Electrocardiogram (ECG) classification is crucial for automated cardiac disease diagnosis, yet existing methods often struggle to capture local morphological details and long-range temporal dependencies simultaneously. To address these challenges, we propose Cardioformer, a novel multi-granularity hybrid model that integrates cross-channel patching, hierarchical residual learning, and a two-stage self-attention mechanism. Cardioformer first encodes multi-scale token embeddings to capture fine-grained local features and global contextual information and then selectively fuses these representations through intra- and inter-granularity self-attention. Extensive evaluations on three benchmark ECG datasets under subject-independent settings demonstrate that model consistently outperforms four state-of-the-art baselines. Our Cardioformer model achieves the AUROC of 96.34$\pm$0.11, 89.99$\pm$0.12, and 95.59$\pm$1.66 in MIMIC-IV, PTB-XL and PTB dataset respectively outperforming PatchTST, Reformer, Transformer, and Medformer models. It also demonstrates strong cross-dataset generalization, achieving 49.18% AUROC on PTB and 68.41% on PTB-XL when trained on MIMIC-IV. These findings underscore the potential of Cardioformer to advance automated ECG analysis, paving the way for more accurate and robust cardiovascular disease diagnosis. We release the source code at https://github.com/KMobin555/Cardioformer.
Deep learning-based electrocardiogram (ECG) classification has shown impressive performance but clinical adoption has been slowed by the lack of transparent and faithful explanations. Post hoc methods such as saliency maps may fail to reflect a model's true decision process. Prototype-based reasoning offers a more transparent alternative by grounding decisions in similarity to learned representations of real ECG segments, enabling faithful, case-based explanations. We introduce ProtoECGNet, a prototype-based deep learning model for interpretable, multi-label ECG classification. ProtoECGNet employs a structured, multi-branch architecture that reflects clinical interpretation workflows: it integrates a 1D CNN with global prototypes for rhythm classification, a 2D CNN with time-localized prototypes for morphology-based reasoning, and a 2D CNN with global prototypes for diffuse abnormalities. Each branch is trained with a prototype loss designed for multi-label learning, combining clustering, separation, diversity, and a novel contrastive loss that encourages appropriate separation between prototypes of unrelated classes while allowing clustering for frequently co-occurring diagnoses. We evaluate ProtoECGNet on all 71 diagnostic labels from the PTB-XL dataset, demonstrating competitive performance relative to state-of-the-art black-box models while providing structured, case-based explanations. To assess prototype quality, we conduct a structured clinician review of the final model's projected prototypes, finding that they are rated as representative and clear. ProtoECGNet shows that prototype learning can be effectively scaled to complex, multi-label time-series classification, offering a practical path toward transparent and trustworthy deep learning models for clinical decision support.
DCentNet is a novel decentralized multistage signal classification approach designed for biomedical data from IoT wearable sensors, integrating early exit points (EEP) to enhance energy efficiency and processing speed. Unlike traditional centralized processing methods, which result in high energy consumption and latency, DCentNet partitions a single CNN model into multiple sub-networks using EEPs. By introducing encoder-decoder pairs at EEPs, the system compresses large feature maps before transmission, significantly reducing wireless data transfer and power usage. If an input is confidently classified at an EEP, processing stops early, optimizing efficiency. Initial sub-networks can be deployed on fog or edge devices to further minimize energy consumption. A genetic algorithm is used to optimize EEP placement, balancing performance and complexity. Experimental results on ECG classification show that with one EEP, DCentNet reduces wireless data transmission by 94.54% and complexity by 21%, while maintaining original accuracy and sensitivity. With two EEPs, sensitivity reaches 98.36%, accuracy 97.74%, wireless data transmission decreases by 91.86%, and complexity is reduced by 22%. Implemented on an ARM Cortex-M4 MCU, DCentNet achieves an average power saving of 73.6% compared to continuous wireless ECG transmission.
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.
