{ "id": "AIBD-0301", "title": "A 76-year-old reads a transient negative T-wave on his own Apple Watch ECG after gym exercise; work-up finds silent three-vessel disease and he has quadruple bypass surgery (Amsterdam UMC)", "summary": "Koster et al. (EHJ Case Reports, 30 Jan 2024): a patient-initiated lead-I watch ECG showed a negative T-wave normalizing after 22 min; exercise test, CT and angiography found 3-vessel disease; CABG.", "date_observed": "2024-01-30", "date_basis": "unassessed", "date_precision": "unassessed", "benefit_status": null, "source_collection": null, "source_entry": null, "account": "Koster, de Winter, Verberne, Spijkerboer and Chamuleau of Amsterdam UMC reported a case in European Heart Journal Case Reports on 30 January 2024. The manuscript was received 26 June 2023 and the event is undated. The patient was a 76-year-old asymptomatic man with a strong family history of coronary disease. He had 30 years of treated hypercholesterolemia and four years of type 2 diabetes. He exercised weekly on a cross trainer. Very infrequently and “solely out of interest”, he recorded a lead-I electrocardiogram (ECG) with his Apple Watch right afterwards. On the last recording he noticed a negative T-wave that deepened over about seven minutes and normalized after 22 minutes. He had no chest pain, breathlessness, dizziness or palpitations. He consulted a cardiologist, whose resting ECG and examination were normal. A bicycle exercise test two days later reproduced the lead-I T-wave change with ST depression up to 4 mm in V5. Cardiac computed tomography (CT) showed stenoses in all coronary arteries (CAD-RADS 4). Invasive angiography showed three-vessel disease and a perfusion scan reversible ischemia in 16% of the myocardium. The heart team chose surgery and he received four bypass grafts. Recovery was uneventful and a repeat exercise ECG at 11 weeks was normal. The authors note Apple does not recommend the watch for detecting infarction or ischemia. They note lead I is not ideal for ischemia and the finding requires systematic study before clinical use. The paper reports no output from the ECG app's rhythm classifier. The wearer saw the abnormality on the trace and clinicians confirmed it.", "category": "benefit created", "unexpected": true, "purpose": "The ECG app is built to record a single-lead ECG and classify atrial fibrillation. Using the trace to spot exercise-induced ischemia is, as the authors say, not endorsed by Apple.", "system": "Apple Watch ECG app (single lead-I recording; its rhythm classifier is not mentioned in the report)", "model_version": null, "developer": "Apple", "deployer": null, "location": "Amsterdam, the Netherlands", "domain": "Healthcare (cardiology)", "segment": "Consumer wearables", "benefit_type": "Improved Physical Health", "taxonomy_note": null, "registry_ids": {}, "ratings": [ { "group": "personal", "depth": 3, "reason": "Silent, extensive, reversible ischemia from three-vessel disease was found and treated with quadruple bypass in an asymptomatic man. The authors' learning point is that such ischemia can end in exercise-induced sudden death. The counterfactual is not established." } ], "ai_role": { "status": "assessed", "statement": "The watch recorded a 30-second lead-I trace at the wearer's initiative. The report gives no classification result from the app. The negative T-wave was noticed by the patient and interpreted by cardiologists, who ordered the exercise test, imaging and surgery. No machine-learning output contributed to the finding as described. The single source is an independent peer-reviewed case report. No maker material was used." }, "evidence": [ { "kind": "case report", "citation": "Koster RW, de Winter RJ, Verberne HJ, Spijkerboer AM, Chamuleau SA (2024). Severe silent ischaemia detected with an Apple Watch in the home setting: a case report. European Heart Journal - Case Reports 8(2):ytae043 (PMC10872691).", "title": "Severe silent ischaemia detected with an Apple Watch in the home setting: a case report", "url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC10872691/", "date": "2024-01-30", "written_by": "independent", "quote": "The use for detecting myocardial ischaemia is not endorsed by Apple but is documented in this case." }, { "kind": "case report", "citation": "Koster