An ultrasound imaging system is for determining stroke volume and/or cardiac output. The imaging system may include a transducer unit for acquiring ultrasound data of a heart of a subject (or an input for receiving the acquired ultrasound data), and a controller. The controller is adapted to implement a two-step procedure, the first step being an initial assessment step, and the second being an imaging step having two possible modes depending upon the outcome of the assessment. In the initial assessment procedure, it is determined whether regurgitant ventricular flow is present. This is performed using Doppler processing techniques applied to an initial ultrasound data set. If regurgitant flow does not exist, stroke volume is determined using segmentation of 3D ultrasound image data to identify and measure the volume of the left or right ventricle at each of end systole and end-diastole, the difference between them giving a measure of stroke volume. If regurgitant flow does exist, stroke volume is determined using Doppler techniques applied to ultrasound data continuously collected throughout a cardiac cycle.