Congenital Heart Disease

Episodic test-time adaptation resets a frozen segmenter to source weights $M_0$ on each case and adapts for a fixed step count. A fixed horizon conflates a cohort-level question, how far to adapt, with an irreducibly per-case one, whether this case should be adapted at all. Cohort means hide that decision: on cross-vendor cardiac MRI the mean $Δ$Dice from adaptation is statistically indistinguishable from zero while 58.7% of cases are individually made worse. We quantify this harm as harmful accepted area (HA), the harmful fraction of the edited area a controller deploys. Held-out tuning gives a stronger baseline than a fixed horizon, but the budget it selects transfers on neither of the two main medical benchmarks, and no global budget can condition on the case. We show that prediction fragmentation---the disagreement geometry between $M_0$ and the adapted mask $M_k$---predicts HA with no labels or extra backward passes at decision time, comparably on three benchmarks (Spearman $ρ$ 0.50--0.60), at a quarter of gradient-norm's latency. A case-level router built on it cuts HA from 0.228 to 0.139 on a benchmark that took no part in its design, with the design frozen and only cut-points recalibrated there. On the cardiac benchmark the design was selected on, the router cuts HA from 0.129 to 0.013 at matched Dice and 1.10 deployed updates, against the retrospective-best budget found post hoc on evaluation labels, and reduces that 58.7% to 20.0%, an upper bound we quantify. Where the retained cases are not net-helped (as on prostate), the router still cuts HA but concedes accuracy, a boundary we report. Thresholds are fit once on a labeled split disjoint from evaluation; decisions use no labels or gradients. The template ports across architecture and domain (nnU-Net$\to$SegFormer, Cityscapes$\to$ACDC) with coordinate, thresholds and per-bucket actions instantiated per domain.

Congenital heart disease (CHD) diagnosis and surgical planning often require patient-specific 3D anatomical models, but manual segmentation is labor-intensive, particularly in complex anatomies. Although deep-learning methods can automate this process, they are typically evaluated in-distribution, despite clinically relevant shifts in scanner, protocol, institution, population, and imaging modality. We present, to our knowledge, the first systematic evaluation of out-of-distribution (OOD) generalization in CHD segmentation, using ImageCHD as a held-out target cohort. We compare representative segmentation architectures under combined CT and CMR training, CT-only training, self-supervised pretraining, and limited target-domain adaptation. In-distribution performance proves to be a poor indicator of cross-cohort robustness: nnU-Net achieves the highest validation Dice (0.77) but falls to 0.51 on ImageCHD, while SwinUNETR generalizes substantially better, reaching 0.67 Dice. MAE and JEPA pretraining provide only modest additional benefit, suggesting that architecture contributes more to robustness than the tested pretraining strategies in this setting. When limited target-domain supervision is introduced, all SwinUNETR variants exceed 0.76 Dice with only 11 labeled ImageCHD cases. These findings demonstrate that conventional in-distribution evaluation can obscure clinically important generalization failures and support explicit cross-dataset testing as a key component of CHD segmentation evaluation.

Cardiovascular diagnosis rests on integrating complementary modalities, like ECG, echocardiography, chest radiographs, and clinical variables, each capturing distinct but correlated aspects of cardiac physiology. Yet most medical foundation models remain modality-specific, combining modalities only for finetuning or post-training. This discards the cross-modal evidence clinicians naturally integrate and ignores the structure within each modality. We introduce Latent-Attention Masked Autoencoders (LAMAE), a multimodal, structure-aware masked autoencoder that jointly learns patient-level representations during self-supervised pretraining. Rather than fusing modalities post hoc, LAMAE exchanges information directly in the latent space through a shared latent-attention module operating over a study-view-entity hierarchy, enabling aggregation of variable observations and graceful handling of missing modalities. Pretrained on over 1.2 million MIMIC-IV hospital stays, LAMAE outperforms modality-specific pretraining and strong contrastive and vision-language baselines across multimodal hospital-stay tasks, such as in-hospital mortality, ICD-10 and DRG coding, and length of stay, while remaining competitive on unimodal tasks. These gains persist even when only a single modality is available at test time, showing that modeling both intra- and inter-modal structure yields more robust, transferable representations.

Whole-heart segmentation (WHS) in computed tomography (CT) and magnetic resonance imaging (MRI) is affected by acquisition shifts and heterogeneous cardiac annotations. Existing WHS systems combine architectural design, transfer learning, and generic spatial or intensity augmentation. We investigate whether changes to data augmentation and training supervision can improve cross-modality WHS while the segmentation architecture is held constant. We present LISynSeg, a data-centric approach that augments real-image nnU-Net training with label-to-image synthesis. Synthetic volumes are generated from cardiac label maps using contrast and acquisition perturbations calibrated to the training cohort, then mixed with real images to retain thoracic context absent from the labels (and thus the synthesized images). We model cardiac label variation through controlled changes in myocardial wall thickness and partial supervision of uncertain vessel endpoints. On the CARE Whole-Heart benchmark, synthetic-only training performs worse than the real-image nnU-Net baseline, whereas calibrated real-synthetic training improves cross-modality segmentation without changing the architecture; the improvement is larger for MRI than for CT. The results show that modifying the training data strategy can benefit model development for heterogeneous cardiac data. Code and trained weights will be released at https://github.com/MedICL-VU/Care26_LISynSeg.

Massage therapy is helpful for the rehabilitation of various diseases, such as headaches caused by migraines and stress. Existing robotic systems have focused on massage therapy on the torso and limbs, but performing massage motions through suitable actuation on a person's head has been a challenge. In this paper, we present MiBOT, a head-worn massage robot that actuates two soft tactors to produce touch motions mimicking human massage. A key design principle behind MiBOT is its silent actuation, which we achieve through pneumatic artificial muscles in conjunction with a controller loop to respond to contact pressure. We evaluated the effectiveness of MiBOT in a controlled study and assessed subjects' blood pressure and heart rate levels while applying MiBOT. We found that our mechanical system generated positive and conclusive quantitative outcomes that are similar to the human-administered massage, decreasing participants' mean systolic and diastolic blood pressure by 2.8 mmHg and 1.7 mmHg, respectively, as well as calming their heart rate by 8-10% on average.

