Qing Cao

Aofan Jiang, Chaoqin Huang, Qing Cao et al.

Electrocardiogram (ECG) is a widely used diagnostic tool for detecting heart conditions. Rare cardiac diseases may be underdiagnosed using traditional ECG analysis, considering that no training dataset can exhaust all possible cardiac disorders. This paper proposes using anomaly detection to identify any unhealthy status, with normal ECGs solely for training. However, detecting anomalies in ECG can be challenging due to significant inter-individual differences and anomalies present in both global rhythm and local morphology. To address this challenge, this paper introduces a novel multi-scale cross-restoration framework for ECG anomaly detection and localization that considers both local and global ECG characteristics. The proposed framework employs a two-branch autoencoder to facilitate multi-scale feature learning through a masking and restoration process, with one branch focusing on global features from the entire ECG and the other on local features from heartbeat-level details, mimicking the diagnostic process of cardiologists. Anomalies are identified by their high restoration errors. To evaluate the performance on a large number of individuals, this paper introduces a new challenging benchmark with signal point-level ground truths annotated by experienced cardiologists. The proposed method demonstrates state-of-the-art performance on this benchmark and two other well-known ECG datasets. The benchmark dataset and source code are available at: \url{https://github.com/MediaBrain-SJTU/ECGAD}

Chaoqin Huang, Zi Zeng, Aofan Jiang et al.

Rare cardiac anomalies are difficult to detect from electrocardiograms (ECGs) due to their long-tailed distribution with extremely limited case counts and demographic disparities in diagnostic performance. These limitations contribute to delayed recognition and uneven quality of care, creating an urgent need for a generalizable framework that enhances sensitivity while ensuring equity across diverse populations. In this study, we developed an AI-assisted two-stage ECG framework integrating self-supervised anomaly detection with demographic-aware representation learning. The first stage performs self-supervised anomaly detection pretraining by reconstructing masked global and local ECG signals, modeling signal trends, and predicting patient attributes to learn robust ECG representations without diagnostic labels. The pretrained model is then fine-tuned for multi-label ECG classification using asymmetric loss to better handle long-tail cardiac abnormalities, and additionally produces anomaly score maps for localization, with CPU-based optimization enabling practical deployment. Evaluated on a longitudinal cohort of over one million clinical ECGs, our method achieves an AUROC of 94.7% for rare anomalies and reduces the common-rare performance gap by 73%, while maintaining consistent diagnostic accuracy across age and sex groups. In conclusion, the proposed equity-aware AI framework demonstrates strong clinical utility, interpretable anomaly localization, and scalable performance across multiple cohorts, highlighting its potential to mitigate diagnostic disparities and advance equitable anomaly detection in biomedical signals and digital health. Source code is available at https://github.com/MediaBrain-SJTU/Rare-ECG.

Aofan Jiang, Chaoqin Huang, Qing Cao et al.

Current computer-aided ECG diagnostic systems struggle with the underdetection of rare but critical cardiac anomalies due to the imbalanced nature of ECG datasets. This study introduces a novel approach using self-supervised anomaly detection pretraining to address this limitation. The anomaly detection model is specifically designed to detect and localize subtle deviations from normal cardiac patterns, capturing the nuanced details essential for accurate ECG interpretation. Validated on an extensive dataset of over one million ECG records from clinical practice, characterized by a long-tail distribution across 116 distinct categories, the anomaly detection-pretrained ECG diagnostic model has demonstrated a significant improvement in overall accuracy. Notably, our approach yielded a 94.7% AUROC, 92.2% sensitivity, and 92.5\% specificity for rare ECG types, significantly outperforming traditional methods and narrowing the performance gap with common ECG types. The integration of anomaly detection pretraining into ECG analysis represents a substantial contribution to the field, addressing the long-standing challenge of long-tail data distributions in clinical diagnostics. Furthermore, prospective validation in real-world clinical settings revealed that our AI-driven approach enhances diagnostic efficiency, precision, and completeness by 32%, 6.7%, and 11.8% respectively, when compared to standard practices. This advancement marks a pivotal step forward in the integration of AI within clinical cardiology, with particularly profound implications for emergency care, where rapid and accurate ECG interpretation is crucial. The contributions of this study not only push the boundaries of current ECG diagnostic capabilities but also lay the groundwork for more reliable and accessible cardiovascular care.

Sarina Thomas, Qing Cao, Anna Novikova et al.

