Principal component conditional generative adversarial networks for imbalanced ECG classification enhancement

Chao Tang

doi:10.1371/journal.pone.0330707

Peer Review History

Original SubmissionMay 13, 2025
2 Jul 2025 Decision Letter - Don S, Editor PONE-D-25-25123 Principal Component Conditional Generative Adversarial Networks for Imbalanced ECG Classification Enhancement PLOS ONE Dear Dr. Tang, Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process. Please submit your revised manuscript by Aug 16 2025 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org. When you're ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file. Please include the following items when submitting your revised manuscript: A rebuttal letter that responds to each point raised by the academic editor and reviewer(s). You should upload this letter as a separate file labeled 'Response to Reviewers'. A marked-up copy of your manuscript that highlights changes made to the original version. You should upload this as a separate file labeled 'Revised Manuscript with Track Changes'. An unmarked version of your revised paper without tracked changes. You should upload this as a separate file labeled 'Manuscript'. If you would like to make changes to your financial disclosure, please include your updated statement in your cover letter. Guidelines for resubmitting your figure files are available below the reviewer comments at the end of this letter. If applicable, we recommend that you deposit your laboratory protocols in protocols.io to enhance the reproducibility of your results. Protocols.io assigns your protocol its own identifier (DOI) so that it can be cited independently in the future. For instructions see: https://journals.plos.org/plosone/s/submission-guidelines#loc-laboratory-protocols. Additionally, PLOS ONE offers an option for publishing peer-reviewed Lab Protocol articles, which describe protocols hosted on protocols.io. Read more information on sharing protocols at https://plos.org/protocols?utm_medium=editorial-email&utm_source=authorletters&utm_campaign=protocols. We look forward to receiving your revised manuscript. Kind regards, Don S Academic Editor PLOS ONE Journal requirements: 1. When submitting your revision, we need you to address these additional requirements. Please ensure that your manuscript meets PLOS ONE's style requirements, including those for file naming. 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Your ethics statement should only appear in the Methods section of your manuscript. If your ethics statement is written in any section besides the Methods, please move it to the Methods section and delete it from any other section. Please ensure that your ethics statement is included in your manuscript, as the ethics statement entered into the online submission form will not be published alongside your manuscript. Additional Editor Comments: Kindly modify the paper according to the reviewers comments. [Note: HTML markup is below. Please do not edit.] Reviewers' comments: Reviewer's Responses to Questions Comments to the Author 1. Is the manuscript technically sound, and do the data support the conclusions? The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented. Reviewer #1: Yes Reviewer #2: Yes ******** 2. Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: No Reviewer #2: Yes ****** 3. Have the authors made all data underlying the findings in their manuscript fully available? The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified. Reviewer #1: No Reviewer #2: Yes ****** 4. Is the manuscript presented in an intelligible fashion and written in standard English? PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here. Reviewer #1: No Reviewer #2: Yes ****** 5. Review Comments to the Author Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters) Reviewer #1: In this paper, the authors discusses the core challenges in ECG signal classification—extremely imbalanced data, significant individual physiological differences, and difficulties in long sequence fitting—by proposing a Principal Component Analysis-based Conditional Generative Adversarial Network (PCA-CGAN). The author has claimed as innovations: (i)Paradigm Shift in ECG Signal Representation: (ii)Transformer-based Conditional Generative Adversarial Network (iii)Two-Stage Conditional Encoding-Decoding Strategy (iv)Resolving the Dilution Effect in Data Augmentation: (v)Breaking the Single-Patient Limitation to Achieve Multi-Patient ECG Signal Generation: The comparison of the claimed approaches with existing literature, as well as performance evaluation, are not sufficiently detailed. There is a lack of quantitative performance comparison and analysis of pros and cons in practical applications. "The coining of sub titles for each session should be in a more precise manner" suggests that the current subtitles are not clear or descriptive enough. To improve them, consider using more specific and informative language that accurately reflects the content of each session. There are numerous instances of English grammatical errors. Reviewer #2: Areas for Improvement / Suggestions Clarity and Language Polishing While the technical content is strong, the manuscript would benefit from language editing for clarity and conciseness. Some expressions are repetitive, and certain technical terms (e.g., “Matthew effect,” “dilution effect”) could be introduced more formally with brief definitions for clarity. Ablation Studies Needed To better isolate the impact of each innovation (PCA, conditional encoding, Transformer), include ablation studies showing performance degradation when