Multidimensional embedded MEMS motion detectors for wearable mechanocardiography and 4D medical imaging

Background: Cardiovascular diseases are the number one cause of death. Of these deaths, almost 80% are due to coronary artery disease (CAD) and cerebrovascular disease. Multidimensional microelectromechanical systems (MEMS) sensors allow measuring the mechanical movement of the heart muscle offering an entirely new and innovative solution to evaluate cardiac rhythm and function. Recent advances in miniaturized motion sensors present an exciting opportunity to study novel device-driven and functional motion detection systems in the areas of both cardiac monitoring and biomedical imaging, for example, in computed tomography (CT) and positron emission tomography (PET). Methods: This Ph.D. work describes a new cardiac motion detection paradigm and measurement technology based on multimodal measuring tools — by tracking the heart’s kinetic activity using micro-sized MEMS sensors — and novel computational approaches — by deploying signal processing and machine learning techniques—for detecting cardiac pathological disorders. In particular, this study focuses on the capability of joint gyrocardiography (GCG) and seismocardiography (SCG) techniques that constitute the mechanocardiography (MCG) concept representing the mechanical characteristics of the cardiac precordial surface vibrations. Results: Experimental analyses showed that integrating multisource sensory data resulted in precise estimation of heart rate with an accuracy of 99% (healthy, n=29), detection of heart arrhythmia (n=435) with an accuracy of 95-97%, ischemic disease indication with approximately 75% accuracy (n=22), as well as significantly improved quality of four-dimensional (4D) cardiac PET images by eliminating motion related inaccuracies using MEMS dual gating approach. Tissue Doppler imaging (TDI) analysis of GCG (healthy, n=9) showed promising results for measuring the cardiac timing intervals and myocardial deformation changes. Conclusion: The findings of this study demonstrate clinical potential of MEMS motion sensors in cardiology that may facilitate in time diagnosis of cardiac abnormalities. Multidimensional MCG can effectively contribute to detecting atrial fibrillation (AFib), myocardial infarction (MI), and CAD. Additionally, MEMS motion sensing improves the reliability and quality of cardiac PET imaging.Moniulotteisten sulautettujen MEMS-liiketunnistimien käyttö sydänkardiografiassa sekä lääketieteellisessä 4D-kuvantamisessa Tausta: Sydän- ja verisuonitaudit ovat yleisin kuolinsyy. Näistä kuolemantapauksista lähes 80% johtuu sepelvaltimotaudista (CAD) ja aivoverenkierron häiriöistä. Moniulotteiset mikroelektromekaaniset järjestelmät (MEMS) mahdollistavat sydänlihaksen mekaanisen liikkeen mittaamisen, mikä puolestaan tarjoaa täysin uudenlaisen ja innovatiivisen ratkaisun sydämen rytmin ja toiminnan arvioimiseksi. Viimeaikaiset teknologiset edistysaskeleet mahdollistavat uusien pienikokoisten liiketunnistusjärjestelmien käyttämisen sydämen toiminnan tutkimuksessa sekä lääketieteellisen kuvantamisen, kuten esimerkiksi tietokonetomografian (CT) ja positroniemissiotomografian (PET), tarkkuuden parantamisessa. Menetelmät: Tämä väitöskirjatyö esittelee uuden sydämen kineettisen toiminnan mittaustekniikan, joka pohjautuu MEMS-anturien käyttöön. Uudet laskennalliset lähestymistavat, jotka perustuvat signaalinkäsittelyyn ja koneoppimiseen, mahdollistavat sydämen patologisten häiriöiden havaitsemisen MEMS-antureista saatavista signaaleista. Tässä tutkimuksessa keskitytään erityisesti mekanokardiografiaan (MCG), joihin kuuluvat gyrokardiografia (GCG) ja seismokardiografia (SCG). Näiden tekniikoiden avulla voidaan mitata kardiorespiratorisen järjestelmän mekaanisia ominaisuuksia. Tulokset: Kokeelliset analyysit osoittivat, että integroimalla usean sensorin dataa voidaan mitata syketiheyttä 99% (terveillä n=29) tarkkuudella, havaita sydämen rytmihäiriöt (n=435) 95-97%, tarkkuudella, sekä havaita iskeeminen sairaus noin 75% tarkkuudella (n=22). Lisäksi MEMS-kaksoistahdistuksen avulla voidaan parantaa sydämen 4D PET-kuvan laatua, kun liikeepätarkkuudet voidaan eliminoida paremmin. Doppler-kuvantamisessa (TDI, Tissue Doppler Imaging) GCG-analyysi (terveillä, n=9) osoitti lupaavia tuloksia sydänsykkeen ajoituksen ja intervallien sekä sydänlihasmuutosten mittaamisessa. Päätelmä: Tämän tutkimuksen tulokset osoittavat, että kardiologisilla MEMS-liikeantureilla on kliinistä potentiaalia sydämen toiminnallisten poikkeavuuksien diagnostisoinnissa. Moniuloitteinen MCG voi edistää eteisvärinän (AFib), sydäninfarktin (MI) ja CAD:n havaitsemista. Lisäksi MEMS-liiketunnistus parantaa sydämen PET-kuvantamisen luotettavuutta ja laatua

