Photoplethysmography

Remote photoplethysmography (rPPG) enables non-contact extraction of blood volume pulse (BVP) signals using consumer-grade cameras. Recent unsupervised rPPG methods learn BVP representations without requiring ground-truth physiological annotations, yet their optimization is often hindered by noisy and unstable gradients, resulting in slow convergence and limited cross-domain generalization. In this paper, we propose FCUS-rPPG, a fast-converging unsupervised rPPG framework with strong generalization capability. Motivated by the observation that BVP representations exhibit both multi-spectral covariation and low-dimensional manifold structure, we design a spectrally shared backbone that facilitates BVP feature disentanglement while improving optimization efficiency. To jointly enhance convergence stability and generalization performance, we further develop a unified optimization framework operating at the gradient, loss-landscape, and feature-representation levels. Specifically, a post-verification masking mechanism filters out misleading gradients according to the weak-amplitude physiological prior of BVP signals; a perturbation-based loss landscape smoothing strategy steers optimization toward more generalizable flat minima; and a noise-aware null-space regularization constrains feature updates to the orthogonal complement of the noise subspace, thereby mitigating noise-induced representation drift. Extensive experiments on five datasets demonstrate that FCUS-rPPG requires only one training epoch, whereas existing methods typically require tens to hundreds of epochs. Notably, FCUS-rPPG consistently achieves state-of-the-art (SOTA) performance in cross-dataset evaluations. This study provides an efficient and robust solution to the real-world deployment of unsupervised rPPG. The source code will be publicly available at https://github.com/JiaJieLee/FCUS-rPPG.

Autonomous Sensory Meridian Response (ASMR) is a somatosensory phenomenon characterized by pleasant tingling sensations and cardiovascular slowing. However, ASMR research has been hindered by a dearth of standardized, open-access multimodal datasets. To address this limitation, we present REST-ASMR (Response to Environmental & Sensory Triggers), a synchronized multimodal dataset designed to capture behavioral reports and physiological dynamics during ASMR, with nature-relaxation videos as control stimuli. The dataset includes high-resolution photoplethysmography (PPG), time-aligned audiovisual stimuli, and continuous subjective annotations from 34 participants. Technical validation showed high stimulus efficacy (97% responder rate), significant stimulus-specific inter-subject agreement (p < 0.05), and a robust PPG-derived ASMR-specific cardiovascular deceleration. Additionally, a Bidirectional Long-Short Term Memory model successfully predicted subjective ASMR tingle states, achieving video-level ASMR vs. Nature classification with perfect accuracy and a frame-level global mean accuracy of 75.51%, macro F1-score of 71.86%, and 100% Nature-baseline specificity, under a strict, leakage-free subject-video double-independent 4-fold cross-validation. REST-ASMR constitutes a dense temporal foundation for affective computing, multimodal research, and the development of personalized models of relaxation-related responses.

Remote photoplethysmography (rPPG) enables non-contact measurement of physiological signals from facial videos, offering strong potential for remote healthcare and daily health monitoring. Driven by this potential, various deep learning-based rPPG methods have been proposed to improve rPPG estimation. However, previous deep learning-based rPPG methods have paid little attention to the quality of training labels and their impact on model learning. Contact-based PPG signals used as training labels often contain noise and variability caused by motion artifacts, inconsistent sensor contact, and morphological distortions. Such label inconsistency can lead models to overfit to the label noise and variability and consequently degrade generalization performance. To address this issue, we propose LQ-rPPG, a label-quantized coarse-to-fine learning framework for robust rPPG estimation. LQ-rPPG consists of a label quantization module and a coarse-to-fine rPPG estimation model. The label quantization module transforms continuous PPG signals into multi-bit quantized pseudo labels with reduced noise and variability. The coarse-to-fine estimation model progressively refines rPPG signals under hierarchical supervision guided by the multi-bit pseudo labels. This design alleviates overfitting to label-specific variations and enables the model to learn structured and consistent representations. As a result, LQ-rPPG achieves robust and generalizable rPPG estimation even under challenging conditions. Experiments on multiple benchmark datasets demonstrate that LQ-rPPG achieves strong performance in both intra- and cross-dataset evaluations, while reducing parameters and multiply-accumulate operations by 88% and 29%, respectively, and increasing throughput by 191%. The code is available at https://github.com/Anonymous-repo-code/LQ-rPPG.

