Novel characterization method of impedance cardiography signals using time-frequency distributions

The purpose of this document is to describe a methodology to select the most adequate time-frequency distribution (TFD) kernel for the characterization of impedance cardiography signals (ICG). The predominant ICG beat was extracted from a patient and was synthetized using time-frequency variant Fourier approximations. These synthetized signals were used to optimize several TFD kernels according to a performance maximization. The optimized kernels were tested for noise resistance on a clinical database. The resulting optimized TFD kernels are presented with their performance calculated using newly proposed methods. The procedure explained in this work showcases a new method to select an appropriate kernel for ICG signals and compares the performance of different time-frequency kernels found in the literature for the case of ICG signals. We conclude that, for ICG signals, the performance (P) of the spectrogram with either Hanning or Hamming windows (P¿=¿0.780) and the extended modified beta distribution (P¿=¿0.765) provided similar results, higher than the rest of analyzed kernels.Peer ReviewedPostprint (published version

Automated Cardiac Rhythm Diagnosis for Electrophysiological Studies, an Enhanced Classifier Approach

INTRODUCTION Heart function can be impaired by rhythm disturbances (cardiac arrhythmia), illustrated by electrocardiogram (ECG) recordings. Computerised arrhythmia diagnosis is well established for ECG’s but less for intracardiac electrophysiological (EP) testing. Accurate diagnosis is pre-requisite for delivering appropriate treatment to patients however existing algorithms misdiagnose a proportion of arrhythmias. Studies suggested artificial intelligence (AI) classifiers are accurate using ECG and intracardiac electrogram features and reviews suggested new features might augment diagnosis. This study aimed to develop an accurate cardiac rhythm diagnostic algorithm for electrophysiological (EP) studies with potential application as a generic rhythm classifier. METHOD An ethically approved prospective clinical study collected clinical history, right atrial and right ventricular intracardiac electrograms, beat-to-beat cardiac stroke volume, body motion and body temperature data during EP studies. An iterative system development life-cycle was used, including knowledge management and classifier development sub-processes. Domain expert knowledge and clinical arrhythmia diagnosis were modelled, synthesised as AI classifiers and used to classify cardiac rhythms. RESULTS Data collected from 65 patients was pre-processed into instances for classifier inputs. Decision tree, naïve Bayes, neural network, support vector machine and inference engine classifiers developed using Matlab showed good performance and were combined as a production system in a mixture-of-experts multi-classifier system. 18 different rhythms were classified, with the naïve Bayes classifier used to classify 11 rhythms, decision tree 4 rhythms, neural network and support vector machine one each, unclassified instances by the inference engine classifier and final class allocation using decision rule. Production system showed overall correct clasification rate 0.960; error 0.040; mean sensitivity 0.855; mean specificity 0.977; mean κ 0.767; mean positive predictive value 0.792; mean negative predictive value 0.975; mean Pearson’s phi 0.787, with P 0.9 for sinus node dysfunction and atrio-ventricular nodal/ junctional tachycardias. Temperature, accelerometry and QT interval were assessed as features by a comparison of algorithm performances with each feature removed and found not to affect classification performance. An evaluation showed 10 beat analysis performed better than 5 beat analysis. CONCLUSIONS Modelling of the clinical diagnosis process produced an AI based mixture-of-experts multi-classifier system, which accurately diagnosed different 18 cardiac rhythms. The naïve Bayes classifier performed best and classified 11 rhythms. Features for clinical symptoms and predisposing factors, atrial electrogram morphology and changes in stroke volume were found to influence rhythm classification. High performances encourage further development and potential future improvements include: a larger sample dataset; inclusion of His and coronary sinus electrograms; data mining for unknown features with significant influence on diagnosis; binary classification. The aim to classify rhythm using artificial intelligence suitable for use during EP studies was satisfied and the research hypothesis that it outperformed current algorithms was accepted. The system was likely to be able to accept updates but needs conversion as a precursor to use in a live clinical environment

