Self-Supervised Cardiac Phase Detection via Single-Parameter Latent Orbits

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-E$^3$Net, an anatomy-guided spatio-temporal network that explicitly embeds cardiac anatomy into LVEF prediction. A dual-phase Endocardial Border Detector (E$^2$CBD) uses phase-specific cross-attention to localize ED/ES endocardial landmarks and produce phase-aware landmark embeddings, while an Endocardial Feature Aggregator (E$^2$FA) 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-E$^3$Net 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.

Self-supervised learning (SSL) is increasingly used in medical imaging to reduce annotation requirements, but representation quality is often judged using a single downstream evaluation setting. For dense clinical tasks, this can confound representation quality with the capacity of the downstream model used to recover task-relevant information. We present a systematic evaluation of self-supervised representations for left-ventricular segmentation and ejection fraction (EF) estimation from apical four-chamber echocardiography on EchoNet-Dynamic. Rather than relying on a single downstream probe, we compare a hierarchy of extraction strategies with increasing expressivity: heuristic extraction without mask-supervised training, frozen linear probes, frozen lightweight decoder probes, and partial fine-tuning. We apply this framework to two complementary representation families: generic frozen self-DIstillation with NO labels (DINOv3) features and a task-adapted dense self-supervised representation, Bootstrap Your Own Segmentation (BYOS). In both families, heuristic extraction substantially understated what was recoverable from the frozen representation. For DINOv3, performance improved from Dice 0.684 and EF mean absolute error (MAE) 13.01 under heuristic extraction to Dice 0.906 and EF MAE 9.65 with a frozen lightweight decoder, approaching a supervised U-Net baseline (Dice 0.915, EF MAE 9.72). For BYOS, performance improved from Dice 0.687 and EF MAE 17.83 under heuristic extraction to Dice 0.902 and EF MAE 8.74 with a frozen lightweight decoder. These results show that conclusions about self-supervised representation quality in dense echocardiographic analysis depend strongly on the downstream extraction strategy used for evaluation. We therefore argue that multi-strategy evaluation is an important methodological consideration for SSL in dense medical image analysis.

Myocardial point tracking (MPT) has recently emerged as a promising direction for motion estimation in echocardiography, driven by advances in general-purpose point tracking methods. However, myocardial motion fundamentally differs from motion encountered in natural videos, as it arises from physiologically constrained deformation that is spatially and temporally continuous throughout the cardiac cycle. Consequently, motion trajectories typically remain locally confined despite substantial tissue deformation. Motivated by these properties, we revisit the architectural design for MPT and find that coarse initialization in commonly used two-stage coarse-to-fine architectures may be unnecessary in this domain. In this work, we propose a fine-stage-only architecture, \textbf{EchoTracker2}, which enriches pixel-precise features with local spatiotemporal context and integrates them with long-range joint temporal reasoning for robust tracking. Experimental results across in-distribution, out-of-distribution (OOD), and public synthetic datasets show that our model improves position accuracy by $6.5\%$ and reduces median trajectory error by $12.2\%$ relative to a domain-specific state-of-the-art (SOTA) model. Compared to the best general-purpose point tracking method, the improvements are $2.0\%$ and $5.3\%$, respectively. Moreover, EchoTracker2 shows better agreement with expert-derived global longitudinal strain (GLS) and enhances test-rest reproducibility. Source code will be available at: https://github.com/riponazad/ptecho.