Many clinical prediction models treat post-intervention outcomes as a one-step mapping from baseline measurements to a future endpoint. However, recovery after a procedure often unfolds as an irregular trajectory: clinical observations, medication changes, repeat interventions, and physiological measurements are recorded asynchronously and can change risk assessment over time. We propose an intervention-aware clinical world model that represents each patient with a structured latent state and evolves it through time-ordered post-intervention events. The model first encodes baseline imaging into a 3D spatial latent state. It then updates this state using procedural context, static covariates, elapsed time, and peri-event physiological embeddings. Follow-up imaging provides training-only supervision through a latent forecasting objective. We apply the framework to atrial fibrillation ablation. During the 90-day recovery window, irregular post-procedure records provide clinically meaningful evidence for long-term recurrence risk. In repeated internal cross-validation on DECAAF-II, our model achieves AUROC 0.756 and AUPRC 0.777 for recurrence prediction. It also achieves a scar-extent MAE of 2.971 percentage points without requiring follow-up MRI intensities at inference. The learned state supports recurrence-risk queries at different horizons and retrospective input editing of blanking-period records.

Electrocardiography (ECG), photoplethysmography (PPG), and phonocardiography (PCG) provide complementary views of the same cardiac cycle, yet existing cardiac foundation models are trained for a single sensing modality, leaving the shared physiology across sensors unexploited. We introduce CardioState-JEPA, a cardiac foundation model to learn a single shared representation jointly across ECG, PPG, and PCG, built on a physiology-aware joint-embedding predictive architecture. The model maps heterogeneous waveforms into a common token space, processes them with a single shared Transformer encoder, and learns by predicting masked latent cardiac states, placing the pretraining target on shared physiology rather than sensor-specific waveform appearance. To handle the temporal offsets between electrical, mechanical, and hemodynamic events, cross-modal prediction uses a learned delay aligner that matches signals at the corresponding cardiac time. Because synchronized multi-sensor recordings are scarce, CardioState-JEPA first learns within-modality structure from abundant unimodal data and then uses paired data to align modalities in latent cardiac time. Evaluated as a frozen encoder across 25 downstream tasks spanning ECG, PPG, and PCG, our encoder improves average PPG classification by 8.2 AUROC points, PCG murmur detection by 18.8 AUROC points, and ECG classification by 15.5 AUROC points over the best self-supervised signal baseline and matches or exceeds cardiac models trained with privileged clinical text or supervised labels on several ECG benchmarks. These results establish that heterogeneous cardiac signals can mutually supervise a single foundation model of cardiac physiology.

Cardiologists interpret electrocardiograms by localizing waveform components, measuring rhythm and interval patterns, and translating these structured observations into diagnostic evidence. Whether this expert reading process can serve as an effective prior for ECG agents remains unclear. To address this question, we introduce LuminaECG, a clinically structured ECG reasoning framework that reformulates ECG interpretation as measurement-grounded visual reading. ECG signals are rendered on standard electrocardiographic grid paper to preserve the spatial and scale cues used in clinical reading. P-wave, QRS-complex, and T-wave boundaries are explicitly delineated, and color-coded segmentation decomposes the waveform into discrete visual measurement primitives. A general 2B vision-language backbone is then trained with low-rank supervised fine-tuning to associate these primitives with diagnostic reasoning, without architectural modification. Across open, proprietary, and ECG-specialist zero-shot baselines, LuminaECG improves both waveform measurement and diagnostic recovery. It reaches a clinically meaningful reader tier on the CODE-test benchmark, transfers across geographically diverse ECG datasets without retraining, and generates reports whose structure contains an emergent prognostic signal. These findings suggest that effective ECG agents require not only larger models, but supervision that preserves the alignment between measurable waveform evidence and clinical knowledge.

The same episode of atrial fibrillation is a minor finding in a healthy adult and grounds for anticoagulation in an elderly patient with hypertension: identical signal, opposite decision. Naming the rhythm is only the start; what determines a patient's outcome is the judgement that follows -- what the arrhythmia is across the whole record, what it means for this patient, and what should be done about it. Recent work pairing large language models with the ECG stops short of this, reading one recording without assembling a patient-level finding; and agentic systems built around it either receive the arrhythmia a device has already detected or target a different diagnostic task, stopping before the decision this task requires. We formulate patient-level arrhythmia decision support as a task and present Cardiologent, a multi-agent system that spans it from detection to decision. An agent for each signal -- a single ECG lead and the photoplethysmogram a wearable acquires -- grounds its window reading in measured features rather than a bare label; the readings are assembled into the patient's rhythm profile and, with the patient's own data, reasoned against clinical guidelines retrieved for the case, with a critic checking each conclusion against the guideline it cites. We evaluate the clinical decision rather than the report, across integrated diagnosis, clinical significance, and urgency and management. Cardiologent scores highest on every axis, first on every patient-level task under both cardiologists and an at-scale LLM judge -- whose agreement with the cardiologists (ICC 0.74, 0.66) matches theirs with each other (0.67). Because each conclusion traces to a cited guideline and is validated against expert cardiologists, it yields decisions a clinician can audit rather than act on blindly -- a step toward use in continuous monitoring.

Foundation models for 12-lead electrocardiograms (ECGs) transfer well across clinical tasks, but the physiological knowledge encoded in their representations remains opaque. We present CADENCE, a framework that decomposes an ECG foundation model into a human-interpretable, queryable dictionary of physiological concepts. Using a BatchTopK sparse autoencoder, CADENCE factorizes Layer-6 embeddings from more than nine million ECG tokens into 8,192 sparse cardiac atoms. These atoms align better than individual dense embedding dimensions with clinical phenotypes and waveform morphology, recovering arrhythmias, conduction abnormalities, infarction and repolarization patterns, chamber and axis findings, and lead- and beat-phase-specific waveform primitives. At Layer 6, the best atoms achieve mean AUROCs of 0.88 for clinical phenotypes and 0.90 for morphology, versus 0.78 and 0.83 for the best dense dimensions. Sparse atom probes match or outperform dense probes for phenotype, morphology, and age prediction while attributing each prediction to a small set of interpretable atoms; phenotype AUROC improves from 0.93 to 0.95. Atom-space geometry recovers physiologically coherent relationships, and targeted atom ablation selectively changes frozen downstream outputs. An automated LLM pipeline generates and quantitatively validates atom descriptions by predicting held-out activations. On independent external ECG datasets, CADENCE recovers overlapping concepts and maintains consistent phenotype-prediction performance. CADENCE provides a scalable framework for discovering and auditing the physiological knowledge encoded by ECG foundation models.

