Photoplethysmography (PPG) sensor in wearable and clinical devices provides valuable physiological insights in a non-invasive and real-time fashion. Specialized Foundation Models (FM) or repurposed time-series FMs are used to benchmark physiological tasks. Our experiments with fine-tuning FMs reveal that Vision FM (VFM) can also be utilized for this purpose and, in fact, surprisingly leads to state-of-the-art (SOT A) performance on many tasks, notably blood pressure estimation. We leverage VFMs by simply transforming one-dimensional PPG signals into image-like two-dimensional representations, such as the Short-Time Fourier transform (STFT). Using the latest VFMs, such as DINOv3 and SIGLIP-2, we achieve promising performance on other vital signs and blood lab measurement tasks as well. Our proposal, Vision4PPG, unlocks a new class of FMs to achieve SOT A performance with notable generalization to other 2D input representations, including STFT phase and recurrence plots. Our work improves upon prior investigations of vision models for PPG by conducting a comprehensive study, comparing them to state-of-the-art time-series FMs, and demonstrating the general PPG processing ability by reporting results on six additional tasks. Thus, we provide clinician-scientists with a new set of powerful tools that is also computationally efficient, thanks to Parameter-Efficient Fine-Tuning (PEFT) techniques. 1 Introduction

Photoplethysmography (PPG) signals encode information about relative changes in blood volume that can be used to assess various aspects of cardiac health non-invasively, e.g.\ to detect atrial fibrillation (AF) or predict blood pressure (BP). Deep networks are well-equipped to handle the large quantities of data acquired from wearable measurement devices. However, they lack interpretability and are prone to overfitting, leaving considerable risk for poor performance on unseen data and misdiagnosis. Here, we describe the use of two scalable uncertainty quantification techniques: Monte Carlo Dropout and the recently proposed Improved Variational Online Newton. These techniques are used to assess the trustworthiness of models trained to perform AF classification and BP regression from raw PPG time series. We find that the choice of hyperparameters has a considerable effect on the predictive performance of the models and on the quality and composition of predicted uncertainties. E.g. the stochasticity of the model parameter sampling determines the proportion of the total uncertainty that is aleatoric, and has varying effects on predictive performance and calibration quality dependent on the chosen uncertainty quantification technique and the chosen expression of uncertainty. We find significant discrepancy in the quality of uncertainties over the predicted classes, emphasising the need for a thorough evaluation protocol that assesses local and adaptive calibration. This work suggests that the choice of hyperparameters must be carefully tuned to balance predictive performance and calibration quality, and that the optimal parameterisation may vary depending on the chosen expression of uncertainty.

Photoplethysmography (PPG) is a widely used non-invasive physiological sensing technique, suitable for various clinical applications. Such clinical applications are increasingly supported by machine learning methods, raising the question of the most appropriate input representation and model choice. Comprehensive comparisons, in particular across different input representations, are scarce. We address this gap in the research landscape by a comprehensive benchmarking study covering three kinds of input representations, interpretable features, image representations and raw waveforms, across prototypical regression and classification use cases: blood pressure and atrial fibrillation prediction. In both cases, the best results are achieved by deep neural networks operating on raw time series as input representations. Within this model class, best results are achieved by modern convolutional neural networks (CNNs). but depending on the task setup, shallow CNNs are often also very competitive. We envision that these results will be insightful for researchers to guide their choice on machine learning tasks for PPG data, even beyond the use cases presented in this work.

Photoplethysmography (PPG)-based blood pressure (BP) estimation represents a promising alternative to cuff-based BP measurements. Recently, an increasing number of deep learning models have been proposed to infer BP from the raw PPG waveform. However, these models have been predominantly evaluated on in-distribution test sets, which immediately raises the question of the generalizability of these models to external datasets. To investigate this question, we trained five deep learning models on the recently released PulseDB dataset, provided in-distribution benchmarking results on this dataset, and then assessed out-of-distribution performance on several external datasets. The best model (XResNet1d101) achieved in-distribution MAEs of 9.4 and 6.0 mmHg for systolic and diastolic BP respectively on PulseDB (with subject-specific calibration), and 14.0 and 8.5 mmHg respectively without calibration. Equivalent MAEs on external test datasets without calibration ranged from 15.0 to 25.1 mmHg (SBP) and 7.0 to 10.4 mmHg (DBP). Our results indicate that the performance is strongly influenced by the differences in BP distributions between datasets. We investigated a simple way of improving performance through sample-based domain adaptation and put forward recommendations for training models with good generalization properties. With this work, we hope to educate more researchers for the importance and challenges of out-of-distribution generalization.