specific components are removed or replaced. Broader Comparison with Existing Methods While SigCWGAN and TD-GAN are compared, additional benchmarking against more recent diffusion models or contrastive learning approaches would further contextualize your model’s effectiveness. Discussion on Limitations and Clinical Translation The paper should include a brief section acknowledging limitations (e.g., reliance on synthetic data, assumptions in PCA), and a forward-looking discussion on how this work can transition into clinical ECG diagnostic tools. Over-Reliance on PCA Justification Although the use of PCA is well-motivated, future directions could explore non-linear dimensionality reduction techniques (e.g., autoencoders or t-SNE embeddings) to validate or enhance the representational efficiency. Ethical and Reproducibility Considerations A brief statement on ethical use, model reproducibility, and potential biases (e.g., how patient diversity was handled) would be welcome in keeping with best practices for clinical AI research. ****** 6. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files. If you choose “no”, your identity will remain anonymous but your review may still be made public. Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy. Reviewer #1: No Reviewer #2: No ******** [NOTE: If reviewer comments were submitted as an attachment file, they will be attached to this email and accessible via the submission site. Please log into your account, locate the manuscript record, and check for the action link "View Attachments". If this link does not appear, there are no attachment files.] While revising your submission, please upload your figure files to the Preflight Analysis and Conversion Engine (PACE) digital diagnostic tool, https://pacev2.apexcovantage.com/. PACE helps ensure that figures meet PLOS requirements. To use PACE, you must first register as a user. Registration is free. Then, login and navigate to the UPLOAD tab, where you will find detailed instructions on how to use the tool. If you encounter any issues or have any questions when using PACE, please email PLOS at figures@plos.org. Please note that Supporting Information files do not need this step. Attachments Attachment Submitted filename: COMMENTS.pdf https://doi.org/10.1371/journal.pone.0330707.r001
Revision 1
4 Jul 2025 Author Response Reviewer #1: In this paper, the authors discusses the core challenges in ECG signal classification—extremely imbalanced data, significant individual physiological differences, and difficulties in long sequence fitting—by proposing a Principal Component Analysis-based Conditional Generative Adversarial Network (PCA-CGAN). The author has claimed as innovations: (i)Paradigm Shift in ECG Signal Representation: (ii)Transformer-based Conditional Generative Adversarial Network (iii)Two-Stage Conditional Encoding-Decoding Strategy (iv)Resolving the Dilution Effect in Data Augmentation: (v)Breaking the Single-Patient Limitation to Achieve Multi-Patient ECG Signal Generation: 1.The comparison of the claimed approaches with existing literature, as well as performance evaluation, are not sufficiently detailed. There is a lack of quantitative performance comparison and analysis of pros and cons in practical applications. 2."The coining of sub titles for each session should be in a more precise manner" suggests that the current subtitles are not clear or descriptive enough. To improve them, consider using more specific and informative language that accurately reflects the content of each session. 3.There are numerous instances of English grammatical errors. Response to Reviewer #1 1. Comparison with existing literature and performance evaluation Thank you for pointing out this critical weakness in our manuscript. We fully agree that our initial submission lacked sufficient comparative analysis. Following your valuable guidance, we have substantially expanded our literature review and added comprehensive experimental analyses comparing our approach with existing methods. We have incorporated extensive experimental analyses comparing our PCA-based approach with other dimensionality reduction techniques, and added detailed quantitative analysis throughout the manuscript. 2. Improvement of section titles We sincerely apologize for the unclear organization and section titles in our original submission. Your comment helped us realize the importance of clear structural presentation. We have restructured the manuscript using a hierarchical heading system that clearly distinguishes between major sections and subsections, making the overall structure much clearer for readers. 3. English grammatical errors We deeply apologize for the numerous grammatical errors in our initial submission. This was indeed unprofessional, and we take full responsibility. We have conducted a thorough proofreading of the entire manuscript and corrected all identified grammatical errors and potential issues. We hope the revised version meets the journal's standards. Reviewer #2: Areas for Improvement / Suggestions 1.Clarity and Language Polishing While the technical content is strong, the manuscript would benefit from language editing for clarity and conciseness. Some expressions are repetitive, and certain technical terms (e.g., “Matthew effect,” “dilution effect”) could be introduced more formally with brief definitions for clarity. 2.Ablation Studies Needed To better isolate the impact of each innovation (PCA, conditional encoding, Transformer), include ablation studies showing performance degradation when specific components are removed or replaced. 