1
|
Carvalho TD, Freitas OGAD, Chalela WA, Hossri CAC, Milani M, Buglia S, Precoma DB, Falcão AMGM, Mastrocola LE, Castro I, Albuquerque PFD, Coutinho RQ, Brito FSD, Alves JDC, Serra SM, Santos MAD, Colombo CSSDS, Stein R, Herdy AH, Silveira ADD, Castro CLBD, Silva MMFD, Meneghello RS, Ritt LEF, Malafaia FL, Marinucci LFB, Pena JLB, Almeida AEMD, Vieira MLC, Stier Júnior AL. Brazilian Guideline for Exercise Test in the Adult Population - 2024. Arq Bras Cardiol 2024; 121:e20240110. [PMID: 38896581 DOI: 10.36660/abc.20240110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/21/2024] Open
Affiliation(s)
- Tales de Carvalho
- Clínica de Prevenção e Reabilitação Cardiosport, Florianópolis, SC - Brasil
- Universidade do Estado de Santa Catarina, Florianópolis, SC - Brasil
| | | | - William Azem Chalela
- Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (InCor-HCFMUSP), São Paulo, SP - Brasil
| | | | - Mauricio Milani
- Universidade de Brasília (UnB), Brasília, DF, Brasil
- Hasselt University, Hasselt - Bélgica
- Jessa Ziekenhuis, Hasselt - Bélgica
| | - Susimeire Buglia
- Instituto Dante Pazzanese de Cardiologia, São Paulo, SP - Brasil
| | | | - Andréa Maria Gomes Marinho Falcão
- Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (InCor-HCFMUSP), São Paulo, SP - Brasil
| | | | - Iran Castro
- Instituto de Cardiologia do Rio Grande do Sul, Porto Alegre, RS - Brasil
| | | | | | | | | | - Salvador Manoel Serra
- Instituto Estadual de Cardiologia Aloysio de Castro (IECAC), Rio de Janeiro, RJ - Brasil
| | - Mauro Augusto Dos Santos
- Instituto Nacional de Cardiologia do Rio de Janeiro, Rio de Janeiro, RJ - Brasil
- Linkcare Saúde, Rio de Janeiro, RJ - Brasil
| | | | - Ricardo Stein
- Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS - Brasil
| | - Artur Haddad Herdy
- Clínica de Prevenção e Reabilitação Cardiosport, Florianópolis, SC - Brasil
| | - Anderson Donelli da Silveira
- Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS - Brasil
- Hospital de Clínicas de Porto Alegre, Porto Alegre, RS - Brasil
- Hospital Moinhos de Vento, Porto Alegre, RS - Brasil
| | - Claudia Lucia Barros de Castro
- Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ - Brasil
- CLINIMEX - Clínica de Medicina de Exercício, Rio de Janeiro, RJ - Brasil
| | | | | | - Luiz Eduardo Fonteles Ritt
- Escola Bahiana de Medicina e Saúde Pública, Salvador, BA - Brasil
- Instituto D'Or de Pesquisa e Ensino, Salvador, BA - Brasil
- Hospital Cárdio Pulmonar, Salvador, BA - Brasil
| | - Felipe Lopes Malafaia
- Hospital Samaritano Paulista, São Paulo, SP - Brasil
- UnitedHealth Group Brasil, São Paulo, SP - Brasil
| | - Leonardo Filipe Benedeti Marinucci
- Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (InCor-HCFMUSP), São Paulo, SP - Brasil
| | - José Luiz Barros Pena
- Faculdade Ciências Médicas de Minas Gerais, Belo Horizonte, MG - Brasil
- Hospital Felício Rocho, Belo Horizonte, MG - Brasil
| | | | - Marcelo Luiz Campos Vieira
- Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (InCor-HCFMUSP), São Paulo, SP - Brasil
- Hospital Israelita Albert Einstein, São Paulo, SP - Brasil
| | - Arnaldo Laffitte Stier Júnior
- Universidade Federal do Paraná (UFPR), Curitiba, PR - Brasil
- Secretaria Municipal de Saúde Curitiba, Curitiba, PR - Brasil
| |
Collapse
|
2
|
Lin PY, Tsai CT, Hsu CF, Lee YH, Huang HP, Huang CC, Liu LYM, Hsu L, Yang TF, Lin PL. The Autonomic Imbalance of Myocardial Ischemia during Exercise Stress Testing: Insight from Short-Term Heart Rate Variability Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:15096. [PMID: 36429812 PMCID: PMC9690482 DOI: 10.3390/ijerph192215096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 11/11/2022] [Accepted: 11/13/2022] [Indexed: 06/16/2023]
Abstract
Exercise stress testing (EST) has limited power in diagnosing obstructive coronary artery disease (CAD). The heart rate variability (HRV) analysis might increase the sensitivity of CAD detection. This study aimed to evaluate the correlation between short-term HRV and myocardial ischemia during EST, including the acceleration, maximum, and recovery stages of heart rate (HR). The HRV during EST from 19 healthy (RHC) subjects and 35 patients with CAD (25 patients with insignificant CAD (iCAD), and 10 patients with significant CAD (sCAD)) were compared. As a result, all HRV indices decreased at the maximum stage and no significant differences between iCAD and sCAD were found. The low-frequency power of heart rate signal (LF) of the RHC group recovered relatively quickly from the third to the sixth minutes after maximum HR, compared with that of the sCAD group. The relative changes of most HRV indices between maximum HR and recovery stage were lower in the sCAD group than in the RHC group, especially in LF, the standard deviation of all normal to normal intervals (SDNN), and the standard deviation in the long axis direction of the Poincaré plot analysis (SD2) indices (p < 0.05). The recovery slope of LF was significantly smaller in the sCAD group than in the RHC group (p = 0.02). The result suggests that monitoring short-term HRV during EST provides helpful insight into the cardiovascular autonomic imbalance in patients with significant CAD. The relative change of autonomic tone, especially the delayed sympathetic recovery, could be an additional marker for diagnosing myocardial ischemia.
