Congenital Heart Disease

Aims: Cardiovascular magnetic resonance (CMR) imaging enables non-invasive assessment of myocardial structure, function, and pathology, but requires substantial experience in interpretation of CMR images that could be supported by artificial intelligence (AI)-based models. However, use of AI models for enhanced CMR reading is limited by labor-intensive data curation, suboptimal model performance, and unclear implementation pathways. Methods and results: We developed an automated data curation pipeline for CMR-based cardiovascular disease (CVD) diagnosis, integrating open-source locally-run large language models (LLMs) to extract diagnostic labels from narrative CMR reports and preprocessing multimodal imaging data, including cine and late-gadolinium-enhancement (LGE) CMR sequences. Three vision foundation models (DINO, VST, UMedPT) were fine-tuned across these modalities in a two-stage approach. The dataset comprised hypertrophic cardiomyopathy (HCM), dilated cardiomyopathy (DCM), ischemic cardiomyopathy (ICM), cardiac amyloidosis (CA), and normal controls (NOR). A total of 988 curated cases were randomly divided into 742 for training and 246 for validation. Fine-tuned AI-models achieved high discriminative diagnostic performance on an independent test set comprising 1067 patients , with individual AUC-ROC values of up to 0.937 for the correct diagnosis of HCM and 0.945 for cardiac amyloidosis. Ensemble strategies combining multiple models and modalities further improved AI-based diagnostic accuracy and robustness, achieving the highest overall diagnostic performance for HCM (AUC=0.959, CI [0.936-0.978]), CA (AUC=0.966, CI [0.939-0.986]), NOR (AUC=0.872, CI [0.852-0.894]), DCM (AUC=0.848, CI [0.808-0.885]) and ICM (AUC=0.840, CI [0.809-0.868]). All training and inference code, along with the trained model weights, are publicly available on https://github.com/sinaamirrajab/CMR_CVD.

Cross-dataset generalisation remains a major barrier to clinical deployment of echocardiographic left ventricular segmentation, yet the sources of this shift are rarely disentangled. We examined whether transfer degradation could be estimated before deployment using handcrafted ultrasound descriptors, VAE latent features, and segmentation-derived latent features across six echocardiographic datasets. Geometry-aware preprocessing substantially improved several poor transfer cases, suggesting that much of the apparent domain shift reflects field-of-view and framing inconsistencies rather than intrinsic acoustic differences alone. Intensity z-normalisation changed dataset separability by less than 0.005, indicating that brightness and contrast are not the dominant shift axis. Absolute Dice drop on held-out source-target pairs was predicted with an R-squared value of 0.612, an MAE of 0.082, and a Spearman rho of 0.681. The variant without LV and fan-shaped features retained approximately 70% of this explanatory power, supporting mask-free transfer-risk monitoring. The most informative discrepancy measure depended on the representation, with CMD strongest in z-normalised handcrafted features, with an absolute r of approximately 0.86 and an R-squared value of approximately 0.70; log-Wasserstein strongest in VAE space, with an r of approximately -0.90 and an R-squared value of approximately 0.81; and log-MMD strongest in LV-segmentation latent features, with an r of approximately -0.92 and an R-squared value of approximately 0.84. Apparent vendor effects were largely dataset-confounded. Echocardiographic domain shift is therefore structured and measurable, and its impact on segmentation can be partly reduced through geometry-aware preprocessing and anticipated using representation-specific transfer-risk estimation.

Accurate delineation of the pericardium in a cardiac CT scan is essential for quantifying epicardial adipose tissue, yet it remains one of the most challenging structures to segment due to its poor contrast boundaries. Instead of solely relying on image gradients, our framework leverages the anatomical context of surrounding anatomical structures to guide the segmentation. This work introduces a novel 3D iterative mesh refinement framework that balances anatomical and geometric forces derived from inherent anatomical rules to refine an initial, possibly ambiguous, segmentation into a high-precision, anatomically plausible result. Designed as a model-agnostic post-processing step, our method uses a 3D vector field to iteratively push the vertices to the correct anatomical locations. Evaluating the refinement on both a high-resolution in-house dataset and a coarse, sparsely annotated open-source dataset, our method consistently improves all volumetric, surface, and anatomical metrics. The framework demonstrates greater improvement when applied to weaker initial segmentations, highlighting its potential for improving segmentations for out-of-domain models and in limited-training-data scenarios. The method is formulated as a gradient-based, GPU-accelerated framework that can be easily extended to other anatomical use cases.

This review provides an overview of recent advancements in automated segmentation methods on Computed Tomography (CT) for two types of cardiac fat: Epicardial adipose Tissue (EAT) and Pericardial Adipose Tissue (PAT). These fat deposits, separated by the pericardium, have been linked to various cardiovascular diseases, with EAT receiving the most research attention. Their complex anatomical context makes manual quantification highly time-consuming and prone to considerable inter-observer variability. Automated methods effectively address these complications, offering a more efficient and consistent solution. This study encompasses a broad range of methods, spanning AI as well as non-AI approaches. Additionally, it presents the remaining challenges, including the need for larger annotated public datasets and optimized attenuation thresholds for contrast-enhanced CT. It is demonstrated that automated methods are able to achieve segmentation results comparable to the quality of human annotation, proving their potential as a clinical tool for discovering new biomarkers and enhancing patient outcomes.

Traditional randomized trials often obscure clinically meaningful heterogeneity in treatment response by focusing on average effects. Leveraging real-world data to emulate clinical trials and estimate heterogeneous treatment effects (HTEs) offers a promising path toward more precise and efficient trial design. In this study, we emulate the DAPA-HF trial using electronic health records from the Mayo Clinic Cloud (MCC) to investigate whether HTE-guided stratification can identify patient subgroups with distinct treatment responses to dapagliflozin versus placebo in patients with heart failure with reduced ejection fraction. All-cause mortality was evaluated using Cox proportional hazards models, with HTEs estimated using a Meta-S learner and subgroups defined using a decision tree-based thresholding approach. In the overall cohort of the emulation, no significant treatment difference was observed (HR, 1.681; 95% CI, 0.828-3.413; p = 0.1507). However, compared with the overall emulated cohort, in which dapagliflozin showed no statistically significant survival benefit, HTE-driven stratification identified subgroups with significant and directionally distinct treatment effects. The beneficial (low-HTE) subgroup showed a significant survival benefit from dapagliflozin (HR = 0.203, 95% CI, 0.087-0.476, p = 0.0002), whereas the harmful (high-HTE) subgroup showed a significant harmful association with markedly increased mortality risk (HR = 6.680, 95% CI, 2.759-16.171, p < 0.0001). These findings indicate that HTE-guided stratification can uncover clinically meaningful beneficial and harmful treatment-effect patterns that are masked in the full-cohort emulation.

Adult and pediatric electrocardiogram (ECG) interpretation relies on age-sensitive criteria, and models pretrained mainly on adult ECGs often transfer poorly to pediatric populations when pediatric labels are scarce. Existing multimodal ECG--text methods typically align waveforms and text at the global sample level, entangling evidence from co-occurring diagnoses and limiting transfer under this gap. We propose Pediatric-Adult ECG Alignment via Cross-modal Enhancement (PEACE), a knowledge-guided framework pretrained on the largely adult MIMIC-IV ECG corpus. PEACE describes each diagnosis along rhythm, morphology, and ST--T axes and, per recording, composes only positive-label descriptors into three axis tokens and a fused embedding. A label query network (LQN) uses diagnostic labels as queries to cross-attend over ECG tokens and axis tokens, while label set aware bidirectional contrastive learning (LSBC) aligns pooled ECG features with the fused embedding when recordings share diagnoses. Curriculum adaptive fusion (CAF) gates alignment strength according to smoothed classification loss and training progress, limiting disruption during early optimization. The knowledge branch is used only for training supervision; inference uses ECG signals alone. On ZZU-pECG, PEACE reaches macro average AUCs of 59.39%, 81.74%, and 91.56% under zero-shot, 50-shot, and full fine-tuning, with the clearest gains over foundation and knowledge-pretraining baselines under limited supervision; versus domain adaptation initializations, zero-shot improves substantially while 50-shot AUC is comparable to DANN. After fine-tuning on PTB-XL, PEACE reaches 96.90% macro average AUC over nine harmonized labels. Ablations confirm that label-conditioned knowledge alignment, rather than global text fusion, is the key driver of pediatric transfer gains.

