EchoXFlow: A Beamspace Echocardiography Dataset for Cardiac Motion, Flow, and Function
Authors: Elias Stenhede, Joanna Sulkowska, Eivind Bjørkan Orstad, Henrik Schirmer, Arian Ranjbar
Organizations: Medical Technology & E-Health, Akershus University Hospital, Norway · Department of Technology Systems, University of Oslo, Norway · Department of Cardiology, Akershus University Hospital, Norway
Abstract
We introduce EchoXFlow, a clinical echocardiography dataset for learning from ultrasound in its native acquisition geometry rather than from scan-converted Cartesian videos. Existing public datasets offer limited opportunities to study cross-modal relationships between cardiac anatomy, myocardial motion, and blood flow, as Doppler is typically absent or fused as RGB overlays, and acquisitions are released after lossy vendor display processing. EchoXFlow comprises 37125 recordings from 666 routine-care examinations, preserving the timing, geometry, and modality relationships needed for physically grounded echo learning. Each recording is retained as separable modality-specific streams: temporally resolved 1D, 2D, and 3D data alongside multiple Doppler modalities, paired with a synchronized ECG. Clinical annotations span guideline-based measurements to dense 2D myocardial contours and 3D left-ventricular endocardial meshes. With its associated open-source tooling, EchoXFlow enables cross-modal, acquisition-aware learning tasks that cannot be formulated from conventional scan-converted videos alone, and serves as a testbed for 4D vision and physically grounded multi-modal learning more broadly.
Point-of-care transthoracic echocardiography (TTE) enables cardiac assessment in virtually any clinical setting, yet its diagnostic utility remains constrained by the expertise required for image acquisition and interpretation. Visual question answering (VQA) offers a promising paradigm for bridging this expertise gap through interactive clinical assistance, but existing echocardiography VQA datasets are limited in scale, restricted to high-quality images, and only cover a few views. We introduce EchoVQA, the first large-scale VQA dataset for echocardiography, comprising 14,299 images and 74,819 question-answer pairs. The dataset integrates public sources (EchoNet-Dynamic, CAMUS) with our own point-of-care acquisitions from two handheld probes (Lumify, Clarius), spanning diverse views and including both high-quality and suboptimal images. Uniquely, EchoVQA includes acquisition guidance questions to help users optimize transducer positioning toward a diagnostic apical 4-chamber view for left ventricular ejection fraction estimation -- a challenging task for novice operators in point-of-care settings. We further develop a parameter-efficient method based on multimodal learnable prompts achieving state-of-the-art performance on most benchmarks, including EchoVQA, with significantly less trainable parameters than existing state-of-the-art approaches.
Standardized echocardiography conclusions provide meaningful supervision for learning ECG representations of echocardiography-derived cardiac findings. Global ECG--text alignment may entangle modality-specific factors, while long-tailed finding distributions provide sparse positive supervision for low-prevalence conditions. We propose EchoBridge with Complementary Shared--Private Projection (CSPP) and Adaptive Prototype Boundary Calibration (APBC). CSPP maps each modality into shared and auxiliary private projections, reduces directional redundancy via within-modality orthogonality, and bidirectionally aligns normalized shared projections. APBC organizes the shared hypersphere with class-specific prototypes, training-frequency-adaptive angular margins, and spherical Riesz repulsion. We evaluate EchoBridge on EchoNext-Mini and independent PKUPH and SHTMU cohorts under four protocols: prompt-based inference without downstream classifier training, in-domain frozen linear probing, target-domain cross-center frozen linear probing, and source-only cross-center transfer, supplemented by finding-specific analyses. EchoBridge improves classifier-free AUROC, AUPRC, and F1 over the strongest baselines by 7.88, 5.61, and 4.54 points, respectively, and achieves the highest point estimates across all in-domain and target-domain probing budgets and both source-only transfer cohorts. Finding-specific analyses show gains for most conditions, including several low-prevalence valvular findings.
Left ventricular ejection fraction (LVEF) is a primary marker of cardiac function. However, routine estimation from endocardial measurements requires manual delineation at end-diastole (ED) and end-systole (ES), a process that is time-consuming and subject to inter-observer variability. Reliable automation is especially valuable for point-of-care ultrasound (POCUS), where computational resources are limited and acquisition quality varies. We propose Echo-E3Net, an anatomy-guided spatio-temporal network that explicitly embeds cardiac anatomy into LVEF prediction. A dual-phase Endocardial Border Detector (E2CBD) uses phase-specific cross-attention to localize ED/ES endocardial landmarks and produce phase-aware landmark embeddings, while an Endocardial Feature Aggregator (E2FA) fuses these embeddings with global statistical descriptors of deep feature maps to refine EF regression. Training is guided by a lightweight geometric loss that uses ED and ES endocardial landmarks to regularize EF prediction. On EchoNet-Dynamic and a PSAX subset of EchoNet-Pediatric, Echo-E3Net attains competitive performance using only 1.55M parameters and 8.05 GFLOPs, an order-of-magnitude compute reduction versus recent baselines, supporting real-time deployment. Our code is publicly available at https://github.com/moeinheidari7829/Echo-E3Net.