Статья
РОЛЬ ИСКУССТВЕННОГО ИНТЕЛЛЕКТА В ДИАГНОСТИКЕ, ЛЕЧЕНИИ И ПРОГНОЗИРОВАНИИ СЕРДЕЧНО-СОСУДИСТЫХ ЗАБОЛЕВАНИЙ
Основные положенияИскусственный интеллект трансформирует кардиологическую практику, обеспечивая более точную диагностику, персонализированное лечение и прогнозирование сердечно-сосудистых осложнений.Впервые систематизированы современные подходы к применению машинного обучения, нейросетевых моделей и аналитики больших данных в клинической кардиологии.Подчеркнуты ключевые направления интеграции ИИ в российское здравоохранение с учетом этических, правовых и организационных аспектов. РезюмеСовременная кардиология переживает этап стремительной цифровой трансформации, в центре которой находится искусственный интеллект (ИИ). Применение алгоритмов машинного и глубокого обучения обеспечивает новые возможности для диагностики, мониторинга и прогнозирования сердечно-сосудистых заболеваний. В обзоре систематизированы данные о внедрении ИИ в ключевые направления кардиологической практики – от сбора и анализа данных до персонализированного выбора терапии. Рассматриваются примеры успешного использования интеллектуальных алгоритмов для интерпретации ЭКГ, визуализации, оценки гемодинамических параметров и прогнозирования осложнений сердечной недостаточности. Отдельное внимание уделено этическим, правовым и организационным аспектам применения ИИ, включая вопросы прозрачности алгоритмов, защиты персональных данных и клинической ответственности. Подчеркивается значение международных и российских нормативных инициатив, направленных на обеспечение безопасного и справедливого использования ИИ в медицине. Особое внимание уделено ситуации в Российской Федерации, где цифровизация здравоохранения становится приоритетом государственной политики. В заключение обсуждаются перспективы развития – квантовые вычисления, эмоциональный ИИ и внедрение технологий в систему медицинского образования. ИИ рассматривается как инструмент повышения точности диагностики, эффективности лечения и качества профилактики сердечно-сосудистых заболеваний, при этом ключевым условием его успеха остаются клиническая валидация и ответственный человеческий контроль.
1. Samorodskaya I.V., Starinskaya M.A., Boytsov S.A. Changes of regional mortality rates from cardiovascular diseases and cognitive disorders in Russia over 2019-2021. Russian Journal of Cardiology. 2023;28(4):5256. (In Russ.) doi:10.15829/1560-4071-2023-5256
2. Vaduganathan M, Mensah GA, Turco JV, et al. The Global Burden of Cardiovascular Diseases and Risk: A Compass for Future Health. J Am Coll Cardiol. 2022;80(25):2361-2371. doi: 10.1016/j.jacc.2022.11.005.
3. Koulaouzidis G, Jadczyk T, Iakovidis DK, et al. Artificial Intelligence in Cardiology-A Narrative Review of Current Status. J Clin Med. 2022;11(13):3910. doi: 10.3390/jcm11133910.
4. Johnson KW, Torres Soto J, Glicksberg BS, et al. Artificial Intelligence in Cardiology. J Am Coll Cardiol. 2018;71(23):2668-2679. doi: 10.1016/j.jacc.2018.03.521.
5. Lehmann DH, Gomes B, Vetter N, et al. Prediction of diagnosis and diastolic filling pressure by AI-enhanced cardiac MRI: a modelling study of hospital data. Lancet Digit Health. 2024;6(6):e407-e417. doi: 10.1016/S2589-7500(24)00063-3.
6. Krittanawong C, Rogers AJ, Aydar M, et al. Integrating blockchain technology with artificial intelligence for cardiovascular medicine. Nat Rev Cardiol. 2020;17(1):1-3. doi: 10.1038/s41569-019-0294-y.
7. van de Leur RR, Bos MN, Taha K, et al. Improving explainability of deep neural network-based electrocardiogram interpretation using variational auto-encoders. Eur Heart J Digit Health. 2022;3(3):390-404. doi: 10.1093/ehjdh/ztac038
8. Attia ZI, Noseworthy PA, Lopez-Jimenez F, et al. An artificial intelligence-enabled ECG algorithm for the identification of patients with atrial fibrillation during sinus rhythm: a retrospective analysis of outcome prediction. Lancet. 2019;394(10201):861-867. doi: 10.1016/S0140-6736(19)31721-0.
9. Ko WY, Siontis KC, Attia ZI, et al. Detection of Hypertrophic Cardiomyopathy Using a Convolutional Neural Network-Enabled Electrocardiogram. J Am Coll Cardiol. 2020;75(7):722-733. doi: 10.1016/j.jacc.2019.12.030.
