arXiv subjects

Guangkun Nie

Publications and source records attributed to Guangkun Nie.

17 recordsLinked to original sources

arXiv2026

Fine-tuning an ECG Foundation Model to Predict Coronary CT Angiography Outcomes

Coronary artery disease (CAD) remains a major global public health burden, yet scalable pre-imaging risk stratification tools are limited. In this multicenter study, we developed and validated an artificial intelligence-enabled electrocardiography (AI-ECG) model using coronary computed tomographic angiography (CCTA) as the anatomical reference to predict vessel-specific hemodynamically significant stenosis ($\geq 70\%$ for RCA, LAD, LCX; $\geq 50\%$ for LM). The model was evaluated in internal and external cohorts, clinically normal ECGs, and prespecified demographic and clinical subgroups. It showed discrimination across vessels in internal validation and consistent external and normal ECG performance. Predicted probabilities increased with CCTA-defined stenosis severity and were converted into vessel-specific low-, intermediate-, and high-risk strata. Calibration and decision curve analyses supported its clinical utility. Integration with guideline-based pre-test probability improved risk reclassification, enhanced rule-out performance, and reduced the gray-zone proportion. In longitudinal follow-up, model-defined risk groups showed clear separation in major adverse cardiovascular events. Waveform- and attribution-based analyses identified structured ECG differences and physiologically meaningful signal regions linked to high-risk predictions. These results support AI-ECG as a feasible tool for pre-imaging risk stratification and clinical triage, warranting prospective validation in broader clinical settings.

cs.CV↗

arXiv2026

Smartwatch Photoplethysmography-Derived Heart Age via ECG-Guided Cross-Modal Pretraining as a Digital Biomarker of Vascular Aging

Digital biomarkers of cardiovascular aging, often termed heart or vascular age, have been widely studied, but most rely on resting electrocardiography (ECG), imaging, or specialized vascular assessments. Evidence linking wearable photoplethysmography (PPG) to arterial stiffness and hypertension remains limited. We developed an ECG-guided cross-modal framework that uses synchronized smartwatch ECG to enhance PPG representation learning during pretraining while requiring only PPG at inference. The study included three OPPO cohorts across China, comprising 581,804 participants and 7,452,131 recordings. The Vascular Health Study cohort supported ECG-PPG self-supervised pretraining, fine-tuning, and internal validation, while two external cohorts assessed associations with pulse wave velocity (PWV) and prevalent hypertension. Combining subject-aware learning with ECG-PPG contrastive alignment, the PPG-only model achieved subject-level mean absolute errors of 5.895 years (Pearson r=0.819) in the PWV cohort and 4.344 years (r=0.800) in the home blood pressure monitoring cohort. Aggregating repeated recordings further improved short-term stability. After adjustment for chronological age, heart age gap was associated with PWV (partial r=0.2627, P<0.001); each 1-year increase corresponded to 0.062 m/s higher PWV, and accelerated versus decelerated heart aging was associated with 0.91 m/s higher adjusted PWV. Each 1-SD increase in adjusted heart age gap was associated with greater odds of prevalent hypertension (OR 1.72, 95% CI 1.49-1.99), while the highest versus lowest quartile had an OR of 4.25. These findings support smartwatch PPG-derived heart age gap as a scalable digital biomarker of arterial stiffness and prevalent hypertension.

eess.SP↗

arXiv2026

EchoBridge: Long-Tail-Aware ECG-Echocardiography Text Alignment for Echocardiography-Derived Cardiac Findings

