A Hybrid Meta-Learning Framework Integrating ECG, Cine-MRI, and Biomarkers for Heart Failure Prediction

Heart failure (HF) remains a major global cause of morbidity and mortality, where early diagnosis is critical for improving patient outcomes. Conventional single-modality approaches often fail to capture the complex and multifactorial nature of HF. This study investigates the feasibility of a late-fusion framework that integrates modality-specific predictions derived independently from cine-MRI, electrocardiographic signals, biomarkers and demographic data for HF prediction. Independent cine-MRI data from 281 patients, ECG recordings from the PTB-XL PhysioNet database and biomarker profiles from 157 patients were retrospectively analyzed as separate modality-specific cohorts. Twenty-five features were extracted and processed. Modality-specific models (Attention U-Net, MLP, XGBoost) were trained separately on pre-extracted features to preserve predictive accuracy while minimizing computational cost. Their outputs were combined through ensemble meta-learning (XGBoost, LightGBM, Random Forest) with sample weighting to handle missing data. The final HF prediction probability was obtained by averaging the outputs across the three meta-learners. The proposed framework achieved competitive diagnostic performance, with 98.00% (95% CI: 94.96–99.45%) accuracy, 97.80% (95% CI: 92.28–99.73%) sensitivity, 98.17% (95% CI: 93.53–99.78%) specificity, an F1-score of 97.80% (95% CI: 93.6–99.8%) and an AUC of 0.978 (95% CI: 0.945–0.996) when evaluated against state-of-the-art methods. The results highlight the potential of late-fusion strategies for integrating independently trained modality-specific predictions, offering a feasible approach for HF risk assessment under heterogeneous data availability.