Sequential beat-to-beat P and T wave delineation and waveform estimation in ECG signals: Block Gibbs sampler and marginalized particle filter

International audienceFor ECG interpretation, the detection and delineation of P and T waves are challenging tasks. This paper proposes sequential Bayesian methods for simultaneous detection, threshold-free delineation, and waveform estimation of P and T waves on a beat-to-beat basis. By contrast to state-of-the-art methods that process multiple-beat signal blocks, the proposed Bayesian methods account for beat-to-beat waveform variations by sequentially estimating the waveforms for each beat. Our methods are based on Bayesian signal models that take into account previous beats as prior information. To estimate the unknown parameters of these Bayesian models, we first propose a block Gibbs sampler that exhibits fast convergence in spite of the strong local dependencies in the ECG signal. Then, in order to take into account all the information contained in the past rather than considering only one previous beat, a sequential Monte Carlo method is presented, with a marginalized particle filter that efficiently estimates the unknown parameters of the dynamic model. Both methods are evaluated on the annotated QT database and observed to achieve significant improvements in detection rate and delineation accuracy compared to state-of-the-art methods, thus providing promising approaches for sequential P and T wave analysis

ECG Denoising using Angular Velocity as a State and an Observation in an Extended Kalman Filter Framework

International audienceIn this paper an efficient filtering procedure based on Extended Kalman Filter (EKF) has been proposed. The method is based on a modified nonlinear dynamic model, previously introduced for the generation of synthetic ECG signals. The proposed method considers the angular velocity of ECG signal, as one of the states of an EKF. We have considered two cases for observation equations, in one case we have assumed a corresponding observation to angular velocity state and in the other case, we have not assumed any observations for it. Quantitative evaluation of the proposed algorithm on the MIT-BIH Normal Sinus Rhythm Database (NSRDB) shows that an average SNR improvement of 8 dB is achieved for an input signal of -4 dB

Identification of cardiac signals in ambulatory ECG data

The Electrocardiogram (ECG) is the primary tool for monitoring heart function. ECG signals contain vital information about the heart which informs diagnosis and treatment of cardiac conditions. The diagnosis of many cardiac arrhythmias require long term and continuous ECG data, often while the participant engages in activity. Wearable ambulatory ECG (AECG) systems, such as the common Holter system, allow heart monitoring for hours or days. The technological trajectory of AECG systems aims towards continuous monitoring during a wide range of activities with data processed locally in real time and transmitted to a monitoring centre for further analysis. Furthermore, hierarchical decision systems will allow wearable systems to produce alerts or even interventions. These functions could be integrated into smartphones.A fundamental limitation of this technology is the ability to identify heart signal characteristics in ECG signals contaminated with high amplitude and non-stationary noise. Noise processing become more severe as activity levels increase, and this is also when many heart problems are present.This thesis focuses on the identification of heart signals in AECG data recorded during participant activity. In particular, it explored ECG filters to identify major heart conditions in noisy AECG data. Gold standard methods use Extended Kalman filters with extrapolation based on sum of Gaussian models. New methods are developed using linear Kalman filtering and extrapolation based on a sum of Principal Component basis signals. Unlike the gold standard methods, extrapolation is heartcycle by heartcycle. Several variants are explored where basic signals span one or two heartcycles, and applied to single or multi-channel ECG data.The proposed methods are extensively tested against standard databases or normal and abnormal ECG data and the performance is compared to gold standard methods. Two performance metrics are used: improvement in signal to noise ratio and the observability of clinically important features in the heart signal. In all tests the proposed method performs better, and often significantly better, than the gold standard methods. It is demonstrated that abnormal ECG signals can be identified in noisy AECG data

ECG denoising and fiducial point extraction using an extended Kalman filtering framework with linear and nonlinear phase observations

International audienceIn this paper we propose an efficient method for denoising and extracting fiducial point (FP) of ECG signals. The method is based on a nonlinear dynamic model which uses Gaussian functions to model ECG waveforms. For estimating the model parameters, we use an extended Kalman filter (EKF). In this framework called EKF25, all the parameters of Gaussian functions as well as the ECG waveforms (P-wave, QRS complex and T-wave) in the ECG dynamical model, are considered as state variables. In this paper, the dynamic time warping method is used to estimate the nonlinear ECG phase observation. We compare this new approach with linear phase observation models. Using linear and nonlinear EKF25 for ECG denoising and nonlinear EKF25 for fiducial point extraction and ECG interval analysis are the main contributions of this paper. Performance comparison with other EKF-based techniques shows that the proposed method results in higher output SNR with an average SNR improvement of 12 dB for an input SNR of-8 dB. To evaluate the FP extraction performance, we compare the proposed method with a method based on partially collapsed Gibbs sampler and an established EKF-based method. The mean absolute error and the root mean square error of all FPs, across all databases are 14 msec and 22 msec, respectively, for our proposed method, with an advantage when using a nonlinear phase observation. These errors are significantly smaller than errors obtained with other methods. For ECG interval analysis, with an absolute mean error and a root mean square error of about 22 msec and 29 msec, the proposed method achieves better accuracy and smaller variability with respect to other methods. Keywords: Electrocardiogram (ECG), Extended Kalman Filter (EKF), Dynamic Time Warping (DTW), Fiducial Point Extraction, Denoising