Cardiometabolic diseases remain among the most persistent drivers of preventable morbidity because diabetes, hypertension, and cardiovascular disease frequently co-occur and share metabolic, vascular, demographic, and behavioral determinants. Existing machine learning studies for chronic disease prediction often emphasize discrimination on a single dataset, while underreporting label leakage, calibration, temporal robustness, external transportability, and subgroup reliability. This paper presents CardioMeta, a calibrated multi-task framework for joint prediction of diabetes, hypertension, and cardiovascular disease across population survey and electronic health record (EHR) data. The study uses NHANES for population-level model development and temporal validation, and MIMIC-IV for EHR-domain evaluation under substantial distribution shift. To reduce circular label reconstruction, the primary analysis excludes disease-defining variables from the corresponding prediction heads, while a full-clinical feature setting is retained only as sensitivity analysis. CardioMeta combines a shared cardiometabolic encoder with disease-specific gated heads and post-hoc probability calibration. In the leakage-reduced temporal validation setting, the model achieved a macro-AUROC of 0.839, macro-AUPRC of 0.536, macro-F1 of 0.614, and expected calibration error of 0.024, with modest but consistent improvements over strong gradient-boosting and neural tabular baselines. External evaluation on MIMIC-IV showed clear degradation under domain shift, while limited fine-tuning partially recovered performance. The findings indicate that the principal value of multi-task cardiometabolic modeling lies not in inflated accuracy, but in reproducible leakage control, calibrated probabilities, and transparent reliability reporting across heterogeneous healthcare data sources.

Cardiovascular diseases are the leading cause of death worldwide, and conditions such as arrhythmia often require long-term monitoring for effective detection and diagnosis. However, current wearable monitoring devices are bulky, uncomfortable, and typically rely on clinicians to manually evaluate electrocardiograms (ECGs). While Deep Learning (DL) algorithms have shown superior performance in arrhythmia detection and classification, their computational complexity coupled with high power consumption limit deployment in wearable devices. To address this challenge, this paper investigates the use of approximation techniques to reduce the power and energy consumption of DL architectures while maintaining acceptable classification performance. Specifically, techniques such as data precision reduction and approximate multiplication are investigated in a state-of-the-art DL model and its corresponding hardware architecture. The model is trained and validated using the MIT-BIH Arrhythmia Database, and hardware implementations employing various approximate multipliers are synthesized and evaluated. Compared with the state-of-the-art 8.75 μW (and 2.08 μJ) reference architecture, our proposed architecture consumes 3.07 μW (and 2.17 μJ) at 12 kHz, showing 64.9% reduction in power consumption while providing an acceptable output quality, i.e., 93.7% classification accuracy and 92.1% sensitivity. At 100 MHz, our proposed architecture consumes 9.45 mW (and 0.8 μJ), showing 61.5% reduction in energy consumption as compared to the state-of-the-art architecture. These results demonstrate that our proposed approximations significantly extend wearable device battery life while preserving the required arrhythmia classification performance.

Long-tailed label distributions reduce the reliability of deep learning for electrocardiogram (ECG) arrhythmia diagnosis, particularly for clinically important but rare abnormalities. Existing rebalancing and logit adjustment methods mainly address class frequency while overlooking direction-dependent morphological variability across ECG classes. This study proposes Angular Gaussian Supervised Contrastive Learning (AG-SCL) for long-tailed multi-label ECG diagnosis. AG-SCL integrates three components into a unified framework: an Angular Gaussian contrastive branch that models full-covariance class uncertainty on unit-normalized embeddings, Adaptive Logit Adjustment that learns bounded label-state-specific prior corrections instead of fixed frequency-based margins, and tail-aware augmentation that generates morphology-preserving views while protecting the 7-25 Hz QRS-dominant band. The method was evaluated on the public PTB-XL benchmark and a nocturnal ECG dataset comprising 1317 hours of recordings from 141 subjects. AG-SCL achieved the best macro-level performance on both datasets. On PTB-XL, it obtained a balanced accuracy of 0.838, sensitivity of 0.709, specificity of 0.968, mean average precision of 0.495, and TPR at 5% FPR of 0.778. On Noc-ECG, the corresponding values were 0.918, 0.889, 0.947, 0.488, and 0.900. The largest gains occurred in rare or morphologically unstable rhythm classes, while ablation studies confirmed the contributions of full-covariance modelling, Adaptive Logit Adjustment, and tail-aware augmentation. AG-SCL improves long-tailed ECG diagnosis by combining prior calibration with anisotropic representation learning, enhancing sensitivity to rare arrhythmias while maintaining clinically relevant specificity. Our code is available at: https://github.com/Open-EXG/AG-SCL-for-Long-Tailed-ECG.

Arrhythmogenic left ventricular cardiomyopathy is a genetic myocardial disease difficult to diagnose due to the lack of gold standard criteria. Simultaneous PET/MR imaging, combined with multiparametric quantitative analysis, could facilitate the identification of different profiles related to the phenotype and progression of cardiomyopathy. This preliminary study focuses on a methodological strategy for dealing with PET/MRI data, including inter-patient data linkage and regional analysis. Two-step clustering was applied to T1 and T2 maps, LGE, and 18F-FDG-PET images of 99 patients genetically diagnosed with arrhythmogenic left ventricular cardiomyopathy. Each patient's images were independently z-scored and summed into a single volume, which was clustered into supervoxels. Thirty-two inter-patient groups of supervoxels were obtained by spectral clustering. An "abnormality" score was assigned to each cluster and modality, and used to visualise abnormal regions likely associated with disease. They enabled the generation of automated textual and bullseye health reports for each patient, which were compared with cardiac imager assessments using balanced accuracy in repeated nested cross-validation. This approach was further validated on a larger cohort of 167 numerical phantoms. The reports generated by clustering accurately identified most of the cardiac physicians' observations (BA = 0.76 $\pm$ 0.04 in repeated nested cross-validation on patients, and BA $\ge$ 0.8 on phantoms). Furthermore, the identified abnormal clusters closely matched their visual observations, facilitating the identification of varying degrees of fibrosis or inflammation on the images. This approach enables a more systematic handling of multimodal PET/MRI data to characterise myocardial heterogeneity in arrhythmogenic left ventricular cardiomyopathy patients.

Background and Objective: Deep video models estimate left-ventricular ejection fraction (EF) from echocardiography with near-expert accuracy, and post-hoc attribution (Chefer relevance for transformers, Grad-CAM for CNNs) is increasingly used to certify that models "look at the right place." Yet whether these explanations are faithful both spatially and temporally is unaudited. Because EF is defined by the end-systolic (ES) and end-diastolic (ED) frames, a faithful explanation must localize the left ventricle (space) and the decisive frames (time). Methods: We fine-tune two distinct EF regressors on EchoNet-Dynamic -- a self-supervised VideoMAE transformer and a Kinetics-pretrained R(2+1)D CNN -- and audit each with architecture-matched attribution along three axes: intersection-over-relevance (IoR) against LV masks, deletion AUC, and a temporal localization index on ES/ED frames, each relative to chance with per-case 95% CIs over 50 studies. A tubelet-occlusion probe separates attribution failure from model behavior. Results: Both models are anatomically faithful -- IoR 2.91x (VideoMAE) and 1.98x (R(2+1)D) above chance -- yet temporally blind: temporal localization is indistinguishable from chance (0.97--1.00) and no better than random attribution. Occlusion shows the models do not preferentially rely on ES/ED (0.90x chance), so temporal blindness reflects model behavior, not an attribution artifact. Conclusions: Spatial faithfulness does not imply temporal faithfulness. Attribution can certify anatomical grounding while masking that a model ignores the clinically decisive frames -- a caution for XAI-based validation of video diagnostic models and a call for temporally-aware training and evaluation.

Comprehensive quantification of cardiac structures from computed tomography (CT) remains limited not by data availability but by the scalability of measurements, which makes routine use impractical. Here we present a unified framework for comprehensive cardiac CT segmentation and phenotyping that combines a human-in-the-loop annotation pipeline, a cardiac CT augmentation technique, and a self-supervised foundation model pre-trained on 60,000 unlabeled cardiac CT scans. Using this approach, we assembled the largest and most comprehensive expert-annotated cardiac CT segmentation dataset to date, comprising 1598 cases and 14 distinct cardiac structures (1000 for training, 598 for the external test set). Across five external datasets, the framework segmented all structures more accurately and comprehensively than existing open-source tools. Self-supervised pre-training improved labeling efficiency, with the most significant gains observed during external evaluation in the low-data regime. Benchmarking across convolutional, transformer, and state-space architectures showed comparable performance, indicating that data quality and pre-training, rather than architecture, drove accuracy. The framework was scaled to population-level phenotyping, with segmented anatomy that carries functionally relevant information about ventricular function and disease severity beyond demographic variables. By openly releasing the largest dataset with human labels, code, model weights, a CT augmentation library, and software, this work provides a reproducible foundation for opportunistic cardiac phenotyping from routinely acquired CT scans.

