Improving structural heart disease screening: AI-ECG and novice AI-guided focused cardiac ultrasound

Structural heart disease (SHD) causes substantial morbidity, yet early detection is limited. In this prospective study, AI-enhanced ECG and AI-guided focused cardiac ultrasound (AI-FoCUS) were assessed for detecting SHD (left ventricular EF < 40%, ≥moderate aortic stenosis, hypertrophic cardiomyopathy, or cardiac amyloidosis) in 995 adults against comprehensive echocardiography performed within 30 min of AI-FoCUS. Nine complete novices used handheld ultrasound (Philips Lumify) with real-time AI guidance (UltraSight) with images interpreted by blinded experts. AI-FoCUS was feasible in 97.3%. Prevalence was 5.0% for EF < 40%, 3.5% for ≥moderate aortic stenosis, and 8.8% for hypertrophic cardiomyopathy or amyloidosis. AI-ECG alone yielded NPV 95.8% but PPV 29.6%, limiting standalone screening. AI-FoCUS alone achieved PPV 95.4% and NPV 98.0%, however requires imaging in all. A two-step strategy (positive AI-ECG followed by AI-FoCUS) maintained high PPV/NPV (96.1%/95.6%) but limited FoCUS imaging to 47%.In this echo referral cohort, novice AI-guided FoCUS acquisition with blinded expert interpretation was feasible and accurate for detecting selected SHD phenotypes. A two-step AI-ECG then AI-FoCUS strategy reduced FoCUS utilization, but lowered sensitivity compared with AI-FoCUS for all. However, both FoCUS-based strategies were superior to AI-ECG based screening alone. This work requires further assessment and validation in lower prevalence populations.