EchoVLM: Measurement-Grounded Multimodal Learning for Echocardiography

Abstract: Echocardiography is the most widely used imaging modality in cardiology, yet its interpretation remains labor-intensive and inherently multimodal, requiring view recognition, quantitative measurements, qualitative assessments, and guideline-based reasoning. While recent vision-LLMs (VLMs) have achieved broad success in natural images and certain medical domains, their potential in echocardiography has been limited by the lack of large-scale, clinically grounded image-text datasets and the absence of measurement-based reasoning central to echo interpretation. We introduce EchoGround-MIMIC, the first measurement-grounded multimodal echocardiography dataset, comprising 19,065 image-text pairs from 1,572 patients with standardized views, structured measurements, measurement-grounded captions, and guideline-derived disease labels. Building on this resource, we propose EchoVLM, a vision-LLM that incorporates two novel pretraining objectives: (i) a view-informed contrastive loss that encodes the view-dependent structure of echocardiographic imaging, and (ii) a negation-aware contrastive loss that distinguishes clinically critical negative from positive findings. Across five types of clinical applications with 36 tasks spanning multimodal disease classification, image-text retrieval, view classification, chamber segmentation, and landmark detection, EchoVLM achieves state-of-the-art performance (86.5% AUC in zero-shot disease classification and 95.1% accuracy in view classification). We demonstrate that clinically grounded multimodal pretraining yields transferable visual representations and establish EchoVLM as a foundation model for end-to-end echocardiography interpretation. We will release EchoGround-MIMIC and the data curation code, enabling reproducibility and further research in multimodal echocardiography interpretation.