorithms allows automated analysis and interpretation of data from, among others, electronic health records, electrocardiography, echocardiography computed tomography, magnetic resonance imaging, and yield to high-performance predictive models supporting decision-making that can improve diagnostic and prognostic performance. Several application of ML predictive models in cardiology were reported, predicting mainly: the deterioration of ventricular function in patients with repaired tetralogy of Fallot using support vector machine (3), the risk of occurrence of cardiovascular events using naïve Bayes fusion and genetic algorithm (4), survival using clinical and electrocardiographic variables with a random forest method (5), occurrence of cardiac arrest using artificial neural networks (6), bleeding after percutaneous coronary intervention using gradient boosting method (7) and more recently survival after transcatheter aortic valve replacement using data provided by the open-access National Inpatient Sample database (8).
ML-based predictive systems have major limitations: interpretability and overfitting. Building predictive models is inherently based on past events, and the future will not necessary resemble the past, nor will these models necessary perform well in a population different from the one represented in the training cohort (9).
There were also challenges for the clinical implementation of these models: ethical limits of use, data security, quality of data or healthy data, dealing with errors and staff remuneration concerns fearing the ability of these algorithm to replace physicians. Barone Rochette (10) stated that AI will probably change the work of cardiac imaging specialists. However, physicians will remain the final decision-maker in medical management on the basis of all elements of the patient’s medical report.
In conclusion, several successful applications of AI in cardiology has been reported allowing significant improvements in diagnosis, therapeutic and prognosis point of views. Healthy data are mandatory for the success of these algorithms. However, AI has to face several challenges for its implementation, specially, ethical limits and fear of the change of physician implication in the patient care. Therefore, physicians should strongly be involved in the development of this tool in order to integrate it adequately into diagnosis and therapeutic strategies.
Turing AM. On computable numbers, with an application to the Entscheidungs problem. Proc Lond Math Soc 1937;42:230–65.
- MooreJ. TheDartmouth College Artificial Intelligence Conference: The Next Fifty Years. AI Magazine. 2006;27(4):87-91.
- Samad MD, Wehner GJ, Arbabshirani MR, Jing L,Powell AJ ,Geva T,et al. Predicting deterioration of ventricular function in patients with repaired tetralogy of Fallot using machine learning. Eur Heart J Cardiovasc Imaging. 2018;19(7):730-8.
- Paredes S, Rocha T, de Carvalho P, Henriques J, Morais J, Ferreira J. Integration of different risk assessment tools to improve stratification of patients with coronary artery disease. Med Biol Eng Comput. 2015;53(10):1069-83.
- Samad MD, Ulloa A, Wehner GJ, Jing L, Hartzel D, Good CW, et al. Predicting survival from large echocardiography and electronic health record datasets: optimization with machine learning. JACC Cardiovasc Imaging. 2019;12(4):681-9.
- Kwon JM, Lee Y, Lee S, Park J. An algorithm based on deep learning for predicting in-hospital cardiac arrest. Am Heart Assoc. 2018;7(13): pii: e008678.
- Mortazavi BJ, Bucholz EM, Desai NR, Huang C, Curtis JP, Masoudi FA, et al. Comparison of machine learning methods with national cardiovascular data registry models for prediction of risk of bleeding after percutaneous coronary intervention. JAMA Netw Open. 2019;2(7):e196835.
- Hernandez-Suarez DF, Kim Y, Villablanca P, et al. Machine learning prediction models for in-hospital mortality after transcatheter aortic valve replacement. J Am Coll Cardiol Intv 2019;12: 1328–38.
- Chen JH, Asch SM. Machine learning and prediction in medicine—beyond the peak of inflated expectations. N Engl J Med 2017;376: 2507–9.
- Barone-Rochette G. Will artificial intelligence change the job of the cardiac imaging specialist? Arch Cardiovasc Dis (2019), https://doi.org/10.1016/j.acvd.2019.11.002