Explainable artificial intelligence identifies and localizes left ventricular scar in hypertrophic cardiomyopathy using 12-Lead electrocardiogram
Bibliographic record
Abstract
Left ventricular (LV) scar is a major risk factor for sudden death and heart failure in hypertrophic cardiomyopathy (HCM). LV scar evolves over time and needs longitudinal assessment. Currently, LV scar detection relies on late gadolinium enhancement MRI, which is limited by high cost and artifacts from implanted cardiac devices. To address this, we developed XplainScar, an explainable machine learning model that identifies LV scar using 12-lead electrocardiogram (ECG) data. XplainScar was trained and validated on retrospective data from 748 HCM patients across two centers (500 from Johns Hopkins hospital for model development, and 248 from UCSF for validation). XplainScar employs a combination of unsupervised and self-supervised representation learning to effectively predict scar presence, and discover ECG features associated with LV scar. XplainScar rapidly analyzes ECG data (< 1 min for 10 patients) and demonstrates strong predictive performance on the held-out test set, achieving an F1-score of 89%, sensitivity of 90%, specificity of 78%, and precision of 88%. By providing an effective, cost-effective, and transparent alternative to MRI, XplainScar has the potential to assist with patient care, and reduce healthcare costs related to LV scar monitoring in HCM. XplainScar is available at https://github.com/KasraNezamabadi/XplainScar .
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.003 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".