Learning from VAE Errors to Support ECG-Based Differential Diagnosis of Myocardial Scar

Myocardial scar identification typically depends on late gadolinium enhancement CMR, a modality constrained by high cost and accessibility. Evaluating a cohort of 300 cardiomyopathic patients, researchers tested whether reconstruction failure in standard 12-lead ECGs could function as an alternative marker. Using a shallow β-VAE trained strictly on normal heartbeats from PTB-XL alongside the ECGx.AI foundation model, Dynamic Time Warping reconstruction errors exhibited statistically significant divergence across 10 of 12 leads, achieving an AUROC of 0.643 via logistic regression.