Echocardiography

We present, to the best of our knowledge, the first publicly available resource for predicting left ventricular ejection fraction (EF) from parasternal long-axis (PLAX) echocardiography. Because no PLAX-EF datasets previously existed, our work focuses on an innovative data generation strategy to overcome this scarcity. By leveraging a time-based correlation between clinical notes and echocardiographic videos, combined with fine-tuning view classifiers and proxy labeling, we created a labeled dataset of over 25,000 PLAX videos. This enables us to train the first reproducible PLAX EF model, achieving a mean absolute error (MAE) of 6.86%. Given that apical four-chamber (A4C) methods, the clinical standard, report MAE values of 6%-7%, our results demonstrate that EF estimation from PLAX views is both feasible and clinically relevant. This surpasses the performance of existing methods and provides a clinically relevant solution for situations where apical views may not be feasible. Going further, we demonstrate that combining PLAX and A4C predictions via simple unweighted late fusion improves both single-view baselines to a 6.37% MAE, underscoring the value of multi-view integration. To promote continued research, we release the dataset labels, trained models, and runnable demos on GitHub, Hugging Face, and Google Colab: https://github.com/Jeffrey4899/PLAX_EF_Labels_202509

Ultrasound (US) provides real-time, radiation-free imaging, but the image quality depends strongly on how the probe is oriented against the patient body. Robotic US can reduce operator workload and improve acquisition consistency; however, most existing systems focus on normal positioning, where the probe is maintained perpendicular to the local surface. This constraint is inadequate for examinations like echocardiography, where obtaining a diagnostic view requires a non-normal probe angle. Consequently, a clinically useful robotic system must sense the local surface in real-time and preserve the desired probe orientation. Here, we propose an omni-directional probe-orientation control framework that integrates RGB-D perception, local-surface modeling, and task-space orientation control. The surface model fuses multi-view point clouds and provides a quadratic estimate of the local surface. A desired imaging direction is then encoded relative to the normal, enabling the probe to track arbitrary angles. The framework was evaluated through flat-surface tracking, phantom target-angle recovery, and in-vivo tracking of an expert selected view. Results show that the mean angular tracking error was 1.06 +- 0.66 deg. The system recovered a non-normal tilt angle of up to 44.39 +- 2.59 deg relative to the surface normal, and acquired the desired heart chamber view in the phantom and in-vivo experiments.

Objective: Concept bottleneck models route prediction through interpretable intermediate variables, and their validity is normally judged by how accurately those variables are predicted. We ask whether that judgement is sufficient, using left ventricular volumes as the concepts underlying ejection fraction estimation from echocardiographic video. Methods: A video transformer encoder was trained on a publicly available echocardiography dataset. End-systolic and end-diastolic volumes formed a concept layer from which ejection fraction was computed analytically, with no residual path to the output. We compared training under an ejection fraction objective alone against training with additional supervision of the volumes in millilitres, and evaluated both on 1276 held-out studies. Results: The concept bottleneck did not increase ejection fraction error relative to direct regression, at 6.89 against 7.13 mean absolute error. Without volume supervision, however, the spread of predicted volumes collapsed to 0.1 millilitres against reference spreads of 35.7 and 45.7 millilitres, while correlation was partly preserved. We show that this follows from an invariance property of the objective: ejection fraction is a ratio and is unchanged when both volumes are rescaled, so the loss determines the concept layer only up to scale. Supervision in absolute units reduced volume error from 89.8 to 25.8 millilitres at a cost of 0.4 in ejection fraction error. Conclusion: Concept accuracy alone can conceal a concept layer that carries no physical scale. Significance: Interpretable intermediate variables in clinical models should be validated against the invariance structure of the training objective, not only against prediction accuracy.

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.

Cross-dataset generalisation remains a major barrier to clinical deployment of echocardiographic left ventricular segmentation, yet the sources of this shift are rarely disentangled. We examined whether transfer degradation could be estimated before deployment using handcrafted ultrasound descriptors, VAE latent features, and segmentation-derived latent features across six echocardiographic datasets. Geometry-aware preprocessing substantially improved several poor transfer cases, suggesting that much of the apparent domain shift reflects field-of-view and framing inconsistencies rather than intrinsic acoustic differences alone. Intensity z-normalisation changed dataset separability by less than 0.005, indicating that brightness and contrast are not the dominant shift axis. Absolute Dice drop on held-out source-target pairs was predicted with an R-squared value of 0.612, an MAE of 0.082, and a Spearman rho of 0.681. The variant without LV and fan-shaped features retained approximately 70% of this explanatory power, supporting mask-free transfer-risk monitoring. The most informative discrepancy measure depended on the representation, with CMD strongest in z-normalised handcrafted features, with an absolute r of approximately 0.86 and an R-squared value of approximately 0.70; log-Wasserstein strongest in VAE space, with an r of approximately -0.90 and an R-squared value of approximately 0.81; and log-MMD strongest in LV-segmentation latent features, with an r of approximately -0.92 and an R-squared value of approximately 0.84. Apparent vendor effects were largely dataset-confounded. Echocardiographic domain shift is therefore structured and measurable, and its impact on segmentation can be partly reduced through geometry-aware preprocessing and anticipated using representation-specific transfer-risk estimation.

