FrameONE: Hierarchical Motion Modeling for Universal Multi-View Echocardiographic Keyframe Detection

Echocardiography is a widely used modality for cardiac assessment due to its non-invasive and cost-effective nature, but the sparse and heterogeneous spatiotemporal views of the heart pose distinct challenges. Existing masked autoencoder (MAE) approaches typically process images or short clips independently, failing to capture the inherent multi-view structure required for coherent cardiac representation. We introduce Latent Attention Masked Autoencoder (LAMAE), a foundation model architecture tailored to the multi-view nature of medical imaging. LAMAE augments the standard MAE with a latent attention module that enables information exchange across frames and views directly in latent space. This allows the model to aggregate variable-length sequences and distinct views, reconstructing a holistic representation of cardiac function from partial observations. We pretrain LAMAE on MIMIC-IV-ECHO, a large-scale, uncurated dataset reflecting real-world clinical variability. To the best of our knowledge, we present the first results for predicting ICD-10 codes from MIMIC-IV-ECHO videos. Furthermore, we empirically demonstrate that representations learned from adult data transfer effectively to pediatric cohorts despite substantial anatomical differences. These results provide evidence that incorporating structural priors, such as multi-view attention, yields significantly more robust and transferable representations.

Automated classification of standard echocardiographic views is crucial for efficient clinical workflow but faces three main challenges. First, publicly available datasets are scarce and limited in scale and view coverage. Second, the performance of some modern video-level architectures for echocardiographic view classification remains underexplored. Third, some view categories exhibit highly similar spatial appearances, making single-frame features insufficient for discrimination, while heterogeneous frame quality complicates robust temporal information fusion. To address these challenges, we release the Echocardiographic Videos of Nine Views (EV9V) dataset, comprising 5,138 videos, 910,579 frames, and 9 standard views, which is, to the best of our knowledge, the largest publicly available echocardiography video dataset. Using EV9V, we systematically benchmark representative video classification architectures, including Convolutional Neural Networks (CNNs), Recurrent Neural Networks (RNNs), and Transformers. Furthermore, we propose a Spatio-Temporal Fusion Model (STFM), an efficient dual-stream CNN-LSTM (Long Short-Term Memory) framework that jointly captures spatial anatomical structures and temporal cardiac dynamics. The proposed framework leverages uncertainty-aware learning to preferentially sample representative video segments during training and evidence-based fusion during inference, improving robustness to variations in frame quality across echocardiographic videos. Extensive experiments demonstrate that our method achieves competitive performance across diverse video classification models, validating the effectiveness of uncertainty-aware spatio-temporal learning for echocardiographic view classification. The code is available at https://github.com/bgx666/stfm.

Accurate identification of end-diastole (ED) and end-systole (ES) in echocardiography underpins the quantification of ventricular function, yet manual selection of these key frames is subjective and introduces clinically significant inter-operator variability. Recent self-supervised methods either prescribe strict periodic trajectories or learn an unconstrained low-dimensional motion subspace from reconstruction or registration objectives. The former offers interpretability but imposes restrictive assumptions on temporal progression, whereas the latter leaves cardiac phase implicit and ED/ES must be recovered through post-hoc geometric processing of the learned trajectory. We translate the physiological observation that cardiac phase is a one-dimensional signal into a prior by constraining the latent motion component to a single-parameter latent orbit, i.e., a global linear trajectory in latent space indexed by a bounded scalar phase variable. Mapping this variable through a sinusoidal nonlinearity yields an oscillatory motion signal with consistent temporal ordering, enabling direct identification of ED and ES from the learned phase signal. This inductive bias allows the model to capture an interpretable representation of the cardiac cycle, while maintaining flexibility to capture irregular heartbeats. Trained on EchoNet-Dynamic without annotations, our minimal single-parameter cardiac phase model learns an effective latent orbit, significantly improves upon the previous state of the art in ED localisation and matches it in ES localisation while using a more constrained representation and fewer training epochs. This demonstrates that a principled physiological inductive bias can match or exceed the performance of more complex representations. Code is available at: https://github.com/BonniciJ/OrbitalEcho/