Collapse
Affiliation(s)
- Ping-Yen Lin
- Department of Electrophyics, National Yang Ming Chiao Tung University, Hsinchu 30010, Taiwan
| | - Cheng-Ting Tsai
- Cardiovascular Center, MacKay Memorial Hospital, Taipei 104217, Taiwan
- Department of Cosmetic Applications and Management, MacKay Junior College of Medicine, Nursing and Management, Taipei 25245, Taiwan
| | | | - Ying-Hsiang Lee
- Cardiovascular Center, MacKay Memorial Hospital, Taipei 104217, Taiwan
- Department of Medicine, MacKay Medical College, New Taipei City 25245, Taiwan
- Department of Artificial Intelligence and Medical Application, MacKay Junior College of Medicine, Nursing and Management, Taipei 25245, Taiwan
| | | | - Chun-Che Huang
- Department of Healthcare Administration, I-Shou University, Kaohsiung 82445, Taiwan
| | - Lawrence Yu-Min Liu
- Department of Medicine, MacKay Medical College, New Taipei City 25245, Taiwan
- Division of Cardiology, Hsinchu MacKay Memorial Hospital, Hsinchu 30071, Taiwan
| | - Long Hsu
- Department of Electrophyics, National Yang Ming Chiao Tung University, Hsinchu 30010, Taiwan
| | - Ten-Fang Yang
- Department of Biological Science and Technology, National Yang Ming Chiao Tung University, Hsinchu 30010, Taiwan
- Graduate Institute of Medical Informatics, Taipei Medical University Hospital, Taipei 110301, Taiwan
| | - Po-Lin Lin
- Division of Cardiology, Hsinchu MacKay Memorial Hospital, Hsinchu 30071, Taiwan
- Department of Biological Science and Technology, National Yang Ming Chiao Tung University, Hsinchu 30010, Taiwan
| |
Collapse
|
3
|
Beadle R, McDonnell D, Ghasemi Roudsari S, Unitt L, Parker S, Varcoe BTH. Assessing heart disease using a novel magnetocardiography device. Biomed Phys Eng Express 2021; 7. [PMID: 33578399 DOI: 10.1088/2057-1976/abe5c5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Accepted: 02/12/2021] [Indexed: 11/12/2022]
Abstract
The aim of this paper is to present the use of a portable, unshielded magnetocardiograph (MCG) and identify key characteristics of MCG scans that could be used in future studies to identify parameters that are sensitive to cardiac pathology. We recruited 50 patients with confirmed myocardial infarction (MI) within the past 12 weeks and 46 volunteers with no history of cardiac disease. A set of 38 parameters were extracted from MCG features including both signals from the sensor array and from magnetic images obtained from the device and principal component analysis was used to concentrate the information contained in these parameters into uncorrelated predictors. Linear fits of these parameters were then used to examine the ability of MCG to distinguish between sub-groups of patients. In the fist instance, the primary aim of this study was to ensure that MCG has a basic ability to separate a highly polarised patient group (young controls from post infarction patients) and to identify parameters that could be used in future studies to build a formal diagnostic tool kit. Parameters that parameterised left ventricular ejection fraction (LVEF) were identified and an example is presented to show differential low and high ejection fractions.
