Impact of Multiple Non-Invasive Biosignals on Cardiovascular Biomarker Estimation via Simulation-Based Inference

As the population ages, the number of patients with cardiovascular diseases continues to increase, highlighting the need for early detection before progression to severe and irreversible functional decline. Consequently, estimating cardiovascular biomarkers from non-invasive biosignals, such as photoplethysmography (PPG) and arterial pressure wave (APW) signals, has attracted increasing attention. These signals can be measured using wearable and cuff-type devices. Previous studies have used PPG and APW signals to estimate cardiovascular biomarkers. However, these signals exhibit strong similarities in both the temporal and frequency domains and primarily reflect peripheral and arterial pulse waveforms. Therefore, they may provide limited information about cardiac mechanical function. In contrast, the quantitative impact of additional biosignals, such as ballistocardiography (BCG), which reflect the body's minute mechanical responses to cardiac ejection, remains unclear. In this study, we generated synthetic PPG, APW, and BCG signals from a unified whole-body cardiovascular circulation model and evaluated the complementary contribution of BCG to probabilistic cardiovascular biomarker estimation. We estimated posterior distributions of cardiovascular biomarkers using neural posterior estimation and simulation-based inference. The results showed that adding BCG signals significantly improved estimation performance. Furthermore, even in ill-posed cases where PPG and APW alone produced multimodal posterior distributions, adding BCG yielded unimodal posterior distributions. These findings provide fundamental insights into signal selection for estimating cardiovascular dynamics.