Deploying deep learning models for automated electrocardiogram classification on resource-constrained wearable devices remains challenging due to high computational costs. To address this, we propose LSTrans, a lightweight hybrid model designed for efficient and sensitive ECG analysis. LSTrans introduces a specialized 1D convolutional backbone with an interleaved layer architecture to capture both macroscopic rhythmic trends and microscopic morphological variations. This backbone is cascaded with a Transformer encoder to model long-range temporal dependencies, incorporating Low-Rank Adaptation across critical layers to compress the model and reduce the trainable parameter space. We further employ homogeneous and heterogeneous knowledge distillation to transfer diagnostic expertise from high-capacity teacher models to the student. Experimental results on multiple benchmark datasets demonstrate that LSTrans achieves a competitive balance between diagnostic sensitivity and resource efficiency, substantially reducing peak memory footprints and training latency during downstream adaptation. The source code is available for review at https://github.com/zyee00128/LSTrans4BIBM.

The automatic detection and classification of cardiovascular disease (CVD) from computed tomography (CT) images plays an important role in clinical practice. Recently, a hybrid pipeline (GRC-Net) for CVD classification was proposed, which leverages a deep-learning-based segmentation and registration method to extract radiomic and geometric features. However, GRC-Net relies on a deterministic segmentation mask, without considering the inherent ambiguity associated with cardiac anatomy. In this paper, we propose GRC-ProbNet, which takes advantage of a deep ensemble to produce multiple segmentation masks for a given input. From these masks, we extract multiple uncertainty features. We analyze these uncertainty features for both their correlation with segmentation error and their propagation effects on downstream CVD classification performance. Our experiments on the publicly available MM-WHS and ASOCA datasets show that the uncertainty measure that best reflects segmentation quality is not necessarily the one that provides the strongest signal for downstream CVD classification. Overall, our results demonstrate that GRC-ProbNet utilizing uncertainty features substantially improves CVD classification AUROC (92.92) compared to the baseline GRC-Net model (91.25%). Our code is publicly available: https://github.com/biomedia-mira/GRC-ProbNet.

Cardiovascular disease risk prediction models often rely on data from a single institution or centrally pooled datasets. Extending these models across institutions could be limited by privacy regulations and constraints on sharing patient-level data. Federated learning enables collaborative model development without transferring sensitive patient data, but its application in healthcare remains challenging because datasets often differ in size, population characteristics, and outcome definitions. In this study, we present a federated deep learning approach for privacy-preserving cardiovascular disease risk prediction that integrates two population-based cohorts with different characteristics: Lifelines, including 148,230 participants meeting the study inclusion criteria with self-reported outcomes, and the Rotterdam Study, including a smaller cohort of 10,155 participants with digitally linked clinical outcomes. Model performance was primarily evaluated on the Rotterdam Study because of its complete follow-up. Deep survival models trained using federated learning achieved higher predictive performance than models trained locally without federation. For the Rotterdam Study, the C-statistic increased from 0.728 (95% CI: 0.717-0.739) to 0.739 (95% CI: 0.728-0.749). For Lifelines, the C-statistic increased from 0.783 (95% CI: 0.775-0.791) to 0.787 (95% CI: 0.780-0.792). These findings suggest that federated deep learning across heterogeneous cohorts can improve cardiovascular disease risk prediction while preserving the privacy of individual-level patient data.

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.

Electrocardiography (ECG) is one of the most widely used tests for diagnosing cardiovascular disease. Yet several remote clinics still utilize paper ECG printouts for their analysis due to limited connectivity and computational capacity. As a result, vast numbers of physical ECGs obtained in remote areas still remain incapable of being accessed by contemporary artificial-intelligence (AI)-based decision support as they require high computational resources or strong high-speed internet connectivity. This causes several cases where conditions like acute coronary occlusion (ACS) is overlooked and reperfusion therapy delayed. Although prior work has tackled digitization and diagnosis separately, and utilized advanced AI models for them, there still remains a lack of a compute-light, on-device framework that reconstructs paper ECGs at high fidelity, while accurately supporting multiple clinically relevant endpoints. We address this need with an end-to-end lightweight on-device digitization-to-diagnosis pipeline that converts a smartphone photo or scan of a paper ECG into a calibrated 12-lead signal and screens for Myocardial Infarction (MI) pathologies, with SHapley Additive exPlanations (SHAP) to support interpretability. Trained and evaluated on 21,799 ECGs from the PTB-XL dataset and further validated on hospital-acquired ECG-Matrix dataset, the complete system runs in <30 s per ECG on CPU-only resources, achieving 95.51% accuracy (F1 = 0.9519) for MI detection on PTB-XL and 88.89% accuracy (F1 = 0.8862) for OMI detection on ECG-Matrix. This work showcases that legacy paper records can be reliably democratized in any part of the world, providing a scalable decision support when digital ECG export, connectivity, or high-end compute are unavailable

Clinical cardiac MRI is commonly acquired with high in-plane resolution but coarse through-plane resolution to reduce scan time and accommodate breath-hold and cardiac-motion constraints, which limits 3D analysis and diagnostic accuracy. We propose STRMSR, a reference- and memory-guided through-plane super-resolution (SR) framework that reconstructs high-resolution (HR) cardiac volumes by leveraging HR reference views acquired from the same subject and intermediate SR results as the memory. Our method uses coarse-to-fine contextual matching to establish robust correspondence between low-resolution target and reference/memory images under spatial misalignment. A learnable patch-wise dynamic feature aggregation module predicts content-adaptive mixture weights for each local patch, effectively fusing dynamic information while suppressing unreliable feature transfers. The intermediate SR results stored in the memory bank ensure slice-to-slice consistency for the super-resolved 3D volume. Experiments on the WHS cardiac MRI dataset under two reference protocols, orthogonal-plane views and long-axis chamber views, demonstrate consistent improvements over baselines at 4x and 8x upsampling factors.

While echocardiography is essential for cardiovascular diagnosis, inherent speckle noise and low signal-to-noise ratio often lead to ambiguous semantic features and fragmented boundaries. These limitations significantly hinder the segmentation accuracy of deep learning models in complex clinical cases. Moreover, temporal motion of the heart plays a critical role in recognizing anatomical structures. To address these challenges, we designed a STLSF module which comprises a window-matching-based semantic correction component and a semantics-guided texture enhancement component. By leveraging local transition probability correlations to correct semantics and employing semantics-guided texture enhancement, the STLSF module effectively mitigates texture instability and ambiguous semantic interpretations caused by disadvantaged echocardiography quality. Additionally, to facilitate the encoder's adaptation to the intrinsic priors of ultrasound-specific imaging patterns, we propose a frequency-aware denoising pre-training method. The entire work builds a convolution-based network with locality inductive bias and long-range dependencies. Extensive experiments confirm our SOTA performance, achieving 93.87% Dice on CAMUS and 92.62% on EchoNet-Dynamic, with respective HD95 values of 3.29mm and 2.73mm.

We propose Bi-PT, a pipeline for reconstructing 3D four-chamber human heart meshes from clinical sparsely sampled cardiac magnetic resonance imaging (CMR) data. This work addresses the error-prone generation of 3D cardiac shape from a sparse point cloud (SPC) extracted from 2D long-axis and short-axis views used in routine clinical CMR protocols. Bi-PT enables accurate inference of the four-chamber heart mesh from the SPC by learning robust point features via bidirectional point cross-attention between an atlas and the SPC, together with per-point semantic labels that improve correspondence estimation. We formulate the deformation field as a Neural Ordinary Differential Equation (NODE) parameterized by a per-point affine transformation and translation to deform the atlas toward the target heart shape. By learning such a NODE, we can guarantee the deformation field to be a locally affine diffeomorphic deformation. We also integrate a semantic label loss into the Chamfer distance to encourage label-consistent correspondences and add a smoothness regularization to stabilize and improve the learning of the deformation field. Extensive experiments demonstrate that Bi-PT achieves accurate and robust performance compared to baselines.

Federated learning (FL) enables collaborative model training across institutions without sharing sensitive patient data. However, the inherent heterogeneity of electrocardiogram (ECG) data across healthcare providers presents significant technical challenges for robust classification. We propose FedDualAtt, a personalized federated learning approach that splits transformer attention heads into global and local branches. Global heads are aggregated via FedAvg to capture shared cross-site patterns, while local heads remain client-specific to adapt to institution-level recording characteristics. Experiments on FedCVD, an FL benchmark for cardiovascular disease detection, demonstrate that FedDualAtt outperforms existing FL and personalized FL methods in ECG classification tasks. Analysis of global-local head ratios reveals that different clients benefit from varying levels of architectural personalization.

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.