Collapse
Affiliation(s)
- Roger Beadle
- Department of Cardiology, South Warwickshire NHS Foundation Trust, Lakin Road Warwick CV34 5BW, Warwick, Warwickshire, CV34 5BW, UNITED KINGDOM OF GREAT BRITAIN AND NORTHERN IRELAND
| | - Donna McDonnell
- Department of Cardiology, South Warwickshire NHS Foundation Trust, Lakin Road Warwick CV34 5BW, Warwick, Warwickshire, CV34 5BW, UNITED KINGDOM OF GREAT BRITAIN AND NORTHERN IRELAND
| | - Shima Ghasemi Roudsari
- Creavo Medical Technologies, Westwood Way Westwood Business Park, Coventry, CV4 8HS, Coventry, CV4 8HS, UNITED KINGDOM OF GREAT BRITAIN AND NORTHERN IRELAND
| | - Lynda Unitt
- Creavo Medical Technologies, Westwood Way Westwood Business Park, Coventry, CV4 8HS, Coventry, CV4 8HS, UNITED KINGDOM OF GREAT BRITAIN AND NORTHERN IRELAND
| | - Steve Parker
- Creavo Medical Technologies, Westwood Way Westwood Business Park, Coventry, CV4 8HS, Coventry, CV4 8HS, UNITED KINGDOM OF GREAT BRITAIN AND NORTHERN IRELAND
| | - Benjamin T H Varcoe
- School of Physics and Astronomy, University of Leeds, Woodhouse Lane, Leeds, West Yorkshire, LS2 9JT, UNITED KINGDOM OF GREAT BRITAIN AND NORTHERN IRELAND
| |
Collapse
|
4
|
Zhang YH, Pan X, Zeng T, Chen L, Huang T, Cai YD. Identifying the RNA signatures of coronary artery disease from combined lncRNA and mRNA expression profiles. Genomics 2020; 112:4945-4958. [PMID: 32919019 DOI: 10.1016/j.ygeno.2020.09.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Revised: 07/28/2020] [Accepted: 09/05/2020] [Indexed: 12/23/2022]
Abstract
Coronary artery disease (CAD) is the most common cardiovascular disease. CAD research has greatly progressed during the past decade. mRNA is a traditional and popular pipeline to investigate various disease, including CAD. Compared with mRNA, lncRNA has better stability and thus may serve as a better disease indicator in blood. Investigating potential CAD-related lncRNAs and mRNAs will greatly contribute to the diagnosis and treatment of CAD. In this study, a computational analysis was conducted on patients with CAD by using a comprehensive transcription dataset with combined mRNA and lncRNA expression data. Several machine learning algorithms, including feature selection methods and classification algorithms, were applied to screen for the most CAD-related RNA molecules. Decision rules were also reported to provide a quantitative description about the effect of these RNA molecules on CAD progression. These new findings (CAD-related RNA molecules and rules) can help understand mRNA and lncRNA expression levels in CAD.
Collapse
Affiliation(s)
- Yu-Hang Zhang
- School of Life Sciences, Shanghai University, Shanghai 200444, China; Shanghai Institute of Nutrition and Health, Shanghai Institutes for Biological Sciences, Chinese Academy of Sciences, Shanghai 200031, China; Channing Division of Network Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
| | - Xiaoyong Pan
- Institute of Image Processing and Pattern Recognition, Shanghai Jiao Tong University, Key Laboratory of System Control and Information Processing, Ministry of Education of China, 200240 Shanghai, China.
| | - Tao Zeng
- Shanghai Research Center for Brain Science and Brain-Inspired Intelligence, Shanghai 201210, China.
| | - Lei Chen
- College of Information Engineering, Shanghai Maritime University, Shanghai 201306, China.
| | - Tao Huang
- Shanghai Institute of Nutrition and Health, Shanghai Institutes for Biological Sciences, Chinese Academy of Sciences, Shanghai 200031, China.
| | - Yu-Dong Cai
- School of Life Sciences, Shanghai University, Shanghai 200444, China.
| |
Collapse
|
5
|
Chen M, He A, Feng K, Liu G, Wang Q. Empirical Mode Decomposition as a Novel Approach to Study Heart Rate Variability in Congestive Heart Failure Assessment. ENTROPY 2019; 21:1169. [PMCID: PMC7514513 DOI: 10.3390/e21121169] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Accepted: 11/22/2019] [Indexed: 06/17/2023]
Abstract
Congestive heart failure (CHF) is a cardiovascular disease related to autonomic nervous system (ANS) dysfunction and fragmented patterns. There is a growing demand for assessing CHF accurately. In this work, 24-h RR interval signals (the time elapsed between two successive R waves of the QRS signal on the electrocardiogram) of 98 subjects (54 healthy and 44 CHF subjects) were analyzed. Empirical mode decomposition (EMD) was chosen to decompose RR interval signals into four intrinsic mode functions (IMFs). Then transfer entropy (TE) was employed to study the information transaction among four IMFs. Compared with the normal group, significant decrease in TE (*→1; information transferring from other IMFs to IMF1, p < 0.001) and TE (3→*; information transferring from IMF3 to other IMFs, p < 0.05) was observed. Moreover, the combination of TE (*→1), TE (3→*) and LF/HF reached the highest CHF screening accuracy (85.7%) in IBM SPSS Statistics discriminant analysis, while LF/HF only achieved 79.6%. This novel method and indices could serve as a new way to assessing CHF and studying the interaction of the physiological phenomena. Simulation examples and transfer entropy applications are provided to demonstrate the effectiveness of the proposed EMD decomposition method in assessing CHF.
