Physiology and Anatomy Aware Inverse Inference of Myocardial Infarction for Cardiac Digital Twin

TL;DR

This paper introduces a novel noninvasive framework using cardiac digital twins and a physiology-aware neural network to improve localization and characterization of myocardial infarction from ECG data.

Contribution

It proposes an anatomy-aware stochastic infarct synthesis and a Physiology and Anatomy Aware Network (PAA-Net) for accurate MI inference, addressing limitations of existing methods.

Findings

Achieved Dice scores of 0.7391 for scar segmentation and 0.5503 for border zone segmentation.

Significantly outperformed existing inverse inference methods.

Enhanced interpretability of ECG-infarct relationships.

Abstract

Accurate localization of myocardial infarction is essential for risk stratification. While LGE-MRI remains the gold standard, it is resource-intensive. Integrating cine MRI with ECG enables a more detailed representation of infarct properties. Existing inverse MI inference methods overlook realistic scar morphology and cardiac repolarization, reducing sensitivity to subtle ECG variations and interpretability of infarct-induced electrophysiological changes. In this paper, we propose a novel framework for noninvasive MI localization using cardiac digital twins. To bridge the domain gap between simulation and reality, we introduce an anatomy-aware stochastic infarct synthesis strategy to synthesize realistic, irregular scars with border zones, mimicking ischemic transmural progression. We then construct a virtual cohort to simulate QRS-T waveforms, capturing both depolarization and repolarization dynamics. Furthermore, we design a Physiology and Anatomy Aware Network (PAA-Net) that jointly encodes 3D myocardial geometry and multi-lead ECGs to infer infarct areas with varying localizations, sizes, spatial extents, and transmuralities. Experimental results demonstrate that our framework significantly outperforms existing methods in inverse inference, achieving Dice scores of 0.7391 and 0.5503 for scar and border zone segmentation, respectively, while further enhancing the interpretability of the ECG-infarct relationship. Our code will be released upon acceptance.