2025
Artificial Intelligence–Enabled Prediction of Heart Failure Risk From Single-Lead Electrocardiograms
Dhingra L, Aminorroaya A, Pedroso A, Khunte A, Sangha V, McIntyre D, Chow C, Asselbergs F, Brant L, Barreto S, Ribeiro A, Krumholz H, Oikonomou E, Khera R. Artificial Intelligence–Enabled Prediction of Heart Failure Risk From Single-Lead Electrocardiograms. JAMA Cardiology 2025, 10 PMID: 40238120, PMCID: PMC12004248, DOI: 10.1001/jamacardio.2025.0492.Peer-Reviewed Original ResearchYale New Haven Health SystemELSA-BrasilPCP-HFNew-onset HFHarrell's C-statisticProspective population-based cohortUK Biobank (UKBBrazilian Longitudinal StudyELSA-Brasil participantsC-statisticPopulation-based cohortIntegrated discrimination improvementReclassification improvementRisk of deathUKB participantsHealth systemRetrospective cohort studyDiscrimination improvementMain OutcomesLeft ventricular systolic dysfunctionHF riskUKBCohort studySingle-lead ECGIndependent of ageDevelopment and Multinational Validation of an Ensemble Deep Learning Algorithm for Detecting and Predicting Structural Heart Disease Using Noisy Single-lead Electrocardiograms
Aminorroaya A, Dhingra L, Pedroso A, Shankar S, Coppi A, Khunte A, Foppa M, Brant L, Barreto S, Ribeiro A, Krumholz H, Oikonomou E, Khera R. Development and Multinational Validation of an Ensemble Deep Learning Algorithm for Detecting and Predicting Structural Heart Disease Using Noisy Single-lead Electrocardiograms. European Heart Journal - Digital Health 2025, ztaf034. DOI: 10.1093/ehjdh/ztaf034.Peer-Reviewed Original ResearchDetectable structural heart diseaseStructural heart diseaseCommunity-based screeningLeft-sided valvular diseaseHeart diseaseELSA-BrasilYale-New Haven HospitalAI-ECG algorithmDeep learning algorithmsPopulation-based cohortSevere LVHEchocardiographic dataPredictive biomarkersHospital-based sitesNew Haven HospitalRisk stratificationValvular diseaseEnsemble deep learning algorithmUK BiobankCommunity hospitalLead I ECGAutomated transformation of unstructured cardiovascular diagnostic reports into structured datasets using sequentially deployed large language models
Vasisht Shankar S, Dhingra L, Aminorroaya A, Adejumo P, Nadkarni G, Xu H, Brandt C, Oikonomou E, Pedroso A, Khera R. Automated transformation of unstructured cardiovascular diagnostic reports into structured datasets using sequentially deployed large language models. European Heart Journal - Digital Health 2025, ztaf030. DOI: 10.1093/ehjdh/ztaf030.Peer-Reviewed Original ResearchEnsemble Deep Learning Algorithm for Structural Heart Disease Screening Using Electrocardiographic Images PRESENT SHD
Dhingra L, Aminorroaya A, Sangha V, Pedroso A, Shankar S, Coppi A, Foppa M, Brant L, Barreto S, Ribeiro A, Krumholz H, Oikonomou E, Khera R. Ensemble Deep Learning Algorithm for Structural Heart Disease Screening Using Electrocardiographic Images PRESENT SHD. Journal Of The American College Of Cardiology 2025, 85: 1302-1313. PMID: 40139886, DOI: 10.1016/j.jacc.2025.01.030.Peer-Reviewed Original ResearchConceptsStructural heart diseaseYale-New Haven HospitalTransthoracic echocardiogramRisk stratificationHeart failureLeft-sided valvular diseaseSevere left ventricular hypertrophyLeft ventricular ejection fractionReceiver-operating characteristic curveVentricular ejection fractionLeft ventricular hypertrophyHeart disease screeningELSA-BrasilEnsemble deep learning algorithmRisk of deathConvolutional neural network modelEjection fractionEnsemble deep learning approachVentricular hypertrophyDeep learning algorithmsNew Haven HospitalDeep learning approachValvular diseaseNeural network modelClinical cohortHarnessing Artificial Intelligence for Innovation in Interventional Cardiovascular Care
