Differences of Heart Rate Variability Between Happiness and Sadness Emotion States: A Pilot Study

This pilot study investigated the differences of heart rate variability (HRV) indices between two opposite emotion states: happiness and sadness, to reveal the differences of autonomic nervous system activity under different emotional states. Forty-eight healthy volunteers were enrolled for this study. Electrocardiography (ECG) signals were recorded under both emotion states with a random measurement order (first happiness emotion measurement then sadness or reverse). RR interval (RRI) time series were extracted from ECGs and multiple HRV indices, including time-domain (MEAN, SDNN, RMSSD and PNN50), frequency-domain (LFn, HFn and LF/HF) and nonlinear indices (SampEn and FuzzyMEn) were calculated. In addition, the effects of heart rate (HR) and mean artery pressure (MAP) on the aforementioned HRV indices were analyzed for both emotion states. The results showed that experimental order had no significant effect on all HRV indices from both happiness and sadness emotions (all P > 0.05). The key result was that among all nine HRV indices, six indices were identified having significant differences between happiness and sadness emotion states: MEAN (P = 0.028), SDNN (P = 0.002), three frequency-domain indices (all P < 0.0001) and FuzzyMEn (P = 0.047), whereas RMSSD, PNN50 and SampEn had no significant differences between the two emotion states. All indices, except for SampEn, had significant positive correlations (all P < 0.01) for the two emotion states. Four time-domain indices decreased with the increase of HR (all P < 0.01), while frequency-domain and nonlinear indices demonstrated no HR-related changes for each emotional state. In addition, all indices (time-domain, frequency-domain and nonlinear) showed no MAP-related changes. It concluded that HRV indices showed significant differences between happiness and sadness emotion states and the findings could help to better understand the inherent differences of cardiovascular time series between different emotion states in clinical practice

Improving accuracy of heart failure detection using data refinement

Due to the wide inter- and intra-individual variability, short-term heart rate variability (HRV) analysis (usually 5 min) might lead to inaccuracy in detecting heart failure. Therefore, RR interval segmentation, which can reflect the individual heart condition, has been a key research challenge for accurate detection of heart failure. Previous studies mainly focus on analyzing the entire 24-h ECG recordings from all individuals in the database which often led to poor detection rate. In this study, we propose a set of data refinement procedures, which can automatically extract heart failure segments and yield better detection of heart failure. The procedures roughly contain three steps: (1) select fast heart rate sequences, (2) apply dynamic time warping (DTW) measure to filter out dissimilar segments, and (3) pick out individuals with large numbers of segments preserved. A physical threshold-based Sample Entropy (SampEn) was applied to distinguish congestive heart failure (CHF) subjects from normal sinus rhythm (NSR) ones, and results using the traditional threshold were also discussed. Experiment on the PhysioNet/MIT RR Interval Databases showed that in SampEn analysis (embedding dimension m = 1, tolerance threshold r = 12 ms and time series length N = 300), the accuracy value after data refinement has increased to 90.46% from 75.07%. Meanwhile, for the proposed procedures, the area under receiver operating characteristic curve (AUC) value has reached 95.73%, which outperforms the original method (i.e., without applying the proposed data refinement procedures) with AUC of 76.83%. The results have shown that our proposed data refinement procedures can significantly improve the accuracy in heart failure detection

Model Selection for Body Temperature Signal Classification Using Both Amplitude and Ordinality-Based Entropy Measures

[EN] Many entropy-related methods for signal classification have been proposed and exploited successfully in the last several decades. However, it is sometimes difficult to find the optimal measure and the optimal parameter configuration for a specific purpose or context. Suboptimal settings may therefore produce subpar results and not even reach the desired level of significance. In order to increase the signal classification accuracy in these suboptimal situations, this paper proposes statistical models created with uncorrelated measures that exploit the possible synergies between them. The methods employed are permutation entropy (PE), approximate entropy (ApEn), and sample entropy (SampEn). Since PE is based on subpattern ordinal differences, whereas ApEn and SampEn are based on subpattern amplitude differences, we hypothesized that a combination of PE with another method would enhance the individual performance of any of them. The dataset was composed of body temperature records, for which we did not obtain a classification accuracy above 80% with a single measure, in this study or even in previous studies. The results confirmed that the classification accuracy rose up to 90% when combining PE and ApEn with a logistic model.Cuesta Frau, D.; Miró Martínez, P.; Oltra Crespo, S.; Jordán Núñez, J.; Vargas-Rojo, B.; González, P.; Varela-Entrecanales, M. (2018). Model Selection for Body Temperature Signal Classification Using Both Amplitude and Ordinality-Based Entropy Measures. Entropy. 20(11):1-18. https://doi.org/10.3390/e20110853118201

