The advent of multimodal large language models (MLLMs) has sparked interest in their application to electrocardiogram (ECG) analysis. However, existing ECG-focused MLLMs primarily focus on report generation tasks, often limited to single 12-lead, short-duration (10s) ECG inputs, thereby un-derutilizing the potential of MLLMs. To this end, we aim to develop a MLLM for ECG analysis that supports a broader range of tasks and more flexible ECG inputs. However, existing ECG-QA datasets are often monotonous. To address this gap, we first constructed the anyECG dataset, which encompasses a wide variety of tasks, including report generation, abnormal waveform localization, and open-ended question answering. In addition to standard hospital ECGs, we introduced long-duration reduced-lead ECGs for home environments and multiple ECG comparison scenarios commonly encountered in clinical practice. Furthermore, we propose the anyECG-chat model, which supports dynamic-length ECG inputs and multiple ECG inputs. We trained the model using a three-stage curriculum training recipe with the anyECG dataset. A comprehensive evaluation was conducted, demonstrating that anyECG-chat is capable of supporting various practical application scenarios, including not only common report generation tasks but also abnormal waveform localization for long-duration reduced-lead ECGs in home environments and comprehensive comparative analysis of multiple ECGs.

The electrocardiogram (ECG) is an essential and effective tool for diagnosing heart diseases. However, its effectiveness can be compromised by noise or unavailability of one or more leads of the standard 12-lead recordings, resulting in diagnostic errors or uncertainty. To address these challenges, we propose TolerantECG, a foundation model for ECG signals that is robust to noise and capable of functioning with arbitrary subsets of the standard 12-lead ECG. TolerantECG training combines contrastive and self-supervised learning frameworks to jointly learn ECG signal representations alongside their corresponding knowledge-retrieval-based text report descriptions and corrupted or lead-missing signals. Comprehensive benchmarking results demonstrate that TolerantECG consistently ranks as the best or second-best performer across various ECG signal conditions and class levels in the PTB-XL dataset, and achieves the highest performance on the MIT-BIH Arrhythmia Database.

Myocardial infarction is a critical manifestation of coronary artery disease, yet detecting it from single-lead electrocardiogram (ECG) remains challenging due to limited spatial information. An intuitive idea is to convert single-lead into multiple-lead ECG for classification by pre-trained models, but generative methods optimized at the signal level in most cases leave a large latent space gap, ultimately degrading diagnostic performance. This naturally raises the question of whether latent space alignment could help. However, most prior ECG alignment methods focus on learning transformation invariance, which mismatches the goal of single-lead detection. To address this issue, we propose SelfMIS, a simple yet effective alignment learning framework to improve myocardial infarction detection from single-lead ECG. Discarding manual data augmentations, SelfMIS employs a self-cutting strategy to pair multiple-lead ECG with their corresponding single-lead segments and directly align them in the latent space. This design shifts the learning objective from pursuing transformation invariance to enriching the single-lead representation, explicitly driving the single-lead ECG encoder to learn a representation capable of inferring global cardiac context from the local signal. Experimentally, SelfMIS achieves superior performance over baseline models across nine myocardial infarction types while maintaining a simpler architecture and lower computational overhead, thereby substantiating the efficacy of direct latent space alignment. Our code and checkpoint will be publicly available after acceptance.

Multimodal large language models (MLLMs) are increasingly being applied in the medical field, particularly in medical imaging. However, developing MLLMs for ECG signals, which are crucial in clinical settings, has been a significant challenge beyond medical imaging. Previous studies have attempted to address this by converting ECGs into several text tags using an external classifier in a training-free manner. However, this approach significantly compresses the information in ECGs and underutilizes the reasoning capabilities of LLMs. In this work, we directly feed the embeddings of ECGs into the LLM through a projection layer, retaining more information about ECGs and better leveraging the reasoning abilities of LLMs. Our method can also effectively handle a common situation in clinical practice where it is necessary to compare two ECGs taken at different times. Recent studies found that MLLMs may rely solely on text input to provide answers, ignoring inputs from other modalities. We analyzed this phenomenon from a causal perspective in the context of ECG MLLMs and discovered that the confounder, severity of illness, introduces a spurious correlation between the question and answer, leading the model to rely on this spurious correlation and ignore the ECG input. Such models do not comprehend the ECG input and perform poorly in adversarial tests where different expressions of the same question are used in the training and testing sets. We designed a de-biased pre-training method to eliminate the confounder's effect according to the theory of backdoor adjustment. Our model performed well on the ECG-QA task under adversarial testing and demonstrated zero-shot capabilities. An interesting random ECG test further validated that our model effectively understands and utilizes the input ECG signal.

Accurate prediction of cardiovascular diseases remains imperative for early diagnosis and intervention, necessitating robust and precise predictive models. Recently, there has been a growing interest in multi-modal learning for uncovering novel insights not available through uni-modal datasets alone. By combining cardiac magnetic resonance images, electrocardiogram signals, and available medical information, our approach enables the capture of holistic status about individuals' cardiovascular health by leveraging shared information across modalities. Integrating information from multiple modalities and benefiting from self-supervised learning techniques, our model provides a comprehensive framework for enhancing cardiovascular disease prediction with limited annotated datasets. We employ a masked autoencoder to pre-train the electrocardiogram ECG encoder, enabling it to extract relevant features from raw electrocardiogram data, and an image encoder to extract relevant features from cardiac magnetic resonance images. Subsequently, we utilize a multi-modal contrastive learning objective to transfer knowledge from expensive and complex modality, cardiac magnetic resonance image, to cheap and simple modalities such as electrocardiograms and medical information. Finally, we fine-tuned the pre-trained encoders on specific predictive tasks, such as myocardial infarction. Our proposed method enhanced the image information by leveraging different available modalities and outperformed the supervised approach by 7.6% in balanced accuracy.

