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Contreras-Briceño F, Espinosa-Ramírez M, Rivera-Greene A, Guerra-Venegas C, Lungenstrass-Poulsen A, Villagra-Reyes V, Caulier-Cisterna R, Araneda OF, Viscor G. Monitoring Changes in Oxygen Muscle during Exercise with High-Flow Nasal Cannula Using Wearable NIRS Biosensors. Biosensors (Basel) 2023; 13:985. [PMID: 37998160 PMCID: PMC10669262 DOI: 10.3390/bios13110985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 11/04/2023] [Accepted: 11/10/2023] [Indexed: 11/25/2023]
Abstract
Exercise increases the cost of breathing (COB) due to increased lung ventilation (V˙E), inducing respiratory muscles deoxygenation (∇SmO2), while the increase in workload implies ∇SmO2 in locomotor muscles. This phenomenon has been proposed as a leading cause of exercise intolerance, especially in clinical contexts. The use of high-flow nasal cannula (HFNC) during exercise routines in rehabilitation programs has gained significant interest because it is proposed as a therapeutic intervention for reducing symptoms associated with exercise intolerance, such as fatigue and dyspnea, assuming that HFNC could reduce exercise-induced ∇SmO2. SmO2 can be detected using optical wearable devices provided by near-infrared spectroscopy (NIRS) technology, which measures the changes in the amount of oxygen bound to chromophores (e.g., hemoglobin, myoglobin, cytochrome oxidase) at the target tissue level. We tested in a study with a cross-over design whether the muscular desaturation of m.vastus lateralis and m.intercostales during a high-intensity constant-load exercise can be reduced when it was supported with HFNC in non-physically active adults. Eighteen participants (nine women; age: 22 ± 2 years, weight: 65.1 ± 11.2 kg, height: 173.0 ± 5.8 cm, BMI: 21.6 ± 2.8 kg·m-2) were evaluated in a cycle ergometer (15 min, 70% maximum watts achieved in ergospirometry (V˙O2-peak)) breathing spontaneously (control, CTRL) or with HFNC support (HFNC; 50 L·min-1, fiO2: 21%, 30 °C), separated by seven days in randomized order. Two-way ANOVA tests analyzed the ∇SmO2 (m.intercostales and m.vastus lateralis), and changes in V˙E and ∇SmO2·V˙E-1. Dyspnea, leg fatigue, and effort level (RPE) were compared between trials by the Wilcoxon matched-paired signed rank test. We found that the interaction of factors (trial × exercise-time) was significant in ∇SmO2-m.intercostales, V˙E, and (∇SmO2-m.intercostales)/V˙E (p < 0.05, all) but not in ∇SmO2-m.vastus lateralis. ∇SmO2-m.intercostales was more pronounced in CTRL during exercise since 5' (p < 0.05). Hyperventilation was higher in CTRL since 10' (p < 0.05). The ∇SmO2·V˙E-1 decreased during exercise, being lowest in CTRL since 5'. Lower dyspnea was reported in HFNC, with no differences in leg fatigue and RPE. We concluded that wearable optical biosensors documented the beneficial effect of HFNC in COB due to lower respiratory ∇SmO2 induced by exercise. We suggest incorporating NIRS devices in rehabilitation programs to monitor physiological changes that can support the clinical impact of the therapeutic intervention implemented.
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Affiliation(s)
- Felipe Contreras-Briceño
- Laboratory of Exercise Physiology, Department of Health Science, Faculty of Medicine, Pontificia Universidad Católica de Chile, Av. Vicuña Mackenna #4860, Santiago 7820436, Chile; (M.E.-R.); (A.R.-G.); (C.G.-V.); (A.L.-P.); (V.V.-R.)
- Millennium Institute for Intelligent Healthcare Engineering (iHEALTH), Av. Vicuña Mackenna #4860, Santiago 7820436, Chile
| | - Maximiliano Espinosa-Ramírez
- Laboratory of Exercise Physiology, Department of Health Science, Faculty of Medicine, Pontificia Universidad Católica de Chile, Av. Vicuña Mackenna #4860, Santiago 7820436, Chile; (M.E.-R.); (A.R.-G.); (C.G.-V.); (A.L.-P.); (V.V.-R.)
| | - Augusta Rivera-Greene
- Laboratory of Exercise Physiology, Department of Health Science, Faculty of Medicine, Pontificia Universidad Católica de Chile, Av. Vicuña Mackenna #4860, Santiago 7820436, Chile; (M.E.-R.); (A.R.-G.); (C.G.-V.); (A.L.-P.); (V.V.-R.)
