Computer versus cardiologist: Is a machine learning algorithm able to outperform an expert in diagnosing a phospholamban p.Arg14del mutation on the electrocardiogram?

Hidde Bleijendaal, Lucas A Ramos, Ricardo R Lopes, Tom E Verstraelen, Sarah W E Baalman, Marinka D Oudkerk Pool, Fleur V Y Tjong, Francisco M Melgarejo-Meseguer, F Javier Gimeno-Blanes, Juan R Gimeno-Blanes, Ahmad S Amin, Michiel M Winter, Henk A Marquering, Wouter E M Kok, Aeilko H Zwinderman, Arthur A M Wilde, Yigal M Pinto

Research output: Contribution to journalArticleAcademicpeer-review

24 Citations (Scopus)


BACKGROUND: Phospholamban (PLN) p.Arg14del mutation carriers are known to develop dilated and/or arrhythmogenic cardiomyopathy, and typical electrocardiographic (ECG) features have been identified for diagnosis. Machine learning is a powerful tool used in ECG analysis and has shown to outperform cardiologists.

OBJECTIVES: We aimed to develop machine learning and deep learning models to diagnose PLN p.Arg14del cardiomyopathy using ECGs and evaluate their accuracy compared to an expert cardiologist.

METHODS: We included 155 adult PLN mutation carriers and 155 age- and sex-matched control subjects. Twenty-one PLN mutation carriers (13.4%) were classified as symptomatic (symptoms of heart failure or malignant ventricular arrhythmias). The data set was split into training and testing sets using 4-fold cross-validation. Multiple models were developed to discriminate between PLN mutation carriers and control subjects. For comparison, expert cardiologists classified the same data set. The best performing models were validated using an external PLN p.Arg14del mutation carrier data set from Murcia, Spain (n = 50). We applied occlusion maps to visualize the most contributing ECG regions.

RESULTS: In terms of specificity, expert cardiologists (0.99) outperformed all models (range 0.53-0.81). In terms of accuracy and sensitivity, experts (0.28 and 0.64) were outperformed by all models (sensitivity range 0.65-0.81). T-wave morphology was most important for classification of PLN p.Arg14del carriers. External validation showed comparable results, with the best model outperforming experts.

CONCLUSION: This study shows that machine learning can outperform experienced cardiologists in the diagnosis of PLN p.Arg14del cardiomyopathy and suggests that the shape of the T wave is of added importance to this diagnosis.

Original languageEnglish
Pages (from-to)79-87
Number of pages9
JournalHeart Rhythm
Issue number1
Early online date8 Sept 2020
Publication statusPublished - 1 Jan 2021


  • Cardiomyopathy
  • Deep learning
  • ECG analysis
  • Genetic heart disease
  • Machine learning
  • Phospholamban

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