Analyse des ondes P et T des signaux ECG à l'aide de méthodes Bayésienne

Cette thèse a pour objet l étude de méthodes Bayésiennes pour l analyse des ondes P et T des signaux ECG. Différents modèles statistiques et des méthodes Bayésiennes associées sont proposés afin de réaliser la détection des ondes P et T et leur caractérisation (détermination du sommet et des limites des ondes ainsi que l estimation des formes d onde). Ces modèles prennent en compte des lois a priori pour les paramètres inconnus (les positions des ondes, les amplitudes et les coefficients de ces formes d'onde) associés aux signaux ECG. Ces lois a priori sont ensuite combinées avec la vraisemblance des données observées pour fournir les lois a posteriori des paramètres inconnus. En raison de la complexité des lois a posteriori obtenues, des méthodes de Monte Carlo par Chaînes de Markov sont proposées pour générer des échantillons distribués asymptotiquement suivant les lois d intérêt. Ces échantillons sont ensuite utilisés pour approcher les estimateurs Bayésiens classiques (MAP ou MMSE). D'autre part, pour profiter de la nature séquentielle du signal ECG, un modèle dynamique est proposé. Une méthode d'inférence Bayésienne similaire à celle développée précédemment et des méthodes de Monte Carlo séquentielles (SMC) sont ensuite étudiées pour ce modèle dynamique. Dans la dernière partie de ce travail, deux modèles Bayésiens introduits dans cette thèse sont adaptés pour répondre à un sujet de recherche clinique spécifique appelé détection de l'alternance des ondes T. Une des approches proposées a servi comme outil d'analyse dans un projet en collaboration avec St. Jude Medical, Inc et l'hôpital de Rangueil à Toulouse, qui vise à évaluer prospectivement la faisabilité de la détection des alternances des ondes T dans les signaux intracardiaques.This thesis studies Bayesian estimation/detection algorithms for P and T wave analysis in ECG signals. In this work, different statistical models and associated Bayesian methods are proposed to solve simultaneously the P and T wave delineation task (determination of the positions of the peaks and boundaries of the individual waves) and the waveform-estimation problem. These models take into account appropriate prior distributions for the unknown parameters (wave locations and amplitudes, and waveform coefficients). These prior distributions are combined with the likelihood of the observed data to provide the posterior distribution of the unknown parameters. Due to the complexity of the resulting posterior distributions, Markov chain Monte Carlo algorithms are proposed for (sample-based) detection/estimation. On the other hand, to take full advantage of the sequential nature of the ECG, a dynamic model is proposed under a similar Bayesian framework. Sequential Monte Carlo methods (SMC) are also considered for delineation and waveform estimation. In the last part of the thesis, two Bayesian models introduced in this thesis are adapted to address a specific clinical research problem referred to as T wave alternans (TWA) detection. One of the proposed approaches has served as an efficient analysis tool in the Endocardial T wave Alternans Study (ETWAS) project in collaboration with St. Jude Medical, Inc and Toulouse Rangueil Hospital. This project was devoted to prospectively assess the feasibility of TWA detection in repolarisation on EGM stored in ICD memories.TOULOUSE-INP (315552154) / SudocSudocFranceF

