Shape-informed cardiac mechanics surrogates in data-scarce regimes via geometric encoding and generative augmentation

Modern forward electrocardiogram (ECG) computational models rely on an accurate representation of the torso domain. The lead-field method enables fast ECG simulations while preserving full geometric fidelity. Achieving high anatomical accuracy in torso representation is, however, challenging in clinical practice, as imaging protocols are typically focused on the heart and often do not include the entire torso. In addition, the computational cost of the lead-field method scales linearly with the number of electrodes, limiting its applicability in high-density recording settings. To date, no existing approach simultaneously achieves high anatomical fidelity, low data requirements and computational efficiency. In this work, we propose a shape-informed surrogate model of the lead-field operator that serves as a drop-in replacement for the full-order model in forward ECG simulations. The proposed framework consists of two components: a geometry-encoding module that maps anatomical shapes into a low-dimensional latent space, and a geometry-conditioned neural surrogate that predicts lead-field gradients from spatial coordinates, electrode positions and latent codes. The proposed method achieves high accuracy in approximating lead fields both within the torso (mean angular error 5°) and inside the heart, resulting in highly accurate ECG simulations (relative mean squared error <2.5%. The surrogate consistently outperforms the widely used pseudo lead-field approximation while preserving negligible inference cost. Owing to its compact latent representation, the method does not require a fully detailed torso segmentation and can therefore be deployed in data-limited settings while preserving high-fidelity ECG simulations.

Computational models of the human heart are widely used to study electromechanical and fluid-dynamical cardiac function and to support applications such as in silico clinical trials. However, most studies remain limited to single or patient-specific anatomies, restricting the inclusion of population-level variability required for uncertainty quantification. A key challenge is translating medical-image segmentations, which may contain artifacts, mesh defects or disjoint domains, into topologically coherent geometries suitable for multiphysics simulations. In this work, we present a semi-automatic pipeline that converts CT-based segmentations into simulation-ready cardiac meshes within a few minutes while preserving anatomical and topological consistency. Building on modern deep learning segmentation methods, the framework incorporates a template-based registration stage to regularize artifacts and enforce mesh-quality constraints. A Chamfer-distance morphing strategy deforms a high-quality template toward each segmented heart, matching individual chambers while preserving topology. The resulting meshes are watertight, isotopological, and endowed with consistent point-to-point correspondence. The pipeline is validated on 58 healthy cardiac CT scans, including all cardiac chambers and proximal vessel segments. The resulting meshes can be represented in a unified shape space, enabling the construction of a statistical shape model of the heart and major vessels. Principal Component Analysis shows that a low-dimensional latent space efficiently captures population variability, while Gaussian Mixture Modeling enables synthetic anatomy generation. Overall, the proposed framework (released open-source) provides a pathway from raw segmentations to simulation-ready cardiac geometries, enabling anatomically consistent virtual cohorts for large-scale in silico studies.

Full-cycle biventricular geometry is essential for characterizing cardiac function. However, dense and temporally consistent 3D+t biventricular meshes are not routinely available, whereas end-diastolic (ED) anatomy can often be obtained reliably. We therefore investigate full-cycle biventricular motion synthesis from a single ED mesh. This task is challenging because cardiac deformation is spatially heterogeneous and phenotype dependent, while conventional global generative models often obscure localized motion patterns. In this study, we propose a region-specific and phenotype-adaptive framework that integrates motion-informed functional parcellation with conditional latent flow. A functional partition learned from reconstructed motion organizes the ventricular surface into regions with coherent dynamics and enables topology-aware regional feature exchange. A phenotype-conditioned rectified-flow model subsequently maps the ED anatomy to full-cycle motion latents through fine-grained conditioning and prototype-routed motion adapters. An optional control branch further incorporates available motion descriptors for controllable synthesis. Experiments on ACDC, M&Ms, and M&Ms-2 demonstrate consistent improvements in geometric accuracy and functional fidelity. Under ED-only synthesis, our method achieves biventricular ASSD, HD95, and vRMSE of $1.49\pm0.34$~mm, $3.77\pm1.06$~mm, and $3.31\pm1.03$~mm, respectively, outperforming all competing methods. Complementary functional and robustness evaluations further demonstrate that the synthesized sequences preserve physiologically plausible ventricular dynamics and generalize across cohorts and disease phenotypes. The code will be released publicly upon acceptance of the manuscript for publication.