Standardized echocardiography conclusions provide meaningful supervision for learning ECG representations of echocardiography-derived cardiac findings. Global ECG--text alignment may entangle modality-specific factors, while long-tailed finding distributions provide sparse positive supervision for low-prevalence conditions. We propose EchoBridge with Complementary Shared--Private Projection (CSPP) and Adaptive Prototype Boundary Calibration (APBC). CSPP maps each modality into shared and auxiliary private projections, reduces directional redundancy via within-modality orthogonality, and bidirectionally aligns normalized shared projections. APBC organizes the shared hypersphere with class-specific prototypes, training-frequency-adaptive angular margins, and spherical Riesz repulsion. We evaluate EchoBridge on EchoNext-Mini and independent PKUPH and SHTMU cohorts under four protocols: prompt-based inference without downstream classifier training, in-domain frozen linear probing, target-domain cross-center frozen linear probing, and source-only cross-center transfer, supplemented by finding-specific analyses. EchoBridge improves classifier-free AUROC, AUPRC, and F1 over the strongest baselines by 7.88, 5.61, and 4.54 points, respectively, and achieves the highest point estimates across all in-domain and target-domain probing budgets and both source-only transfer cohorts. Finding-specific analyses show gains for most conditions, including several low-prevalence valvular findings.

cs.LG↗

arXiv2026

ImputeECG: Deep Learning Reconstruction of Complete 12-Lead Electrocardiograms from Incomplete Recordings for Cardiac Assessment

Complete digital 12-lead electrocardiograms (ECGs) are essential for AI-enabled cardiovascular assessment, yet many clinical ECG records, particularly those digitized from ECG images, remain incomplete because of short display formats, incomplete waveform digitization, lead loss, or signal corruption. We developed ImputeECG, a mask-conditioned one-dimensional Transformer autoencoder that completes 12-lead, 10-s ECGs while retaining all observed samples. The model was trained on PTB-XL and evaluated on PTB-XL and CPSC2018 under simulated incomplete settings, with additional real-world validation in a 43,633-record Kailuan clinical cohort after ECG image digitization. Metrics were computed over originally missing regions, with analyses of morphology and downstream diagnostic utility. On PTB-XL, ImputeECG reduced missing-region MAE by 41.7-51.0% and MSE by 54.0-63.7% versus the strongest baseline, with lower errors in R-peak timing, RR interval, QRS duration, QT interval, and P-wave, QRS-complex, and T-wave reconstruction. On CPSC2018, ImputeECG reduced MAE by 49.7-51.9%, supporting external generalization. In downstream multi-label classification, ImputeECG restored performance to 92.28% AUROC and 33.88% AUPRC in the most incomplete PTB-XL setting, approaching complete-ECG performance. On CPSC2018, completed ECGs achieved 94.75-95.89% AUROC and 78.83-81.86% AUPRC across settings. In Kailuan, ECG completion improved zero-shot sex prediction AUROC from 82.6% to 85.8% and reduced age prediction MAE from 10.72 to 9.87 years after image-based ECG digitization. These findings support ECG completion as a practical strategy for converting incomplete ECG records into AI-ready 12-lead, 10-s digital signals and extending the usable scope of ECG archives for digital cardiac assessment.

cs.LG↗

arXiv2026

ECGFlowCMR: Pretraining with ECG-Generated Cine CMR Helps Cardiac Disease Classification and Phenotype Prediction

Cardiac Magnetic Resonance (CMR) imaging provides a comprehensive assessment of cardiac structure and function but remains constrained by high acquisition costs and reliance on expert annotations, limiting the availability of large-scale labeled datasets. In contrast, electrocardiograms (ECGs) are inexpensive, widely accessible, and offer a promising modality for conditioning the generative synthesis of cine CMR. To this end, we propose ECGFlowCMR, a novel ECG-to-CMR generative framework that integrates a Phase-Aware Masked Autoencoder (PA-MAE) and an Anatomy-Motion Disentangled Flow (AMDF) to address two fundamental challenges: (1) the cross-modal temporal mismatch between multi-beat ECG recordings and single-cycle CMR sequences, and (2) the anatomical observability gap due to the limited structural information inherent in ECGs. Extensive experiments on the UK Biobank and a proprietary clinical dataset demonstrate that ECGFlowCMR can generate realistic cine CMR sequences from ECG inputs, enabling scalable pretraining and improving performance on downstream cardiac disease classification and phenotype prediction tasks.

eess.IV↗

arXiv2026

CausalMoE: A Billion-Scale Multimodal Foundation Model for Granger Causal Discovery with Pattern-Routed Heterogeneous Experts