Electrocardiogram (ECG) interpretation requires specialized expertise, often involving synthesizing insights from ECG signals with complex clinical queries posed in natural language. The scarcity of labeled ECG data coupled with the diverse nature of clinical inquiries presents a significant challenge for developing robust and adaptable ECG diagnostic systems. This work introduces a novel multimodal meta-learning method for few-shot ECG question answering, addressing the challenge of limited labeled data while leveraging the rich knowledge encoded within large language models (LLMs). Our LLM-agnostic approach integrates a pre-trained ECG encoder with a frozen LLM (e.g., LLaMA and Gemma) via a trainable fusion module, enabling the language model to reason about ECG data and generate clinically meaningful answers. Extensive experiments demonstrate superior generalization to unseen diagnostic tasks compared to supervised baselines, achieving notable performance even with limited ECG leads. For instance, in a 5-way 5-shot setting, our method using LLaMA-3.1-8B achieves accuracy of 84.6%, 77.3%, and 69.6% on single verify, choose and query question types, respectively. These results highlight the potential of our method to enhance clinical ECG interpretation by combining signal processing with the nuanced language understanding capabilities of LLMs, particularly in data-constrained scenarios.

Accurate interpretation of Electrocardiogram (ECG) signals is pivotal for diagnosing cardiovascular diseases. Integrating ECG signals with their accompanying textual reports holds immense potential to enhance clinical diagnostics through the combination of physiological data and qualitative insights. However, this integration faces significant challenges due to inherent modality disparities and the scarcity of labeled data for robust cross-modal learning. To address these obstacles, we propose C-MELT, a novel framework that pre-trains ECG and text data using a contrastive masked auto-encoder architecture. C-MELT uniquely combines the strengths of generative with enhanced discriminative capabilities to achieve robust cross-modal representations. This is accomplished through masked modality modeling, specialized loss functions, and an improved negative sampling strategy tailored for cross-modal alignment. Extensive experiments on five public datasets across diverse downstream tasks demonstrate that C-MELT significantly outperforms existing methods, achieving 15% and 2% increases in linear probing and zero-shot performance over state-of-the-art models, respectively. These results highlight the effectiveness of C-MELT, underscoring its potential to advance automated clinical diagnostics through multi-modal representations. Electrocardiograms (ECGs), obtained through non-invasive electrode placement, provide a critical window into the heart's electrical activity by measuring voltage differences across specific anatomical regions. The standard 12-lead ECG, which captures unique electrical potential differences from each lead, plays a vital role in diagnosing a wide spectrum of cardiac conditions, like arrhythmias. In recent years, significant progress has been made in leveraging deep learning techniques for automated ECG interpretation (Yan et al., 2019; Ebrahimi et al., 2020; Siontis et al., 2021).

Interpreting electrocardiograms (ECGs) and generating comprehensive reports remain challenging tasks in cardiology, often requiring specialized expertise and significant time investment. To address these critical issues, we propose ECG-ReGen, a retrieval-based approach for ECG-to-text report generation and question answering. Our method leverages a self-supervised learning for the ECG encoder, enabling efficient similarity searches and report retrieval. By combining pre-training with dynamic retrieval and Large Language Model (LLM)-based refinement, ECG-ReGen effectively analyzes ECG data and answers related queries, with the potential of improving patient care. Experiments conducted on the PTB-XL and MIMIC-IV-ECG datasets demonstrate superior performance in both in-domain and cross-domain scenarios for report generation. Furthermore, our approach exhibits competitive performance on ECG-QA dataset compared to fully supervised methods when utilizing off-the-shelf LLMs for zero-shot question answering. This approach, effectively combining self-supervised encoder and LLMs, offers a scalable and efficient solution for accurate ECG interpretation, holding significant potential to enhance clinical decision-making.

The electrocardiogram (ECG) is one of the most commonly used non-invasive, convenient medical monitoring tools that assist in the clinical diagnosis of heart diseases. Recently, deep learning (DL) techniques, particularly self-supervised learning (SSL), have demonstrated great potential in the classification of ECG. SSL pre-training has achieved competitive performance with only a small amount of annotated data after fine-tuning. However, current SSL methods rely on the availability of annotated data and are unable to predict labels not existing in fine-tuning datasets. To address this challenge, we propose Multimodal ECG-Text Self-supervised pre-training (METS), the first work to utilize the auto-generated clinical reports to guide ECG SSL pre-training. We use a trainable ECG encoder and a frozen language model to embed paired ECG and automatically machine-generated clinical reports separately. The SSL aims to maximize the similarity between paired ECG and auto-generated report while minimize the similarity between ECG and other reports. In downstream classification tasks, METS achieves around 10% improvement in performance without using any annotated data via zero-shot classification, compared to other supervised and SSL baselines that rely on annotated data. Furthermore, METS achieves the highest recall and F1 scores on the MIT-BIH dataset, despite MIT-BIH containing different classes of ECG compared to the pre-trained dataset. The extensive experiments have demonstrated the advantages of using ECG-Text multimodal self-supervised learning in terms of generalizability, effectiveness, and efficiency.