Remote photoplethysmography (rPPG) enables non-contact measurement of cardiac pulse signals by analyzing subtle color changes in facial videos. Nevertheless, extracting rPPG signals remains challenging because of their extremely weak signal strength and susceptibility to illumination noise. In this paper, we propose an rPPG signal extraction method that exploits the quasi-periodic characteristics of rPPG signals. Our approach models quasi-periodicity of the rPPG signal, which arises from the stable cardiac cycle, as a block-sparse structure in the time-frequency domain. To incorporate a block-sparse model and enable adaptive signal separation under illumination fluctuations, we construct a time-varying signal separation framework. Experiments using a public dataset demonstrate the effectiveness of our method.

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

Uncertainty quantification (UQ) is critical for safety-critical domains like healthcare, yet it is rarely evaluated under realistic out-of-distribution (OOD) conditions. Here, we assessed predictive performance and uncertainty reliability for deep learning-based blood pressure (BP) estimation from photoplethysmography (PPG) signals under both in-distribution (ID) and OOD settings. Using an XResNet1D-50 trained on PulseDB and tested on four external datasets, we compared deep ensembles (DE) and Monte Carlo dropout (MCD) with Gaussian negative log-likelihood (GNLL) and mean squared error (MSE) losses, optionally followed by post-hoc recalibration via conformal prediction (CP), temperature scaling (TS), and isotonic regression (IR). The key findings of our study are as follows: (1) DE provides stronger predictive robustness under domain shift than MCD, an advantage that becomes clear primarily under external shift. (2) Recalibrated GNLL-based methods yield the best uncertainty calibration (e.g., GNLL+DE+CP for systolic blood pressure (SBP), GNLL+DE+TS for diastolic blood pressure (DBP)), while MSE-based uncertainty requires recalibration to become practically useful. (3) Across settings, CP and TS offer the most consistent gains, with IR remaining competitive in several cases. Overall, our results identify DE-based methods as most robust for predictive performance under domain shift, GNLL as strongest for native UQ, and recalibration as essential for making MSE-based uncertainty practical. These findings highlight the need to jointly assess predictive accuracy and calibration on external data for trustworthy cuffless BP estimation

Wearables are widely used for mobile health monitoring, and photoplethysmography (PPG) is a key sensing modality for heart rate and related physiological measurements. However, public in-the-wild PPG datasets remain largely wrist-centric or limited to short, controlled studies, constraining research on emerging wearable form factors. We present Multi-site PPG, an in-the-wild physiological dataset collected from four custom-developed unobtrusive wearables: a smart earring, ring, watch, and necklace. Each device records green and infrared reflective PPG, 3-axis acceleration, and temperature with timestamps for cross-device alignment, while a Polar H10 chest strap provides reference electrocardiogram (ECG). Participants wore the devices for multiple days during daytime activities while continuing their normal routines. The dataset contains over 350 hours of raw data and 230-290 hours of modeling-ready 8-second windows per wearable. We benchmark heuristic, supervised, and self-supervised heart-rate estimation methods, showing substantial body-site differences: the best methods achieve mean absolute errors (MAEs) of 2.30 bpm on the earring, 5.13 bpm on the ring, 8.37 bpm on the watch, and 8.68 bpm on the necklace. We further analyze motion effects and evaluate multi-site and PPG-accelerometer fusion, demonstrating the dataset's value for robust physiological sensing across emerging wearable form factors.