10. Goto S, Mahara K, Beussink-Nelson L, et al. Artificial intelligence-enabled fully automated detection of cardiac amyloidosis using electrocardiograms and echocardiograms. Nat Commun. 2021;12(1):2726. doi: 10.1038/s41467-021-22877-8.
11. Galloway CD, Valys AV, Shreibati JB, et al. Development and Validation of a Deep-Learning Model to Screen for Hyperkalemia From the Electrocardiogram. JAMA Cardiol. 2019;4(5):428-436. doi: 10.1001/jamacardio.2019.0640.
12. Soloviev I.A. I.A., Kurochkina O.N. Artificial intelligence applications in cardiology: a review. Russian Journal of Cardiology. 2024;29(11S):5673. (In Russ.) https://doi.org/10.15829/1560-4071-2024-5673
13. Attia ZI, Kapa S, Lopez-Jimenez F, et al.. Screening for cardiac contractile dysfunction using an artificial intelligence-enabled electrocardiogram. Nat Med. 2019;25(1):70-74. doi: 10.1038/s41591-018-0240-2.
14. Hughes A, Shandhi MMH, Master H, et al. Wearable devices in cardiovascular medicine. Circ Res. 2023;132(5):652-670. doi:10.1161/CIRCRESAHA.122.322389.
15. Mannhart D, Lefebvre B, Gardella C, et al. Clinical validation of an artificial intelligence algorithm offering cross-platform detection of atrial fibrillation using smart device electrocardiograms. Arch Cardiovasc Dis. 2023;116(4):249-257. doi:10.1016/j.acvd.2023.04.003.
16. Maksakova A.Yu., Kim S.A., Ashurova M.A., et al. Identification of atrial fibrillation predictors on an electrocardiogram using a neural network. Russian Journal of Cardiology. 2024;29(11S):5907. (In Russ.) https://doi.org/10.15829/1560-4071-2024-5907
17. Hannun AY, Rajpurkar P, Haghpanahi M, et al. Cardiologist-level arrhythmia detection and classification in ambulatory electrocardiograms using a deep neural network. Nat Med. 2019;25(1):65-69. doi:10.1038/s41591-018-0268-3.
18. Levy J, Álvarez D, Del Campo F, et al. Deep learning for obstructive sleep apnea diagnosis based on single channel oximetry. Nat Commun. 2023;14:4881. doi:10.1038/s41467-023-40604-3.
19. Shahar E, Whitney CW, Redline S, et al. Sleep-disordered breathing and cardiovascular disease: cross-sectional results of the Sleep Heart Health Study. Am J Respir Crit Care Med. 2001;163(1):19-25. doi:10.1164/ajrccm.163.1.2001008.
20. Hatib F, Jian Z, Buddi S, et al. Machine-learning algorithm to predict hypotension based on high-fidelity arterial pressure waveform analysis. Anesthesiology. 2018;129(4):663-674. doi:10.1097/ALN.0000000000002300.
21. Isaeva AV, Demkina AE, Vladzymyrskyy AV, et al. Remote monitoring of patients with chronic heart failure: A prospective randomized study. Digital Diagnostics. 2024;5(2):203-218. (In Russ.). doi: 10.17816/DD568897
22. Garcia R, Gras D, Mansourati J, et al. Pre-emptive treatment of heart failure exacerbations in patients managed with the HeartLogic™ algorithm. ESC Heart Fail. 2024;11(4):1228-1235. doi:10.1002/ehf2.14624.
23. Brugts JJ, Radhoe SP, Clephas PRD, et al. Remote haemodynamic monitoring of pulmonary artery pressures in patients with chronic heart failure (MONITOR-HF): a randomised clinical trial. Lancet. 2023;401(10391):2113-2123. doi:10.1016/S0140-6736(23)00923-6.
24. Narang A, Bae R, Hong H, et al. Utility of a deep-learning algorithm to guide novices to acquire echocardiograms for limited diagnostic use. JAMA Cardiol. 2021;6(6):624-632. doi:10.1001/jamacardio.2021.0185.
25. Howard JP, Fisher L, Shun-Shin MJ, et al. Cardiac rhythm device identification using neural networks. JACC Clin Electrophysiol. 2019;5(5):576-586. doi:10.1016/j.jacep.2019.02.003.
26. Betancur J, Commandeur F, Motlagh M, et al. Deep learning for prediction of obstructive disease from fast myocardial perfusion SPECT: a multicenter study. JACC Cardiovasc Imaging. 2018;11(11):1654-1663. doi:10.1016/j.jcmg.2018.01.020.
