Key result
The AI-based echocardiographic analysis tool showed no systematic sex-related differences in performance for most parameters, though absolute errors were higher in men for tricuspid regurgitation velocity and in women for the E/é ratio.
Why the study?
AI systems may exhibit sex bias and perform worse for certain groups, potentially leading to unequal healthcare outcomes.
Does fully automated AI-based echocardiographic analysis exhibit sex-related differences in agreement with clinical assessment in patients with normal cardiac function, systolic dysfunction, or diastolic dysfunction?
Observational (n=183)
Blinded analysis
No
Does fully automated AI-based echocardiographic analysis exhibit sex-related differences in agreement with clinical assessment in patients with normal cardiac function, systolic dysfunction, or diastolic dysfunction?
Answers are grounded in this paper and cite their sources.
AI-based echocardiographic analysis showed no systematic sex-related bias in classifying normal versus pathological findings, though minor parameter-specific differences in measurement agreement were observed.
BACKGROUND: Artificial intelligence (AI) has the potential to improve echocardiography. However, AI systems may exhibit sex bias, reproducing societal stereotypes and performing worse for certain groups, potentially leading to unequal healthcare outcomes. Therefore, the aim of this study was to investigate whether there are sex-related differences in the agreement between a fully automated AI-based analysis and routine echocardiographic report generated by the interpreting cardiologist in patients undergoing transthoracic echocardiography. METHODS: This retrospective study evaluated seven echocardiographic parameters in 95 women and 88 men by comparing AI-generated values with clinical assessments. Participants included individuals with normal cardiac function (34 women, 31 men) and patients with systolic (30 women, 29 men) or diastolic dysfunction (31 women, 28 men). Parameters included ejection fraction, left ventricular volume, left atrial volume, é velocities (septal and lateral), tricuspid valve regurgitation, and E/é ratio. Potential sex-based differences were assessed by comparing agreement between clinical and AI-generated values in women and men using correlations, absolute errors, Bland-Altman analyses and AUC values. RESULTS: Correlation coefficients in women ranged from 0.67 to 0.93 and in men from 0.32 to 0.93. Absolute errors did not differ significantly between sexes for five of the seven evaluated parameters. However, men showed a higher absolute error for TR velocity (0.15 vs. 0.07, p = 0.001), whereas women showed a higher absolute error for the E/é ratio (0.76 vs. 0.39, p < 0.001). Bland-Altman analysis showed larger mean differences in men for five of seven parameters. The magnitude of the differences in AUC values between women and men was small, ranging from 0.017 (TR velocity) to 0.048 (left ventricular ejection fraction). CONCLUSIONS: This study did not demonstrate systematic sex-related differences in AI performance, but the findings require confirmation in larger cohorts. Continued monitoring for bias remains important as AI integration in echocardiography expands.
No takes yet. Share an insight, caveat, or question.
Blixt et al. (2026) conducted an observational in Normal cardiac function, systolic dysfunction, and diastolic dysfunction (n=183). AI-based echocardiographic analysis (US2ai) vs. Routine clinical echocardiographic report was evaluated on Sex-related differences in absolute errors between AI-generated and clinical echocardiographic parameters (p=0.001 for TR velocity; <0.001 for E/é ratio). The AI-based echocardiographic analysis tool showed no systematic sex-related differences in performance for most parameters, though absolute errors were higher in men for tricuspid regurgitation velocity and in women for the E/é ratio.
Synapse has enriched 10 related papers. Consider them for comparative context: