Systematic ReviewResearchQuality Improvement

Meta-analysis of 538,735 patients finds AI-enabled ECG detects asymptomatic systolic heart failure with high discriminatory accuracy

American journal of preventive cardiology (PubMed)May 30, 2026

AI-summarized from the linked source. Educational brief, not medical advice.

Brief summary

A systematic review and meta-analysis of externally validated AI-ECG models across 538,735 individuals found that AI algorithms identify asymptomatic left ventricular systolic dysfunction with pooled AUROCs of 0.87 to 0.93 across ejection fraction thresholds, though real-world delays between ECG and echocardiography introduce risk of bias.

What NurseJet pulled from the source

Asymptomatic left ventricular dysfunction (LVD) represents a critical stage in the heart failure trajectory where early detection and guideline-directed medical therapy can prevent symptomatic decompensation and mortality. Transthoracic echocardiography is resource-intensive, prompting interest in 12-lead artificial intelligence-enabled electrocardiography (AI-ECG) as a scalable point-of-care screening tool. This systematic review and meta-analysis synthesized exclusively externally validated AI-ECG studies identified through September 2025, evaluating 12 asymptomatic and 30 symptomatic cohorts comprising 538,735 participants. In asymptomatic cohorts, AI-ECG demonstrated high discriminatory accuracy for left ventricular systolic dysfunction (LVSD), achieving pooled areas under the receiver operating characteristic curve (AUROCs) of 0.87 (95% CI: 0.75–0.99) for ejection fraction (LVEF) <= 35%, 0.93 (95% CI: 0.88–0.97) for LVEF <= 40%, and 0.89 (95% CI: 0.85–0.97) for LVEF <= 50%. These discrimination metrics were comparable to symptomatic cohorts (AUROCs 0.85 to 0.90). For asymptomatic left ventricular diastolic dysfunction (LVDD), performance was moderate (AUROC 0.76, 95% CI: 0.66–0.86). The authors emphasized that substantial heterogeneity (I2 > 85%) and prolonged intervals between ECG acquisition and confirmatory echocardiography in retrospective datasets highlight the need for prospective clinical trial validation.

Why this matters for nurses

Cardiac telemetry, outpatient clinic, and emergency nurses perform thousands of 12-lead ECGs on patients with hypertension, diabetes, or mild dyspnea who have never had an echocardiogram. Understanding that verified AI-ECG models can reliably flag occult systolic dysfunction from a standard surface ECG illuminates how upcoming clinical decision support tools will help nurses and providers initiate timely cardiac evaluations before acute heart failure hospitalization occurs.

Bedside takeaway

In a meta-analysis of 538,735 patients, externally validated AI-ECG identified asymptomatic systolic dysfunction with pooled AUROCs of 0.87 to 0.93.

Key takeaways

Meta-analysis included 12 asymptomatic and 30 symptomatic externally validated AI-ECG cohorts totaling 538,735 individuals.
AI-ECG demonstrated high discriminatory accuracy for asymptomatic systolic dysfunction (pooled AUROC 0.93 for LVEF <= 40%).
For severe systolic impairment (LVEF <= 35%), pooled AUROC was 0.87 (95% CI: 0.75–0.99).
Performance for asymptomatic diastolic dysfunction was moderate with a pooled AUROC of 0.76 (95% CI: 0.66–0.86).
High statistical heterogeneity (I2 > 85%) and real-world time gaps between ECG and echocardiograms necessitate confirmatory prospective validation.

Practice implications

When clinical decision support alerts indicate potential left ventricular systolic dysfunction on an ECG, treat the finding as a screening trigger rather than a definitive diagnosis. Review patient symptoms, medications, and cardiac history, and coordinate with providers for formal transthoracic echocardiography and guideline-directed therapy evaluation.

Limitations & cautions

Substantial statistical heterogeneity across studies (I2 > 85%); potential bias resulting from real-world time delays between ECG recording and confirmatory echocardiography; small-study effects observed in asymptomatic cohorts.
AI-summarized from the linked source. Review the original article before applying to practice.

Citations

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American journal of preventive cardiology (PubMed)

American journal of preventive cardiology (PubMed). External validation of artificial intelligence-guided electrocardiogram (AI-ECG) in detecting asymptomatic left ventricular dysfunction: A systematic review and meta-analysis.