Photoplethysmography (PPG) has become a ubiquitous physiological signal; however, current generative models still struggle to preserve realistic waveform morphology and learn a latent structure that captures cardiac and respiratory physiology. PPG generators trained with adversarial losses can produce plausible waveforms, but provide no inference path from a real signal to a latent representation. Variational autoencoders, on the other hand, map the PPG data to latent codes, although their decoders often blur systolic upstrokes and dampen amplitude and spectral details. Diffusion models improve waveform fidelity, but typically lack an inference path for reconstruction and physiological analysis. We propose VampPrior Latent Diffusion (VAMP-Diff), a jointly trained variational diffusion model that combines a temporal PPG encoder, a conditional one-dimensional diffusion decoder, and VampPrior regularization on a compact pooled latent. The model uses full temporal latent during diffusion reconstruction, giving the decoder access to beat timing and morphology while generating samples from learned VampPrior components instead of a fixed Gaussian prior. We demonstrate on the CapnoBase dataset that VAMP-Diff produces realistic PPG signals, reconstructs sharper physiological waveforms than Gaussian-prior baselines, preserves heart-rate information, maintains respiratory-rate consistency, and is sensitive to waveform corruptions through reconstruction error.

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

Cardiovascular stability estimation from wearable photoplethysmography (PPG) requires a principled nonlinear framework, yet major gaps persist in heuristic parameter selection and evaluation protocols that inflate reported performance. We introduce a Stability-Constrained Cardiovascular Stability Index (SCSI) grounded in Cardiac Stability Theory and validate it across 176,742 segments from four heterogeneous PPG datasets at three temporal scales. Cross-dataset analysis demonstrates a large Kruskal-Wallis effect size (eta2 = 0.351, p < 0.001), strong cross-scale consistency (kappa > 0.97), and significant correlation with respiratory rate across 53 ICU records (Spearman r = 0.346, p = 0.011). We identify three evaluation artifacts that inflate heuristic AUC from a true baseline of 0.573 to 0.752: segment-level cross-validation leakage, test-set normalization leakage, and pooled-AUC overweighting that conceals per-patient failure. Correcting these artifacts and applying Bayesian optimization over 15 joint parameters yields SCSI with cross-validation AUC of 0.720. On 18 held-out records, SCSI achieves pooled AUC of 0.757 (95% CI: 0.686-0.828) and negative predictive value of 0.966 for tachypnea screening, while per-record AUC of 0.497 +/- 0.207 is disclosed for transparency. External validation on 42 elective-surgery records yields AUC of 0.621, confirming cross-population generalization. Ablation analysis identifies the nonlinear complexity module as the dominant component. A sparse three-component architecture is proposed as the minimal deployable configuration. The corrected protocol provides a reproducible benchmark for future wearable cardiovascular stability indices.

Cardiovascular disease remains the leading cause of global mortality, yet scalable cardiac monitoring is hindered by the gap between diagnostic-rich ECG and ubiquitous wearable PPG. Bridging this gap requires representations that are compact, transferable across modalities and devices, and deployable without task-specific retraining. Here we introduce biosignal fingerprints: compact latent representations of cardiovascular state derived from a cross-modal foundation model, the Multi-modal Masked Autoencoder (M2AE), trained on over 3.4 million paired ECG and PPG signals. M2AE integrates modality-specific encoders with a shared bottleneck and dual decoders, jointly optimized using reconstruction and cross-modal contrastive objectives, yielding generalizable fingerprints that retain intra- and inter-modality features. Like a biometric fingerprint, these representations uniquely encode an individual's cardiovascular state in a modality-agnostic, privacy-preserving form reusable across clinical tasks without exposing raw waveform data or requiring model retraining. Across 7 downstream tasks, spanning cross-modal reconstruction, cardiovascular disease classification, hypertension detection, mortality prediction, and demographic inference, biosignal fingerprints achieve competitive or superior performance compared to leading domain-specialist foundation models in frozen settings, including an AUROC of 0.974 for five-class CVD classification and 0.877 for hypertension detection, with a maximum improvement of 27.7% in AUROC across 5 classification tasks. Critically, strong performance is maintained with only a single modality, enabling deployment in resource-constrained, single-sensor environments typical of real-world wearable monitoring, with direct implications for continuous cardiovascular monitoring across clinical and consumer health settings.