Heart beat variability analysis in perinatal brain injury and infection

Tese de mestrado integrado, Engenharia Biomédica e Biofísica (Engenharia Clínica e Instrumentação Médica) Universidade de Lisboa, Faculdade de Ciências, 2018Todos os anos, mais de 95 mil recém-nascidos são admitidos nas Unidades de Cuidados Intensivos Neonatais (UCIN) do Reino Unido, devido principalmente a partos prematuros ou outras complicações que pudessem ter ocorrido, como é o caso da encefalopatia hipóxico-isquémica (EHI), que assume 3% de todas as admissões nas unidades referidas. EHI é o termo que define uma complicação inesperada durante o parto, que resulta em lesões neurológicas a longo prazo e até em morte neonatal, devido à privação de oxigénio e fluxo sanguíneo ao recém-nascido durante o nascimento. Estima-se que tenha uma incidência de um a seis casos por 1000 nascimentos. Nos países desenvolvidos, a hipotermia é utilizada como método preventivo-terapêutico para esta condição. No entanto, existem dois grandes obstáculos para a obtenção da neuroprotecção pretendida e totalmente benéfica, na prática clínica. Em primeiro lugar, esta técnica é eficaz se for iniciada dentro de seis horas após o parto. Visto que o estado clínico da encefalopatia neonatal evolui nos dias posteriores ao nascimento, a sua deteção precoce é um grande desafio. Tal situação pode levar a diversos erros nas UCIN, tal como indivíduos sujeitos à terapia de hipotermia desnecessariamente, ou ainda mais grave, casos em que recém-nascidos foram inicialmente considerados como saudáveis, não tendo sido submetidos à terapia referida, apresentarem sinais de EHI após seis horas de vida. A segunda questão prende-se com o facto de a neuroprotecção poder ser perdida se o bebé estiver stressado durante o tratamento. Para além disso, não existe nenhuma ferramenta válida para a avaliação da dor dos recém-nascidos submetidos a esta terapia. Os obstáculos frisados anteriormente demonstram duas necessidades ainda não correspondidas: a carência de um método não invasivo e largamente adaptável a diferentes cenários para uma correta identificação de recém-nascidos com maior probabilidade de HIE, dentro de uma margem de seis horas após o parto, mas também um método preciso de stress em tempo real, não invasivo, que possa orientar tanto pessoal médico, como pais, de modo a oferecer um tratamento mais responsável, célere e individualizado. Deste modo, a análise do ritmo cardíaco demostra um enorme potencial para ser um biomarcador de encefalopatia neonatal, bem como um medidor de stress, através da eletrocardiografia (ECG), visto que é um importante indicador de homeostase, mas também de possíveis condições que podem afetar o sistema nervoso autónomo e, consequentemente, o equilíbrio do corpo humano. É extremamente difícil a obtenção de um parâmetro fisiológico, sem a presença de artefactos, especialmente no caso de recém-nascidos admitidos nas UCIN. Tanto no caso da aquisição de ECGs, como de outros parâmetros, existe uma maior probabilidade de o sinal ser corrompido por artefactos, visto que são longas aquisições, normalmente dias, onde o bebé é submetido a diversas examinações médicas, está rodeado de equipamentos eletrónicos, entre outros. Artefactos são definidos como uma distorção do sinal, podendo ser causados por diversas fontes, fisiológicas ou não. A sua presença nos dados adquiridos influencia e dissimula as informações corretas e reais, podendo mesmo levar a diagnósticos e opções terapêuticas erradas e perigosas para o paciente. Apesar de existirem diversos algoritmos de identificação de artefactos adequados para o sinal cardíaco adulto, são poucos os que funcionam corretamente para o de recém-nascido. Para além disso, é necessário bastante tempo tanto para o staff clínico, como para os investigadores, para o processo de visualização e identificação de artefactos no eletrocardiograma manualmente. Deste modo, o projeto desenvolvido na presente dissertação propõe um novo algoritmo de identificação e marcação de artefactos no sinal cardíaco de recém-nascidos. Para tal, foi criado um modelo híbrido de um método que tem em consideração todas as relações matemáticas de batimento para batimento cardíaco, com outro que tem como objetivo a remoção de spikes no mesmo sinal. O algoritmo final para além de cumprir com o objetivo descrito acima, é também adaptável a diferentes tipos de artefactos presentes no sinal, permitindo ao utilizador, de uma forma bastante intuitiva, escolher o tipo de parâmetros e passos a aplicar, podendo ser facilmente utilizado por profissionais de diferentes áreas. Deste modo, este algoritmo é uma mais-valia quando aplicado no processamento de sinal pretendido, evitando assim uma avaliação visual demorada de todo o sinal. Para obter a melhor performance possível, durante o desenvolvimento do algoritmo foram sempre considerados os resultados de validação, tais como exatidão, sensibilidade, entre outros. Para tal, foram analisados e comparados eletrocardiogramas de 4 recém-nascidos saudáveis e 4 recém-nascidos com encefalopatia. Todos possuíam aproximadamente 5 horas de sinal cardíaco adquirido após o nascimento, com diferentes níveis de presença de artefactos. O algoritmo final, obteve uma taxa de sensibilidade de 96.2% (±2.4%) e uma taxa de exatidão de 92.6% (±3.2%). Como se pode verificar pelos valores obtidos, o algoritmo obteve percentagens altas nos vários parâmetros de classificação, o que significa uma deteção correta. A taxa de exatidão apresenta um valor mais