# TRACE: Expert-Aligned ECG Representation Learning with Rigorous Benchmarking and Real-World Validation in Acute Cardiac Care

arXiv: https://arxiv.org/abs/2609.34088 · HTML: https://mlsanity.com/paper/2609.34088/

## Key facts

- No citing papers in the map yet (data through 14 Oct 2026).
- Builds on 19 of its 40 references that are in the map.
- First posted on arXiv 28 Sep 2026.

## Builds on (most cited first, 19 of 19)

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- [ECG-FM: An Open Electrocardiogram Foundation Model](https://mlsanity.com/paper/2408.05178/) (2024)
- [Guiding Masked Representation Learning to Capture Spatio-Temporal Relationship of Electrocardiogram](https://mlsanity.com/paper/2402.09450/) (2024)
- [Zero-Shot ECG Classification with Multimodal Learning and Test-time Clinical Knowledge Enhancement](https://mlsanity.com/paper/2403.06659/) (2024)
- [ECG-QA: A Comprehensive Question Answering Dataset Combined With Electrocardiogram](https://mlsanity.com/paper/2306.15681/) (2023)
- [ECG-Chat: A Large ECG-Language Model for Cardiac Disease Diagnosis](https://mlsanity.com/paper/2408.08849/) (2024)
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- [MEIT: Multimodal Electrocardiogram Instruction Tuning on Large Language Models for Report Generation](https://mlsanity.com/paper/2403.04945/) (2024)
- [Boosting Masked ECG-Text Auto-Encoders as Discriminative Learners](https://mlsanity.com/paper/2410.02131/) (2024)
- [Unlocking the diagnostic potential of electrocardiograms through information transfer from cardiac magnetic resonance imaging](https://mlsanity.com/paper/2308.05764/) (2023)
- [MEDBind: Unifying Language and Multimodal Medical Data Embeddings](https://mlsanity.com/paper/2403.12894/) (2024)
- [CREMA: A Contrastive Regularized Masked Autoencoder for Robust ECG Diagnostics across Clinical Domains](https://mlsanity.com/paper/2407.07110/) (2024)
- [SuPreME: A Supervised Pre-training Framework for Multimodal ECG Representation Learning](https://mlsanity.com/paper/2502.19668/) (2025)
- [EchoingECG: An Electrocardiogram Cross-Modal Model for Echocardiogram Tasks](https://mlsanity.com/paper/2509.25791/) (2025)
- [TsLLM: Augmenting LLMs for General Time Series Understanding and Prediction](https://mlsanity.com/paper/2510.01111/) (2025)

## Abstract (arXiv)

TRACE (Text-Reinforced Analysis of Cardio ECGs) is a multimodal electrocardiogram (ECG) representation model that learns clinically grounded signal embeddings for downstream cardiac classification. It is designed to address the limitations of existing CLIP-style training, which often struggles with noisy clinical text and fails to leverage the complementary strengths of unimodal (from ECG) and cross-modal (between ECG and matched cardiologist reports) learning. To bridge this gap, we propose a hybrid architecture that jointly learns unimodal and cross-modal representations via uncertainty-weighted multi-task learning while utilizing an LLM-based pipeline to extract high-fidelity findings from cardiologist reports. We evaluate TRACE across a spectrum of clinical urgency, establishing robust performance on public benchmarks for arrhythmia classification and structural abnormalities relative to existing unimodal and multimodal ECG models. To demonstrate real-world utility, we further validate the model on acute coronary occlusion (ACO), where the prevailing ST-elevation criteria miss 25-34% of true occlusions. Utilizing a large private ACO dataset with expert-annotated ground truth, TRACE significantly outperforms real-world clinical practice, yielding a 19.0% increase in sensitivity or a 62.6% reduction in false positive rates at the clinical baseline. This extensive evaluation confirms that TRACE delivers both strong performance on benchmark tasks and tangible clinical impact in the most acute, high-risk cardiac scenarios.