3.Broader Comparison with Existing Methods While SigCWGAN and TD-GAN are compared, additional benchmarking against more recent diffusion models or contrastive learning approaches would further contextualize your model’s effectiveness. 4.Discussion on Limitations and Clinical Translation The paper should include a brief section acknowledging limitations (e.g., reliance on synthetic data, assumptions in PCA), and a forward-looking discussion on how this work can transition into clinical ECG diagnostic tools. 5.Over-Reliance on PCA Justification Although the use of PCA is well-motivated, future directions could explore non-linear dimensionality reduction techniques (e.g., autoencoders or t-SNE embeddings) to validate or enhance the representational efficiency. 6.Ethical and Reproducibility Considerations A brief statement on ethical use, model reproducibility, and potential biases (e.g., how patient diversity was handled) would be welcome in keeping with best practices for clinical AI research. Response to Reviewer #2 1. Clarity and technical term definitions You are absolutely right that technical terms should be properly introduced. We apologize for this oversight. Technical terms such as "Matthew effect" and "dilution effect" are now formally introduced with clear definitions and explanations before their discussion in the text. 2. Ablation studies Thank you for this excellent suggestion. We realize that ablation studies are crucial for validating our contributions. Following your guidance, we have conducted comprehensive ablation studies, analyzing the performance changes when each component is removed. 3. Broader comparison with existing methods Your point about needing broader comparisons is well-taken. We have added more in-depth descriptions and comparisons of various model types, and included comprehensive discussions on different approaches. 4. Discussion on limitations We greatly appreciate you highlighting the need for a balanced discussion of limitations. At the end of the paper, we have added a section candidly describing the model's limitations, discussing both its advantages and disadvantages. 5. Non-linear dimensionality reduction techniques Thank you for suggesting this important comparison. We have added discussions and comparisons of other non-linear dimensionality reduction techniques, analyzing the advantages, disadvantages, and applicable scope of each technique. 6. Code and data availability Following your recommendation for reproducibility, we have included the paper's code and datasets in the submission attachments to facilitate better understanding and reproduction of our work. Attachments Attachment Submitted filename: Response to Reviewers.docx https://doi.org/10.1371/journal.pone.0330707.r002
9 Jul 2025 Decision Letter - Don S, Editor PONE-D-25-25123R1 Principal Component Conditional Generative Adversarial Networks for Imbalanced ECG Classification Enhancement PLOS ONE Dear Dr. Tang, Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process. Please submit your revised manuscript by Aug 23 2025 11:59PM, if you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org. When you're ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file. Please include the following items when submitting your revised manuscript: A rebuttal letter that responds to each point raised by the academic editor and reviewer(s). You should upload this letter as a separate file labeled 'Response to Reviewers'. A marked-up copy of your manuscript that highlights changes made to the original version. You should upload this as a separate file labeled 'Revised Manuscript with Track Changes'. An unmarked version of your revised paper without tracked changes. You should upload this as a separate file labeled 'Manuscript'. If you would like to make changes to your financial disclosure, please include your updated statement in your cover letter. Guidelines for resubmitting your figure files are available below the reviewer comments at the end of this letter. If applicable, we recommend that you deposit your laboratory protocols in protocols.io to enhance the reproducibility of your results. Protocols.io assigns your protocol its own identifier (DOI) so that it can be cited independently in the future. For instructions see: https://journals.plos.org/plosone/s/submission-guidelines#loc-laboratory-protocols. Additionally, PLOS ONE offers an option for publishing peer-reviewed Lab Protocol articles, which describe protocols hosted on protocols.io. Read more information on sharing protocols at https://plos.org/protocols?utm_medium=editorial-email&utm_source=authorletters&utm_campaign=protocols. We look forward to receiving your revised manuscript. Kind regards, Don S Academic Editor PLOS ONE Reviewer2 comments: Areas for Improvement / Suggestions Clarity and Language Polishing While the technical content is strong, the manuscript would benefit from language editing for clarity and conciseness. Some expressions are repetitive, and certain technical terms (e.g., “Matthew effect,” “dilution effect”) could be introduced more formally with brief definitions for clarity. Ablation Studies Needed To better isolate the impact of each innovation (PCA, conditional encoding, Transformer), include ablation studies showing performance degradation when specific components are removed or replaced. Broader Comparison with Existing Methods While SigCWGAN and TD-GAN are compared, additional benchmarking against more recent diffusion models or contrastive learning approaches would further contextualize your model’s effectiveness. Discussion on Limitations and Clinical Translation The paper should include a brief section