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:2605.20278v2 Announce Type: replace-cross Abstract: Long-form image captioning exposes a reward granularity problem in RL: captions are judged as whole sequences, while the important errors occur at the level of individual visual claims. A good dense caption should be both faithful and informative, avoiding hallucination without omitting salient details. Yet pairwise preferences, reference-based metrics, and holistic scalar rewards compress these local errors into a single sequence-level signal, obscuring the tradeoff between factuality and coverage. We introduce ClaimDiff-RL, a framework that uses reference-conditioned atomic claim differences as the reward unit for caption RL. Given an image, an actor caption, and a reference caption, a multimodal judge enumerates visually grounded differences, verifies each difference against the image, assigns open-vocabulary error types and severity levels, and produces per-difference statistics for reward composition. This makes hallucinated claims and omitted salient facts separately measurable and tunable. Experiments show that holistic scalar rewards can reduce hallucination by increasing missing facts, while ClaimDiff-RL exposes this faithfulness and coverage tradeoff and enables more balanced operating points. On a 160-image human-labeled diagnostic benchmark, public captioning benchmarks, and VQA benchmarks, ClaimDiff-RL improves the hallucination--missing-fact balance, preserves general capability, and even surpasses Gemini-3-Pro-Preview on several fine-grained Capability dimensions such as object counting, spatial relations, and scene recognition. These results suggest that typed, verifiable claim differences are an effective reward unit for fine-grained and diagnosable caption RL.