P and T wave analysis in ECG signals using Bayesian methods

Cette thèse a pour objet l’étude de méthodes Bayésiennes pour l’analyse des ondes P et T des signaux ECG. Différents modèles statistiques et des méthodes Bayésiennes associées sont proposés afin de réaliser la détection des ondes P et T et leur caractérisation (détermination du sommet et des limites des ondes ainsi que l’estimation des formes d’onde). Ces modèles prennent en compte des lois a priori pour les paramètres inconnus (les positions des ondes, les amplitudes et les coefficients de ces formes d'onde) associés aux signaux ECG. Ces lois a priori sont ensuite combinées avec la vraisemblance des données observées pour fournir les lois a posteriori des paramètres inconnus. En raison de la complexité des lois a posteriori obtenues, des méthodes de Monte Carlo par Chaînes de Markov sont proposées pour générer des échantillons distribués asymptotiquement suivant les lois d’intérêt. Ces échantillons sont ensuite utilisés pour approcher les estimateurs Bayésiens classiques (MAP ou MMSE). D'autre part, pour profiter de la nature séquentielle du signal ECG, un modèle dynamique est proposé. Une méthode d'inférence Bayésienne similaire à celle développée précédemment et des méthodes de Monte Carlo séquentielles (SMC) sont ensuite étudiées pour ce modèle dynamique. Dans la dernière partie de ce travail, deux modèles Bayésiens introduits dans cette thèse sont adaptés pour répondre à un sujet de recherche clinique spécifique appelé détection de l'alternance des ondes T. Une des approches proposées a servi comme outil d'analyse dans un projet en collaboration avec St. Jude Medical, Inc et l'hôpital de Rangueil à Toulouse, qui vise à évaluer prospectivement la faisabilité de la détection des alternances des ondes T dans les signaux intracardiaques. ABSTRACT : This thesis studies Bayesian estimation/detection algorithms for P and T wave analysis in ECG signals. In this work, different statistical models and associated Bayesian methods are proposed to solve simultaneously the P and T wave delineation task (determination of the positions of the peaks and boundaries of the individual waves) and the waveform-estimation problem. These models take into account appropriate prior distributions for the unknown parameters (wave locations and amplitudes, and waveform coefficients). These prior distributions are combined with the likelihood of the observed data to provide the posterior distribution of the unknown parameters. Due to the complexity of the resulting posterior distributions, Markov chain Monte Carlo algorithms are proposed for (sample-based) detection/estimation. On the other hand, to take full advantage of the sequential nature of the ECG, a dynamic model is proposed under a similar Bayesian framework. Sequential Monte Carlo methods (SMC) are also considered for delineation and waveform estimation. In the last part of the thesis, two Bayesian models introduced in this thesis are adapted to address a specific clinical research problem referred to as T wave alternans (TWA) detection. One of the proposed approaches has served as an efficient analysis tool in the Endocardial T wave Alternans Study (ETWAS) project in collaboration with St. Jude Medical, Inc and Toulouse Rangueil Hospital. This project was devoted to prospectively assess the feasibility of TWA detection in repolarisation on EGM stored in ICD memories

