ARTIFICIAL intelligence (AI) is emerging as a crucial component of health care to help improve performance and efficiency of physicians. Below we will examine how AI can aid in chest X-rays and cardiac ultrasounds.

AI and chest X-rays

Researchers have developed a deep learning model that uses a single chest X-ray to predict the 10-year risk of death from a heart attack or stroke from atherosclerotic heart disease. Results of the study were presented at the yearly meeting of the Radiological Society of North America (RSNA) in Chicago (November 27 to Dec 1, 2022).

Deep learning is an advanced type of AI that can be trained to search X-ray images to find patterns associated with disease. This finding offers huge potential solution for population-based large-scale screening of cardiovascular disease risk using existing chest X-ray images and could be potentially significant in low resource environments since X-rays are widely available and often inexpensive. This type of screening could be used to identify individuals who would benefit from primary and secondary prevention using proven treatment strategies like the “statin” class of cholesterol reducing agents. Current guidelines recommend estimating 10-year risk of major adverse cardiovascular disease events to establish who should get a statin for primary prevention.

This risk is calculated using the atherosclerotic cardiovascular disease (ASCVD) risk score, a statistical model that considers a host of variables, including age, sex, race, systolic blood pressure, hypertension treatment, smoking, type 2 diabetes, and blood tests. Statin medication is recommended for patients with a 10-year risk of 7.5 per cent or higher. The variables necessary to calculate ASCVD risk are often not available, which makes alternative approaches for population-based screening desirable. As chest X-rays are commonly available, an AI deep learning model may help identify individuals at high risk. The investigators showed that based on a single existing chest X-ray image, deep learning model predicted future major adverse cardiovascular events with similar performance and incremental value to the established clinical standard.

AI and cardiac ultrasounds (echocardiography or echo)

Just a few days ago, UltraSight, an Israeli-based digital health pioneer, announced new findings from a landmark pivotal study using AI in cardiac ultrasound. According to the results, UltraSight’s AI guidance technology allowed medical professionals, with no prior sonography experience, to accurately perform echocardiographic examinations and acquire high quality diagnostic images of the heart comparable to those performed by professional cardiac sonographers.

This multi-centre study evaluated 2D transthoracic echocardiography images acquired by providers with no prior cardiac ultrasound training or experience, using UltraSight’s AI real-time guidance software compared to those performed by a professional sonographer, without using the software.

The quality of the exams conducted by both the novice users and professional cardiac sonographers were remarkably comparable. Health-care professionals without prior sonography were able to capture diagnostic quality ultrasound images of patients’ hearts just by following the guidance offered by the software. The study demonstrated that UltraSight’s technology allowed health-care professionals, regardless of their sonography experience, to capture diagnostic quality cardiac ultrasound exams. This is a potential game changer that would allow wide scale availability of echocardiography (cardiac ultrasound) examinations, a critically important tool in the clinical evaluation of many cardiac and non-cardiac patients.

AI-based models allow for quantitative measures, which allow clinicians to provide both diagnostic and prognostic information that helps improve the overall care of patients.

Solutions offered by AI not only enable prediction and prevention of problems, but also could eventually help diminish health disparities and the burden on health systems and clinicians, especially in low-resource environments.

Dr Ernest Madu, MD, FACC and Dr Paul Edwards, MD, FACC are consultant cardiologists for Heart Institute of the Caribbean (HIC) and HIC Heart Hospital. HIC is the regional centre of excellence for cardiovascular care in the English-speaking Caribbean and has pioneered a transformation in the way cardiovascular care is delivered in the region. HIC Heart Hospital is registered by the Ministry of Health and Wellness and is the only heart hospital in Jamaica. Correspondence to info@caribbeanheart.com or call 876-906-2107