Blood pressure (BP) is a key indicator of cardiovascular health. As hypertension remains a global cause of morbidity and mortality, accurate, continuous, and non-invasive BP monitoring is therefore of paramount importance. Photoplethysmography (PPG) and electrocardiography (ECG) can potentially enable continuous BP monitoring, yet training accurate and robust machine learning (ML) models remains challenging due to variability in data quality and patient-specific factors. Recently, multiple research groups explored Electroencephalographic (EEG)--based foundation models and demonstrated their exceptional ability to learn rich temporal resolution. Considering the morphological similarities between different biosignals, the question arises of whether a model pre-trained on one modality can effectively be exploited to improve the accuracy of a different signal type. In this work, we take an initial step towards generalized biosignal foundation models by investigating whether model representations learned from abundant EEG data can effectively be transferred to ECG/PPG data solely with fine-tuning, without the need for large-scale additional pre-training, for the BP estimation task. Evaluations on the MIMIC-III and VitalDB datasets demonstrate that our approach achieves near state-of-the-art accuracy for diastolic BP (mean absolute error of 1.57 mmHg) and surpasses by 1.5x the accuracy of prior works for systolic BP (mean absolute error 2.72 mmHg). Additionally, we perform dynamic INT8 quantization, reducing the smallest model size by over 3.5x (from 13.73 MB down to 3.83 MB) while preserving performance, thereby enabling unobtrusive, real-time BP monitoring on resource-constrained wearable devices.

Continuous blood pressure (BP) monitoring is essential for timely diagnosis and intervention in critical care settings. However, BP varies significantly across individuals, this inter-patient variability motivates the development of personalized models tailored to each patient's physiology. In this work, we propose a personalized BP forecasting model mainly using electrocardiogram (ECG) and photoplethysmogram (PPG) signals. This time-series model incorporates 2D representation learning to capture complex physiological relationships. Experiments are conducted on datasets collected from three diverse scenarios with BP measurements from 60 subjects total. Results demonstrate that the model achieves accurate and robust BP forecasts across scenarios within the Association for the Advancement of Medical Instrumentation (AAMI) standard criteria. This reliable early detection of abnormal fluctuations in BP is crucial for at-risk patients undergoing surgery or intensive care. The proposed model provides a valuable addition for continuous BP tracking to reduce mortality and improve prognosis.

Time series data mining is immensely important in extensive applications, such as traffic, medical, and e-commerce. In this paper, we focus on medical temporal variation modeling, \emph{i.e.,} cuffless blood pressure (BP) monitoring which has great value in cardiovascular healthcare. Although providing a comfortable user experience, such methods are suffering from the demand for a significant amount of realistic data to train an individual model for each subject, especially considering the invasive or obtrusive BP ground-truth measurements. To tackle this challenge, we introduce a novel physics-informed temporal network~(PITN) with adversarial contrastive learning to enable precise BP estimation with very limited data. Specifically, we first enhance the physics-informed neural network~(PINN) with the temporal block for investigating BP dynamics' multi-periodicity for personal cardiovascular cycle modeling and temporal variation. We then employ adversarial training to generate extra physiological time series data, improving PITN's robustness in the face of sparse subject-specific training data. Furthermore, we utilize contrastive learning to capture the discriminative variations of cardiovascular physiologic phenomena. This approach aggregates physiological signals with similar blood pressure values in latent space while separating clusters of samples with dissimilar blood pressure values. Experiments on three widely-adopted datasets with different modailties (\emph{i.e.,} bioimpedance, PPG, millimeter-wave) demonstrate the superiority and effectiveness of the proposed methods over previous state-of-the-art approaches. The code is available at~\url{https://github.com/Zest86/ACL-PITN}.

