BeatFlow-ECG: Rectified Flow for ECG Reconstruction from Indirect Wearable Signals

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 an important modality for continuous cardiovascular monitoring, including atrial fibrillation (AF) detection. However, labeled AF recordings remain limited in many clinical settings, making model adaptation difficult when only limited target data are available. Generative modeling offers a natural way to alleviate this scarcity by synthesizing additional AF signals. Existing approaches, however, mainly generate samples that match the target condition without explicitly modeling how an observed source recording should be transformed, making it difficult to leverage abundant source recordings from a specific population or cohort for targeted augmentation. We introduce PulseFlow, a source-conditioned counterfactual generation framework that combines conditional representation learning with invertible latent transport to edit cardiac rhythm while retaining information from the source. Experiments across two clinical cohorts demonstrate effective rhythm transformation, measurable source correspondence, and improved AF classification under limited labels.

Cine cardiovascular magnetic resonance (CMR) analysis relies on multi-frame sequences capturing the full cardiac cycle. However, standard multi-frame acquisition depends heavily on electrocardiogram (ECG) gating and repeated breath-holds, posing challenges in uncooperative populations, resource-limited settings, and temporally corrupted datasets. Existing methods that synthesize full cardiac sequences either rely on explicit ECG signals to parameterize myocardium function, or employ deformable registration without physiological constraints, failing to faithfully reproduce clinically relevant dynamic metrics such as ejection fraction (EF) and ventricular contraction magnitude. We present PhaseFlow, a unified generative framework that overcomes both limitations. PhaseFlow estimates a non-linear cardiac phase signal directly from the input sequence via a segmentation-derived left-ventricular (LV) area curve, capturing the asymmetric dynamics of systole and diastole without any ECG dependency. At inference, this phase signal is provided by a pathology-specific template, informing phase-specific frame generation. A rectified flow model conditioned on the phase and slice position synthesizes the full cardiac motion trajectory in the latent space, decoded into a diffeomorphic displacement field that warps end-diastole pixel intensities directly, eliminating the reconstruction blur often accompanying the variational autoencoder. On the ACDC benchmark, PhaseFlow achieves superior physiological fidelity and image realism, with best LV volume curve $R^2$, structural similarity (SSIM) and generative quality (FID) among all baselines. Ablation studies confirm that each proposed component contributes measurably to the overall performance.