Accurate pixel-level classification of coronary angiograms is critical for cardiovascular disease assessment, yet the field lacks standardized evaluation protocols. In this work we demonstrate a new benchmark for the assessment of deep learning models which densely classify pixels of coronary angiograms to one of SYNTAX classes (or background). The evaluation covers 24 distinct architectures starting with classic convnets to recent state-space-based vision algorithms. We release CARDIAG - a multi-center, multi-label dataset which we carefully split to reliably compute metrics, accounting for diameter error, overlap, centerline quality and calibration. The data contains SYNTAX labels, binary, uncertainty and segmentation masks as well as intermediate frames together with the selected non-sensitive DICOM metadata. From the multitude of algorithms, we nominate ConvNeXt V2 encoder with DeepLab V3 Plus decoder as the best performing, achieving macro $F_1=0.456$, which we then ensemble with Mamba U-Net and Feature Pyramid Network, for an increased $F_1=0.479$. We demonstrate all the architectures to be well calibrated and determine the generalization of the top 5 methods, together with the data efficiency of these architectures. We highlight the importance of both high-resolution and low-resolution features in encoding. We also demonstrate the model correctness in the context of patient demographic, vessel sides and projection angle configurations. Overall the released benchmark allows for future studies to robustly and rigorously assess the proposals, not only for SYNTAX segmentation, but lesion detection and many more.

Fetal electrocardiogram (fECG) and Doppler ultrasound provide complementary views of fetal cardiovascular function: fECG captures electrical activity while Doppler reflects mechanical hemodynamics shaped by factors such as placental resistance and vascular compliance. Understanding the recoverable and unrecoverable Doppler components through reconstruction from fECG offers insight into the relative contributions of electrical versus mechanical factors in fetal circulation, thereby informing clinical decisions. In addition, clinical evidence of maternal-fetal cardiac coupling suggests that maternal cardiovascular dynamics may also inform fetal hemodynamics. To computationally model these relationships, we propose a cross-modal generative framework combining dilated convolutions with cross-modal attention to selectively incorporate maternal ECG and self-attention to capture long-range temporal dependencies. Trained on 885 synchronized fetal/maternal ECG and Doppler envelope segments from 39 pregnancies, our model synthesizes Doppler envelopes with power spectral density mean squared error (PSD MSE) of 49.9 +/- 15.8 dB^2 (51% lower than two-channel baseline) and heart-rate error of 4.71 +/- 0.77 bpm (1.5% better than baseline; negligible relative to the 110-160 bpm physiological range). Cross-modal attention yields a 39% PSD MSE reduction over naive dual-channel concatenation, quantifying the contribution of maternal-fetal coupling. Our proposed framework advances computational modeling of the maternal-fetal cardiovascular system by enabling the synthesis of Doppler envelopes from dual-lead ECG. By analysis of both recoverable and residual Doppler components, this approach enables quantification of the purely mechanical contributions to Doppler waveforms -- those not recoverable from electrical recordings -- ultimately facilitating a more comprehensive fetal assessment.

Complete digital 12-lead electrocardiograms (ECGs) are essential for AI-enabled cardiovascular assessment, yet many clinical ECG records, particularly those digitized from ECG images, remain incomplete because of short display formats, incomplete waveform digitization, lead loss, or signal corruption. We developed ImputeECG, a mask-conditioned one-dimensional Transformer autoencoder that completes 12-lead, 10-s ECGs while retaining all observed samples. The model was trained on PTB-XL and evaluated on PTB-XL and CPSC2018 under simulated incomplete settings, with additional real-world validation in a 43,633-record Kailuan clinical cohort after ECG image digitization. Metrics were computed over originally missing regions, with analyses of morphology and downstream diagnostic utility. On PTB-XL, ImputeECG reduced missing-region MAE by 41.7-51.0% and MSE by 54.0-63.7% versus the strongest baseline, with lower errors in R-peak timing, RR interval, QRS duration, QT interval, and P-wave, QRS-complex, and T-wave reconstruction. On CPSC2018, ImputeECG reduced MAE by 49.7-51.9%, supporting external generalization. In downstream multi-label classification, ImputeECG restored performance to 92.28% AUROC and 33.88% AUPRC in the most incomplete PTB-XL setting, approaching complete-ECG performance. On CPSC2018, completed ECGs achieved 94.75-95.89% AUROC and 78.83-81.86% AUPRC across settings. In Kailuan, ECG completion improved zero-shot sex prediction AUROC from 82.6% to 85.8% and reduced age prediction MAE from 10.72 to 9.87 years after image-based ECG digitization. These findings support ECG completion as a practical strategy for converting incomplete ECG records into AI-ready 12-lead, 10-s digital signals and extending the usable scope of ECG archives for digital cardiac assessment.

Accurate detection of end-systole (ES) and end-diastole (ED) frames is fundamental to echocardiographic assessment. Existing methods are typically developed in a view-specific manner, depend on auxiliary annotations or intensive visual modeling, which limits their generalizability. In multi-view modeling, keyframe detection is driven by shared cardiac motion, yet large appearance differences and motion patterns make unified modeling challenging. To address these issues, we propose FrameONE, a unified end-to-end framework for multi-view echocardiographic keyframe detection. FrameONE introduces a Hierarchical Motion Modeling strategy: an intra-view multi-task learning reduces appearance bias and promotes motion-focused representations within each view; an inter-view general motion learning module further separates view-agnostic dynamics from view-specific patterns, enabling shared yet flexible motion representation learning across views. Extensive experiments on 25,872 videos spanning four standard views demonstrate that FrameONE achieves state-of-the-art keyframe detection accuracy with strong cross-view generalization. Code is available at https://github.com/szuboy/FrameONE.

The cardiovascular system evolves along a bounded trajectory in physiological state space that converges to a compact geometric object: the cardiac attractor. A wearable photoplethysmograph (PPG) or electrocardiograph (ECG) observes a one-dimensional projection of this attractor; by Takens' embedding theorem, delay coordinates reconstruct its full geometry. Three decades of nonlinear cardiac dynamics have extracted Lyapunov exponents, recurrence statistics, and sample entropy from reconstructed attractors, yet no principled account exists of which attractor properties capture which cardiovascular quantities, or why, leaving feature selection as a search problem and negative results uninterpretable. We introduce Attractor Domain Theory (ADT), which proves that the reconstructed attractor's information partitions into three mutually non-redundant domains: the Geometry Domain G (delay embedding; native capability: artifact rejection), the Ergodic Domain S (asymptotic statistical invariants; native capability: stability estimation), and the Variational Domain V (finite-time Lyapunov exponent field; native capability: hemodynamic inference). We prove a Domain Sufficiency Theorem (the Parseval analog for attractor information) and establish that three domains are necessary and sufficient. Geometry Domain validation via the SCSI framework across 176,742 PPG segments from four datasets yields AUC = 0.757 [0.686-0.828] and NPV = 0.966 after correcting three systematic evaluation artifacts (+0.179 net inflation). Ablation confirms C_NL as the dominant Geometry Domain component (Delta AUC = -0.413) and intra-domain redundancy across five components.