acknowledging limitations (e.g., reliance on synthetic data, assumptions in PCA), and a forward-looking discussion on how this work can transition into clinical ECG diagnostic tools. Over-Reliance on PCA Justification Although the use of PCA is well-motivated, future directions could explore non-linear dimensionality reduction techniques (e.g., autoencoders or t-SNE embeddings) to validate or enhance the representational efficiency. Ethical and Reproducibility Considerations A brief statement on ethical use, model reproducibility, and potential biases (e.g., how patient diversity was handled) would be welcome in keeping with best practices for clinical AI research. [NOTE: If reviewer comments were submitted as an attachment file, they will be attached to this email and accessible via the submission site. Please log into your account, locate the manuscript record, and check for the action link "View Attachments". If this link does not appear, there are no attachment files.] While revising your submission, please upload your figure files to the Preflight Analysis and Conversion Engine (PACE) digital diagnostic tool, https://pacev2.apexcovantage.com/. PACE helps ensure that figures meet PLOS requirements. To use PACE, you must first register as a user. Registration is free. Then, login and navigate to the UPLOAD tab, where you will find detailed instructions on how to use the tool. If you encounter any issues or have any questions when using PACE, please email PLOS at figures@plos.org. Please note that Supporting Information files do not need this step. https://doi.org/10.1371/journal.pone.0330707.r003
Revision 2
9 Jul 2025 Author Response Reviewer #1: In this paper, the authors discusses the core challenges in ECG signal classification—extremely imbalanced data, significant individual physiological differences, and difficulties in long sequence fitting—by proposing a Principal Component Analysis-based Conditional Generative Adversarial Network (PCA-CGAN). The author has claimed as innovations: (i)Paradigm Shift in ECG Signal Representation: (ii)Transformer-based Conditional Generative Adversarial Network (iii)Two-Stage Conditional Encoding-Decoding Strategy (iv)Resolving the Dilution Effect in Data Augmentation: (v)Breaking the Single-Patient Limitation to Achieve Multi-Patient ECG Signal Generation: 1.The comparison of the claimed approaches with existing literature, as well as performance evaluation, are not sufficiently detailed. There is a lack of quantitative performance comparison and analysis of pros and cons in practical applications. 2."The coining of sub titles for each session should be in a more precise manner" suggests that the current subtitles are not clear or descriptive enough. To improve them, consider using more specific and informative language that accurately reflects the content of each session. 3.There are numerous instances of English grammatical errors. Response to Reviewer #1 1. Comparison with existing literature and performance evaluation Thank you for pointing out this critical weakness in our manuscript. We fully agree that our initial submission lacked sufficient comparative analysis. Following your valuable guidance, we have substantially expanded our literature review and added comprehensive experimental analyses comparing our approach with existing methods. We have incorporated extensive experimental analyses comparing our PCA-based approach with other dimensionality reduction techniques, and added detailed quantitative analysis throughout the manuscript. 2. Improvement of section titles We sincerely apologize for the unclear organization and section titles in our original submission. Your comment helped us realize the importance of clear structural presentation. We have restructured the manuscript using a hierarchical heading system that clearly distinguishes between major sections and subsections, making the overall structure much clearer for readers. 3. English grammatical errors We deeply apologize for the numerous grammatical errors in our initial submission. This was indeed unprofessional, and we take full responsibility. We have conducted a thorough proofreading of the entire manuscript and corrected all identified grammatical errors and potential issues. We hope the revised version meets the journal's standards. Reviewer #2: Areas for Improvement / Suggestions 1.Clarity and Language Polishing While the technical content is strong, the manuscript would benefit from language editing for clarity and conciseness. Some expressions are repetitive, and certain technical terms (e.g., “Matthew effect,” “dilution effect”) could be introduced more formally with brief definitions for clarity. 2.Ablation Studies Needed To better isolate the impact of each innovation (PCA, conditional encoding, Transformer), include ablation studies showing performance degradation when specific components are removed or replaced. 3.Broader Comparison with Existing Methods While SigCWGAN and TD-GAN are compared, additional benchmarking against more recent diffusion models or contrastive learning approaches would further contextualize your model’s effectiveness. 4.Discussion on Limitations and Clinical Translation The paper should include a brief section acknowledging limitations (e.g., reliance on synthetic data, assumptions in PCA), and a forward-looking discussion on how this work can transition into clinical ECG diagnostic tools. 5.Over-Reliance on PCA Justification Although the use of PCA is well-motivated, future directions could explore non-linear dimensionality reduction techniques (e.g., autoencoders or t-SNE embeddings) to validate or enhance the representational efficiency. 