Electrocardiograms (ECG), which record the electrophysiological activity of the heart, have become a crucial tool for diagnosing these diseases. In recent years, the application of deep learning techniques has significantly improved the performance of ECG signal classification. Multi-resolution feature analysis, which captures and processes information at different time scales, can extract subtle changes and overall trends in ECG signals, showing unique advantages. However, common multi-resolution analysis methods based on simple feature addition or concatenation may lead to the neglect of low-resolution features, affecting model performance. To address this issue, this paper proposes the Multi-Resolution Mutual Learning Network (MRM-Net). MRM-Net includes a dual-resolution attention architecture and a feature complementary mechanism. The dual-resolution attention architecture processes high-resolution and low-resolution features in parallel. Through the attention mechanism, the high-resolution and low-resolution branches can focus on subtle waveform changes and overall rhythm patterns, enhancing the ability to capture critical features in ECG signals. Meanwhile, the feature complementary mechanism introduces mutual feature learning after each layer of the feature extractor. This allows features at different resolutions to reinforce each other, thereby reducing information loss and improving model performance and robustness. Experiments on the PTB-XL and CPSC2018 datasets demonstrate that MRM-Net significantly outperforms existing methods in multi-label ECG classification performance. The code for our framework will be publicly available at https://github.com/wxhdf/MRM.
This research paper explores ways to apply Federated Learning (FL) and Differential Privacy (DP) techniques to population-scale Electrocardiogram (ECG) data. The study learns a multi-label ECG classification model using FL and DP based on 1,565,849 ECG tracings from 7 hospitals in Alberta, Canada. The FL approach allowed collaborative model training without sharing raw data between hospitals while building robust ECG classification models for diagnosing various cardiac conditions. These accurate ECG classification models can facilitate the diagnoses while preserving patient confidentiality using FL and DP techniques. Our results show that the performance achieved using our implementation of the FL approach is comparable to that of the pooled approach, where the model is trained over the aggregating data from all hospitals. Furthermore, our findings suggest that hospitals with limited ECGs for training can benefit from adopting the FL model compared to single-site training. In addition, this study showcases the trade-off between model performance and data privacy by employing DP during model training. Our code is available at https://github.com/vikhyatt/Hospital-FL-DP.
Traditionally, machine learning-based clinical prediction models have been trained and evaluated on patient data from a single source, such as a hospital. Cross-validation methods can be used to estimate the accuracy of such models on new patients originating from the same source, by repeated random splitting of the data. However, such estimates tend to be highly overoptimistic when compared to accuracy obtained from deploying models to sources not represented in the dataset, such as a new hospital. The increasing availability of multi-source medical datasets provides new opportunities for obtaining more comprehensive and realistic evaluations of expected accuracy through source-level cross-validation designs. In this study, we present a systematic empirical evaluation of standard K-fold cross-validation and leave-source-out cross-validation methods in a multi-source setting. We consider the task of electrocardiogram based cardiovascular disease classification, combining and harmonizing the openly available PhysioNet CinC Challenge 2021 and the Shandong Provincial Hospital datasets for our study. Our results show that K-fold cross-validation, both on single-source and multi-source data, systemically overestimates prediction performance when the end goal is to generalize to new sources. Leave-source-out cross-validation provides more reliable performance estimates, having close to zero bias though larger variability. The evaluation highlights the dangers of obtaining misleading cross-validation results on medical data and demonstrates how these issues can be mitigated when having access to multi-source data.
Electrocardiograms (ECGs) are non-invasive diagnostic tools crucial for detecting cardiac arrhythmic diseases in clinical practice. While ECG Self-supervised Learning (eSSL) methods show promise in representation learning from unannotated ECG data, they often overlook the clinical knowledge that can be found in reports. This oversight and the requirement for annotated samples for downstream tasks limit eSSL's versatility. In this work, we address these issues with the Multimodal ECG Representation Learning (MERL}) framework. Through multimodal learning on ECG records and associated reports, MERL is capable of performing zero-shot ECG classification with text prompts, eliminating the need for training data in downstream tasks. At test time, we propose the Clinical Knowledge Enhanced Prompt Engineering (CKEPE) approach, which uses Large Language Models (LLMs) to exploit external expert-verified clinical knowledge databases, generating more descriptive prompts and reducing hallucinations in LLM-generated content to boost zero-shot classification. Based on MERL, we perform the first benchmark across six public ECG datasets, showing the superior performance of MERL compared against eSSL methods. Notably, MERL achieves an average AUC score of 75.2% in zero-shot classification (without training data), 3.2% higher than linear probed eSSL methods with 10\% annotated training data, averaged across all six datasets. Code and models are available at https://github.com/cheliu-computation/MERL
Electrocardiograms (ECG) are widely employed as a diagnostic tool for monitoring electrical signals originating from a heart. Recent machine learning research efforts have focused on the application of screening various diseases using ECG signals. However, adapting to the application of screening disease is challenging in that labeled ECG data are limited. Achieving general representation through self-supervised learning (SSL) is a well-known approach to overcome the scarcity of labeled data; however, a naive application of SSL to ECG data, without considering the spatial-temporal relationships inherent in ECG signals, may yield suboptimal results. In this paper, we introduce ST-MEM (Spatio-Temporal Masked Electrocardiogram Modeling), designed to learn spatio-temporal features by reconstructing masked 12-lead ECG data. ST-MEM outperforms other SSL baseline methods in various experimental settings for arrhythmia classification tasks. Moreover, we demonstrate that ST-MEM is adaptable to various lead combinations. Through quantitative and qualitative analysis, we show a spatio-temporal relationship within ECG data. Our code is available at https://github.com/bakqui/ST-MEM.
