Ashrith Guha

This review examines the role of artificial intelligence (AI) across the heart failure (HF) continuum, with particular emphasis on patient identification and early recognition, AI-enabled electrocardiography and echocardiography, etiologic and phenotypic classification, electronic health record-based staging and risk prediction, advanced HF identification, continuous monitoring, treatment optimization, and emerging applications of agentic AI.

Background: Quantitative assessment of right ventricular (RV) function by transthoracic echocardiogram (TTE) commonly relies on tricuspid annular plane systolic excursion (TAPSE) and lateral tricuspid annulus peak systolic velocity (S′). However, full cardiac cycle data may provide additional information beyond these two systolic measures. Objective: We sought to (1) automate the estimation of systolic parameters (TAPSE and S′) from tissue spectral Doppler imaging (Tissue Doppler Imaging [TDI]) and (2) integrate these tabular systolic parameters and the full‐cycle functional signal to estimate RV systolic function. Methods: We identified 387 patients who underwent both TTE and cardiac magnetic resonance imaging (CMR) within 24 h. We developed and validated an automated algorithm to extract TAPSE and S′ from raw TDI. We trained two classifier models for RV dysfunction (RVEF < 45%): (1) Tabular model (RVD _TABULAR ) using algorithmic measurement of TAPSE/S′ and age/sex, and (2) Integrated model (RVD _INTEGRATED ), an attention‐based neural network model using the entire digitized TDI waveforms in addition to tabular data. Results: In the TTE‐CMR paired dataset, the proposed algorithm accurately estimated S′ (mean error: −0.05 cm/s) and TAPSE (mean error: −0.97 mm). Tabular model RVD _TABULAR achieved an AUROC of 0.71 and an AUPRC of 0.48 for predicting RVEF INTEGRATED achieved significantly better performance (AUROC: 0.768; AUPRC: 0.56). In the external validation cohort with pulmonary hypertension (PH), the integrated model's prediction was significantly associated with event‐free survival ( p = 0.036). Conclusions: We developed a fully automated pipeline that integrates digitized TDI waveforms with both parametric and non‐parametric features to classify RVEF <45%. This approach can effectively risk‐stratify patients with PH.

Purpose of review: The role of imaging in diagnosis of pulmonary hypertension is multifaceted, spanning from estimation of pulmonary arterial pressures, understanding pulmonary artery-right ventricular interaction, and identification of the cause. The purpose of this review is to provide a comprehensive overview of multimodality imaging in evaluation of pulmonary hypertension as well as the novel applications of imaging techniques that have improved our detection and understanding of pulmonary hypertension. Recent findings: There are diverse imaging modalities available for comprehensive assessment of pulmonary hypertension that are expanding with new tracers (e.g., hyperpolarized xenon gas, ¹²⁹Xe) and imaging techniques (C-arm cone-bean computed tomography). Artificial intelligence applications may improve efficiency and accuracy of screening for pulmonary hypertension as well as further characterize pulmonary vasculopathies using computed tomography of the chest. In the face of increasing imaging options, a “value-based imaging” approach should be adopted to reduce unnecessary burden on the patient and the healthcare system without compromising the accuracy and completeness of diagnostic assessment. Summary: Future studies are needed to optimize use of multimodality imaging and artificial intelligence in comprehensive evaluation of patients with pulmonary hypertension.

Heart transplantation is a marvel of modern medicine for patients with end-stage heart failure. Decades of research and surgical innovation have overcome challenges in immunology, organ preservation, and patient care. From the earliest heart transplants on canines and primates, the field evolved through immunosuppressive therapies, development of the bioptome for endomyocardial biopsy and, recently, the use of cell free DNA and molecular microscopy for assessing rejection. Newer developments in organ preservation systems and transport systems bring remarkable increases in the availability of donors.