Aminorroaya A, Biswas D, Pedroso A, Khera R. Harnessing Artificial Intelligence for Innovation in Interventional Cardiovascular Care. Journal Of The Society For Cardiovascular Angiography & Interventions 2025, 4: 102562. PMID: 40230673, PMCID: PMC11993883, DOI: 10.1016/j.jscai.2025.102562.Peer-Reviewed Original ResearchClinical careCommunity-based screening programCare quality outcomesPatient outcomesPatient-focused careHarness artificial intelligenceArtificial intelligencePotential of AIImprove patient outcomesIndividualized clinical careTransform careTransform clinical practiceCardiovascular careScreening programHealth dataQuality outcomesCareClinical workflowClinical tasksAcute coronary syndromeClinical practiceHeart diseaseAI-driven technologiesInterventionAI-enabledEvaluation of a Machine Learning-Guided Strategy for Elevated Lipoprotein(a) Screening in Health Systems
Aminorroaya A, Dhingra L, Oikonomou E, Khera R. Evaluation of a Machine Learning-Guided Strategy for Elevated Lipoprotein(a) Screening in Health Systems. Circulation Genomic And Precision Medicine 2025, 18: e004632. PMID: 39846171, PMCID: PMC11835527, DOI: 10.1161/circgen.124.004632.Peer-Reviewed Original ResearchConceptsYale New Haven Health SystemHealth systemVanderbilt University Medical CenterHealth system electronic health recordUniversity Medical CenterCoronary Artery Risk DevelopmentMulti-Ethnic Study of AtherosclerosisElectronic health recordsMedical CenterUS health systemHealth system patientsAssociated with significantly higher oddsMulti-Ethnic StudyUS-based cohortStudy of AtherosclerosisSignificantly higher oddsHealth recordsUK BiobankAtherosclerosis RiskRisk DevelopmentHigher oddsElevated Lp(aUniversal screeningSystem patientsStudy cohortHeart failure risk stratification using artificial intelligence applied to electrocardiogram images: a multinational study
Dhingra L, Aminorroaya A, Sangha V, Pedroso A, Asselbergs F, Brant L, Barreto S, Ribeiro A, Krumholz H, Oikonomou E, Khera R. Heart failure risk stratification using artificial intelligence applied to electrocardiogram images: a multinational study. European Heart Journal 2025, 46: 1044-1053. PMID: 39804243, DOI: 10.1093/eurheartj/ehae914.Peer-Reviewed Original ResearchYale New Haven Health SystemELSA-BrasilPCP-HFUK BiobankHF riskBrazilian Longitudinal Study of Adult HealthLongitudinal Study of Adult HealthBrazilian Longitudinal StudyRisk of new-onset HFPooled Cohort EquationsPrimary HF hospitalizationsHigher HF riskHarrell's C-statisticRisk of deathNew-onset HFCohort EquationsHealth systemComprehensive clinical evaluationAdult healthHeart failureIncident HFHF hospitalizationBaseline HFC-statisticPrevent HF
2024
A Multicenter Evaluation of the Impact of Therapies on Deep Learning-Based Electrocardiographic Hypertrophic Cardiomyopathy Markers
