1 Concordia Institute for Information Systems Engineering, Concordia University, Montreal, Canada. Electronic address: hanae.elmekki@mail.concordia.ca.
2 Concordia Institute for Information Systems Engineering, Concordia University, Montreal, Canada. Electronic address: ahmed.alagha@mail.concordia.ca.
3 Concordia Institute for Information Systems Engineering, Concordia University, Montreal, Canada; Artificial Intelligence & Cyber Systems Research Center, Department of CSM, Lebanese American University, Beirut, Lebanon. Electronic address: hani.sami@mail.concordia.ca.
4 Department of Mechanical, Industrial and Aerospace Engineering, Concordia University, Montreal, Canada. Electronic address: amanda.spilkin@mail.concordia.ca.
5 Department of Medicine, Laval University, Quebec, Canada. Electronic address: antonela-mariel.zanuttini.1@ulaval.ca.
6 Department of Mechanical, Industrial and Aerospace Engineering, Concordia University, Montreal, Canada. Electronic address: ehsan.zaker

Cardiac ultrasound (US) scanning is one of the most commonly used techniques in cardiology to diagnose the health of the heart and its proper functioning. During a typical US scan, medical professionals take several images of the heart to be classified based on the cardiac views they contain, with a focus on high-quality images. However, this task is time consuming and error prone. Therefore, it is necessary to consider ways to automate these tasks and assist medical professionals in classifying and assessing cardiac US images. Machine learning (ML) techniques are regarded as a prominent solution due to their success in the development of numerous applications aimed at enhancing the medical field, including addressing the shortage of echography technicians. However, the limited availability of medical data presents a significant barrier to the application of ML in the field of cardiology, particularly regarding US images of the heart. This paper addresses this challenge by introducing the first open graded dataset for Cardiac Assessment and ClassificaTion of UltraSound (CACTUS), which is available online. This dataset contains images obtained from scanning a CAE Blue Phantom and representing various heart views and different quality levels, exceeding the conventional cardiac views typically found in literature. Additionally, the paper introduces a Deep Learning (DL) framework consisting of two main components. The first component is responsible for classifying cardiac US images based on the heart view using a Convolutional Neural Network (CNN) architecture. The second component uses the concept of Transfer Learning (TL) to utilize knowledge from the first component and fine-tune it to create a model for grading and assessing cardiac images. The framework demonstrates high performance in both classification and grading, achieving up to 99.43% accuracy and as low as 0.3067 error, respectively. To showcase its robustness, the framework is further fine-tuned using new images representing additional cardiac views and also compared to several other state-of-the-art architectures. The framework's outcomes and its performance in handling real-time scans were also assessed using a questionnaire answered by cardiac experts.