arXiv:2605.25446v1 Announce Type: new Abstract: Electrocardiography (ECG) is central to cardiovascular care, but conventional AI models are often restricted to common arrhythmias and may generalize poorly across populations or clinically subtle diseases. We developed ECG Contrastive Language-Image Pre-training (ECGCLIP), a signal-language contrastive learning framework that aligns ECG waveforms with expert diagnostic reports. ECGCLIP was pre-trained on 2,837,962 ECG studies from 1,324,856 patients and evaluated on a held-out internal test set plus nine independent external cohorts comprising about 1.5 million ECGs. Evaluation covered 89 downstream tasks, including 45 ECG diagnoses, 39 echocardiographic targets, and 5 rare cardiac diseases, using PRAUC as the primary metric. ECGCLIP consistently improved performance over random initialization and Merl-R18 baselines. On the internal test set, ECGCLIP-R34 achieved strong performance for atrial fibrillation (PRAUC 0.900) and ST-segment elevation myocardial infarction (PRAUC 0.383), with robust generalization across all external cohorts. It also improved low-prevalence and diagnostically elusive diseases, including Ebstein anomaly, constrictive pericarditis, dextrocardia, and cardiac amyloidosis, with internal PRAUC values of 0.253, 0.175, 0.121, and 0.201, respectively. ECGCLIP was data efficient, matching or exceeding full-dataset baseline performance with only 10% of training data. Feature visualization and saliency analysis suggested clinically meaningful representations aligned with established electrocardiographic criteria. These findings indicate that large-scale ECG-report contrastive pre-training can expand routine ECG interpretation beyond common arrhythmias toward broad cardiovascular assessment and opportunistic screening of echocardiographic and rare conditions.

arXiv:2605.25534v1 Announce Type: new Abstract: Multimodal Large Language Models (MLLMs) excel at structural reasoning yet suffer from a sharp logical brittleness in structural consistency. We term this phenomenon Structural Cognitive Overload (SCO), a byproduct of the contention between deep reasoning and safety alignment. However, prior work has predominantly targeted typographic and pixel-level perturbations, leaving the study of SCO largely unexplored. To this end, we propose StructBreak, an automated end-to-end framework designed to quantify SCO. By leveraging StructBreak, we uncover a novel higher-order cognitive overload attack paradigm; notably, this attack operates under a practical black-box setting, requiring no internal model access. Consequently, we utilize this framework to establish a comprehensive benchmark spanning ten diverse threat scenarios. Empirical evaluations on six leading MLLMs reveal that SCO readily triggers toxic generation, yielding a 92% average ASR (up to 97% on Gemini 2.5). To elucidate the mechanism of SCO, we further conduct model-level interpretations spanning attention dynamics, latent space topology, and geometric analysis. Our findings reveal that StructBreak acts as a novel structural channel to circumvent safety filters. Furthermore, the limited efficacy of inherent safety mechanisms underscores that current alignment paradigms are insufficient for the era of complex multimodal reasoning.