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Article History

Received: 7 September 2024

Accepted: 10 June 2025

First Online: 22 July 2025

Competing interests

: V.S. and R.K. are co-inventors of US pending patent applications WO2023230345A1, ‘Articles and methods for format-independent detection of hidden cardiovascular disease from printed electrocardiographic images using deep learning’, and 63/484,426, ‘Biometric contrastive learning for data-efficient deep learning from electrocardiographic images’, filed by Yale University. These patents cover the methods of training an AI model to detect structural heart disease in a format-independent manner using varied image formats as inputs and the biocontrastive pretraining used in the present study. They are also co-founders of Ensight-AI, along with H.M.K. P.M.C. is the founder and CEO of DGTL Health BV. R.K. is an Associate Editor of JAMA. In addition to awards from the National Heart, Lung, and Blood Institute and the Doris Duke Charitable Foundation, he receives research support, through Yale University, from Bristol Myers Squibb, Novo Nordisk and BridgeBio. R.K. and E.K.O. are co-inventors of US pending patent applications 63/562,335, ‘Artificial intelligence-guided screening of under-recognized cardiomyopathies adapted for point-of-care cardiac ultrasound’; 18/813,882, ‘Multimodality artificial intelligence systems to track the progression of pre-clinical amyloid cardiomyopathy’; 63/619,241, ‘A multi-modal video-based progression score for aortic stenosis using artificial intelligence’; US20220336048A1, ‘Methods for neighborhood phenomapping for clinical trials’; 63/508,315, ‘Machine learning method for adaptive trial enrichment’; and 63/606,203, ‘Methods of generating digital twin-based datasets’, filed by Yale University and unrelated to this work. R.K. and E.K.O. are co-founders of Evidence2Health, a precision health platform to improve evidence-based cardiovascular care. E.K.O. has been a consultant for Caristo Diagnostics, Ltd. and Ensight-AI, Inc. and has received royalty fees from technology licensed through the University of Oxford. H.M.K. works under contract with the Centers for Medicare & Medicaid Services to support quality measurement programs; was a recipient of a research grant from Johnson & Johnson, through Yale University, to support clinical trial data sharing; was a recipient of a research agreement, through Yale University, from the Shenzhen Center for Health Information for work to advance intelligent disease prevention and health promotion; collaborates with the National Center for Cardiovascular Diseases in Beijing; receives payment from the Arnold & Porter Law Firm for work related to the Sanofi clopidogrel litigation, from the Martin Baughman Law Firm for work related to the Cook Celect IVC filter litigation and from the Siegfried and Jensen Law Firm for work related to Vioxx litigation; chairs a Cardiac Scientific Advisory Board for UnitedHealth; was a member of the IBM Watson Health Life Sciences Board; is a member of the Advisory Board for Element Science, the Advisory Board for Facebook and the Physician Advisory Board for Aetna; and is the co-founder of Hugo Health, a personal health information platform, and the co-founder of Refactor Health, a healthcare AI-augmented data management company. The remaining authors declare no competing interests.