Extraction and Detection of Fetal Electrocardiograms from Abdominal Recordings

The non-invasive fetal ECG (NIFECG), derived from abdominal surface electrodes, offers novel diagnostic possibilities for prenatal medicine. Despite its straightforward applicability, NIFECG signals are usually corrupted by many interfering sources. Most significantly, by the maternal ECG (MECG), whose amplitude usually exceeds that of the fetal ECG (FECG) by multiple times. The presence of additional noise sources (e.g. muscular/uterine noise, electrode motion, etc.) further affects the signal-to-noise ratio (SNR) of the FECG. These interfering sources, which typically show a strong non-stationary behavior, render the FECG extraction and fetal QRS (FQRS) detection demanding signal processing tasks. In this thesis, several of the challenges regarding NIFECG signal analysis were addressed. In order to improve NIFECG extraction, the dynamic model of a Kalman filter approach was extended, thus, providing a more adequate representation of the mixture of FECG, MECG, and noise. In addition, aiming at the FECG signal quality assessment, novel metrics were proposed and evaluated. Further, these quality metrics were applied in improving FQRS detection and fetal heart rate estimation based on an innovative evolutionary algorithm and Kalman filtering signal fusion, respectively. The elaborated methods were characterized in depth using both simulated and clinical data, produced throughout this thesis. To stress-test extraction algorithms under ideal circumstances, a comprehensive benchmark protocol was created and contributed to an extensively improved NIFECG simulation toolbox. The developed toolbox and a large simulated dataset were released under an open-source license, allowing researchers to compare results in a reproducible manner. Furthermore, to validate the developed approaches under more realistic and challenging situations, a clinical trial was performed in collaboration with the University Hospital of Leipzig. Aside from serving as a test set for the developed algorithms, the clinical trial enabled an exploratory research. This enables a better understanding about the pathophysiological variables and measurement setup configurations that lead to changes in the abdominal signal's SNR. With such broad scope, this dissertation addresses many of the current aspects of NIFECG analysis and provides future suggestions to establish NIFECG in clinical settings.:Abstract Acknowledgment Contents List of Figures List of Tables List of Abbreviations List of Symbols (1)Introduction 1.1)Background and Motivation 1.2)Aim of this Work 1.3)Dissertation Outline 1.4)Collaborators and Conflicts of Interest (2)Clinical Background 2.1)Physiology 2.1.1)Changes in the maternal circulatory system 2.1.2)Intrauterine structures and feto-maternal connection 2.1.3)Fetal growth and presentation 2.1.4)Fetal circulatory system 2.1.5)Fetal autonomic nervous system 2.1.6)Fetal heart activity and underlying factors 2.2)Pathology 2.2.1)Premature rupture of membrane 2.2.2)Intrauterine growth restriction 2.2.3)Fetal anemia 2.3)Interpretation of Fetal Heart Activity 2.3.1)Summary of clinical studies on FHR/FHRV 2.3.2)Summary of studies on heart conduction 2.4)Chapter Summary (3)Technical State of the Art 3.1)Prenatal Diagnostic and Measuring Technique 3.1.1)Fetal heart monitoring 3.1.2)Related metrics 3.2)Non-Invasive Fetal ECG Acquisition 3.2.1)Overview 3.2.2)Commercial equipment 3.2.3)Electrode configurations 3.2.4)Available NIFECG databases 3.2.5)Validity and usability of the non-invasive fetal ECG 3.3)Non-Invasive Fetal ECG Extraction Methods 3.3.1)Overview on the non-invasive fetal ECG extraction methods 3.3.2)Kalman filtering basics 3.3.3)Nonlinear Kalman filtering 3.3.4)Extended Kalman filter for FECG estimation 3.4)Fetal QRS Detection 3.4.1)Merging multichannel fetal QRS detections 3.4.2)Detection performance 3.5)Fetal Heart Rate Estimation 3.5.1)Preprocessing the fetal heart rate 3.5.2)Fetal heart rate statistics 3.6)Fetal ECG Morphological Analysis 3.7)Problem Description 3.8)Chapter Summary (4)Novel Approaches for Fetal ECG Analysis 4.1)Preliminary Considerations 4.2)Fetal ECG Extraction by means of Kalman Filtering 4.2.1)Optimized Gaussian approximation 4.2.2)Time-varying covariance matrices 4.2.3)Extended Kalman filter with unknown inputs 4.2.4)Filter calibration 4.3)Accurate Fetal QRS and Heart Rate Detection 4.3.1)Multichannel evolutionary QRS correction 4.3.2)Multichannel fetal heart rate estimation using Kalman filters 4.4)Chapter Summary (5)Data Material 5.1)Simulated Data 5.1.1)The FECG Synthetic Generator (FECGSYN) 5.1.2)The FECG Synthetic Database (FECGSYNDB) 5.2)Clinical Data 5.2.1)Clinical NIFECG recording 5.2.2)Scope and limitations of this study 5.2.3)Data annotation: signal quality and fetal amplitude 5.2.4)Data annotation: fetal QRS annotation 5.3)Chapter Summary (6)Results for Data Analysis 6.1)Simulated Data 6.1.1)Fetal QRS detection 6.1.2)Morphological analysis 6.2)Own Clinical Data 6.2.1)FQRS correction using the evolutionary algorithm 6.2.2)FHR correction by means of Kalman filtering (7)Discussion and Prospective 7.1)Data Availability 7.1.1)New measurement protocol 7.2)Signal Quality 7.3)Extraction Methods 7.4)FQRS and FHR Correction Algorithms (8)Conclusion References (A)Appendix A - Signal Quality Annotation (B)Appendix B - Fetal QRS Annotation (C)Appendix C - Data Recording GU