The adoption of deep learning in ECG diagnosis is often hindered by the scarcity of large, well-labeled datasets in real-world scenarios, leading to the use of transfer learning to leverage features learned from larger datasets. Yet the prevailing assumption that transfer learning consistently outperforms training from scratch has never been systematically validated. In this study, we conduct the first extensive empirical study on the effectiveness of transfer learning in multi-label ECG classification, by investigating comparing the fine-tuning performance with that of training from scratch, covering a variety of ECG datasets and deep neural networks. We confirm that fine-tuning is the preferable choice for small downstream datasets; however, when the dataset is sufficiently large, training from scratch can achieve comparable performance, albeit requiring a longer training time to catch up. Furthermore, we find that transfer learning exhibits better compatibility with convolutional neural networks than with recurrent neural networks, which are the two most prevalent architectures for time-series ECG applications. Our results underscore the importance of transfer learning in ECG diagnosis, yet depending on the amount of available data, researchers may opt not to use it, considering the non-negligible cost associated with pre-training.
Sleep apnea (SA) is a significant respiratory condition that poses a major global health challenge. Previous studies have investigated several machine and deep learning models for electrocardiogram (ECG)-based SA diagnoses. Despite these advancements, conventional feature extractions derived from ECG signals, such as R-peaks and RR intervals, may fail to capture crucial information encompassed within the complete PQRST segments. In this study, we propose an innovative approach to address this diagnostic gap by delving deeper into the comprehensive segments of the ECG signal. The proposed methodology draws inspiration from Matrix Profile algorithms, which generate an Euclidean distance profile from fixed-length signal subsequences. From this, we derived the Min Distance Profile (MinDP), Max Distance Profile (MaxDP), and Mean Distance Profile (MeanDP) based on the minimum, maximum, and mean of the profile distances, respectively. To validate the effectiveness of our approach, we use the modified LeNet-5 architecture as the primary CNN model, along with two existing lightweight models, BAFNet and SE-MSCNN, for ECG classification tasks. Our extensive experimental results on the PhysioNet Apnea-ECG dataset revealed that with the new feature extraction method, we achieved a per-segment accuracy up to 92.11 \% and a per-recording accuracy of 100\%. Moreover, it yielded the highest correlation compared to state-of-the-art methods, with a correlation coefficient of 0.989. By introducing a new feature extraction method based on distance relationships, we enhanced the performance of certain lightweight models, showing potential for home sleep apnea test (HSAT) and SA detection in IoT devices. The source code for this work is made publicly available in GitHub: https://github.com/vinuni-vishc/MPCNN-Sleep-Apnea.
In practical electrocardiography (ECG) interpretation, the scarcity of well-annotated data is a common challenge. Transfer learning techniques are valuable in such situations, yet the assessment of transferability has received limited attention. To tackle this issue, we introduce MELEP, which stands for Muti-label Expected Log of Empirical Predictions, a measure designed to estimate the effectiveness of knowledge transfer from a pre-trained model to a downstream multi-label ECG diagnosis task. MELEP is generic, working with new target data with different label sets, and computationally efficient, requiring only a single forward pass through the pre-trained model. To the best of our knowledge, MELEP is the first transferability metric specifically designed for multi-label ECG classification problems. Our experiments show that MELEP can predict the performance of pre-trained convolutional and recurrent deep neural networks, on small and imbalanced ECG data. Specifically, we observed strong correlation coefficients (with absolute values exceeding 0.6 in most cases) between MELEP and the actual average F1 scores of the fine-tuned models. Our work highlights the potential of MELEP to expedite the selection of suitable pre-trained models for ECG diagnosis tasks, saving time and effort that would otherwise be spent on fine-tuning these models.
