{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,15]],"date-time":"2026-09-15T18:18:28Z","timestamp":1789496308669,"version":"build-2803163510"},"reference-count":31,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"9","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["Circ: Cardiovascular Imaging"],"published-print":{"date-parts":[[2026,9]]},"abstract":"<jats:sec>\n                    <jats:title>BACKGROUND:<\/jats:title>\n                    <jats:p>Accurate assessment of left ventricular outflow tract (LVOT) gradients is critical for hypertrophic cardiomyopathy management, yet Doppler-based measurements are technically demanding and require expertise. The objective of this work was to develop a multi-view deep learning model capable of classifying LVOT obstruction (&gt;20 mm\u2009Hg) using routine 2-dimensional echocardiographic windows without reliance on Doppler imaging.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS:<\/jats:title>\n                    <jats:p>We trained and externally validated a cross-attention-based video-to-video fusion framework that integrated EchoPrime-derived video representations from 3 standard transthoracic echocardiographic views to classify LVOT gradients.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS:<\/jats:title>\n                    <jats:p>Training was performed on a derivation cohort (N=1833) from a tertiary care system in the United States, with model performance evaluated on an internally held-out test set (N=275) and a Korean external validation cohort (N=46). Single-view baselines showed limited discrimination (external area under the receiver operating curves, 0.47\u20130.70). Conversely, the domain-specific foundational model (EchoPrime) achieved superior single-view performance (area under the receiver operating curves, 0.75\u20130.80 internal; 0.79\u20130.83 external), highlighting the importance of echo-specific pretraining and temporal modeling. The proposed multi-view fusion further enhanced predictive performance, with the late fusion model reaching an area under the receiver operating curve of 0.84 on the external cohort with significant population-shift.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS:<\/jats:title>\n                    <jats:p>These results suggest LVOT physiology is encoded in routine 2-dimensional imaging and can be leveraged for clinically relevant gradient classification without Doppler input. The proposed artificial intelligence-guided strategy demonstrates substantial cost savings compared with the screen-all approach. By integrating complementary spatial-temporal information across multiple views, our approach generalizes robustly across populations and may enable real-time decision support, extend LVOT assessment to portable or resource-limited settings, and complement Doppler-based evaluation for longitudinal hypertrophic cardiomyopathy management.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1161\/circimaging.126.019956","type":"journal-article","created":{"date-parts":[[2026,8,6]],"date-time":"2026-08-06T09:00:21Z","timestamp":1786006821000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":1,"title":["Beyond Doppler: Scalable AI Detection of LVOT Obstruction in HCM"],"prefix":"10.1161","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0009-0005-8326-3109","authenticated-orcid":true,"given":"Owen R.","family":"Crystal","sequence":"first","affiliation":[{"name":"Department of Cardiovascular Medicine (O.R.C., J.M.F., I.G.S., C.A., C.V.E., L.C., R.A., S.J.L.), Mayo Clinic, Phoenix, AZ."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5824-8485","authenticated-orcid":true,"given":"Juan M.","family":"Farina","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine (O.R.C., J.M.F., I.G.S., C.A., C.V.E., L.C., R.A., S.J.L.), Mayo Clinic, Phoenix, AZ."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6459-9767","authenticated-orcid":true,"given":"Isabel G.","family":"Scalia","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine (O.R.C., J.M.F., I.G.S., C.A., C.V.E., L.C., R.A., S.J.L.), Mayo Clinic, Phoenix, AZ."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5877-7478","authenticated-orcid":true,"given":"Chadi","family":"Ayoub","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine (O.R.C., J.M.F., I.G.S., C.A., C.V.E., L.C., R.A., S.J.L.), Mayo Clinic, Phoenix, AZ."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0278-2192","authenticated-orcid":true,"given":"Cecilia C.","family":"Villa Etchegoyen","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine (O.R.C., J.M.F., I.G.S., C.A., C.V.E., L.C., R.A., S.J.L.), Mayo Clinic, Phoenix, AZ."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8769-5471","authenticated-orcid":true,"given":"Laur\u00e8ve","family":"Chollet","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine (O.R.C., J.M.F., I.G.S., C.A., C.V.E., L.C., R.A., S.J.L.), Mayo Clinic, Phoenix, AZ."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3773-2665","authenticated-orcid":true,"given":"Hyung Bok","family":"Park","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Department of Internal Medicine, International St. Mary\u2019s Hospital, Catholic Kwandong University College of Medicine, Incheon, South Korea (H.B.P.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7356-0020","authenticated-orcid":true,"given":"Kyung An","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Incheon St. Mary\u2019s Hospital, The Catholic University of Korea, Seoul, South Korea (K.A.K.