Myocardial infarction (MI) remains a leading cause of mortality worldwide. Echocardiography (Echo) is a widely available modality for MI assessment, where regional wall motion abnormality is a key indicator. Prior learning based methods for myocardial motion analysis often use handcrafted descriptors or densely supervised estimation, but the need for extensive annotation limits applicability. Foundation models have recently improved vision-based Echo analysis; however, most methods operate on single views and segment-level localization remains unreliable under view-dependent ambiguity, especially in apical views. To address this, we propose MCF-Net, a novel motion-guided multi-view fusion framework that fuses myocardial motion cues with foundation model representations to localize infarction. Visual features are extracted using EchoPrime, a pretrained Echo foundation model shared across dual views. Cardiac motion is modeled with extremely sparse supervision: a single annotated template frame is transferred across videos to initialize point tracking, avoiding dense labels. Motion-derived segment-aware soft masks provide coarse spatial priors that selectively enhance features for challenging myocardial segments. A motion-conditioned fusion mechanism then integrates motion and vision across views, refining predictions without overriding strong appearance cues. On segment-level MI localization, MCF-Net achieves 72.4\% F1 and 84.9\% accuracy, outperforming state-of-the-art motion-only, vision-only, and fusion baselines.
Shreyasvi Natraj, Cyrus Achtari, Felice Gragnano +3cs.LG
Electrocardiography (ECG) is one of the most widely used tests for diagnosing cardiovascular disease. Yet several remote clinics still utilize paper ECG printouts for their analysis due to limited connectivity and computational capacity. As a result, vast numbers of physical ECGs obtained in remote areas still remain incapable of being accessed by contemporary artificial-intelligence (AI)-based decision support as they require high computational resources or strong high-speed internet connectivity. This causes several cases where conditions like acute coronary occlusion (ACS) is overlooked and reperfusion therapy delayed. Although prior work has tackled digitization and diagnosis separately, and utilized advanced AI models for them, there still remains a lack of a compute-light, on-device framework that reconstructs paper ECGs at high fidelity, while accurately supporting multiple clinically relevant endpoints. We address this need with an end-to-end lightweight on-device digitization-to-diagnosis pipeline that converts a smartphone photo or scan of a paper ECG into a calibrated 12-lead signal and screens for Myocardial Infarction (MI) pathologies, with SHapley Additive exPlanations (SHAP) to support interpretability. Trained and evaluated on 21,799 ECGs from the PTB-XL dataset and further validated on hospital-acquired ECG-Matrix dataset, the complete system runs in <30 s per ECG on CPU-only resources, achieving 95.51% accuracy (F1 = 0.9519) for MI detection on PTB-XL and 88.89% accuracy (F1 = 0.8862) for OMI detection on ECG-Matrix. This work showcases that legacy paper records can be reliably democratized in any part of the world, providing a scalable decision support when digital ECG export, connectivity, or high-end compute are unavailable
Cardiovascular disease is still one of the main causes of death around the world. Acute myocardial infarction (MI), or heart attack, claims millions of lives each year. MI happens when blood flow to the coronary arteries is blocked or reduced, which causes permanent damage to the heart muscle. Without treatment, this can lead to cardiac arrest, where the heart stops pumping blood to the organs, resulting in organ failure and death. Even survivors often face serious problems like heart failure, pulmonary edema, and asystole. Research shows that 5 to 10 percent of survivors die within the first year after an MI, and nearly half need to be hospitalized again. Early thrombolytic treatment leads to better outcomes, so there is a clear need for faster and more accurate ways to diagnose MI. Right now, doctors usually review patient history and use their own experience to find the causes of MI. This process takes a lot of time and can be inconsistent. Detecting MI accurately and quickly can help patients take better care of themselves and prevent fatal events. In this study, we introduce an automated model to predict deadly outcomes of MI and help doctors understand important biomarkers linked to its complications. This approach aims to make diagnosis clearer, faster, and more affordable. The process includes preparing the data, filling in missing values, and handling imbalanced data using SVMSMOTE, ADASYN, and class-weighted methods. We use wrapper and embedded feature selection to find the most important variables, then scale the features for consistency. The model combines Logistic Regression, Random Forest, Light-GBM, and Bagging SVM, and is further improved with an artificial neural network to increase accuracy. We evaluate all models using precision, recall, and other key measures to find the best option for clinical use.
