Detecting fetal heart sounds by means of Fractal Dimension analysis in the Wavelet domain

Phonocardiography is a low-cost technique for the detection of fetal heart sounds (FHS) that can extend clinical auscultation in mobile and home care setups. The work presented here examines the transferability of a Wavelet Transform (WT)-based method that combines also Fractal Dimension (FD) analysis, previously proposed as WT-FD for the cases of lung and bowel sound analysis [4], to the extraction of FHSs. The WT-FD method has been evaluated with 12 simulated FHS signals and has shown promising results in terms of accuracy and performance (89%) in identifying the location of heartbeat, even in cases of signals with additive noise up to (6dB). This robustness paves the way for WT-FD testing in real FHSs, recorded under clinical setting, clearly contributing to better evaluation of the fetal heart functionality.

Predicting depressed patients with suicidal ideation from ECG recordings

Globally suicidal behavior is the third most common cause of death among patients with major depressive disorder (MDD). This study presents multi-lag tone-entropy (T-E) analysis of heart rate variability (HRV) as a screening tool for identifying MDD patients with suicidal ideation. Sixty-one ECG recordings (10 min) were acquired and analyzed from control subjects (29 CONT), 16 MDD subjects with (MDDSI+) and 16 without suicidal ideation (MDDSI-). After ECG preprocessing, tone and entropy values were calculated for multiple lags (m: 1-10). The MDDSI+ group was found to have a higher mean tone value compared to that of the MDDSI- group for lags 1-8, whereas the mean entropy value was lower in MDDSI+ than that in CONT group at all lags (1-10). Leave-one-out cross-validation tests, using a classification and regression tree (CART), obtained 94.83 % accuracy in predicting MDDSI+ subjects by using a combination of tone and entropy values at all lags and including demographic factors (age, BMI and waist circumference) compared to results with time and frequency domain HRV analysis. The results of this pilot study demonstrate the usefulness of multi-lag T-E analysis in identifying MDD patients with suicidal ideation and highlight the change in autonomic nervous system modulation of the heart rate associated with depression and suicidal ideation.

Identifying depressed patients with and without suicidal ideation by finger photo-plethysmography

Major Depressive Disorder (MDD) is a serious mental disorder that if untreated not only affects physical health but also has a high risk of suicide. While the neurophysiological phenomena that contribute to the formation of Suicidal Ideation (SI) are still ill-defined, clear links between MDD and cardiovascular disease have been reported. The aim of this study is to extract suitable features from arterial pulse signals with a view to predicting SI within MDD and control groups. Sixteen unmedicated MDD patients with a history of SI (MDDSI+), sixteen without SI (MDDSI-) and twenty-nine healthy subjects (CONT) were recruited at a psychiatric clinic in the UAE. Depression severity and SI were assessed using the Hamilton Depression Rating Scale and Beck Depression Inventory. Pulse Wave Amplitude (PWA) was calculated as the difference between the peak (Systole) and the valley (Diastole) of the arterial pulse within each cardiac cycle. Then, 2D Tone-Entropy (TE) features were extracted from the Systole, Diastole and PWA time series. The TE features extracted from Diastole were the best markers for predicting MDDSI+. The overall classification accuracies of Classification and Regression Tree (CART) model by using TE features of Systole, Diastole and PWA were 88.52%, 90.2% and 88.52% respectively. When all TE features were combined, accuracy increased up to 93.44% in identifying MDDSI+/MDDSI-/Control groups.

Risk stratification of cardiac autonomic neuropathy based on multi-lag Tone-Entropy

Cardiac autonomic neuropathy (CAN) is an irreversible condition affecting the autonomic nervous system, which leads to abnormal functioning of the visceral organs and affects critical body functions such as blood pressure, heart rate and kidney filtration. This study presents multi-lag Tone-Entropy (T-E) analysis of heart rate variability (HRV) at multiple lags as a screening tool for CAN. A total of 41 ECG recordings were acquired from diabetic subjects with definite CAN (CAN+) and without CAN (CAN-) and analyzed. Tone and entropy values of each patient were calculated for different beat sequence lengths (len: 50-900) and lags (m: 1-8). The CAN- group was found to have a lower mean tone value compared to that of CAN+ group for all m and len, whereas the mean entropy value was higher in CAN- than that in CAN+ group. Leave-one-out (LOO) cross-validation tests using a quadratic discriminant (QD) classifier were applied to investigate the performance of multi-lag T-E features. We obtained 100 % accuracy for tone and entropy with len = 250 and m = {2, 3} settings, which is better than the performance of T-E technique based on lag m = 1. The results demonstrate the usefulness of multi-lag T-E analysis over single lag analysis in CAN diagnosis for risk stratification and highlight the change in autonomic nervous system modulation of the heart rate associated with cardiac autonomic neuropathy.

