Joon-myoung Kwon

Hyunseung Chung, Jiho Kim, Joon-myoung Kwon et al.

Electrocardiogram (ECG) synthesis is the area of research focused on generating realistic synthetic ECG signals for medical use without concerns over annotation costs or clinical data privacy restrictions. Traditional ECG generation models consider a single ECG lead and utilize GAN-based generative models. These models can only generate single lead samples and require separate training for each diagnosis class. The diagnosis classes of ECGs are insufficient to capture the intricate differences between ECGs depending on various features (e.g. patient demographic details, co-existing diagnosis classes, etc.). To alleviate these challenges, we present a text-to-ECG task, in which textual inputs are used to produce ECG outputs. Then we propose Auto-TTE, an autoregressive generative model conditioned on clinical text reports to synthesize 12-lead ECGs, for the first time to our knowledge. We compare the performance of our model with other representative models in text-to-speech and text-to-image. Experimental results show the superiority of our model in various quantitative evaluations and qualitative analysis. Finally, we conduct a user study with three board-certified cardiologists to confirm the fidelity and semantic alignment of generated samples. our code will be available at https://github.com/TClife/text_to_ecg

Jungwoo Oh, Gyubok Lee, Seongsu Bae et al.

Question answering (QA) in the field of healthcare has received much attention due to significant advancements in natural language processing. However, existing healthcare QA datasets primarily focus on medical images, clinical notes, or structured electronic health record tables. This leaves the vast potential of combining electrocardiogram (ECG) data with these systems largely untapped. To address this gap, we present ECG-QA, the first QA dataset specifically designed for ECG analysis. The dataset comprises a total of 70 question templates that cover a wide range of clinically relevant ECG topics, each validated by an ECG expert to ensure their clinical utility. As a result, our dataset includes diverse ECG interpretation questions, including those that require a comparative analysis of two different ECGs. In addition, we have conducted numerous experiments to provide valuable insights for future research directions. We believe that ECG-QA will serve as a valuable resource for the development of intelligent QA systems capable of assisting clinicians in ECG interpretations. Dataset URL: https://github.com/Jwoo5/ecg-qa

Jungwoo Oh, Hyunseung Chung, Joon-myoung Kwon et al.

In recent years, self-supervised learning methods have shown significant improvement for pre-training with unlabeled data and have proven helpful for electrocardiogram signals. However, most previous pre-training methods for electrocardiogram focused on capturing only global contextual representations. This inhibits the models from learning fruitful representation of electrocardiogram, which results in poor performance on downstream tasks. Additionally, they cannot fine-tune the model with an arbitrary set of electrocardiogram leads unless the models were pre-trained on the same set of leads. In this work, we propose an ECG pre-training method that learns both local and global contextual representations for better generalizability and performance on downstream tasks. In addition, we propose random lead masking as an ECG-specific augmentation method to make our proposed model robust to an arbitrary set of leads. Experimental results on two downstream tasks, cardiac arrhythmia classification and patient identification, show that our proposed approach outperforms other state-of-the-art methods.

Radhika Dua, Jiyoung Lee, Joon-myoung Kwon et al.

Electrocardiogram (ECG) signals are beneficial in diagnosing cardiovascular diseases, which are one of the leading causes of death. However, they are often contaminated by noise artifacts and affect the automatic and manual diagnosis process. Automatic deep learning-based examination of ECG signals can lead to inaccurate diagnosis, and manual analysis involves rejection of noisy ECG samples by clinicians, which might cost extra time. To address this limitation, we present a two-stage deep learning-based framework to automatically detect the noisy ECG samples. Through extensive experiments and analysis on two different datasets, we observe that the deep learning-based framework can detect slightly and highly noisy ECG samples effectively. We also study the transfer of the model learned on one dataset to another dataset and observe that the framework effectively detects noisy ECG samples.

Byeong Tak Lee, Yong-Yeon Jo, Joon-Myoung Kwon

We study scaling convolutional neural networks (CNNs), specifically targeting Residual neural networks (ResNet), for analyzing electrocardiograms (ECGs). Although ECG signals are time-series data, CNN-based models have been shown to outperform other neural networks with different architectures in ECG analysis. However, most previous studies in ECG analysis have overlooked the importance of network scaling optimization, which significantly improves performance. We explored and demonstrated an efficient approach to scale ResNet by examining the effects of crucial parameters, including layer depth, the number of channels, and the convolution kernel size. Through extensive experiments, we found that a shallower network, a larger number of channels, and smaller kernel sizes result in better performance for ECG classifications. The optimal network scale might differ depending on the target task, but our findings provide insight into obtaining more efficient and accurate models with fewer computing resources or less time. In practice, we demonstrate that a narrower search space based on our findings leads to higher performance.

