Knowledge-Guided Cross-Modal Fusion for Adult-to-Pediatric ECG Transfer via Label-Conditioned Contrastive Alignment

Adult and pediatric electrocardiogram (ECG) interpretation relies on age-sensitive criteria, and models pretrained mainly on adult ECGs often transfer poorly to pediatric populations when pediatric labels are scarce. Existing multimodal ECG--text methods typically align waveforms and text at the global sample level, entangling evidence from co-occurring diagnoses and limiting transfer under this gap. We propose Pediatric-Adult ECG Alignment via Cross-modal Enhancement (PEACE), a knowledge-guided framework pretrained on the largely adult MIMIC-IV ECG corpus. PEACE describes each diagnosis along rhythm, morphology, and ST--T axes and, per recording, composes only positive-label descriptors into three axis tokens and a fused embedding. A label query network (LQN) uses diagnostic labels as queries to cross-attend over ECG tokens and axis tokens, while label set aware bidirectional contrastive learning (LSBC) aligns pooled ECG features with the fused embedding when recordings share diagnoses. Curriculum adaptive fusion (CAF) gates alignment strength according to smoothed classification loss and training progress, limiting disruption during early optimization. The knowledge branch is used only for training supervision; inference uses ECG signals alone. On ZZU-pECG, PEACE reaches macro average AUCs of 59.39%, 81.74%, and 91.56% under zero-shot, 50-shot, and full fine-tuning, with the clearest gains over foundation and knowledge-pretraining baselines under limited supervision; versus domain adaptation initializations, zero-shot improves substantially while 50-shot AUC is comparable to DANN. After fine-tuning on PTB-XL, PEACE reaches 96.90% macro average AUC over nine harmonized labels. Ablations confirm that label-conditioned knowledge alignment, rather than global text fusion, is the key driver of pediatric transfer gains.

A Multi-Resolution Mutual Learning Network for Multi-Label ECG Classification

Electrocardiograms (ECG), which record the electrophysiological activity of the heart, have become a crucial tool for diagnosing these diseases. In recent years, the application of deep learning techniques has significantly improved the performance of ECG signal classification. Multi-resolution feature analysis, which captures and processes information at different time scales, can extract subtle changes and overall trends in ECG signals, showing unique advantages. However, common multi-resolution analysis methods based on simple feature addition or concatenation may lead to the neglect of low-resolution features, affecting model performance. To address this issue, this paper proposes the Multi-Resolution Mutual Learning Network (MRM-Net). MRM-Net includes a dual-resolution attention architecture and a feature complementary mechanism. The dual-resolution attention architecture processes high-resolution and low-resolution features in parallel. Through the attention mechanism, the high-resolution and low-resolution branches can focus on subtle waveform changes and overall rhythm patterns, enhancing the ability to capture critical features in ECG signals. Meanwhile, the feature complementary mechanism introduces mutual feature learning after each layer of the feature extractor. This allows features at different resolutions to reinforce each other, thereby reducing information loss and improving model performance and robustness. Experiments on the PTB-XL and CPSC2018 datasets demonstrate that MRM-Net significantly outperforms existing methods in multi-label ECG classification performance. The code for our framework will be publicly available at https://github.com/wxhdf/MRM.