Echocardiography is the first imaging modality used for assessing cardiac function, and accurate segmentation of cardiac structures is essential for deriving biomarkers. However, the development of effective automated segmentation models for multiple cardiac structures is challenged by the difficulty of training on datasets from different sources that are often partially-labelled. This study aims to address this challenge by evaluating the performance of three loss functions - adaptive categorical cross entropy (aCCE) loss, marginal loss, and the adaptive binary cross entropy (aBCE) loss - in handling partially-labelled data. We conduct a comprehensive comparison of these loss functions across multiple scenarios and network architectures: intra-domain and inter-domain tasks, with both single and multiple partial-labels, and varying proportions of fully-labelled to partially-labelled data. Our experiments reveal that all three loss functions exhibit strong performance in intra-domain segmentation tasks, effectively handling label variations within the same domain. For inter-domain tasks, where models are trained on datasets with a domain shift, the aBCE and marginal losses show superior performance when dealing with the case of one label being missing from some training examples. In scenarios involving more than one label being missing, marginal loss outperforms the other methods, demonstrating its robustness in such complex conditions. These results highlight the strengths of each loss function depending on the labelling scenario, emphasizing the importance of selecting the appropriate loss function to optimize model performance. This study represents the first investigation of techniques for handling partially-labelled data from multiple different domains in echocardiography segmentation and provides a comprehensive comparison of loss-based solutions.

Accurate patient-specific tetrahedral cardiac meshes are essential for in-silico trials, yet common segmentation-then-modelling pipelines can blur thin-wall anatomy and offer limited cross-case correspondence. We propose HeartVolMesh, which lifts each template vertex to an anisotropic Gaussian kernel and uses a 3D CNN-GNN to predict per-vertex displacements and Cholesky-parameterized covariances from volumetric images. Training is guided by a covariance-aware negative log-likelihood loss with lightweight mesh regularization. For volumetric meshing, we warp a fixed tetrahedral template to the reconstructed surface via staged alignment, non-rigid registration, and deformation propagation, preserving connectivity and correspondence by construction, with resolution controlled by template density. Experiments show consistent gains over deformation-based baselines in surface mesh accuracy and volumetric mesh fidelity.

Real-time cardiac cine MRI enables visualization of the beating heart during free breathing, but severe undersampling and motion make reconstruction highly challenging. A central challenge for reconstruction is incorporating powerful priors of cardiac anatomy while remaining computationally efficient. We propose Piecewise Dynamic Diffusion Regularization (PDDR), a reconstruction method that integrates a spatiotemporal diffusion model as a generative prior within a variational reconstruction framework for cine MRI. The model employs dedicated spatial layers to encode anatomical structure and temporal layers to capture cardiac motion learned from gated cine data. PDDR leverages the dynamic prior in a piecewise manner, enabling the efficient use of spatiotemporal diffusion models for processing of long real-time sequences. Experiments on retrospectively accelerated and prospective real-time cine MRI demonstrate that PDDR outperforms classical, unsupervised, and diffusion-based methods, delivering high-quality reconstructions with substantially reduced computation time compared to state-of-the-art baselines. These results highlight PDDR as a practical and scalable solution for free-breathing, real-time cardiac MRI. Code is available at https://github.com/MLI-lab/pddr.

Clinical cardiac imaging pipelines currently deploy separate models for each dataset and modality, incurring redundant training costs and precluding knowledge sharing across anatomically related tasks. Consolidating semi-supervised learning, unsupervised domain adaptation, and domain generalisation into one model is therefore a practical necessity, yet naive joint training exposes a fundamental barrier: conflicting label semantics between datasets collapse LA Dice from 90.31% to 83.38%, while gradient imbalance across tasks of unequal complexity suppresses the weaker tasks throughout training. We present UniT-Diff, a unified diffusion segmentation framework that resolves these conflicts through three targeted mechanisms. An 11-channel task-specific output space physically partitions label categories, eliminating cross-task gradient sign reversal by construction. SNR-Adaptive Task Conditioning (SATC) scales the task token by the log signal-to-noise ratio of the current diffusion timestep, suppressing domain-specific bias during coarse denoising and restoring full task guidance as the signal clears. Task-Type-Aware Conditional Dropout (TTACD) permanently removes the task token for domain-generalisation inputs, routing them through a shared neutral pathway that draws on cross-dataset cardiac anatomy rather than source-vendor statistics. Under a single parameter set, UniT-Diff surpasses independently trained task-specific baselines on all three benchmarks simultaneously: +0.87% on LA, +1.77% on MMWHS, and +0.88% on MNMS.

Accurate 4D whole-heart mesh reconstruction from sparse cine MRI is critical for creating cardiac digital twins, but remains challenging due to limited 2D slice coverage and the complex coupling between cardiac shape and motion. Existing methods often rely on intermediate contour fitting and typically reconstruct static, single-phase, or partial cardiac geometries, limiting their ability to capture full-chamber dynamics. We propose a novel end-to-end framework for reconstructing temporally resolved whole-heart meshes from multi-view 2D cine MRI sequences by learning an image-to-mesh mapping. The framework incorporates a differentiable contour renderer inspired by the Beer-Lambert attenuation principle, enabling anatomy-aware supervision of 3D+t mesh deformation through contour-based projection losses. To improve temporal consistency across the cardiac cycle, we further introduce a multi-scale temporal modeling module that integrates global cycle-level dynamics with local inter-frame coherence to generate smooth and physiologically plausible mesh trajectories. The proposed method achieved a whole-heart mean absolute error of 1.68 $\pm$ 0.31 mm and a motion jitter of 0.77 $\pm$ 0.17 $\mathrm{mm}/\mathrm{frame}^{3}$, outperforming existing methods with lower reconstruction error and substantially improved motion smoothness. It also improved 2D contour alignment across multiple cine MRI views and supported downstream proof-of-concept electrophysiological simulation. The code will be released publicly upon acceptance of the manuscript for publication.

In multi-source ECG deployment, models may need to incorporate new data sources when earlier raw ECGs cannot be retained or replayed. Freezing a pretrained backbone and assigning each source an isolated classifier prevents parameter interference, but deployment still requires selecting an expert when source metadata are unavailable. We study this distinction through IRFE-ECG, an incremental expert bank built on frozen 1024-dimensional ECGFounder features. Each arriving domain adds a balanced-softmax linear expert, while a lightweight router is fitted only on retained training features and domain labels from sources observed so far. A validation-calibrated margin rule fuses the two most likely experts instead of committing to a single routed expert. On CPSC, PTB-XL, Georgia, and Chapman-Shaoxing, source-aware expert selection reaches $0.7915\pm0.0036$ Macro-F1 and a matched offline independent-head reference reaches $0.7885\pm0.0009$, supporting strong source-aware expert retention. Without source IDs, an MLP router reaches $0.7756\pm0.0027$ and top-2 margin fusion reaches $0.7782\pm0.0022$. The top-2 gain over hard MLP routing is small ($+0.0026$), with a 95% confidence interval from paired bootstrap that includes zero. Across three domain orders, the top-2-to-oracle gap remains $0.0111$--$0.0133$, identifying autonomous source inference as the main remaining bottleneck. No raw ECGs are replayed, but frozen training features are retained for router updates; the method is therefore not memory-free.Code is available at https://github.com/yufanlu221/IRFE-ECG.

Data analysis in the medical domain often encounters scenarios involving a limited target dataset and a large, unannotated dataset with a general distribution. Under such circumstances, self-supervised learning (SSL) methods are highly effective for utilizing large datasets, making them a popular choice for electrocardiogram (ECG) analysis. This work presents the Event Reconstruction Joint-Embedding Predictive Architecture (ER-JEPA), a lightweight SSL framework for multivariate time series, whose name and two-fold hierarchical structure are inspired by the diagnostic approach of cardiologists. At its core, ER-JEPA features: (1) a two-stage structure that constructs representations for each time interval and subsequently processes these representations as a univariate time series, (2) the hierarchical integration of two Joint-Embedding Predictive Architectures (JEPAs), and (3) a Vision Transformer (ViT) backbone. The structural concatenation of two JEPAs categorizes the model as a Hierarchical JEPA (H-JEPA), designed to encode multiple levels of abstract representations for enhanced prediction on complex tasks. This study reports a successful application of H-JEPA to 12-lead ECG data as a multivariate time series, alongside an analysis of the sensitivity of hierarchical representation during the pretraining stage. Pretrained on approximately 180,000 10-second recordings, the model achieves state-of-the-art downstream performance on the ST-MEM benchmark, with rapid computation and minimal resource usage.