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https://pubmed.ncbi.nlm.nih.gov/42893154/

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This summary does not replace clinical judgment, facility policy, provider orders, or official guidelines. Verify practice changes against the original source and local protocol.

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Journal of clinical neuroscience : official journal of the Neurosurgical Society of Australasia (PubMed)Sep 8, 2026Research Article

A prospective, double-blind randomized controlled trial of 150 adults undergoing emergency decompressive craniectomy for traumatic brain injury found that subanaesthetic ketamine (0.5 mg/kg/h) significantly reduced propofol consumption, fentanyl use, and vasopressor requirements without worsening intracranial pressure or cerebral perfusion.

Emergency Med-SurgAI summaryReview source

Research ArticleResearchMedication SafetyAI summary · original source linked below

During emergency decompressive craniectomy for traumatic brain injury (TBI) with acute subdural hematoma, maintaining cerebral perfusion pressure while controlling intracranial pressure (ICP) is paramount. Propofol-based total intravenous anesthesia (TIVA) provides favorable metabolic suppression but frequently induces dose-dependent vasodilation and hypotension requiring vasopressor support. In this prospective, double-blind, three-arm randomized controlled trial, 150 adults undergoing emergency craniectomy were randomized 1:1:1 to receive adjunctive subanaesthetic ketamine (0.5 mg/kg/h), lidocaine (2 mg/kg/h), or placebo alongside target-controlled infusion of propofol titrated to maintain mean arterial pressure within 20% of baseline. Mean propofol consumption was significantly lowest in the ketamine group (100.73 ± 31.72 µg/kg/min) compared with lidocaine (115.86 ± 38.11 µg/kg/min) and placebo (131.53 ± 44.54 µg/kg/min; p < 0.001). Ketamine administration also significantly decreased intraoperative fentanyl requirements (63.85 ± 36.23 µg vs 83.64 ± 32.27 µg for lidocaine vs 153.55 ± 57.28 µg for placebo; p < 0.001) and reduced median vasopressor boluses (2 vs 3 vs 3; p = 0.031). Importantly, intracranial pressure, cerebral perfusion pressure, intraoperative brain relaxation scores, and Glasgow Outcome Scale-Extended scores were comparable across all three groups, demonstrating that low-dose ketamine did not adversely affect intracranial dynamics.

Key takeaways

Prospective, double-blind RCT randomized 150 adults undergoing emergency decompressive craniectomy for traumatic acute subdural hematoma.
Subanaesthetic ketamine (0.5 mg/kg/h) reduced propofol consumption from 131.53 to 100.73 µg/kg/min (p < 0.001).
Intraoperative fentanyl requirements dropped by more than 58% in the ketamine group compared with placebo (p < 0.001).
Vasopressor requirements were significantly decreased in the ketamine arm (median 2 vs 3 boluses, p = 0.031).
Intracranial pressure, cerebral perfusion pressure, brain relaxation, and neurological recovery scores showed no detrimental differences.

Why this matters on shift

Neurocritical care and perioperative nurses frequently navigate the challenge of hemodynamic instability and hypoperfusion in patients with acute traumatic brain injury. Historically, ketamine was avoided due to unsubstantiated fears of worsening intracranial hypertension. This trial reinforces growing clinical consensus that low-dose ketamine provides valuable opioid- and sedative-sparing effects while stabilizing systemic hemodynamics without compromising intracranial dynamics.

Bedside takeaway

An RCT of 150 emergency craniectomy patients found subanaesthetic ketamine cut propofol and fentanyl use and reduced vasopressors without raising ICP or lowering CPP.

Nursing implications

When caring for neurotrauma patients receiving subanaesthetic ketamine infusions, maintain continuous arterial line hemodynamic monitoring and ICP/CPP tracking per unit protocol. Recognize that low-dose ketamine stabilizes mean arterial pressure and lowers sedative needs, but ensure close monitoring of pupil reactivity, neurological assessment, and ventilator synchrony.

Limitations & cautions

Single-center trial in patients with acute subdural hematoma undergoing surgical decompression; TIVA was titrated to hemodynamic targets rather than processed EEG; findings cannot be generalized to unoperated traumatic brain injuries.
AI-summarized from the linked source. Review the original article before applying to practice.