Congenital heart disease (CHD) refers to the abnormal anatomical structure caused by the abnormal development of the heart and great vessels during embryonic development. Traditional diagnostics often fail to achieve high accuracy and efficiency, especially given the complexity of cardiac anatomy. This study presents a specialized multi-view deep learning framework for CHD binary classification using echocardiographic images. A large-scale CHD dataset, including five views, was used to train the model, enabling it to integrate multi-angle image data. The framework utilizes advanced feature extraction and attention mechanisms to improve diagnostic precision and reliability. An uncertainty-based decision-making component is also integrated to handle low-quality images, enhancing diagnostic outcomes. Experimental results show that this method achieves top-tier performance on our dataset and provides a robust tool for early CHD detection, underscoring its potential for clinical use. The dataset and source code will be released upon paper acceptance.

The vascular network in the human body is characterized by blood vessels exhibiting drastic structural variations in radius, length, topological properties, and branching patterns. This heterogeneity, together with location-specific anatomical background variations, poses a significant challenge for robust, large-scale analysis of the entire cardiovascular system. As a result, most research has focused on narrow, isolated segments of the vascular network. While such targeted studies provide valuable insights, they inherently limit the ability to assess the systemic health and functional integrity of the vascular network as a whole. In this work, we aim to bridge this gap to advance both clinical diagnostics and our fundamental understanding of vascular physiology. We propose the task of segmenting all vessels in CT images, ranging from the largest components of the cardiovascular system to even minuscule mesenteric vessels. To this end, we introduce vesselFM-CT, the first model capable of robustly segmenting all blood vessels in 3D CT images. VesselFM-CT is trained via an iterative, multi-step process and optimizes our proposed TubeLoss loss function, effectively addressing the inherent heterogeneity of the cardiovascular system. We demonstrate that vesselFM-CT outperforms all baselines and enables automated, precise extraction of the cardiovascular system from CT images, thereby unlocking a wide range of clinical and technical perspectives, including automated disease classification and synthetic CT image generation.

Multimodal Large Language Models (MLLMs) have shown strong performance on public medical benchmarks, yet existing evaluations often remain weak proxies for clinical use, relying on isolated inputs and simplified recognition-style tasks. We introduce CardioLens, a leakage-resistant evaluation testbed for multi-sequence Cardiovascular Magnetic Resonance (CMR), constructed from private hospital archives through a rigorous report-to-QA construction and verification pipeline. CardioLens contains 473,896 slices and 13,494 verified QA pairs across 4D Cine, LGE, perfusion, and T2-weighted imaging, and evaluates three stages of CMR interpretation: image understanding, report generation, and disease diagnosis. Across 24 state-of-the-art MLLMs, CardioLens reveals a substantial clinical reality gap: models perform poorly overall, with performance degrading along the real CMR workflow. Confusion analysis further shows a category-collapse failure mode, where models default to frequent abnormal categories rather than distinguishing clinically distinct findings. To rule out MLLM-compatible input construction as the primary cause, we compare random, clinically motivated, and data-driven slice selection protocols under different slice budgets; performance changes only marginally, typically by about 1%. Explicit reasoning prompts also fail to rescue performance, often making models more conservative rather than improving visual evidence use. These results show that current MLLMs remain far from reliable CMR interpretation, where clinical decisions require integrating distributed evidence across sequences, views, and temporal phases. CardioLens provides a clinically grounded testbed for developing next-generation MLLMs toward real-world clinical deployment.

Electrocardiography (ECG) remains central to cardiovascular screening, yet interpretation remains largely manual and episodic. Clinical practice relies on brief resting ECGs and, when required, long-duration ambulatory recordings, both generating data that require resource-intensive review. Consequently, subtle morphological changes or progressive drift preceding clinically apparent abnormalities may go unnoticed. We propose a motif-based framework that defines beat-aligned ECG motifs as interpretable cardiac signatures and quantifies morphological drift and deviation across short and long-term monitoring. Motifs are representative cardiac cycles capturing dominant morphology. We introduce three interpretable drift metrics: deviation from a normal sinus rhythm (NSR), deviation from a personalised baseline, and a motif instability index. Motifs are extracted by selecting beats that minimise Dynamic Time Warping (DTW) distance within fixed windows. We evaluate these metrics on short (PTB-XL) and long-duration (MIT-BIH Arrhythmia) ECG datasets. Interpretability is achieved through representative motif overlays and fiducial-based visualisations, enabling direct inspection of morphological changes. In MIT-BIH, the proposed metrics significantly separated predominantly normal from arrhythmic subjects (p<0.01). In PTB-XL, NSR deviation distinguished normal from abnormal ECGs across major diagnostic subtypes (p<1e-4, Cliff's delta up to 0.93). ECG motifs provide an interpretable representation of cardiac morphology, supporting scalable longitudinal monitoring and early detection of morphology-driven change.

Electrocardiography (ECG) is central to cardiovascular care, but conventional AI models are often restricted to common arrhythmias and may generalize poorly across populations or clinically subtle diseases. We developed ECG Contrastive Language-Image Pre-training (ECGCLIP), a signal-language contrastive learning framework that aligns ECG waveforms with expert diagnostic reports. ECGCLIP was pre-trained on 2,837,962 ECG studies from 1,324,856 patients and evaluated on a held-out internal test set plus nine independent external cohorts comprising about 1.5 million ECGs. Evaluation covered 89 downstream tasks, including 45 ECG diagnoses, 39 echocardiographic targets, and 5 rare cardiac diseases, using PRAUC as the primary metric. ECGCLIP consistently improved performance over random initialization and Merl-R18 baselines. On the internal test set, ECGCLIP-R34 achieved strong performance for atrial fibrillation (PRAUC 0.900) and ST-segment elevation myocardial infarction (PRAUC 0.383), with robust generalization across all external cohorts. It also improved low-prevalence and diagnostically elusive diseases, including Ebstein anomaly, constrictive pericarditis, dextrocardia, and cardiac amyloidosis, with internal PRAUC values of 0.253, 0.175, 0.121, and 0.201, respectively. ECGCLIP was data efficient, matching or exceeding full-dataset baseline performance with only 10% of training data. Feature visualization and saliency analysis suggested clinically meaningful representations aligned with established electrocardiographic criteria. These findings indicate that large-scale ECG-report contrastive pre-training can expand routine ECG interpretation beyond common arrhythmias toward broad cardiovascular assessment and opportunistic screening of echocardiographic and rare conditions.

While Deep Learning (DL) enhances automated electrocardiogram (ECG) analysis, clinical deployment is hindered by class imbalance and the generalization gap. This paper presents HeartBeatAI, a deep learning framework combining domain generalization, multi-scale feature aggregation, and clinical explainability for robust 12-lead ECG classification. Moving beyond image-based paradigms, HeartBeatAI integrates a Squeeze-and-Excitation (SE) ResNet to isolate diagnostic leads alongside a Multi-Layer Concentration Pipeline to capture macro-rhythm and micro-morphological anomalies. To mitigate domain shift, the framework employs MixStyle regularization and Label Smoothing. Rigorous benchmarking across four large-scale datasets using intra-source and Leave-One-Domain-Out (LODO) protocols demonstrates high performance (98% Macro F1-score) under intra-source conditions. However, LODO evaluations reveal significant degradation in detecting rare anomalies, highlighting a persistent challenge in cross-institutional deployment.