Collapse
Affiliation(s)
- Mingjing Chen
- Department of Biomedical Engineering, School of Basic Medical Sciences, Guangzhou Medical University, Guangzhou 511436, China;
- School of Biomedical Engineering, Sun Yat-sen University, Guangzhou 510275, China; (A.H.); (K.F.); (G.L.)
| | - Aodi He
- School of Biomedical Engineering, Sun Yat-sen University, Guangzhou 510275, China; (A.H.); (K.F.); (G.L.)
| | - Kaicheng Feng
- School of Biomedical Engineering, Sun Yat-sen University, Guangzhou 510275, China; (A.H.); (K.F.); (G.L.)
| | - Guanzheng Liu
- School of Biomedical Engineering, Sun Yat-sen University, Guangzhou 510275, China; (A.H.); (K.F.); (G.L.)
| | - Qian Wang
- Department of Biomedical Engineering, School of Basic Medical Sciences, Guangzhou Medical University, Guangzhou 511436, China;
| |
Collapse
|
6
|
Estévez-Báez M, Machado C, García-Sánchez B, Rodríguez V, Alvarez-Santana R, Leisman G, Carrera JME, Schiavi A, Montes-Brown J, Arrufat-Pié E. Autonomic impairment of patients in coma with different Glasgow coma score assessed with heart rate variability. Brain Inj 2019; 33:496-516. [PMID: 30755043 DOI: 10.1080/02699052.2018.1553312] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
PRIMARY OBJECTIVE The objective of this study is to assess the functional state of the autonomic nervous system in healthy individuals and in individuals in coma using measures of heart rate variability (HRV) and to evaluate its efficiency in predicting mortality. DESIGN AND METHODS Retrospective group comparison study of patients in coma classified into two subgroups, according to their Glasgow coma score, with a healthy control group. HRV indices were calculated from 7 min of artefact-free electrocardiograms using the Hilbert-Huang method in the spectral range 0.02-0.6 Hz. A special procedure was applied to avoid confounding factors. Stepwise multiple regression logistic analysis (SMLRA) and ROC analysis evaluated predictions. RESULTS Progressive reduction of HRV was confirmed and was associated with deepening of coma and a mortality score model that included three spectral HRV indices of absolute power values of very low, low and very high frequency bands (0.4-0.6 Hz). The SMLRA model showed sensitivity of 95.65%, specificity of 95.83%, positive predictive value of 95.65%, and overall efficiency of 95.74%. CONCLUSIONS HRV is a reliable method to assess the integrity of the neural control of the caudal brainstem centres on the hearts of patients in coma and to predict patient mortality.
Collapse
Affiliation(s)
- Mario Estévez-Báez
- a Department of Clinical Neurophysiology , Institute of Neurology and Neurosurgery , Havana , Cuba
| | - Calixto Machado
- a Department of Clinical Neurophysiology , Institute of Neurology and Neurosurgery , Havana , Cuba
| | | | | | | | - Gerry Leisman
- d Faculty of Health Sciences , University of Haifa , Haifa , Israel
| | | | - Adam Schiavi
- e Anesthesiology and Critical Care Medicine, Neurosciences Critical Care Division , Johns Hopkins Hospital , Baltimore , MD , USA
| | - Julio Montes-Brown
- f Department of Medicine & Health Science , University of Sonora , Sonora , Mexico
| | - Eduardo Arrufat-Pié
- g Institute of Basic and Preclinical Sciences, "Victoria de Girón" , Havana , Cuba
| |
Collapse
|
7
|
Lyon A, Mincholé A, Martínez JP, Laguna P, Rodriguez B. Computational techniques for ECG analysis and interpretation in light of their contribution to medical advances. J R Soc Interface 2018; 15:20170821. [PMID: 29321268 PMCID: PMC5805987 DOI: 10.1098/rsif.2017.0821] [Citation(s) in RCA: 74] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Accepted: 12/08/2017] [Indexed: 01/09/2023] Open
Abstract
Widely developed for clinical screening, electrocardiogram (ECG) recordings capture the cardiac electrical activity from the body surface. ECG analysis can therefore be a crucial first step to help diagnose, understand and predict cardiovascular disorders responsible for 30% of deaths worldwide. Computational techniques, and more specifically machine learning techniques and computational modelling are powerful tools for classification, clustering and simulation, and they have recently been applied to address the analysis of medical data, especially ECG data. This review describes the computational methods in use for ECG analysis, with a focus on machine learning and 3D computer simulations, as well as their accuracy, clinical implications and contributions to medical advances. The first section focuses on heartbeat classification and the techniques developed to extract and classify abnormal from regular beats. The second section focuses on patient diagnosis from whole recordings, applied to different diseases. The third section presents real-time diagnosis and applications to wearable devices. The fourth section highlights the recent field of personalized ECG computer simulations and their interpretation. Finally, the discussion section outlines the challenges of ECG analysis and provides a critical assessment of the methods presented. The computational methods reported in this review are a strong asset for medical discoveries and their translation to the clinical world may lead to promising advances.
