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AI’s Context Dependence, Keep Benching, and TARTAN-HF
By Viktor Zarev, Virginia Hunt
August 24, 2026
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Together with
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“If you’re a physician sitting across from a patient and you hear this: “My LLM suspects I have XYZ diagnosis based on these symptoms, labs, and so on…” What is your reaction?”
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Christina Farr
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A recent JAMA study suggested AI will replace doctors by 2035, but its authors might want to consider the individuality of every patient and every physician on the planet before making such claims. Today’s top story is a reminder why.
Thanks for reading,
Vik
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With all the talk of AI outperforming and replacing doctors, a new JACC study reminds us – AI diagnostic algorithms don’t perform great when applied to populations different from the ones they’re trained on.
- The algorithm in question is Pathway Labs’ EchoNext, an AI-ECG model trained on multicenter hospital data for detecting structural heart disease (SHD).
- EchoNext launched in June to mixed reception. The New York Times wrote a positive piece about the problem it solves, while some cardiologists called it unnecessary.
What better way to address the critics than with real world data? EchoNext was applied to patients from PREVUE-VALVE, a community-based study of adults aged 65-85 who underwent in-home ECG and echo.
But the details of those participants’ disease matters and they looked fundamentally different from EchoNext’s training data.
- SHD prevalence in the real-world community participants was just 8% versus 43% in the hospital training data.
- The community-based patients’ SHD also presented as less severe.
- Moderate tricuspid regurgitation was more common in these participants than the usual systolic heart failure from the hospital patient group.
With those differences in mind, it’s no wonder EchoNext showed a drop in diagnostic performance among community-based patients.
- Model discrimination fell to an AUC of 71% compared to 83% in the hospital.
- Adjusting for differences in prevalence and case mix narrowed but didn’t close that gap.
- But, AUC did rise to 79% in participants with an abnormal ECG.
- It also reached 76% among patients with worse health status.
In the context of EchoNext’s potential applications, these results are still decent (though an AUC > 80% is preferred for clinical reliability).
There’s a lesson to be learned here, and it goes beyond this one model.
- AI algorithms can only be as good as the data they’re trained on, especially since they lack the intuition of human doctors.
The Takeaway
Diagnostic AI is an eventuality in medicine, but that doesn’t mean that it’ll be perfectly reliable for every patient or population. Rather, physicians encountering and eventually using tools like EchoNext will still need to rely on their gut and experience, no matter AI’s utility.
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Telemedicine Isn’t About Technology. It’s About People.
With temporary telehealth rules expiring, millions of Medicare patients may lose their ability to see their doctors remotely. Read why Monebo and the Alliance for Connected Care are urging Congress to make telemedicine a permanent part of the healthcare system.
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PIA’s Post-Processing Solution
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The Benefits of Cardiovascular Structured Reporting
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- TARTAN-HF’s Screening Success: Researchers in Scotland developed a new HF screening flow for diabetic patients that combines at least one risk factor with an echo evaluation. Among the study’s 706 randomized patients, those in the screening group were 25x more likely to receive an HF diagnosis than those in the usual care group. These results underscore just how relevant the new CKM paradigm is for heart diseases like HF which don’t develop on their own. Read the full story here.
- NOACs for AFib and AD: Non-vitamin K oral anticoagulants deter dementia in AFib patients, and an EHJ study revealed they may boost brain health for AFib patients with Alzheimer’s disease. Among 7.3k patients, NOAC users had 0.23- and 0.21-point improvements on the 30-point MMSE tests compared to non-users and warfarin users, respectively. When NOACs went head-to-head with warfarin, NOAC use yielded ~20 percentage point decreases in stroke risk and major bleeding, alongside small reductions in mortality and fracture.
- LIB’s Autoinjector Approval: LIB Therapeutic’s LEROCHOL has gotten some more nods from the FDA this week, including approval for an autoinjector version of the PCSK9i and an updated indication. When the medication first launched in the U.S., the pre-filled syringes were strictly indicated for LDL-C lowering. Now, the FDA has extended indications across PCSK9is to include cardioprotective benefits administered as an add-on to statins. The autoinjectors will maintain the $199 price tag of the manual syringes.
- Bempedoic Acid’s Benefits Continue: No statins, no problem. Bempedoic acid showed it not only offers cardioprotective benefits for statin-intolerant patients with PAD, it also protects patients’ limbs. Among 1.6k patients, bempedoic acid reduced total major adverse limb events by 45% and resulted in 29% fewer occurrences of CV-related deaths or MALE. Interestingly, bempedoic acid treatment also showed big benefits for patients without PAD, lowering their risk of CV-related deaths or MALE by 18%.
- Renata Rakes in $25M: Renata Medical reeled in $25M in Series D funding led by healthcare investment giant ARCHIMED to scale up use of the Minima Stent System internationally. The growth stent is the first of its kind to be designed for newborns and infants with CHDs. That’s a big part of why Renata was one of many cardiology medtech companies to receive CMS’s approval for NTAP reimbursement last year, which is a good sign of fast-moving advancements in the field.