Electrocardiography (ECG) is the clinical standard for cardiac assessment but requires dedicated hardware that does not scale to daily-life monitoring. Photoplethysmography (PPG) is ubiquitous in wearables but lacks ECG-specific diagnostic morphology and is corrupted by motion and sensor noise. PPG-to-ECG generation aims to bridge this gap by recovering electrical morphology and timing from peripheral pulse signals. However, existing methods largely rely on statistical alignment and data-driven generation. They fail to explicitly structure the latent space around physiology-aware electro-hemodynamic factors and lack constraints from forward physiological dynamics. To address these challenges, we propose PG-LRF, a physiology-guided latent rectified flow framework. PG-LRF introduces an electro-hemodynamic simulator that co-models ECG and PPG through shared cardiac phase dynamics. Guided by this simulator, a Physiology-Aware AutoEncoder learns a structured electro-hemodynamic latent space. Then we integrate this simulator guidance into a PPG-conditioned latent rectified flow, enforcing ECG-side morphology consistency and ECG-to-PPG forward hemodynamic consistency during generative transport. Experiments on the large-scale MC-MED dataset demonstrate that PG-LRF significantly improves PPG-to-ECG generation and downstream cardiovascular disease classification, proving its ability to generate ECGs that are both signal-faithful and physiologically plausible under the ECG-to-PPG hemodynamic pathway

Biosignals acquired from different locations on the body often provide temporally ordered views of the same underlying physiological process. However, most existing self supervised learning methods treat these signals as interchangeable views, overlooking the directional temporal dynamics that link them. A canonical example is the relationship between electrocardiography (ECG), which captures the electrical activation initiating each heartbeat, and photoplethysmography (PPG), which records the resulting peripheral pulse delayed by vascular dynamics. To capture this structured relationship, we introduce xMAE, a biosignal pretraining framework that leverages masked cross modal reconstruction across temporally ordered biosignals as a training time constraint to encourage physiologically meaningful timing structure in the learned representations. We show that pretraining with xMAE yields representations that outperform both unimodal and multimodal baselines on 15 of 19 downstream tasks, including cardiovascular outcome prediction, abnormal laboratory test detection, sleep staging, and demographic inference, while generalizing across devices, body locations, and acquisition settings. Further analysis suggests that the ECG PPG timing structure is reflected in the learned PPG representations. More broadly, xMAE demonstrates the effectiveness of incorporating temporal structure into multimodal pretraining when signals observe different stages of a shared underlying process. Code is available at https://github.com/hzhou3/xMAE.

Unaddressed pain in neonates can lead to adverse effects, including delayed development and slower weight gain, emphasising the need for more objective and reliable pain assessment methods. Hence, automated methods using behavioural and physiological pain indicators have been developed to aid healthcare professionals in the Neonatal ICU. Traditional contact-based methods for physiological parameter estimation are unsuitable for long-term monitoring and increase the risk of spreading diseases like COVID-19. We introduce a novel approach using remote photoplethysmography (rPPG) to estimate pulse signals in a non-contact manner and employ them for neonatal pain detection. The temporal signals acquired from regions-of-interest (ROIs) affected by skin deformations may exhibit lower quality and provide erroneous rPPG signals. Therefore, we incorporated a quality parameter to select the temporal signals obtained from ROIs that are least affected by skin deformations. Further, we employed signal-to-noise ratio as a fitness parameter to extract the rPPG signal corresponding to the clip that is least affected by noise. Experimental findings demonstrate that the rPPG signals provide useful information for neonatal pain detection, and signals extracted from the blue colour channel outperform those extracted from other colour channels. We also show that combining rPPG and audio features provides better results than individual modalities.

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

Remote Photoplethysmography (rPPG) enables convenient non-contact physiological measurement. Existing Self-Supervised Learning (SSL) methods commonly fall into a correlation trap: they tend to learn the most dominant periodic signals in the data, such as high-energy motion or illumination noise, rather than the faint, true rPPG signal, leading to poor model generalization. To address this, we propose a new SSL paradigm, Physiological Causal Probing (PCP), which treats the latent rPPG signal as the underlying physical source and the resulting pixel chrominance variations as its visual manifestation. Its core idea is to shift from passive correlation learning to active, precise intervention: it intervenes on the video based on a proposed rPPG hypothesis, and verifies whether the post-intervention changes match physical expectations. We propose the Interv-rPPG framework to implement PCP: an rPPG extractor named PhysMambaFormer hypothesizes the rPPG signal, while a Controllable Physiological Signal Editor conducts precise chrominance-domain interventions on videos based on this hypothesis. Interv-rPPG validates the physical realism of the hypothesis through Falsifiability via Nulling' and Axiomatic Equivariance'. Our editor achieves precise editing of the rPPG signal by intervening in the low-frequency chrominance components of the video. Our method improves both in-domain and cross-domain performance on challenging datasets such as VIPL-HR and MMPD. Furthermore, it surpasses the supervised baseline in complex cross-dataset settings, while remaining competitive on clean datasets where the intervention mechanism may introduce slight residual chrominance noise. Extensive experiments, including diagnostic analysis of nuisance sensitivity, demonstrate that the PCP paradigm effectively resists motion and illumination artifacts.

