Electrocardiogram (ECG) is the primary non-invasive diagnostic tool for monitoring cardiac conditions and is crucial in assisting clinicians. Recent studies have concentrated on classifying cardiac conditions using ECG data but have overlooked ECG report generation, which is time-consuming and requires clinical expertise. To automate ECG report generation and ensure its versatility, we propose the Multimodal ECG Instruction Tuning (MEIT) framework, the first attempt to tackle ECG report generation with LLMs and multimodal instructions. To facilitate future research, we establish a benchmark to evaluate MEIT with various LLMs backbones across two large-scale ECG datasets. Our approach uniquely aligns the representations of the ECG signal and the report, and we conduct extensive experiments to benchmark MEIT with nine open-source LLMs using more than 800,000 ECG reports. MEIT’s results underscore the superior performance of instruction-tuned LLMs, showcasing their proficiency in quality report generation, zero-shot capabilities, resilience to signal perturbation, and alignment with human expert evaluation. These findings emphasize the efficacy of our MEIT framework and its potential for real-world clinical application.

Medical Vision-Language Pre-training (MedVLP) has made significant progress in enabling zero-shot tasks for medical image understanding. However, training MedVLP models typically requires large-scale datasets with paired, high-quality image-text data, which are scarce in the medical domain. Recent advancements in Large Language Models (LLMs) and diffusion models have made it possible to generate large-scale synthetic image-text pairs. This raises the question: Can MedVLP succeed using purely synthetic data? To address this, we use off-the-shelf generative models to create synthetic radiology reports and paired Chest X-ray (CXR) images, and propose an automated pipeline to build a diverse, high-quality synthetic dataset, enabling a rigorous study that isolates model and training settings, focusing entirely from the data perspective.Our results show that MedVLP models trained exclusively on synthetic data outperform those trained on real data by 3.8% in averaged AUC on zero-shot classification. Moreover, using a combination of synthetic and real data leads to a further improvement of 9.07%. Additionally, MedVLP models trained on synthetic or mixed data consistently outperform those trained on real data in zero-shot grounding, as well as in fine-tuned classification and segmentation tasks.Our analysis suggests MedVLP trained on well-designed synthetic data can outperform models trained on real datasets, which may be limited by low-quality samples and long-tailed distributions[^1].[^1]: All data and code will be released upon acceptance.

Automatic radiology report generation holds significant potential to streamline the labor-intensive process of report writing by radiologists, particularly for 3D radiographs such as CT scans. While CT scans are critical for clinical diagnostics, they remain less explored compared to 2D radiographs. To date, there has been no comprehensive benchmark for 3D radiograph report generation (3DRRG), nor sufficient investigation into the optimal training strategies for Vision Language Models (VLMs) in this context, particularly with respect to vision encoder choices, visual token compression, and model scaling.In this work, we make two three contributions. We curate CT-3DRRG, the largest publicly available 3D CT-report dataset, establishing a robust and diverse benchmark for evaluating VLM performance on 3DRRG. Furthermore, we propose a comprehensive training recipe for building high-performing VLMs for 3DRRG, exploring key factors such as vision encoder pretraining strategies, visual token compression, and the impact of data & model scale. Guided by these findings, we introduce Argus, a state-of-the-art family of VLMs that achieve superior performance across different model sizes and input 3D medical image resolutions, efficiently processing high-resolution 3D images up to 512 × 512 × 256.

Recent advancements in multimodal representation learning for electrocardiogram (ECG) have moved onto learning representations by aligning ECG signals with their paired free-text reports. However, current methods often result in suboptimal alignment of ECG signals with their corresponding text reports, thereby limiting diagnostic accuracy. This is primarily due to the complexity and unstructured nature of medical language, which makes it challenging to effectively align ECG signals with the corresponding text reports. Additionally, these methods are unable to handle arbitrary combinations of ECG leads as inputs, which poses a challenge since 12-lead ECGs may not always be available in under-resourced clinical environments.In this work, we propose the **Knowledge-enhanced Multimodal ECG Representation Learning (K-MERL)** framework to address these challenges. K-MERL leverages large language models (LLMs) to extract structured knowledge from free-text reports, enhancing the effectiveness of ECG multimodal learning. Furthermore, we design a lead-aware ECG encoder to capture lead-specific spatial-temporal characteristics of 12-lead ECGs, with dynamic lead masking. This novel encoder allows our framework to handle arbitrary lead inputs, rather than being limited to a fixed set of full 12 leads, which existing methods necessitate.We evaluate K-MERL on six external ECG datasets and demonstrate its superior capability. K-MERL not only outperforms all existing methods in zero-shot classification and linear probing tasks using 12 leads, but also achieves state-of-the-art (SOTA) results in partial-lead settings, with an average improvement of **16%** in AUC score on zero-shot classification compared to previous SOTA multimodal methods. All data and code will be released upon acceptance.

Cardiovascular diseases are a leading cause of death and disability worldwide. Electrocardiogram (ECG) is critical for diagnosing and monitoring cardiac health, but obtaining large-scale annotated ECG datasets is labor-intensive and time-consuming. Recent ECG Self-Supervised Learning (eSSL) methods mitigate this by learning features without extensive labels but fail to capture fine-grained clinical semantics and require extensive task-specific fine-tuning. To address these challenges, we propose SuPreME, a Supervised Pre-training framework for Multimodal ECG representation learning. SuPreME is pre-trained using structured diagnostic labels derived from ECG report entities through a one-time offline extraction with Large Language Models (LLMs), which help denoise, standardize cardiac concepts, and improve clinical representation learning. By fusing ECG signals with textual cardiac queries instead of fixed labels, SuPreME enables zero-shot classification of unseen conditions without further fine-tuning. We evaluate SuPreME on six downstream datasets covering 106 cardiac conditions, achieving superior zero-shot AUC performance of 77.20%, surpassing state-of-the-art eSSLs by 4.98%. Results demonstrate SuPreME’s effectiveness in leveraging structured, clinically relevant knowledge for high-quality ECG representations.