Collapse
Affiliation(s)
- Aurore Lyon
- Department of Computer Science, British Heart Foundation, Oxford, UK
| | - Ana Mincholé
- Department of Computer Science, British Heart Foundation, Oxford, UK
| | - Juan Pablo Martínez
- Biomedical Signal Interpretation and Computational Simulation (BSICoS) Group, University of Zaragoza, CIBER-BBN, Zaragoza, Spain
| | - Pablo Laguna
- Biomedical Signal Interpretation and Computational Simulation (BSICoS) Group, University of Zaragoza, CIBER-BBN, Zaragoza, Spain
| | - Blanca Rodriguez
- Department of Computer Science, British Heart Foundation, Oxford, UK
| |
Collapse
|
8
|
Very High Frequency Oscillations of Heart Rate Variability in Healthy Humans and in Patients with Cardiovascular Autonomic Neuropathy. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2018; 1070:49-70. [PMID: 29429029 DOI: 10.1007/5584_2018_154] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Literature reports on the very high frequency (VHF) range of 0.4-0.9 Hz in heart rate variability (HRV) are scanty. The VHF presence in cardiac transplant patients and other conditions associated with reduced vagal influence on the heart encouraged us to explore this spectral band in healthy subjects and in patients diagnosed with cardiac autonomic neuropathy (CAN), and to assess the potential clinical value of some VHF indices. The study included 80 healthy controls and 48 patients with spinocerebellar ataxia type 2 (SCA2) with CAN. The electrocardiographic recordings of short 5-min duration were submitted to three different spectral analysis methods, including the most generally accepted procedure, and the two novel methods using the Hilbert-Huang transform. We demonstrated the presence of VHF activity in both groups of subjects. However, VHF power spectral density, expressed in relative normalized units, was significantly greater in the SCA2 patients than that in healthy subjects, amounting to 36.1 ± 17.4% vs. 22.9 ± 14.1%, respectively, as also was the instantaneous VHF spectral frequency, 0.58 ± 0.05 vs. 0.64 ± 0.07 Hz, respectively. These findings were related to the severity of CAN. We conclude that VHF activity of HRV is integral to the cardiovascular autonomic control.
Collapse
|
9
|
Chang CC, Hsu HY, Hsiao TC. The interpretation of very high frequency band of instantaneous pulse rate variability during paced respiration. Biomed Eng Online 2014; 13:46. [PMID: 24750578 PMCID: PMC4004528 DOI: 10.1186/1475-925x-13-46] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2014] [Accepted: 04/15/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Pulse rate (PR) indicates heart beat rhythm and contains various intrinsic characteristics of peripheral regulation. Pulse rate variability (PRV) is a reliable method to assess autonomic nervous system function quantitatively as an effective alternative to heart rate variability. However, the frequency range of PRV is limited by the temporal resolution of PR based on heart rate and it is further restricted the exploration of optimal autoregulation frequency based on spectral analysis. METHODS Recently, a new novel method, called instantaneous PRV (iPRV), was proposed. iPRV breaks the limitation of temporal resolution and extends the frequency band. Moreover, iPRV provides a new frequency band, called very high frequency band (VHF; 0.4-0.9 Hz). RESULTS The results showed that the VHF indicated the influences of respiratory maneuvers (paced respiration at 6-cycle and 30-cycle) and the nonstationary condition (head-up tilt; HUT). CONCLUSIONS VHF is as a potential indication of autoregulation in higher frequency range and with peripheral regulation. It helps for the frequency exploration of cardiovascular autoregulation.
