This paper shows that apparent calibration improvements in cardiac digital twins may be artifacts of measurement conventions. Comparison of four models on a shared backbone revealed that CAMUS bias removal is explained by a +6.30 point difference between single-plane and biplane ejection fraction measurements, not by actual improvement. Replicating EchoNet-Dynamic with extractor aligned to the apical four-chamber plane removed overestimation and reversed the ranking.
Highlights the importance of rigorous validation and consideration of measurement conventions when evaluating models, which is critical for the reliability of digital twins in medical and industrial applications.
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