baixo, comparativamente ao parâmetro da sensibilidade, pois em diversas situações, normalmente perto de artefactos, os batimentos normais são considerados como artefactos, pelo algoritmo. Contudo, essa taxa não é alarmante, tendo sido considerada uma taxa reduzida, pelo pessoal médico. Após o processamento do sinal cardíaco dos grupos mencionados acima, um estudo comparativo, utilizando parâmetros da variabilidade do ritmo cardíaco, foi realizado. Diferenças significativas foram encontradas entre os dois grupos, onde o saudável assumiu sempre valores maiores. SDNN e baixa frequência foram os parâmetros que traduziram uma diferença maior entre os dois grupos, com um p-value <0.01. De modo a corresponder ao segundo obstáculo referido nesta dissertação, outro objetivo desta tese foi a criação de um algoritmo que pudesse identificar e diferenciar uma situação de stress nesta faixa etária, com recurso ao ritmo cardíaco. Um estudo multidimensional foi aplicado aos diferentes métodos de entropia utilizados nesta tese (approximate entropy, sample entropy, multiscales entopy e fuzzy entropy) de modo a estudar como os diferentes métodos de entropia interagem entre si e quais são os resultados dessa relação, especialmente na distinção de estados normais e stressantes. Para tal, a utilização de clusters foi essencial. Dado que para todos os ECGs de bebés saudáveis analisados neste projeto foram registados todas as possíveis situações de stress, como é o caso de choro, examinações médicas, mudança de posição, entre outros, foram escolhidos 10 minutos do sinal do ritmo cardíaco adquirido, antes da situação, para análise. Infelizmente, associado a um evento stressante, na maioria dos casos encontra-se uma percentagem bastante alta do sinal corrompida por artefactos. No entanto, em alguns casos foi possível observar uma clara distinção de grupos de clusters, indicando que naquele período de tempo, houve uma mudança de estado. Foi também realizado um estudo intensivo de diversos métodos de entropia aplicados ao grupo de sujeitos apresentados nesta dissertação, onde foi provado que o método mais adequado a nível de diferenciação é a Fuzzy Entropy (p=0.0078). Ainda é possível sugerir alguns aspetos e apontar algumas limitações, no âmbito de poderem ser ultrapassadas no futuro. Em primeiro lugar, é necessária a aquisição de mais eletrocardiogramas, quer de recém-nascidos saudáveis, quer com encefalopatia hipóxico-isquémica, de modo a aumentar o tamanho da amostra e, deste modo diminuir os valores do desvio-padrão em todos os parâmetros calculados. Relativamente ao estudo do stress, seria interessante, com uma amostra maior, a definição de clusters, de modo a ter uma identificação precisa de situações stressantes. Para além disso, a transformação do software atualmente escrito em MATLAB para GUI (interface gráfica do utilizador), a fim de tornar mais acessível a sua utilização por profissionais de diversas áreas.In Neonatal Intensive Care Unit (NICU), the heart rate (HR) offers significant insight into the autonomic function of sick newborns, especially with hypoxic ischemic encephalopathy condition (HIE). However, the intensity of clinical care and monitoring contributes to the electrocardiogram (ECG) to be often noisy and contaminated with artefacts from various sources. These artefacts, defined as any distortion of the signal caused by diverse sources, being physiological or non-physiological features, interfere with the characterization and subsequent evaluation of the heart rate, leading to grave consequences, both in diagnostic and therapeutic decisions. Besides, its manual inspection in the ECG trace is highly time-consuming, which is not feasible in clinical monitoring, especially in NICU. In this dissertation, it is proposed an algorithm capable of automatically detect and mark artefacts in neonatal ECG data, mainly dealing with mathematical aspects of the heart rate, starting from the raw signal. Also, it is proposed an adjacent algorithm, using complexity science applied to HR data, with the objective of identifying stress scenarios. Periods of 10-minute ECG were considered from 8 newborns (4 healthy and 4 HIE) to the identification of stress situations, whereas for the artefacts removal algorithm small portions varying in time length according to the amount of noise present in the originally 5 hours long samples were utilised. In this report it is also present several comparisons utilising heart rate parameters between healthy and HIE groups. Fuzzy Entropy was considered the best method to differentiate both groups (p=0.00078). In this report, substantial differences in heart rate variability were found between healthy and HIE groups, especially in SDNN and low frequency (p<0.01), confirming results of previous literature. For the final artefact removal algorithm, it is illustrated significant differences between raw and post-processed ECG signals. This method had a Recall rate of 96.2% (±2.4%) and a Precision Rate of 92.6% (±3.2%), demonstrating high efficiency in ECG noise removal. Regarding stress measures, associated with a stressful event, in most cases there is a high percentage of the signal corrupted by artefacts. However, in some cases it was possible to see a clear distinction between groups of clusters, indicating that in that period, there was a change of state. Not all the time segments from subjects demonstrated differences in stress stages, indicating that there is still room for improvement in the method developed

