通过心电引导跨模态预训练从智能手表光体积描记术衍生的心龄作为血管衰老的数字生物标志物
Smartwatch Photoplethysmography-Derived Heart Age via ECG-Guided Cross-Modal Pretraining as a Digital Biomarker of Vascular Aging
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中文总结 AI 辅助
本研究开发心电引导跨模态框架，利用智能手表PPG衍生的心龄差作为数字生物标志物，证实其与动脉僵硬度、高血压显著相关，可用于血管衰老评估。
中文摘要 AI 辅助
心血管衰老的数字生物标志物（常称为心龄或血管年龄）已被广泛研究，但多数依赖静息心电图（ECG）、成像或专业血管评估。目前可穿戴设备光体积描记术（PPG）与动脉僵硬度、高血压的关联证据仍有限。本研究开发了一种心电引导跨模态框架，该框架在预训练阶段利用同步智能手表ECG增强PPG表征学习，而推理阶段仅需PPG数据。研究纳入中国的三个OPPO队列，共包含581804名参与者和7452131条记录。其中血管健康研究队列用于ECG-PPG自监督预训练、微调及内部验证，另外两个外部队列用于评估与脉搏波速度（PWV）和现有高血压的关联。结合受试者感知学习与ECG-PPG对比对齐，仅使用PPG的模型在PWV队列中实现受试者级平均绝对误差为5.895年（皮尔逊相关系数r=0.819），在家庭血压监测队列中为4.344年（r=0.800）。重复记录的聚合进一步提升了短期稳定性。在校正时序年龄后，心龄差与PWV相关（偏相关系数r=0.2627，P<0.001）；心龄差每增加1年对应PWV升高0.062 m/s，心龄加速衰老与减速衰老相比，校正后PWV升高0.91 m/s。校正后心龄差每增加1个标准差，现有高血压的优势比（OR）为1.72（95%置信区间1.49-1.99），最高四分位组与最低四分位组相比OR为4.25。这些发现支持智能手表PPG衍生的心龄差作为动脉僵硬度和现有高血压的可扩展数字生物标志物。
英文摘要
Digital biomarkers of cardiovascular aging, often termed heart or vascular age, have been widely studied, but most rely on resting electrocardiography (ECG), imaging, or specialized vascular assessments. Evidence linking wearable photoplethysmography (PPG) to arterial stiffness and hypertension remains limited. We developed an ECG-guided cross-modal framework that uses synchronized smartwatch ECG to enhance PPG representation learning during pretraining while requiring only PPG at inference. The study included three OPPO cohorts across China, comprising 581,804 participants and 7,452,131 recordings. The Vascular Health Study cohort supported ECG-PPG self-supervised pretraining, fine-tuning, and internal validation, while two external cohorts assessed associations with pulse wave velocity (PWV) and prevalent hypertension. Combining subject-aware learning with ECG-PPG contrastive alignment, the PPG-only model achieved subject-level mean absolute errors of 5.895 years (Pearson r=0.819) in the PWV cohort and 4.344 years (r=0.800) in the home blood pressure monitoring cohort. Aggregating repeated recordings further improved short-term stability. After adjustment for chronological age, heart age gap was associated with PWV (partial r=0.2627, P<0.001); each 1-year increase corresponded to 0.062 m/s higher PWV, and accelerated versus decelerated heart aging was associated with 0.91 m/s higher adjusted PWV. Each 1-SD increase in adjusted heart age gap was associated with greater odds of prevalent hypertension (OR 1.72, 95% CI 1.49-1.99), while the highest versus lowest quartile had an OR of 4.25. These findings support smartwatch PPG-derived heart age gap as a scalable digital biomarker of arterial stiffness and prevalent hypertension.