Collapse
Affiliation(s)
| | | | - Tzu-Chien Hsiao
- Biomedical Electronics Translational Research Center and Biomimetic Systems Research Center, National Chiao Tung University, Taiwan, ROC.
| |
Collapse
|
10
|
Frequency range extension of spectral analysis of pulse rate variability based on Hilbert-Huang transform. Med Biol Eng Comput 2014; 52:343-51. [PMID: 24435320 DOI: 10.1007/s11517-013-1135-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2013] [Accepted: 12/21/2013] [Indexed: 10/25/2022]
Abstract
Heart rate variability (HRV) is a well-accepted indicator for neural regulatory mechanisms in cardiovascular circulation. Its spectrum analysis provides the powerful means of observing the modulation between sympathetic and parasympathetic nervous system. The timescale of HRV is limited by discrete beat-to-beat time intervals; therefore, the exploration region of frequency band of HRV spectrum is relatively narrow. It had been proved that pulse rate variability (PRV) is a surrogate measurement of HRV in most of the circumstances. Moreover, arterial pulse wave contains small oscillations resulting from complex regulation of cardiac pumping function and vascular tone at higher frequency range. This study proposed a novel instantaneous PRV (iPRV) measurement based on Hilbert-Huang transform. Fifteen healthy subjects participated in this study and received continuous blood pressure wave recording in supine and passive head-up tilt. The result showed that the very-high-frequency band (0.4-0.9 Hz) varied during head-up tilt and had strong correlation (r = 0.77) with high-frequency band and medium correlation (r = 0.643) with baroreflex sensitivity. The very-high-frequency band of iPRV helps for the exploration of non-stationary autoregulation and provides the non-stationary spectral evaluation of HRV without distortion or information loss.
Collapse
|
11
|
Fletcher GF, Ades PA, Kligfield P, Arena R, Balady GJ, Bittner VA, Coke LA, Fleg JL, Forman DE, Gerber TC, Gulati M, Madan K, Rhodes J, Thompson PD, Williams MA. Exercise standards for testing and training: a scientific statement from the American Heart Association. Circulation 2013; 128:873-934. [PMID: 23877260 DOI: 10.1161/cir.0b013e31829b5b44] [Citation(s) in RCA: 1230] [Impact Index Per Article: 111.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
|
12
|
Orini M, Bailón R, Mainardi L, Laguna P. Synthesis of HRV signals characterized by predetermined time-frequency structure by means of time-varying ARMA models. Biomed Signal Process Control 2012. [DOI: 10.1016/j.bspc.2011.05.003] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
|
13
|
Bailón R, Serrano P, Laguna P. Influence of time-varying mean heart rate in coronary artery disease diagnostic performance of heart rate variability indices from exercise stress testing. J Electrocardiol 2011; 44:445-52. [DOI: 10.1016/j.jelectrocard.2011.02.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2010] [Indexed: 11/26/2022]
|
14
|
Noriega M, Martínez JP, Laguna P, Bailón R, Almeida R. Respiration effect on wavelet-based ECG T-wave end delineation strategies. IEEE Trans Biomed Eng 2011; 59:1818-28. [PMID: 21622070 DOI: 10.1109/tbme.2011.2157824] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
The main purpose of this paper is to study the influence of the mechanical effect of respiration over the T-wave end delineation. We compared the performance of an automatic delineation system based on the wavelet transform (WT), considering single lead (SL), global delineation locations obtained from SL annotations (SLR), and multilead (ML) approaches. The linear relation between the variations on T-wave end locations obtained with each of the methods and the mechanical effect of respiration was quantified using spectral coherence and ARARX modeling both in simulated signals and in real data. We also explored the evolution of the vectorcardiographic spatial loop using the projection on the main direction of the WT in the region close to the T-wave end ( T(e)) and its relation with respiration. The dispersion of the additional T-wave end location error due to respiration was reduced by 15% using SLR with respect to SL, while ML allows for a reduction of around 40%. The percentage of that error correlated with respiration was in average 99% using SL while 82% and 72% using SLR and ML, respectively. Thus, results suggest that ML is the most adequate strategy for T-wave delineation, allowing the reduction of the instability of T-wave end location caused by respiration.
Collapse
Affiliation(s)
- Maikel Noriega
- Communications and Electronical Department, Oriente University, Santiago de Cuba 90400, Cuba.
