Reconstructing 12-lead ECG from 3-lead ECG using variational autoencoder to improve cardiac disease detection of wearable ECG devices

Twelve-lead electrocardiograms (ECGs) are the clinical gold standard for cardiac diagnosis, offering comprehensive spatial coverage of the heart necessary for detecting conditions such as myocardial infarction (MI). However, their lack of portability limits continuous and large-scale deployment. In contrast, three-lead ECG systems are widely used in wearable devices due to their simplicity and mobility, but they often fail to capture pathologies localized in unmeasured regions. To bridge this gap, we propose WearECG, a Variational Autoencoder (VAE) method that reconstructs 12-lead ECGs from three leads (II, V1, V5). Our model includes architectural improvements to better capture temporal and spatial dependencies in ECG signals. We evaluate generation quality using MSE, MAE, and Fréchet Inception Distance (FID), and assess clinical validity via a Turing test with expert cardiologists. To further validate the diagnostic utility, we fine-tune ECGFounder—a large-scale pretrained ECG model—on a multi-label classification task involving over 40 cardiac conditions, including 6 different myocardial infarction locations using both real and generated signals. Experiments on the MIMIC and PTB-XL datasets show that our method produces physiologically realistic and diagnostically informative signals, with robust performance in downstream tasks. This work demonstrates the potential of generative modeling for ECG reconstruction and its implications for scalable, low-cost cardiac screening.