Physiology and Anatomy Aware Inverse Inference of Myocardial Infarction for Cardiac Digital Twin

Accurate 3D geometric characterization of myocardial infarction (MI) is essential for building cardiac digital twins (CDTs) to precisely simulate infarct-related electrophysiology. Late gadolinium enhancement magnetic resonance imaging (LGE MRI) is the clinical reference for locating MI, yet its reliance on contrast agents restricts use in renally impaired patients and limits longitudinal follow-ups. As an alternative, contrast-free cine MRI visualizes abnormal ventricular wall motion, which is highly indicative of the infarcted area. In this study, we propose a novel explicit geometry-motion embedded model to fully automatically reconstruct personalized, simulation-ready 3D MI geometries directly from multi-view cine MRIs. Specifically, we construct a 4D (3D + t) biventricular mesh to explicitly extract and decouple geometry-aware and motion-aware features. We further design a dual-branch module for adaptive geometry-motion fusion to capture spatiotemporal dependencies for mapping infarcted region. Furthermore, we introduce multi-scale supervision utilizing an AHA-17 segment-guided cross-attention mechanism to steer the prediction, ensuring biophysically consistent reconstruction. Experimental results on 225 cine MRIs demonstrated that the proposed 3D MI reconstruction achieved high performance with an average Dice score of 0.678 $\pm$ 0.011. In the downstream in-silico electrophysiological simulation evaluations, the results were highly consistent with the LGE-derived ground truth, highlighting the great potential of the proposed model for contrast-free scar characterization and seamless integration into CDT modeling. The code will be released publicly upon acceptance of the manuscript for publication.

Myocardial substrate abnormalities, such as myocardial scar and myocardial infarction (MI), are associated with adverse cardiovascular outcomes. Electrocardiography (ECG) provides a low-cost and widely available tool for detecting these abnormalities, but ECG-based detection remains challenging due to heterogeneous lead-dependent manifestations, high-dimensional multi-lead signals, class imbalance, and the limited interpretability of deep learning models. We propose a multi-scale attention-enhanced convolutional network (MSAIC-Net) for ECG-based myocardial substrate abnormality detection. MSAIC-Net employs parallel atrous convolutional branches to extract ECG features across multiple temporal receptive fields. %, enabling the model to capture both local and longer-range temporal patterns. Channel attention is then used to adaptively reweight informative lead-wise and feature-channel representations. To address class imbalance and improve feature separability, we introduce a novel imbalance-aware supervised contrastive learning strategy that encourages samples from the same class to form compact representations while increasing separation between abnormal and normal samples. Lead-wise permutation importance is further incorporated to quantify the contribution of each ECG lead and improve model interpretability. The proposed method was evaluated on two complementary datasets: a low-data institutional cohort from the University of Virginia (UVA) Health System for myocardial scar classification and the large-scale public PTB-XL dataset from PhysioNet for MI identification. Experimental results show that MSAIC-Net outperforms baseline models, with particularly pronounced improvements in the low-data UVA cohort. Overall, the proposed framework provides an effective and interpretable approach for ECG-based detection of myocardial substrate abnormalities.

Myocardial infarction (MI) is a leading cause of death, and its adverse outcomes are urgent to predict. Yet ECG-based prognostic models underperform because deep learning requires large, labelled datasets, which are scarce in medicine. Foundation models can learn from unlabelled ECGs via selfsupervision, but medically relevant training strategies remain underexplored. We propose a pretrained artificial intelligence model that combines patient-specific temporal information using contrastive learning with supervised multitask heads, then fine-tunes on post-MI outcome prediction. The proposed model outperformed a model trained from scratch (0.794 vs 0.608 AUC) showing that clinically structured ECG modelling improves classification in limited data regimes.