- Don’t Skip Chest Day! Turns out your pecs could be a cardiac biomarker. One JACC study developed an algorithm for quantifying pectoral muscle mass from 55.7k cardiac MRI exams, as well as a sarcopenic obesity index that combines low muscle with body weight. In turn, a higher index was associated with adverse cardiac remodeling and increased risk of incident HF (HR: 1.31), cardiovascular death (HR: 1.51), and all-cause mortality. These results mirror a trend we’ve seen in longevity medicine that lifetime muscle mass plays an important role in how long we stay healthy.
- The Atrium and Amyloid Disease: A new analysis of Alnylam Amvuttra’s (vutrisiran) HELIOS-B trial found that left atrial (LA) dysfunction independently predicts worse outcomes in ATTR-CM patients. Among 644 patients, poor LA strain functional measures like reservoir and contractile strain were tied to higher mortality, recurrent CV events, HF hospitalizations, and incident AFib. Curiously, the left atrium volume was not. Amvuttra modestly improved these measures, but more importantly a patient’s LA contractile strain could be a more accurate measure of their disease burden than atrial volume.
- Heart Failure Cost Savings: Hello Heart announced a study showing that its AI-driven heart health program was associated with lower costs and hospital use among HF patients. Comparing 292 participants against matched controls, researchers found that those enrolled in the CV self-management program saw a $7,000 reduction in total medical spend per participant on average. This came alongside 47 fewer inpatient admissions and 297 fewer inpatient days per 100 participants. That’s notable since the less HF patients hospitalized, the lower the strain on health systems.
- 25 Years of AS Mortality: How far have we come at reducing AS mortality? According to a CDC WONDER analysis, not that far. Researchers examined 637k aortic stenosis–related deaths among U.S. adults 65 and older and found that mortality declined modestly from 1999 to 2024 (age-adjusted rate 55.74% to 52.46%). However, taking a closer look at the data showed that mortality stayed stable in men while declining in women, and remained highest in non-Hispanic white individuals.
- Federal Funding for Stroke Robots: The HHS’ ARPA-H awarded Siemens Healthineers up to $31.1M over five years to develop autonomous remote endovascular robotics. While it sounds like sci-fi, the idea is to let robots perform mechanical thrombectomy for acute ischemic stroke without direct human input. Siemens also committed to $5.4M in cost sharing, bringing the project’s total investment to $36.5M. Stryker is a sub-awardee on the contract, building on the two companies’ stroke care partnership that began a year ago.
- Clash of the HCM Titans: Cytokinetics is suing Bristol Myers Squibb to defend patents covering its newly launched heart drug Myqorzo. The suit alleges that BMS obtained a patent that applies to a method of treating HCM that includes the active ingredient in Cytokinetics’ Myqorzo. It is curious how BMS obtained such a patent considering that Cytokinetics says the company had “zero involvement” in Myqorzo’s development. The patent litigation will certainly slow Cytokinetics’ attempts to secure market share with its HCM drug, despite Myqorzo’s potentially superior efficacy.
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Heart Failure Places Enormous Strain on our Healthcare Systems and Patients
There are 3.7 million US patients with HFpEF or HFmrEF, with prevalence only expected to rise. To learn more about the heart failure landscape and Bayer’s commitment to addressing patient unmet need, watch the video here.
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The Economics of AI-Assisted HF Diagnosis
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State-of-the-Art Cardiac Monitoring at Scale
Cleared for 13 different heart rhythm interpretations, AccurKardia’s AccurECG 2.0 shortens the time from an arrhythmia incident to clinical intervention. Watch here to find out how AccurKardia and Specialized Medical are teaming up to bring the AccurECG 2.0 technology to clinicians across the U.S.
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- Merge Cardio 12.5 is Officially Available! From AI-generated echo measurements to upgraded UI and reports, Merge Cardio 12.5 brings a long list of new innovations to the table. Find out more about how Merge Cardio’s latest version streamlines workflows to make your cardiovascular service line more cost-effective and patient-centered.
- How Automated MRI Software Transformed Radiology Regional: Radiology Regional recently integrated automated MRI scanning software into their imaging practice imaging. Hear from their team how automating CMR scans transformed their practice and enhanced patient care.
- ALL‑RISE Trial Results Are In: The CathWorks FFRangio™ system met noninferiority to wire-based physiology for MACE at one year with statistically significant improvement in resource utilization and reduced procedure time. CathWorks FFRangio™ system is the new standard in coronary physiology. See the ALL-RISE data. The information provided by the CathWorks FFRangio™ system is intended to be used by a qualified clinician in conjunction with the patient’s clinical history, symptoms, and other diagnostic tests, as well as the clinician’s professional evaluation. Source: Fearon et al. NEJM 2026. doi: 10.1056/NEJMoa2600949
- The Unified Cardiac Workflow: Cardiovascular disease remains the leading cause of global mortality, yet diagnostic workflows remain fragmented. That’s why it’s so important that Circle Cardiovascular Imaging’s cvi42 is the industry’s first unified platform for reading Cardiac MRI and Cardiac CT, and PCAT analysis within a single application.
- From Fetal to Adult Cardiovascular Ultrasound: Continuity of care is critical when it comes to a patient’s cardiovascular health. That’s why cardiologists across America are picking Fujifilm’s Lisendo 880 cardiovascular ultrasound for its versatility and precise imaging starting at a patient’s fetal development to adulthood.
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