Ejection fraction (EF) of the left ventricle (LV) is considered as one of the most important measurements for diagnosing acute heart failure and can be estimated during cardiac ultrasound acquisition. While recent successes in deep learning research successfully estimate EF values, the proposed models often lack an explanation for the prediction. However, providing clear and intuitive explanations for clinical measurement predictions would increase the trust of cardiologists in these models. In this paper, we explore predicting EF measurements with Natural Language Explanation (NLE). We propose a model that in a single forward pass combines estimation of the LV contour over multiple frames, together with a set of modules and routines for computing various motion and shape attributes that are associated with ejection fraction. It then feeds the attributes into a large language model to generate text that helps to explain the network's outcome in a human-like manner. We provide experimental evaluation of our explanatory output, as well as EF prediction, and show that our model can provide EF comparable to state-of-the-art together with meaningful and accurate natural language explanation to the prediction. The project page can be found at https://github.com/guybenyosef/EchoNarrator .

Durgesh Kumar Singh, Qing Cao, Sarina Thomas et al.

Clinical guidelines recommend performing left ventricular (LV) linear measurements in B-mode echocardiographic images at the basal level -- typically at the mitral valve leaflet tips -- and aligned perpendicular to the LV long axis along a virtual scanline (SL). However, most automated methods estimate landmarks directly from B-mode images for the measurement task, where even small shifts in predicted points along the LV walls can lead to significant measurement errors, reducing their clinical reliability. A recent semi-automatic method, EnLVAM, addresses this limitation by constraining landmark prediction to a clinician-defined SL and training on generated Anatomical Motion Mode (AMM) images to predict LV landmarks along the same. To enable full automation, a contour-aware SL placement approach is proposed in this work, in which the LV contour is estimated using a weakly supervised B-mode landmark detector. SL placement is then performed by inferring the LV long axis and the basal level- mimicking clinical guidelines. Building on this foundation, we introduce \textit{WiseLVAM} -- a novel, fully automated yet manually adaptable framework for automatically placing the SL and then automatically performing the LV linear measurements in the AMM mode. \textit{WiseLVAM} utilizes the structure-awareness from B-mode images and the motion-awareness from AMM mode to enhance robustness and accuracy with the potential to provide a practical solution for the routine clinical application. The source code is publicly available at https://github.com/SFI-Visual-Intelligence/wiselvam.git.

Aofan Jiang, Chaoqin Huang, Qing Cao et al.

The electrocardiogram (ECG) is an essential tool for diagnosing heart disease, with computer-aided systems improving diagnostic accuracy and reducing healthcare costs. Despite advancements, existing systems often miss rare cardiac anomalies that could be precursors to serious, life-threatening issues or alterations in the cardiac macro/microstructure. We address this gap by focusing on self-supervised anomaly detection (AD), training exclusively on normal ECGs to recognize deviations indicating anomalies. We introduce a novel self-supervised learning framework for ECG AD, utilizing a vast dataset of normal ECGs to autonomously detect and localize cardiac anomalies. It proposes a novel masking and restoration technique alongside a multi-scale cross-attention module, enhancing the model's ability to integrate global and local signal features. The framework emphasizes accurate localization of anomalies within ECG signals, ensuring the method's clinical relevance and reliability. To reduce the impact of individual variability, the approach further incorporates crucial patient-specific information from ECG reports, such as age and gender, thus enabling accurate identification of a broad spectrum of cardiac anomalies, including rare ones. Utilizing an extensive dataset of 478,803 ECG graphic reports from real-world clinical practice, our method has demonstrated exceptional effectiveness in AD across all tested conditions, regardless of their frequency of occurrence, significantly outperforming existing models. It achieved superior performance metrics, including an AUROC of 91.2%, an F1 score of 83.7%, a sensitivity rate of 84.2%, a specificity of 83.0%, and a precision of 75.6% with a fixed recall rate of 90%. It has also demonstrated robust localization capabilities, with an AUROC of 76.5% and a Dice coefficient of 65.3% for anomaly localization.

Durgesh K. Singh, Ahcene Boubekki, Qing Cao et al.

Linear measurements of the left ventricle (LV) in the Parasternal Long Axis (PLAX) view using B-mode echocardiography are crucial for cardiac assessment. These involve placing 4-6 landmarks along a virtual scanline (SL) perpendicular to the LV axis near the mitral valve tips. Manual placement is time-consuming and error-prone, while existing deep learning methods often misalign landmarks, causing inaccurate measurements. We propose a novel framework that enhances LV measurement accuracy by enforcing straight-line constraints. A landmark detector is trained on Anatomical M-Mode (AMM) images, computed in real time from B-mode videos, then transformed back to B-mode space. This approach addresses misalignment and reduces measurement errors. Experiments show improved accuracy over standard B-mode methods, and the framework generalizes well across network architectures. Our semi-automatic design includes a human-in-the-loop step where the user only places the SL, simplifying interaction while preserving alignment flexibility and clinical relevance.