Citations · exact source links

Journal of clinical neuroscience : official journal of the Neurosurgical Society of Australasia (PubMed). Comparison of subanaesthetic ketamine and lidocaine as adjuvants to propofol-based total intravenous anesthesia on propofol requirement during emergency decompressive craniectomy for traumatic brain injury: a prospective, double-blind, three-arm randomized controlled trial.

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European journal of emergency medicine : official journal of the European Society for Emergency Medicine (PubMed)Oct 27, 2026Systematic Review

A systematic review of 11 studies covering 10,115 emergency department patients with chest pain found that commercial point-of-care high-sensitivity cardiac troponin assays achieve 96.3% to 100% sensitivity and 98.1% to 100% negative predictive value for ruling out acute myocardial infarction upon arrival.

Emergency TelemetryAI summaryReview source

Systematic ReviewResearchWorkflowAI summary · original source linked below

High-sensitivity cardiac troponin (hs-cTn) assays have transformed emergency chest pain triage, but standard central laboratory processing often incurs turnaround delays exceeding an hour. This systematic review evaluated 11 studies (including both derivation and validation cohorts) comprising 10,115 adult ED patients presenting with chest pain suggestive of acute coronary syndrome to determine the diagnostic accuracy of four commercial point-of-care hs-cTn devices with turnaround times under 20 minutes. Applied as a single-test rule-out upon ED arrival, high sensitivity and negative predictive value (NPV) were documented: Atellica VTLi demonstrated 98.8% to 100% sensitivity for troponin <4 ng/L (NPV 99.8%–100%) and 100% sensitivity for <7 ng/L (NPV 100%); Pathfast showed 96.3% to 100% sensitivity for <3 ng/L (NPV 98.1%–100%); i-STAT achieved 99.8% sensitivity for <5 ng/L (NPV 100%); and TriageTrue achieved 100% sensitivity for <3 ng/L (NPV 100%). Serial testing using the 99th percentile across 0- to 3-hour protocols yielded variable sensitivities (VTLi 64.8%–100%, Pathfast 83%–87%, and TriageTrue 79.8%), demonstrating that POC assays are most reliable when utilized for rapid arrival rule-out at low thresholds.

Key takeaways

Systematic review analyzed 11 derivation and validation studies encompassing 10,115 emergency chest pain patients.
Point-of-care hs-cTn devices provided rapid turnaround times (<20 minutes) suitable for bedside emergency testing.
Single-test arrival rule-out achieved 96.3% to 100% sensitivity and 98.1% to 100% negative predictive value across four commercial devices.
Serial protocols at the 99th percentile exhibited broader sensitivity variability (64.8% to 100%), favoring arrival threshold pathways.
Integration into clinical decision protocols can expedite low-risk rule-out while central laboratory confirmation remains prudent for ambiguous presentations.

Why this matters on shift

Emergency nurses triage hundreds of potential acute coronary syndrome presentations where rapid risk stratification prevents bed overcrowding and expedites definitive interventions. Understanding that verified bedside hs-cTn devices deliver lab-comparable rule-out accuracy in under 20 minutes allows triage nurses and rapid-assessment teams to accelerate clinical decision-making, shorten emergency stays, and safely reassure low-risk individuals.

Bedside takeaway

A systematic review of 10,115 emergency patients showed point-of-care high-sensitivity troponin assays rule out acute myocardial infarction upon arrival with 96.3% to 100% sensitivity.

Nursing implications

When evaluating acute chest pain using point-of-care hs-cTn platforms, recognize that extremely low arrival concentrations offer high negative predictive value for acute myocardial infarction, but adhere strictly to facility serial draw algorithms and ECG evaluations for indeterminate or evolving symptoms.

Limitations & cautions

Review included both derivation and prospective validation studies evaluated via QUADAS-3; diagnostic accuracy varied considerably when serial testing was evaluated at the 99th percentile rather than arrival rule-out thresholds; devices cannot replace continuous electrocardiographic monitoring or clinical risk scoring.
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Citations · exact source links

European journal of emergency medicine : official journal of the European Society for Emergency Medicine (PubMed). Diagnostic accuracy of high-sensitivity point-of-care troponin assays in emergency department for patients presenting with chest pain: a systematic review.