| | - Camila Guerra-Venegas
- Laboratory of Exercise Physiology, Department of Health Science, Faculty of Medicine, Pontificia Universidad Católica de Chile, Av. Vicuña Mackenna #4860, Santiago 7820436, Chile; (M.E.-R.); (A.R.-G.); (C.G.-V.); (A.L.-P.); (V.V.-R.)
| | - Antonia Lungenstrass-Poulsen
- Laboratory of Exercise Physiology, Department of Health Science, Faculty of Medicine, Pontificia Universidad Católica de Chile, Av. Vicuña Mackenna #4860, Santiago 7820436, Chile; (M.E.-R.); (A.R.-G.); (C.G.-V.); (A.L.-P.); (V.V.-R.)
| | - Victoria Villagra-Reyes
- Laboratory of Exercise Physiology, Department of Health Science, Faculty of Medicine, Pontificia Universidad Católica de Chile, Av. Vicuña Mackenna #4860, Santiago 7820436, Chile; (M.E.-R.); (A.R.-G.); (C.G.-V.); (A.L.-P.); (V.V.-R.)
| | - Raúl Caulier-Cisterna
- Department of Informatics and Computing, Faculty of Engineering, Universidad Tecnológica Metropolitana, Av. José Pedro Alessandri #1242, Santiago 7800002, Chile;
| | - Oscar F. Araneda
- Laboratory of Integrative Physiology of Biomechanics and Physiology of Effort, Kinesiology School, Faculty of Medicine, Universidad de los Andes, Av. Monseñor Álvaro del Portillo 12455, Santiago 7620001, Chile;
| | - Ginés Viscor
- Secció de Fisiologia, Departament de Biologia Cel·lular, Fisiologia i Immunologia, Facultat de Biologia, Universitat de Barcelona, Av. Diagonal #643, 08028 Barcelona, Spain;
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Suárez-Idueta L, Yargawa J, Blencowe H, Bradley E, Okwaraji YB, Pingray V, Gibbons L, Gordon A, Warrilow K, Paixao ES, Falcão IR, Lisonkova S, Wen Q, Mardones F, Caulier-Cisterna R, Velebil P, Jírová J, Horváth-Puhó E, Sørensen HT, Sakkeus L, Abuladze L, Gissler M, Heidarzadeh M, Moradi-Lakeh M, Yunis KA, Al Bizri A, Karalasingam SD, Jeganathan R, Barranco A, Broeders L, van Dijk AE, Huicho L, Quezada-Pinedo HG, Cajachagua-Torres KN, Alyafei F, AlQubaisi M, Cho GJ, Kim HY, Razaz N, Söderling J, Smith LK, Kurinczuk J, Lowry E, Rowland N, Wood R, Monteath K, Pereyra I, Pravia G, Ohuma EO, Lawn JE. Vulnerable newborn types: Analysis of population-based registries for 165 million births in 23 countries, 2000-2021. BJOG 2023. [PMID: 37156241 DOI: 10.1111/1471-0528.17505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Accepted: 04/04/2023] [Indexed: 05/10/2023]
Abstract
OBJECTIVE To examine the prevalence of novel newborn types among 165 million live births in 23 countries from 2000 to 2021. DESIGN Population-based, multi-country analysis. SETTING National data systems in 23 middle- and high-income countries. POPULATION Liveborn infants. METHODS Country teams with high-quality data were invited to be part of the Vulnerable Newborn Measurement Collaboration. We classified live births by six newborn types based on gestational age information (preterm <37 weeks versus term ≥37 weeks) and size for gestational age defined as small (SGA, <10th centile), appropriate (10th-90th centiles), or large (LGA, >90th centile) for gestational age, according to INTERGROWTH-21st standards. We considered small newborn types of any combination of preterm or SGA, and term + LGA was considered large. Time trends were analysed using 3-year moving averages for small and large types. MAIN OUTCOME MEASURES Prevalence of six newborn types. RESULTS We analysed 165 017 419 live births and the median prevalence of small types was 11.7% - highest in Malaysia (26%) and Qatar (15.7%). Overall, 18.1% of newborns were large (term + LGA) and was highest in Estonia 28.8% and Denmark 25.9%. Time trends of small and large infants were relatively stable in most countries. CONCLUSIONS The distribution of newborn types varies across the 23 middle- and high-income countries. Small newborn types were highest in west Asian countries and large types were highest in Europe. To better understand the global patterns of these novel newborn types, more information is needed, especially from low- and middle-income countries.