Therapy-induced cardiotoxicity is the leading non-oncological cause of treatment interruption in breast cancer patients, yet early, automated risk stratification from routine cardiac imaging remains an unsolved problem. We present EchoRisk, the first curated, multicentre, longitudinal echocardiography dataset with explicit cardiotoxicity labels, released as the primary technical reference for the EchoRisk-MICCAI 2026 challenge. The dataset comprises 422 patients enrolled in the EU-funded CARDIOCARE prospective study across five European sites, yielding 2,159 echocardiography videos across 1,123 clinical exams acquired at up to five longitudinal timepoints, alongside a dedicated cohort of 280 patients with baseline imaging for early cardiotoxicity prediction. Three clinically grounded tasks are defined: automated estimation of left ventricular ejection fraction from cine video (Task 1), classification of LV dysfunction from longitudinal imaging (Task 2), and early prediction of therapy-induced cardiotoxicity from pre-therapy baseline echocardiography alone (Task 3). For each task we specify the evaluation protocol, primary and secondary metrics, and ranking procedure. We establish baseline performance using an R(2+1)D video backbone with LSTM aggregation trained from Kinetics-400 pretrained weights, demonstrating strong discriminative performance for cardiac functional assessment and LV dysfunction classification, while early cardiotoxicity prediction from a single pre-therapy video remains a significant open problem for the community. The dataset, evaluation code, and baseline implementations are publicly available to serve as a benchmark for further collaboration, comparison, and the creation of task-specific architectures in cardio-oncology.

Implicit neural representations (INRs) are well suited to cardiac motion estimation, providing continuous, compact representations of motion fields. However, fitting an INR to each image sequence is time-consuming and sensitive to the optimisation trajectory. Learned priors can help guide optimisation towards plausible motion fields and enable faster adaptation, but learning priors for cardiac motion INRs remains under-explored. In this work, we compare four strategies for learning cardiac motion priors, including a population prior learned by joint optimisation, a consensus prior obtained by weight averaging, auto-decoders, and meta-learning. Using short-axis tagged cardiac magnetic resonance images from the UK Biobank, we evaluate their impact on tracking accuracy, motion behaviour, and adaptation trajectory. All learned priors substantially improved early adaptation performance compared with random initialisation. While the simple consensus prior was effective, auto-decoders recovered large deformations faster during early adaptation. Meta-learning achieved strong early performance and maintained the best adaptation trajectory over 50 iterations.

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.

In light of strides in Arti cial Intelligence (AI) and its wide spread application, challenges persist in the interpretability of AI models, particularly within specialized domains like healthcare, such as electro cardiograph (ECG) recognition. Rather than relying solely on end-to-end convolutional neural networks, this paper introduces a novel approach using a domain knowledge-based graph convolution network for ECG recognition. Key landmarks points of PRQST, vital to ECG interpreta tion, are incorporated as domain knowledge. The double-stream directed graph is employed to model both intra and inter ECG cycles. Speci cally, spatial directed graphs capture the positional relationships among key points, while temporal directed graphs delineate temporal dependencies between adjacent cycles in extended ECG sequences. Experimental re sults on the First Chinese ECG Intelligent Competition dataset, which speci cally classify ECG into nine categories, prove the e cacy of the proposed model. The overall average F1 score is 88.1%, the average F1 score of rare categories is 76.3%, both outperform the state-of-the-art models. The introduction of domain knowledge did enhance the detec tion performance, especially for rare categories.

Graph-based cardiac segmentation with implicit anatomical correspondences provides topological guarantees and population-level analysis capabilities, but models trained on independent frames of image sequences exhibit temporal discontinuities that affect reliable clinical measurements, particularly in cardiac ultrasound. In this work, we introduce self-supervised temporal regularization as a post-training refinement stage that exploits the temporal coherence in image sequences to enforce consistent cardiac segmentation and motion estimation over time, without requiring per-frame annotations. By penalizing velocity and acceleration discontinuities across consecutive frames, our method achieves temporally consistent segmentations while maintaining the learned anatomical correspondences. We further leverage these correspondences to automatically map landmarks to the AHA 17-segment clinical standard, enabling standardized regional assessment and detection of pathological myocardial motion patterns. Validation on CAMUS dataset demonstrates the clinical utility of combining temporal consistency with automatic regional mapping. The code is publicly available at https://github.com/david-montalvoo/MaskHybridGNet-TempReg

Dynamic contrast-enhanced cardiac CT enables time-resolved analysis of contrast filling and washout in the left atrium (LA) and left atrial appendage (LAA), with potential applications for assessing blood stasis in atrial fibrillation (AF). Accurate segmentation across all frames is required for such analysis but is challenging due to large temporal contrast variations and the use of a single annotation per registered sequence. This creates a trade-off between training for robustness and limiting label noise. In this study, we investigate how temporal training-set design affects nnUNet-based segmentation of the LA and LAA in dynamic 4DCT. We compare training using a minimal two-frame dataset reflecting standard clinical practice, a physiologically selected subset of frames, and the full 27-frame sequence. We further evaluate the impact of foreground-based normalization. Training with all frames yielded the best performance in early low-contrast phases. However, the physiologically selected subset achieved comparable performance from the filling phase onward. Applying normalization parameters derived from the full dataset improved performance of reduced datasets in low-contrast frames, but did not fully close the gap. These findings highlight the importance of temporal diversity in training data for robust segmentation in dynamic CT, while indicating that carefully selected frame subsets may provide an effective trade-off between performance and efficiency for downstream applications.

Structured tabular data dominates clinical medicine, yet existing benchmarks fail to reflect real-world properties like complex survey sampling, demographic oversampling, and subgroup fairness. We introduce the NHANES Accelerometry Cardiometabolic Benchmark, derived from NHANES 2003-2006, comprising 1,381 adults with hip-worn accelerometry, fasting laboratory biomarkers, dietary intake, and anthropometrics. We evaluate three tabular learning methods -- ridge regression, XGBoost, and the foundation model TabPFN v2 -- to predict glycated haemoglobin (HbA1c), fasting triglycerides, and C-reactive protein (CRP) from activity phenotypes and lifestyle covariates. TabPFN v2 achieves the best overall performance (HbA1c R^2=0.156, CRP R^2=0.383), while triglycerides remain largely unpredictable (R^2 < 0.05), consistent with known genetic dominance. We apply split conformal prediction to generate distribution-free 90% prediction intervals and evaluate demographic coverage equity across sex and race/ethnicity subgroups. Marginal coverage aligns with the 90% target for CRP and HbA1c but falls below for triglycerides. At the subgroup level, we observe localized undercoverage (e.g., HbA1c for Mexican American participants), illustrating the gap between marginal guarantees and the conditional coverage required for clinical fairness. Code and data are at https://github.com/felizzi/nhanes-accel-cardiometabolic-benchmark.

Computational models of the human heart are widely used to study electromechanical and fluid-dynamical cardiac function and to support applications such as in silico clinical trials. However, most studies remain limited to single or patient-specific anatomies, restricting the inclusion of population-level variability required for uncertainty quantification. A key challenge is translating medical-image segmentations, which may contain artifacts, mesh defects or disjoint domains, into topologically coherent geometries suitable for multiphysics simulations. In this work, we present a semi-automatic pipeline that converts CT-based segmentations into simulation-ready cardiac meshes within a few minutes while preserving anatomical and topological consistency. Building on modern deep learning segmentation methods, the framework incorporates a template-based registration stage to regularize artifacts and enforce mesh-quality constraints. A Chamfer-distance morphing strategy deforms a high-quality template toward each segmented heart, matching individual chambers while preserving topology. The resulting meshes are watertight, isotopological, and endowed with consistent point-to-point correspondence. The pipeline is validated on 58 healthy cardiac CT scans, including all cardiac chambers and proximal vessel segments. The resulting meshes can be represented in a unified shape space, enabling the construction of a statistical shape model of the heart and major vessels. Principal Component Analysis shows that a low-dimensional latent space efficiently captures population variability, while Gaussian Mixture Modeling enables synthetic anatomy generation. Overall, the proposed framework (released open-source) provides a pathway from raw segmentations to simulation-ready cardiac geometries, enabling anatomically consistent virtual cohorts for large-scale in silico studies.

Cardiac magnetic resonance imaging (CMR) routinely records structured acquisition metadata, yet most CMR foundation models rely primarily on image-only pre-training and leave this naturally available source of weak semantic supervision largely underexplored. We propose MetaCLIP-CMR, a metadata-driven framework based on Contrastive Language--Image Pre-training (CLIP), which converts imaging modality, anatomical view, scanner vendor, field strength, and scanner model into textual supervision for CMR representation learning. The pretrained image encoder is evaluated on imaging modality classification, cine view classification, and cardiac segmentation. MetaCLIP-CMR achieves 86.8% modality accuracy and 86.5% cine view accuracy, clearly outperforming ImageNet and masked reconstruction initialisations. For downstream cardiac segmentation, MetaCLIP-CMR consistently obtains the highest Dice score across the evaluated ACDC and M&Ms cine short-axis (SAX) settings under both full-data and 20% fine-tuning regimes. Compared with recent image-focused large-scale CMR pre-training models, MetaCLIP-CMR achieves comparable ACDC segmentation performance, while requiring less than 1% of their pre-training image scale. These results suggest that metadata learning offers a natural and easy-to-use strategy for transforming routinely recorded acquisition information into effective supervision for foundation-level CMR representation learning, highlighting the promise of metadata-driven multimodal pre-training.