6.Ethical and Reproducibility Considerations A brief statement on ethical use, model reproducibility, and potential biases (e.g., how patient diversity was handled) would be welcome in keeping with best practices for clinical AI research. Response to Reviewer #2 1. Clarity and technical term definitions You are absolutely right that technical terms should be properly introduced. We apologize for this oversight. Technical terms such as "Matthew effect" and "dilution effect" are now formally introduced with clear definitions and explanations before their discussion in the text. 2. Ablation studies Thank you for this excellent suggestion. We realize that ablation studies are crucial for validating our contributions. Following your guidance, we have conducted comprehensive ablation studies, analyzing the performance changes when each component is removed. 3. Broader comparison with existing methods Your point about needing broader comparisons is well-taken. We have added more in-depth descriptions and comparisons of various model types, and included comprehensive discussions on different approaches. 4. Discussion on limitations We greatly appreciate you highlighting the need for a balanced discussion of limitations. At the end of the paper, we have added a section candidly describing the model's limitations, discussing both its advantages and disadvantages. 5. Non-linear dimensionality reduction techniques Thank you for suggesting this important comparison. We have added discussions and comparisons of other non-linear dimensionality reduction techniques, analyzing the advantages, disadvantages, and applicable scope of each technique. 6. Code and data availability Following your recommendation for reproducibility, we have included the paper's code and datasets in the submission attachments to facilitate better understanding and reproduction of our work. The complete implementation of PCA-CGAN, including training scripts, evaluation metrics, and preprocessing pipelines, is publicly available at: https://github.com/ChaoTang20250509/PCA_CGAN Attachments Attachment Submitted filename: Response to Reviewer 2.docx https://doi.org/10.1371/journal.pone.0330707.r004
23 Jul 2025 Decision Letter - Don S, Editor PONE-D-25-25123R2 Principal Component Conditional Generative Adversarial Networks for Imbalanced ECG Classification Enhancement PLOS ONE Dear Dr. Tang, Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process. Please submit your revised manuscript by Sep 06 2025 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org. When you're ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file. Please include the following items when submitting your revised manuscript: A rebuttal letter that responds to each point raised by the academic editor and reviewer(s). You should upload this letter as a separate file labeled 'Response to Reviewers'. A marked-up copy of your manuscript that highlights changes made to the original version. You should upload this as a separate file labeled 'Revised Manuscript with Track Changes'. An unmarked version of your revised paper without tracked changes. You should upload this as a separate file labeled 'Manuscript'. If you would like to make changes to your financial disclosure, please include your updated statement in your cover letter. Guidelines for resubmitting your figure files are available below the reviewer comments at the end of this letter. If applicable, we recommend that you deposit your laboratory protocols in protocols.io to enhance the reproducibility of your results. Protocols.io assigns your protocol its own identifier (DOI) so that it can be cited independently in the future. For instructions see: https://journals.plos.org/plosone/s/submission-guidelines#loc-laboratory-protocols. Additionally, PLOS ONE offers an option for publishing peer-reviewed Lab Protocol articles, which describe protocols hosted on protocols.io. Read more information on sharing protocols at https://plos.org/protocols?utm_medium=editorial-email&utm_source=authorletters&utm_campaign=protocols. We look forward to receiving your revised manuscript. Kind regards, Don S Academic Editor PLOS ONE Additional Editor Comments: kindly modify the paper according the reviewers and journal template. Paper need to have a structure Introduction, Related work,... Reviewers' comments: Reviewer's Responses to Questions Comments to the Author 1. If the authors have adequately addressed your comments raised in a previous round of review and you feel that this manuscript is now acceptable for publication, you may indicate that here to bypass the “Comments to the Author” section, enter your conflict of interest statement in the “Confidential to Editor” section, and submit your "Accept" recommendation. Reviewer #1: (No Response) Reviewer #2: All comments have been addressed ******** 2. Is the manuscript technically sound, and do the data support the conclusions? The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented. Reviewer #1: Yes Reviewer #2: Yes ****** 3. Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: Yes Reviewer #2: Yes ****** 4. Have the authors made all data underlying the findings in their manuscript fully available? The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified. Reviewer #1: No Reviewer #2: Yes ****** 5. Is the manuscript presented in an intelligible fashion and written in standard English? PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here. Reviewer #1: No Reviewer #2: Yes ****** 6. Review Comments to the Author Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters) Reviewer #1: The second suggestion given in my earlier comment "The coining of sub titles for each session should be in a more precise manner" suggests that the current subtitles are not clear or descriptive enough. To improve them, consider using more specific and informative language that accurately reflects the content of each session." has not been addressed properly. The manuscript should have Introduction session. Rename " Related Work and Problem Analysis" as "Introduction" Rename "Conclusions and Technical Limitations" as "Discussions" and include relevant details into it. Also add more contents to discussion section incorporating your inference from comparisons and analysis. Conclusion session should be brief and should contain only two paragraphs including the future work. A separate session on "Related Works" should be added just after "Introduction" session . The references are very few. This manuscript has the potential to include more than 30 references. Reviewer #2: Concerns addressed as mentioned in the review. The grammatical errors have been corrected and paperhas been structured ****** 7. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files. If you choose “no”, your identity will remain anonymous but your review may still be made public. Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy. Reviewer #1: No Reviewer #2: No ******** [NOTE: If reviewer comments were submitted as an attachment file, they will be attached to this email and accessible via the submission site. Please log into your account, locate the manuscript record, and check for the action link "View Attachments". If this link does not appear, there are no attachment files.] While revising your submission, please upload your figure files to the Preflight Analysis and Conversion Engine (PACE) digital diagnostic tool, https://pacev2.apexcovantage.com/. PACE helps ensure that figures meet PLOS requirements. To use PACE, you must first register as a user. Registration is free. Then, login and navigate to the UPLOAD tab, where you will find detailed instructions on how to use the tool. If you encounter any issues or have any questions when using PACE, please email PLOS at figures@plos.org. Please note that Supporting Information files do not need this step. https://doi.org/10.1371/journal.pone.0330707.r005
Revision 3
24 Jul 2025 Author Response Reviewer #1: The second suggestion given in my earlier comment "The coining of sub titles for each session should be in a more precise manner" suggests that the current subtitles are not clear or descriptive enough. To improve them, consider using more specific and informative language that accurately reflects the content of each session." has not been addressed properly. The manuscript should have Introduction session. Rename " Related Work and Problem Analysis" as "Introduction" Rename "Conclusions and Technical Limitations" as "Discussions" and include relevant details into it. Also add more contents to discussion section incorporating your inference from comparisons and analysis. Conclusion session should be brief and should contain only two paragraphs including the future work. A separate session on "Related Works" should be added just after "Introduction" session . The references are very few. This manuscript has the potential to include more than 30 references. Response to Reviewer #1 Thank you for your constructive feedback. We have carefully addressed all your suggestions to improve the clarity and organization of our manuscript. Below are the specific changes we have made: 1. Manuscript Structure Reorganization: • We have restructured the manuscript to include a clear "Introduction" section as the opening, which provides the background and motivation for our research. • Following your suggestion, we have created a separate "Related Work" section immediately after the Introduction, which comprehensively reviews existing ECG classification and generation methods. • The previous "Conclusions and Technical Limitations" has been renamed to "Discussions" and substantially expanded with more detailed analysis of our findings, comparisons with existing methods, and technical limitations. • The "Conclusion" section has been condensed to two concise paragraphs, including future work directions. 2. Enhanced Section Titles: We have revised all section titles to be more precise and descriptive: • "Introduction" - clearly establishes the research context • "Related Work" - systematically reviews existing literature • "Methodology and Technical Contributions" - details our approach • "Data Preprocessing and Feature Analysis" - describes data handling • "Network Architecture Design" - explains the PCA-CGAN structure • "Experimental Results and Analysis" - presents findings • "Discussions" - provides in-depth analysis and limitations • "Conclusion" - summarizes key contributions and future directions 3. Expanded References: We have significantly expanded our reference list from the original count to 32 references, incorporating more recent and relevant works in ECG classification, generative models, and data augmentation techniques. 4. Enhanced Discussion Section: The Discussions section now includes: • In-depth analysis of main research achievements and contributions • Detailed comparison with state-of-the-art methods • Theoretical innovation and methodology paradigm shifts • Technical breakthroughs in cross-patient generalization • Multidimensional performance advantage analysis • Comprehensive discussion of technical limitations and theoretical boundaries We believe these revisions have significantly improved the manuscript's organization, clarity, and academic rigor. Thank you again for your valuable suggestions that helped strengthen our work. Attachments Attachment Submitted filename: Response to Reviewer 1.docx https://doi.org/10.1371/journal.pone.0330707.r006