Recent statistics indicate that approximately 1.3 billion individuals worldwide suffer from hypertension, a leading cause of premature death globally. Blood pressure (BP) serves as a critical health indicator for accurate and timely diagnosis and/or treatment of hypertension. Driven by recent advancements in Artificial Intelligence (AI) and Deep Neural Networks (DNNs), there has been a surge of interest in developing data-driven and cuff-less BP estimation solutions. In this context, current literature predominantly focuses on coupling Electrocardiography (ECG) and Photoplethysmography (PPG) sensors, though this approach is constrained by reliance on multiple sensor types. An alternative, utilizing standalone PPG signals, presents challenges due to the absence of auxiliary sensors (ECG), requiring the use of morphological features while addressing motion artifacts and high-frequency noise. To address these issues, the paper introduces the TransfoRhythm framework, a Transformer-based DNN architecture built upon the recently released physiological database, MIMIC-IV. Leveraging Multi-Head Attention (MHA) mechanism, TransfoRhythm identifies dependencies and similarities across data segments, forming a robust framework for cuff-less BP estimation solely using PPG signals. To our knowledge, this paper represents the first study to apply the MIMIC IV dataset for cuff-less BP estimation, and TransfoRhythm is the first MHA-based model trained via MIMIC IV for BP prediction. Performance evaluation through comprehensive experiments demonstrates TransfoRhythm's superiority over its state-of-the-art counterparts. Specifically, TransfoRhythm achieves highly accurate results with Root Mean Square Error (RMSE) of [1.84, 1.42] and Mean Absolute Error (MAE) of [1.50, 1.17] for systolic and diastolic blood pressures, respectively.

Hypertension, a leading contributor to cardiovascular morbidity, underscores the need for accurate and continuous blood pressure (BP) monitoring. Photoplethysmography (PPG) presents a promising approach to this end. However, the precision of BP estimates derived from PPG signals has been the subject of ongoing debate, necessitating a comprehensive evaluation of their effectiveness and constraints. We developed a calibration-based Siamese ResNet model for BP estimation, using a signal input paired with a reference BP reading. We compared the use of normalized PPG (N-PPG) against the normalized Invasive Arterial Blood Pressure (N-IABP) signals as input. The N-IABP signals do not directly present systolic and diastolic values but theoretically provide a more accurate BP measure than PPG signals since it is a direct pressure sensor inside the body. Our strategy establishes a critical benchmark for PPG performance, realistically calibrating expectations for PPG's BP estimation capabilities. Nonetheless, we compared the performance of our models using different signal-filtering conditions to evaluate the impact of filtering on the results. We evaluated our method using the AAMI and the BHS standards employing the VitalDB dataset. The N-IABP signals meet with AAMI standards for both Systolic Blood Pressure (SBP) and Diastolic Blood Pressure (DBP), with errors of 1.29+-6.33mmHg for systolic pressure and 1.17+-5.78mmHg for systolic and diastolic pressure respectively for the raw N-IABP signal. In contrast, N-PPG signals, in their best setup, exhibited inferior performance than N-IABP, presenting 1.49+-11.82mmHg and 0.89+-7.27mmHg for systolic and diastolic pressure respectively. Our findings highlight the potential and limitations of employing PPG for BP estimation, showing that these signals contain information correlated to BP but may not be sufficient for predicting it accurately.

Cardiovascular diseases (CVDs) are the leading cause of death worldwide, with blood pressure serving as a crucial indicator. Arterial blood pressure (ABP) waveforms provide continuous pressure measurements throughout the cardiac cycle and offer valuable diagnostic insights. Consequently, there is a significant demand for non-invasive and cuff-less methods to measure ABP waveforms continuously. Accurate prediction of ABP waveforms can also improve the estimation of mean blood pressure, an essential cardiovascular health characteristic. This study proposes a novel framework based on the physics-informed DeepONet approach to predict ABP waveforms. Unlike previous methods, our approach requires the predicted ABP waveforms to satisfy the Navier-Stokes equation with a time-periodic condition and a Windkessel boundary condition. Notably, our framework is the first to predict ABP waveforms continuously, both with location and time, within the part of the artery that is being simulated. Furthermore, our method only requires ground truth data at the outlet boundary and can handle periodic conditions with varying periods. Incorporating the Windkessel boundary condition in our solution allows for generating natural physical reflection waves, which closely resemble measurements observed in real-world cases. Moreover, accurately estimating the hyper-parameters in the Navier-Stokes equation for our simulations poses a significant challenge. To overcome this obstacle, we introduce the concept of meta-learning, enabling the neural networks to learn these parameters during the training process.