Byeong Tak Lee, Joon-myoung Kwon, Yong-Yeon Jo

Domain generalization aim to train models to effectively perform on samples that are unseen and outside of the distribution. Adversarial data augmentation (ADA) is a widely used technique in domain generalization. It enhances the model robustness by including synthetic samples designed to simulate potential unseen scenarios into the training datasets, which is then used to train the model. However, in time series data, traditional ADA approaches often fail to address distribution shifts related to temporal characteristics. To address this limitation, we propose Temporal Adversarial Data Augmentation (TADA) for time series data, which incorporate time warping into ADA. Although time warping is inherently non-differentiable, ADA relies on generating samples through backpropagation. We resolve this issue by leveraging the duality between phase shifts in the frequency domain and time shifts in the time domain, thereby making the process differentiable. Our evaluations across various time series datasets demonstrate that TADA outperforms existing methods for domain generalization. In addition, using distribution visualization, we confirmed that the distribution shifts induced by TADA are clearly different from those induced by ADA, and together, they effectively simulate real-world distribution shifts.

Jin Yu, JaeHo Park, TaeJun Park et al.

Leveraging Large Language Models (LLMs) with Retrieval-Augmented Generation (RAG) for analyzing medical data, particularly Electrocardiogram (ECG), offers high accuracy and convenience. However, generating reliable, evidence-based results in specialized fields like healthcare remains a challenge, as RAG alone may not suffice. We propose a Zero-shot ECG diagnosis framework based on RAG for ECG analysis that incorporates expert-curated knowledge to enhance diagnostic accuracy and explainability. Evaluation on the PTB-XL dataset demonstrates the framework's effectiveness, highlighting the value of structured domain expertise in automated ECG interpretation. Our framework is designed to support comprehensive ECG analysis, addressing diverse diagnostic needs with potential applications beyond the tested dataset.

Yong-Yeon Jo, Byeong Tak Lee, Beom Joon Kim et al.

Online Test-Time Adaptation (OTTA) enhances model robustness by updating pre-trained models with unlabeled data during testing. In healthcare, OTTA is vital for real-time tasks like predicting blood pressure from biosignals, which demand continuous adaptation. We introduce a new test-time scenario with streams of unlabeled samples and occasional labeled samples. Our framework combines supervised and self-supervised learning, employing a dual-queue buffer and weighted batch sampling to balance data types. Experiments show improved accuracy and adaptability under real-world conditions.

Junho Song, Jong-Hwan Jang, DongGyun Hong et al.

Electrocardiogram (ECG) diagnosis remains challenging due to limited labeled data and the need to capture subtle yet clinically meaningful variations in rhythm and morphology. We present CREMA (Contrastive Regularized Masked Autoencoder), a foundation model for 12-lead ECGs designed to learn generalizable representations through self-supervised pretraining. CREMA combines generative learning and contrastive regularization via a Contrastive Regularized MAE loss, and employs a Signal Transformer (SiT) architecture to capture both local waveform details and global temporal dependencies. We evaluate CREMA on benchmark datasets and real-world clinical environments, including deployment scenarios with significant distribution shifts. CREMA outperforms supervised baselines and existing self-supervised models in both linear probing and fine-tuning evaluations. Notably, it maintains superior performance across diverse clinical domains, such as emergency care, highlighting its robustness under real-world conditions. These results demonstrate that CREMA serves as a scalable and reliable foundation model for ECG diagnostics, supporting downstream applications across heterogeneous and high-risk clinical settings.

Yong-Yeon Jo, Young Sang Choi, Jong-Hwan Jang et al.

The electrocardiogram (ECG) records electrical signals in a non-invasive way to observe the condition of the heart, typically looking at the heart from 12 different directions. Several types of the cardiac disease are diagnosed by using 12-lead ECGs Recently, various wearable devices have enabled immediate access to the ECG without the use of wieldy equipment. However, they only provide ECGs with a couple of leads. This results in an inaccurate diagnosis of cardiac disease due to lacking of required leads. We propose a deep generative model for ECG synthesis from two asynchronous leads to ten leads. It first represents a heart condition referring to two leads, and then generates ten leads based on the represented heart condition. Both the rhythm and amplitude of leads generated resemble those of the original ones, while the technique removes noise and the baseline wander appearing in the original leads. As a data augmentation method, our model improves the classification performance of models compared with models using ECGs with only one or two leads.