31 Jul 2025 Decision Letter - Don S, Editor PONE-D-25-25123R3 Principal Component Conditional Generative Adversarial Networks for Imbalanced ECG Classification Enhancement PLOS ONE Dear Dr. Tang, Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process. Please submit your revised manuscript by Sep 13 2025 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org. When you're ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file. Please include the following items when submitting your revised manuscript: A rebuttal letter that responds to each point raised by the academic editor and reviewer(s). You should upload this letter as a separate file labeled 'Response to Reviewers'. A marked-up copy of your manuscript that highlights changes made to the original version. You should upload this as a separate file labeled 'Revised Manuscript with Track Changes'. An unmarked version of your revised paper without tracked changes. You should upload this as a separate file labeled 'Manuscript'. If you would like to make changes to your financial disclosure, please include your updated statement in your cover letter. Guidelines for resubmitting your figure files are available below the reviewer comments at the end of this letter. If applicable, we recommend that you deposit your laboratory protocols in protocols.io to enhance the reproducibility of your results. Protocols.io assigns your protocol its own identifier (DOI) so that it can be cited independently in the future. For instructions see: https://journals.plos.org/plosone/s/submission-guidelines#loc-laboratory-protocols. Additionally, PLOS ONE offers an option for publishing peer-reviewed Lab Protocol articles, which describe protocols hosted on protocols.io. Read more information on sharing protocols at https://plos.org/protocols?utm_medium=editorial-email&utm_source=authorletters&utm_campaign=protocols. We look forward to receiving your revised manuscript. Kind regards, Don S Academic Editor PLOS ONE Journal Requirements: 1. If the reviewer comments include a recommendation to cite specific previously published works, please review and evaluate these publications to determine whether they are relevant and should be cited. There is no requirement to cite these works unless the editor has indicated otherwise. 2. Please review your reference list to ensure that it is complete and correct. If you have cited papers that have been retracted, please include the rationale for doing so in the manuscript text, or remove these references and replace them with relevant current references. Any changes to the reference list should be mentioned in the rebuttal letter that accompanies your revised manuscript. If you need to cite a retracted article, indicate the article’s retracted status in the References list and also include a citation and full reference for the retraction notice. Additional Editor Comments : kindly remove the section "Related Work and Problem Analysis" and split into two main section. The first one is "Introduction " and the second main heading is "Related Work" [Note: HTML markup is below. Please do not edit.] [NOTE: If reviewer comments were submitted as an attachment file, they will be attached to this email and accessible via the submission site. Please log into your account, locate the manuscript record, and check for the action link "View Attachments". If this link does not appear, there are no attachment files.] While revising your submission, please upload your figure files to the Preflight Analysis and Conversion Engine (PACE) digital diagnostic tool, https://pacev2.apexcovantage.com/. PACE helps ensure that figures meet PLOS requirements. To use PACE, you must first register as a user. Registration is free. Then, login and navigate to the UPLOAD tab, where you will find detailed instructions on how to use the tool. If you encounter any issues or have any questions when using PACE, please email PLOS at figures@plos.org. Please note that Supporting Information files do not need this step. https://doi.org/10.1371/journal.pone.0330707.r007
Revision 4
5 Aug 2025 Author Response Reviewer #1: The second suggestion given in my earlier comment "The coining of sub titles for each session should be in a more precise manner" suggests that the current subtitles are not clear or descriptive enough. To improve them, consider using more specific and informative language that accurately reflects the content of each session." has not been addressed properly. The manuscript should have Introduction session. Rename " Related Work and Problem Analysis" as "Introduction" Rename "Conclusions and Technical Limitations" as "Discussions" and include relevant details into it. Also add more contents to discussion section incorporating your inference from comparisons and analysis. Conclusion session should be brief and should contain only two paragraphs including the future work. A separate session on "Related Works" should be added just after "Introduction" session . The references are very few. This manuscript has the potential to include more than 30 references. Response to Reviewer #1 Thank you for your constructive feedback. We have carefully addressed all your suggestions to improve the clarity and organization of our manuscript. Below are the specific changes we have made: 1. Manuscript Structure Reorganization: • We have restructured the manuscript to include a clear "Introduction" section as the opening, which provides the background and motivation for our research. • Following your suggestion, we have created a separate "Related Work" section immediately after the Introduction, which comprehensively reviews existing ECG classification and generation methods. • The previous "Conclusions and Technical Limitations" has been renamed to "Discussions" and substantially expanded with more detailed analysis of our findings, comparisons with existing methods, and technical limitations. • The "Conclusion" section has been condensed to two concise paragraphs, including future work directions. 