AI Learning for Pediatric Right Ventricular Assessment: Development and Validation Across Multiple Centers

BackgroundCongenital and acquired heart disease affects [~]1% of children globally, with right ventricular (RV) dysfunction being a common and complex issue due to conditions like congenital heart disease (CHD), pulmonary hypertension (PH), and prematurity. Accurate RV assessment is challenging due to its unique geometry, interventricular interactions, and morphological variability in pediatric patients. Fractional area change (FAC), a key echocardiographic measure, correlates strongly with disease severity, aiding in timely intervention and prognosis. AI learning shows the potential to automate and standardize RV assessments, overcoming traditional limitations and improving early diagnosis and management of pediatric cardiovascular disorders. MethodsUsing 24,984 echocardiograms from 3,993 pediatric patients across four tertiary care centers (one in North America, three in Asia), we developed and validated an AI framework for automated RV assessment. The framework employs multi-task learning to perform ventricular segmentation, beat-by-beat quantification of RV FAC, and identification of cardiac abnormalities like PH. It was also extended to enhance left ventricular (LV) functional assessment. FindingsOur AI system achieved Dice similarity coefficients of 0.86 (apical-four-chamber, A4C) and 0.88 (parasternal-short-axis, PSAX) for RV segmentation, matching expert annotations. It demonstrated robust RV functional assessment, with AUCs of 0.95 (U.S. cohort) and 0.97 (Asian cohort). For PH classification, diagnostic accuracies were 0.95 (U.S.) and 0.94 (Asian), confirming consistent performance across populations. When extended to LV assessment, the framework significantly improved LV ejection fraction (EF) prediction in both U.S. and Asian cohorts. InterpretationThis validated AI framework enables reliable, automated ventricular function analysis, matching expert-level performance. By enhancing clinical workflows and standardizing pediatric cardiac assessments, it has the potential to improve care management for pediatric cardiovascular disorders, particularly in resource-limited settings. FundingThis work was supported by the U.S. NIH 1R41HL160362-01 to XBL and K23HL150279 to AT.