Semantic Compensation via Adversarial Removal for Robust Zero-Shot ECG Diagnosis

TL;DR

This paper introduces SCAR, a framework that enhances zero-shot ECG diagnosis robustness by training models to maintain semantic alignment and recover diagnostic information despite missing data segments.

Contribution

SCAR explicitly trains ECG-language models to handle missing data through adversarial masking and semantic reweighting, improving robustness and transferability.

Findings

SCAR improves semantic robustness under lead and temporal missingness.

SCAR outperforms baselines in harder cases with missing primary diagnostic evidence.

SCAR enhances transferability in linear probing tasks.

Abstract

Recent ECG--language pretraining methods enable zero-shot diagnosis by aligning cardiac signals with clinical text, but they do not explicitly model robustness to partial observation and are typically studied under fully observed ECG settings. In practice, diagnostically critical leads or temporal segments may be missing due to electrode detachment, motion artifacts, or signal corruption, causing severe degradation of cross-modal semantic alignment. In this paper, we propose \textbf{SCAR}, a robust ECG--language pretraining framework for \textbf{S}emantic \textbf{C}ompensation via \textbf{A}dversarial \textbf{R}emoval. SCAR improves robustness by explicitly training the model to remain semantically aligned with semantically critical missingness and to recover diagnostic meaning from the remaining visible evidence. Specifically, we introduce a differentiable adversarial masker to remove the most alignment-critical spatio-temporal ECG tokens during training, forcing the ECG encoder to learn representations that remain semantically aligned with clinical text even when primary diagnostic evidence is missing. Under such adversarial corruption, we equip the ECG encoder with a semantically supervised adaptive selector that learns to reweight the remaining visible tokens and compensate with secondary yet diagnostically informative morphological cues. To evaluate robustness beyond classification accuracy, we further introduce Counterfactual Missingness Resolution Score (CMRS), which quantifies how well feature preserve diagnostic semantics under missingness. Experiments on $6$ datasets show that SCAR consistently improves semantic robustness under joint lead and temporal missingness, with particularly clear advantages in harder cases where primary diagnostic evidence is unavailable, while also yielding stronger linear-probing transferability.