Beyond 1D: Vision Transformers and Multichannel Signal Images for PPG-to-ECG Reconstruction

Reconstructing ECG from PPG is a promising yet challenging task. While recent advancements in generative models have significantly improved ECG reconstruction, accurately capturing fine-grained waveform features remains a key challenge. To address this, we propose a novel PPG-to-ECG reconstruction method that leverages a Vision Transformer (ViT) as the core network. Unlike conventional approaches that rely on single-channel PPG, our method employs a four-channel signal image representation, incorporating the original PPG, its first-order difference, second-order difference, and area under the curve. This multi-channel design enriches feature extraction by preserving both temporal and physiological variations within the PPG. By leveraging the self-attention mechanism in ViT, our approach effectively captures both inter-beat and intra-beat dependencies, leading to more robust and accurate ECG reconstruction. Experimental results demonstrate that our method consistently outperforms existing 1D convolution-based approaches, achieving up to 29% reduction in PRD and 15% reduction in RMSE. The proposed approach also produces improvements in other evaluation metrics, highlighting its robustness and effectiveness in reconstructing ECG signals. Furthermore, to ensure a clinically relevant evaluation, we introduce new performance metrics, including QRS area error, PR interval error, RT interval error, and RT amplitude difference error. Our findings suggest that integrating a four-channel signal image representation with the self-attention mechanism of ViT enables more effective extraction of informative PPG features and improved modeling of beat-to-beat variations for PPG-to-ECG mapping. Beyond demonstrating the potential of PPG as a viable alternative for heart activity monitoring, our approach opens new avenues for cyclic signal analysis and prediction.