Cardiorespiratory Coupling Analysis Based on Entropy and Cross-Entropy in Distinguishing Different Depression Stages

AimsThis study used entropy- and cross entropy-based methods to explore the cardiorespiratory coupling of depressive patients, and thus to assess the values of those entropy methods for identifying depression patients with different disease severities.MethodsElectrocardiogram (ECG) and respiration signals from 69 depression patients were recorded simultaneously for 5 min. Patients were classified into three groups according to the Hamilton Depression Rating Scale (HDRS) scores: group Non-De (HDRS 0–7), Mid-De (HDRS 8–17), and Con-De (HDRS &gt;17). Sample entropy (SEn), fuzzy measure entropy (FMEn) and high-frequency power (HF) were computed on the original RR interval time series and breath-to-breath interval time series. Cross sample entropy (CSEn) and cross fuzzy measure entropy (CFMEn) were computed on interval time series resampled at 2 Hz and 4 Hz, respectively. The difference among three patient groups and correlation between entropy values and HDRS scores were analyzed by statistical analysis. Surrogate data were also employed to confirm the validation of entropy measures in this study.ResultsA consistent increasing trend has been found among most entropy measures from Non-De, to Mid-De, and to Con-De groups, and a significant (p &lt; 0.05) difference in FMEn of RR intervals exists between Non-De and Mid-De or Con-De groups. Significant differences have been also found in all cross entropies, between Non-De and Con-De groups and between Mid-De and Con-De groups. Furthermore, significant correlations also exist between HDRS scores and FMEn of RR intervals (R = 0.24, p &lt; 0.05), CSEn at 4 Hz (R = 0.26, p &lt; 0.05) or 2 Hz (R = 0.28, p &lt; 0.05) resampling, and CFMEn at 4 Hz (R = 0.31, p &lt; 0.01) or 2 Hz (R = 0.30, p &lt; 0.05) resampling. A significant difference of cardiorespiratory coupling parameters between different depression stages and significant correlations between entropy measures and depression severity both indicate central autonomic dysregulation in depression patients and reflect varying degrees of vagal modulation reduction among different depression levels. Analysis based on surrogate data confirms that the non-linear properties of the physiological signals played a major role in depression recognition.ConclusionThe current study demonstrates the potential of cardiorespiratory coupling in the auxiliary diagnosis of depression based on the entropy method

