Key result
AI-automated handheld echocardiography detects LVEF ≤40% with ~93% diagnostic accuracy vs cart-based scans.
Why the study?
Echocardiography is a rate-limiting step in timely diagnosis of heart failure, and automated reporting may streamline workflow but its accuracy and interchangeability with expert analysis were uncertain.
Does fully automated artificial intelligence analysis of handheld echocardiography accurately detect LVEF ≤40% compared to expert human-analyzed cart-based echocardiograms in patients with suspected heart failure?
Observational (n=867)
Blinded core laboratory sonographers
Yes
Does fully automated artificial intelligence analysis of handheld echocardiography accurately detect LVEF ≤40% compared to expert human-analyzed cart-based echocardiograms in patients with suspected heart failure?
Effect estimate: Diagnostic accuracy 0.93 (95% CI 0.90-0.95)
Fully automated AI analysis of handheld echocardiograms provides high diagnostic accuracy for detecting LVEF ≤40% and is interchangeable with expert human analysis of cart-based scans, potentially accelerating heart failure diagnosis.
Supports point-of-care LVEF assessment in suspected HF; hypothesis-generating and should not yet change practice.
AIMS: Echocardiography is a rate-limiting step in the timely diagnosis of heart failure (HF). Automated reporting of echocardiograms has the potential to streamline workflow. The aim of this study was to test the diagnostic accuracy of fully automated artificial intelligence (AI) analysis of images acquired using handheld echocardiography and its interchangeability with expert human-analysed cart-based echocardiograms in a real-world cohort with suspected HF. METHODS AND RESULTS: In this multicentre, prospective, observational study, patients with suspected HF had two echocardiograms: one handheld portable and one cart-based scan. Both echocardiograms were analysed using fully automated AI software and by human expert sonographers. The primary endpoint was the diagnostic accuracy of AI-automated analysis of handheld echocardiography to detect left ventricular ejection fraction (LVEF) ≤40%. Other endpoints included the interchangeability (assessed using individual equivalence coefficient [IEC]), between AI-automated and human analysis of cart-based LVEF. A total of 867 patients participated. The AI-automated analysis produced an LVEF in 61% of the handheld scans and 77% of the cart-based scans, compared to 76% and 77% of human analyses of the handheld and cart-based scans, respectively. The AI-automated analysis of handheld echocardiography had a diagnostic accuracy of 0.93 (95% confidence interval [CI] 0.90, 0.95) for identifying LVEF ≤40% (compared to the human analysis of cart-based transthoracic echocardiography scans). AI-automated analysis of LVEF on handheld devices was interchangeable with cart-based LVEF reported by two expert humans (IEC -0.40, 95% CI -0.60, -0.16). CONCLUSIONS: Artificial intelligence-automated analysis of handheld echocardiography had good diagnostic accuracy for detecting LVEF ≤40%. AI-automated analysis of LVEF of handheld scans was interchangeable with cart-based expert human analysis.
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Campbell et al. (2025) conducted an observational in Suspected heart failure (n=867). AI-automated analysis of handheld echocardiography vs. Human expert analysis of cart-based echocardiograms was evaluated on Diagnostic accuracy to detect LVEF ≤40% (Diagnostic accuracy 0.93, 95% CI 0.90-0.95). AI-automated analysis of handheld echocardiography demonstrated a diagnostic accuracy of 0.93 (95% CI 0.90-0.95) for detecting LVEF ≤40% compared to human analysis of cart-based echocardiograms.
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