Integrating Heterogeneous Echocardiography AI Outputs in Language Space: Learnable Late Fusion with a Supervised LLM

Abstract

View- and target-specific echocardiography AI models capture useful but complementary information and may not achieve sufficient predictive performance in isolation. A learned ensemble is a natural way to combine these outputs, but heterogeneous models typically require each output to be converted into a binary decision, probability, confidence score, or fixed-length feature vector. We developed a supervised large language model (LLM)-based late-fusion module that directly aggregates view-specific predicted finding statements and predicted measurements in language space and learns a case-level fusion function. In patient-level three-fold cross-validation of 859 examinations from 646 patients, the proposed method integrated heterogeneous outputs within a single framework, performed comparably to the best-performing reference strategy evaluated, and outperformed a general-purpose LLM without task-specific training. These results suggest that a supervised LLM can combine multiple upstream models without model-specific output conversion or feature engineering that requires medical knowledge.