Relevance of Artificial Intelligence-Assisted Echocardiography for Left Ventricular Ejection Fraction Assessment in Geriatric Patients (REFERENCE-AI)

July 8, 2026 updated by: Gérond'if

Heart failure (HF) is the leading cause of hospitalization among adults aged 80 years and older and represents a major diagnostic challenge in geriatric medicine due to frequently atypical clinical presentations and the presence of multiple comorbidities. Although transthoracic echocardiography (TTE) with measurement of left ventricular ejection fraction (LVEF) remains the gold standard for cardiac functional assessment, access to echocardiography is often limited in geriatric wards.

Recent advances in artificial intelligence (AI) have enabled the development of portable ultrasound devices and automated image analysis software capable of providing reliable and reproducible LVEF measurements. AI-assisted automated LVEF assessment (AutoEF-AI) may therefore represent a valuable alternative to conventional echocardiography for the cardiac evaluation of older patients with heart failure.

Study Overview

Status

Not yet recruiting

Conditions

Intervention / Treatment

Detailed Description

Prospective, single-center interventional study comparing two methods of left ventricular ejection fraction measurement in patients aged 75 years and older hospitalized for acute heart failure.Each hemodynamically stable participant will undergo two echocardiographic examinations performed within 24 hours:

  • Standard Echocardiography (Reference Method)
  • AI-assisted automated LVEF assessment (AutoEF-AI)

Study Type

Interventional

Enrollment (Estimated)

130

Phase

  • Not Applicable

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Contact

Study Contact Backup

Study Locations

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Ages Eligible for Study

  • Older Adult

Accepts Healthy Volunteers

No

Description

Inclusion Criteria:

  • Age ≥75 years.
  • Hospitalization in a geriatric unit for acute heart failure according to the 2021 ESC diagnostic criteria.
  • Hemodynamic stability at the time of echocardiographic examination.
  • Ability to understand study information, provide written informed consent, and willingness to participate.
  • Affiliation with, or beneficiary of, a health insurance/social security scheme.

Exclusion Criteria:

  • Hemodynamic instability preventing echocardiographic assessment.
  • Contraindication to transthoracic echocardiography.
  • Patients under legal protection (guardianship, curatorship, or judicial protection measures) or unable to provide informed consent.
  • Refusal to participate in the study.

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

  • Primary Purpose: Diagnostic
  • Allocation: Non-Randomized
  • Interventional Model: Crossover Assignment
  • Masking: Single

Arms and Interventions

Participant Group / Arm
Intervention / Treatment
Other: Standard Echocardiography (Reference method)
The standard echocardiography will be performed by a cardiologist as part of routine clinical care.
Diagnostic test: Standard Echocardiography (Reference method)
The standard echocardiography will be performed by an expert cardiologist as part of routine clinical care and will serve as the gold standard
Experimental: AutoEF-AI Assessment
AI-assisted automated LVEF assessment
Diagnostic test: AutoEF-AI Assessment

Performed by a geriatrician who has completed a one-day practical training session and combines:

  • A handheld ultrasound device providing real-time image acquisition guidance for obtaining apical views.
  • Us2.ai software for automated LVEF analysis. The geriatrician is blinded to results of the gold standard echocardiography performed by the cardiologist.

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Agreement between LVEF measured using AutoEF-AI and LVEF measured using standard echocardiography.
Time Frame: At baseline

Agreement will be assessed using:

  • Intraclass Correlation Coefficient (ICC)
  • Spearman correlation coefficient
  • Bland-Altman analysis
  • Weighted kappa coefficient for the classification of patients according to LVEF categories (≤40%, 41-49%, and ≥50%)
At baseline

Secondary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Diagnostic performance of AutoEF-AI for the detection of LVEF <50%, including sensitivity, specificity, positive predictive value, negative predictive value, and overall accuracy.
Time Frame: At baseline
Calculation of the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and overall accuracy of AutoEF-AI for identifying left ventricular ejection fraction (LVEF) below 50%, compared with the standard reference method.
At baseline
Analysis of factors associated with agreement between the two methods
Time Frame: At baseline
Multiple linear regression model will be used to identify clinical and technical variables (age, sex, cardiovascular history, presence of a pacemaker, cardiac arrhythmias, image quality, comorbidities, etc.) associated with a significant discrepancy between LVEF measurements obtained using AutoEF-AI and standard echocardiography.
At baseline
Feasibility of AutoEF-AI use by a geriatrician after a short training program
Time Frame: At baseline
  • Success rate of valid image acquisition (i.e acquizition of analyzable apical views suitable for automated analysis)
  • Quality of the acquired images (image quality score and proportion of non-analyzable images)
  • Difficulties encountered during the use of the AutoEF-AI device
At baseline

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

Gérond'if

Investigators

  • Principal Investigator: Olivier HANON, MD PhD, Geriatric Department, Broca hospital

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start (Estimated)

June 30, 2026

Primary Completion (Estimated)

June 30, 2028

Study Completion (Estimated)

June 30, 2028

Study Registration Dates

First Submitted

July 1, 2026

First Submitted That Met QC Criteria

July 8, 2026

First Posted (Actual)

July 14, 2026

Study Record Updates

Last Update Posted (Actual)

July 14, 2026

Last Update Submitted That Met QC Criteria

July 8, 2026

Last Verified

July 1, 2026

More Information

Terms related to this study

Keywords

Additional Relevant MeSH Terms

Other Study ID Numbers

  • 2025-A02039-40

Drug and device information, study documents

Studies a U.S. FDA-regulated drug product

No

Studies a U.S. FDA-regulated device product

No

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

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