Dhingra L, Sangha V, Aminorroaya A, Bryde R, Gaballa A, Ali A, Mehra N, Krumholz H, Sen S, Kramer C, Martinez M, Desai M, Oikonomou E, Khera R. A Multicenter Evaluation of the Impact of Therapies on Deep Learning-Based Electrocardiographic Hypertrophic Cardiomyopathy Markers. The American Journal Of Cardiology 2024, 237: 35-40. PMID: 39581517, PMCID: PMC11761372, DOI: 10.1016/j.amjcard.2024.11.028.Peer-Reviewed Original ResearchCleveland Clinic FoundationHypertrophic cardiomyopathyMedian follow-up periodHypertrophic cardiomyopathy therapyMonitoring treatment responseFollow-up periodImpact of therapyAtlantic Health SystemLack of improvementOral alternativePost-SRTMedical therapyTreatment responseMulticenter evaluationInterventricular septumPercutaneous reductionMavacamtenTherapyPatientsClinic FoundationPoint-of-care monitoringECGECG imagesScoresHealth systemNatural Language Processing of Clinical Documentation to Assess Functional Status in Patients With Heart Failure
Adejumo P, Thangaraj P, Dhingra L, Aminorroaya A, Zhou X, Brandt C, Xu H, Krumholz H, Khera R. Natural Language Processing of Clinical Documentation to Assess Functional Status in Patients With Heart Failure. JAMA Network Open 2024, 7: e2443925. PMID: 39509128, PMCID: PMC11544492, DOI: 10.1001/jamanetworkopen.2024.43925.Peer-Reviewed Original ResearchConceptsFunctional status assessmentArea under the receiver operating characteristic curveClinical documentationElectronic health record dataHF symptomsOptimal care deliveryHealth record dataAssess functional statusStatus assessmentClinical trial participationProcessing of clinical documentsFunctional status groupCare deliveryOutpatient careMain OutcomesMedical notesTrial participantsNew York Heart AssociationFunctional statusQuality improvementRecord dataHeart failureClinical notesDiagnostic studiesStatus groupsArtificial Intelligence–Enhanced Risk Stratification of Cancer Therapeutics–Related Cardiac Dysfunction Using Electrocardiographic Images
Oikonomou E, Sangha V, Dhingra L, Aminorroaya A, Coppi A, Krumholz H, Baldassarre L, Khera R. Artificial Intelligence–Enhanced Risk Stratification of Cancer Therapeutics–Related Cardiac Dysfunction Using Electrocardiographic Images. Circulation Cardiovascular Quality And Outcomes 2024, 18: e011504. PMID: 39221857, PMCID: PMC11745701, DOI: 10.1161/circoutcomes.124.011504.Peer-Reviewed Original ResearchCancer therapeutics-related cardiac dysfunctionGlobal longitudinal strainLeft ventricular systolic dysfunctionCardiac dysfunctionBreast cancerNon-Hodgkin lymphoma therapyNon-Hodgkin's lymphomaVentricular systolic dysfunctionAssociated with worse global longitudinal strainRisk stratification strategiesHigh-risk groupMonths post-treatmentPost hoc analysisElectrocardiographic (ECGTrastuzumab exposureLymphoma therapySystolic dysfunctionAI-ECGBefore treatmentRisk biomarkersLongitudinal strainLow riskStratification strategiesHigher incidencePositive screenComparative Effectiveness of Second-Line Antihyperglycemic Agents for Cardiovascular Outcomes A Multinational, Federated Analysis of LEGEND-T2DM
Khera R, Aminorroaya A, Dhingra L, Thangaraj P, Pedroso Camargos A, Bu F, Ding X, Nishimura A, Anand T, Arshad F, Blacketer C, Chai Y, Chattopadhyay S, Cook M, Dorr D, Duarte-Salles T, DuVall S, Falconer T, French T, Hanchrow E, Kaur G, Lau W, Li J, Li K, Liu Y, Lu Y, Man K, Matheny M, Mathioudakis N, McLeggon J, McLemore M, Minty E, Morales D, Nagy P, Ostropolets A, Pistillo A, Phan T, Pratt N, Reyes C, Richter L, Ross J, Ruan E, Seager S, Simon K, Viernes B, Yang J, Yin C, You S, Zhou J, Ryan P, Schuemie M, Krumholz H, Hripcsak G, Suchard M. Comparative Effectiveness of Second-Line Antihyperglycemic Agents for Cardiovascular Outcomes A Multinational, Federated Analysis of LEGEND-T2DM. Journal Of The American College