et al. (2024), Eur Heart J Case Rep 8(2):ytae043, case presentation.", "title": "Severe silent ischaemia detected with an Apple Watch in the home setting: a case report", "url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC10872691/", "date": "2024-01-30", "written_by": "independent", "quote": "he noticed immediately after exercise, a negative T-wave that became more prominent in ∼7 min, then slowly returned back to a normal positive T-wave after 22 min" }, { "kind": "case report", "citation": "Koster et al. (2024), Eur Heart J Case Rep 8(2):ytae043, treatment.", "title": "Severe silent ischaemia detected with an Apple Watch in the home setting: a case report", "url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC10872691/", "date": "2024-01-30", "written_by": "independent", "quote": "Coronary bypass surgery was performed with four bypasses on all coronary arteries involved" }, { "kind": "case report", "citation": "Koster et al. (2024), Eur Heart J Case Rep 8(2):ytae043, learning points.", "title": "Severe silent ischaemia detected with an Apple Watch in the home setting: a case report", "url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC10872691/", "date": "2024-01-30", "written_by": "independent", "quote": "Extensive exercise-induced reversible myocardial ischaemia may remain asymptomatic and can result in exercise-induced sudden death." } ], "replication": { "produced_by": [ "A wearer who records a watch ECG right after exercise and looks at the waveform, not only the rhythm label", "A cardiologist willing to investigate a watch trace in an asymptomatic patient", "Exercise testing, CT, angiography and perfusion imaging to confirm and grade the disease" ], "must_hold": [ "The lead-I trace reproduces T-wave changes faithfully, which the authors say appeared accurate though frequency characteristics are undocumented", "Ischemia that shows in lead I, which the authors call not ideal for the purpose", "Tolerance of false positives and investigation cascades, which the authors flag as unstudied" ], "echoes": [] }, "paired_incident": null, "headline": "Apple Watch ECG T-wave leads a 76-year-old to quadruple bypass", "metric": "he received four bypass grafts; recovery was uneventful", "comparator": { "against": "the cardiologist's resting 12-lead ECG and physical examination", "before": "A standard ECG was completely normal, as was physical examination.", "after": "he noticed immediately after exercise, a negative T-wave that became more prominent in ∼7 min, then slowly returned back to a normal positive T-wave after 22 min", "basis": "measured", "quote": "He consulted a cardiologist and there was agreement that this Apple Watch observation warranted further investigation. A standard ECG was completely normal, as was physical examination.", "url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC10872691/" }, "later": { "status": "unknown", "date": null, "note": "The paper's own 11-week postoperative exercise ECG (normal) is part of the first report; nothing published later about the patient was found.", "quote": null, "url": null }, "value": null, "developer_country": "United States", "deployer_country": null, "unrated_because": null, "brief_notes": null, "brief": null, "revisions": [ { "date": "2026-10-20", "change": "Record drafted from the cited sources.", "source": null, "editor": "AIBD" }, { "date": "2026-10-21", "change": "Benefit type set to Improved Physical Health under Trustible's full taxonomy of 23 types; it was Improved Accessibility among the six first used.", "source": "https://trustible.ai/post/a-framework-for-measuring-the-benefits-of-ai/", "editor": "AIBD" }, { "date": "2026-10-21", "change": "Added what the benefit is measured against from the cited sources.", "source": "https://pmc.ncbi.nlm.nih.gov/articles/PMC10872691/", "editor": "AIBD" }, { "date": "2026-10-21", "change": "Country of the developer added from the organization's own site or a registry.", "source": "https://en.wikipedia.org/wiki/Apple_Inc.", "editor": "AIBD" }, { "date": "2026-10-21", "change": "Prose pass: a rating reason, account, purpose, the replication conditions, the system's part rewritten in shorter sentences with abbreviations expanded; facts, figures and quotations unchanged.", "source": null, "editor": "AIBD" } ], "confidence": "studied", "shade": "high", "claim_status": "Independently