27. Juarez-Orozco LE, Martinez-Manzanera O, van der Zant FM, et al. Deep learning in quantitative PET myocardial perfusion imaging: a study on cardiovascular event prediction. JACC Cardiovasc Imaging. 2020;13(1 Pt 1):180-182. doi:10.1016/j.jcmg.2019.08.009.
28. Gherardini M, Mazomenos E, Menciassi A, et al. Catheter segmentation in X-ray fluoroscopy using synthetic data and transfer learning with light U-nets. Comput Methods Programs Biomed. 2020;192:105420. doi:10.1016/j.cmpb.2020.105420.
29. Seetharam K, Brito D, Farjo PD, et al. The role of artificial intelligence in cardiovascular imaging: state of the art review. Front Cardiovasc Med. 2020;7:618849. doi:10.3389/fcvm.2020.618849.
30. Nolan MT, Thavendiranathan P. Automated quantification in echocardiography. JACC Cardiovasc Imaging. 2019;12(6):1073-1092. doi:10.1016/j.jcmg.2018.11.038.
31. Zhang J, Gajjala S, Agrawal P, et al. Fully automated echocardiogram interpretation in clinical practice. Circulation. 2018;138(16):1623-1635. doi:10.1161/CIRCULATIONAHA.118.034338.
32. Weikert T, Francone M, Abbara S, et al. Machine learning in cardiovascular radiology: ESCR position statement on design requirements, quality assessment, current applications, opportunities, and challenges. Eur Radiol. 2021;31(6):3909-3922. doi:10.1007/s00330-020-07417-0.
33. Schneider M, Bartko P, Geller W, et al. A machine learning algorithm supports ultrasound-naïve novices in the acquisition of diagnostic echocardiography loops and provides accurate estimation of LVEF. Int J Cardiovasc Imaging. 2021;37(2):577-586. doi:10.1007/s10554-020-02046-6.
34. Brown K, Roshanitabrizi P, Rwebembera J, et al. Using artificial intelligence for rheumatic heart disease detection by echocardiography: focus on mitral regurgitation. J Am Heart Assoc. 2024;13(9):e031257. doi:10.1161/JAHA.123.031257.
35. Dey D, Slomka PJ, Leeson P, et al. Artificial intelligence in cardiovascular imaging: JACC state-of-the-art review. J Am Coll Cardiol. 2019;73(11):1317-1335. doi:10.1016/j.jacc.2018.12.054.
36. Prakosa A, Arevalo HJ, Deng D, et al. Personalized virtual-heart technology for guiding the ablation of infarct-related ventricular tachycardia. Nat Biomed Eng. 2018;2(10):732-740. doi:10.1038/s41551-018-0282-2.
37. Williams MC, Kwiecinski J, Doris M, et al. Low-attenuation noncalcified plaque on coronary computed tomography angiography predicts myocardial infarction: results from the Multicenter SCOT-HEART Trial. Circulation. 2020;141(18):1452-1462. doi:10.1161/CIRCULATIONAHA.119.044720.
38. Zhang L, Sun J, Jiang B, et al. Development of artificial intelligence in epicardial and pericoronary adipose tissue imaging: a systematic review. Eur J Hybrid Imaging. 2021;5:14. doi:10.1186/s41824-021-00107-0.
39. Tzolos E, Williams MC, McElhinney P, et al. Pericoronary adipose tissue attenuation, low-attenuation plaque burden, and 5-year risk of myocardial infarction. JACC Cardiovasc Imaging. 2022;15(6):1078-1088. doi:10.1016/j.jcmg.2022.02.004.
40. Chan K, Wahome E, Tsiachristas A, et al. Inflammatory risk and cardiovascular events in patients without obstructive coronary artery disease: the ORFAN multicentre, longitudinal cohort study. Lancet. 2024;403(10398):2606-2618. doi:10.1016/S0140-6736(24)00596-8.
41. Chen Q, Pan T, Wang YN, et al. A coronary CT angiography radiomics model to identify vulnerable plaque and predict cardiovascular events. Radiology. 2023;307(3):e221693. doi:10.1148/radiol.221693.
42. Xu P, Xue Y, Schoepf UJ, et al. Radiomics: the next frontier of cardiac computed tomography. Circ Cardiovasc Imaging. 2021;14(1):e011747. doi:10.1161/CIRCIMAGING.120.011747.