Background and Objective: Deep video models estimate left-ventricular ejection fraction (EF) from echocardiography with near-expert accuracy, and post-hoc attribution (Chefer relevance for transformers, Grad-CAM for CNNs) is increasingly used to certify that models "look at the right place." Yet whether these explanations are faithful both spatially and temporally is unaudited. Because EF is defined by the end-systolic (ES) and end-diastolic (ED) frames, a faithful explanation must localize the left ventricle (space) and the decisive frames (time). Methods: We fine-tune two distinct EF regressors on EchoNet-Dynamic -- a self-supervised VideoMAE transformer and a Kinetics-pretrained R(2+1)D CNN -- and audit each with architecture-matched attribution along three axes: intersection-over-relevance (IoR) against LV masks, deletion AUC, and a temporal localization index on ES/ED frames, each relative to chance with per-case 95% CIs over 50 studies. A tubelet-occlusion probe separates attribution failure from model behavior. Results: Both models are anatomically faithful -- IoR 2.91x (VideoMAE) and 1.98x (R(2+1)D) above chance -- yet temporally blind: temporal localization is indistinguishable from chance (0.97--1.00) and no better than random attribution. Occlusion shows the models do not preferentially rely on ES/ED (0.90x chance), so temporal blindness reflects model behavior, not an attribution artifact. Conclusions: Spatial faithfulness does not imply temporal faithfulness. Attribution can certify anatomical grounding while masking that a model ignores the clinically decisive frames -- a caution for XAI-based validation of video diagnostic models and a call for temporally-aware training and evaluation.

While echocardiography is essential for cardiovascular diagnosis, inherent speckle noise and low signal-to-noise ratio often lead to ambiguous semantic features and fragmented boundaries. These limitations significantly hinder the segmentation accuracy of deep learning models in complex clinical cases. Moreover, temporal motion of the heart plays a critical role in recognizing anatomical structures. To address these challenges, we designed a STLSF module which comprises a window-matching-based semantic correction component and a semantics-guided texture enhancement component. By leveraging local transition probability correlations to correct semantics and employing semantics-guided texture enhancement, the STLSF module effectively mitigates texture instability and ambiguous semantic interpretations caused by disadvantaged echocardiography quality. Additionally, to facilitate the encoder's adaptation to the intrinsic priors of ultrasound-specific imaging patterns, we propose a frequency-aware denoising pre-training method. The entire work builds a convolution-based network with locality inductive bias and long-range dependencies. Extensive experiments confirm our SOTA performance, achieving 93.87% Dice on CAMUS and 92.62% on EchoNet-Dynamic, with respective HD95 values of 3.29mm and 2.73mm.

Therapy-induced cardiotoxicity is the leading non-oncological cause of treatment interruption in breast cancer patients, yet early, automated risk stratification from routine cardiac imaging remains an unsolved problem. We present EchoRisk, the first curated, multicentre, longitudinal echocardiography dataset with explicit cardiotoxicity labels, released as the primary technical reference for the EchoRisk-MICCAI 2026 challenge. The dataset comprises 422 patients enrolled in the EU-funded CARDIOCARE prospective study across five European sites, yielding 2,159 echocardiography videos across 1,123 clinical exams acquired at up to five longitudinal timepoints, alongside a dedicated cohort of 280 patients with baseline imaging for early cardiotoxicity prediction. Three clinically grounded tasks are defined: automated estimation of left ventricular ejection fraction from cine video (Task 1), classification of LV dysfunction from longitudinal imaging (Task 2), and early prediction of therapy-induced cardiotoxicity from pre-therapy baseline echocardiography alone (Task 3). For each task we specify the evaluation protocol, primary and secondary metrics, and ranking procedure. We establish baseline performance using an R(2+1)D video backbone with LSTM aggregation trained from Kinetics-400 pretrained weights, demonstrating strong discriminative performance for cardiac functional assessment and LV dysfunction classification, while early cardiotoxicity prediction from a single pre-therapy video remains a significant open problem for the community. The dataset, evaluation code, and baseline implementations are publicly available to serve as a benchmark for further collaboration, comparison, and the creation of task-specific architectures in cardio-oncology.