Human cognitive performance is constrained by limited mental resources, yet continuous computational estimation of cognitive capacity dynamics remains an open challenge. We propose a theory-driven multimodal learning framework that models capacity-related cognitive state as a two-dimensional physiological representation defined by voluntary resource allocation (mental effort) and overload-related strain (stress). The proposed architecture combines dual-stream encoding of cardiac (IBI/HRV) and electrodermal (EDA) signals with late fusion and task-specific output heads that independently estimate probabilistic effort and stress states. Evaluation on the SWELL-KW dataset using strict leave-one-subject-out cross-validation demonstrates cross-individual generalization (stress: 70.0% balanced accuracy; effort: 72.2%), with significant gains from multimodal integration and theory-guided supervision. Rather than collapsing physiological dynamics into a single workload label, the proposed effort--stress state-space enables structured differentiation between distinct cognitive regimes, including productive engagement and overload-related strain. Predicted state trajectories exhibit significant demand-sensitive shifts under controlled workload manipulations, with effort and stress responding differentially across interruption and time-pressure conditions. These results suggest that physiologically grounded multidimensional state representations may provide a foundation for adaptive systems capable of continuous capacity-aware monitoring and human-centered interaction.

Point-of-care transthoracic echocardiography (TTE) enables cardiac assessment in virtually any clinical setting, yet its diagnostic utility remains constrained by the expertise required for image acquisition and interpretation. Visual question answering (VQA) offers a promising paradigm for bridging this expertise gap through interactive clinical assistance, but existing echocardiography VQA datasets are limited in scale, restricted to high-quality images, and only cover a few views. We introduce EchoVQA, the first large-scale VQA dataset for echocardiography, comprising 14,299 images and 74,819 question-answer pairs. The dataset integrates public sources (EchoNet-Dynamic, CAMUS) with our own point-of-care acquisitions from two handheld probes (Lumify, Clarius), spanning diverse views and including both high-quality and suboptimal images. Uniquely, EchoVQA includes acquisition guidance questions to help users optimize transducer positioning toward a diagnostic apical 4-chamber view for left ventricular ejection fraction estimation -- a challenging task for novice operators in point-of-care settings. We further develop a parameter-efficient method based on multimodal learnable prompts achieving state-of-the-art performance on most benchmarks, including EchoVQA, with significantly less trainable parameters than existing state-of-the-art approaches.

Machine learning methods provide a methodological innovation that can help screen for cardiovascular disease through noninvasive and readily available measurement modalities. Recent investments in using electrocardiogram (ECG) data to screen for structural heart disease (SHD) are one example, where ECGs provide a low-cost, available modality for screening. This has led to the EchoNext dataset, a paired ECG-echocardiogram data repository for testing new methods of SHD detection. However, relatively few studies have investigated how more probabilistic classification through Bayesian inference may improve uncertainty quantification in this setting. Moreover, few studies have considered how triage systems can be developed to alleviate healthcare bottlenecks, such as the review of data from underserved, rural clinics by expert sonographers for SHD assessment. In this study, we leverage existing ECG-echocardiogram data to compare frequentist and Bayesian neural network classifiers. We show that the Bayesian approach is comparable or better than frequentist methods in SHD classification, and that they have a more robust uncertainty quantification attached to them. We provide an example of how this uncertainty-aware classification scheme can be used for screening SHD, providing a proof-of-concept for how machine learning can help with triage in getting individuals expert sonographer input when SHD is highly likely or measurements are highly uncertain.

Cardiac motion over a cardiac cycle is crucial for quantifying regional function and is strongly affected by cardiovascular diseases. Since temporally dense mesh sequences are difficult to obtain in practice, we focus on leveraging the more accessible end-diastolic frame to infer a full-cycle sequence. Due to strong regional and disease-specific differences, traditional methods often oversmooth the data by relying on generative models that are optimized for global patterns. To address this problem, we propose Region-Aware and Phenotype-Adaptive Bi-Ventricular Cardiac Motion Synthesis (RePCM) for single frame Bi-ventricular mesh motion completion. In Stage I, a reconstruction network learns vertex wise motion descriptors and clustering yields a data driven functional partition, providing an explicit motion derived region structure. In Stage II, a Region-Specific Injection Module enforces masked, synchronized region exchange within a conditional VAE, preserving localized specific dynamics and restricting cross-region mixing. A Phenotype-Adaptive Mixture-of-Experts prior conditioned on ED shape uses anatomy-guided cues to model latent motion trends and capture inter-disease variability. Experiments on three datasets covering different cardiovascular diseases show consistent gains in geometric and functional metrics and improved preservation of region specific dynamics.

Accurate cardiac output (CO) estimation from photoplethysmography (PPG) is promising for unobtrusive hemodynamic monitoring, but remains difficult since CO is jointly determined by cardiac function and vascular tone. Conventional feature-based models use physiologically meaningful PPG descriptors, yet depend on accurate pulse detection and may miss latent temporal relationships. In contrast, fully end-to-end deep learning models learn directly from raw PPG but often underuse established PPG-derived prior information. Here, we introduce the Cross-View Attention Fusion Network (CVAF-Net), a prior-guided dual-view deep learning model for CO estimation from short, fixed-length PPG segments. CVAF-Net processes raw PPG as a temporal view and a feature sequence map (FSM) as a structured prior-guided view, and fuses the two representations through cross-view attention. The model was independently evaluated using 5-, 15-, and 30-s segments from three datasets: simulated pulse waves (3323 subjects), vasoconstriction provocation (79 subjects), and resting/cycling activities (10 subjects), and was compared with multiple machine learning and deep learning benchmarks. CVAF-Net outperformed most benchmark methods and achieved performance comparable to a state-of-the-art Transformer-based model, with a mean absolute error (MAE) of 0.19 L/min (MAPE: 3.95%) on simulated data and high accuracy in real-world settings (minimum MAE: 1.20 L/min). Importantly, CVAF-Net reduced FLOPs by twelvefold compared with the leading Transformer-based model. Plausibility analysis showed physiologically consistent CO estimates, with expected correlations with age ($ρ= -0.274$), heart rate ($ρ= 0.894$), and systemic vascular resistance ($ρ= -0.740$). These findings indicate that CVAF-Net provides an accurate, computationally efficient, and generalizable approach for continuous wearable-based CO monitoring.

