The Sound of Death: Deep Learning Reveals Vascular Damage from Carotid Ultrasound

Cardiovascular diseases (CVDs) remain the leading cause of mortality worldwide, yet early risk detection is often limited by available diagnostics. Carotid ultrasound, a non-invasive and widely accessible modality, encodes rich structural and hemodynamic information that is largely untapped. Here, we present a machine learning (ML) framework that extracts clinically meaningful representations of vascular damage (VD) from carotid ultrasound videos, using hypertension as a weak proxy label. The model learns robust features that are biologically plausible, interpretable, and strongly associated with established cardiovascular risk factors, comorbidities, and laboratory measures. High VD stratifies individuals for myocardial infarction, cardiac death, and all-cause mortality, matching or outperforming conventional risk models such as SCORE2. Explainable AI analyses reveal that the model relies on vessel morphology and perivascular tissue characteristics, uncovering novel functional and anatomical signatures of vascular damage. This work demonstrates that routine carotid ultrasound contains far more prognostic information than previously recognized. Our approach provides a scalable, non-invasive, and cost-effective tool for population-wide cardiovascular risk assessment, enabling earlier and more personalized prevention strategies without reliance on laboratory tests or complex clinical inputs.

Deep Learning for Cardiovascular Risk Assessment: Proxy Features from Carotid Sonography as Predictors of Arterial Damage

In this study, hypertension is utilized as an indicator of individual vascular damage. This damage can be identified through machine learning techniques, providing an early risk marker for potential major cardiovascular events and offering valuable insights into the overall arterial condition of individual patients. To this end, the VideoMAE deep learning model, originally developed for video classification, was adapted by finetuning for application in the domain of ultrasound imaging. The model was trained and tested using a dataset comprising over 31,000 carotid sonography videos sourced from the Gutenberg Health Study (15,010 participants), one of the largest prospective population health studies. This adaptation facilitates the classification of individuals as hypertensive or non-hypertensive (75.7% validation accuracy), functioning as a proxy for detecting visual arterial damage. We demonstrate that our machine learning model effectively captures visual features that provide valuable insights into an individual's overall cardiovascular health.