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Affiliation(s)
| | - Judith Yargawa
- Maternal, Adolescent, Reproductive & Child Health (MARCH) Centre, London School of Hygiene & Tropical Medicine, London, UK
| | - Hannah Blencowe
- Maternal, Adolescent, Reproductive & Child Health (MARCH) Centre, London School of Hygiene & Tropical Medicine, London, UK
| | - Ellen Bradley
- Maternal, Adolescent, Reproductive & Child Health (MARCH) Centre, London School of Hygiene & Tropical Medicine, London, UK
| | - Yemisrach B Okwaraji
- Maternal, Adolescent, Reproductive & Child Health (MARCH) Centre, London School of Hygiene & Tropical Medicine, London, UK
| | - Veronica Pingray
- Department of Mother & Child Health, Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina
| | - Luz Gibbons
- Department of Mother & Child Health, Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina
| | - Adrienne Gordon
- Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Kara Warrilow
- Centre for Research Excellence in Stillbirth, MRI-UQ, Mater Research Institute, The University of Queensland, Brisbane, Queensland, Australia
| | - Enny S Paixao
- Maternal, Adolescent, Reproductive & Child Health (MARCH) Centre, London School of Hygiene & Tropical Medicine, London, UK
- Centre of Data and Knowledge Integration for Health (CIDACS), Instituto Gonçalo Moniz, Fiocruz Bahia, Fundação Oswaldo Cruz, Salvador, Brazil
| | - Ila Rocha Falcão
- Centre of Data and Knowledge Integration for Health (CIDACS), Instituto Gonçalo Moniz, Fiocruz Bahia, Fundação Oswaldo Cruz, Salvador, Brazil
| | - Sarka Lisonkova
- Department of Obstetrics & Gynaecology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Qi Wen
- Department of Obstetrics & Gynaecology, University of British Columbia, Vancouver, British Columbia, Canada
| | | | | | - Petr Velebil
- Department of Obstetrics and Gynaecology, Institute for the Care of Mother and Child, Prague, Czech Republic
| | - Jitka Jírová
- Department of Data Analysis, Institute of Health Information and Statistics of the Czech Republic, Prague, Czech Republic
| | | | | | - Luule Sakkeus
- School of Governance, Law and Society, Estonian Institute for Population Studies, Tallinn University, Tallinn, Estonia
| | - Lili Abuladze
- School of Governance, Law and Society, Estonian Institute for Population Studies, Tallinn University, Tallinn, Estonia
| | - Mika Gissler
- Department of Knowledge Brokers, THL Finnish Institute for Health and Welfare, Helsinki, Finland
| | | | - Maziar Moradi-Lakeh
- Department of Community Medicine, Preventive Medicine and Public Health Research Centre, Iran University of Medical Sciences, Tehran, Iran
| | - Khalid A Yunis
- Department of Paediatrics and Adolescent Medicine, American University of Beirut, Beirut, Lebanon
| | - Ayah Al Bizri
- Department of Paediatrics and Adolescent Medicine, American University of Beirut, Beirut, Lebanon
| | - Shamala D Karalasingam
- Department of Obstetrics and Gynaecology, Faculty of Medicine, University of Cyberjaya, Cyberjaya, Malaysia
| | - Ravichandran Jeganathan
- Department of Obstetrics & Gynaecology, Hospital Sultanah Aminah, Ministry of Health, Johor Bahru, Malaysia
| | - Arturo Barranco
- Directorate of Health Information, Ministry of Health, Mexico City, Mexico
| | | | | | - Luis Huicho
- Centro de Investigación en Salud Materna e Infantil, Centro de Investigación para el Desarrollo Integral y Sostenible and School of Medicine, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Hugo Guillermo Quezada-Pinedo
- The Generation R Study Group, Department of Paediatrics, Division of Neonatology, Erasmus MC - Sophia Children's Hospital, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Kim Nail Cajachagua-Torres
- The Generation R Study Group, Department of Paediatrics, Division of Neonatology, Erasmus MC - Sophia Children's Hospital, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | | | | | - Geum Joon Cho
- Department of Obstetrics and Gynaecology, Korea University College of Medicine, Seoul, South Korea
| | - Ho Yeon Kim
- Department of Obstetrics and Gynaecology, Korea University College of Medicine, Seoul, South Korea