Of Cardiology 2024, 84: 904-917. PMID: 39197980, PMCID: PMC12045554, DOI: 10.1016/j.jacc.2024.05.069.Peer-Reviewed Original ResearchConceptsGLP-1 RAsSecond-line agentsGLP-1Antihyperglycemic agentsCardiovascular diseaseMACE riskGlucagon-like peptide-1 receptor agonistsSodium-glucose cotransporter 2 inhibitorsPeptide-1 receptor agonistsDipeptidyl peptidase-4 inhibitorsEffects of SGLT2isType 2 diabetes mellitusPeptidase-4 inhibitorsAdverse cardiovascular eventsCox proportional hazards modelsRandom-effects meta-analysisCardiovascular risk reductionTarget trial emulationProportional hazards modelCorrelation between hospital rates of survival to discharge and long-term survival for in-hospital cardiac arrest: Insights from Get With The Guidelines®-Resuscitation registry
Khera R, Aminorroaya A, Kennedy K, Chan P, Investigators A, Grossestreuer A, Moskowitz A, Ornato J, Churpek M, Starks M, Girotra S, Perman S. Correlation between hospital rates of survival to discharge and long-term survival for in-hospital cardiac arrest: Insights from Get With The Guidelines®-Resuscitation registry. Resuscitation 2024, 202: 110322. PMID: 39029583, PMCID: PMC11390317, DOI: 10.1016/j.resuscitation.2024.110322.Peer-Reviewed Original ResearchRisk-standardized survival ratesIn-hospital cardiac arrestWeighted kappa coefficientResuscitation RegistryLong-term survivalSurvivors of in-hospital cardiac arrestHierarchical logistic regression modelsCardiac arrestIn-hospitalLogistic regression modelsLong-term outcomesSurvival dataKappa coefficientHospital performanceIn-hospital survivalMedicare filesMedicare beneficiariesYears of ageHospitalization ratesPost-discharge survivalHospital dischargeRate of survivalMedicareHospitalRegression modelsPerformance of contemporary cardiovascular risk stratification scores in Brazil: an evaluation in the ELSA-Brasil study
Camargos A, Barreto S, Brant L, Ribeiro A, Dhingra L, Aminorroaya A, Bittencourt M, Figueiredo R, Khera R. Performance of contemporary cardiovascular risk stratification scores in Brazil: an evaluation in the ELSA-Brasil study. Open Heart 2024, 11: e002762. PMID: 38862252, PMCID: PMC11168182, DOI: 10.1136/openhrt-2024-002762.Peer-Reviewed Original ResearchConceptsPooled Cohort EquationsELSA-BrasilRisk scoreCardiovascular diseaseCVD eventsCommunity-based cohort studyArea under the receiver operating characteristic curveCVD risk scoreELSA-Brasil studyIncident CVD eventsMiddle-income countriesAdjudicated CVD eventsCardiovascular disease riskCVD scoreCohort EquationsNational guidelinesRisk stratification scoresWhite womenAge/sex groupsCohort studyProspective cohortLMICsSex/race groupsHigher incomeRisk discriminationDevelopment and multinational validation of an algorithmic strategy for high Lp(a) screening
Aminorroaya A, Dhingra L, Oikonomou E, Saadatagah S, Thangaraj P, Vasisht Shankar S, Spatz E, Khera R. Development and multinational validation of an algorithmic strategy for high Lp(a) screening. Nature Cardiovascular Research 2024, 3: 558-566. PMID: 39195936, DOI: 10.1038/s44161-024-00469-1.Peer-Reviewed Original ResearchElectronic health recordsAssociated with premature atherosclerotic cardiovascular diseaseElevated Lp(aHealth recordsUK BiobankPremature atherosclerotic cardiovascular diseaseMachine learning modelsAtherosclerotic cardiovascular diseaseCohort studyReal-world settingsTargeted screeningCardiovascular diseaseLearning modelsNovel targeted therapeuticsAlgorithmic strategiesCohortProbability thresholdScreeningClinical featuresValidation cohortElevated lipoproteinRisk inspectionARICLp(aReal-world evaluation of an algorithmic machine-learning-guided testing approach in stable chest pain: a multinational, multicohort study
