ECG-FM: an open electrocardiogram foundation model
Why this work is in the frame
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Bibliographic record
Abstract
Objectives: To develop ECG-FM, an open-weight foundation model for electrocardiogram (ECG) analysis, rigorously evaluate its performance on clinically salient tasks, and openly release it alongside a public benchmark. Materials and Methods: In a study using 1.5 million 12-lead ECGs, we present ECG-FM, a transformer-based foundation model pretrained with hybrid self-supervision that combines masked reconstruction and contrastive learning with ECG-specific augmentation. Downstream, we evaluate multi-label ECG interpretation and prediction of reduced left ventricular ejection fraction (LVEF), introducing an openly available benchmark on the MIMIC-IV-ECG dataset. We assess ECG-FM's capabilities through data scaling experiments, latent-space structure analysis, and attention-based saliency. Results: (0.929). The pretrained encoder showcases competitive linear probing performance, with functionally discriminative embeddings. Discussion: Findings indicate that ECG-FM is generalizable, label-efficient, and discriminative for screening, risk stratification, and monitoring. Its representations capture low-level morphology and high-order cardiac semantics, and the pretrained encoder serves as a robust feature-set generator. This work mitigates reliance on large labeled datasets, reduces compute and data requirements, and lowers barriers to reproducibility and cross-study comparison. Conclusion: ECG-FM is an open, rigorously validated ECG foundation model intended to accelerate transparent, comparable research in the ECG analysis subfield. It is designed for rapid integration and evaluation, especially for delivering practical gains in low-label settings. We release our code, model weights, tutorials, and benchmark at https://github.com/bowang-lab/ECG-FM/.
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Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.001 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from it