| | - Neda Razaz
- Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Jonas Söderling
- Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Lucy K Smith
- Department of Health Sciences, College of Life Sciences, University of Leicester, Leicester, UK
| | - Jennifer Kurinczuk
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Estelle Lowry
- School of Natural and Built Environment, Queen's University Belfast, Belfast, UK
| | - Neil Rowland
- Queen's Management School, Queen's University Belfast, Belfast, UK
| | - Rachael Wood
- Public Health Scotland, Edinburgh, UK
- Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Kirsten Monteath
- Department of Maternity and Sexual Health Team, Public Health Scotland, Edinburgh, UK
| | - Isabel Pereyra
- Catholic University of the Maule, Región del Maule, Chile
- Department of Wellness and Health, Catholic University of Uruguay, Montevideo, Uruguay
| | - Gabriella Pravia
- Department of Wellness and Health, Catholic University of Uruguay, Montevideo, Uruguay
| | - Eric O Ohuma
- Maternal, Adolescent, Reproductive & Child Health (MARCH) Centre, London School of Hygiene & Tropical Medicine, London, UK
| | - Joy E Lawn
- Maternal, Adolescent, Reproductive & Child Health (MARCH) Centre, London School of Hygiene & Tropical Medicine, London, UK
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Oyarzún JE, Caulier-Cisterna R, González-Appelgren JP, Gonzalez L, Trujillo O, Eblen-Zajjur A, Uribe S. Non-invasive near-infrared spectroscopy assessment of the spinal neurovascular response in a patient with transverse myelitis: a case report. BMC Neurol 2022; 22:393. [PMID: 36280834 PMCID: PMC9590209 DOI: 10.1186/s12883-022-02881-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 09/11/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Transverse myelitis (TM) is characterized by acute development of motor, sensory and autonomic dysfunctions due to horizontally diffused inflammation in one or more segments of the spinal cord in the absence of a compressive lesion. The not well-known inflammation process induces demyelination resulting in neurological dysfunction. CASE PRESENTATION In this case report we used a functional Near-Infrared Spectroscopy (fNIRS) technique to evaluate changes in the peri-spinal vascular response induced by a peripheral median nerve electrical stimulation in a patient with chronic transverse myelitis (TM). fNIRS showed drastically reduced signal amplitude in the peri-spinal vascular response, compared to that obtained from a healthy control group throughout most of the C7-T1 and T10-L2 spinal cord segments. CONCLUSION The potential use of this relatively non-invasive fNIRS technology support the potential clinical application of this method for functional test of the spinal cord through the assessment of the spinal neurovascular response.
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Affiliation(s)
- Juan Esteban Oyarzún
- grid.7870.80000 0001 2157 0406Centro de Imágenes Biomédicas, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Raúl Caulier-Cisterna
- grid.7870.80000 0001 2157 0406Centro de Imágenes Biomédicas, Pontificia Universidad Católica de Chile, Santiago, Chile ,Rielo Institute for Integral Development, New York, USA
| | - Juan Pablo González-Appelgren
- grid.7870.80000 0001 2157 0406Centro de Imágenes Biomédicas, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Leticia Gonzalez
- grid.7870.80000 0001 2157 0406Centro de Imágenes Biomédicas, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Oscar Trujillo
- grid.7870.80000 0001 2157 0406Neurology Department, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Antonio Eblen-Zajjur
- grid.412193.c0000 0001 2150 3115Laboratorio de Neurociencia Traslacional, Facultad de Medicina, Universidad Diego Portales Santiago, Santiago, Chile
| | - Sergio Uribe
- grid.7870.80000 0001 2157 0406Centro de Imágenes Biomédicas, Pontificia Universidad Católica de Chile, Santiago, Chile ,grid.7870.80000 0001 2157 0406Radiology Department, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
