From Automated ECG Interpretation to Multimodal Cardiovascular Intelligence: The Evolution of Artificial Intelligence in Cardiovascular Medicine

Artificial intelligence (AI) is rapidly transforming cardiovascular medicine, driven by the increasing availability of large-scale clinical data and advances in machine learning. Early computational applications in cardiology were primarily limited to rule-based electrocardiogram interpretation systems. Over time, these approaches have evolved into sophisticated deep learning models capable of analysing complex cardiovascular signals and imaging data. In parallel with the broader development of digital health technologies, including wearable devices, electronic health records, and remote monitoring systems, AI applications have expanded across multiple domains of cardiovascular care. These now include electrocardiographic (ECG) and electrophysiological analysis, cardiovascular imaging, surgical planning, and multimodal risk prediction. More recently, multimodal AI models have emerged that integrate heterogeneous data sources such as imaging, physiological signals, clinical records, and genomic information, enabling more comprehensive characterisation of cardiovascular disease. Beyond diagnostic applications, AI is increasingly influencing system-level aspects of cardiovascular medicine, including clinical decision support, workflow optimisation, medical education, and clinical trial design. This narrative review traces the historical and clinical evolution of artificial intelligence in cardiovascular medicine from early automated ECG interpretation systems to contemporary multimodal and system-level applications. It highlights key technological developments, current clinical applications, translational challenges, and the emerging role of AI within digital cardiovascular health ecosystems, with particular emphasis on early disease detection, risk stratification, prognostic modelling, and personalised cardiovascular care.