Revealing Hidden Myocardial Infarction Signatures from Brief Single-Lead Electrocardiograms: A Novel Framework for Smart Wearable Applications

The electrocardiogram (ECG) contains rich nonlinear and non-stationary dynamic information that is only partly captured by conventional ECG interpretation and beat-to-beat metrics, and is increasingly analyzed using black-box artificial intelligence models that often lack interpretability. Here, we introduce the ECG time–frequency “eyeball”, an interpretable framework that transforms a brief single-lead ECG recording into a geometric signature and a set of low-dimensional rotational and geometrical features using empirical mode decomposition and Hilbert-based analytic signal mapping. In 30-second Lead I–equivalent recordings from 170 healthy subjects and 80 patients with acute myocardial infarction (AMI), the proposed “eyeball” metrics significantly differentiated groups, with AMI associated with higher rotational frequency metrics, lower envelope metrics, and displaced centroid location. Representative examples revealed a coherent morphologic spectrum from normal patterns to geometries consistent with myocardial ischemia, injury, and infarction. The representation remained stable across recording windows from 30 seconds to 5 minutes, and individual “eyeball” features achieved areas under the receiver operating characteristic curve (AUCs) of up to 0.78 for AMI detection. These findings suggest that the ECG time–frequency “eyeball” condenses clinically relevant nonlinear ECG dynamics into an interpretable representation that may reveal hidden AMI signatures, complement conventional ECG interpretation, and provide a foundation for accessible single-lead cardiovascular screening using future smart wearables.