Integrating AI-ECG and point-of-care cardiac ultrasound for screening structural heart disease: A proof-of-concept study

IF 3.4 2区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

American heart journal Pub Date : 2026-04-01 Epub Date: 2025-12-31 DOI:10.1016/j.ahj.2025.107337

Francisco B. Alexandrino MD , Reid Schlesinger MD , Jared Bird MD , Eunjung Lee PhD , Abhishek J. Deshmukh MBBS , Vuyisile T. Nkomo MD, MPH , Jae K. Oh , Peter A. Noseworthy MD , Patricia A. Pellikka MD , Zachi Attia PhD , Francisco Lopez-Jimenez MD , Paul A. Friedman , Garvan C. Kane MD, PhD , Sorin V. Pislaru MD, PhD , Gal Tsaban MD, PhD

{"title":"Integrating AI-ECG and point-of-care cardiac ultrasound for screening structural heart disease: A proof-of-concept study","authors":"Francisco B. Alexandrino MD , Reid Schlesinger MD , Jared Bird MD , Eunjung Lee PhD , Abhishek J. Deshmukh MBBS , Vuyisile T. Nkomo MD, MPH , Jae K. Oh , Peter A. Noseworthy MD , Patricia A. Pellikka MD , Zachi Attia PhD , Francisco Lopez-Jimenez MD , Paul A. Friedman , Garvan C. Kane MD, PhD , Sorin V. Pislaru MD, PhD , Gal Tsaban MD, PhD","doi":"10.1016/j.ahj.2025.107337","DOIUrl":null,"url":null,"abstract":"<div><h3>Background</h3><div>Early structural heart disease (SHD) detection is crucial for improving prognostic outcomes, but widely accessible screening methods are lacking. The advent of artificial intelligence-enabled electrocardiograms (AI-ECG) and point-of-care cardiac-ultrasonography (POCCUS) offers promising new approaches for patient screening. We explored the feasibility and potential of integrating these innovative technologies into a practical SHD screening framework.</div></div><div><h3>Methods</h3><div>Outpatients undergoing ECG at the Mayo Clinic ECG laboratory between November 2023 and February 2024 were pragmatically offered POCCUS, performed by novice operators and reviewed by expert echocardiographers. AI-ECG and POCCUS findings were integrated to assess SHD, including reduced left ventricular systolic function (ejection-fraction<50%), aortic stenosis, and increased left ventricular wall thickness suggestive of cardiac amyloidosis or hypertrophic cardiomyopathy. Operators were blinded to patients’ comorbidities and formal echocardiogram results.</div></div><div><h3>Results</h3><div>Of 486 patients (median-age 64 years; 49% women), 286 had available formal echocardiography, with 17.5% having SHD. AI-ECG had a 32% positive predictive value (PPV) and a 94% negative predictive value (NPV) to detect any SHD. Adding POCCUS increased the overall PPV to 64% with an NPV of 93%, with an increase in diagnostic accuracy from 67% to 88%. Notably, 89.5% (17/19) of the “false positives” by AI-ECG + POCCUS had less-than-moderate-SHD. Applying the AI-ECG + POCCUS screening workflow on the entire cohort resulted in a number-needed-to-screen of 8 to identify 1 patient requiring formal echocardiography.</div></div><div><h3>Conclusions</h3><div>The integration of AI-ECG and POCCUS holds promise as a potentially effective screening method for SHD, facilitating improved patient selection for formal echocardiography.</div></div>","PeriodicalId":7868,"journal":{"name":"American heart journal","volume":"294 ","pages":"Article 107337"},"PeriodicalIF":3.4000,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"American heart journal","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S0002870325003990","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2025/12/31 0:00:00","PubModel":"Epub","JCR":"Q1","JCRName":"CARDIAC & CARDIOVASCULAR SYSTEMS","Score":null,"Total":0}

引用次数: 0

Abstract

Background

Early structural heart disease (SHD) detection is crucial for improving prognostic outcomes, but widely accessible screening methods are lacking. The advent of artificial intelligence-enabled electrocardiograms (AI-ECG) and point-of-care cardiac-ultrasonography (POCCUS) offers promising new approaches for patient screening. We explored the feasibility and potential of integrating these innovative technologies into a practical SHD screening framework.

Methods

Outpatients undergoing ECG at the Mayo Clinic ECG laboratory between November 2023 and February 2024 were pragmatically offered POCCUS, performed by novice operators and reviewed by expert echocardiographers. AI-ECG and POCCUS findings were integrated to assess SHD, including reduced left ventricular systolic function (ejection-fraction<50%), aortic stenosis, and increased left ventricular wall thickness suggestive of cardiac amyloidosis or hypertrophic cardiomyopathy. Operators were blinded to patients’ comorbidities and formal echocardiogram results.

Results

Of 486 patients (median-age 64 years; 49% women), 286 had available formal echocardiography, with 17.5% having SHD. AI-ECG had a 32% positive predictive value (PPV) and a 94% negative predictive value (NPV) to detect any SHD. Adding POCCUS increased the overall PPV to 64% with an NPV of 93%, with an increase in diagnostic accuracy from 67% to 88%. Notably, 89.5% (17/19) of the “false positives” by AI-ECG + POCCUS had less-than-moderate-SHD. Applying the AI-ECG + POCCUS screening workflow on the entire cohort resulted in a number-needed-to-screen of 8 to identify 1 patient requiring formal echocardiography.

Conclusions

The integration of AI-ECG and POCCUS holds promise as a potentially effective screening method for SHD, facilitating improved patient selection for formal echocardiography.

Abstract Image

查看原文本刊更多论文

整合AI-ECG和即时心脏超声筛查结构性心脏病：一项概念验证研究

背景：早期结构性心脏病（SHD）检测对改善预后至关重要，但缺乏广泛可及的筛查方法。人工智能心电图（AI-ECG）和即时心脏超声检查（POCCUS）的出现为患者筛查提供了有希望的新方法。我们探索了将这些创新技术整合到实际的SHD筛选框架中的可行性和潜力。方法：2023年11月至2024年2月在梅奥诊所心电实验室接受心电图检查的门诊患者，采用实用的POCCUS，由新手操作并由超声心动图专家审核。综合AI-ECG和POCCUS结果来评估SHD，包括左心室收缩功能降低（射血分数）结果：在486例患者（中位年龄64岁；49%为女性）中，286例进行了正式的超声心动图检查，其中17.5%患有SHD。AI-ECG检测任何SHD的阳性预测值为32%，阴性预测值为94%。添加POCCUS将总PPV提高到64%，NPV提高到93%，诊断准确率从67%提高到88%。值得注意的是，89.5%（17/19）的AI-ECG+POCCUS“假阳性”为中度以下shd。在整个队列中应用AI-ECG+POCCUS筛查工作流程导致需要筛查的数字为8，以确定需要正式超声心动图的患者。结论：AI-ECG和POCCUS的结合有望成为一种潜在的有效的SHD筛查方法，有助于改善患者对正式超声心动图的选择。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

American heart journal 医学-心血管系统

CiteScore

8.20

自引率

2.10%

发文量

214

审稿时长

38 days

期刊介绍： The American Heart Journal will consider for publication suitable articles on topics pertaining to the broad discipline of cardiovascular disease. Our goal is to provide the reader primary investigation, scholarly review, and opinion concerning the practice of cardiovascular medicine. We especially encourage submission of 3 types of reports that are not frequently seen in cardiovascular journals: negative clinical studies, reports on study designs, and studies involving the organization of medical care. The Journal does not accept individual case reports or original articles involving bench laboratory or animal research.