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Caulier-Cisterna R, Sanromán-Junquera M, Muñoz-Romero S, Blanco-Velasco M, Goya-Esteban R, García-Alberola A, Rojo-Álvarez JL. Spatial-Temporal Signals and Clinical Indices in Electrocardiographic Imaging (I): Preprocessing and Bipolar Potentials. Sensors (Basel) 2020; 20:E3131. [PMID: 32492938 PMCID: PMC7309141 DOI: 10.3390/s20113131] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 05/28/2020] [Accepted: 05/29/2020] [Indexed: 12/19/2022]
Abstract
During the last years, Electrocardiographic Imaging (ECGI) has emerged as a powerful and promising clinical tool to support cardiologists. Starting from a plurality of potential measurements on the torso, ECGI yields a noninvasive estimation of their causing potentials on the epicardium. This unprecedented amount of measured cardiac signals needs to be conditioned and adapted to current knowledge and methods in cardiac electrophysiology in order to maximize its support to the clinical practice. In this setting, many cardiac indices are defined in terms of the so-called bipolar electrograms, which correspond with differential potentials between two spatially close potential measurements. Our aim was to contribute to the usefulness of ECGI recordings in the current knowledge and methods of cardiac electrophysiology. For this purpose, we first analyzed the basic stages of conventional cardiac signal processing and scrutinized the implications of the spatial-temporal nature of signals in ECGI scenarios. Specifically, the stages of baseline wander removal, low-pass filtering, and beat segmentation and synchronization were considered. We also aimed to establish a mathematical operator to provide suitable bipolar electrograms from the ECGI-estimated epicardium potentials. Results were obtained on data from an infarction patient and from a healthy subject. First, the low-frequency and high-frequency noises are shown to be non-independently distributed in the ECGI-estimated recordings due to their spatial dimension. Second, bipolar electrograms are better estimated when using the criterion of the maximum-amplitude difference between spatial neighbors, but also a temporal delay in discrete time of about 40 samples has to be included to obtain the usual morphology in clinical bipolar electrograms from catheters. We conclude that spatial-temporal digital signal processing and bipolar electrograms can pave the way towards the usefulness of ECGI recordings in the cardiological clinical practice. The companion paper is devoted to analyzing clinical indices obtained from ECGI epicardial electrograms measuring waveform variability and repolarization tissue properties.
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Affiliation(s)
- Raúl Caulier-Cisterna
- Department of Signal Theory and Communications, Telematics and Computing Systems, Rey Juan Carlos University, Fuenlabrada, 28943 Madrid, Spain; (R.C.-C.); (M.S.-J.); (S.M.-R.); (R.G.-E.)
| | - Margarita Sanromán-Junquera
- Department of Signal Theory and Communications, Telematics and Computing Systems, Rey Juan Carlos University, Fuenlabrada, 28943 Madrid, Spain; (R.C.-C.); (M.S.-J.); (S.M.-R.); (R.G.-E.)
| | - Sergio Muñoz-Romero
- Department of Signal Theory and Communications, Telematics and Computing Systems, Rey Juan Carlos University, Fuenlabrada, 28943 Madrid, Spain; (R.C.-C.); (M.S.-J.); (S.M.-R.); (R.G.-E.)
- Center for Computational Simulation, Universidad Politécnica de Madrid, Boadilla, 28223 Madrid, Spain
| | - Manuel Blanco-Velasco
- Department of Signal Theory and Communications, Universidad de Alcalá, Alcalá de Henares, 28805 Madrid, Spain;
| | - Rebeca Goya-Esteban
- Department of Signal Theory and Communications, Telematics and Computing Systems, Rey Juan Carlos University, Fuenlabrada, 28943 Madrid, Spain; (R.C.-C.); (M.S.-J.); (S.M.-R.); (R.G.-E.)
| | - Arcadi García-Alberola
- Arrhythmia Unit, Hospital Clínico Universitario Virgen de la Arrixaca de Murcia, El Palmar, 30120 Murcia, Spain;
| | - José Luis Rojo-Álvarez
- Department of Signal Theory and Communications, Telematics and Computing Systems, Rey Juan Carlos University, Fuenlabrada, 28943 Madrid, Spain; (R.C.-C.); (M.S.-J.); (S.M.-R.); (R.G.-E.)