In principle, deep generative models can be used to perform domain adaptation; i.e. align the input feature representations of test data with that of a separate discriminative model's training data. This can help improve the discriminative model's performance on the test data. However, generative models are prone to producing hallucinations and artefacts that may degrade the quality of generated data, and therefore, predictive performance when processed by the discriminative model. While uncertainty quantification can provide a means to assess the quality of adapted data, the standard framework for evaluating the quality of predicted uncertainties may not easily extend to generative models due to the common lack of ground truths (among other reasons). Even with ground truths, this evaluation is agnostic to how the generated outputs are used on the downstream task, limiting the extent to which the uncertainty reliability analysis provides insights about the utility of the uncertainties with respect to the intended use case of the adapted examples. Here, we describe how decision-theoretic uncertainty quantification can address these concerns and provide a convenient framework for evaluating the trustworthiness of generated outputs, in particular, for domain adaptation. We consider a case study in photoplethysmography time series denoising for Atrial Fibrillation classification. This formalises a well-known heuristic method of using a downstream classifier to assess the quality of generated outputs.

Photoplethysmography (PPG) is widely used in wearable health monitoring, but its reliability is often degraded by noise and motion artifacts, limiting downstream applications such as heart rate (HR) estimation. This paper presents a deep learning framework for PPG denoising with an emphasis on preserving physiological information. In this framework, we propose DPNet, a Mamba-based denoising backbone designed for effective temporal modeling. To further enhance denoising performance, the framework also incorporates a scale-invariant signal-to-distortion ratio (SI-SDR) loss to promote waveform fidelity and an auxiliary HR predictor (HRP) that provides physiological consistency through HR-based supervision. Experiments on the BIDMC dataset show that our method achieves strong robustness against both synthetic noise and real-world motion artifacts, outperforming conventional filtering and existing neural models. Our method can effectively restore PPG signals while maintaining HR accuracy, highlighting the complementary roles of SI-SDR loss and HR-guided supervision. These results demonstrate the potential of our approach for practical deployment in wearable healthcare systems.

The scarcity of temporally aligned pre-event physiological data limits the study of stroke risk states before documented clinical recognition. We focus on patients who experienced stroke during hospitalization while undergoing continuous monitoring, enabling retrospective analysis of pre-anchor photoplethysmography (PPG). Using MIMIC-III and MC-MED, an LLM-assisted pipeline generated candidate stroke anchors from unstructured notes. All retained anchors underwent physician adjudication, and a stratified 100-case double-review audit showed 95.0% candidate-to-adjudicated agreement within +/-15 min. We identified 176 MIMIC-III patients and 154 MC-MED patients with eligible synchronized pre-anchor PPG. A fixed 17-channel hemodynamic representation and ResNet-1D classifier were evaluated using patient-level five-fold internal validation and frozen external testing. At validation-selected operating points, F1-scores were 0.7956, 0.8759, and 0.9406 for 4-, 5-, and 6-hour horizons in MIMIC-III and 0.9256, 0.9595, and 0.9888 in MC-MED; the corresponding threshold-free AUCs ranged from 0.6124 to 0.7079. The PPG model achieved higher F1 than four non-waveform clinical and structured-EHR comparators in all six cohort-horizon settings. On high-risk non-stroke controls, window-level false-positive rates ranged from 0.1371 to 0.2938 and decreased to 0.0183-0.1739 after persistence aggregation. These retrospective findings support measurable pre-anchor PPG structure, but do not establish biological stroke onset, a calibrated bedside alarm, or a clinically validated prediction lead time.