An artificial intelligence (AI) tool paired with the single-lead electrocardiogram (ECG) sensors on a smartwatch accurately diagnosed structural heart diseases, such as weakened pumping ability, damaged valves or thickened heart muscle, according to a preliminary study to be presented at the American Heart Association's Scientific Sessions 2025.
Researchers said this is the first prospective study to show that an AI algorithm can detect multiple structural heart diseases based on measures taken from a single-lead ECG sensor on the back and digital crown of a smartwatch. The findings, while preliminary, suggest that smartwatches combined with AI could make screening for these conditions more accessible.
"Millions of people wear smartwatches, and they are currently mainly used to detect heart rhythm problems such as atrial fibrillation. Structural heart diseases, on the other hand, are usually found with an echocardiogram, an advanced ultrasound imaging test of the heart that requires special equipment and isn't widely available for routine screening," said study author Arya Aminorroaya, M.D., M.P.H., an internal medicine resident at Yale New Haven Hospital and a research affiliate at the Cardiovascular Data Science (CarDS) Lab at Yale School of Medicine. "In our study, we explored whether the same smartwatches people wear every day could also help find these hidden structural heart diseases earlier, before they progress to serious complications or cardiac events."
The research team developed the AI algorithm using more than 266,000 12-lead ECG recordings from more than 110,000 adults. They adapted it to interpret single-lead ECGs by isolating one lead and accounting for real-world interference. After external validation, they prospectively recruited 600 participants who underwent 30-second, single-lead ECGs using a smartwatch. The algorithm accurately identified structural heart disease with 88% performance on a standard scale, 86% sensitivity, and 99% negative predictive value.
"On its own, a single-lead ECG is limited; it can't replace a 12-lead ECG test available in health care settings. However, with AI, it becomes powerful enough to screen for important heart conditions," said Rohan Khera, M.D., M.S., senior author and director of the CarDS Lab. "This could make early screening for structural heart disease possible on a large scale, using devices many people already own."
The study limitations include a small number of patients with the actual disease and the number of false positive results. The researchers plan to evaluate the AI tool in broader settings and explore integration into community screening programs. The abstract is available at the Scientific Sessions 2025 Online Program Planner.