ADAPTIVE MODELS-BASED CARDIAC SIGNALS ANALYSIS AND FEATURE EXTRACTION

Signal modeling and feature extraction are among the most crucial and important steps for stochastic signal processing. In this thesis, a general framework that employs adaptive model-based recursive Bayesian state estimation for signal processing and feature extraction is described. As a case study, the proposed framework is studied for the problem of cardiac signal analysis. The main objective is to improve the signal processing aspects of cardiac signals by developing new techniques based on adaptive modelling of electrocardiogram (ECG) wave-forms. Specially several novel and improved approaches to model-based ECG decomposition, waveform characterization and feature extraction are proposed and studied in detail. In the concept of ECG decomposition and wave-forms characterization, the main idea is to extend and improve the signal dynamical models (i.e. reducing the non-linearity of the state model with respect to previous solutions) while combining with Kalman smoother to increase the accuracy of the model in order to split the ECG signal into its waveform components, as it is proved that Kalman filter/smoother is an optimal estimator in minimum mean square error (MMSE) for linear dynamical systems. The framework is used for many real applications, such as: ECG components extraction, ST segment analysis (estimation of a possible marker of ventricular repolarization known as T/QRS ratio) and T-wave Alternans (TWA) detection, and its extension to many other applications is straightforward. Based on the proposed framework, a novel model to characterization of Atrial Fibrillation (AF) is presented which is more effective when compared with other methods proposed with the same aims. In this model, ventricular activity (VA) is represented by a sum of Gaussian kernels, while a sinusoidal model is employed for atrial activity (AA). This new model is able to track AA, VA and fibrillatory frequency simultaneously against other methods which try to analyze the atrial fibrillatory waves (f-waves) after VA cancellation. Furthermore we study a new ECG processing method for assessing the spatial dispersion of ventricular repolarization (SHVR) using V-index and a novel algorithm to estimate the index is presented, leading to more accurate estimates. The proposed algorithm was used to study the diagnostic and prognostic value of the V-index in patients with symptoms suggestive of Acute Myocardial Infraction (AMI)

P Wave Detection in Pathological ECG Signals

Důležitou součástí hodnocení elektrokardiogramu (EKG) a následné detekce srdečních patologií, zejména v dlouhodobém monitorování, je detekce vln P. Výsledky detekce vln P umožňují získat ze záznamu EKG více informací o srdeční činnosti. Podle správně detekovaných pozic vln P je možné detekovat a odlišit patologie, které současné programy používané v medicínské praxi identifikovat neumožňují (např. atrioventrikulární blok 1., 2. a 3. stupně, cestující pacemaker, Wolffův-Parkinsonův-Whiteův syndrom). Tato dizertační práce představuje novou metodu detekce vln P v záznamech EKG během fyziologické a zejména patologické srdeční činnosti. Metoda je založena na fázorové transformaci, inovativních pravidlech detekce a identifikaci možných patologií zpřesňující detekci vln P. Dalším důležitým výsledkem práce je vytvoření dvou veřejně dostupných databází záznamů EKG s obsahem patologií a anotovanými vlnami P. Dizertační práce je rozdělena na teoretickou část a soubor publikací představující příspěvek autora v oblasti detekce vlny P.Accurate software for the P wave detection, mainly in long-term monitoring, is an important part of electrocardiogram (ECG) evaluation and subsequent cardiac pathological events detection. The results of P wave detection allow us to obtain more information from the ECG records. According to the correct P wave detection, it is possible to detect and distinguish cardiac pathologies which are nowadays automatically undetectable by commonly used software in medical practice (events e.g. atrioventricular block 1st, 2nd and 3rd degree, WPW syndrome, wandering pacemaker, etc.). This thesis introduces a new method for P wave detection in ECG signals during both physiological and pathological heart function. This novel method is based on a phasor transform, innovative rules, and identification of possible pathologies that improve P wave detection. An equally important part of the work is the creation of two publicly available databases of physiological and pathological ECG records with annotated P waves. The dissertation is divided into theoretical analysis and a set of publications representing the contribution of the author in the area of P wave detection.

PREDICTION OF RESPIRATORY MOTION

Radiation therapy is a cancer treatment method that employs high-energy radiation beams to destroy cancer cells by damaging the ability of these cells to reproduce. Thoracic and abdominal tumors may change their positions during respiration by as much as three centimeters during radiation treatment. The prediction of respiratory motion has become an important research area because respiratory motion severely affects precise radiation dose delivery. This study describes recent radiotherapy technologies including tools for measuring target position during radiotherapy and tracking-based delivery systems. In the first part of our study we review three prediction approaches of respiratory motion, i.e., model-based methods, model-free heuristic learning algorithms, and hybrid methods. In the second part of our work we propose respiratory motion estimation with hybrid implementation of extended Kalman filter. The proposed method uses the recurrent neural network as the role of the predictor and the extended Kalman filter as the role of the corrector. In the third part of our work we further extend our research work to present customized prediction of respiratory motion with clustering from multiple patient interactions. For the customized prediction we construct the clustering based on breathing patterns of multiple patients using the feature selection metrics that are composed of a variety of breathing features. In the fourth part of our work we retrospectively categorize breathing data into several classes and propose a new approach to detect irregular breathing patterns using neural networks. We have evaluated the proposed new algorithm by comparing the prediction overshoot and the tracking estimation value. The experimental results of 448 patients’ breathing patterns validated the proposed irregular breathing classifier