One view to rule them all? Artificial Intelligence Assessment of Valvular Disease and Ventricular Function by a Single Echocardiography View

Lior Fisher^1,2*Michael Fiman³Ella Segal^2,4Shira Lidar^2,3Noa Rubin³Adiel Am-Shalom³Ido Cohen^1,2Kobi Faierstein^1,3Avishai M. Tsur^3,5,6Ehud Schwammenthal¹Robert Klempfner¹Eyal Zimlichman^2,3Ehud Raanani^1,2Elad Maor^1,2*

• ¹Sheba medical center Division of Cardiology, Ramat gan, Israel
• ²Tel Aviv University, Tel Aviv-Yafo, Israel
• ³Sheba Medical Center, Ramat Gan, Israel
• ⁴sheba medical center Department of Otolaryngology — Head and Neck Surgery, Ramat Gan, Israel
• ⁵Tel Aviv University Faculty of Medical and Health Sciences, Tel Aviv-Yafo, Israel
• ⁶Hebrew University of Jerusalem Faculty of Medicine,, Jerusalem, Israel

ABSTRACT Background : Valvular heart disease and heart failure are major global health burdens, yet access to comprehensive echocardiography is often limited, particularly in resource-constrained settings. Artificial intelligence (AI) may enable rapid, point-of-care cardiac assessment using simplified imaging protocols . Objectives : To evaluate whether a deep learning model can accurately detect significant valvular and ventricular dysfunction using only a single two-dimensional apical four-chamber echocardiographic view, including images acquired by non-cardiologists with handheld ultrasound devices . Methods: We retrospectively analyzed 120,127 echocardiographic studies from a tertiary medical center to train and validate a deep learning model for identifying moderate-or-greater mitral or tricuspid regurgitation, right ventricular dysfunction, and reduced left ventricular ejection fraction (≤40%). A prospective cohort of 209 patients underwent handheld point-of-care cardiac ultrasound performed by non-cardiologist physicians, with same-hospitalization comprehensive echocardiography as the reference standard . Results: In retrospective testing, model areas under the curve (AUCs) were 0.883 for mitral regurgitation, 0.913 for tricuspid regurgitation, 0.940 for right ventricular dysfunction, and 0.982 for reduced ejection fraction. In the prospective cohort, AUCs were 0.72, 0.87, 0.95, and 0.97 for the same respective targets . Conclusions: A single-view deep learning model demonstrated strong diagnostic accuracy for detecting significant valvular and ventricular dysfunction across both standard and handheld ultrasound acquisitions. This approach may facilitate rapid, scalable cardiac function screening by non-cardiologists in diverse clinical environments . (Clinical Trial Registration: NCT05455541).