Granger Causal Discovery (GCD) is fundamental for analyzing temporal dependencies in complex systems. However, existing neural GCD methods predominantly rely on a "one-size-fits-all" paradigm, struggling to capture distribution shifts and dynamic regime changes inherent in real-world time series. This often leads to entangled representations and spurious causal graphs. In this paper, we propose CausalMoE, a billion-scale multimodal Granger causal foundation model that explicitly models patch-level heterogeneity. CausalMoE introduces a Pattern-Routed Mixture of Heterogeneous Experts, which dynamically identifies latent temporal patterns and routes patches to specialized domain experts, effectively decoupling regime-specific mechanisms from shared dynamics. To ensure interpretable graph recovery, we design a Causality-Aware Self-Attention mechanism operating across variables, yielding sparse Granger causal graphs via proximal optimization. Furthermore, CausalMoE is the first to integrate LLMs and VLMs to align numerical signals with textual and visual priors, regularizing causal estimation in complex scenarios. Extensive experiments demonstrate that CausalMoE establishes a new state-of-the-art on fully supervised benchmarks, while effectively generalizing to few-shot settings where traditional methods fail.

cs.LG↗

arXiv2026

AnyPPG: An ECG-Guided PPG Foundation Model Trained on Over 100,000 Hours of Recordings for Holistic Health Profiling

Photoplethysmography (PPG) is widely used as a non-invasive and accessible modality for continuous health monitoring. However, despite being a peripheral hemodynamic signal intrinsically coupled with systemic circulation, existing research has largely confined its scope to a narrow range of cardiovascular tasks, leaving a fundamental question underexplored: to what extent can PPG support holistic health profiling beyond traditional cardiovascular applications? To answer this question, we present AnyPPG, a foundation model-based framework designed to reveal the broader health-profiling potential of PPG. To ensure reliable performance for this investigation, AnyPPG is pretrained with ECG guidance on the most diverse PPG corpus with synchronized ECG to date, comprising over 100,000 hours of recordings from six large-scale data sources. This pretraining yields robust and physiologically grounded PPG representations that provide a reliable basis for subsequent analysis. Building upon this pretrained model, we conduct a systematic investigation into the association between PPG and holistic health through, to our knowledge, the first PPG-based phenome-wide disease detection study, spanning 1,468 disease phenotypes in more than 15,000 subjects. Our evaluation demonstrates the effectiveness of AnyPPG: across eight clinical and wearable datasets covering 15 downstream tasks, it achieves the best performance in 13 tasks. More importantly, in the phenome-wide analysis, AnyPPG exhibits meaningful discriminative capability (AUC $\ge$ 0.70) for 307 phenotypes across 16 distinct phecode chapters, including 230 non-circulatory conditions such as dementia and chronic kidney disease, many of which have rarely been explored using PPG. Collectively, these findings indicate that easily acquired PPG signals encode rich health-related information extending well beyond conventional cardiovascular assessment.

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arXiv2026

A Scoping Review of Deep Learning Methods for Photoplethysmography Data

Background: Photoplethysmography (PPG) is a non-invasive optical sensing technique widely used to capture hemodynamic information, with broad deployment in both clinical monitoring systems and wearable devices. In recent years, the integration of deep learning has substantially advanced PPG signal analysis and expanded its applications across healthcare and non-healthcare domains. Methods: We conducted a comprehensive literature search for studies applying deep learning to PPG data published between January 1, 2017 and December 31, 2025, using Google Scholar, PubMed, and Dimensions. The included studies were analyzed from three key perspectives: tasks, models, and data. Results: A total of 460 papers applying deep learning techniques to PPG signal analysis were included. These studies span a wide range of application domains, from traditional physiological monitoring tasks such as cardiovascular assessment to emerging applications including sleep analysis, cross-modality signal reconstruction, and biometric identification. Conclusions: Deep learning has significantly advanced PPG signal analysis by enabling more effective extraction of physiological information. Compared with traditional machine learning approaches reliant on handcrafted features, deep learning methods generally achieve improved performance and offer greater flexibility in model development. Nevertheless, several challenges remain, including limited availability of large-scale high-quality datasets, insufficient validation in real-world environments, and concerns over model interpretability, scalability, and computational efficiency. Addressing these challenges and exploring emerging research directions will be essential for further progress in deep learning-based PPG analysis.