Reasonably and effectively monitoring arrhythmias through ECG signals has significant implications for human health. With the development of deep learning, numerous ECG classification algorithms based on deep learning have emerged. However, most existing algorithms trade off high accuracy for complex models, resulting in high storage usage and power consumption. This also inevitably increases the difficulty of implementation on wearable Artificial Intelligence-of-Things (AIoT) devices with limited resources. In this study, we proposed a universally applicable ultra-lightweight binary neural network(BNN) that is capable of 5-class and 17-class arrhythmia classification based on ECG signals. Our BNN achieves 96.90% (full precision 97.09%) and 97.50% (full precision 98.00%) accuracy for 5-class and 17-class classification, respectively, with state-of-the-art storage usage (3.76 KB and 4.45 KB). Compared to other binarization works, our approach excels in supporting two multi-classification modes while achieving the smallest known storage space. Moreover, our model achieves optimal accuracy in 17-class classification and boasts an elegantly simple network architecture. The algorithm we use is optimized specifically for hardware implementation. Our research showcases the potential of lightweight deep learning models in the healthcare industry, specifically in wearable medical devices, which hold great promise for improving patient outcomes and quality of life. Code is available on: https://github.com/xpww/ECG_BNN_Net
The field of deep-learning-based ECG analysis has been largely dominated by convolutional architectures. This work explores the prospects of applying the recently introduced structured state space models (SSMs) as a particularly promising approach due to its ability to capture long-term dependencies in time series. We demonstrate that this approach leads to significant improvements over the current state-of-the-art for ECG classification, which we trace back to individual pathologies. Furthermore, the model's ability to capture long-term dependencies allows to shed light on long-standing questions in the literature such as the optimal sampling rate or window size to train classification models. Interestingly, we find no evidence for using data sampled at 500Hz as opposed to 100Hz and no advantages from extending the model's input size beyond 3s. Based on this very promising first assessment, SSMs could develop into a new modeling paradigm for ECG analysis.
Electrocardiogram (ECG) signal is one of the most effective sources of information mainly employed for the diagnosis and prediction of cardiovascular diseases (CVDs) connected with the abnormalities in heart rhythm. Clearly, single modality ECG (i.e. time series) cannot convey its complete characteristics, thus, exploiting both time and time-frequency modalities in the form of time-series data and spectrogram is needed. Leveraging the cutting-edge self-supervised learning (SSL) technique on unlabeled data, we propose SSL-based multimodality ECG classification. Our proposed network follows SSL learning paradigm and consists of two modules corresponding to pre-stream task, and down-stream task, respectively. In the SSL-pre-stream task, we utilize self-knowledge distillation (KD) techniques with no labeled data, on various transformations and in both time and frequency domains. In the down-stream task, which is trained on labeled data, we propose a gate fusion mechanism to fuse information from multimodality.To evaluate the effectiveness of our approach, ten-fold cross validation on the 12-lead PhysioNet 2020 dataset has been conducted.
Nowadays, an increasing number of people are being diagnosed with cardiovascular diseases (CVDs), the leading cause of death globally. The gold standard for identifying these heart problems is via electrocardiogram (ECG). The standard 12-lead ECG is widely used in clinical practice and the majority of current research. However, using a lower number of leads can make ECG more pervasive as it can be integrated with portable or wearable devices. This article introduces two novel techniques to improve the performance of the current deep learning system for 3-lead ECG classification, making it comparable with models that are trained using standard 12-lead ECG. Specifically, we propose a multi-task learning scheme in the form of the number of heartbeats regression and an effective mechanism to integrate patient demographic data into the system. With these two advancements, we got classification performance in terms of F1 scores of 0.9796 and 0.8140 on two large-scale ECG datasets, i.e., Chapman and CPSC-2018, respectively, which surpassed current state-of-the-art ECG classification methods, even those trained on 12-lead data. To encourage further development, our source code is publicly available at https://github.com/lhkhiem28/LightX3ECG.
