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August 8, 2026European Heart Journal - Digital HealthOpen Access

Real-life clinical validation of AI-assisted echocardiography for aortic root and LVOT measurements against human readers and cardiac magnetic resonance

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Why the study?

AI algorithms may improve echocardiographic measurement standardization, but direct validation against CMR remains limited.

Does automated AI measurement of TTE provide comparable agreement to expert manual TTE for aortic root and LVOT diameters when compared against CMR in patients undergoing both imaging modalities?

Population

169 patients with analyzable TTE and CMR recordings within seven days

Comparison

AI-assisted TTE vs expert manual TTE vs CMR

Design

Validation study

Key result

AI-assisted echocardiography demonstrated comparable agreement with CMR for LVOT (ICC 0.70; 95% CI 0.61-0.77), STJ, and SoV measurements, but clinically significant differences occurred in up to 36.7%.

Authors

PMPatrycja Mołek-DziadoszOBOleksandra BondarchukAWAleksandra Woźniak

Discussion

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Overview

AI-assisted TTE offers comparable agreement to manual measurements versus CMR but requires oversight; leaves open need for prospective validation before routine adoption.

Key Points

  • To evaluate the agreement between AI-assisted echocardiography, expert manual echocardiography, and cardiac magnetic resonance for aortic root and LVOT diameters.
  • 183 patients underwent echocardiography and cardiac magnetic resonance within 7 days
  • 169 patients had complete measurements of LVOT, SoV, and STJ
  • Agreement was assessed using intraclass correlation coefficients and Bland-Altman analysis.
  • AI measurements showed ICC of 0.70 for LVOT, 0.77 for STJ, and 0.77 for SoV compared to CMR
  • Clinically significant differences (≥2 mm for LVOT; ≥4 mm for STJ and SoV) were found in 36.7% of LVOT, 20% of STJ, and 11.8% of SoV measurements
  • Expert agreement with CMR yielded ICCs of 0.63, 0.71, and 0.85 for LVOT, STJ, and SoV, respectively.

Study Design

Type

Observational (n=169)

Structured PICO

Does automated AI measurement of TTE provide comparable agreement to expert manual TTE for aortic root and LVOT diameters when compared against CMR in patients undergoing both imaging modalities?

P
Population
169 patients with analyzable TTE and CMR recordings performed within seven days.
E
Exposure
Automated AI measurements of TTE using the US2.AI platform.
C
Comparator
Expert manual TTE measurements (by two expert echocardiographers) and cardiovascular magnetic resonance (CMR) as the gold standard.
O
Outcome
Agreement between AI-assisted TTE, expert manual TTE, and CMR for aortic root (SoV, STJ) and LVOT diameters, assessed using intraclass correlation coefficients (ICC) and Bland-Altman analysis.surrogate

Main Result

Effect estimate: ICC 0.70 (95% CI 0.61-0.77)

AI-assisted echocardiography shows comparable agreement to expert readers for aortic root and LVOT measurements against CMR, though physician oversight remains necessary due to clinically significant differences in a subset of patients.

Cite This Study

Mołek-Dziadosz et al. (2026) reported an observational. AI-assisted transthoracic echocardiography vs. Expert manual TTE and cardiovascular magnetic resonance was evaluated on Agreement with CMR for LVOT diameter (ICC 0.70, 95% CI 0.61-0.77). AI-assisted echocardiography demonstrated comparable agreement with CMR for LVOT (ICC 0.70; 95% CI 0.61-0.77), STJ, and SoV measurements, but clinically significant differences occurred in up to 36.7%.

synapsesocial.com/papers/6a76da8cf12abadc79814ef4https://doi.org/10.1093/ehjdh/ztag126
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