Chain of Flow: A Foundational Generative Framework for ECG-to-4D Cardiac Digital Twins

A clinically actionable Cardiac Digital Twin (CDT) should reconstruct individualised cardiac anatomy and physiology, update its internal state from multimodal signals, and enable a broad range of downstream simulations beyond isolated tasks. However, existing CDT frameworks remain limited to task-specific predictors rather than building a patient-specific, manipulable virtual heart. In this work, we introduce Chain of Flow (COF), a foundational ECG-driven generative framework that reconstructs full 4D cardiac structure and motion from a single cardiac cycle. The method integrates cine-CMR and 12-lead ECG during training to learn a unified representation of cardiac geometry, electrophysiology, and motion dynamics. We evaluate Chain of Flow on diverse cohorts and demonstrate accurate recovery of cardiac anatomy, chamber-wise function, and dynamic motion patterns. The reconstructed 4D hearts further support downstream CDT tasks such as volumetry, regional function analysis, and virtual cine synthesis. By enabling full 4D organ reconstruction directly from ECG, COF transforms cardiac digital twins from narrow predictive models into fully generative, patient-specific virtual hearts. Code will be released after review.

Multi-Scale Target-Aware Representation Learning for Fundus Image Enhancement

High-quality fundus images provide essential anatomical information for clinical screening and ophthalmic disease diagnosis. Yet, due to hardware limitations, operational variability, and patient compliance, fundus images often suffer from low resolution and signal-to-noise ratio. Recent years have witnessed promising progress in fundus image enhancement. However, existing works usually focus on restoring structural details or global characteristics of fundus images, lacking a unified image enhancement framework to recover comprehensive multi-scale information. Moreover, few methods pinpoint the target of image enhancement, e.g., lesions, which is crucial for medical image-based diagnosis. To address these challenges, we propose a multi-scale target-aware representation learning framework (MTRL-FIE) for efficient fundus image enhancement. Specifically, we propose a multi-scale feature encoder (MFE) that employs wavelet decomposition to embed both low-frequency structural information and high-frequency details. Next, we design a structure-preserving hierarchical decoder (SHD) to fuse multi-scale feature embeddings for real fundus image restoration. SHD integrates hierarchical fusion and group attention mechanisms to achieve adaptive feature fusion while retaining local structural smoothness. Meanwhile, a target-aware feature aggregation (TFA) module is used to enhance pathological regions and reduce artifacts. Experimental results on multiple fundus image datasets demonstrate the effectiveness and generalizability of MTRL-FIE for fundus image enhancement. Compared to state-of-the-art methods, MTRL-FIE achieves superior enhancement performance with a more lightweight architecture. Furthermore, our approach generalizes to other ophthalmic image processing tasks without supervised fine-tuning, highlighting its potential for clinical applications.