Cardiopulmonary exercise testing (CPET) provides a comprehensive assessment of functional capacity by measuring key physiological variables including oxygen consumption ($VO_2$), carbon dioxide production ($VCO_2$), and pulmonary ventilation ($VE$) during exercise. Previous research has established that parameters such as peak $VO_2$ and $VE/VCO_2$ ratio serve as robust predictors of mortality risk in chronic heart failure patients. In this study, we leverage CPET variables as surrogate mortality endpoints for patients with Congenital Heart Disease (CHD). To our knowledge, this represents the first successful implementation of an advanced machine learning approach that predicts CPET outcomes by integrating electrocardiograms (ECGs) with information derived from clinical letters. Our methodology began with extracting unstructured patient information-including intervention history, diagnoses, and medication regimens-from clinical letters using natural language processing techniques, organizing this data into a structured database. We then digitized ECGs to obtain quantifiable waveforms and established comprehensive data linkages. The core innovation of our approach lies in exploiting the Riemannian geometric properties of covariance matrices derived from both 12-lead ECGs and clinical text data to develop robust regression and classification models. Through extensive ablation studies, we demonstrated that the integration of ECG signals with clinical documentation, enhanced by covariance augmentation techniques in Riemannian space, consistently produced superior predictive performance compared to conventional approaches.

Since clinical letters contain sensitive information, clinical-related datasets can not be widely applied in model training, medical research, and teaching. This work aims to generate reliable, various, and de-identified synthetic clinical letters. To achieve this goal, we explored different pre-trained language models (PLMs) for masking and generating text. After that, we worked on Bio\_ClinicalBERT, a high-performing model, and experimented with different masking strategies. Both qualitative and quantitative methods were used for evaluation. Additionally, a downstream task, Named Entity Recognition (NER), was also implemented to assess the usability of these synthetic letters. The results indicate that 1) encoder-only models outperform encoder-decoder models. 2) Among encoder-only models, those trained on general corpora perform comparably to those trained on clinical data when clinical information is preserved. 3) Additionally, preserving clinical entities and document structure better aligns with our objectives than simply fine-tuning the model. 4) Furthermore, different masking strategies can impact the quality of synthetic clinical letters. Masking stopwords has a positive impact, while masking nouns or verbs has a negative effect. 5) For evaluation, BERTScore should be the primary quantitative evaluation metric, with other metrics serving as supplementary references. 6) Contextual information does not significantly impact the models' understanding, so the synthetic clinical letters have the potential to replace the original ones in downstream tasks.