In the process of patient diagnosis, non-invasive measurements are widely used due to their low risks and quick results. Electrocardiogram (ECG), as a non-invasive method to collect heart activities, is used to diagnose cardiac conditions. Analyzing the ECG typically requires domain expertise, which is a roadblock to applying artificial intelligence (AI) for healthcare. Through advances in self-supervised learning and foundation models, AI systems can now acquire and leverage domain knowledge without relying solely on human expertise. However, there is a lack of comprehensive analyses over the foundation models' performance on ECG. This study aims to answer the research question: "Are Foundation Models Useful for ECG Analysis?" To address it, we evaluate language/general time-series/ECG foundation models in comparison with time-series deep learning models. The experimental results show that general time-series/ECG foundation models achieve a top performance rate of 80%, indicating their effectiveness in ECG analysis. In-depth analyses and insights are provided along with comprehensive experimental results. This study highlights the limitations and potential of foundation models in advancing physiological waveform analysis. The data and code for this benchmark are publicly available at https://github.com/yuhaoxu99/ECGMultitasks-Benchmark.

Timely access to laboratory values is critical for clinical decision-making, yet current approaches rely on invasive venous sampling and are intrinsically delayed. Electrocardiography (ECG), as a non-invasive and widely available signal, offers a promising modality for rapid laboratory estimation. Recent progress in deep learning has enabled the extraction of latent hematological signatures from ECGs. However, existing models are constrained by low signal-to-noise ratios, substantial inter-individual variability, limited data diversity, and suboptimal generalization, especially when adapted to low-lead wearable devices. In this work, we conduct an exploratory study leveraging transfer learning to fine-tune ECGFounder, a large-scale pre-trained ECG foundation model, on the Multimodal Clinical Monitoring in the Emergency Department (MC-MED) dataset from Stanford. We generated a corpus of more than 20 million standardized ten-second ECG segments to enhance sensitivity to subtle biochemical correlates. On internal validation, the model demonstrated strong predictive performance (area under the curve above 0.65) for thirty-three laboratory indicators, moderate performance (between 0.55 and 0.65) for fifty-nine indicators, and limited performance (below 0.55) for sixteen indicators. This study provides an efficient artificial-intelligence driven solution and establishes the feasibility scope for real-time, non-invasive estimation of laboratory values.

Electrocardiograms (ECGs) are inexpensive, widely used, and well-suited to deep learning. Recently, interest has grown in developing foundation models for ECGs - models that generalise across diverse downstream tasks. However, consistent evaluation has been lacking: prior work often uses narrow task selections and inconsistent datasets, hindering fair comparison. Here, we introduce BenchECG, a standardised benchmark comprising a comprehensive suite of publicly available ECG datasets and versatile tasks. We also propose xECG, an xLSTM-based recurrent model trained with SimDINOv2 self-supervised learning, which achieves the best BenchECG score compared to publicly available state-of-the-art models. In particular, xECG is the only publicly available model to perform strongly on all datasets and tasks. By standardising evaluation, BenchECG enables rigorous comparison and aims to accelerate progress in ECG representation learning. xECG achieves superior performance over earlier approaches, defining a new baseline for future ECG foundation models.

-- This study introduces OpenECG, a large-scale benchmark of 1.2 million 12-lead ECG recordings from nine centers, to evaluate ECG foundation models (ECG-FMs) trained on public datasets. We investigate three self-supervised learning methods (SimCLR, BYOL, MAE) with ResNet-50 and Vision Transformer architectures, assessing model generalization through leave-one-dataset-out experiments and data scaling analysis. Results show that pre-training on diverse datasets significantly improves generalization, with BYOL and MAE outperforming SimCLR, highlighting the efficacy of feature-consistency and generative learning over contrastive approaches. Data scaling experiments reveal that performance saturates at 60-70% of total data for BYOL and MAE, while SimCLR requires more data. These findings demonstrate that publicly available ECG data can match or surpass proprietary datasets in training robust ECG-FMs, paving the way for scalable, clinically meaningful AI-driven ECG analysis. Electrocardiography (ECG) is a fundamental tool for diagnosing cardiovascular diseases (CVDs), which are among the leading causes of mortality worldwide. ECG enables clinicians to detect arrhythmias, myocardial infarction, and other heart conditions(Moreno-S anchez et al. 2024). Despite its importance, several challenges hinder the effective utilization of ECG in clinical practice: First, the diagnostic accuracy can differ significantly among cardiologists due to varying levels of training and experience.

Acute Coronary Syndrome (ACS) is a life - threatening cardiovascular condition where early and accurate diagnosis is critical for effective treatment and improved patient outcomes. This study explores the use of ECG foundation models, specifically ST - MEM and ECG - FM, to enhance ACS risk assessment using prehospital ECG data collected in the ambulances . Both models leverage self - supervised learning (SSL), with ST - MEM using a reconstruction - based approach and ECG - FM employing contrastive learning, capt uring unique spatial and temporal ECG features. We evaluate the performance of these models individually and through a fusion approach, where their embeddings are combined for enhanced prediction. Results demonstrate that both foundation models outperform a baseline ResNet - 50 model, with the fusion - based approach achieving the highest perf ormance (AUROC: 0.843 0.006, AUCPR: 0.674 0.012). These findings highlight the potential of ECG foundation models for early ACS detection and motivate further exploration of advanced fusion strategies to maximize complementary feature utilization.

Artificial intelligence (AI) has demonstrated significant potential in ECG analysis and cardiovascular disease assessment. Recently, foundation models have played a remarkable role in advancing medical AI. The development of an ECG foundation model holds the promise of elevating AI-ECG research to new heights. However, building such a model faces several challenges, including insufficient database sample sizes and inadequate generalization across multiple domains. Additionally, there is a notable performance gap between single-lead and multi-lead ECG analyses. We introduced an ECG Foundation Model (ECGFounder), a general-purpose model that leverages real-world ECG annotations from cardiology experts to broaden the diagnostic capabilities of ECG analysis. ECGFounder was trained on over 10 million ECGs with 150 label categories from the Harvard-Emory ECG Database, enabling comprehensive cardiovascular disease diagnosis through ECG analysis. The model is designed to be both an effective out-of-the-box solution, and a to be fine-tunable for downstream tasks, maximizing usability. Importantly, we extended its application to lower rank ECGs, and arbitrary single-lead ECGs in particular. ECGFounder is applicable to supporting various downstream tasks in mobile monitoring scenarios. Experimental results demonstrate that ECGFounder achieves expert-level performance on internal validation sets, with AUROC exceeding 0.95 for eighty diagnoses. It also shows strong classification performance and generalization across various diagnoses on external validation sets. When fine-tuned, ECGFounder outperforms baseline models in demographic analysis, clinical event detection, and cross-modality cardiac rhythm diagnosis. The trained model and data will be publicly released upon publication through the bdsp.io. Our code is available at https://github.com/bdsp-core/ECGFounder