Automated Aortic Regurgitation Detection and Quantification: A Deep Learning Approach Using Multi-View Echocardiography

BackgroundAccurate evaluation of aortic regurgitation (AR) severity is necessary for early detection and chronic disease management. AR is most commonly assessed by Doppler echocardiography, however limitations remain given variable image quality and need to integrate information from multiple views. This study developed and validated a deep learning model for automated AR severity assessment from multi-view color Doppler videos. MethodsWe developed a video-based convolutional neural network (R2+1D) to classify AR severity using color Doppler echocardiography videos from five standard views: parasternal long-axis (PLAX), PLAX-aortic valve focus, apical three-chamber (A3C), A3C-aortic valve focus, and apical five-chamber (A5C). The model was trained on 47,638 videos from 32,396 studies (23,240 unique patients) from Cedars-Sinai Medical Center (CSMC) and externally validated on 3369 videos from 1504 studies (1493 unique patients) from Stanford Healthcare Center (SHC). ResultsCombining assessments from multiple views, the EchoNet-AR model achieved excellent identification of both at least moderate AR (AUC 0.95, [95% CI 0.94-0.96]) and severe AR (AUC 0.97, [95% CI 0.96 - 0.98]). This performance was consistent in the external SHC validation cohort for both at least moderate AR (AUC 0.92, [95% CI 0.88-0.96]) and severe AR (AUC 0.94, [95% CI 0.89-0.98]). Subgroup analysis showed robust model performance across varying image quality, valve morphologies, and patient demographics. Saliency map visualizations demonstrated that the model focused on the proximal flow convergence zone and vena contracta, appropriately narrowing on hemodynamically significant regions. ConclusionThe EchoNet-AR model accurately classifies AR severity and synthesizes information across multiple echocardiographic views with robust generalizability in an external cohort. The model shows potential as an automated clinical decision support tool for AR assessment, however clinical interpretation remains essential, particularly in complex cases with multiple valve pathologies or altered hemodynamics. Graphical Abstract O_FIG O_LINKSMALLFIG WIDTH=200 HEIGHT=143 SRC="FIGDIR/small/25323918v1_ufig1.gif" ALT="Figure 1"> View larger version (54K): org.highwire.dtl.DTLVardef@12c7eb1org.highwire.dtl.DTLVardef@31b5d7org.highwire.dtl.DTLVardef@1995106org.highwire.dtl.DTLVardef@967746_HPS_FORMAT_FIGEXP M_FIG C_FIG PLAX, parasternal long-axis view; PLAX-AV, parasternal long-axis view focused on the aortic valve; A3C, apical three-chamber view; A3C-AV, apical three-chamber view focused on the aortic valve; A5C, apical five-chamber view.