| | | | | | | | | |
Collapse
|
15
|
Noriega M, Martinez JP, Laguna P, Romero D, Bailon R, Almeida R. Respiration effect on single and multi lead ECG delineation strategies. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2011; 2010:3575-8. [PMID: 21096831 DOI: 10.1109/iembs.2010.5627479] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The main purpose of this work is to study the influence of the mechanical effect of the respiration over T wave end delineation. The performance of automatic delineation systems based in Wavelet Transform (WT) was compared, considering single lead (SL), post processing selection rules (SLR) and multi lead (ML) approaches. The T wave locations obtained over real and simulated ECG signals were analyzed together with the respective respiratory signal (ECG-derived or simulated). The linear relation between the variations on obtained marks and the mechanical effect of the respiration was measured using spectral coherence. With respect to the ML strategy we also explored the evolution of the vectorcardiographic spatial loop using the direction of maximum projection of the WT in the region close to the T wave end (T(e)). The relation between this direction and the respiration is also explored. The marks obtained from the SLR and ML delineation strategies show advantage over the SL strategy based marks. The coherence around the respiratory frequency between the respiratory signal and the error in T end marks was found to be higher using SLR (a minimum of 0.92) than using ML (a maximum of 0.80). According to obtained results, the multi lead delineation presents a lower sensibility to the mechanical effect of the respiration for the T wave end delineation, particularly the obtained with ML.
Collapse
Affiliation(s)
- M Noriega
- Comunications and Electronical Departament of Oriente University, Santiago de Cuba (Cuba).
| | | | | | | | | | | |
Collapse
|
16
|
Analysis of heart rate variability during exercise stress testing using respiratory information. Biomed Signal Process Control 2010. [DOI: 10.1016/j.bspc.2010.05.005] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
|
17
|
A multilead scheme based on periodic component analysis for T-wave alternans analysis in the ECG. Ann Biomed Eng 2010; 38:2532-41. [PMID: 20387121 DOI: 10.1007/s10439-010-0029-z] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2010] [Accepted: 03/27/2010] [Indexed: 10/19/2022]
Abstract
T-wave alternans (TWA) is a cardiac phenomenon that appears in the electrocardiogram (ECG) and is associated with the mechanisms leading to sudden cardiac death (SCD). In this study, we propose the use of a multilead TWA analysis scheme that combines the Laplacian likelihood ratio (LLR) method and periodic component analysis (piCA), an eigenvalue decomposition technique whose aim is to extract the most periodic sources of the signal. The proposed scheme is evaluated in different scenarios--from synthetic signals to stress test ECGs--and is compared to other reported schemes based on the LLR method. Results demonstrate that the piCA-based scheme provides a superior ability to detect TWA than previously reported schemes, and has the potential to improve the prognostic value of testing for TWA.
Collapse
|
18
|
Monasterio V, Laguna P, Martínez JP. Multilead analysis of T-wave alternans in the ECG using principal component analysis. IEEE Trans Biomed Eng 2009; 56:1880-90. [PMID: 19272977 DOI: 10.1109/tbme.2009.2015935] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
T-wave alternans (TWA) is a cardiac phenomenon associated with the mechanisms leading to sudden cardiac death. Several methods exist to automatically detect and estimate TWA in the ECG on a single-lead basis, and their main drawback is their poor sensitivity to low-amplitude TWA. In this paper, we propose a multilead analysis scheme to improve the detection and estimation of TWA. It combines principal component analysis with a single-lead method based on the generalized likelihood ratio test. The proposed scheme is evaluated and compared to a single-lead scheme by means of a simulation study, in which different types of simulated and physiological noise are considered under realistic conditions. Simulation results show that the multilead scheme can detect TWA with an SNR 30 dB lower and allows the estimation of TWA with an SNR 25 dB lower than the single-lead scheme. The two analysis schemes are also applied to stress test ECG records. Results show that the multilead scheme provides a higher detection power and that TWA detections obtained with this scheme are significantly different in healthy volunteers and ischemic patients, whereas they are not with the single-lead scheme.
Collapse
Affiliation(s)
- Violeta Monasterio
- Centro de Investigación Biomédica en Red de Bioingeniería, Biomateriales y Nanomedicina, Communications Technology Group, Aragón Institute of Engineering Research, University of Zaragoza, Zaragoza 50018, Spain.
| | | | | |
Collapse
|
19
|
García J, Trigo JD, Alesanco A, Serrano P, Mateo J, Istepanian RSH. Design and evaluation of a wireless decision-support system for heart rate variability study in haemodialysis follow-up procedures. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2007; 88:273-282. [PMID: 17963978 DOI: 10.1016/j.cmpb.2007.09.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/27/2007] [Revised: 07/20/2007] [Accepted: 09/15/2007] [Indexed: 05/25/2023]
Abstract
In this paper a new wireless decision-support system for haemodialysis patients using heart rate variability (HRV) is presented. The telemedicine system provides connectivity to three participant sites: the general practitioner or nurse at the point of care in the dialysis unit, the remote information and processing server and the cardiologist. At the clinical point of care, the nurse acquires the electrocardiogram (ECG) by using a tailored mobile telecardiology system as well as other relevant physiological information during the clinical procedure, and sends it to the information server. The received information is stored in a secure file server, linked to the patient database and the ECG signal is automatically analyzed by using advanced signal processing tools in the processing server, where a complete clinical results report is generated. The cardiologist can then be linked by means of a web browser to the information server to analyze these results for further clinical diagnosis support. The system has been applied to study HRV in patients undergoing haemodialysis. The clinical report consisted of trends for time- and frequency-domain HRV indexes and other supplementary information automatically calculated, which show the response of the electrical activity of the heart to the dialysis process and that can be helpful for the follow-up of these patients. The telecardiology framework has been successfully evaluated both by the patients and the hospital personnel showing a high compliance with the system. The design and implementation of the telecardiology system have followed the most recent advances in web technologies, biomedical information and storage standards and signal processing techniques. The presented system can be used as a telemedicine tool for clinical diagnosis support and could also be used in other clinical settings.
