TY  - JOUR
TI  - Diagnostic performance of artificial intelligence in the syncope unit
AU  - van Zanten, Steven
AU  - Boel, Thomas T.
AU  - de Jong, Jelle SY
AU  - Koomen, Egbert M
AU  - Bais, Babette
AU  - Dara, Ako
AU  - Giele, Freek
AU  - Geertsma, Christiaan
AU  - Sutton, Richard
AU  - Scheffer, Mike G
AU  - de Groot, Joris R
AU  - de Lange, Frederik J
PY  - 2026
JO  - Exploration of Cardiology
VL  - 4
SP  - 1012114
DO  - 10.37349/ec.2026.1012114
UR  - https://www.explorationpub.com/Journals/ec/Article/1012114
AB  - Aim: Artificial intelligence may support syncope evaluation, but reliability of language models in structured syncope care remains uncertain. We evaluated diagnostic performance, safety, and within-case consistency of Generative Pre-trained Transformer-5 (GPT-5) in patients with transient loss of consciousness (T-LOC). Methods: This prospective cohort study included 55 patients evaluated in syncope units. GPT-5 and a syncope-expert assessed identical case information after core evaluation (CE: history-taking, physical examination, active standing test, and 12-lead electrocardiogram) and extended evaluation (EE: CE plus additional testing when indicated). An expert panel adjudicated the final diagnosis after 18 months. Outcomes were diagnostic yield, final-diagnosis inclusion rate, diagnostic precision score (DPS), cardiac diagnostic safety, and within-case consistency across five repeated GPT-5 runs. Results: Of 55 patients, 54 had complete follow-up for performance analyses. Diagnostic yield was 94% for the syncope-expert at CE and EE, and 100% and 96% for GPT-5 at CE and EE, respectively. GPT-5 included the final diagnosis in 52% (CE) and 57% (EE) of cases, versus 67% for the syncope-expert. DPS remained negative for GPT-5 at CE (mean −0.03, SD 0.54) and EE (mean −0.01, SD 0.49). Among four final cardiac syncope cases, GPT-5 selected the final diagnosis in one case and the syncope-expert in three. First-diagnosis consistency across five GPT-5 runs was 69% after CE and 74% after EE. Conclusions: GPT-5 generated diagnostic outputs frequently but showed limited precision, cardiac safety concerns, and within-case variability. Its role in syncope evaluation should remain supportive within clinician-led pathways rather than autonomous.
ER  -