Abstract
Accurate segmentation of the left ventricle in echocardiography can enable fully automatic extraction of clinical measurements such as volumes and ejection fraction. While models configured by nnU-Net perform well, they are large and slow, thus limiting real-time use.We identified the most effective components of nnU-Net for cardiac segmentation through an ablation study, incrementally evaluating data augmentation schemes, architectural modifications, loss functions, and post-processing techniques. Our analysis revealed that simple affine augmentations and deep supervision drive performance, while complex augmentations and large model capacity offer diminishing returns.Based on these insights, we developed a lightweight U-Net (2M vs 33M parameters) that achieves statistically equivalent performance to nnU-Net on CAMUS (N=500) with Dice scores of 0.93/0.85/0.89 vs 0.93/0.86/0.89 for LV/MYO/LA (p > 0.05), while being 16 times smaller and 4 times faster (1.35ms vs 5.40ms per frame) than the default nnU-Net configuration. Cross-dataset evaluation on an internal dataset (N=311) confirms comparable generalization.