Organizations: Department of Computer Science, Emory University · Department of Computer Science, University of California, Los Angeles · Nell Hodgson Woodruff School of Nursing, Emory University · Department of Computer Science, University of Southern California · Department of Statistics, University of Wisconsin–Madison
Abstract
Electrocardiography (ECG) is the clinical standard for cardiac assessment but requires dedicated hardware that does not scale to daily-life monitoring. Photoplethysmography (PPG) is ubiquitous in wearables but lacks ECG-specific diagnostic morphology and is corrupted by motion and sensor noise. PPG-to-ECG generation aims to bridge this gap by recovering electrical morphology and timing from peripheral pulse signals. However, existing methods largely rely on statistical alignment and data-driven generation. They fail to explicitly structure the latent space around physiology-aware electro-hemodynamic factors and lack constraints from forward physiological dynamics. To address these challenges, we propose PG-LRF, a physiology-guided latent rectified flow framework. PG-LRF introduces an electro-hemodynamic simulator that co-models ECG and PPG through shared cardiac phase dynamics. Guided by this simulator, a Physiology-Aware AutoEncoder learns a structured electro-hemodynamic latent space. Then we integrate this simulator guidance into a PPG-conditioned latent rectified flow, enforcing ECG-side morphology consistency and ECG-to-PPG forward hemodynamic consistency during generative transport. Experiments on the large-scale MC-MED dataset demonstrate that PG-LRF significantly improves PPG-to-ECG generation and downstream cardiovascular disease classification, proving its ability to generate ECGs that are both signal-faithful and physiologically plausible under the ECG-to-PPG hemodynamic pathway
Photoplethysmography (PPG) has become a ubiquitous physiological signal; however, current generative models still struggle to preserve realistic waveform morphology and learn a latent structure that captures cardiac and respiratory physiology. PPG generators trained with adversarial losses can produce plausible waveforms, but provide no inference path from a real signal to a latent representation. Variational autoencoders, on the other hand, map the PPG data to latent codes, although their decoders often blur systolic upstrokes and dampen amplitude and spectral details. Diffusion models improve waveform fidelity, but typically lack an inference path for reconstruction and physiological analysis. We propose VampPrior Latent Diffusion (VAMP-Diff), a jointly trained variational diffusion model that combines a temporal PPG encoder, a conditional one-dimensional diffusion decoder, and VampPrior regularization on a compact pooled latent. The model uses full temporal latent during diffusion reconstruction, giving the decoder access to beat timing and morphology while generating samples from learned VampPrior components instead of a fixed Gaussian prior. We demonstrate on the CapnoBase dataset that VAMP-Diff produces realistic PPG signals, reconstructs sharper physiological waveforms than Gaussian-prior baselines, preserves heart-rate information, maintains respiratory-rate consistency, and is sensitive to waveform corruptions through reconstruction error.
Photoplethysmography (PPG), a non-invasive measure of changes in blood volume, is widely used in both wearable devices and clinical settings. Recent PPG foundation models either use open-source ICU datasets with pretraining paradigms that require curated data and thus complicate generalization to field-like data, or use closed-source field-like PPG data. In contrast, we propose a PPG foundation model that does not require high-quality or field-like pretraining data, and instead leverages accompanying electrocardiogram and respiratory signals in ICU datasets to select contrastive samples during pretraining. Our approach allows the model to retain and learn from noisy PPG segments, improving robustness at inference. Our model, pretrained on 3x fewer subjects than existing state-of-the-art approaches, achieves performance improvements on 14 out of 15 diverse downstream tasks, including field-like daily activity and heart rate prediction. Our results demonstrate that multimodal supervision can integrate complementary physiological information to improve the robustness of PPG foundation models and enhance their generalization to consumer-grade data.
Cardiac Magnetic Resonance (CMR) imaging provides a comprehensive assessment of cardiac structure and function but remains constrained by high acquisition costs and reliance on expert annotations, limiting the availability of large-scale labeled datasets. In contrast, electrocardiograms (ECGs) are inexpensive, widely accessible, and offer a promising modality for conditioning the generative synthesis of cine CMR. To this end, we propose ECGFlowCMR, a novel ECG-to-CMR generative framework that integrates a Phase-Aware Masked Autoencoder (PA-MAE) and an Anatomy-Motion Disentangled Flow (AMDF) to address two fundamental challenges: (1) the cross-modal temporal mismatch between multi-beat ECG recordings and single-cycle CMR sequences, and (2) the anatomical observability gap due to the limited structural information inherent in ECGs. Extensive experiments on the UK Biobank and a proprietary clinical dataset demonstrate that ECGFlowCMR can generate realistic cine CMR sequences from ECG inputs, enabling scalable pretraining and improving performance on downstream cardiac disease classification and phenotype prediction tasks.