Chain of Flow: ECG-Conditioned 4D Cardiac Cine Generation from Patient-Specific Anatomical Anchor

Cardiac cine magnetic resonance imaging (MRI) is central to functional cardiac assessment, yet a full current cine sequence may not always be directly available at the point of analysis. We introduce Chain of Flow (COF), an electrocardiography (ECG)-conditioned framework that combines patient-specific MRI and current ECG for subject-specific 4D cardiac cine generation. On the UK Biobank dataset, COF achieves strong image-level fidelity and downstream function-oriented performance on a shared same-visit evaluable benchmark. Multi-slice and multi-resolution analyses indicate stable structural generation quality across the short-axis stack and heterogeneous acquisition resolutions. Controlled phase-robustness analyses across resampled input MRI phases further provide same-visit proxy support for patient-specific MRI plus current ECG when a target MRI phase is not directly observed. A cross-visit route provides exploratory serial evidence, with the clearest gains in current-facing region-of-interest readout. Disease-category functional audits, case-level volume-trajectory evidence review further delineate where the current patient-specific MRI plus ECG formulation remains stable for anatomy-aware downstream cardiac analysis. Code is available at https://anonymous.4open.science/r/COF-paper-release-C88B.