Identifying robust associations between cardiac imaging phenotypes and clinical diseases is fundamental to population-scale cardiovascular research and reliable risk stratification. However, current phenome-wide association studies rely on pre-defined, single-variable phenotypes or expert-crafted features, which limits their ability to capture clinically meaningful non-linear effects and cross-phenotype interactions. To address this, we propose CPAgents, an iterative phenotype-Composition framework for cardiovascular Phenome-wide association study (PheWAS) that automatically constructs and validates interpretable composite phenotypes (e.g., polynomial, ratio, and interaction forms) from base imaging features. Specifically, our system coordinates three agents: (i) an Analyst that identifies statistical pathologies and nominates candidate transformations; (ii) a Proposer that generates constrained, medically and statistically motivated expressions under numerical safety rules; and (iii) a Verifier that evaluates candidates using multi-stage criteria and produces transparent evidence trails for accepted phenotypes. Evaluated on a population-scale cardiac imaging cohort, the discovered composite phenotypes markedly improve disease discrimination: across 72 classifier-disease-metric combinations, our variants achieve the top rank in 56 cases versus 18 for baselines, with gains observed across all nine clinical disease categories. Our framework yields compact, clinically interpretable phenotype formulas with transparent evidence trails, enabling scalable discovery of stronger phenotype-disease associations beyond expert-driven feature selection.

Echocardiography is the most widely used non-invasive cardiac imaging modality, providing essential information for cardiovascular diagnosis. Interpreting an echocardiogram requires synthesizing complementary evidence across multiple heart views to identify abnormalities and produce structured clinical reports. While recent efforts focus on improving classification performance, most models lack explicit diagnostic reasoning and spatially grounded anatomical evidence, limiting clinician trust. We present EchoSonar-R, a multi-view reasoning-enabled vision-language model that jointly performs multi-label disease classification and report generation from echocardiography studies. EchoSonar-R combines a spatiotemporal video encoder with a structure-aware cardiac detector that provides spatially grounded anatomical cues to improve interpretability and clinician trust during cross-view reasoning. EchoSonar-R is trained in two stages: supervised fine-tuning (SFT) on reasoning-annotated targets, followed by Group Relative Policy Optimization (GRPO) with task-specific rewards that jointly align classification and report generation within a unified reinforcement-learning framework. Across a private multi-view dataset and two public benchmarks, EchoSonar-R improves macro balanced accuracy by 17.1% on the private set and 6.1% on MIMICEchoQA over the strongest baseline, achieves a GREEN clinical faithfulness score of 0.800, and produces interpretable reasoning traces grounded in multi-view visual evidence.

Developing robust artificial intelligence models for 4D (3D + time) medical imaging is constrained by limited annotated data, inter-device domain shifts, and privacy restrictions. To address this, we propose a 4D controllable generative framework for anatomically consistent data augmentation. A semi-supervised variational autoencoder learns a compact latent representation of anatomical volumes while jointly predicting aligned segmentation masks in a unified framework. Anatomical structure is then disentangled from temporal dynamics through a cascaded latent diffusion model (LDM). A static LDM generates subject-specific anatomy conditioned on clinical priors (diagnosis and volumes measures) and a subsequent motion LDM estimates residual latent motions, ensuring strict temporal coherence across the 4D sequence. The proposed approach was evaluated on cine cardiac MRI as a representative 4D imaging application. Experiments across multiple datasets demonstrate high controllability of static anatomy (Pearson r > 0.8) and strong temporal coherence (FVD = 288.08). In cross-vendor generalization experiments, augmenting training sets with synthetic 4D sequences significantly improves downstream segmentation performance. Using nnU-Net, the proposed augmentation strategy improves the average Dice score by 1.4% and reduces the Hausdorff Distance by 3.0mm compared to training on real data alone, for the left ventricle, Dice improves by 2.8% with a 5.4mm reduction in boundary error. Overall, this framework provides a scalable and controllable solution for 4D medical image synthesis, supporting the development of more robust models with limited annotations and cross-vendor variability. Code available on https://github.com/cyiheng/4DCardiacMRISynthesis.

Cardiac magnetic resonance imaging (CMR) captures rich spatiotemporal information about ventricular structure and motion, but conventional risk models use only a few image-derived indices from selected cardiac phases. We present a latent dynamical model that encodes bi-ventricular anatomy and full-cycle cine motion as a continuous latent trajectory, using heart-rate-aware neural ordinary differential equation (ODE) dynamics and a graph-based mesh autoencoder to reconstruct anatomically consistent 3D+t ventricular motion. A covariate-conditioned prior defines the expected end-diastolic latent state, and a Cox proportional hazards model tests whether deviations from this prior predict incident heart failure. We studied 72,386 UK Biobank participants without baseline cardiovascular disease, including 367 incident heart failure events. In a held-out evaluation subset, adding the latent score to refitted pooled cohort equations improved the stratified C-index from 0.704 to 0.785, compared with 0.764 for seven established cardiac markers. Compared with non-graph and non-ODE approaches, the proposed model gave the best trade-off between reconstruction fidelity, generative realism, and downstream prognostic performance. These results suggest that continuous full-cycle modeling of ventricular motion provides informative cardiac phenotypes beyond conventional CMR summaries, while external validation in more representative patient cohorts is required before clinical risk-prediction use.

Risk stratification for pulmonary embolism (PE) is critical for clinical decision-making. Stratification guidelines are based on patient medical records, parameters measured from computed tomography pulmonary angiography (CTPA), and blood tests. However, blood tests are often missing in routine practice. This work studies whether state-of-the-art models can accurately classify risk stratification from only medical records and biomarkers extracted from CTPA images. We benchmark different approaches to combine medical records and cardiac biomarkers with rich pulmonary vascular information; we add vascular biomarkers to tabular models and apply graph neural networks (GNNs) on the vascular tree's intrinsic graph representation. We use a private dataset (n=353) with uniquely complete data for PE risk stratification. Our results show that, among global features, medical records and cardiac biomarkers are the most significant predictors, while vascular biomarkers do not further improve stratification. Even more surprising, even GNNs on vascular graphs fail to outperform strong tabular baseline on global features. We consider hypotheses, on both models and data, that could explain this suboptimal performance. Our investigation suggests that, counter-intuitively, vascular graphs might hold no discriminative information for PE risk stratification. Code is available from https://github.com/creatis-myriad/GENESIS.

Explainability techniques are used to assess the output of various deep learning models. This is especially true in healthcare, where models need to be trusted and decisions justified. Explainability (XAI) tools use heuristics which often add signal noise to the explanation "core". It is not always obvious what is signal from the model and what is noise from the XAI. We propose the use of spectral entropy as a measure of noise in XAI output. We demonstrate its usefulness in the context of classifying arrhythmias in an ECG dataset with different post hoc explainability techniques.

Existing ECG report generation is tightly coupled -- interpretation and reporting fused end-to-end, so errors propagate without stage-level recourse -- while agent-based systems decouple tasks but remain single-pass, never revisiting earlier outputs. Clinical ECG reporting instead unfolds iteratively, requiring progressive context integration and bidirectional editing. We present \textsc{ATRIA}, a multi-agent ECG reporting system that mirrors the clinician's iterative workflow: it binds every report claim to its supporting evidence, flags statements unsupported by that evidence, incorporates additional context mid-session, and lets clinicians verify and revise individual findings rather than accept one opaque output. Because its agents use ECG analysis models already in clinical use, the underlying findings are clinically trustworthy; and as a cloud-based web service, \textsc{ATRIA} is ready for immediate deployment. We demonstrate \textsc{ATRIA} through four interaction cases, with a live demo and video available.