Oikonomou E, Aminorroaya A, Dhingra L, Partridge C, Velazquez E, Desai N, Krumholz H, Miller E, Khera R. Real-world evaluation of an algorithmic machine-learning-guided testing approach in stable chest pain: a multinational, multicohort study. European Heart Journal - Digital Health 2024, 5: 303-313. PMID: 38774380, PMCID: PMC11104476, DOI: 10.1093/ehjdh/ztae023.Peer-Reviewed Original ResearchRisk of acute myocardial infarctionAssociated with lower oddsHospital health systemCoronary artery diseaseCardiac testingRisk of adverse outcomesUK BiobankHealth systemProvider-drivenLower oddsAssociated with better outcomesAcute myocardial infarctionBlack raceStable chest painFemale sexReal world evaluationDiabetes historyMulticohort studyFunction testsSuspected coronary artery diseaseYounger ageRisk profileAdverse outcomesMultinational cohortPost hoc analysisBurden of Ischemic Heart Disease and Its Attributable Risk Factors in North Africa and the Middle East, 1990 to 2019: Results From the GBD Study 2019
Aminorroaya A, Moghaddam S, Tavolinejad H, Aryan Z, Heidari B, Ebrahimi H, Naderian M, Shobeiri P, Ghanbari A, Rezaei N, Malekpour M, Haghshenas R, Rezaei N, Larijani B, Farzadfar F. Burden of Ischemic Heart Disease and Its Attributable Risk Factors in North Africa and the Middle East, 1990 to 2019: Results From the GBD Study 2019. Journal Of The American Heart Association 2024, 13: e030165. PMID: 37956220, PMCID: PMC10926818, DOI: 10.1161/jaha.123.030165.Peer-Reviewed Original ResearchConceptsDisability-adjusted life yearsBurden of ischemic heart diseaseDisability-adjusted life year ratesRates of ischemic heart diseaseIschemic heart diseaseRisk factorsMortality of ischemic heart diseaseEpidemiology of ischemic heart diseaseIschemic heart disease burdenHigh low-density lipoprotein cholesterolDietary risk factorsLost disability-adjusted life yearsYears of lifeHeart diseaseGBD studyPremature mortalityLow-density lipoprotein cholesterolSystolic blood pressureHighest burdenMetabolic riskBehavioral risksLife yearsPremature deathContemporary epidemiologyLipoprotein cholesterol
2023
Multinational patterns of second line antihyperglycaemic drug initiation across cardiovascular risk groups: federated pharmacoepidemiological evaluation in LEGEND-T2DM
Khera R, Dhingra L, Aminorroaya A, Li K, Zhou J, Arshad F, Blacketer C, Bowring M, Bu F, Cook M, Dorr D, Duarte-Salles T, DuVall S, Falconer T, French T, Hanchrow E, Horban S, Lau W, Li J, Liu Y, Lu Y, Man K, Matheny M, Mathioudakis N, McLemore M, Minty E, Morales D, Nagy P, Nishimura A, Ostropolets A, Pistillo A, Posada J, Pratt N, Reyes C, Ross J, Seager S, Shah N, Simon K, Wan E, Yang J, Yin C, You S, Schuemie M, Ryan P, Hripcsak G, Krumholz H, Suchard M. Multinational patterns of second line antihyperglycaemic drug initiation across cardiovascular risk groups: federated pharmacoepidemiological evaluation in LEGEND-T2DM. BMJ Medicine 2023, 2: e000651. PMID: 37829182, PMCID: PMC10565313, DOI: 10.1136/bmjmed-2023-000651.Peer-Reviewed Original ResearchType 2 diabetes mellitusSecond-line treatmentCardiovascular risk groupsDiabetes mellitusCardiovascular diseaseAntihyperglycaemic drugsLine treatmentRisk groupsObservational Health