Purpose: Chest X-rays are essential for diagnosing pulmonary conditions, but limited access in resource-constrained settings can delay timely diagnosis. Electrocardiograms (ECGs), in contrast, are widely available, non-invasive, and often acquired earlier in clinical workflows. This study aims to assess whether ECG features and patient demographics can predict chest radiograph findings using an interpretable machine learning approach. Methods: Using the MIMIC-IV database, Extreme Gradient Boosting (XGBoost) classifiers were trained to predict diverse chest radiograph findings from ECG-derived features and demographic variables. Recursive feature elimination was performed independently for each target to identify the most predictive features. Model performance was evaluated using the area under the receiver operating characteristic curve (AUROC) with bootstrapped 95% confidence intervals. Shapley Additive Explanations (SHAP) were applied to interpret feature contributions. Results: Models successfully predicted multiple chest radiograph findings with varying accuracy. Feature selection tailored predictors to each target, and including demographic variables consistently improved performance. SHAP analysis revealed clinically meaningful contributions from ECG features to radiographic predictions. Conclusion: ECG-derived features combined with patient demographics can serve as a proxy for certain chest radiograph findings, enabling early triage or pre-screening in settings where radiographic imaging is limited. Interpretable machine learning demonstrates potential to support radiology workflows and improve patient care.

Type 2 Diabetes Mellitus (T2DM) remains a global health challenge, underscoring the need for early and accurate risk prediction. This study presents ECG-DiaNet, a multimodal deep learning model that integrates electrocardiogram (ECG) features with clinical risk factors (CRFs) to enhance T2DM onset prediction. Using data from Qatar Biobank (QBB), we trained and validated models on a development cohort (n=2043) and evaluated performance on a longitudinal test set (n=395) with five-year follow-up. ECG-DiaNet outperformed unimodal ECG-only and CRF-only models, achieving a higher AUROC (0.845 vs 0.8217) than the CRF-only model, with statistical significance (DeLong p<0.001). Reclassification metrics further confirmed improvements: Net Reclassification Improvement (NRI=0.0153) and Integrated Discrimination Improvement (IDI=0.0482). Risk stratification into low-, medium-, and high-risk groups showed ECG-DiaNet achieved superior positive predictive value (PPV) in high-risk individuals. The model's reliance on non-invasive and widely available ECG signals supports its feasibility in clinical and community health settings. By combining cardiac electrophysiology and systemic risk profiles, ECG-DiaNet addresses the multifactorial nature of T2DM and supports precision prevention. These findings highlight the value of multimodal AI in advancing early detection and prevention strategies for T2DM, particularly in underrepresented Middle Eastern populations.

Electrocardiogram (ECG) signals are widely shared across multiple clinical applications for diagnosis, health monitoring, and biometric authentication. While valuable for healthcare, they also carry unique biometric identifiers that pose privacy risks, especially when ECG data shared across multiple entities. These risks are amplified in shared environments, where re-identification threats can compromise patient privacy. Existing deep learning re-identification models prioritize accuracy but lack explainability, making it challenging to understand how the unique biometric characteristics encoded within ECG signals are recognized and utilized for identification. Without these insights, despite high accuracy, developing secure and trustable ECG data-sharing frameworks remains difficult, especially in diverse, multi-source environments. In this work, we introduce TransECG, a Vision Transformer (ViT)-based method that uses attention mechanisms to pinpoint critical ECG segments associated with re-identification tasks like gender, age, and participant ID. Our approach demonstrates high accuracy (89.9% for gender, 89.9% for age, and 88.6% for ID re-identification) across four real-world datasets with 87 participants. Importantly, we provide key insights into ECG components such as the R-wave, QRS complex, and P-Q interval in re-identification. For example, in the gender classification, the R wave contributed 58.29% to the model's attention, while in the age classification, the P-R interval contributed 46.29%. By combining high predictive performance with enhanced explainability, TransECG provides a robust solution for privacy-conscious ECG data sharing, supporting the development of secure and trusted healthcare data environment.

