arXiv:2509.25480v1 Announce Type: cross Abstract: The 12-lead electrocardiogram (ECG) is the gold standard for cardiovascular monitoring, offering superior diagnostic granularity and specificity compared to photoplethysmography (PPG). However, existing 12-lead ECG systems rely on cumbersome multi-electrode setups, limiting sustained monitoring in ambulatory settings, while current PPG-based methods fail to reconstruct multi-lead ECG due to the absence of inter-lead constraints and insufficient modeling of spatial-temporal dependencies across leads. To bridge this gap, we introduce P2Es, an innovative demographic-aware diffusion framework designed to generate clinically valid 12-lead ECG from PPG signals via three key innovations. Specifically, in the forward process, we introduce frequency-domain blurring followed by temporal noise interference to simulate real-world signal distortions. In the reverse process, we design a temporal multi-scale generation module followed by frequency deblurring. In particular, we leverage KNN-based clustering combined with contrastive learning to assign affinity matrices for the reverse process, enabling demographic-specific ECG translation. Extensive experimental results show that P2Es outperforms baseline models in 12-lead ECG reconstruction.