The accurate automated diagnosis of cardiac abnormalities from 12-lead electrocardiograms (ECGs) is critical for managing cardiovascular disease. However, detecting concurrent conditions remains a challenge for traditional deep learning models, which often have limited ability to model the long-range dependencies inherent in ECG signals. This manuscript proposes HexagonalWarriorMamba (HWMamba), a framework built on the Mamba architecture that processes 12-lead ECGs as single-channel 2D images rather than conventional 1D time series. By integrating a hierarchical architecture with a 2D Selective Scan mechanism, HWMamba is designed to model global context and complex spatial relationships within the data. The model is evaluated on the PhysioNet/Computing in Cardiology Challenge 2021 dataset, which includes 26 diagnostic labels and comprises recordings collected from seven institutions across four countries and three continents. Results demonstrate that HWMamba outperforms current state-of-the-art (SOTA) methods across five key threshold-dependent metrics, including Challenge Score and Subset Accuracy. These improvements provide a balance between strong discriminative capability and effective threshold selection derived from the training data, while maintaining near-SOTA performance in Macro AUROC. This Hexagonal Warrior performance, reflecting consistent performance across multiple evaluation dimensions, positions HWMamba as a robust and versatile approach for multi-label ECG classification.

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.

Electrocardiogram (ECG) diagnosis in clinical practice relies on structured reasoning over multiple hierarchical aspects, including cardiac rhythm, conduction properties, waveform morphology, and overall diagnostic impression. However, most existing approaches predict labels directly from ECG signals without explicit clinical reasoning, resulting in opaque decisions that lack clinical alignment. To bridge this gap, we propose CardioThink, a physician-inspired multimodal large language model (MLLM) framework that explicitly models the diagnostic reasoning process through human-interpretable intermediate stages (rhythm, conduction, morphology, and impression) to derive final classification results. Furthermore, we introduce Structured Set Policy Optimization (SSPO) to jointly optimize adherence to this structured reasoning format and the accuracy of variable-size diagnostic sets, without requiring manually annotated reasoning traces. Extensive experiments on diverse ECG benchmarks demonstrate the significant superiority of our approach in diagnostic accuracy, while simultaneously providing interpretable clinical reasoning. Notably, reasoning quality evaluations confirm that SSPO substantially enhances the clinical validity of the generated rationales. These findings reveal that moving beyond direct label prediction toward structured reasoning offers a more clinically aligned direction for future ECG modeling.

Accurate delineation of electrocardiogram (ECG), the segmentation of meaningful waveform features, is crucial for cardiovascular diagnostics. However, the scarcity of annotated data poses a significant challenge for training deep learning models. Conventional semi-supervised semantic segmentation (SemiSeg) methods primarily focus on consistency from unlabeled data, underutilizing the information exchange possible between labeled and unlabeled sets. To address this, we introduce CardioMix, a framework built on a bidirectional CutMix strategy guided by cardiac patterns for ECG segmentation. This approach enriches the labeled set with realistic variations from unlabeled data while simultaneously applying stronger supervisory signals to the unlabeled set, as the cardiac pattern-guided mixing ensures all augmented samples remain physiologically meaningful. Our framework is designed as a plug-and-play module, demonstrating high compatibility with various SemiSeg algorithms. Extensive experiments on SemiSegECG, a public multi-dataset benchmark for ECG delineation, demonstrate that CardioMix consistently outperforms existing CutMix-based fusion strategies across diverse datasets and labeled ratios as a plug-and-play module compatible with various SemiSeg algorithms.

This work proposes Attractor-Vascular Coupling Theory (AVCT), a mathematical framework showing that cardiac attractor geometry encodes blood pressure (BP) information sufficient for AAMI-standard estimation, and validates the theory through a calibrated cuffless BP model using photoplethysmography (PPG). AVCT is grounded in Cardiac Stability Theory and operationalized using Takens delay embedding and attractor morphology extraction. Two theorems, one proposition, and one corollary formally justify the use of PPG attractor features for BP estimation and predict the feature-importance hierarchy. A LightGBM model trained on pulse transit time (PTT) and Cardiac Stability Index (CSI) attractor features under single-point calibration was evaluated using strict leave-one-subject-out cross-validation (LOSO-CV) on 46 subjects from BIDMC ICU (n = 9) and VitalDB surgical data (n = 37), comprising 29,684 windows. The model achieved systolic BP (SBP) mean absolute error (MAE) of 2.05 mmHg and diastolic BP (DBP) MAE of 1.67 mmHg, with correlations r = 0.990 and r = 0.991, satisfying the AAMI/IEEE SP10 requirement of MAE below 5 mmHg. Median per-subject MAE was 1.87/1.54 mmHg, and 70%/76% of subjects individually satisfied AAMI criteria. A PPG-only ablation using nine smartphone attractor features matched the ECG+PPG model within 0.05 mmHg, demonstrating that clinical-grade BP tracking is achievable using only a smartphone camera while surpassing prior generalized LOSO-CV results using fewer sensors. All four AVCT predictions were quantitatively confirmed, with 91.5% error reduction from uncalibrated to calibrated estimation (epsilon_cal = 0.915). Unlike post-hoc explainable AI methods, AVCT predicts features satisfying the architectural faithfulness criterion of the Explainable-AI Trustworthiness (EAT) framework and grounding BP estimation in nonlinear dynamical systems theory.

Electrocardiogram (ECG) interpretation is essential for diagnosing a wide range of cardiac abnormalities. While deep learning has shown strong potential for automating ECG classification, many existing models rely on large, computationally intensive architectures that hinder practical deployment. In this paper, we present an empirical study of convolutional neural network (CNN) architectures, exploring tradeoffs between diagnostic accuracy and computational efficiency. We benchmark two established baselines: AttiaNet, a compact model composed of sequential temporal and spatial blocks, and DeepResidualCNN, the winning architecture of the 2021 PhysioNet/Computing in Cardiology Challenge. Building on these, we propose three lightweight models: (i) ParallelCNN, which employs dual temporal and spatial branches for parallel pattern extraction; (ii) ParallelCNNew, a variant with symmetric weight initialization for balanced feature learning; and (iii) SimpleNet, a streamlined architecture that jointly processes temporal and spatial dimensions. Our experiments span three publicly available 12-lead ECG datasets from Germany, China, and the United States, covering binary, multiclass, and multilabel classification tasks across diverse patient populations. We further evaluate the impact of integrating low-cost demographic metadata (age and sex) to improve performance with minimal overhead. To ensure fair comparison, we introduce a unified Efficiency Score that integrates model size, inference speed, memory usage, and AUC performance. By balancing diagnostic performance and efficiency, our models offer a scalable and viable foundation for next-generation AI systems in cardiovascular care.