While recent multimodal large language models (MLLMs) have advanced automated ECG interpretation, they still face two key limitations: (1) insufficient multimodal synergy between time series signals and visual ECG representations, and (2) limited explainability in linking diagnoses to granular waveform evidence. We introduce GEM, the first MLLM unifying ECG time series, 12-lead ECG images and text for grounded and clinician-aligned ECG interpretation. GEM enables feature-grounded analysis, evidence-driven reasoning, and a clinician-like diagnostic process through three core innovations: a dual-encoder framework extracting complementary time series and image features, cross-modal alignment for effective multimodal understanding, and knowledge-guided instruction generation for generating high-granularity grounding data (ECG-Grounding) linking diagnoses to measurable parameters ($e.g.$, QRS/PR Intervals). Additionally, we propose the Grounded ECG Understanding task, a clinically motivated benchmark designed to comprehensively assess the MLLM's capability in grounded ECG understanding. Experimental results on both existing and our proposed benchmarks show GEM significantly improves predictive performance (CSN $7.4\% \uparrow$), explainability ($22.7\% \uparrow$), and grounding ($24.8\% \uparrow$), making it more suitable for real-world clinical applications. GitHub repository: https://github.com/lanxiang1017/GEM.git

Electrocardiogram (ECG) analysis has emerged as a promising tool for identifying physiological changes associated with neuropsychiatric conditions. The relationship between cardiovascular health and neuropsychiatric disorders suggests that ECG abnormalities could serve as valuable biomarkers for more efficient detection, therapy monitoring, and risk stratification. However, the potential of the ECG to accurately distinguish neuropsychiatric conditions, particularly among diverse patient populations, remains underexplored. This study utilized ECG markers and basic demographic data to predict neuropsychiatric conditions using machine learning models, with targets defined through ICD-10 codes. Both internal and external validation were performed using the MIMIC-IV and ECG-View datasets respectively. Performance was assessed using AUROC scores. To enhance model interpretability, Shapley values were applied to provide insights into the contributions of individual ECG features to the predictions. Significant predictive performance was observed for conditions within the neurological and psychiatric groups. For the neurological group, Alzheimer's disease (G30) achieved an internal AUROC of 0.813 (0.812-0.814) and an external AUROC of 0.868 (0.867-0.868). In the psychiatric group, unspecified dementia (F03) showed an internal AUROC of 0.849 (0.848-0.849) and an external AUROC of 0.862 (0.861-0.863). Discriminative features align with known ECG markers but also provide hints on potentially new markers. ECG offers significant promise for diagnosing and monitoring neuropsychiatric conditions, with robust predictive performance across internal and external cohorts. Future work should focus on addressing potential confounders, such as therapy-related cardiotoxicity, and expanding the scope of ECG applications, including personalized care and early intervention strategies.

Background: Neoplasms remains a leading cause of mortality worldwide, with timely diagnosis being crucial for improving patient outcomes. Current diagnostic methods are often invasive, costly, and inaccessible to many populations. Electrocardiogram (ECG) data, widely available and non-invasive, has the potential to serve as a tool for neoplasms diagnosis by using physiological changes in cardiovascular function associated with neoplastic prescences. Methods: This study explores the application of machine learning models to analyze ECG features for the diagnosis of neoplasms. We developed a pipeline integrating tree-based models with Shapley values for explainability. The model was trained and internally validated and externally validated on a second large-scale independent external cohort to ensure robustness and generalizability. Findings: The results demonstrate that ECG data can effectively capture neoplasms-associated cardiovascular changes, achieving high performance in both internal testing and external validation cohorts. Shapley values identified key ECG features influencing model predictions, revealing established and novel cardiovascular markers linked to neoplastic conditions. This non-invasive approach provides a cost-effective and scalable alternative for the diagnosis of neoplasms, particularly in resource-limited settings. Similarly, useful for the management of secondary cardiovascular effects given neoplasms therapies. Interpretation: This study highlights the feasibility of leveraging ECG signals and machine learning to enhance neoplasms diagnostics. By offering interpretable insights into cardio-neoplasms interactions, this approach bridges existing gaps in non-invasive diagnostics and has implications for integrating ECG-based tools into broader neoplasms diagnostic frameworks, as well as neoplasms therapy management.