Prediction of postoperative atrial fibrillation using the electrocardiogram: A proof of concept

Hospital patients recovering from major cardiac surgery are at high risk of postoperative atrial fibrillation (POAF), an arrhythmia which can be life-threatening. With the development of a tool to predict POAF early enough, the development of the arrhythmia could be potentially prevented using prophylactic treatments, thus reducing risks and hospital costs. To date, no reliable method suitable for autonomous clinical integration has been proposed yet. This thesis presents a study on the prediction of POAF using the electrocardiogram. A novel P-wave quality assessment tool to automatically identify high-quality P-waves was designed, and its clinical utility was assessed. Prediction of paroxysmal atrial fibrillation (AF) was performed by implementing and improving a selection of previously proposed methods. This allowed to perform a systematic comparison of those methods, and to test if their combination improved prediction of AF. Finally, prediction of POAF was tested in a clinically relevant scenario. This included studying the 48 hours preceding POAF, and automatically excluding noise-corrupted P-waves using the quality assessment tool. The P-wave quality assessment tool identified high-quality P-waves with high sensitivity (0.93) and good specificity (0.84). In addition, this tool improved the ability to predict AF, since it improved the precision of P-wave measurements. The best predictors of AF and POAF were measurements of the variability in P-wave time- and morphological features. Paroxysmal AF could be predicted with high specificity (0.93) and good sensitivity (0.82) when several predictors were combined. Furthermore, POAF could be predicted 48 hours before its onset with good sensitivity (0.74) and specificity (0.70). This leaves time for prophylactic treatments to be administered and possibly prevent POAF. Despite being promising, further work is required for these techniques to be useful in the clinical setting

Advanced Signal Processing in Wearable Sensors for Health Monitoring

Smart, wearables devices on a miniature scale are becoming increasingly widely available, typically in the form of smart watches and other connected devices. Consequently, devices to assist in measurements such as electroencephalography (EEG), electrocardiogram (ECG), electromyography (EMG), blood pressure (BP), photoplethysmography (PPG), heart rhythm, respiration rate, apnoea, and motion detection are becoming more available, and play a significant role in healthcare monitoring. The industry is placing great emphasis on making these devices and technologies available on smart devices such as phones and watches. Such measurements are clinically and scientifically useful for real-time monitoring, long-term care, and diagnosis and therapeutic techniques. However, a pertaining issue is that recorded data are usually noisy, contain many artefacts, and are affected by external factors such as movements and physical conditions. In order to obtain accurate and meaningful indicators, the signal has to be processed and conditioned such that the measurements are accurate and free from noise and disturbances. In this context, many researchers have utilized recent technological advances in wearable sensors and signal processing to develop smart and accurate wearable devices for clinical applications. The processing and analysis of physiological signals is a key issue for these smart wearable devices. Consequently, ongoing work in this field of study includes research on filtration, quality checking, signal transformation and decomposition, feature extraction and, most recently, machine learning-based methods

Computational methods for physiological data

Thesis (Ph. D.)--Harvard-MIT Division of Health Sciences and Technology, 2009.Author is also affiliated with the MIT Dept. of Electrical Engineering and Computer Science. Cataloged from PDF version of thesis.Includes bibliographical references (p. 177-188).Large volumes of continuous waveform data are now collected in hospitals. These datasets provide an opportunity to advance medical care, by capturing rare or subtle phenomena associated with specific medical conditions, and by providing fresh insights into disease dynamics over long time scales. We describe how progress in medicine can be accelerated through the use of sophisticated computational methods for the structured analysis of large multi-patient, multi-signal datasets. We propose two new approaches, morphologic variability (MV) and physiological symbolic analysis, for the analysis of continuous long-term signals. MV studies subtle micro-level variations in the shape of physiological signals over long periods. These variations, which are often widely considered to be noise, can contain important information about the state of the underlying system. Symbolic analysis studies the macro-level information in signals by abstracting them into symbolic sequences. Converting continuous waveforms into symbolic sequences facilitates the development of efficient algorithms to discover high risk patterns and patients who are outliers in a population. We apply our methods to the clinical challenge of identifying patients at high risk of cardiovascular mortality (almost 30% of all deaths worldwide each year). When evaluated on ECG data from over 4,500 patients, high MV was strongly associated with both cardiovascular death and sudden cardiac death. MV was a better predictor of these events than other ECG-based metrics. Furthermore, these results were independent of information in echocardiography, clinical characteristics, and biomarkers.(cont.) Our symbolic analysis techniques also identified groups of patients exhibiting a varying risk of adverse outcomes. One group, with a particular set of symbolic characteristics, showed a 23 fold increased risk of death in the months following a mild heart attack, while another exhibited a 5 fold increased risk of future heart attacks.by Zeeshan Hassan Syed.Ph.D