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

Cardiac magnetic resonance (CMR) segmentation underpins quantitative assessment of ventricular structure and function, yet reliable delineation remains difficult due to low tissue contrast, fuzzy boundaries, and inter scan variability. We present CardiacNAS, an evolutionary neural architecture search (NAS) framework that couples a UNet like supernet with a cardiac aware search space spanning depth width, kernel size, filter size, attention, fusion, activation, dropout, and residual scaling. The search is explicitly resource aware, jointly optimizing dice similarity coefficient (DSC) and 95th percentile Hausdorff distance (HD95) versus model size and floating point operations (FLOPs) under fixed compute budgets. Candidate architectures are instantiated from the supernet, trained with proxy budgets, and evolved through crossover, mutation, and elitist selection. We evaluate on the ACDC dataset and compare against six state of the art methods, using qualitative comparisons, learning curve analyses, and design factor correlation studies. The resulting model attains 93.22% average DSC and 4.73 mm HD95 with 3.58M parameters and 14.56 GFLOPs, demonstrating a favorable accuracy efficiency trade off. Analyses indicate that searched attention and fusion choices, together with residual scaling, contribute to improved boundary fidelity and stability. CardiacNAS offers a principled, resource aware approach to deployable CMR segmentation with transparent reporting of architectural complexity and compute budgets.

We present Cardiac Stability Theory (CST), an axiomatically grounded framework formally defining cardiovascular health as a stability margin around a cardiac dynamical attractor. From four axioms we derive the Cardiac Stability Index (CSI), a composite scalar in [0,1] integrating the largest Lyapunov exponent, recurrence determinism, and signal entropy via time-delay embedding. The ECG-based model (CSISurrogateV2, CNN-Transformer) achieves $R^2=0.8788$, MAE$=0.0234$ on PTB-XL (21,799 recordings). We extend CSI to smartphone PPG via Complementary Domain Transfer (CDT): CSISurrogateV2 generates pseudo-labels for the BUT PPG dataset (48 recordings, 12 subjects), training TinyCSINet (122,849 parameters), achieving MAE$=0.0557$, $ρ=0.660$ on the held-out test set ($n=1065$ windows) at ${<}30$ ms mobile latency. CDT is validated on BIDMC, Welltory, and RWS-PPG. Paired validation on 5,035 BIDMC windows yields $r=0.454$ ($ρ=0.485$, $p<10^{-295}$), confirming correlated cardiac stability across modalities. CSI is negatively correlated with age (slope $= -0.000225$ CSI/year, PTB-XL), discriminates atrial fibrillation from normal sinus rhythm (AUROC$=0.89$), and is robust under Perturbation Invariance Training (max AUC drop 1.65%). We derive HeartSpan, a longitudinal stability metric relative to population age norms, enabling continuous non-invasive cardiac monitoring from commodity smartphones for longevity tracking and cardiac risk stratification.

Transthoracic echocardiography is the reference standard for confirming structural heart disease (SHD), but first-line screening is limited by cost, workflow burden, and specialist availability. We evaluated whether open pretrained electrocardiogram (ECG) foundation models can support echo-confirmed multi-label SHD detection using the public EchoNext Mini-Model benchmark. Six echocardiography-derived abnormalities were targeted: reduced left ventricular ejection fraction, increased left ventricular wall thickness, aortic stenosis, mitral regurgitation, tricuspid regurgitation, and right ventricular systolic dysfunction. Under a common pipeline, we compared engineered ECG features with gradient boosting, end-to-end waveform learning from scratch, and transfer from open ECG foundation models. We then applied in-domain self-supervised adaptation of an ECG foundation model (ECG-FM) on EchoNext waveforms followed by selective supervised fine-tuning, and evaluated trade-offs between discrimination and adaptation cost. Adapted ECG-FM models achieved the best overall performance: peak macro-AUROC 0.8509 and macro-AUPRC 0.4297, while a parameter-efficient operating point preserved AUROC (0.8501) and attained the highest fixed-threshold macro-F1 0.3691. Late fusion with covariates did not improve threshold-independent discrimination, and evaluated LoRA, alternative backbones, and mixture-of-foundations strategies did not surpass the best adapted single-backbone models. These results indicate that for ECG-based case finding and echocardiography triage, combining target-domain self-supervised adaptation with selective supervised updating of a pretrained ECG backbone is the most effective transfer strategy.

Self-supervised learning in healthcare has largely relied on invariance-based objectives, which maximize similarity between different views of the same patient. While effective for static anatomy, this paradigm is fundamentally misaligned with clinical diagnosis, as it mathematically compels the model to suppress the transient pathological changes it is intended to detect. We propose a shift towards Action-Conditioned World Models that learn to simulate the dynamics of disease progression, or Event-Conditioned. Adapting the LeJEPA framework to physiological time-series, we define pathology not as a static label, but as a transition vector acting on a patient's latent state. By predicting the future electrophysiological state of the heart given a disease onset, our model explicitly disentangles stable anatomical features from dynamic pathological forces. Evaluated on the MIMIC-IV-ECG dataset, our approach outperforms fully supervised baselines on the critical triage task. Crucially, we demonstrate superior sample efficiency: in low-resource regimes, our world model outperforms supervised learning by over 0.05 AUROC. These results suggest that modeling biological dynamics provides a dense supervision signal that is far more robust than static classification. Source code is available at https://github.com/cljosegfer/lesaude-dynamics

Systolic murmurs are extra heart sounds that occur during the contraction phase of the cardiac cycle, often indicating heart abnormalities caused by turbulent blood flow. Their intensity, pitch, and quality vary, requiring precise identification for the accurate diagnosis of cardiac disorders. This study presents an automatic classification system for systolic murmurs using a feature extraction module, followed by a classification model. The feature extraction module employs complex orthogonal matching pursuit to project single or multiple murmur segments onto a redundant dictionary composed of multiresolution complex Gabor basis functions (GBFs). The resulting projection weights are split and reshaped into variable-resolution time--frequency feature matrices. Processing multiple segments of a single recording using a shared dictionary mitigates murmur variability. This is achieved by learning the weights for each segment while enforcing that they correspond to the same set of basis functions in the dictionary, promoting consistent time--frequency feature matrices. The classification model is built based on a vision transformer to process multiple input matrices of different resolutions by passing each through a convolutional neural network for patch tokenization. All embedding tokens are then concatenated to form a matrix and forwarded to an encoder layer that includes multihead attention, residual connections, and a convolutional network with a kernel size of one. This integration of multiresolution feature extraction with transformer-based feature classification enhances the accuracy and reliability of heart murmur identification. An experimental analysis of four types of systolic murmurs from the CirCor DigiScope dataset demonstrates the effectiveness of the system, achieving a classification accuracy of $95.96\%$.

