6,102 research outputs found
Advances in computational modelling for personalised medicine after myocardial infarction
Myocardial infarction (MI) is a leading cause of premature morbidity and mortality worldwide. Determining which patients will experience heart failure and sudden cardiac death after an acute MI is notoriously difficult for clinicians. The extent of heart damage after an acute MI is informed by cardiac imaging, typically using echocardiography or sometimes, cardiac magnetic resonance (CMR). These scans provide complex data sets that are only partially exploited by clinicians in daily practice, implying potential for improved risk assessment. Computational modelling of left ventricular (LV) function can bridge the gap towards personalised medicine using cardiac imaging in patients with post-MI. Several novel biomechanical parameters have theoretical prognostic value and may be useful to reflect the biomechanical effects of novel preventive therapy for adverse remodelling post-MI. These parameters include myocardial contractility (regional and global), stiffness and stress. Further, the parameters can be delineated spatially to correspond with infarct pathology and the remote zone. While these parameters hold promise, there are challenges for translating MI modelling into clinical practice, including model uncertainty, validation and verification, as well as time-efficient processing. More research is needed to (1) simplify imaging with CMR in patients with post-MI, while preserving diagnostic accuracy and patient tolerance (2) to assess and validate novel biomechanical parameters against established prognostic biomarkers, such as LV ejection fraction and infarct size. Accessible software packages with minimal user interaction are also needed. Translating benefits to patients will be achieved through a multidisciplinary approach including clinicians, mathematicians, statisticians and industry partners
Double symbolic joint entropy in nonlinear dynamic complexity analysis
Symbolizations, the base of symbolic dynamic analysis, are classified as
global static and local dynamic approaches which are combined by joint entropy
in our works for nonlinear dynamic complexity analysis. Two global static
methods, symbolic transformations of Wessel N. symbolic entropy and base-scale
entropy, and two local ones, namely symbolizations of permutation and
differential entropy, constitute four double symbolic joint entropies that have
accurate complexity detections in chaotic models, logistic and Henon map
series. In nonlinear dynamical analysis of different kinds of heart rate
variability, heartbeats of healthy young have higher complexity than those of
the healthy elderly, and congestive heart failure (CHF) patients are lowest in
heartbeats' joint entropy values. Each individual symbolic entropy is improved
by double symbolic joint entropy among which the combination of base-scale and
differential symbolizations have best complexity analysis. Test results prove
that double symbolic joint entropy is feasible in nonlinear dynamic complexity
analysis.Comment: 7 pages, 4 figure
Quantification of depth of anesthesia by nonlinear time series analysis of brain electrical activity
We investigate several quantifiers of the electroencephalogram (EEG) signal
with respect to their ability to indicate depth of anesthesia. For 17 patients
anesthetized with Sevoflurane, three established measures (two spectral and one
based on the bispectrum), as well as a phase space based nonlinear correlation
index were computed from consecutive EEG epochs. In absence of an independent
way to determine anesthesia depth, the standard was derived from measured blood
plasma concentrations of the anesthetic via a pharmacokinetic/pharmacodynamic
model for the estimated effective brain concentration of Sevoflurane. In most
patients, the highest correlation is observed for the nonlinear correlation
index D*. In contrast to spectral measures, D* is found to decrease
monotonically with increasing (estimated) depth of anesthesia, even when a
"burst-suppression" pattern occurs in the EEG. The findings show the potential
for applications of concepts derived from the theory of nonlinear dynamics,
even if little can be assumed about the process under investigation.Comment: 7 pages, 5 figure
Detection of impaired cerebral autoregulation improves by increasing arterial blood pressure variability
Although the assessment of dynamic cerebral autoregulation (CA) based on measurements of spontaneous fluctuations in arterial blood pressure (ABP) and cerebral blood flow (CBF) is a convenient and much used method, there remains uncertainty about its reliability. We tested the effects of increasing ABP variability, provoked by a modification of the thigh cuff method, on the ability of the autoregulation index to discriminate between normal and impaired CA, using hypercapnia as a surrogate for dynamic CA impairment. In 30 healthy volunteers, ABP (Finapres) and CBF velocity (CBFV, transcranial Doppler) were recorded at rest and during 5% CO(2) breathing, with and without pseudo-random sequence inflation and deflation of bilateral thigh cuffs. The application of thigh cuffs increased ABP and CBFV variabilities and was not associated with a distortion of the CBFV step response estimates for both normocapnic and hypercapnic conditions (P=0.59 and P=0.96, respectively). Sensitivity and specificity of CA impairment detection were improved with the thigh cuff method, with the area under the receiver-operator curve increasing from 0.746 to 0.859 (P=0.031). We conclude that the new method is a safe, efficient, and appealing alternative to currently existing assessment methods for the investigation of the status of CA
Sleep apnea-hypopnea quantification by cardiovascular data analysis
Sleep apnea is the most common sleep disturbance and it is an important risk
factor for cardiovascular disorders. Its detection relies on a polysomnography,
a combination of diverse exams.
In order to detect changes due to sleep disturbances such as sleep apnea
occurrences, without the need of combined recordings, we mainly analyze
systolic blood pressure signals (maximal blood pressure value of each beat to
beat interval). Nonstationarities in the data are uncovered by a segmentation
procedure, which provides local quantities that are correlated to
apnea-hypopnea events. Those quantities are the average length and average
variance of stationary patches. By comparing them to an apnea score previously
obtained by polysomnographic exams, we propose an apnea quantifier based on
blood pressure signal.
This furnishes an alternative procedure for the detection of apnea based on a
single time series, with an accuracy of 82%
Short-term Heart Rate Turbulence Analysis Versus Variability and Baroreceptor Sensitivity in Patients With Dilated Cardiomyopathy
New methods for the analysis of arrhythmias and their hemodynamic consequences have been applied in risk stratification, in particular to patients after myocardial infarction. This study investigates the suitability of short-term heart rate turbulence (HRT) analysis in comparison to heart rate and blood pressure variability as well as baroreceptor sensitivity analyses to characterise the regulatory differences between patients with dilated cardiomyopathy (DCM) and healthy controls. In this study, 30 minutes data of non-invasive continuous blood pressure and ECGs of 37 DCM patients and 167 controls measured under standard resting conditions were analysed. The results show highly significant differences between DCM patients and controls in heart rate and blood pressure variability as well as in baroreceptor sensitivity parameters. Applying a combined heart rate-blood pressure trigger, ventricular premature beats were detected in 24.3% (9) of the DCM patients and 11.3% (19) of the controls. This fact demonstrates the limited applicability of short-term HRT analyses. However, the HRT parameters showed significant differences in this subgroup with ventricular premature beats (turbulence onset: DCM: 1.80±2.72, controls: - 4.34±3.10, p<0.001; turbulence slope: DCM: 6.75±5.50, controls: 21.30±17.72, p=0.021). Considering all (including HRT) parameters in the subgroup with ventricular beats, a discrimination rate between DCM patients and controls of 88.0% was obtained (max. 6 parameters). The corresponding value obtained for the total group was 86.3% (without HRT parameters). Comparable classification rates and high correlations between heart rate turbulence and variability and baroreflex parameters point to a more universal applicability of the latter methods
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