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

Méabh M Killalea1, Jordan Borgeson1, Conor J Kane1

  • 1Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA.

NPJ Digital Medicine
|June 9, 2026
PubMed

Insights

AI-guided focused cardiac ultrasound (AI-FoCUS) and AI-enhanced ECG show promise for detecting structural heart disease (SHD). A two-step approach reduced imaging needs while maintaining accuracy, outperforming AI-ECG screening alone.

Area of Science:

  • Cardiology
  • Artificial Intelligence
  • Medical Imaging

Background:

  • Structural heart disease (SHD) presents a significant health burden with limited early detection methods.
  • Current diagnostic approaches can be resource-intensive and may not be widely accessible.

Purpose of the Study:

  • To evaluate the feasibility and accuracy of AI-enhanced electrocardiogram (AI-ECG) and AI-guided focused cardiac ultrasound (AI-FoCUS) for detecting specific SHD phenotypes.
  • To compare a two-step AI-ECG followed by AI-FoCUS strategy against standalone AI-FoCUS and AI-ECG screening.

Main Methods:

  • A prospective study involving 995 adults, assessing AI-ECG and AI-FoCUS against comprehensive echocardiography.
  • Novices utilized handheld ultrasound with real-time AI guidance (UltraSight), with images interpreted by blinded experts.
  • SHD phenotypes included low ejection fraction, moderate aortic stenosis, hypertrophic cardiomyopathy, and cardiac amyloidosis.

Main Results:

  • AI-FoCUS was feasible in 97.3% of cases.
  • Standalone AI-FoCUS demonstrated high positive predictive value (PPV) of 95.4% and negative predictive value (NPV) of 98.0%.
  • The two-step AI-ECG/AI-FoCUS strategy achieved high PPV (96.1%) and NPV (95.6%), reducing FoCUS utilization to 47% but lowering sensitivity compared to universal AI-FoCUS.

Conclusions:

  • Novice-performed AI-guided FoCUS acquisition is feasible and accurate for detecting selected SHD phenotypes in an echo referral setting.
  • A two-step AI-ECG then AI-FoCUS strategy effectively reduces the need for ultrasound imaging while maintaining high diagnostic performance.
  • Both AI-FoCUS-based strategies significantly outperformed AI-ECG screening alone, highlighting the potential of AI in SHD detection.

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