Background: Liver diseases are a major global health concern, often diagnosed using resource-intensive methods. Electrocardiogram (ECG) data, widely accessible and non-invasive, offers potential as a diagnostic tool for liver diseases, leveraging the physiological connections between cardiovascular and hepatic health. Methods: This study applies machine learning models to ECG data for the diagnosis of liver diseases. The pipeline, combining tree-based models with Shapley values for explainability, was trained, internally validated, and externally validated on an independent cohort, demonstrating robust generalizability. Findings: Our results demonstrate the potential of ECG to derive biomarkers to diagnose liver diseases. Shapley values revealed key ECG features contributing to model predictions, highlighting already known connections between cardiovascular biomarkers and hepatic conditions as well as providing new ones. Furthermore, our approach holds promise as a scalable and affordable solution for liver disease detection, particularly in resource-limited settings. Interpretation: This study underscores the feasibility of leveraging ECG features and machine learning to enhance the diagnosis of liver diseases. By providing interpretable insights into cardiovascular-liver interactions, the approach bridges existing gaps in non-invasive diagnostics, offering implications for broader systemic disease monitoring.

Electrocardiogram (ECG) captures the heart's electrical signals, offering valuable information for diagnosing cardiac conditions. However, the scarcity of labeled data makes it challenging to fully leverage supervised learning in medical domain. Self-supervised learning (SSL) offers a promising solution, enabling models to learn from unlabeled data and uncover meaningful patterns. In this paper, we show that masked modeling in the latent space can be a powerful alternative to existing self-supervised methods in the ECG domain. We introduce ECG-JEPA, a SSL model for 12-lead ECG analysis that learns semantic representations of ECG data by predicting in the hidden latent space, bypassing the need to reconstruct raw signals. This approach offers several advantages in the ECG domain: (1) it avoids producing unnecessary details, such as noise, which is common in ECG; and (2) it addresses the limitations of na\"ive L2 loss between raw signals. Another key contribution is the introduction of Cross-Pattern Attention (CroPA), a specialized masked attention mechanism tailored for 12-lead ECG data. ECG-JEPA is trained on the union of several open ECG datasets, totaling approximately 180,000 samples, and achieves state-of-the-art performance in various downstream tasks including ECG classification and feature prediction. Our code is openly available at https://github.com/sehunfromdaegu/ECG_JEPA.

Introduction: Laboratory value represents a cornerstone of medical diagnostics, but suffers from slow turnaround times, and high costs and only provides information about a single point in time. The continuous estimation of laboratory values from non-invasive data such as electrocardiogram (ECG) would therefore mark a significant frontier in healthcare monitoring. Despite its transformative potential, this domain remains relatively underexplored within the medical community. Methods: In this preliminary study, we used a publicly available dataset (MIMIC-IV-ECG) to investigate the feasibility of inferring laboratory values from ECG features and patient demographics using tree-based models (XGBoost). We define the prediction task as a binary prediction problem of predicting whether the lab value falls into low or high abnormalities. The model performance can then be assessed using AUROC. Results: Our findings demonstrate promising results in the estimation of laboratory values related to different organ systems based on a small yet comprehensive set of features. While further research and validation are warranted to fully assess the clinical utility and generalizability of ECG-based estimation in healthcare monitoring, our findings lay the groundwork for future investigations into approaches to laboratory value estimation using ECG data. Such advancements hold promise for revolutionizing predictive healthcare applications, offering faster, non-invasive, and more affordable means of patient monitoring.

Introduction: Ensuring timely and accurate diagnosis of medical conditions is paramount for effective patient care. Electrocardiogram (ECG) signals are fundamental for evaluating a patient's cardiac health and are readily available. Despite this, little attention has been given to the remarkable potential of ECG data in detecting non-cardiac conditions. Methods: In our study, we used publicly available datasets (MIMIC-IV-ECG-ICD and ECG-VIEW II) to investigate the feasibility of inferring general diagnostic conditions from ECG features. To this end, we trained a tree-based model (XGBoost) based on ECG features and basic demographic features to estimate a wide range of diagnoses, encompassing both cardiac and non-cardiac conditions. Results: Our results demonstrate the reliability of estimating 23 cardiac as well as 21 non-cardiac conditions above 0.7 AUROC in a statistically significant manner across a wide range of physiological categories. Our findings underscore the predictive potential of ECG data in identifying well-known cardiac conditions. However, even more striking, this research represents a pioneering effort in systematically expanding the scope of ECG-based diagnosis to conditions not traditionally associated with the cardiac system.