43. Lamotkin A.I., Korabelnikov D.I., Lamotkin I.A., et al. Artificial intelligence in healthcare and medicine: the history of key events, its significance for doctors, the level of development in different countries. FARMAKOEKONOMIKA. Modern Pharmacoeconomics and Pharmacoepidemiology. 2024;17(2):243-250. (In Russ.) https://doi.org/10.17749/2070-4909/farmakoekonomika.2024.254
44. Khera AV, Chaffin M, Aragam KG, et al. Genome-wide polygenic scores for common diseases identify individuals with risk equivalent to monogenic mutations. Nat Genet. 2018;50(9):1219-1224. doi:10.1038/s41588-018-0183-z.
45. Singh M, Kumar A, Khanna NN, et al. Artificial intelligence for cardiovascular disease risk assessment in personalised framework: a scoping review. eClinicalMedicine. 2024;73:102660. doi:10.1016/j.eclinm.2024.102660.
46. Mustafa A, Wei C, Grovu R, et al. Using novel machine learning tools to predict optimal discharge following transcatheter aortic valve replacement. Arch Cardiovasc Dis. 2025;118(1):26-34. doi:10.1016/j.acvd.2024.08.008.
47. Friedrich S, Groß S, König IR, et al. Applications of artificial intelligence/machine learning approaches in cardiovascular medicine: a systematic review with recommendations. Eur Heart J Digit Health. 2021;2(4):424-436. doi:10.1093/ehjdh/ztab054.
48. Shangina AM, Benimetskaya KS, Efremova YuE, et al. Personalized approach to treatment choice using a digital profile of patient with cardiovascular diseases: the features of clinical decision-making support service. Russian Cardiology Bulletin. 2024;19(4 2):105 112. (In Russ.) https://doi.org/10.17116/Cardiobulletin202419042105
49. Jalepalli SK, Gupta P, Dekker ALAJ, et al. Development and validation of multicentre study on novel Artificial Intelligence-based Cardiovascular Risk Score (AICVD). Fam Med Community Health. 2024;12:e002340. doi:10.1136/fmch-2023-002340.
50. Mamedov M.N., Savchuk E.A., Karimov A.K. Artificial intelligence in cardiology. International Journal of Heart and Vascular Diseases. 2024. 12(43): 5-11. (In Russ.). Doi: 10.24412/2311-1623-2024-43-5-11
51. Olawade DB, Aderinto N, Olatunji G, et al. Advancements and applications of artificial intelligence in cardiology: current trends and future prospects. J Med Surg Public Health. 2024;3:100109. doi:10.1016/j.glmedi.2024.100109.
52. Ning Y, Teixayavong S, Shang Y, et al. Generative artificial intelligence and ethical considerations in health care: a scoping review and ethics checklist. Lancet Digit Health. 2024;6(8):e598-e611. doi:10.1016/S2589-7500(24)00143-2.
53. Bajwa J, Munir U, Nori A, et al. Artificial intelligence in healthcare: transforming the practice of medicine. Future Healthc J. 2021;8(3):e188. doi:10.7861/fhj.2021-0095.
54. Khera R, Oikonomou EK, Nadkarni GN, et al. Transforming cardiovascular care with artificial intelligence: from discovery to practice. J Am Coll Cardiol. 2024;84(2):97-114. doi:10.1016/j.jacc.2024.05.003.
55. Armoundas AA, Narayan SM, Arnett DK, et al. Use of artificial intelligence in improving outcomes in heart disease: a scientific statement from the American Heart Association. Circulation. 2024;149(11):e1028-e1050. doi:10.1161/CIR.0000000000001201.
56. Glover B, Badawi A. Development of an AI co-pilot for decision support in oral anticoagulation management for atrial fibrillation using simulated patients. Heart. 2024;110(Suppl 1):A30. doi:10.1136/heartjnl-2024-ICS.31.
57. Thangaraj PM, Benson SH, Oikonomou EK, et al. Cardiovascular care with digital twin technology in the era of generative artificial intelligence. Eur Heart J. 2024;45(5):ehae619. doi:10.1093/eurheartj/ehae619.
58. Strange G, Stewart S, Watts A, et al. Enhanced detection of severe aortic stenosis via artificial intelligence: a clinical cohort study. Open Heart. 2023;10(1):e002265. doi:10.1136/openhrt-2023-002265.
59. Stamate E, Piraianu AI, Ciobotaru OR, et al. Revolutionizing cardiology through artificial intelligence–big data from proactive prevention to precise diagnostics and cutting-edge treatment: a comprehensive review of the past 5 years. Diagnostics (Basel). 2024;14(11):1103. doi:10.3390/diagnostics14111103.
