Transthoracic echocardiography (TTE) plays a key role in the assessment of cardiomyopathy but remains time-consuming and highly dependent on operator expertise. AI-based automated echocardiographic analysis may improve efficiency and measurement reproducibility; however, validation against cardiovascular magnetic resonance (CMR) in patients with cardiomyopathy remains limited.
To validate an AI-based automated echocardiography algorithm (AI-Echo) against expert manual echocardiography and CMR in patients with ischemic cardiomyopathy (ICM), hypertrophic cardiomyopathy (HCM), or cardiac amyloidosis (CA).
This single-center retrospective study included 145 patients with ICM (n=49), HCM (n=48), or CA (n=48) who underwent TTE and CMR within one month between August 2013 and November 2025. AI-Echo was compared with expert echocardiography and CMR for left ventricular ejection fraction (LVEF), end-diastolic volume (EDV), end-systolic volume (ESV), LV mass, interventricular septal thickness at end-diastole (IVSd), and left atrial diameter (LAD) measurements. Agreement was assessed using Pearson correlation coefficient (r) and mean absolute error (MAE), with Bland–Altman plots. Correlations were compared using Steiger's Z-test.
AI-Echo showed strong agreement with manual echocardiography across all measured parameters:
| Parameter | AI-Echo | Manual Echo | r (vs Manual) | MAE |
|---|---|---|---|---|
| LVEF (%) | 47.79 ± 13.07 | 51.62 ± 15.27 | 0.81 | 7.84 |
| EDV (mL) | 106.49 ± 48.42 | 118.40 ± 52.21 | 0.95 | 15.46 |
| ESV (mL) | 59.13 ± 39.19 | 62.22 ± 43.78 | 0.94 | 11.03 |
| LV Mass (g) | 208.36 ± 58.96 | 222.52 ± 70.42 | 0.82 | 31.89 |
| IVSd (mm) | 12.52 ± 3.29 | 12.88 ± 3.88 | 0.80 | 1.81 |
| LAD (mm) | 40.73 ± 6.83 | 45.10 ± 7.20 | 0.81 | 4.97 |
Compared with CMR, AI-Echo showed correlations comparable to manual echocardiography for LVEF (r=0.86 vs 0.87), IVSd (r=0.81 vs 0.79), and LAD (r=0.77 vs 0.72; all p≥0.05). For volumetric parameters, AI-Echo demonstrated higher correlation with CMR than manual echo: LVEDV (r=0.88 vs 0.85), LVESV (r=0.95 vs 0.93), and LV mass (r=0.80 vs 0.74; all p<0.05). Across all three cardiomyopathy subgroups, AI-Echo correlations with CMR ranged from r=0.65–0.90, with no subgroup showing inferiority to manual echo on Steiger's test (all p≥0.05).
In patients with ICM, HCM and cardiac amyloidosis, AI-Echo produced measurements in strong agreement with expert manual echocardiography and showed similar or higher agreement with CMR. These findings support AI-Echo as an efficient and validated approach for quantitative assessment of cardiac structure and function in cardiomyopathy.