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.

We present a family of open-source Music Foundation Models designed to advance large-scale music understanding and generation across diverse tasks and modalities. Our framework consists of four major components: (1) HeartCLAP, an audio-text alignment model; (2) HeartTranscriptor, a robust lyric recognition model optimized for real-world music scenarios; and (3) HeartCodec, a low-frame-rate (12.5 Hz) yet high-fidelity music codec tokenizer that captures long-range musical structure while preserving fine-grained acoustic details and enabling efficient autoregressive modeling; (4) HeartMuLa, an LLM-based song generation model capable of synthesizing high-fidelity music under rich, user-controllable conditions (e.g., textual style descriptions, lyrics, and reference audio). In addition, it provides two specialized modes: (i) fine-grained musical attribute control, which allows users to specify the style of different song sections (e.g., intro, verse, chorus) using natural language prompts; and (ii) short, engaging music generation, which is suitable as background music for short videos. Lastly, HeartMuLa improves significantly when scaled to 7B parameters. For the first time, we show that a Suno-level, commercial-grade system can be reproduced using academic-scale data and GPU resources. We expect these foundation models to serve as strong baselines for future research and to facilitate practical applications in multimodal content production.

Cardiovascular diseases (CVDs) are the leading cause of death worldwide, accounting for approximately 17.9 million deaths each year. Early detection is critical, creating a demand for accurate and inexpensive pre-screening methods. Deep learning has recently been applied to classify abnormal heart sounds indicative of CVDs using synchronised phonocardiogram (PCG) and electrocardiogram (ECG) signals, as well as multichannel PCG (mPCG). However, state-of-the-art architectures remain underutilised due to the limited availability of synchronised and multichannel datasets. Augmented datasets and pre-trained models provide a pathway to overcome these limitations, enabling transformer-based architectures to be trained effectively. This work combines traditional signal processing with denoising diffusion models, WaveGrad and DiffWave, to create an augmented dataset to fine-tune a Wav2Vec 2.0-based classifier on multimodal and multichannel heart sound datasets. The approach achieves state-of-the-art performance. On the Computing in Cardiology (CinC) 2016 dataset of single channel PCG, accuracy, unweighted average recall (UAR), sensitivity, specificity and Matthew's correlation coefficient (MCC) reach 92.48%, 93.05%, 93.63%, 92.48%, 94.93% and 0.8283, respectively. Using the synchronised PCG and ECG signals of the training-a dataset from CinC, 93.14%, 92.21%, 94.35%, 90.10%, 95.12% and 0.8380 are achieved for accuracy, UAR, sensitivity, specificity and MCC, respectively. Using a wearable vest dataset consisting of mPCG data, the model achieves 77.13% accuracy, 74.25% UAR, 86.47% sensitivity, 62.04% specificity, and 0.5082 MCC. These results demonstrate the effectiveness of transformer-based models for CVD detection when supported by augmented datasets, highlighting their potential to advance multimodal and multichannel heart sound classification.

Left ventricular ejection fraction (LVEF) is a primary marker of cardiac function. However, routine estimation from endocardial measurements requires manual delineation at end-diastole (ED) and end-systole (ES), a process that is time-consuming and subject to inter-observer variability. Reliable automation is especially valuable for point-of-care ultrasound (POCUS), where computational resources are limited and acquisition quality varies. We propose Echo-E$^3$Net, an anatomy-guided spatio-temporal network that explicitly embeds cardiac anatomy into LVEF prediction. A dual-phase Endocardial Border Detector (E$^2$CBD) uses phase-specific cross-attention to localize ED/ES endocardial landmarks and produce phase-aware landmark embeddings, while an Endocardial Feature Aggregator (E$^2$FA) fuses these embeddings with global statistical descriptors of deep feature maps to refine EF regression. Training is guided by a lightweight geometric loss that uses ED and ES endocardial landmarks to regularize EF prediction. On EchoNet-Dynamic and a PSAX subset of EchoNet-Pediatric, Echo-E$^3$Net attains competitive performance using only 1.55M parameters and 8.05 GFLOPs, an order-of-magnitude compute reduction versus recent baselines, supporting real-time deployment. Our code is publicly available at https://github.com/moeinheidari7829/Echo-E3Net.

Cardiac arrhythmia, a condition characterized by irregular heartbeats, often serves as an early indication of various heart ailments. With the advent of deep learning, numerous innovative models have been introduced for diagnosing arrhythmias using Electrocardiogram (ECG) signals. However, recent studies solely focus on the performance of models, neglecting the interpretation of their results. This leads to a considerable lack of transparency, posing a significant risk in the actual diagnostic process. To solve this problem, this paper introduces MambaCapsule, a deep neural networks for ECG arrhythmias classification, which increases the explainability of the model while enhancing the accuracy.Our model utilizes Mamba for feature extraction and Capsule networks for prediction, providing not only a confidence score but also signal features. Akin to the processing mechanism of human brain, the model learns signal features and their relationship between them by reconstructing ECG signals in the predicted selection. The model evaluation was conducted on MIT-BIH and PTB dataset, following the AAMI standard. MambaCapsule has achieved a total accuracy of 99.54% and 99.59% on the test sets respectively. These results demonstrate the promising performance of under the standard test protocol.

Accurate identification of end-diastole (ED) and end-systole (ES) in echocardiography underpins the quantification of ventricular function, yet manual selection of these key frames is subjective and introduces clinically significant inter-operator variability. Recent self-supervised methods either prescribe strict periodic trajectories or learn an unconstrained low-dimensional motion subspace from reconstruction or registration objectives. The former offers interpretability but imposes restrictive assumptions on temporal progression, whereas the latter leaves cardiac phase implicit and ED/ES must be recovered through post-hoc geometric processing of the learned trajectory. We translate the physiological observation that cardiac phase is a one-dimensional signal into a prior by constraining the latent motion component to a single-parameter latent orbit, i.e., a global linear trajectory in latent space indexed by a bounded scalar phase variable. Mapping this variable through a sinusoidal nonlinearity yields an oscillatory motion signal with consistent temporal ordering, enabling direct identification of ED and ES from the learned phase signal. This inductive bias allows the model to capture an interpretable representation of the cardiac cycle, while maintaining flexibility to capture irregular heartbeats. Trained on EchoNet-Dynamic without annotations, our minimal single-parameter cardiac phase model learns an effective latent orbit, significantly improves upon the previous state of the art in ED localisation and matches it in ES localisation while using a more constrained representation and fewer training epochs. This demonstrates that a principled physiological inductive bias can match or exceed the performance of more complex representations. Code is available at: https://github.com/BonniciJ/OrbitalEcho/