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7081-4286","authenticated-orcid":true,"given":"Reza","family":"Arsanjani","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine (O.R.C., J.M.F., I.G.S., C.A., C.V.E., L.C., R.A., S.J.L.), Mayo Clinic, Phoenix, AZ."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Steven J.","family":"Lester","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine (O.R.C., J.M.F., I.G.S., C.A., C.V.E., L.C., R.A., S.J.L.), Mayo Clinic, Phoenix, AZ."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3327-8004","authenticated-orcid":true,"given":"Imon","family":"Banerjee","sequence":"additional","affiliation":[{"name":"Department of Radiology (I.B.), Mayo Clinic, Phoenix, AZ."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"e_1_3_3_2_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIR.0000000000001250"},{"key":"e_1_3_3_3_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.echo.2024.02.010"},{"key":"e_1_3_3_4_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.106.644682"},{"key":"e_1_3_3_5_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(21)00763-7"},{"key":"e_1_3_3_6_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.echo.2022.03.012"},{"key":"e_1_3_3_7_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjcard.2017.08.047"},{"key":"e_1_3_3_8_2","doi-asserted-by":"publisher","DOI":"10.1002\/clc.20594"},{"key":"e_1_3_3_9_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(24)00924-3"},{"key":"e_1_3_3_10_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00330-018-5674-x"},{"key":"e_1_3_3_11_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.echo.2023.07.001"},{"key":"e_1_3_3_12_2","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehad456"},{"key":"e_1_3_3_13_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcmg.2023.09.011"},{"key":"e_1_3_3_14_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.echo.2025.04.002"},{"key":"e_1_3_3_15_2","doi-asserted-by":"publisher","DOI":"10.1161\/JAHA.124.033767"},{"key":"e_1_3_3_16_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIR.0000000000000937"},{"key":"e_1_3_3_17_2","doi-asserted-by":"publisher","DOI":"10.1186\/s44156-025-00078-z"},{"key":"e_1_3_3_18_2","doi-asserted-by":"publisher","DOI":"10.1117\/1.JMI.10.5.054502"},{"key":"e_1_3_3_19_2","doi-asserted-by":"publisher","DOI":"10.3390\/jimaging9020048"},{"key":"e_1_3_3_20_2","doi-asserted-by":"publisher","DOI":"10.1038\/s41586-025-09850-x"},{"key":"e_1_3_3_21_2","doi-asserted-by":"crossref","unstructured":"Huang G Liu Z van der Maaten L Weinberger K. Densely connected convolutional networks. Proc. IEEE Conf. Comput. Vis. Pattern Recognit. CVPR. 2017;4700\u20134708","DOI":"10.1109\/CVPR.2017.243"},{"key":"e_1_3_3_22_2","doi-asserted-by":"crossref","unstructured":"Deng J Dong W Socher R Li LJ Li K Fei-Fei L. ImageNet: a large-scale hierarchical image database. In: 2009 IEEE Conference on Computer Vision and Pattern Recognition. 2009:248\u2013255","DOI":"10.1109\/CVPR.2009.5206848"},{"key":"e_1_3_3_23_2","doi-asserted-by":"crossref","unstructured":"Wang Z Wu Z Agarwal D Sun J. MedCLIP: contrastive learning from unpaired medical images and text. In: Proceedings of the 2022 Conference on Empirical Methods in Natural Language Processing. 2022:3876\u20133887","DOI":"10.18653\/v1\/2022.emnlp-main.256"},{"key":"e_1_3_3_24_2","doi-asserted-by":"publisher","unstructured":"Tran D Wang H Torresani L Ray J LeCun Y Paluri M. A closer look at spatiotemporal convolutions for action recognition. In: 2018 IEEE\/CVF Conference on Computer Vision and Pattern Recognition. 2018:6450\u20136459. doi:10.1109\/CVPR.2018.00675","DOI":"10.1109\/CVPR.2018.00675"},{"key":"e_1_3_3_25_2","article-title":"The Kinetics Human Action Video Dataset.","author":"Kay W","year":"2017","unstructured":"Kay W, Carreira J, Simonyan K, Zhang B, Hillier C, Vijayanarasimhan S, Viola F, Green T, Back T, Natsev P, et al. The Kinetics Human Action Video Dataset. arXiv. 2017;abs\/1705.06950:arXiv:1705.06950. doi: https:\/\/doi.org\/10.48550\/arXiv.1705.06950.","journal-title":"arXiv"},{"key":"e_1_3_3_26_2","doi-asserted-by":"publisher","DOI":"10.1007\/978-3-319-10590-1_53"},{"key":"e_1_3_3_27_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIR.0000000000001250"},{"key":"e_1_3_3_28_2","doi-asserted-by":"publisher","DOI":"10.1093\/ehjcvp\/pvaf036"},{"key":"e_1_3_3_29_2","doi-asserted-by":"publisher","DOI":"10.1093\/ehjdh\/ztaf086"},{"key":"e_1_3_3_30_2","doi-asserted-by":"publisher","DOI":"10.21037\/qims-24-2161"},{"key":"e_1_3_3_31_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.echo.2025.08.008"},{"key":"e_1_3_3_32_2","doi-asserted-by":"publisher","DOI":"10.1007\/s10554-022-02724-7"}],"container-title":["Circulation: Cardiovascular Imaging"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ahajournals.org\/doi\/full\/10.1161\/CIRCIMAGING.126.019956","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,15]],"date-time":"2026-09-15T18:00:24Z","timestamp":1789495224000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ahajournals.org\/doi\/10.1161\/CIRCIMAGING.126.019956"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9]]},"references-count":31,"journal-issue":{"issue":"9","published-print":{"date-parts":[[2026,9]]}},"alternative-id":["10.1161\/CIRCIMAGING.126.019956"],"URL":"https:\/\/doi.org\/10.1161\/circimaging.126.019956","relation":{},"ISSN":["1941-9651","1942-0080"],"issn-type":[{"value":"1941-9651","type":"print"},{"value":"1942-0080","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9]]},"assertion":[{"value":"2026-04-17","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-07-15","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-08-06","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}