Current and emerging role of AI in echocardiography

Heart failure is a clinical syndrome in which the heart cannot pump blood sufficiently to meet the body’s needs, leading to symptoms like shortness of breath, fatigue, and fluid build-up in tissues. It arises from structural or functional abnormalities of the heart that impair ventricular filling or ejection of blood.

This may involve reduced systolic function (the heart’s pumping ability), preserved ejection fraction (diastolic dysfunction), or a mix of both.

“Heart failure is not a single disease, it is the final common pathway of many cardiac conditions that impair the heart’s ability to pump and circulate blood effectively,” said Dr Xavier Brown, post-doctoral Fellow, Heart Institute of the Caribbean.

During his presentation at the Masters of Medicine Conferences held at the AC Hotel in Kingston, Dr Brown said that, while detailed population-wide heart failure prevalence figures are limited in many Caribbean countries, cardiovascular disease (of which heart failure is a major component) is a leading cause of death in the region. In Jamaica, for instance, cardiovascular disease accounts for roughly a third of all deaths.

Studies in Afro-Caribbean communities living in the United Kingdom, often considered a proxy for patterns seen in Caribbean descent populations, show that specific cardiomyopathy types differ by ethnicity:

Among Afro-Caribbean patients with clinical heart failure studied in London, non-ischemic dilated cardiomyopathy was the most common cause.

Rates of ischemic cardiomyopathy (due to coronary artery disease) were much lower (13 per cent) compared with white patients. Cardiac amyloidosis (ATTR V122I), a genetic condition more prevalent in people of African descent, accounted for over 11 per cent of cases.

“In Afro-Caribbean patients, hypertension and non-ischemic cardiomyopathies often dominate the heart failure landscape, reminding us that regional genetics, environment, and risk factor patterns shape disease prevalence,” Dr Brown said.

“Echocardiography is our cornerstone for diagnosing and managing heart failure, it tells us how well the heart pumps, how thick the walls are, and whether valves or muscle movements are abnormal,” Dr Brown said.

Artificial intelligence (AI), especially machine learning (ML) and deep learning (DL), is now being integrated into echocardiography to support clinicians:

1. AUTOMATED IMAGE INTERPRETATION

• AI systems are trained on thousands to millions of echo images and expert reports. They learn patterns associated with normal and abnormal heart structures so that:

• View classification identifies which anatomical view is on screen.

• Segmentation isolates heart chambers and walls.

• Measurements (like ejection fraction) are calculated automatically.

2. DIAGNOSTIC PROBABILITY SCORING

After processing the image data, AI tools can assign probabilities that a patient has a specific condition for example heart failure with reduced ejection fraction, hypertrophic cardiomyopathy, amyloidosis. These probabilities help clinicians weigh diagnoses quantitatively rather than purely subjectively.

“AI doesn’t replace the clinician, but it adds a second, statistically grounded lens, turning echo images into quantified diagnostic probabilities that refine and speed clinical decisions,” Dr Brown said.

3. WORKFLOW AND QUALITY ENHANCEMENTS

AI assists with image acquisition (guiding probe placement), standardising measurements, flagging poor quality images, and potentially generating draft reports, saving time and reducing variability.

WHY AI MATTERS IN ECHOCARDIOGRAPHY

Accuracy & Consistency: AI can reduce measurement variability between operators

Speed: Automated analysis can cut interpretation time significantly

Access: In resource-constrained settings, AI might extend diagnostic reach where cardiology specialists are limited

Probability-Driven Decisions: Rather than a binary normal/abnormal call, AI yields nuanced risk scores that integrate data patterns beyond human visual assessment

“We are entering an era where echo plus AI doesn’t just show us the heart, it helps predict what that image means for this person’s future risk and optimal care path,” Dr Brown said.

keisha.hill@gleanerjm.com