Segmentation of left ventricle (LV) from cardiac ultrasound images provides a quantitative functional analysis of the heart to diagnose disease. Active Shape Model (ASM) is widely used for LV segmentation, but it suffers from the drawback that initialization of the shape model is not sufficiently close to the target, especially when dealing with abnormal shapes in disease. In this work, a two-step framework is improved to achieve a fast and efficient LV segmentation. First, a robust and

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... t detection based on Hough forest localizes cardiac feature points. Such feature points are used to predict the initial fitting of the LV shape model. Second, ASM is applied to further fit the LV shape model to the cardiac ultrasound image. With the robust initialization, ASM is able to achieve more accurate segmentation. The performance of the proposed method is evaluated on a dataset of 810 cardiac ultrasound images that are mostly abnormal shapes. This proposed method is compared with several combinations of ASM and existing initialization methods. Our experiment results demonstrate that accuracy of the proposed method for feature point detection for initialization was 40% higher than the existing methods. Moreover, the proposed method significantly reduces the number of necessary ASM fitting loops and thus speeds up the whole segmentation process. Therefore, the proposed method is able to achieve more accurate and efficient segmentation results and is applicable to unusual shapes of heart with cardiac diseases, such as left atrial enlargement.