studied", "claim_basis": "Sources: one independent case report. The cited evidence includes no finding by a regulator or court.", "profile": { "case_id": "AIBD-0301", "catalog_version": "1.0.0", "source_fingerprint": "7f02698d60bc4f405f2972c173105df69d640a735070abf328fc8c24784f1e95", "collection_refs": [ { "collection_id": "aibd", "version": "snapshot-8bf7cfec9cb185aa" }, { "collection_id": "aibd", "version": "2026-10-25" }, { "collection_id": "viator", "version": "2026-10-25" } ], "source_ids": [ "AIBD-0301-source-0001", "AIBD-0301-source-0002", "AIBD-0301-source-0003", "AIBD-0301-source-0004" ], "families": { "strategic assessments": { "state": "not_assessed", "review_state": "not_assessed", "coverage": "partial", "record_ids": [] }, "evaluations": { "state": "not_assessed", "review_state": "not_assessed", "coverage": "partial", "record_ids": [] }, "monetary observations": { "state": "not_assessed", "review_state": "not_assessed", "coverage": "partial", "record_ids": [] }, "institutional decisions": { "state": "not_assessed", "review_state": "not_assessed", "coverage": "partial", "record_ids": [] } }, "fields": { "actors[]": { "state": "value_present", "value": { "kind": "record_fields", "fields": { "developer": "Apple" } }, "provenance": { "kind": "legacy_record", "basis": "Preserved from the existing AIBD record; external sources were not rechecked.", "record_fields": [ "developer" ], "source_refs": [] }, "review_state": "record_mapped", "coverage": "partial" }, "actors[].ownership_control": { "state": "not_assessed", "review_state": "not_assessed", "coverage": "partial" }, "ai_contribution": { "state": "value_present", "value": { "kind": "record_fields", "fields": { "ai_role": { "status": "assessed", "statement": "The watch recorded a 30-second lead-I trace at the wearer's initiative. The report gives no classification result from the app. The negative T-wave was noticed by the patient and interpreted by cardiologists, who ordered the exercise test, imaging and surgery. No machine-learning output contributed to the finding as described. The single source is an independent peer-reviewed case report. No maker material was used." } } }, "provenance": { "kind": "legacy_record", "basis": "Preserved from the existing AIBD record; external sources were not rechecked.", "record_fields": [ "ai_role" ], "source_refs": [] }, "review_state": "record_mapped", "coverage": "partial" }, "ai_relationship": { "state": "value_present", "value": { "kind": "record_fields", "fields": { "category": "benefit created", "ai_role": { "status": "assessed", "statement": "The watch recorded a 30-second lead-I trace at the wearer's initiative. The report gives no classification result from the app. The negative T-wave was noticed by the patient and interpreted by cardiologists, who ordered the exercise test, imaging and surgery. No machine-learning output contributed to the finding as described. The single source is an independent peer-reviewed case report. 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The manuscript was received 26 June 2023 and the event is undated. The patient was a 76-year-old asymptomatic man with a strong family history of coronary disease. He had 30 years of treated hypercholesterolemia and four years of type 2 diabetes. He exercised weekly on a cross trainer. Very infrequently and “solely out of interest”, he recorded a lead-I electrocardiogram (ECG) with his Apple Watch right afterwards. On the last recording he noticed a negative T-wave that deepened over about seven minutes and normalized after 22 minutes. He had no chest pain, breathlessness, dizziness or palpitations. He consulted a cardiologist, whose resting ECG and examination were normal. A bicycle exercise test two days later reproduced the lead-I T-wave change with ST depression up to 4 mm in V5. Cardiac computed tomography (CT) showed stenoses in all coronary arteries (CAD-RADS 4). Invasive angiography showed three-vessel disease and a perfusion scan reversible ischemia in 16% of the myocardium. The heart team chose surgery and he received four bypass grafts. Recovery was uneventful and a repeat exercise ECG at 11 weeks was normal. The authors note Apple does not recommend the watch for detecting infarction or