Preliminary assessment of patients undergoing echocardiographic evaluation of left ventricular ejection fraction (LVEF) using artificial intelligence (AI) was superior to initial sonographer assessment in terms of safety and efficacy, according to findings from EchoNeT-RCT presented Aug. 27 during ESC Congress 2022 in Barcelona.

Researchers randomly assigned 3,495 transthoracic echocardiograms performed on adults for any clinical indication to either AI initial assessment or sonographer initial assessment, after which blinded cardiologists reviewed the assessment and provided a final report of LVEF. The primary endpoint was the frequency of a greater than 5% change in LVEF between the initial assessment (AI or sonographer) and the final cardiologist report. The safety endpoint was the difference between the final cardiologist report and a historical cardiologist report.

Overall results found the proportion of studies substantially changed was 16.8% in the AI group and 27.2% in the sonographer group (difference -10.4%, 95% CI -13.2% to -7.7%, p<0.001 for noninferiority, p<0.001 for superiority). In terms of safety, the mean absolute difference was 6.29% in the AI group compared with 7.23% in the sonographer group (difference -0.96%, 95% CI -1.34% to -0.54%, p<0.001 for superiority).

"We learned a lot from running a randomized trial of an AI algorithm, which hasn't been done before in cardiology," said David Ouyang, MD, FACC, who presented the findings. "First, we learned that this type of trial is highly feasible in the right setting, where the AI algorithm can be integrated into the usual clinical workflow in a blinded fashion. Second, we learned that blinding really can work well in this situation." He noted that cardiologists reviewing the assessments couldn't tell the difference between a scan that was initially reviewed by AI or a sonographer.

"We are excited by the implications of the trial," he said. "What this means for the future is that certain AI algorithms, if developed and integrated in the right way, could be very effective at not only improving the quality of echo reading output but also increasing efficiencies in time and effort spent by sonographers and cardiologists by simplifying otherwise tedious but important tasks."

Clinical Topics: Noninvasive Imaging, Echocardiography/Ultrasound

Keywords: ESC Congress, ESC22, ACC International, Stroke Volume, Ventricular Function, Left, Artificial Intelligence, Echocardiography

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