Machine Learning in Left Ventricular Hypertrophy Detection: Systematic Review and Meta-Analysis

Background: In recent years, researchers have investigated machine learning (ML)-based approaches for the detection of left ventricular hypertrophy (LVH). However, the accuracy of ML in detecting LVH varies across different modeling variables and models. Systematic evidence is lacking in understanding how different ML approaches affect LVH detection accuracy. Objective: The aim of this study is to systematically assess the diagnostic accuracy of these ML approaches to inform the development of artificial intelligence tools. Methods: PubMed, Embase, Cochrane Library, and Web of Science were comprehensively searched up to November 12, 2025. The Prediction Model Risk of Bias Assessment Tool was used to evaluate the risk of bias. Subgroup analyses were performed based on ML model types and modeling variables (electrocardiogram [ECG], clinical features, and echocardiography). Only diagnostic 2×2 tables from validation sets were pooled for meta-analysis, with all statistical analyses performed using Stata. Results: A total of 25 studies were included in the analysis. The performance of ML models varied with input data types and algorithms. A meta-analysis showed that ECG-based models, in comparison, exhibited a sensitivity of 0.76 (95% CI 0.66-0.84) and a specificity of 0.84 (95% CI 0.78-0.89). Echocardiography-based models had a sensitivity ranging from 0.71 to 0.94 and a specificity ranging from 0.67 to 0.96. The models based on clinical features had a sensitivity of 0.78 (95% CI 0.69-0.85) and a specificity of 0.71 (95% CI 0.65-0.76). A subgroup analysis of the ECG-based models revealed that the deep learning model produced a sensitivity of 0.71 (95% CI 0.60-0.80) and a specificity of 0.79 (95% CI 0.65-0.88). Conclusions: ML demonstrates reasonably high accuracy in detecting LVH. However, these conclusions are derived from limited evidence. Meanwhile, the extreme heterogeneity reported in the meta-analysis requires more critical interpretation. Current conclusions regarding model accuracy should be interpreted with caution. Therefore, future research should focus on constructing high-performance ML models based on imaging data for LVH diagnosis.