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Heart & lung : the journal of critical care (PubMed)Sep 18, 2026Research Article

A randomized controlled trial of 66 adult cardiac surgery patients undergoing median sternotomy found that adding dexmedetomidine to bilateral transversus thoracic muscle plane blocks significantly prolonged time to first rescue analgesia and reduced 24-hour postoperative fentanyl consumption compared to bupivacaine alone.

ICU TelemetryAI summaryReview source

Research ArticleResearchMedication SafetyAI summary · original source linked below

Post-sternotomy pain contributes significantly to delayed respiratory recovery, prolonged mechanical ventilation, and hemodynamic instability in cardiac intensive care units. In this randomized controlled trial, 66 adult patients (ASA physical status I–III) scheduled for open cardiac surgery via median sternotomy received bilateral ultrasound-guided transversus thoracic muscle plane blocks (TTPB) following induction of anesthesia. Participants were randomized to three groups: dexamethasone (0.25% bupivacaine plus 8 mg dexamethasone), dexmedetomidine (0.25% bupivacaine plus 1 mcg/kg dexmedetomidine), and control (0.25% bupivacaine alone). The primary outcome was time to first rescue analgesia following extubation. Time to first rescue analgesia was significantly longer in the dexmedetomidine group compared with the dexamethasone and control cohorts (p < 0.001). Total 24-hour postoperative fentanyl consumption was significantly reduced in both the dexmedetomidine and dexamethasone groups compared to controls (p < 0.001), accompanied by consistently lower numerical pain scores. Extubation times and intraoperative fentanyl consumption were comparable across all three arms (p > 0.05).

Key takeaways

Randomized trial evaluated bilateral transversus thoracic muscle plane blocks in 66 cardiac surgery patients.
Dexmedetomidine as an adjuvant significantly lengthened the duration of pain relief prior to first rescue analgesia (p < 0.001).
Both dexmedetomidine and dexamethasone significantly diminished total 24-hour postoperative fentanyl consumption (p < 0.001).
Postoperative pain scores were consistently lower in both adjuvant cohorts compared to plain bupivacaine.
Neither adjuvant delayed postoperative extubation times or altered intraoperative opioid requirements.

Why this matters on shift

Cardiothoracic ICU nurses manage intense acute post-sternotomy pain where excessive opioid use risks respiratory depression, delayed weaning, delirium, and ileus. Regional plane blocks with prolonged action facilitate smooth recovery, deeper spontaneous breaths, earlier incentive spirometry, and reduced systemic opioid exposure without hindering timely extubation in recovering cardiac surgical patients.

Bedside takeaway

In an RCT of 66 cardiac surgery patients, adding dexmedetomidine or dexamethasone to parasternal plane blocks significantly cut 24-hour opioid consumption and improved pain control.

Nursing implications

In postoperative sternotomy patients receiving ultrasound-guided parasternal blocks with adjuvants, anticipate prolonged analgesia; perform routine multimodal pain and sedation assessments, monitor for adjuvant-related bradycardia or hypotension, and encourage early pulmonary toilet as pain remains well controlled.

Limitations & cautions

Single-center trial in 66 patients; limited to elective adult cardiac procedures (ASA I–III); did not evaluate long-term persistent post-sternotomy pain or chronic opioid use after hospital discharge.
AI-summarized from the linked source. Review the original article before applying to practice.

Citations · exact source links

Heart & lung : the journal of critical care (PubMed). Comparison of analgesic efficacy of dexamethasone and dexmedetomidine as an adjuvant to local anaesthetic in transversus thoracic muscle plane block in adult patients undergoing median sternotomy: A randomised controlled trial.

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AI-summarized from the linked source. Review the original article before applying to practice.

Key takeaways

Practice implications

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More updates for this clinical area

Randomized trial of 150 traumatic brain injury patients finds adjunctive ketamine cuts propofol and opioid requirements during decompressive craniectomy

Systematic review of 10,115 emergency chest pain patients finds point-of-care high-sensitivity troponin reliably rules out acute myocardial infarction on arrival

Randomized trial of 66 cardiac surgery patients shows dexmedetomidine in parasternal plane block extends post-sternotomy analgesia and cuts 24-hour opioids