Myocardial substrate abnormalities, such as myocardial scar and myocardial infarction (MI), are associated with adverse cardiovascular outcomes. Electrocardiography (ECG) provides a low-cost and widely available tool for detecting these abnormalities, but ECG-based detection remains challenging due to heterogeneous lead-dependent manifestations, high-dimensional multi-lead signals, class imbalance, and the limited interpretability of deep learning models. We propose a multi-scale attention-enhanced convolutional network (MSAIC-Net) for ECG-based myocardial substrate abnormality detection. MSAIC-Net employs parallel atrous convolutional branches to extract ECG features across multiple temporal receptive fields. %, enabling the model to capture both local and longer-range temporal patterns. Channel attention is then used to adaptively reweight informative lead-wise and feature-channel representations. To address class imbalance and improve feature separability, we introduce a novel imbalance-aware supervised contrastive learning strategy that encourages samples from the same class to form compact representations while increasing separation between abnormal and normal samples. Lead-wise permutation importance is further incorporated to quantify the contribution of each ECG lead and improve model interpretability. The proposed method was evaluated on two complementary datasets: a low-data institutional cohort from the University of Virginia (UVA) Health System for myocardial scar classification and the large-scale public PTB-XL dataset from PhysioNet for MI identification. Experimental results show that MSAIC-Net outperforms baseline models, with particularly pronounced improvements in the low-data UVA cohort. Overall, the proposed framework provides an effective and interpretable approach for ECG-based detection of myocardial substrate abnormalities.
Accurate 3D geometric characterization of myocardial infarction (MI) is essential for building cardiac digital twins (CDTs) to precisely simulate infarct-related electrophysiology. Late gadolinium enhancement magnetic resonance imaging (LGE MRI) is the clinical reference for locating MI, yet its reliance on contrast agents restricts use in renally impaired patients and limits longitudinal follow-ups. As an alternative, contrast-free cine MRI visualizes abnormal ventricular wall motion, which is highly indicative of the infarcted area. In this study, we propose a novel explicit geometry-motion embedded model to fully automatically reconstruct personalized, simulation-ready 3D MI geometries directly from multi-view cine MRIs. Specifically, we construct a 4D (3D + t) biventricular mesh to explicitly extract and decouple geometry-aware and motion-aware features. We further design a dual-branch module for adaptive geometry-motion fusion to capture spatiotemporal dependencies for mapping infarcted region. Furthermore, we introduce multi-scale supervision utilizing an AHA-17 segment-guided cross-attention mechanism to steer the prediction, ensuring biophysically consistent reconstruction. Experimental results on 225 cine MRIs demonstrated that the proposed 3D MI reconstruction achieved high performance with an average Dice score of 0.678 $\pm$ 0.011. In the downstream in-silico electrophysiological simulation evaluations, the results were highly consistent with the LGE-derived ground truth, highlighting the great potential of the proposed model for contrast-free scar characterization and seamless integration into CDT modeling. The code will be released publicly upon acceptance of the manuscript for publication.
Accurate localization of myocardial infarction is essential for risk stratification. While LGE-MRI remains the gold standard, it is resource-intensive. Integrating cine MRI with ECG enables a more detailed representation of infarct properties. Existing inverse MI inference methods overlook realistic scar morphology and cardiac repolarization, reducing sensitivity to subtle ECG variations and interpretability of infarct-induced electrophysiological changes. In this paper, we propose a novel framework for noninvasive MI localization using cardiac digital twins. To bridge the domain gap between simulation and reality, we introduce an anatomy-aware stochastic infarct synthesis strategy to synthesize realistic, irregular scars with border zones, mimicking ischemic transmural progression. We then construct a virtual cohort to simulate QRS-T waveforms, capturing both depolarization and repolarization dynamics. Furthermore, we design a Physiology and Anatomy Aware Network (PAA-Net) that jointly encodes 3D myocardial geometry and multi-lead ECGs to infer infarct areas with varying localizations, sizes, spatial extents, and transmuralities. Experimental results demonstrate that our framework significantly outperforms existing methods in inverse inference, achieving Dice scores of 0.7391 and 0.5503 for scar and border zone segmentation, respectively, while further enhancing the interpretability of the ECG-infarct relationship. Our code will be released upon acceptance.