Cross-View Attention Fusion Net: A Prior-Guided Dual-View Representation Learning for Cardiac Output Estimation from Short-Term PPG Signals

Abstract:Accurate cardiac output (CO) estimation from photoplethysmography (PPG) is promising for unobtrusive hemodynamic monitoring, but remains difficult since CO is jointly determined by cardiac function and vascular tone. Conventional feature-based models use physiologically meaningful PPG descriptors, yet depend on accurate pulse detection and may miss latent temporal relationships. In contrast, fully end-to-end deep learning models learn directly from raw PPG but often underuse established PPG-derived prior information. Here, we introduce the Cross-View Attention Fusion Network (CVAF-Net), a prior-guided dual-view deep learning model for CO estimation from short, fixed-length PPG segments. CVAF-Net processes raw PPG as a temporal view and a feature sequence map (FSM) as a structured prior-guided view, and fuses the two representations through cross-view attention. The model was independently evaluated using 5-, 15-, and 30-s segments from three datasets: simulated pulse waves (3323 subjects), vasoconstriction provocation (79 subjects), and resting/cycling activities (10 subjects), and was compared with multiple machine learning and deep learning benchmarks. CVAF-Net outperformed most benchmark methods and achieved performance comparable to a state-of-the-art Transformer-based model, with a mean absolute error (MAE) of 0.19 L/min (MAPE: 3.95%) on simulated data and high accuracy in real-world settings (minimum MAE: 1.20 L/min). Importantly, CVAF-Net reduced FLOPs by twelvefold compared with the leading Transformer-based model. Plausibility analysis showed physiologically consistent CO estimates, with expected correlations with age ($\rho = -0.274$), heart rate ($\rho = 0.894$), and systemic vascular resistance ($\rho = -0.740$). These findings indicate that CVAF-Net provides an accurate, computationally efficient, and generalizable approach for continuous wearable-based CO monitoring.

Medical Physics (physics.med-ph); Machine Learning (cs.LG)

arXiv:2605.19666 [physics.med-ph]

(or arXiv:2605.19666v2 [physics.med-ph] for this version)

https://doi.org/10.48550/arXiv.2605.19666 Focus to learn more arXiv-issued DOI via DataCite

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