In the field of cardiac electrophysiology (EP), effectively reducing noise in intra-cardiac signals is crucial for the accurate diagnosis and treatment of arrhythmias and cardiomyopathies. However, traditional noise reduction techniques fall short in addressing the diverse noise patterns from various sources, often non-linear and non-stationary, present in these signals. This work introduces a Variational Autoencoder (VAE) model, aimed at improving the quality of intra-ventricular monophasic action potential (MAP) signal recordings. By constructing representations of clean signals from a dataset of 5706 time series from 42 patients diagnosed with ischemic cardiomyopathy, our approach demonstrates superior denoising performance when compared to conventional filtering methods commonly employed in clinical settings. We assess the effectiveness of our VAE model using various metrics, indicating its superior capability to denoise signals across different noise types, including time-varying non-linear noise frequently found in clinical settings. These results reveal that VAEs can eliminate diverse sources of noise in single beats, outperforming state-of-the-art denoising techniques and potentially improving treatment efficacy in cardiac EP.

Purpose: We investigated the utilization of privacy-preserving, locally-deployed, open-source Large Language Models (LLMs) to extract diagnostic information from free-text cardiovascular magnetic resonance (CMR) reports. Materials and Methods: We evaluated nine open-source LLMs on their ability to identify diagnoses and classify patients into various cardiac diagnostic categories based on descriptive findings in 109 clinical CMR reports. Performance was quantified using standard classification metrics including accuracy, precision, recall, and F1 score. We also employed confusion matrices to examine patterns of misclassification across models. Results: Most open-source LLMs demonstrated exceptional performance in classifying reports into different diagnostic categories. Google's Gemma2 model achieved the highest average F1 score of 0.98, followed by Qwen2.5:32B and DeepseekR1-32B with F1 scores of 0.96 and 0.95, respectively. All other evaluated models attained average scores above 0.93, with Mistral and DeepseekR1-7B being the only exceptions. The top four LLMs outperformed our board-certified cardiologist (F1 score of 0.94) across all evaluation metrics in analyzing CMR reports. Conclusion: Our findings demonstrate the feasibility of implementing open-source, privacy-preserving LLMs in clinical settings for automated analysis of imaging reports, enabling accurate, fast and resource-efficient diagnostic categorization.

As the number of patients with heart failure increases, machine learning (ML) has garnered attention in cardiomyopathy diagnosis, driven by the shortage of pathologists. However, endomyocardial biopsy specimens are often small sample size and require techniques such as feature extraction and dimensionality reduction. This study aims to determine whether texture features are effective for feature extraction in the pathological diagnosis of cardiomyopathy. Furthermore, model designs that contribute toward improving generalization performance are examined by applying feature selection (FS) and dimensional compression (DC) to several ML models. The obtained results were verified by visualizing the inter-class distribution differences and conducting statistical hypothesis testing based on texture features. Additionally, they were evaluated using predictive performance across different model designs with varying combinations of FS and DC (applied or not) and decision boundaries. The obtained results confirmed that texture features may be effective for the pathological diagnosis of cardiomyopathy. Moreover, when the ratio of features to the sample size is high, a multi-step process involving FS and DC improved the generalization performance, with the linear kernel support vector machine achieving the best results. This process was demonstrated to be potentially effective for models with reduced complexity, regardless of whether the decision boundaries were linear, curved, perpendicular, or parallel to the axes. These findings are expected to facilitate the development of an effective cardiomyopathy diagnostic model for its rapid adoption in medical practice.

The breakthrough of OpenAI o1 highlights the potential of enhancing reasoning to improve LLM. Yet, most research in reasoning has focused on mathematical tasks, leaving domains like medicine underexplored. The medical domain, though distinct from mathematics, also demands robust reasoning to provide reliable answers, given the high standards of healthcare. However, verifying medical reasoning is challenging, unlike those in mathematics. To address this, we propose verifiable medical problems with a medical verifier to check the correctness of model outputs. This verifiable nature enables advancements in medical reasoning through a two-stage approach: (1) using the verifier to guide the search for a complex reasoning trajectory for fine-tuning LLMs, (2) applying reinforcement learning (RL) with verifier-based rewards to enhance complex reasoning further. Finally, we introduce HuatuoGPT-o1, a medical LLM capable of complex reasoning, which outperforms general and medical-specific baselines using only 40K verifiable problems. Experiments show complex reasoning improves medical problem-solving and benefits more from RL. We hope our approach inspires advancements in reasoning across medical and other specialized domains.

The segmentation and classification of cardiac magnetic resonance imaging are critical for diagnosing heart conditions, yet current approaches face challenges in accuracy and generalizability. In this study, we aim to further advance the segmentation and classification of cardiac magnetic resonance images by introducing a novel deep learning-based approach. Using a multi-stage process with U-Net and ResNet models for segmentation, followed by Gaussian smoothing, the method improved segmentation accuracy, achieving a Dice coefficient of 0.974 for the left ventricle and 0.947 for the right ventricle. For classification, a cascade of deep learning classifiers was employed to distinguish heart conditions, including hypertrophic cardiomyopathy, myocardial infarction, and dilated cardiomyopathy, achieving an average accuracy of 97.2%. The proposed approach outperformed existing models, enhancing segmentation accuracy and classification precision. These advancements show promise for clinical applications, though further validation and interpretation across diverse imaging protocols is necessary.