cs.AI↗

arXiv2026

Holter-to-Sleep: AI-Enabled Repurposing of Single-Lead ECG for Sleep Phenotyping

Sleep disturbances are tightly linked to cardiovascular risk, yet polysomnography (PSG)-the clinical reference standard-remains resource-intensive and poorly suited for multi-night, home-based, and large-scale screening. Single-lead electrocardiography (ECG), already ubiquitous in Holter and patch-based devices, enables comfortable long-term acquisition and encodes sleep-relevant physiology through autonomic modulation and cardiorespiratory coupling. Here, we present a proof-of-concept Holter-to-Sleep framework that, using single-lead ECG as the sole input, jointly supports overnight sleep phenotyping and Holter-grade cardiac phenotyping within the same recording, and further provides an explicit analytic pathway for scalable cardio-sleep association studies. The framework is developed and validated on a pooled multi-center PSG sample of 10,439 studies spanning four public cohorts, with independent external evaluation to assess cross-cohort generalizability, and additional real-world feasibility assessment using overnight patch-ECG recordings via objective-subjective consistency analysis. This integrated design enables robust extraction of clinically meaningful overnight sleep phenotypes under heterogeneous populations and acquisition conditions, and facilitates systematic linkage between ECG-derived sleep metrics and arrhythmia-related Holter phenotypes. Collectively, the Holter-to-Sleep paradigm offers a practical foundation for low-burden, home-deployable, and scalable cardio-sleep monitoring and research beyond traditional PSG-centric workflows.

eess.SP↗

arXiv2026

Artificial intelligence-enabled single-lead ECG for non-invasive hyperkalemia detection: development, multicenter validation, and proof-of-concept deployment

Hyperkalemia is a life-threatening electrolyte disorder that is common in patients with chronic kidney disease and heart failure, yet frequent monitoring remains difficult outside hospital settings. We developed and validated Pocket-K, a single-lead AI-ECG system initialized from the ECGFounder foundation model for non-invasive hyperkalemia screening and handheld deployment. In this multicentre observational study using routinely collected clinical ECG and laboratory data, 34,439 patients contributed 62,290 ECG--potassium pairs. Lead I data were used to fine-tune the model. Data from Peking University People's Hospital were divided into development and temporal validation sets, and data from The Second Hospital of Tianjin Medical University served as an independent external validation set. Hyperkalemia was defined as venous serum potassium > 5.5 mmol/L. Pocket-K achieved AUROCs of 0.936 in internal testing, 0.858 in temporal validation, and 0.808 in external validation. For KDIGO-defined moderate-to-severe hyperkalemia (serum potassium >= 6.0 mmol/L), AUROCs increased to 0.940 and 0.861 in the temporal and external sets, respectively. External negative predictive value exceeded 99.3%. Model-predicted high risk below the hyperkalemia threshold was more common in patients with chronic kidney disease and heart failure. A handheld prototype enabled near-real-time inference, supporting future prospective evaluation in native handheld and wearable settings.

cs.LG↗

arXiv2026

PPGFlowECG: Latent Rectified Flow with Cross-Modal Encoding for PPG-Guided ECG Generation and Cardiovascular Disease Detection