- Center for Computational Simulation, Universidad Politécnica de Madrid, Boadilla, 28223 Madrid, Spain
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Caulier-Cisterna R, Blanco-Velasco M, Goya-Esteban R, Muñoz-Romero S, Sanromán-Junquera M, García-Alberola A, Rojo-Álvarez JL. Spatial-Temporal Signals and Clinical Indices in Electrocardiographic Imaging (II): Electrogram Clustering and T-wave Alternans. Sensors (Basel) 2020; 20:s20113070. [PMID: 32485879 PMCID: PMC7309062 DOI: 10.3390/s20113070] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Revised: 04/17/2020] [Accepted: 04/27/2020] [Indexed: 06/11/2023]
Abstract
During the last years, attention and controversy have been present for the first commercially available equipment being used in Electrocardiographic Imaging (ECGI), a new cardiac diagnostic tool which opens up a new field of diagnostic possibilities. Previous knowledge and criteria of cardiologists using intracardiac Electrograms (EGM) should be revisited from the newly available spatial-temporal potentials, and digital signal processing should be readapted to this new data structure. Aiming to contribute to the usefulness of ECGI recordings in the current knowledge and methods of cardiac electrophysiology, we previously presented two results: First, spatial consistency can be observed even for very basic cardiac signal processing stages (such as baseline wander and low-pass filtering); second, useful bipolar EGMs can be obtained by a digital processing operator searching for the maximum amplitude and including a time delay. In addition, this work aims to demonstrate the functionality of ECGI for cardiac electrophysiology from a twofold view, namely, through the analysis of the EGM waveforms, and by studying the ventricular repolarization properties. The former is scrutinized in terms of the clustering properties of the unipolar an bipolar EGM waveforms, in control and myocardial infarction subjects, and the latter is analyzed using the properties of T-wave alternans (TWA) in control and in Long-QT syndrome (LQTS) example subjects. Clustered regions of the EGMs were spatially consistent and congruent with the presence of infarcted tissue in unipolar EGMs, and bipolar EGMs with adequate signal processing operators hold this consistency and yielded a larger, yet moderate, number of spatial-temporal regions. TWA was not present in control compared with an LQTS subject in terms of the estimated alternans amplitude from the unipolar EGMs, however, higher spatial-temporal variation was present in LQTS torso and epicardium measurements, which was consistent through three different methods of alternans estimation. We conclude that spatial-temporal analysis of EGMs in ECGI will pave the way towards enhanced usefulness in the clinical practice, so that atomic signal processing approach should be conveniently revisited to be able to deal with the great amount of information that ECGI conveys for the clinician.
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Affiliation(s)
- Raúl Caulier-Cisterna
- Department of Signal Theory and Communications, Telematics and Computing Systems, Rey Juan Carlos University, 28943 Fuenlabrada, Madrid, Spain; (R.C.-C.); (R.G.-E.); (S.M.-R.); (M.S.-J.)
| | - Manuel Blanco-Velasco
- Department of Signal Theory and Communications, Universidad de Alcalá, 28805 Alcalá de Henares, Madrid, Spain;
| | - Rebeca Goya-Esteban
- Department of Signal Theory and Communications, Telematics and Computing Systems, Rey Juan Carlos University, 28943 Fuenlabrada, Madrid, Spain; (R.C.-C.); (R.G.-E.); (S.M.-R.); (M.S.-J.)
| | - Sergio Muñoz-Romero
- Department of Signal Theory and Communications, Telematics and Computing Systems, Rey Juan Carlos University, 28943 Fuenlabrada, Madrid, Spain; (R.C.-C.); (R.G.-E.); (S.M.-R.); (M.S.-J.)
- Center for Computational Simulation, Universidad Politécnica de Madrid, 28223 Boadilla, Madrid, Spain
| | - Margarita Sanromán-Junquera
- Department of Signal Theory and Communications, Telematics and Computing Systems, Rey Juan Carlos University, 28943 Fuenlabrada, Madrid, Spain; (R.C.-C.); (R.G.-E.); (S.M.-R.); (M.S.-J.)
| | - Arcadi García-Alberola
- Arrhythmia Unit, Hospital Clínico Universitario Virgen de la Arrixaca de Murcia, El Palmar, 30120 Murcia, Spain;
| | - José Luis Rojo-Álvarez
- Department of Signal Theory and Communications, Telematics and Computing Systems, Rey Juan Carlos University, 28943 Fuenlabrada, Madrid, Spain; (R.C.-C.); (R.G.-E.); (S.M.-R.); (M.S.-J.)