Purpose: To evaluate the feasibility and challenges of heart chamber segmentation from non-contrast CT scans using contrastive unpaired image translation and deep learning-based segmentation. Approach: We developed ChameleonNet, a framework utilizing the Contrastive Unpaired Translation (CUT) network with decoupled contrastive learning (DCL) loss to synthesize non-contrast CT from contrast CT scans. Using annotations of four heart chambers (left atrium (LA), left ventricle (LV), right atrium (RA), and right ventricle (RV)) from contrast scans, we trained a Hausdorff distance loss-enhanced nnU-Net on synthesized non-contrast images. The translation model was trained with 35,538 contrast-enhanced and 37,197 non-contrast CT slices. The segmentation model was trained with 292 synthesized non-contrast scans. Performance was evaluated using Dice similarity coefficient (DSC) and 95th Hausdorff distance (HD95) on 36 synthesized non-contrast scans, and volume agreement on 36 real non-contrast CT scans was assessed using Pearson correlation, mean absolute percentage error (MAPE), and mean percentage error (MPE). Results: The segmentation model achieved DSC of 0.94 (0.01), 0.91 (0.04), 0.92 (0.03), 0.93 (0.02), and HD95 of 3.63 (1.49), 5.74 (4.08), 5.18 (1.77), 5.51 (3.21) mm on synthesized non-contrast images for LA, LV, RA, and RV, respectively. On real non-contrast CT scans, Pearson correlations were 0.93, 0.82, 0.87, and 0.89 (all p<0.001), with MAPE ranging from 9.22% to 20.79%, and MPE ranging from -12.52% to 4.67%. Conclusions: ChameleonNet demonstrated feasibility for heart chamber segmentation from non-contrast CT without manual non-contrast annotations. However, volume errors, particularly for LV and RV, indicate that further refinement and validation are needed before clinical use.

Contrastive representation learning struggles on physiological signals when each subject contributes a distinct baseline pattern. If class differences overlap with subject differences,class-level objectives such as supervised contrastive learning tend to merge per-subject structure into a single per-class cluster,removing the individual variation that a model needs to generalize to unseen patients. We study this problem in the setting of Paroxysmal Atrial Fibrillation(PAF) detection from RR-interval(RRI) sequences and propose a patient-aware contrastive objective that forms positive pairs only from same-patient, same-class segments, preserving each patient's own sinus rhythm(SR) baseline while still pushing the two classes apart. Examining the learned embeddings directly, our objective achieves the most consistent per-patient SR structure (cohesion $0.850$ vs. $0.800$ for supervised contrastive loss (SupCon) and $0.772$ for binary cross-entropy (BCE)). We also identify that BCE produces the cleanest global class separation yet the most disordered per-patient structure. This is precisely why a linear probe trained on its features breaks down on unseen patients. On the IRIDIA-AF dataset, the resulting representation reaches a patient-independent Area Under the Receiver Operating Characteristic Curve (AUROC) of $0.989 \pm 0.003$ with $2.6\times$ lower seed variance than supervised contrastive baselines.These results highlight that per-subject geometric consistency, rather than global class separability, is key to robust cross-patient generalization.

Self-supervised learning (SSL) is increasingly used in medical imaging to reduce annotation requirements, but representation quality is often judged using a single downstream evaluation setting. For dense clinical tasks, this can confound representation quality with the capacity of the downstream model used to recover task-relevant information. We present a systematic evaluation of self-supervised representations for left-ventricular segmentation and ejection fraction (EF) estimation from apical four-chamber echocardiography on EchoNet-Dynamic. Rather than relying on a single downstream probe, we compare a hierarchy of extraction strategies with increasing expressivity: heuristic extraction without mask-supervised training, frozen linear probes, frozen lightweight decoder probes, and partial fine-tuning. We apply this framework to two complementary representation families: generic frozen self-DIstillation with NO labels (DINOv3) features and a task-adapted dense self-supervised representation, Bootstrap Your Own Segmentation (BYOS). In both families, heuristic extraction substantially understated what was recoverable from the frozen representation. For DINOv3, performance improved from Dice 0.684 and EF mean absolute error (MAE) 13.01 under heuristic extraction to Dice 0.906 and EF MAE 9.65 with a frozen lightweight decoder, approaching a supervised U-Net baseline (Dice 0.915, EF MAE 9.72). For BYOS, performance improved from Dice 0.687 and EF MAE 17.83 under heuristic extraction to Dice 0.902 and EF MAE 8.74 with a frozen lightweight decoder. These results show that conclusions about self-supervised representation quality in dense echocardiographic analysis depend strongly on the downstream extraction strategy used for evaluation. We therefore argue that multi-strategy evaluation is an important methodological consideration for SSL in dense medical image analysis.

Multimodal large language models (LLMs) are increasingly adopted to interpret 12-lead ECG images, though the interpretations often lack validation. However, ECG image understanding significantly differs from general images as it depends on precise waveform morphology, lead relationships and accurate interval measurements. This study investigated whether zero-shot multimodal LLMs can reliably distinguish normal and abnormal ECG images and, in parallel, evaluated CNN-based models for clinically grounded references. Standard 12-lead ECG recordings were rendered as single-page images for a binary normal-abnormal classification task. Three prominent LLMs (GPT-5.2, GPT-4.1, and Gemini-2.5 Pro) were tested using a fixed zero-shot prompt across multiple runs. In parallel, a physiology-aware CNN-based model was developed with the capability to aggregate features from the predefined anatomical lead groups. The model was compared with ResNet18, DenseNet121, VGG16 baselines, and all the models were evaluated on an internal test set and external PTB-XL dataset. Across seeds, CNN-based models demonstrated stable discrimination, with average internal ROC-AUC of 0.92-0.94, and external ROC-AUC of 0.85-0.86. The proposed LeadGroupECG model significantly improved over its backbone internally without compromising external generalization. It remained competitive with other baselines, while consistently highlighting anatomical lead-group contributions. In contrast, zero-shot LLM discrimination remained near-chance (ROC-AUC around 0.5). The PR-AUC improved slightly when ECGs used a grid-based calibration background compared with the grid-free ECGs. Although multimodal LLMs can generate reasonable ECG narratives, their zero-shot diagnostic discrimination remains limited. Therefore, clinically framed, domain-specific architectures remain essential for AI-based ECG interpretation.

Breast arterial calcification (BAC) on screening mammograms is an emerging cardiovascular risk biomarker, but quantitative use requires reproducible segmentation and expert pixel-level labels are costly. We present BAC-JEPA, a label-efficient segmentation framework trained on procedurally generated arterial calcification inserted into real mammographic backgrounds with exact masks. Candidate backgrounds were selected from model-screened mammograms with low predicted BAC response; the generator samples arterial structure, disease burden, radiographic appearance, and hard-negative distractors including nonarterial calcifications and metallic objects. Synthetic masks are paired with mammography self-supervised Vision Transformer encoders and a high-resolution convolutional decoder to produce full-resolution segmentation maps. The study used 75,472 mammography studies from 34,956 patients for background selection and representation learning, trained on synthetic images from 10,000 backgrounds, selected checkpoints with 1,000 development backgrounds, and evaluated transfer on all 1,000 human-labeled BacSeg synthetic 2D mammograms. On held-out synthetic validation data, the larger backbone achieved IoU 0.5325 and Dice 0.6357. On BacSeg, image-level classification from segmentation probability maps reached AUROC 0.8719, with 0.8547 for the smaller backbone. Four-view inference required 110.68--213.63 ms on an RTX 5090 GPU, and severe-preset synthetic image generation averaged 2.7071 s per image on a multicore workstation. These results indicate that BAC-specific synthetic supervision can produce useful image-level transfer without human pixel-level training masks, while expert-reviewed real-mammogram segmentation remains necessary for clinical validation and calibration.

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.

Detecting when a nonlinear dynamical system departs from its normal regime is a recurring problem across the sciences, from cardiology to climate and energy systems. We show that a very simple Kolmogorov--Smirnov test on the output weights of a reservoir computer is highly sensitive to regime changes in nonlinear dynamical systems, including those invisible to both classical nonlinear measures and modern deep-learning detectors. The core idea of our algorithm is to treat the readout layer of a reservoir computer as a representation of the input dynamics. Since the input mapping and the reservoir itself are random and fixed, the trained output weights are the only object encoding the system at hand. We summarize this fingerprint by the empirical cumulative distribution function of the readout weights and compare it to a reference band built from the training data. This unsupervised, online detector distinguishes two visually indistinguishable butterfly-shaped attractors, resolves parameter drifts seven times smaller than the strongest deep-learning baseline, flags noise four orders of magnitude below the signal, and identifies ventricular flutter in a clinical ECG recording. More broadly, we aim to establish a perspective on reservoir computers in which the trained output weights are treated as a representation of the learned system in their own right, rather than merely as a means to forecasting.