Characterization and interpretation of cardiovascular and cardiorespiratory dynamics in cardiomyopathy patients

Aplicat embargament des de la data de defensa fins el dia 20/5/2022The main objective of this thesis was to study the variability of the cardiac, respiratory and vascular systems through electrocardiographic (ECG), respiratory flow (FLW) and blood pressure (BP) signals, in patients with idiopathic (IDC), dilated (DCM), or ischemic (ICM) disease. The aim of this work was to introduce new indices that could contribute to characterizing these diseases. With these new indices, we propose methods to classify cardiomyopathy patients (CMP) according to their cardiovascular risk or etiology. In addition, a new tool was proposed to reconstruct artifacts in biomedical signals. From the ECG, BP and FLW signals, different data series were extracted: beat to beat intervals (BBI - ECG), systolic and diastolic blood pressure (SBP and DBP - BP), and breathing duration (TT - FLW). -Firstly, we propose a novel artifact reconstruction method applied to biomedical signals. The reconstruction process makes use of information from neighboring events while maintaining the dynamics of the original signal. The method is based on detecting the cycles and artifacts, identifying the number of cycles to reconstruct, and predicting the cycles used to replace the artifact segments. The reconstruction results showed that most of the artifacts were correctly detected, and physiological cycles were incorrectly detected as artifacts in fewer than 1% of the cases. The second part is related to the cardiac death risk stratification of patients based on their left ventricular ejection (LVEF), using the Poincaré plot analysis, and classified as low (LVEF > 35%) or high (LVEF = 35%) risk. The BBI, SBP, and IT series of 46 CMP patients were applied. The linear discriminant analysis and support vector machines (SVM) classification methods were used. When comparing low risk vs high risk, an accuracy of 98 12% was obtained. Our results suggest that a dysfunction in the vagal activity could prevent the body from correctly maintaining circulatory homeostasis Next, we studied cardio-vascular couplings based on heart rate (HRV) and blood pressure (BPV) variability analyses in order to introduce new indices for noninvasive risk stratification in IDC patients. The ECG and BP signals of 91 IDC patients, and 49 healthy subjects were used. The patients were stratified by their sudden cardiac death risk as: high risk (IDCHR), when after two years the subject either died or suffered complications, or low risk (IDCLR) otherwise. Several indices were extracted from the BBI and SBP, and analyzed using the segmented Poincaré plot analysis, the high-resolution joint symbolic dynamics, and the normalized short time partial directed coherence methods. SVM models were built to classify these patients based on their sudden cardiac death risk. The SVM IDCLR vs IDCHR model achieved 98 9% accuracy with an area under the curve (AUC) of 0.96. Our results suggest that IDCHR patients have decreased HRV and increased BPV compared to both the IDCLR patients and the control subjects, suggesting a decrease in their vagal activity and the compensation of sympathetic activity. Lastly, we analyzed the cardiorespiratory interaction associated with the systems related to ICM and DCM disease. We propose an analysis based on vascular activity as the input and output of the baroreflex response. The aim was to analyze the suitability of cardiorespiratory and vascular interactions for the classification of ICM and DCM patients. We studied 41 CMP patients and 39 healthy subjects. Three new sub-spaces were defined: 'up' for increasing values, 'down' for decreasing values, and 'no change' otherwise, and a three-dimensional representation was created for each sub-space that was characterized statistically and morphologically. The resulting indices were used to classify the patients by their etiology through SVM models achieving 92.7% accuracy for ICM vs DCM patients comparison. The results reflected