Comparison of AI-Enabled Cardiac Chambers Volumetry Based on Non-Gated Chest CT Scans with Echocardiography
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Can a routine chest CT provide cardiac chamber information comparable to echocardiography?
A new HeartLung.AI AI-CVD study, to be presented at ESC Congress 2026, investigates whether AI-enabled cardiac chamber volumetry derived from routine non-gated, non-contrast chest CT can provide clinically meaningful information comparable to measurements obtained from echocardiography.
The opportunity is substantial. Approximately 19 million non-gated chest CT scans are performed each year in the United States for a wide range of clinical indications. These examinations are not primarily acquired to evaluate cardiac function, yet they contain anatomical information about the heart that could potentially be extracted automatically using AI.
Study Design
The study included 1,675 participants from the Multi-Ethnic Study of Atherosclerosis (MESA) who underwent both non-gated, non-contrast chest CT and echocardiography during MESA Exam 6 between 2016 and 2018.
At baseline:
158 participants had atrial fibrillation (AF)
37 had heart failure (HF)
Of those with HF, 9 had an ejection fraction below 40%
Participants were also followed for incident cardiovascular outcomes. Over a median 2.6-year follow-up, 16 new HF events occurred, while over a median 1.6 years, 49 new AF events were observed.
CT vs. Echocardiography
The study directly compared AI-derived cardiac chamber measurements from non-gated CT with corresponding echocardiographic measurements.
Rather than asking whether routine CT should replace echocardiography, the study addresses a broader opportunity: Can cardiac information already present in millions of existing chest CT scans be used to identify patients with clinically relevant cardiac abnormalities and future risk?
The analyses compared the two imaging approaches for:
Discrimination of prevalent heart failure and atrial fibrillation, as well as prediction of incident HF and AF during follow-up.
Why It Matters
Echocardiography remains a dedicated and important cardiac imaging modality. But millions of patients undergo chest CT every year for other clinical reasons.
If AI can reliably quantify cardiac chamber characteristics from those existing scans, a routine chest CT could become an additional opportunity to detect cardiac abnormalities and identify individuals who may benefit from further cardiovascular evaluation.
This represents the broader concept of opportunistic cardiovascular screening: extracting clinically meaningful information from imaging that has already been acquired, rather than requiring another examination solely for initial risk assessment.
One routine chest CT. Automated cardiac chamber assessment. More cardiovascular information from imaging already performed.
📍 To be presented at ESC Congress 2026 · Munich
By Seyed Reza Mirjalili, MD
Download the full presentation below to explore the CT-versus-echocardiography comparisons, study results, and potential clinical implications.
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