Electrocardiography (ECG) is the clinical gold standard for cardiovascular disease (CVD) assessment, yet continuous monitoring is constrained by the need for dedicated hardware and trained personnel. Photoplethysmography (PPG) is ubiquitous in wearable devices and readily scalable, but it lacks electrophysiological specificity, limiting diagnostic reliability. While generative methods aim to translate PPG into clinically useful ECG signals, existing approaches are limited by the misalignment of physiological semantics in generative models and the complexity of modeling in high-dimensional signals. To address these limitations, we propose PPGFlowECG, a two-stage framework that aligns PPG and ECG in a shared latent space using the CardioAlign Encoder and then synthesizes ECGs with latent rectified flow. We further provide a formal analysis of this coupling, showing that the CardioAlign Encoder is necessary to guarantee stable and semantically consistent ECG synthesis under our formulation. Extensive experiments on four datasets demonstrate improved synthesis fidelity and downstream diagnostic utility. These results indicate that PPGFlowECG supports scalable, wearable-first CVD screening when standard ECG acquisition is unavailable.

cs.LG↗

arXiv2026

AnyECG: Evolved ECG Foundation Model for Holistic Health Profiling

Background: Artificial intelligence enabled electrocardiography (AI-ECG) has demonstrated the ability to detect diverse pathologies, but most existing models focus on single disease identification, neglecting comorbidities and future risk prediction. Although ECGFounder expanded cardiac disease coverage, a holistic health profiling model remains needed. Methods: We constructed a large multicenter dataset comprising 13.3 million ECGs from 2.98 million patients. Using transfer learning, ECGFounder was fine-tuned to develop AnyECG, a foundation model for holistic health profiling. Performance was evaluated using external validation cohorts and a 10-year longitudinal cohort for current diagnosis, future risk prediction, and comorbidity identification. Results: AnyECG demonstrated systemic predictive capability across 1172 conditions, achieving an AUROC greater than 0.7 for 306 diseases. The model revealed novel disease associations, robust comorbidity patterns, and future disease risks. Representative examples included high diagnostic performance for hyperparathyroidism (AUROC 0.941), type 2 diabetes (0.803), Crohn disease (0.817), lymphoid leukemia (0.856), and chronic obstructive pulmonary disease (0.773). Conclusion: The AnyECG foundation model provides substantial evidence that AI-ECG can serve as a systemic tool for concurrent disease detection and long-term risk prediction.

eess.SP↗

arXiv2025

AnyECG-Lab: An Exploration Study of Fine-tuning an ECG Foundation Model to Estimate Laboratory Values from Single-Lead ECG Signals

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.

cs.LG↗

arXiv2025

Combining ECG Foundation Model and XGBoost to Predict In-Hospital Malignant Ventricular Arrhythmias in AMI Patients

Malignant ventricular arrhythmias (VT/VF) following acute myocardial infarction (AMI) are a major cause of in-hospital death, yet early identification remains a clinical challenge. While traditional risk scores have limited performance, end-to-end deep learning models often lack the interpretability needed for clinical trust. This study aimed to develop a hybrid predictive framework that integrates a large-scale electrocardiogram (ECG) foundation model (ECGFounder) with an interpretable XGBoost classifier to improve both accuracy and interpretability. We analyzed 6,634 ECG recordings from AMI patients, among whom 175 experienced in-hospital VT/VF. The ECGFounder model was used to extract 150-dimensional diagnostic probability features , which were then refined through feature selection to train the XGBoost classifier. Model performance was evaluated using AUC and F1-score , and the SHAP method was used for interpretability. The ECGFounder + XGBoost hybrid model achieved an AUC of 0.801 , outperforming KNN (AUC 0.677), RNN (AUC 0.676), and an end-to-end 1D-CNN (AUC 0.720). SHAP analysis revealed that model-identified key features, such as "premature ventricular complexes" (risk predictor) and "normal sinus rhythm" (protective factor), were highly consistent with clinical knowledge. We conclude that this hybrid framework provides a novel paradigm for VT/VF risk prediction by validating the use of foundation model outputs as effective, automated feature engineering for building trustworthy, explainable AI-based clinical decision support systems.

cs.AI↗

arXiv2025

Artificial Intelligence-derived Photoplethysmography Age as a Digital Biomarker for Cardiovascular Health