The National Institute of Health defines Sudden Cardiac Arrest (SCA) as a moment when the heart is not beating sufficiently to maintain perfusion due to the heart's electrical or mechanical failure [1]. SCA is the leading cause of death among youth athletes -- a focus group that has a heightened risk of SCA -- with 1 in 16,000 young athletes and 1 in 5200 athletes at the elite level afflicted yearly [1, 2]. For youth athletes, the primary cause of SCA is hypertrophic cardiomyopathy (HCM) in the U.S. and arrhythmogenic right ventricular cardiomyopathy (ARVC) in Europe. SCA may also result from coronary artery disease, Long QT Syndrome, Myocarditis, Wolff-Parkinson-White syndrome, and dilated cardiomyopathy [1-4]. Figure 1 provides a comprehensive list of significant predictors of SCA [5]. While these disorders do not always lead to instances of SCA, they present a substantial increase in the chance of SCA events, which is further amplified by the innate risk of sports participation [6-9]. Concerningly, the current 14-point questionnaire pre-participation evaluation (PPE) recommended by the American Heart Association (AHA) is ineffective at detecting risk factors with poor sensitivity and specificity of 18.8% and 68.0%

Cardiovascular diseases (CVDs) present significant challenges for early and accurate diagnosis. While cardiac magnetic resonance imaging (CMR) is the gold standard for assessing cardiac function and diagnosing CVDs, its high cost and technical complexity limit accessibility. In contrast, electrocardiography (ECG) offers promise for large-scale early screening. This study introduces CardiacNets, an innovative model that enhances ECG analysis by leveraging the diagnostic strengths of CMR through cross-modal contrastive learning and generative pretraining. CardiacNets serves two primary functions: (1) it evaluates detailed cardiac function indicators and screens for potential CVDs, including coronary artery disease, cardiomyopathy, pericarditis, heart failure and pulmonary hypertension, using ECG input; and (2) it enhances interpretability by generating high-quality CMR images from ECG data. We train and validate the proposed CardiacNets on two large-scale public datasets (the UK Biobank with 41,519 individuals and the MIMIC-IV-ECG comprising 501,172 samples) as well as three private datasets (FAHZU with 410 individuals, SAHZU with 464 individuals, and QPH with 338 individuals), and the findings demonstrate that CardiacNets consistently outperforms traditional ECG-only models, substantially improving screening accuracy. Furthermore, the generated CMR images provide valuable diagnostic support for physicians of all experience levels. This proof-of-concept study highlights how ECG can facilitate cross-modal insights into cardiac function assessment, paving the way for enhanced CVD screening and diagnosis at a population level.

In the past few years, deep learning algorithms have been widely used for cardiac image segmentation. However, most of these architectures rely on convolutions that hardly model long-range dependencies, limiting their ability to extract contextual information. In order to tackle this issue, this article introduces the Swin Filtering Block network (SFB-net) which takes advantage of both conventional and swin transformer layers. The former are used to introduce spatial attention at the bottom of the network, while the latter are applied to focus on high level semantically rich features between the encoder and decoder. An average Dice score of 92.4 was achieved on the ACDC dataset. To the best of our knowledge, this result outperforms any other work on this dataset. The average Dice score of 87.99 obtained on the M\&M's dataset demonstrates that the proposed method generalizes well to data from different vendors and centres.

Cardiac magnetic resonance imaging (CMR), considered the gold standard for noninvasive cardiac assessment, is a diverse and complex modality requiring a wide variety of image processing tasks for comprehensive assessment of cardiac morphology and function. Advances in deep learning have enabled the development of state-of-the-art (SoTA) models for these tasks. However, model training is challenging due to data and label scarcity, especially in the less common imaging sequences. Moreover, each model is often trained for a specific task, with no connection between related tasks. In this work, we introduce a vision foundation model trained for CMR assessment, that is trained in a self-supervised fashion on 36 million CMR images. We then finetune the model in supervised way for 9 clinical tasks typical to a CMR workflow, across classification, segmentation, landmark localization, and pathology detection. We demonstrate improved accuracy and robustness across all tasks, over a range of available labeled dataset sizes. We also demonstrate improved few-shot learning with fewer labeled samples, a common challenge in medical image analyses. We achieve an out-of-box performance comparable to SoTA for most clinical tasks. The proposed method thus presents a resource-efficient, unified framework for CMR assessment, with the potential to accelerate the development of deep learning-based solutions for image analysis tasks, even with few annotated data available.

The scarcity of subspecialist medical expertise, particularly in rare, complex and life-threatening diseases, poses a significant challenge for healthcare delivery. This issue is particularly acute in cardiology where timely, accurate management determines outcomes. We explored the potential of AMIE (Articulate Medical Intelligence Explorer), a large language model (LLM)-based experimental AI system optimized for diagnostic dialogue, to potentially augment and support clinical decision-making in this challenging context. We curated a real-world dataset of 204 complex cases from a subspecialist cardiology practice, including results for electrocardiograms, echocardiograms, cardiac MRI, genetic tests, and cardiopulmonary stress tests. We developed a ten-domain evaluation rubric used by subspecialists to evaluate the quality of diagnosis and clinical management plans produced by general cardiologists or AMIE, the latter enhanced with web-search and self-critique capabilities. AMIE was rated superior to general cardiologists for 5 of the 10 domains (with preference ranging from 9% to 20%), and equivalent for the rest. Access to AMIE's response improved cardiologists' overall response quality in 63.7% of cases while lowering quality in just 3.4%. Cardiologists' responses with access to AMIE were superior to cardiologist responses without access to AMIE for all 10 domains. Qualitative examinations suggest AMIE and general cardiologist could complement each other, with AMIE thorough and sensitive, while general cardiologist concise and specific. Overall, our results suggest that specialized medical LLMs have the potential to augment general cardiologists' capabilities by bridging gaps in subspecialty expertise, though further research and validation are essential for wide clinical utility.