Collapse
Affiliation(s)
- José García
- Communications Technologies Group (GTC), Aragón Institute of Engineering Research (I3A), University of Zaragoza, María de Luna 1, 50018, Zaragoza, Spain.
| | | | | | | | | | | |
Collapse
|
20
|
Virtanen M, Kähönen M, Nieminen T, Karjalainen P, Tarvainen M, Lehtimäki T, Lehtinen R, Nikus K, Kööbi T, Niemi M, Niemelä K, Turjanmaa V, Malmivuo J, Viik J. Heart rate variability derived from exercise ECG in the detection of coronary artery disease. Physiol Meas 2007; 28:1189-200. [PMID: 17906387 DOI: 10.1088/0967-3334/28/10/005] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
The diagnostic performance of heart rate variability (HRV) analysis from exercise ECG in the detection of coronary artery disease (CAD) is unknown. Bicycle exercise ECG recordings from The Finnish Cardiovascular Study (FINCAVAS) of angiography-proofed CAD patients (n = 112) and a patient group with a low likelihood of CAD (n = 114) were analyzed. HRV parameters (SDNN, RMSSD, Poincaré SD1 and SD2) were calculated from 1 min segments before exercise, during exercise and after exercise. All the parameters were in addition calculated from heart rate (HR)-corrected RR-interval segments. The ST-segment depressions in each stage were also determined. The diagnostic performance of the parameters was evaluated with the area under the receiver operating characteristic (ROC) curve method. The uncorrected HRV parameters showed the best diagnostic performance in the recovery segments but the correlation with HR was also high (SDNN: 0.758/-0.64, RMSSD: 0.747/-0.60; area under the ROC/correlation coefficient). The HR correction decreased the correlation and the diagnostic performance in recovery segments (SDNN: 0.515/-0.12, RMSSD: 0.609/0.20). The diagnostic performance of ST-level at its best was higher than any of HRV parameters (ST-level: 0.795/0.36). According to the results, the HR correction decreased the diagnostic performance of the recovery phase. The HRV parameters calculated from 1 min segments of exercise test ECG were not as capable as traditional ST-segment analysis. In conclusion, the HRV analysis from exercise or recovery phase seems to be inadequate in the detection of CAD.
Collapse
Affiliation(s)
- Matti Virtanen
- Ragnar Granit Institute, Tampere University of Technology, PO Box 692, FI-33101, Finland
| | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
21
|
Bailón R, Sörnmo L, Laguna P. A robust method for ECG-based estimation of the respiratory frequency during stress testing. IEEE Trans Biomed Eng 2006; 53:1273-85. [PMID: 16830932 DOI: 10.1109/tbme.2006.871888] [Citation(s) in RCA: 82] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
A robust method is presented for electrocardiogram (ECG)-based estimation of the respiratory frequency during stress testing. Such ECGs contain highly nonstationary noise and exhibit changes in QRS morphology which, when combined with the dynamic nature of the respiratory frequency, make most existing methods break down. The present method exploits the oscillatory pattern of the rotation angles of the heart's electrical axis as induced by respiration. The series of rotation angles, obtained from least-squares loop alignment, is subject to power spectral analysis and estimation of the respiratory frequency. Robust techniques are introduced to handle the nonstationary properties of exercise ECGs. The method is evaluated by means of both simulated signals, and ECG/airflow signals recorded from 14 volunteers and 20 patients during stress testing. The resulting respiratory frequency estimation error is, for simulated signals, equal to 0.5% +/- 0.2%, mean +/- SD (0.002 +/- 0.001 Hz), whereas the error between respiratory frequencies of the ECG-derived method and the airflow signals is 5.9% +/- 4% (0.022 +/- 0.016Hz). The results suggest that the method is highly suitable for analysis of noisy ECG signals recorded during stress testing.
Collapse
Affiliation(s)
- Raquel Bailón
- Communications Technology Group, Aragón Institute of Engineering Research (I3A), University of Zaragoza, María de Luna 1, 50015 Zaragoza, Spain.
| | | | | |
Collapse
|