Reading the Whole Heart: Latent-Attention Masked Autoencoders for Multimodal Cardiac Representation Learning

Abstract

Cardiovascular diagnosis and treatment rest on integrating complementary modalities, such as electrocardiogram, echocardiography, and chest X-rays, each capturing distinct but complementary aspects of cardiac pathophysiology. Yet most medical foundation models remain modality-specific, combining modalities only for finetuning or post-training. This discards the cross-modal evidence clinicians naturally integrate and ignores the structure within each modality. We introduce Latent-Attention Masked Autoencoder (LAMAE), a multimodal, structure-aware masked autoencoder that jointly learns patient-level representations during self-supervised pretraining. Instead of fusing modalities post hoc, LAMAE exchanges information directly in the latent space through a shared latent-attention module operating over a study-view-entity hierarchy, enabling aggregation of variable observations and handling of missing modalities. Pretrained on over 500'000 MIMIC-IV hospital stays, LAMAE outperforms modality-specific pretraining and strong contrastive and vision-language baselines across multimodal hospital-stay tasks, such as in-hospital mortality, ICD-10 and DRG coding, and length of stay, while remaining competitive on unimodal tasks. Modeling this structure also pays off within a single modality: even without cross-modal information, the latent-attention module improves representations over modality-specific pretraining.