Large-scale cross-modality pretrained model enhances cardiovascular state estimation and cardiomyopathy detection from electrocardiograms: An AI system development and multi-center validation study

Cardiovascular diseases (CVDs) present significant challenges for early and accurate diagnosis. While cardiac magnetic resonance imaging (CMR) is the gold standard for assessing cardiac function and diagnosing CVDs, its high cost and technical complexity limit accessibility. In contrast, electrocardiography (ECG) offers promise for large-scale early screening. This study introduces CardiacNets, an innovative model that enhances ECG analysis by leveraging the diagnostic strengths of CMR through cross-modal contrastive learning and generative pretraining. CardiacNets serves two primary functions: (1) it evaluates detailed cardiac function indicators and screens for potential CVDs, including coronary artery disease, cardiomyopathy, pericarditis, heart failure and pulmonary hypertension, using ECG input; and (2) it enhances interpretability by generating high-quality CMR images from ECG data. We train and validate the proposed CardiacNets on two large-scale public datasets (the UK Biobank with 41,519 individuals and the MIMIC-IV-ECG comprising 501,172 samples) as well as three private datasets (FAHZU with 410 individuals, SAHZU with 464 individuals, and QPH with 338 individuals), and the findings demonstrate that CardiacNets consistently outperforms traditional ECG-only models, substantially improving screening accuracy. Furthermore, the generated CMR images provide valuable diagnostic support for physicians of all experience levels. This proof-of-concept study highlights how ECG can facilitate cross-modal insights into cardiac function assessment, paving the way for enhanced CVD screening and diagnosis at a population level.

Cross-Phase Mutual Learning Framework for Pulmonary Embolism Identification on Non-Contrast CT Scans

Pulmonary embolism (PE) is a life-threatening condition where rapid and accurate diagnosis is imperative yet difficult due to predominantly atypical symptomatology. Computed tomography pulmonary angiography (CTPA) is acknowledged as the gold standard imaging tool in clinics, yet it can be contraindicated for emergency department (ED) patients and represents an onerous procedure, thus necessitating PE identification through non-contrast CT (NCT) scans. In this work, we explore the feasibility of applying a deep-learning approach to NCT scans for PE identification. We propose a novel Cross-Phase Mutual learNing framework (CPMN) that fosters knowledge transfer from CTPA to NCT, while concurrently conducting embolism segmentation and abnormality classification in a multi-task manner. The proposed CPMN leverages the Inter-Feature Alignment (IFA) strategy that enhances spatial contiguity and mutual learning between the dual-pathway network, while the Intra-Feature Discrepancy (IFD) strategy can facilitate precise segmentation of PE against complex backgrounds for single-pathway networks. For a comprehensive assessment of the proposed approach, a large-scale dual-phase dataset containing 334 PE patients and 1,105 normal subjects has been established. Experimental results demonstrate that CPMN achieves the leading identification performance, which is 95.4\% and 99.6\% in patient-level sensitivity and specificity on NCT scans, indicating the potential of our approach as an economical, accessible, and precise tool for PE identification in clinical practice.

Rapid and Accurate Diagnosis of Acute Aortic Syndrome using Non-contrast CT: A Large-scale, Retrospective, Multi-center and AI-based Study

Chest pain symptoms are highly prevalent in emergency departments (EDs), where acute aortic syndrome (AAS) is a catastrophic cardiovascular emergency with a high fatality rate, especially when timely and accurate treatment is not administered. However, current triage practices in the ED can cause up to approximately half of patients with AAS to have an initially missed diagnosis or be misdiagnosed as having other acute chest pain conditions. Subsequently, these AAS patients will undergo clinically inaccurate or suboptimal differential diagnosis. Fortunately, even under these suboptimal protocols, nearly all these patients underwent non-contrast CT covering the aorta anatomy at the early stage of differential diagnosis. In this study, we developed an artificial intelligence model (DeepAAS) using non-contrast CT, which is highly accurate for identifying AAS and provides interpretable results to assist in clinical decision-making. Performance was assessed in two major phases: a multi-center retrospective study (n = 20,750) and an exploration in real-world emergency scenarios (n = 137,525). In the multi-center cohort, DeepAAS achieved a mean area under the receiver operating characteristic curve of 0.958 (95% CI 0.950-0.967). In the real-world cohort, DeepAAS detected 109 AAS patients with misguided initial suspicion, achieving 92.6% (95% CI 76.2%-97.5%) in mean sensitivity and 99.2% (95% CI 99.1%-99.3%) in mean specificity. Our AI model performed well on non-contrast CT at all applicable early stages of differential diagnosis workflows, effectively reduced the overall missed diagnosis and misdiagnosis rate from 48.8% to 4.8% and shortened the diagnosis time for patients with misguided initial suspicion from an average of 681.8 (74-11,820) mins to 68.5 (23-195) mins. DeepAAS could effectively fill the gap in the current clinical workflow without requiring additional tests.