Background: Photoplethysmography (PPG), increasingly available through wearable devices, provides a non-invasive means of monitoring human hemodynamics. In this study, we introduce artificial intelligence-derived photoplethysmography (AI-PPG) age, a deep learning-based estimate of biological age from raw PPG signals, and evaluate its potential as a digital biomarker for cardiovascular health. Methods: We developed a deep learning model with a distribution-aware loss function to reduce bias from imbalanced data. The model was trained and evaluated on the UK Biobank cohort (N = 212,231). We analyzed the association between the AI-PPG age gap (AI-PPG age minus calendar age) and multiple cardiovascular and metabolic outcomes, assessed its longitudinal value using serial PPG measurements, and externally validated its generalizability in an independent MIMIC-III-derived cohort (N = 2,343). Results: After adjusting for key confounders, participants with an AI-PPG age gap greater than 9 years have a significantly higher risk of major adverse cardiovascular and cerebrovascular events (hazard ratio of 2.37, p = 8.46x10$^{-80}$), as well as seven secondary outcomes including coronary heart disease and myocardial infarction (all p < 0.005). Conversely, those with a gap below -9 years show a lower risk profile. Longitudinal analysis demonstrates that changes in AI-PPG age add predictive value over time. In the external validation cohort, each one-year increase in AI-PPG age gap is associated with higher in-hospital mortality (odds ratio of 1.02, p = 0.01). Conclusions: AI-PPG age is a scalable, non-invasive biomarker for cardiovascular health assessment. Integrated with wearable devices, it may enable population-level screening, personalized monitoring, and early intervention.

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arXiv2025

Dist Loss: Enhancing Regression in Few-Shot Region through Distribution Distance Constraint

Imbalanced data distributions are prevalent in real-world scenarios, posing significant challenges in both imbalanced classification and imbalanced regression tasks. They often cause deep learning models to overfit in areas of high sample density (many-shot regions) while underperforming in areas of low sample density (few-shot regions). This characteristic restricts the utility of deep learning models in various sectors, notably healthcare, where areas with few-shot data hold greater clinical relevance. While recent studies have shown the benefits of incorporating distribution information in imbalanced classification tasks, such strategies are rarely explored in imbalanced regression. In this paper, we address this issue by introducing a novel loss function, termed Dist Loss, designed to minimize the distribution distance between the model's predictions and the target labels in a differentiable manner, effectively integrating distribution information into model training. Dist Loss enables deep learning models to regularize their output distribution during training, effectively enhancing their focus on few-shot regions. We have conducted extensive experiments across three datasets spanning computer vision and healthcare: IMDB-WIKI-DIR, AgeDB-DIR, and ECG-Ka-DIR. The results demonstrate that Dist Loss effectively mitigates the negative impact of imbalanced data distribution on model performance, achieving state-of-the-art results in sparse data regions. Furthermore, Dist Loss is easy to integrate, complementing existing methods.

cs.LG↗

arXiv2024

Deep Imbalanced Regression to Estimate Vascular Age from PPG Data: a Novel Digital Biomarker for Cardiovascular Health

Photoplethysmography (PPG) is emerging as a crucial tool for monitoring human hemodynamics, with recent studies highlighting its potential in assessing vascular aging through deep learning. However, real-world age distributions are often imbalanced, posing significant challenges for deep learning models. In this paper, we introduce a novel, simple, and effective loss function named the Dist Loss to address deep imbalanced regression tasks. We trained a one-dimensional convolutional neural network (Net1D) incorporating the Dist Loss on the extensive UK Biobank dataset (n=502,389) to estimate vascular age from PPG signals and validate its efficacy in characterizing cardiovascular health. The model's performance was validated on a 40% held-out test set, achieving state-of-the-art results, especially in regions with small sample sizes. Furthermore, we divided the population into three subgroups based on the difference between predicted vascular age and chronological age: less than -10 years, between -10 and 10 years, and greater than 10 years. We analyzed the relationship between predicted vascular age and several cardiovascular events over a follow-up period of up to 10 years, including death, coronary heart disease, and heart failure. Our results indicate that the predicted vascular age has significant potential to reflect an individual's cardiovascular health status. Our code will be available at https://github.com/Ngk03/AI-vascular-age.

cs.CV↗