60. Engelhardt S, Dar SUH, Sharan L, et al. Artificial intelligence in cardiovascular imaging and intervention. Herz. 2024;49(4):327-334. doi:10.1007/s00059-024-05264-z.
61. Jain SS, Elias P, Poterucha T, et al. Artificial intelligence in cardiovascular care–part 2: applications: JACC Review Topic of the Week. J Am Coll Cardiol. 2024;83(21):2487-2496. doi:10.1016/j.jacc.2024.03.401.
62. Angoulvant D, Granjeon-Noriot S, Amarenco P, et al. In-silico trial emulation to predict the cardiovascular protection of new lipid-lowering drugs: an illustration through the design of the SIRIUS programme. Eur J Prev Cardiol. 2024;31(15):1820-1830. doi:10.1093/eurjpc/zwae254.
63. Sardar P, Abbott JD, Kundu A, et al. Impact of artificial intelligence on interventional cardiology: from decision-making aid to advanced interventional procedure assistance. JACC Cardiovasc Interv. 2019;12(13):1293-1303. doi:10.1016/j.jcin.2019.04.048.
64. Danilov A, Aronow WS. Artificial intelligence in cardiology: applications and obstacles. Curr Probl Cardiol. 2023;48:101750. doi:10.1016/j.cpcardiol.2023.101750.
65. Nedadur R, Wang B, Tsang W. Artificial intelligence for the echocardiographic assessment of valvular heart disease. Heart. 2022;108(20):1592-1599. doi:10.1136/heartjnl-2021-319725.
66. Al’Aref SJ, Anchouche K, Singh G, et al. Clinical applications of machine learning in cardiovascular disease and its relevance to cardiac imaging. Eur Heart J. 2019;40(24):1975-1986. doi:10.1093/eurheartj/ehy404.
67. Burnam M, Develle R, Polosajian L, et al. Safety and efficacy of adaptive atrial pacing regulated by blood pressure during low-level exercise: a proof-of-concept study. ESC Heart Fail. 2024;11(11):2460-2463. doi:10.1002/ehf2.14854.
68. Gala D, Makaryus AN. The utility of language models in cardiology: a narrative review of the benefits and concerns of ChatGPT-4. Int J Environ Res Public Health. 2023;20(15):6438. doi:10.3390/ijerph20156438.
69. Madaudo C, Parlati ALM, Di Lisi D, et al. Artificial intelligence in cardiology: a peek at the future and the role of ChatGPT in cardiology practice. J Cardiovasc Med (Hagerstown). 2024;25(10):766-771. doi:10.2459/JCM.0000000000001664.
70. Elias P, Jain SS, Poterucha T, et al. Artificial intelligence for cardiovascular care–part 1: advances: JACC Review Topic of the Week. J Am Coll Cardiol. 2024;83(21):2472-2486. doi:10.1016/j.jacc.2024.03.400.
71. Aliferis C, Simon G. Overfitting, underfitting and general model overconfidence and under-performance pitfalls and best practices in machine learning and AI. In: Simon GJ, Aliferis C, eds. Artificial Intelligence and Machine Learning in Health Care and Medical Sciences: Best Practices and Pitfalls. Springer; 2024.
72. Geneş M, Çelik M. Assessment of ChatGPT’s compliance with ESC acute coronary syndrome management guidelines at 30-day intervals. Life (Basel). 2024;14(10):1235. doi:10.3390/life14101235.
73. Hatem R, Simmons B, Thornton JE. A call to address AI “hallucinations” and how healthcare professionals can mitigate their risks. Cureus. 2023;15(8):e44720. doi:10.7759/cureus.44720.
74. Makimoto H, Kohro T. Adopting artificial intelligence in cardiovascular medicine: a scoping review. Hypertens Res. 2024;47(7):685-699. doi:10.1038/s41440-023-01469-7.
75. Scholte NTB, van der Boon RMA. Eco-conscious healthcare: merging clinical efficacy with sustainability. Eur Heart J Digit Health. 2025;6(3):313-314. doi:10.1093/ehjdh/ztaf017.
76. Babu SV, Ramya P, Gracewell J. Revolutionizing heart disease prediction with quantum-enhanced machine learning. Sci Rep. 2024;14:7453. doi:10.1038/s41598-024-55991-w.
77. Itchhaporia D. Artificial intelligence in cardiology. Trends Cardiovasc Med. 2022;32(1):34-41. doi:10.1016/j.tcm.2020.11.007.
78. Quer G, Arnaout R, Henne M, et al. Machine learning and the future of cardiovascular care: JACC state-of-the-art review. J Am Coll Cardiol. 2021;77(3):300-313. doi:10.1016/j.jacc.2020.11.030.