Accurate detection of end-systole (ES) and end-diastole (ED) frames is fundamental to echocardiographic assessment. Existing methods are typically developed in a view-specific manner, depend on auxiliary annotations or intensive visual modeling, which limits their generalizability. In multi-view modeling, keyframe detection is driven by shared cardiac motion, yet large appearance differences and motion patterns make unified modeling challenging. To address these issues, we propose FrameONE, a unified end-to-end framework for multi-view echocardiographic keyframe detection. FrameONE introduces a Hierarchical Motion Modeling strategy: an intra-view multi-task learning reduces appearance bias and promotes motion-focused representations within each view; an inter-view general motion learning module further separates view-agnostic dynamics from view-specific patterns, enabling shared yet flexible motion representation learning across views. Extensive experiments on 25,872 videos spanning four standard views demonstrate that FrameONE achieves state-of-the-art keyframe detection accuracy with strong cross-view generalization. Code is available at https://github.com/szuboy/FrameONE.

Echocardiography is the most widely used non-invasive cardiac imaging modality, providing essential information for cardiovascular diagnosis. Interpreting an echocardiogram requires synthesizing complementary evidence across multiple heart views to identify abnormalities and produce structured clinical reports. While recent efforts focus on improving classification performance, most models lack explicit diagnostic reasoning and spatially grounded anatomical evidence, limiting clinician trust. We present EchoSonar-R, a multi-view reasoning-enabled vision-language model that jointly performs multi-label disease classification and report generation from echocardiography studies. EchoSonar-R combines a spatiotemporal video encoder with a structure-aware cardiac detector that provides spatially grounded anatomical cues to improve interpretability and clinician trust during cross-view reasoning. EchoSonar-R is trained in two stages: supervised fine-tuning (SFT) on reasoning-annotated targets, followed by Group Relative Policy Optimization (GRPO) with task-specific rewards that jointly align classification and report generation within a unified reinforcement-learning framework. Across a private multi-view dataset and two public benchmarks, EchoSonar-R improves macro balanced accuracy by 17.1% on the private set and 6.1% on MIMICEchoQA over the strongest baseline, achieves a GREEN clinical faithfulness score of 0.800, and produces interpretable reasoning traces grounded in multi-view visual evidence.

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.

Echocardiography (echo) is a widely used imaging modality for assessing cardiac function, with Left Ventricular Filling Pressure (LVFP) serving as a critical physiological marker for conditions such as heart failure. Standard LVFP classification into normal \emph{vs} elevated categories relies on the Doppler-derived $E/e'$ ratio, which is operator-dependent and often unavailable in resource-limited settings, motivating methods that infer LVFP directly from B-mode echo. Existing deep learning approaches achieve high performance but remain largely black-box, limiting clinical interpretability. We propose HypOProto, a hyperbolic, ordinal prototype-based framework for interpretable LVFP classification using a frozen, explainable foundation model backbone. HypOProto arranges prototypes along the physiological $E/e'$ scale, placing borderline cases near the hyperboloid root where small angular differences separate similar cases, while normal and elevated cases occupy outward positions reflecting increasing diagnostic certainty. This hyperbolic geometry encodes clinically meaningful ordinal relationships and improves interpretability. We also introduce a novel Hyperbolic Prototype Angular Separation (HyperPAS) loss, enforcing inter-class prototype separation in hyperbolic space. HypOProto achieves SOTA performance while maintaining transparency, and highlights clinically relevant regions in visualizations. This work represents the first prototype-based framework for LVFP classification in echo. Our code can be found at https://github.com/DeepRCL/HypOProto.

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.

Congenital heart disease (CHD) refers to the abnormal anatomical structure caused by the abnormal development of the heart and great vessels during embryonic development. Traditional diagnostics often fail to achieve high accuracy and efficiency, especially given the complexity of cardiac anatomy. This study presents a specialized multi-view deep learning framework for CHD binary classification using echocardiographic images. A large-scale CHD dataset, including five views, was used to train the model, enabling it to integrate multi-angle image data. The framework utilizes advanced feature extraction and attention mechanisms to improve diagnostic precision and reliability. An uncertainty-based decision-making component is also integrated to handle low-quality images, enhancing diagnostic outcomes. Experimental results show that this method achieves top-tier performance on our dataset and provides a robust tool for early CHD detection, underscoring its potential for clinical use. The dataset and source code will be released upon paper acceptance.