2. Enhanced Section Titles: We have revised all section titles to be more precise and descriptive: • "Introduction" - clearly establishes the research context • "Related Work" - systematically reviews existing literature • "Methodology and Technical Contributions" - details our approach • "Data Preprocessing and Feature Analysis" - describes data handling • "Network Architecture Design" - explains the PCA-CGAN structure • "Experimental Results and Analysis" - presents findings • "Discussions" - provides in-depth analysis and limitations • "Conclusion" - summarizes key contributions and future directions 3. Expanded References: We have significantly expanded our reference list from the original count to 32 references, incorporating more recent and relevant works in ECG classification, generative models, and data augmentation techniques. 4. Enhanced Discussion Section: The Discussions section now includes: • In-depth analysis of main research achievements and contributions • Detailed comparison with state-of-the-art methods • Theoretical innovation and methodology paradigm shifts • Technical breakthroughs in cross-patient generalization • Multidimensional performance advantage analysis • Comprehensive discussion of technical limitations and theoretical boundaries We believe these revisions have significantly improved the manuscript's organization, clarity, and academic rigor. Thank you again for your valuable suggestions that helped strengthen our work. Attachments Attachment Submitted filename: Response_to_Reviewer_1_auresp_4.docx https://doi.org/10.1371/journal.pone.0330707.r008
6 Aug 2025 Decision Letter - Don S, Editor Principal Component Conditional Generative Adversarial Networks for Imbalanced ECG Classification Enhancement PONE-D-25-25123R4 Dear Dr. Tang We’re pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it meets all outstanding technical requirements. Within one week, you’ll receive an e-mail detailing the required amendments. When these have been addressed, you’ll receive a formal acceptance letter and your manuscript will be scheduled for publication. An invoice will be generated when your article is formally accepted. Please note, if your institution has a publishing partnership with PLOS and your article meets the relevant criteria, all or part of your publication costs will be covered. Please make sure your user information is up-to-date by logging into Editorial Manager at Editorial Manager® and clicking the ‘Update My Information' link at the top of the page. For questions related to billing, please contact billing support. If your institution or institutions have a press office, please notify them about your upcoming paper to help maximize its impact. If they’ll be preparing press materials, please inform our press team as soon as possible -- no later than 48 hours after receiving the formal acceptance. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information, please contact onepress@plos.org. Kind regards, Don S Academic Editor PLOS ONE https://doi.org/10.1371/journal.pone.0330707.r009
Formally Accepted
Acceptance Letter - Don S, Editor PONE-D-25-25123R4 PLOS ONE Dear Dr. Tang, I'm pleased to inform you that your manuscript has been deemed suitable for publication in PLOS ONE. Congratulations! Your manuscript is now being handed over to our production team. At this stage, our production department will prepare your paper for publication. This includes ensuring the following: * All references, tables, and figures are properly cited * All relevant supporting information is included in the manuscript submission, * There are no issues that prevent the paper from being properly typeset You will receive further instructions from the production team, including instructions on how to review your proof when it is ready. Please keep in mind that we are working through a large volume of accepted articles, so please give us a few days to review your paper and let you know the next and final steps. Lastly, if your institution or institutions have a press office, please let them know about your upcoming paper now to help maximize its impact. If they'll be preparing press materials, please inform our press team within the next 48 hours. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information, please contact onepress@plos.org. You will receive an invoice from PLOS for your publication fee after your manuscript has reached the completed accept phase. If you receive an email requesting payment before acceptance or for any other service, this may be a phishing scheme. Learn how to identify phishing emails and protect your accounts at https://explore.plos.org/phishing. If we can help with anything else, please email us at customercare@plos.org. Thank you for submitting your work to PLOS ONE and supporting open access. Kind regards, PLOS ONE Editorial Office Staff on behalf of Dr. Don S Academic Editor PLOS ONE https://doi.org/10.1371/journal.pone.0330707.r010

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