MyoCardBench: A Real-World Data Benchmark for Evaluating Large Language Models in Clinically Authentic Cardiovascular Care Scenarios

Background: Most medical large language model (LLM) benchmarks focus on examination knowledge or isolated tasks and may not reflect the longitudinal, multimodal, and safety-critical workflow of cardiovascular care. Objective: To develop MyoCardBench, a real-world benchmark spanning the cardiovascular care continuum, and assess LLM performance across clinical dimensions and specialist tasks. Methods: MyoCardBench includes 2,263 items from 13 task-specific datasets derived from de-identified cardiovascular records and examination data. Sixteen cardiology physicians conducted annotation and reference construction, followed by cross-review from two senior cardiologists. Seven LLMs generated 15,841 outputs under standardized zero-shot settings. Open-ended tasks were evaluated using key-point coverage and holistic clinical quality, while CardioEthics was scored by accuracy. Results: GPT-5.4 achieved the highest macro-average (62.55) and item-weighted mean (62.19), followed by Gemini 3.1 Pro (59.95) and Qwen 3.6 27B (59.72). GPT-5.4 ranked first in all three dimensions. CardioAuxReport performed best (86.38), whereas CardioECGRead (17.25) and CardioEthics (17.34) were lowest. The largest gaps between holistic clinical quality and key-point coverage occurred in CardioComm (52.71), CardioEmergRescue (52.05), and CardioTreatPlan (48.80). Conclusions: To our knowledge, MyoCardBench is the largest real-world, multi-task benchmark for LLM evaluation across the cardiovascular care continuum and offers the broadest coverage of clinically authentic cardiology scenarios reported to date. It provides a rigorous framework for identifying model strengths, clinically important omissions, and priorities for future development.

A Signal-Language Foundation Model for Broad-Spectrum Cardiovascular Assessment from Routine Electrocardiography

Electrocardiography (ECG) is central to cardiovascular care, but conventional AI models are often restricted to common arrhythmias and may generalize poorly across populations or clinically subtle diseases. We developed ECG Contrastive Language-Image Pre-training (ECGCLIP), a signal-language contrastive learning framework that aligns ECG waveforms with expert diagnostic reports. ECGCLIP was pre-trained on 2,837,962 ECG studies from 1,324,856 patients and evaluated on a held-out internal test set plus nine independent external cohorts comprising about 1.5 million ECGs. Evaluation covered 89 downstream tasks, including 45 ECG diagnoses, 39 echocardiographic targets, and 5 rare cardiac diseases, using PRAUC as the primary metric. ECGCLIP consistently improved performance over random initialization and Merl-R18 baselines. On the internal test set, ECGCLIP-R34 achieved strong performance for atrial fibrillation (PRAUC 0.900) and ST-segment elevation myocardial infarction (PRAUC 0.383), with robust generalization across all external cohorts. It also improved low-prevalence and diagnostically elusive diseases, including Ebstein anomaly, constrictive pericarditis, dextrocardia, and cardiac amyloidosis, with internal PRAUC values of 0.253, 0.175, 0.121, and 0.201, respectively. ECGCLIP was data efficient, matching or exceeding full-dataset baseline performance with only 10% of training data. Feature visualization and saliency analysis suggested clinically meaningful representations aligned with established electrocardiographic criteria. These findings indicate that large-scale ECG-report contrastive pre-training can expand routine ECG interpretation beyond common arrhythmias toward broad cardiovascular assessment and opportunistic screening of echocardiographic and rare conditions.

Mirror: A Multi-Agent System for AI-Assisted Ethics Review

Ethics review is a foundational mechanism of modern research governance, yet contemporary systems face increasing strain as ethical risks arise as structural consequences of large-scale, interdisciplinary scientific practice. The demand for consistent and defensible decisions under heterogeneous risk profiles exposes limitations in institutional review capacity rather than in the legitimacy of ethics oversight. Recent advances in large language models (LLMs) offer new opportunities to support ethics review, but their direct application remains limited by insufficient ethical reasoning capability, weak integration with regulatory structures, and strict privacy constraints on authentic review materials. In this work, we introduce Mirror, an agentic framework for AI-assisted ethical review that integrates ethical reasoning, structured rule interpretation, and multi-agent deliberation within a unified architecture. At its core is EthicsLLM, a foundational model fine-tuned on EthicsQA, a specialized dataset of 41K question-chain-of-thought-answer triples distilled from authoritative ethics and regulatory corpora. EthicsLLM provides detailed normative and regulatory understanding, enabling Mirror to operate in two complementary modes. Mirror-ER (expedited Review) automates expedited review through an executable rule base that supports efficient and transparent compliance checks for minimal-risk studies. Mirror-CR (Committee Review) simulates full-board deliberation through coordinated interactions among expert agents, an ethics secretary agent, and a principal investigator agent, producing structured, committee-level assessments across ten ethical dimensions. Empirical evaluations demonstrate that Mirror significantly improves the quality, consistency, and professionalism of ethics assessments compared with strong generalist LLMs.

Tracing the Heart's Pathways: ECG Representation Learning from a Cardiac Conduction Perspective

The multi-lead electrocardiogram (ECG) stands as a cornerstone of cardiac diagnosis. Recent strides in electrocardiogram self-supervised learning (eSSL) have brightened prospects for enhancing representation learning without relying on high-quality annotations. Yet earlier eSSL methods suffer a key limitation: they focus on consistent patterns across leads and beats, overlooking the inherent differences in heartbeats rooted in cardiac conduction processes, while subtle but significant variations carry unique physiological signatures. Moreover, representation learning for ECG analysis should align with ECG diagnostic guidelines, which progress from individual heartbeats to single leads and ultimately to lead combinations. This sequential logic, however, is often neglected when applying pre-trained models to downstream tasks. To address these gaps, we propose CLEAR-HUG, a two-stage framework designed to capture subtle variations in cardiac conduction across leads while adhering to ECG diagnostic guidelines. In the first stage, we introduce an eSSL model termed Conduction-LEAd Reconstructor (CLEAR), which captures both specific variations and general commonalities across heartbeats. Treating each heartbeat as a distinct entity, CLEAR employs a simple yet effective sparse attention mechanism to reconstruct signals without interference from other heartbeats. In the second stage, we implement a Hierarchical lead-Unified Group head (HUG) for disease diagnosis, mirroring clinical workflow. Experimental results across six tasks show a 6.84% improvement, validating the effectiveness of CLEAR-HUG. This highlights its ability to enhance representations of cardiac conduction and align patterns with expert diagnostic guidelines.