Performer: A Novel PPG-to-ECG Reconstruction Transformer for a Digital Biomarker of Cardiovascular Disease Detection

Electrocardiography (ECG), an electrical measurement which captures cardiac activities, is the gold standard for diagnosing cardiovascular disease (CVD). However, ECG is infeasible for continuous cardiac monitoring due to its requirement for user participation. By contrast, photoplethysmography (PPG) provides easy-to-collect data, but its limited accuracy constrains its clinical usage. To combine the advantages of both signals, recent studies incorporate various deep learning techniques for the reconstruction of PPG signals to ECG; however, the lack of contextual information as well as the limited abilities to denoise biomedical signals ultimately constrain model performance. In this research, we propose Performer, a novel Transformer-based architecture that reconstructs ECG from PPG and combines the PPG and reconstructed ECG as multiple modalities for CVD detection. This method is the first time that Transformer sequence-to-sequence translation has been performed on biomedical waveform reconstruction, combining the advantages of both PPG and ECG. We also create Shifted Patch-based Attention (SPA), an effective method to encode/decode the biomedical waveforms. Through fetching the various sequence lengths and capturing cross-patch connections, SPA maximizes the signal processing for both local features and global contextual representations. The proposed architecture generates a state-of-the-art performance of 0.29 RMSE for the reconstruction of PPG to ECG on the BIDMC database, surpassing prior studies. We also evaluated this model on the MIMIC-III dataset, achieving a 95.9% accuracy in CVD detection, and on the PPG-BP dataset, achieving 75.9% accuracy in related CVD diabetes detection, indicating its generalizability. As a proof of concept, an earring wearable named PEARL (prototype), was designed to scale up the point-of-care (POC) healthcare system.