ischemia. They note lead I is not ideal for ischemia and the finding requires systematic study before clinical use. The paper reports no output from the ECG app's rhythm classifier. The wearer saw the abnormality on the trace and clinicians confirmed it.", "benefit_type": "Improved Physical Health" } }, "provenance": { "kind": "legacy_record", "basis": "Preserved from the existing AIBD record; external sources were not rechecked.", "record_fields": [ "account", "benefit_type" ], "source_refs": [] }, "review_state": "record_mapped", "coverage": "partial" }, "outcomes[].distribution": { "state": "not_assessed", "review_state": "not_assessed", "coverage": "partial" }, "outcomes[].duration": { "state": "not_assessed", "review_state": "not_assessed", "coverage": "partial" }, "outcomes[].id": { "state": "not_assessed", "review_state": "not_assessed", "coverage": "partial" }, "outcomes[].stakeholder_group": { "state": "value_present", "value": { "kind": "record_fields", "fields": { "ratings": [ { "group": "personal", "depth": 3, "reason": "Silent, extensive, reversible ischemia from three-vessel disease was found and treated with quadruple bypass in an asymptomatic man. The authors' learning point is that such ischemia can end in exercise-induced sudden death. The counterfactual is not established." } ] } }, "provenance": { "kind": "legacy_record", "basis": "Preserved from the existing AIBD record; external sources were not rechecked.", "record_fields": [ "ratings" ], "source_refs": [] }, "review_state": "record_mapped", "coverage": "partial" }, "outcomes[].status": { "state": "not_assessed", "review_state": "not_assessed", "coverage": "partial" }, "outcomes[].tradeoffs": { "state": "not_assessed", "review_state": "not_assessed", "coverage": "partial" }, "outcomes[].unexpected": { "state": "value_present", "value": { "kind": "record_fields", "fields": { "unexpected": true, "purpose": "The ECG app is built to record a single-lead ECG and classify atrial fibrillation. Using the trace to spot exercise-induced ischemia is, as the authors say, not endorsed by Apple." } }, "provenance": { "kind": "legacy_record", "basis": "Preserved from the existing AIBD record; external sources were not rechecked.", "record_fields": [ "unexpected", "purpose" ], "source_refs": [] }, "review_state": "record_mapped", "coverage": "partial" }, "places[]": { "state": "value_present", "value": { "kind": "record_fields", "fields": { "location": "Amsterdam, the Netherlands", "developer_country": "United States" } }, "provenance": { "kind": "legacy_record", "basis": "Preserved from the existing AIBD record; external sources were not rechecked.", "record_fields": [ "location", "developer_country" ], "source_refs": [] }, "review_state": "record_mapped", "coverage": "partial" }, "purpose": { "state": "value_present", "value": { "kind": "record_fields", "fields": { "purpose": "The ECG app is built to record a single-lead ECG and classify atrial fibrillation. 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He consulted a cardiologist, whose resting ECG and examination were normal. A bicycle exercise test two days later reproduced the lead-I T-wave change with ST depression up to 4 mm in V5. Cardiac computed tomography (CT) showed stenoses in all coronary arteries (CAD-RADS 4). Invasive angiography showed three-vessel disease and a perfusion scan reversible ischemia in 16% of the myocardium. The heart team chose surgery and he received four bypass grafts. Recovery was uneventful and a repeat exercise ECG at 11 weeks was normal. The authors note Apple does not recommend the watch for detecting infarction or ischemia. They note lead I is not ideal for ischemia and the finding requires systematic study before clinical use. The paper reports no output from the ECG app's rhythm classifier. 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The heart team chose surgery and he received four bypass grafts. Recovery was uneventful and a repeat exercise ECG at 11 weeks was normal. The authors note Apple does not recommend the watch for detecting infarction or ischemia. They note lead I is not ideal for ischemia and the finding requires systematic study before clinical use. The paper reports no output from the ECG app's rhythm classifier. 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