Qian Shao, Bang Du, Zepeng Li et al.
Clinical trials remain critical in cardiac drug development but face high failure rates due to efficacy limitations and safety risks, incurring substantial costs. In-silico trial methodologies, particularly generative models simulating drug-induced electrocardiogram (ECG) alterations, offer a potential solution to mitigate these challenges. While existing models show progress in ECG synthesis, their constrained fidelity and inability to characterize individual-specific pharmacological response patterns fundamentally limit clinical translatability. To address these issues, we propose a novel Drug-Aware Diffusion Model (DADM). Specifically, we construct a set of ordinary differential equations to provide external physical knowledge (EPK) of the realistic ECG morphology. The EPK is used to adaptively constrain the morphology of the generated ECGs through a dynamic cross-attention (DCA) mechanism. Furthermore, we propose an extension of ControlNet to incorporate demographic and drug data, simulating individual drug reactions. Compared to the other eight state-of-the-art (SOTA) ECG generative models: 1) Quantitative and expert evaluation demonstrate that DADM generates ECGs with superior fidelity; 2) Comparative results on two real-world databases covering 8 types of drug regimens verify that DADM can more accurately simulate drug-induced changes in ECGs, improving the accuracy by at least 5.79% and recall by 8%. In addition, the ECGs generated by DADM can also enhance model performance in downstream drug-effect classification tasks.