Modeling long-sequence medical time series data, such as electrocardiograms (ECG), poses significant challenges due to high sampling rates, multichannel signal complexity, inherent noise, and limited labeled data. While recent self-supervised learning (SSL) methods, based on various encoder architectures such as convolutional neural networks, have been proposed to learn representations from unlabeled data, they often fall short in capturing long-range dependencies and noise-invariant features. Structured state space models (S4) excel at long-sequence modeling, but existing S4 architectures fail to capture the unique characteristics of multichannel physiological waveforms. In this work, we propose SL-S4Wave, a self-supervised learning framework that combines contrastive learning with a tailored encoder built on structured state space models. The encoder incorporates multi-layer global convolution using multiscale subkernels, enabling the capture of both fine-grained local patterns and long-range temporal dependencies in noisy, high-resolution multichannel waveforms. Extensive experiments on real-world datasets demonstrate that SL-S4Wave (1) consistently outperforms state-of-the-art supervised and self-supervised baselines in a challenging arrhythmia detection task, (2) achieves high performance with significantly fewer labeled examples, showcasing strong label efficiency, and (3) maintains robust performance on long waveform segments, highlighting its capacity to model complex temporal dynamics in long sequences that most existing approaches fail to efficiently model, and (4) transfers effectively to unseen arrhythmia types, underscoring its robust cross-domain generalization. We additionally evaluate SL-S4Wave on multiple EEG tasks, achieving superior performance over strong baselines, demonstrating generalizability of our approach beyond cardiac waveforms.

Echocardiography (echo) is a widely used imaging modality for assessing cardiac function, with Left Ventricular Filling Pressure (LVFP) serving as a critical physiological marker for conditions such as heart failure. Standard LVFP classification into normal \emph{vs} elevated categories relies on the Doppler-derived $E/e'$ ratio, which is operator-dependent and often unavailable in resource-limited settings, motivating methods that infer LVFP directly from B-mode echo. Existing deep learning approaches achieve high performance but remain largely black-box, limiting clinical interpretability. We propose HypOProto, a hyperbolic, ordinal prototype-based framework for interpretable LVFP classification using a frozen, explainable foundation model backbone. HypOProto arranges prototypes along the physiological $E/e'$ scale, placing borderline cases near the hyperboloid root where small angular differences separate similar cases, while normal and elevated cases occupy outward positions reflecting increasing diagnostic certainty. This hyperbolic geometry encodes clinically meaningful ordinal relationships and improves interpretability. We also introduce a novel Hyperbolic Prototype Angular Separation (HyperPAS) loss, enforcing inter-class prototype separation in hyperbolic space. HypOProto achieves SOTA performance while maintaining transparency, and highlights clinically relevant regions in visualizations. This work represents the first prototype-based framework for LVFP classification in echo. Our code can be found at https://github.com/DeepRCL/HypOProto.

Building personalized cardiac electrophysiology (EP) digital twins requires identifying the appropriate model structure for each patient, not merely fitting parameters. Traditional methods rely on experts to manually prescribe hybrid physics-neural architectures, which requires deep domain expertise and does not transfer across patients. Recent works have applied large language models (LLMs) to generate or act as hybrid models. However, despite their promising generalization capacity, these LLM-based methods lack the structural priors needed for stable cardiac simulations. Hence, we propose LEADS, a framework that formulates cardiac EP domain knowledge as a structured action space and utilizes an LLM agent to discover hybrid models. The agent follows an iterative reasoning-and-action loop to select, combine, and refine hybrid models, whilst gradient descent handles parameter fitting. The proposed LEADS designs every candidate model towards physically grounded, interpretable, and numerically stable, while allowing open-ended architectural discovery. We validate LEADS on synthetic data with three ground-truth reaction models and on real cardiac EP data, demonstrating that it outperforms both human-designed hybrid models and other LLM-based hybrid modeling.

Automated classification of standard echocardiographic views is crucial for efficient clinical workflow but faces three main challenges. First, publicly available datasets are scarce and limited in scale and view coverage. Second, the performance of some modern video-level architectures for echocardiographic view classification remains underexplored. Third, some view categories exhibit highly similar spatial appearances, making single-frame features insufficient for discrimination, while heterogeneous frame quality complicates robust temporal information fusion. To address these challenges, we release the Echocardiographic Videos of Nine Views (EV9V) dataset, comprising 5,138 videos, 910,579 frames, and 9 standard views, which is, to the best of our knowledge, the largest publicly available echocardiography video dataset. Using EV9V, we systematically benchmark representative video classification architectures, including Convolutional Neural Networks (CNNs), Recurrent Neural Networks (RNNs), and Transformers. Furthermore, we propose a Spatio-Temporal Fusion Model (STFM), an efficient dual-stream CNN-LSTM (Long Short-Term Memory) framework that jointly captures spatial anatomical structures and temporal cardiac dynamics. The proposed framework leverages uncertainty-aware learning to preferentially sample representative video segments during training and evidence-based fusion during inference, improving robustness to variations in frame quality across echocardiographic videos. Extensive experiments demonstrate that our method achieves competitive performance across diverse video classification models, validating the effectiveness of uncertainty-aware spatio-temporal learning for echocardiographic view classification. The code is available at https://github.com/bgx666/stfm.

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.

Continuous cardiac monitoring in wearable devices demands classifiers that are simultaneously accurate, energy-efficient, and deployable on resource-constrained hardware. While deep neural network approaches have demonstrated high classification accuracy for electrocardiogram (ECG) arrhythmia detection, their substantial parameter counts and reliance on multiply-accumulate-intensive operations make them impractical for low-cost edge platforms. In this work, we propose ECG-LDC, a hardware-software co-design framework that adapts Low-Dimensional Computing (LDC) for real-time ECG arrhythmia classification. ECG-LDC employs a dual-encoder architecture with dedicated value and feature codebooks to independently encode morphological waveform features and RR-interval temporal features, enabling effective capture of both intra-beat and inter-beat cardiac dynamics. The framework encompasses data preprocessing, model training, and a hardware accelerator architecture prototyped on the Pynq-Z2 platform. Implemented using binary representations and XOR/XNOR-based operations, ECG-LDC achieves $97.18\%$ accuracy with a memory footprint of only $3.86\ \text{kB}$. ECG-LDC sacrifices approximately $1.8\%$ accuracy versus SOTA TinyML classifiers but achieves $11$~$570\times$ reduction in memory usage; among FPGA-based five-class arrhythmia classifiers, it delivers the highest accuracy with up to $2.4\times$ fewer LUTs and zero DSP block utilization, affirming its suitability for real-time arrhythmia detection on resource-constrained wearable platforms.

Ventricular tachycardia is a life-threatening rhythm disorder and a major cause of sudden cardiac death. Pace-mapping is a clinical procedure for identifying the intervention target during catheter ablation of VT. It requires clinicians to pace different sites in the ventricles and rapidly interpret the resulting electrocardiograms to determine where to pace next or whether a target site has been identified. Active learning AI models have been proposed to guide clinicians to the next pacing site, showing promise in reducing the number of pacing sites and improving the efficiency of pace-mapping. Existing methods require retraining each target without the ability to transfer knowledge across multiple VTs within the same patient or across patients. We introduce cAPM for continuous AI-assisted pace-mapping to capture and transfer knowledge accumulated from past pace-mapping data to reduce the number of pace-mapping data needed for future target VTs. This is made possible by a task-agnostic surrogate neural network that learns the mapping from pacing sites to 12-lead ECG morphology, an active-learning strategy that refines this surrogate model by selecting the most informative pacing site for each target, and a continual learning strategy to do so sequentially while retaining knowledge from prior targets. Evaluated on an in-silico testbed consisting of sequentially-presented localization tasks across different physiological conditions and ventricular geometries, cAPM with and without replay of past data samples achieved an 81% probability of localizing within clinical tolerance (5 mm accuracy) using 4.5 pace-mapping sites, compared to the state-of-the-art active-learning method achieving 38% probability using 13.7 pacing sites. These results provide a strong basis for preparing cAPM towards in-vivo preclinical and clinical studies where it can be used to guide pace-mapping.

Building patient-specific cardiac models sits at the heart of precision cardiology, yet getting those models into clinical use keeps running into the same wall: mesh generation is slow, messy, and frustrating. The standard workflow -- segmenting the image, running Marching Cubes, and then manually cleaning up the result -- is time-consuming, inconsistent across operators, and demands specialist knowledge most clinical teams do not have. We take a fundamentally different approach. Instead of treating segmentation and mesh generation as two separate problems, we train a single end-to-end network that goes directly from a raw 3D medical image to a smooth, simulation-ready cardiac surface mesh. The core is a 3D Swin Transformer encoder-decoder that extracts volumetric features from CT or MRI volumes, paired with a Graph Attention Network (GAT) head that iteratively deforms a template mesh to fit the patient's cardiac boundary. We tested on the MM-WHS 2017 benchmark using both CT and MRI. Segmentation scores were competitive (Dice of 0.84 on CT, 0.83 on MRI), but the primary focus is mesh quality: mean Chamfer distance of 1.8 mm, with 95th-percentile surface distance below 5 mm. Every mesh is produced in a single forward pass -- no Marching Cubes, no smoothing filters, no manual cleanup. We argue that for cardiac digital twin pipelines, geometric fidelity and topological correctness matter more than pixel-level Dice scores. By removing the post-processing bottleneck, this approach makes patient-specific cardiac simulation substantially more accessible for clinical use.