Defining asymmetry in heart rate variability signals using a Poincaré plot

The asymmetry in heart rate variability is a visibly obvious phenomenon in the Poincaré plot of normal sinus rhythm. It shows the unevenness in the distribution of points above and below the line of identity, which indicates instantaneous changes in the beat to beat heart rate. The major limitation of the existing asymmetry definition is that it considers only the instantaneous changes in the beat to beat heart rate rather than the pattern (increase/decrease). In this paper, a novel definition of asymmetry is proposed considering the geometry of a 2D Poincaré plot. Based on the proposed definition, traditional asymmetry indices--Guzik's index (GI), Porta's index (PI) and Ehlers' index (EI)--have been redefined. In order to compare the effectiveness of the new definition, all indices have been calculated for RR interval series of 54 subjects with normal sinus rhythm of 5 min and 30 min duration. The new definition resulted in a higher prevalence of normal subjects showing asymmetry in heart rate variability.

Cardiac rhythms of late pre-pipped and pipped chick embryos exposed to altered oxygen environments

During the final stages of embryonic development in chickens, diffusive gas exchange through the chorioallantoic membrane (CAM) is progressively replaced by pulmonary respiration that begins with internal pipping (IP) of the CAM. Late chick embryos going through the transition from CAM respiration to pulmonary respiration were exposed to hyperoxic (100% O(2)) and hypoxic (10% O(2)/N(2)) environments for 2-h and the responses of baseline heart rate (HR), and HR fluctuation patterns were investigated. 16- and 18-day-old (referred to as 18-d) embryos and 20-d externally pipped (EP) embryos were examined as pre-pipped embryos and pipped embryos, respectively. 19-d embryos were divided into two groups: embryos that had not yet internally pipped (Pre-IP embryos) and embryos that had internally pipped (IP embryos). IP was identified by detecting the breathing signal with a condenser microphone attached hermetically on the eggshell (i.e. acoustorespirogram) on day 19 of incubation. In the hyperoxic environment, HR baseline of pre-pipped embryos remained unchanged and that of pipped embryos was depressed. In the hypoxic environment, HR baseline of 16-d pre-pipped embryos was depressed and that of pipped (IP and EP) embryos elevated. These different responses in pipped embryos might be partially attributed to increased cholinergic input from the vagus nerve in hyperoxia and increased adrenergic response in hypoxia. While hyperoxia did not induce marked modification of instantaneous heart rate (IHR) fluctuation patterns, hypoxia tended to augment transient decelerations of IHR in late pre-pipped embryos and markedly depressed HR fluctuations in pipped embryos.

Maturation of the homeothermic response of heart rate to altered ambient temperature in developing chick hatchlings (Gallus gallus domesticus)

On the basis of evidence showing that instantaneous heart rate (IHR) of chick hatchlings responds to exposure to altered ambient temperature (Ta; Tazawa H, Moriya K, Tamura A, and Akiyama R. Comp Biochem Physiol A 131A: 797-803, 2002), we elucidate here the developmental timeline for the homeothermic response of HR in newly hatched chicks ( days 0-7) maintained at room temperature (∼24-27°C). Hatchlings were exposed to Ta of 25, 35, and 25°C for 1-h periods, respectively, and IHR was measured together with skin temperature (Ts) during this warming and cooling bout. Early 0-day-old (0 day) chicks responded to warming and cooling exposures with various changes in HR baseline. In newly hatched chicks (0-7 h old), HR baseline was elevated during warming (Δ126 beats/min, n = 13) and declined during cooling (-Δ94 beats/min). With progress of development on day 0, the elevation of HR baseline during warming decreased and advanced 0-day chicks tended to decrease HR baseline during warming rather than increase HR. The more developed 1- to 7-day-old chicks exhibited the expected homeothermic decrease in HR during warming. The diurnal variations of HR responses during warming and cooling on the first day of post-egg life indicate that pronounced development of thermoregulatory competence occurs during the day of hatching ( day 0). The response of IHR fluctuations to altered Ta was observed in the form of low- and high-frequency oscillations. High-frequency oscillations corresponding to respiratory sinus arrhythmia developed as the hatchlings aged. There was a significant increase in the number of chicks exhibiting both low- and high-frequency oscillations that depended on age and the development of thermoregulatory competence of hatchlings.

Development of respiratory rhythms in perinatal chick embryos

In chick embryos, gas exchange takes place via the chorioallantoic membrane (CAM) and the lungs at approximately 1 day prior to hatching. The present study was designed to elucidate the development of respiratory rhythms in the chick embryo during the whole pipping (perinatal) period with a condenser-microphone measuring system. The microphone was hermetically attached on the eggshell over the air cell on day 18 of incubation. It first detected a cardiogenic signal (i.e. acoustocardiogram), and then beak clapping and breathing signals (acoustorespirogram, ARG). The first signals of lung ventilation appeared intermittently and irregularly approximately once per 5 s among the clapping signals after the embryo penetrated its beak into the air cell (internal pipping, IP). The respiratory rhythm then developed irregularly, with a subsequent more regular rate. The envelope pattern of breathing from the onset of IP through external pipping (EP) to hatching was constructed by a specially devised procedure, which eliminated external and internal noises. The envelope patterns indicated that the IP, EP and whole perinatal periods of 10 embryos were 14.1+/-6.4 (S.D.), 13.6+/-4.0 and 27.6+/-5.4 h, respectively. In addition, they also indicated the period of embryonic hatching activity (i.e. climax) which was 48+/-19 min. The development of respiratory rhythm was also shown by the instantaneous respiratory rate (IRR) which was designated as an inverse value of two adjacent ARG waves.