Uncertainty Quantification in Cardiac Model Personalisation from Ultrafast Ultrasound

Reliable clinical deployment of machine learning requires models that know when they are likely to fail, particularly for subgroups underrepresented in training data. A common case is pediatric care, where models trained on adult cohorts can silently under-perform on children with no indication that something has gone wrong. As retraining with labeled pediatric data is often infeasible, detecting such failures at inference time is a critical clinical need. Building on the VIDS (Variational Inference under Distribution Shifts) framework, we introduce VIDS-Seg, which applies amortized variational inference over a lightweight prediction head to make this adaptive, OOD-aware prior tractable for dense image segmentation. We evaluate VIDS-Seg on left ventricular segmentation in echocardiography, a setting where pediatric anatomy differs systematically from the adult population most segmentation models are trained on, training on an adult cohort (EchoNet-Dynamic) and evaluating zero-shot on a pediatric cohort (EchoNet-Pediatric). Across all age strata, VIDS-Seg matches competitive baselines in segmentation accuracy while producing substantially higher spatial correspondence between predicted uncertainty and segmentation error, an advantage that persists even after applying temperature scaling to all baselines. Downstream, it yields more accurate and stable ejection fraction estimates and more reliable detection of cardiac malfunction in the infant subgroup. Our results indicate that OOD-aware uncertainty quantification can serve as a practical safety layer for deployed segmentation models, enabling detection of silent failures in underrepresented subgroups without retraining or additional labeled data.

Electrocardiogram (ECG)-based models have achieved strong performance in diagnostic tasks, yet they remain limited in modeling how cardiac dynamics evolve under external interventions. In particular, existing approaches focus primarily on static prediction and lack mechanisms to capture ECG variations under different pharmacological conditions. In this work, we propose an ECG World Model for action-conditioned predictive simulation of cardiac electrophysiology. Moving beyond disjoint pipelines, our framework features a principled integration of physiological ordinary differential equation (ODE) priors into latent diffusion dynamics via energy regularization. This structural constraint enables the synthesis of physiologically plausible post-intervention ECG trajectories while effectively mitigating generative hallucinations. Building on this simulation process, we introduce an uncertainty-aware evaluation strategy that leverages the stochasticity of diffusion sampling to characterize both the expected clinical risk and its variability, allowing a more reliable comparative assessment of candidate interventions. We evaluate our method across diverse settings, including controlled drug-response scenarios and real-world clinical records. Beyond standard waveform metrics, experimental results demonstrate improved risk calibration and strong alignment with expert-informed treatment preferences. These results establish our approach as a robust foundation for safe and intervention-aware clinical decision support.

As the population ages, the number of patients with cardiovascular diseases continues to increase, highlighting the need for early detection before progression to severe and irreversible functional decline. Consequently, estimating cardiovascular biomarkers from non-invasive biosignals, such as photoplethysmography (PPG) and arterial pressure wave (APW) signals, has attracted increasing attention. These signals can be measured using wearable and cuff-type devices. Previous studies have used PPG and APW signals to estimate cardiovascular biomarkers. However, these signals exhibit strong similarities in both the temporal and frequency domains and primarily reflect peripheral and arterial pulse waveforms. Therefore, they may provide limited information about cardiac mechanical function. In contrast, the quantitative impact of additional biosignals, such as ballistocardiography (BCG), which reflect the body's minute mechanical responses to cardiac ejection, remains unclear. In this study, we generated synthetic PPG, APW, and BCG signals from a unified whole-body cardiovascular circulation model and evaluated the complementary contribution of BCG to probabilistic cardiovascular biomarker estimation. We estimated posterior distributions of cardiovascular biomarkers using neural posterior estimation and simulation-based inference. The results showed that adding BCG signals significantly improved estimation performance. Furthermore, even in ill-posed cases where PPG and APW alone produced multimodal posterior distributions, adding BCG yielded unimodal posterior distributions. These findings provide fundamental insights into signal selection for estimating cardiovascular dynamics.