Data SciencesGlucagon-like peptide-1 receptor agonistsElectronic health recordsSodium-glucose cotransporter 2 inhibitorsCalendar year trendsPeptide-1 receptor agonistsUS databaseOutcomes of patientsCotransporter 2 inhibitorsAdministrative claims databaseSecond-line drugsHealth recordsSodium-glucose cotransporter-2 inhibitorsMedication useMetformin monotherapyGuideline recommendationsOutcome measuresRisk of incident cardiovascular diseases at national and subnational levels in Iran from 2000 to 2016 and projection through 2030: Insights from Iran STEPS surveys
Ebrahimi H, Masinaei M, Aminorroaya A, Aryan Z, Mehdipour P, Rostam-Abadi Y, Ahmadi N, Moghaddam S, Pishgar F, Ghanbari A, Rezaei N, Takian A, Farzadfar F. Risk of incident cardiovascular diseases at national and subnational levels in Iran from 2000 to 2016 and projection through 2030: Insights from Iran STEPS surveys. PLOS ONE 2023, 18: e0290006. PMID: 37611004, PMCID: PMC10446220, DOI: 10.1371/journal.pone.0290006.Peer-Reviewed Original ResearchConceptsCardiovascular disease riskRisk of cardiovascular diseaseNon-communicable disease risk factor surveillanceCardiovascular diseaseCVD riskWorld Health OrganizationRisk of incident cardiovascular diseaseRisk factor surveillanceFramingham 10-year CVD riskAdult Iranian populationIncident cardiovascular diseaseRisk factor modificationCardiovascular disease risk stratificationEvidence-based decisionsFramingham modelHealth policyNationally representative datasetFactor modificationRisk estimation modelIranian populationHealth OrganizationFraminghamSurvey's backgroundRiskSubnational levelUse of Smart Devices to Track Cardiovascular Health Goals in the United States
Aminorroaya A, Dhingra L, Nargesi A, Oikonomou E, Krumholz H, Khera R. Use of Smart Devices to Track Cardiovascular Health Goals in the United States. JACC Advances 2023, 2: 100544. PMID: 38094515, PMCID: PMC10718569, DOI: 10.1016/j.jacadv.2023.100544.Peer-Reviewed Original ResearchHealth goalsRisk of cardiovascular diseaseCardiovascular risk factorsNationally representative Health Information National Trends SurveyHealth Information National Trends SurveyU.S. adultsCardiovascular diseaseNational Trends SurveyRisk factors of hypertensionDigital health interventionsCardiovascular health goalsHealth-related goalsRisk of CVDFactors of hypertensionU.S. adult populationCardiovascular risk managementHigher educational attainmentLow-income individualsSmart devicesTrends SurveyImprove careHealth interventionsNational estimatesRisk factorsSurvey participantsDetection of left ventricular systolic dysfunction from single-lead electrocardiography adapted for portable and wearable devices
Khunte A, Sangha V, Oikonomou E, Dhingra L, Aminorroaya A, Mortazavi B, Coppi A, Brandt C, Krumholz H, Khera R. Detection of left ventricular systolic dysfunction from single-lead electrocardiography adapted for portable and wearable devices. Npj Digital Medicine 2023, 6: 124. PMID: 37433874, PMCID: PMC10336107, DOI: 10.1038/s41746-023-00869-w.Peer-Reviewed Original ResearchArtificial intelligenceRandom Gaussian noiseNoisy electrocardiogramGaussian noiseElectrocardiogram (ECGWearable devicesSingle-lead electrocardiogramPortable devicesSNRWearableNoiseDevice noiseRepositoryAI-based screeningIntelligenceDetectionDevicesNoise sourcesVentricular systolic dysfunctionModelElectrocardiogramSingle-lead electrocardiographyTraining
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