Why does cardiology need artificial intelligence?

Thomas Modine, MD PhD

Authors: W. Ben-Ali MD Ph.D1,2, P. Ouvertchouk MD1, A. Sudre MD1, T. Modine MD PhD

  1. Structural valve program, CHRU-Lille, Lille, France
  2. Department of cardiac surgery, Montreal Heart Institute, Montréal, Canada

The concepts of artificial intelligence (AI) was firstly reported in a publication of Alan Turing in 19371. The term AI was used for the first time at the Dartmouth Conference in 19562. 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 machine3, the risk of occurrence of cardiovascular events using naïve Bayes fusion and genetic algorithm4, survival using clinical and electrocardiographic variables with a random forest method5, occurrence of cardiac arrest using artificial neural networks6, bleeding after percutaneous coronary intervention using gradient boosting method7 and more recently survival after transcatheter aortic valve replacement using data provided by the open-access National Inpatient Sample database8.

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 cohort9.

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 Rochette10 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 have to face several challenges for its implementation, specially, ethical limits and fear of the change of physician implication in the patient care. Therefore, physician should strongly be involved in the development of this tool in order to integrate it adequately into diagnosis and therapeutic strategies.



 February 2020