We introduce Echo-POSED, a self-supervised framework for real-time transthoracic echocardiography (TTE) guidance that recommends probe adjustments directly from 2D ultrasound images, without the need for expert-labelled views or tracked probe trajectories. Instead, it trains on 2D views sliced from routinely acquired 3D echocardiography volumes, enforcing equivariance to probe motions while remaining invariant to cardiac phase, yielding a pose representation on $\mathrm{SO}(3)\times\mathrm{SO}(3)$. Across a held-out split and public external 3D--TTE datasets (including vendor shift), Echo-POSED maintains geometric consistency under virtual perturbations and enables intra- and inter-patient guidance simulations, achieving a combined mean angular error of 8.2 degrees between the guided and target views in intra-patient simulations with cardiac motion.

Speckle tracking echocardiography (STE) is the clinical standard for myocardial strain estimation. Despite good performance on global strain (GLS), its accuracy for regional strain remains limited, even though this biomarker is highly relevant for early diagnosis and the characterization of subtle abnormalities. from clinical data. Deep learning is a promising alternative, but its development is constrained by the lack of reliable motion references. Existing solutions rely either on STE-derived labels or on simulations generated by physics-based models, but these synthetic sequences still have limited realism compared with clinical data.In this paper, we propose a novel simulation strategy that incorporates speckle decorrelation measures from real videos and uses an iterative refinement process to improve the motion realism in the simulations. We created an open-source photorealistic dataset of 1,478 videos with reference motion, which was used to train an echocardiographic motion estimation algorithm. The proposed method achieves unmatched performance on global and regional strain, notably reaching a GLS variability of 1.42% in an inter-expert setting compared to 1.78% for the clinical reference.

Artificial intelligence-enabled electrocardiography (AI-ECG) can detect heart failure (HF), including disease not captured by left ventricular ejection fraction (LVEF), but the cardiac phenotypes underlying model predictions remain unclear. We therefore investigated whether AI-ECG-predicted HF risk aligns with established echocardiographic measures of myocardial dysfunction, remodelling, and filling pressures. We retrospectively analysed ECG and echocardiography data from 8147 patients who underwent both examinations within three days at Akershus University Hospital between 1 January 2023 and 1 June 2025. A previously validated AI-ECG model for HF detection was applied to all ECGs. Spearman's rank correlation $ρ$ quantified associations between echocardiographic parameters and AI-ECG risk. Subgroup analyses were performed by sex and left ventricular ejection fraction (LVEF). External validation included 36,286 ECG-echocardiography pairs from Columbia University Irving Medical Center. Global longitudinal strain (GLS) showed the strongest correlation ($ρ$=0.57), followed by mitral annular plane systolic excursion (MAPSE) ($ρ$=-0.49) and LVEF ($ρ$=-0.45). In patients with LVEF>50%, correlations remained substantial for GLS, MAPSE, and diastolic-related parameters. Volumetric left ventricular indices correlated less strongly in women, whereas diastolic indices showed stronger correlations in women than in men. Physiological validation showed that AI-ECG HF risk predictions align primarily with measures of systolic function, particularly global longitudinal strain, while also capturing diastolic-related abnormalities in patients with preserved LVEF. This approach may improve clinical interpretability and identify opportunities for model refinement.

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.

Machine learning methods provide a methodological innovation that can help screen for cardiovascular disease through noninvasive and readily available measurement modalities. Recent investments in using electrocardiogram (ECG) data to screen for structural heart disease (SHD) are one example, where ECGs provide a low-cost, available modality for screening. This has led to the EchoNext dataset, a paired ECG-echocardiogram data repository for testing new methods of SHD detection. However, relatively few studies have investigated how more probabilistic classification through Bayesian inference may improve uncertainty quantification in this setting. Moreover, few studies have considered how triage systems can be developed to alleviate healthcare bottlenecks, such as the review of data from underserved, rural clinics by expert sonographers for SHD assessment. In this study, we leverage existing ECG-echocardiogram data to compare frequentist and Bayesian neural network classifiers. We show that the Bayesian approach is comparable or better than frequentist methods in SHD classification, and that they have a more robust uncertainty quantification attached to them. We provide an example of how this uncertainty-aware classification scheme can be used for screening SHD, providing a proof-of-concept for how machine learning can help with triage in getting individuals expert sonographer input when SHD is highly likely or measurements are highly uncertain.