- Center for Computational Simulation, Universidad Politécnica de Madrid, 28223 Boadilla, Madrid, Spain
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Caulier-Cisterna R, Muñoz-Romero S, Sanromán-Junquera M, García-Alberola A, Rojo-Álvarez JL. A new approach to the intracardiac inverse problem using Laplacian distance kernel. Biomed Eng Online 2018; 17:86. [PMID: 29925384 PMCID: PMC6011421 DOI: 10.1186/s12938-018-0519-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2018] [Accepted: 06/13/2018] [Indexed: 11/30/2022] Open
Abstract
Background The inverse problem in electrophysiology consists of the accurate estimation of the intracardiac electrical sources from a reduced set of electrodes at short distances and from outside the heart. This estimation can provide an image with relevant knowledge on arrhythmia mechanisms for the clinical practice. Methods based on truncated singular value decomposition (TSVD) and regularized least squares require a matrix inversion, which limits their resolution due to the unavoidable low-pass filter effect of the Tikhonov regularization techniques. Methods We propose to use, for the first time, a Mercer’s kernel given by the Laplacian of the distance in the quasielectrostatic field equations, hence providing a Support Vector Regression (SVR) formulation by following the principles of the Dual Signal Model (DSM) principles for creating kernel algorithms. Results Simulations in one- and two-dimensional models show the performance of our Laplacian distance kernel technique versus several conventional methods. Firstly, the one-dimensional model is adjusted for yielding recorded electrograms, similar to the ones that are usually observed in electrophysiological studies, and suitable strategy is designed for the free-parameter search. Secondly, simulations both in one- and two-dimensional models show larger noise sensitivity in the estimated transfer matrix than in the observation measurements, and DSM−SVR is shown to be more robust to noisy transfer matrix than TSVD. Conclusion These results suggest that our proposed DSM−SVR with Laplacian distance kernel can be an efficient alternative to improve the resolution in current and emerging intracardiac imaging systems.
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Affiliation(s)
- Raúl Caulier-Cisterna
- Department of Signal Theory and Communications and Telematics and Computation, Rey Juan Carlos University, Camino del Molino s/n, 28943, Fuenlabrada, Madrid, Spain
| | - Sergio Muñoz-Romero
- Department of Signal Theory and Communications and Telematics and Computation, Rey Juan Carlos University, Camino del Molino s/n, 28943, Fuenlabrada, Madrid, Spain.,Center for Computational Simulation, Universidad Politécnica de Madrid, Madrid, Spain
| | - Margarita Sanromán-Junquera
- Department of Signal Theory and Communications and Telematics and Computation, Rey Juan Carlos University, Camino del Molino s/n, 28943, Fuenlabrada, Madrid, Spain
| | - Arcadi García-Alberola
- Arrhythmia Unit, Hospital General Universitario Virgen de la Arrixaca, El Palmar, Murcia, Spain
| | - José Luis Rojo-Álvarez
- Department of Signal Theory and Communications and Telematics and Computation, Rey Juan Carlos University, Camino del Molino s/n, 28943, Fuenlabrada, Madrid, Spain. .,Center for Computational Simulation, Universidad Politécnica de Madrid, Madrid, Spain.
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Almendral J, Caulier-Cisterna R, Rojo-Álvarez JL. Resetting and entrainment of reentrant arrhythmias: part I: concepts, recognition, and protocol for evaluation: surface ECG versus intracardiac recordings. Pacing Clin Electrophysiol 2013; 36:508-32. [PMID: 23305213 PMCID: PMC3666092 DOI: 10.1111/pace.12064] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/31/2012] [Revised: 10/14/2012] [Accepted: 11/24/2012] [Indexed: 11/27/2022]
Abstract
In this paper, we review the information accumulated over the years regarding the phenomena of resetting and entrainment of reentrant arrhythmias. Over three decades of research and clinical applications, these phenomena have demonstrated that they stay as a main tool for an intellectual understanding of reentry and to base strategies for localization of critical areas for ablative therapies. This review will be divided into two parts. This first part deals with the bases for the concept development, the means for the detection of these phenomena, and their mechanistic implications. Resetting is described as a particular response of a given rhythm to an external perturbation, indicating interaction between them. Entrainment indicates continuous reset of the rhythm when the perturbation is repetitive. The mechanisms that explain these responses in reentrant rhythms are presented. Fusion, both at the surface electrocardiogram and at the level of intracardiac recordings, is discussed in detail, with its value and limitations as a key concept to recognize entrainment and reentry. Computer simulations are used as an aid to a better understanding. Differences between resetting and entrainment are considered, and a pacing protocol to study these phenomena described.
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Affiliation(s)
- Jesús Almendral
- Cardiac Arrhythmia Unit, Grupo Hospital de Madrid, Universidad CEU-San Pablo, Madrid, Spain.
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