New methods for continuous non-invasive blood pressure measurement

Hlavním cílem této práce je nalezení nové metodiky pro měření kontinuálního neinvazivního krevního tlaku na základě rychlosti šíření pulzní vlny v krevním řečišti. Práce se opírá o rešerši zabývající se základním modelem pro stanovení kontinuálního neinvazivního krevního tlaku na základě měření zpoždění pulzní vlny a jeho rozšířením. Z informací získaných z rešerše se upravila metodika měření doby zpoždění pulzní vlny / rychlosti šíření pulzní vlny, aby bylo možné docílit přesnějších výsledků a omezit tak lidský faktor, který způsobuje významnou nepřesnost vlivem nedokonalého rozmístění senzorů. Rešerše se rovněž podrobně zabývá modely pro stanovení kontinuálního neinvazivního krevního tlaku a jejich úprav zajištujících zvýšení přesnosti. Mezi úpravy modelů zejména patří vstupní parametry popisující krevní oběh - systémový cévní odpor, elasticita cév, tuhost cév. Práce se taky zabývá úpravami stávajícího modelu krevního řečiště pro bližší přizpůsobení fyzického modelu k reálnému cévnímu systému lidského těla. Mezi tyto úpravy patří i funkce baroreflexu či simulace různé tvrdosti stěny umělých cévních segmentů. Protože se jedná o simulační model krevního řečiště, důležitým krokem je také měření tlakové a objemové pulzní vlny, kde není možné využít konvenční senzory pro fotopletysmografii kvůli absenci částic pohlcující světlo. Na základě experimentálního měření pro různé nastavení modelu krevního řečiště bylo provedeno měření pulzní vlny pomocí tlakových a kapacitních senzorů s následným zpracováním měřených signálů a detekcí příznaků charakterizující pulzní vlnu. Na základě příznaku byly stanoveny predikční regresní modely, které vykazovaly dostatečnou přesnost jejich určení, a tak následovaly dvě metody pro získání parametru o tvrdosti cévní stěny na základě měřitelných parametrů. První metodou byl predikční regresní model, který vykazoval přesnost 74,1 % a druhou metodou byl adaptivní neuro-fuzzy inferenční systém, který vykazoval přesnost 98,7 %. Tyto stanovení rychlosti pulzní vlny bylo ověřeno dalším přímým měřením pulzní vlny a výsledky byly srovnány. Výsledkem disertační práce je určení rychlosti šíření pulzní vlny s využitím pouze jednoho pletysmografického senzoru bez nutnosti měření na dvou různých místech s přesným měřením vzdálenosti a možnosti aplikace v klinické praxi.The main objective of this work is to find a new methodology for measuring continuous non-invasive blood pressure based on the pulse wave velocity in the vascular system. The work is based on the literature research of the basic model for the determination of non-invasive continuous blood pressure based on the measurement of pulse transit time. From the information obtained from the review, the methodology of measuring the pulse transit time/pulse wave velocity was modified in order to achieve more accurate results and to reduce the human factor that causes significant inaccuracy due to imperfect sensor placement. The review discusses in detail the models for continuous non-invasive blood pressure estimation and their modifications to ensure increased accuracy. In particular, model modifications include input parameters describing blood circulation - systemic vascular resistance, vascular elasticity, and vascular stiffness. The thesis deals with modifications to the existing physical vascular model to more closely mimic the real vascular system of the human body. These modifications include the baroreflex function or the simulation of different wall hardness of artificial arterial segments. As this is a simulation model of the vascular system, the measurement of pressure and volume pulse wave is also an important step, where it is not possible to use photoplethysmography method due to the absence of light absorbing particles. Based on the experimental measurements for different settings of the vascular model, pulse wave measurements were performed using pressure and capacitive sensors with subsequent processing of the measured signals and detection of the pulse wave features. Predictive regression models were established based on the pulse wave features and showed sufficient accuracy in their determination, followed by two methods for obtaining the parameter on the hardness of the vascular wall based on the measurable parameters. The first method was a predictive regression model, which showed an accuracy of 74.1 %, and the second method was an adaptive neuro-fuzzy inference system, which showed an accuracy of 98.7 %. These pulse wave velocity determinations were verified by further direct pulse wave measurements and the results were compared. The dissertation results in the determination of pulse wave propagation velocity using only one plethysmographic sensor without the need for measurements at two different locations with accurate distance measurements and the possibility of application in clinical practice.450 - Katedra kybernetiky a biomedicínského inženýrstvívyhově

Physiological time-series investigations of cardiovascular regulation in healthy young adults during physical exercise.

Physiological parameters may be recorded non-invasively to gain information on cardiovascular function which can then characterise populations with various pathologies. Physical exercise produces specific autonomic nervous system (ANS) changes. There has been no comprehensive profiling of cardiovascular function during exercise or simultaneous characterisation of the influence of exercise on cardiac ventricular function and electrical activity. This work aims to address that, using a combination of physiological parameters. Between-lead agreement for ambulatory electrocardiographic (EGG) depolarisation-repolarisation (QT) interval was quantified during rest and exercise. In contrast to cardiac interval (RR) data, between-lead bias and limits of agreement for QT interval data should be quantified when reporting results from an ambulatory EGG system and between-gender QT differences should also be accounted for. EGG electrode location appears to significantly affect QT-RR hysteresis, the shortening of the post-exercise QT interval relative to that at similar heart rates during exercise or pre-exercise rest, further emphasising the need for standardisation of EGG electrode placement. Sample entropy (SampEn) measures data complexity. Few studies have compared SampEn of RR data (SampEn-RR) during exercise, whilst none have examined SampEn for the corresponding QT interval (SampEn-QT). Fractal analysis assesses data correlation and scaling structures. Detrended fluctuation analysis (DFA) provides a scaling exponent (a) which describes these properties. This has not been quantified for RR interval data during post-exercise recovery and has not been reported for QT interval data. Differences in a magnitudes for RR and QT data suggest that these quantities have different fractal properties. Exercise perturbs the resting QT-RR relationship via hysteresis. The QT variability index (QTVI) quantifies the relative autonomic influence on the atrial and ventricular myocardium during rest and exercise. QTVI is a consistent measure of cardiac ventricular function and as such appears to be a more useful index than other parameters based on RR or QT interval alone

The acute (immediate) specific haemodynamic effects of reflexology

Reflexology is one of the top six complementary therapies used in the UK. Reflexologists claim that massage to specific points of the feet increases blood supply to referred or 'mapped' organs in the body. Empirical evidence to validate this claim is scarce. This three-phase RCT measured changes in haemodynamic parameters in subjects receiving reflexology treatment applied to specific areas of the foot which are thought to correspond to the heart (intervention) compared with reflexology applied to other areas on the foot which are not (control)