Reconstructing 4D (3D+t) cardiac geometry from sparse 2D echocardiography is highly desirable yet fundamentally challenged by geometric ambiguity and temporal discontinuity. To tackle these issues, we propose Echo4DIR, a novel test-time 4D implicit reconstruction framework. Specifically, we learn robust 3D shape priors from statistical shape models (SSMs) via a cardiac conditional SDF, constructing an Epipolar Mask Encoder module with epipolar cross attention to effectively fuse multi-view features. To bridge the synthetic-to-real domain gap, we introduce a self-supervised SDF-tailored differentiable rendering strategy for patient-specific 3D shape adaptation using uncalibrated clinical masks without requiring 3D ground truth. Crucially, the inherent continuity of implicit representation overcomes sparse observations, enabling anatomically reliable geometry at arbitrary resolutions. Furthermore, to empower our framework with physically continuous 4D extension, we introduce a Radial SDF Alignment strategy that strictly locks shape evolution to the predicted velocity field, fundamentally eliminating mesh drift. Extensive experiments on synthetic benchmarks and real clinical datasets demonstrate that Echo4DIR achieves state-of-the-art 4D cardiac mesh reconstruction, notably yielding an impressive clinical overlap of up to 98.35% Dice and 96.75% IoU.

Deep learning models for echocardiography segmentation often struggle to generalise across institutions, scanners, and patient populations, where collecting large, consistently annotated datasets is infeasible. Data augmentation is inexpensive and widely used to improve the robustness of deep learning models; however, its role in enhancing cross-dataset generalisability in echocardiography remains insufficiently understood. This study presents a large-scale multi-dataset evaluation of 29 data augmentation techniques and their pairwise combinations for 2D left ventricular segmentation using a U-Net trained on Unity, CAMUS, and EchoNet Dynamic datasets. Each augmentation was explored under several hyperparameter settings and assessed through repeated runs using Dice and IoU in both in-domain and cross-dataset scenarios, with statistical significance quantified via independent t-tests. In-domain accuracy was near-saturated and insensitive to augmentation, whereas cross-dataset performance varied widely. Geometry-based augmentations including affine, shift-scale-rotate, flip, and perspective produced the largest and most consistent gains, while aggressive intensity- and artefact-based transforms often degraded transfer. Moreover, pairwise combinations outperformed individual augmentations mainly when the two transformations were complementary, particularly by improving some difficult domain-shift cases from poor to acceptable performance. These findings provide empirical guidance for designing augmentation policies that improve the robustness and transferability of echocardiography segmentation models.

Transthoracic echocardiography (TTE) is the first-line imaging modality for diagnosing bicuspid aortic valve (BAV), yet diagnostic performance varies with operator expertise and image quality. We developed an explainable AI model that distinguishes BAV from tricuspid aortic valves (TAV) using routinely acquired parasternal long-axis (PLAX) cine loops. A multi-backbone video ensemble was trained and evaluated using a leakage-aware, stratified outer cross-validation protocol on $N{=}90$ patient studies (48 BAV, 42 TAV). Across fixed outer splits and 10 random seeds, the calibrated stacked ensemble achieved an outer-CV F1-score of $0.907$ and recall of $0.877$. Frame-level Grad-CAM localized salient evidence to the aortic root and leaflet plane, while globally aggregated SHAP values quantified each video backbone's contribution to the stacked prediction, enabling transparent, case-level auditability. These findings indicate that PLAX-based video ensembles can support reliable BAV/TAV classification from routine echocardiographic cine loops and may facilitate earlier detection in non-specialist or resource-limited clinical settings.

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.

Echocardiography interpretation requires integrating multi-view temporal evidence with quantitative measurements and guideline-grounded reasoning, yet existing foundation-model pipelines largely solve isolated subtasks and fail when tool outputs are noisy or values fall near clinical cutoffs. We propose Echo-CoPilot, an end-to-end agentic framework that combines a multi-perspective workflow with knowledge-graph-guided measurement selection. Echo-CoPilot runs three independent ReAct-style agents, structural, pathological, and quantitative, that invoke specialized echocardiography tools to extract parameters while querying EchoKG to determine which measurements are required for the clinical question and which should be avoided. A self-contrast language model then compares the evidence-grounded perspectives, generates a discrepancy checklist, and re-queries EchoKG to apply the appropriate guideline thresholds and resolve conflicts, reducing hallucinated measurement selection and borderline flip-flops. On MIMICEchoQA, Echo-CoPilot provides higher accuracy compared to SOTA baselines and, under a stochasticity stress test, achieves higher reliability through more consistent conclusions and fewer answer changes across repeated runs. Our code is publicly available at https://github.com/moeinheidari7829/Echo-CoPilot.

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.

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/