Multi-task artificial intelligence annotation of echocardiographic images: a retrospective multi-cohort study

Summary Background A comprehensive transthoracic echocardiogram involves the assessment of over 70 parameters, placing a substantial burden on sonographers and physicians for manual annotation with considerable inter-observer variability. Prior open-source segmentation models have largely addressed 2D B-mode ventricular function, leaving a gap in the spectral Doppler and atrial measurements required for valvular and diastolic assessment such as velocity-time integral (VTI) and atrial chamber size. Methods In this retrospective multi-cohort study, we developed EchoNet-Segmentation, comprehensive task-specific deep learning segmentation models for left and right atrial area and VTI Doppler measurements. Training used 186,712 sonographer-annotated images from 93,978 studies (56,855 patients) at Cedars-Sinai Medical Center (CSMC). Performance was evaluated on a held-out CSMC test set, a CSMC temporal split, an external Kaiser Permanente Northern California cohort, and the public MIMIC-Echo dataset. Findings On the CSMC held-out test set, our AI models showed strong agreement with sonographer measurements, with R2 of 0.817-0.882 and mean absolute error (MAE) of 1.13-3.80 cm for automated VTI measurements, and R2 of 0.675-0.747 and MAE of 2.48-2.52 cm2 for left and right atrial area segmentation. Performance was consistently confirmed on the CSMC temporal split (VTI: R2 0.606-0.866, atrial area: R2 0.694-0.705) and on the KPNC external cohort (VTI: R2 0.575-0.859, atrial area: R2 0.803-0.876), on the MIMIC-Echo dataset. Robustness was demonstrated on a different vendor's machines and across subgroups. EchoNet-Segmentation outperformed an open-source medical image foundation model with bounding-box, point prompt configurations on R2, MAE, and Dice score on both held-out test dataset and MIMIC apical four-chamber data. Interpretation EchoNet-Segmentation is the first open-source framework that delivers accurate, generalizable automated measurement across several key routine echocardiographic parameters, supporting end-to-end automation of clinically important echocardiographic assessments. Public release of model weights, code, and demonstration tools can facilitate reproducibility, research use and clinical deployment.