a more pronounced deterioration of the autonomous regulation in DCM patients.El objetivo de esta tesis fue estudiar la variabilidad de los sistemas cardíaco, respiratorio y vascular a través de señales electrocardiográficas (ECG), de flujo respiratorio (FLW) y de presión arterial (BP), en pacientes con cardiopatía idiopática (IDC). dilatada (DCM) o isquémica (ICM). El objetivo de este trabajo fue introducir nuevos indices que contribuyan a caracterizar estas enfermedades. Proponemos métodos para clasificar pacientes con cardiomiopatía (CMP) de acuerdo con su riesgo cardiovascular o etiología. Además, se propuso una nueva herramienta para reconstruir artefactos en señales biomédicas. De las señales de ECG, BP y FLW, se extrajeron diferentes series temporales: intervalos latido-a-latido (BBI - ECG), presión arterial sistólica y diastólica (SBP y DBP - BP) y la duración de la respiración (TT - FLW). En primer lugar, proponemos un método de reconstrucción de artefactos aplicado a señales biomédicas. El proceso de reconstrucción usa la información de eventos vecinos manteniendo la dinámica de la señal. El método se basa en detectar ciclos y artefactos, en identificar el número de ciclos a reconstruir y en predecir los ciclos utilizados para reemplazar los artefactos. La mayoría de los artefactos probados fueron detectados y reconstruidos correctamente y los ciclos fisiológicos fueron detectados incorrectamente como artefactos en menos del 1% de los casos, La segunda parte está relacionada con la estratificación de riesgo de muerte cardiovascular en función de la fracción de eyección ventricular izquierda (FEVI), mediante el análisis de Poincaré, en bajo (FEVI > 35%) y alto riesgo (FEVI 5 35%). Se utilizaron las series BBI, SBP y TT de 46 pacientes con CMP. Se utilizaron para la clasificación el análisis discriminante lineal y las máquinas de soporte vectorial (SVM). Al comparar los pacientes de bajo y alto riesgo, se obtuvo una exactitud del 98%. Los resultados sugieren la disfunción de la actividad vagal en pacientes de alto riesgo. A continuación, estudiamos los acoplamientos cardiovasculares basados en el análisis de la variabilidad de la frecuencia cardiaca (HRV) y la presión arterial (BPV) para introducir nuevos índices de estratificación de riesgo en pacientes con IDC. Se utilizaron las señales de ECG y BP de 91 pacientes con IDC y 49 sujetos sanos. Los pacientes fueron estratificados por su riesgo cardíaco como: alto riesgo (IDCHR), cuando después de dos años el sujeto murió, o bajo riesgo (IDCLR) en otro caso. Se extrajeron indices utilizando el análisis de Poincaré segmentado, la dinámica simbólica articulada de alta resolución y la coherencia parcial dirigida a corto plazo normalizada. Se construyeron modelos SVM para clasificar a estos pacientes en función de su riesgo cardiovascular. El modelo IDCLR vs IDCHR logró una exactitud del 98% con un área bajo la curva de 0.96. Los resultados sugieren que los pacientes IDCHR tienen sus HRV y BPV disminuidos en comparación con los pacientes IDCLR, lo que sugiere una disminución en su actividad vagal y la compensación de la actividad simpática. Finalmente, analizamos la interacción cardiorrespiratoria asociada con los sistemas relacionados con ICM y DCM. Proponemos un análisis basado en la actividad vascular como entrada y salida de la respuesta baroreflectora. El objetivo fue analizar la capacidad de las interacciones cardiorrespiratorias y vasculares para la clasificación de pacientes con ICM y DCM. Estudiamos 41 pacientes con CMP y 39 sujetos sanos. Se definieron tres sub-espacios: 'up' para valores crecientes, 'down' para los decrecientes, y 'no-change' en otro caso, y se creó una representación tridimensional que se caracterizó estadística y morfológicamente. Los indices resultantes se usaron para clasificar a los pacientes por su etiología con modelos SVM que lograron una exactitud de 92% cuando los pacientes ICM y DCM fueron comparados. Los resultados reflejaron un deterioro más pronunciado de la regulación autónoma en pacientes con DCM.Postprint (published version