Cardiovascular diseases (CVDs) are a group of heart and blood vessel disorders that is one of the most serious dangers to human health, and the number of such patients is still growing. Early and accurate detection plays a key role in successful treatment and intervention. Electrocardiogram (ECG) is the gold standard for identifying a variety of cardiovascular abnormalities. In clinical practices and most of the current research, standard 12-lead ECG is mainly used. However, using a lower number of leads can make ECG more prevalent as it can be conveniently recorded by portable or wearable devices. In this research, we develop a novel deep learning system to accurately identify multiple cardiovascular abnormalities by using only three ECG leads.
Artificial intelligence has made great progress in medical data analysis, but the lack of robustness and trustworthiness has kept these methods from being widely deployed. As it is not possible to train networks that are accurate in all scenarios, models must recognize situations where they cannot operate confidently. Bayesian deep learning methods sample the model parameter space to estimate uncertainty, but these parameters are often subject to the same vulnerabilities, which can be exploited by adversarial attacks. We propose a novel ensemble approach based on feature decorrelation and Fourier partitioning for teaching networks diverse complementary features, reducing the chance of perturbation-based fooling. We test our approach on single and multi-channel electrocardiogram classification, and adapt adversarial training and DVERGE into the Bayesian ensemble framework for comparison. Our results indicate that the combination of decorrelation and Fourier partitioning generally maintains performance on unperturbed data while demonstrating superior robustness and uncertainty estimation on projected gradient descent and smooth adversarial attacks of various magnitudes. Furthermore, our approach does not require expensive optimization with adversarial samples, adding much less compute to the training process than adversarial training or DVERGE. These methods can be applied to other tasks for more robust and trustworthy models.
This paper proposes a low-cost and highly accurate ECG-monitoring system intended for personalized early arrhythmia detection for wearable mobile sensors. Earlier supervised approaches for personalized ECG monitoring require both abnormal and normal heartbeats for the training of the dedicated classifier. However, in a real-world scenario where the personalized algorithm is embedded in a wearable device, such training data is not available for healthy people with no cardiac disorder history. In this study, (i) we propose a null space analysis on the healthy signal space obtained via sparse dictionary learning, and investigate how a simple null space projection or alternatively regularized least squares-based classification methods can reduce the computational complexity, without sacrificing the detection accuracy, when compared to sparse representation-based classification. (ii) Then we introduce a sparse representation-based domain adaptation technique in order to project other existing users' abnormal and normal signals onto the new user's signal space, enabling us to train the dedicated classifier without having any abnormal heartbeat of the new user. Therefore, zero-shot learning can be achieved without the need for synthetic abnormal heartbeat generation. An extensive set of experiments performed on the benchmark MIT-BIH ECG dataset shows that when this domain adaptation-based training data generator is used with a simple 1-D CNN classifier, the method outperforms the prior work by a significant margin. (iii) Then, by combining (i) and (ii), we propose an ensemble classifier that further improves the performance. This approach for zero-shot arrhythmia detection achieves an average accuracy level of 98.2% and an F1-Score of 92.8%. Finally, a personalized energy-efficient ECG monitoring scheme is proposed using the above-mentioned innovations.
A large number of people suffer from life-threatening cardiac abnormalities, and electrocardiogram (ECG) analysis is beneficial to determining whether an individual is at risk of such abnormalities. Automatic ECG classification methods, especially the deep learning based ones, have been proposed to detect cardiac abnormalities using ECG records, showing good potential to improve clinical diagnosis and help early prevention of cardiovascular diseases. However, the predictions of the known neural networks still do not satisfactorily meet the needs of clinicians, and this phenomenon suggests that some information used in clinical diagnosis may not be well captured and utilized by these methods. In this paper, we introduce some rules into convolutional neural networks, which help present clinical knowledge to deep learning based ECG analysis, in order to improve automated ECG diagnosis performance. Specifically, we propose a Handcrafted-Rule-enhanced Neural Network (called HRNN) for ECG classification with standard 12-lead ECG input, which consists of a rule inference module and a deep learning module. Experiments on two large-scale public ECG datasets show that our new approach considerably outperforms existing state-of-the-art methods. Further, our proposed approach not only can improve the diagnosis performance, but also can assist in detecting mislabelled ECG samples. Our codes are available at https://github.com/alwaysbyx/ecg_processing.