Artificial intelligence-based echocardiography assessment to detect pulmonary hypertension

Background Tricuspid regurgitation jet velocity (TRJV) on echocardiography is used for screening patients with suspected pulmonary hypertension (PH). Artificial intelligence (AI) tools, such as the US2.AI, have been developed for automated evaluation of echocardiograms and can yield measurements that aid PH detection. This study evaluated the performance and utility of the US2.AI in a consecutive cohort of patients with suspected PH.

Methods 1031 patients who had been investigated for suspected PH between 2009–2021 were retrospectively identified from the ASPIRE registry. All patients had undergone echocardiography and right heart catheterisation (RHC). Based on RHC results, 771 (75%) patients with a mean pulmonary arterial pressure >20 mmHg were classified as having a diagnosis of PH (as per the 2022 European guidelines). Echocardiograms were evaluated manually and by the US2.AI tool to yield TRJV measurements.

Results The AI tool demonstrated high interpretation yield, successfully measuring TRJV in 87% of echocardiograms. Manually- and automatically-derived TRJV values showed excellent agreement (intraclass correlation coefficient: 0.94; 95% CI 0.94–0.95) with minimal bias (Bland-Altman analysis). Automated TRJV measurements showed equally high diagnostic accuracy for PH as manual measurements (AUC: 0.88 [95% CI 0.84, 0.90] versus 0.88 [95% CI 0.86, 0.91]).

Conclusion Automated TRJV measurements on echocardiography were similar to manual measurements, with similarly high and non-inferior diagnostic accuracy for PH. These findings demonstrate that automated measurement of TRJV on echocardiography is feasible, accurate and reliable and support the implementation of AI-based approaches to echocardiogram evaluation and diagnostic imaging for PH.