Comparison of Different Methods for Estimating Cardiac Timings: A Comprehensive Multimodal Echocardiography Investigation

Cardiac time intervals are important hemodynamic indices and provide information about left ventricular performance. Phonocardiography (PCG), impedance cardiography (ICG), and recently, seismocardiography (SCG) have been unobtrusive methods of choice for detection of cardiac time intervals and have potentials to be integrated into wearable devices. The main purpose of this study was to investigate the accuracy and precision of beat-to-beat extraction of cardiac timings from the PCG, ICG and SCG recordings in comparison to multimodal echocardiography (Doppler, TDI, and M-mode) as the gold clinical standard. Recordings were obtained from 86 healthy adults and in total 2,120 cardiac cycles were analyzed. For estimation of the pre-ejection period (PEP), 43% of ICG annotations fell in the corresponding echocardiography ranges while this was 86% for SCG. For estimation of the total systolic time (TST), these numbers were 43, 80, and 90% for ICG, PCG, and SCG, respectively. In summary, SCG and PCG signals provided an acceptable accuracy and precision in estimating cardiac timings, as compared to ICG

Artifact Noise Removal Techniques and Automatic Annotation on Seismocardiogram Using Two Tri-axial Accelerometers

Heart disease are ones of the most death causes in the world. Many studies investigated in evaluating the heart performance in order to detect cardiac diseases in the early stage. The aim of this study is to monitor the heart activities in long-term on active people to reduce the risk of heart disease. Specifically, this study investigates the motion noise removal techniques using two-accelerometer sensor system and various positions of the sensors on gentle movement and walking of subjects. The study also ends up with algorithms to detect cardiac phases and events on Seismocardiogram (SCG) based on acceleration sensors. A Wi-Fi based data acquisition system and a framework on Matlab are developed to collect and process data while the subjects are in motion. The tests include eight volunteers who have no record of heart disease. The walking and running data on the subjects are analyzed to find the minimal-noise bandwidth of the SCG signal. This bandwidth is used to design bandpass filters in the motion noise removal techniques and peak signal detection. There are three main techniques of combining data of the two sensors to mitigate the motion artifact: analog processing, digital processing and fusion processing. The analog processing comprises analog ADDER/SUBTRACTOR and bandpass filter to remove the motion before entering the data acquisition system. The digital processing processes all the data using combinations of total acceleration and z-axis only acceleration. The fusion processing automatically controls the amplification gain of the SUBTRACTOR to improve signal quality as long as a signal saturation is detected. The three techniques are tested on three placements of sensors including horizontal, vertical, and diagonal on gentle motion and walking. In general, the total acceleration and z-axis acceleration are best techniques to deal with gentle motion on all placements which improve average systolic signal-noise-ratio (SNR) around 2 times and average diastolic SNR around 3 times comparing to only one accelerometer. With walking motion, overall the ADDER and zaxis acceleration are best techniques on all placements of the sensors on the body which enhance about 7 times of average systolic SNR and about 11 times of average diastolic SNR comparing to only one accelerometer. The combination of two sensors also increases the average number of recognizable systole and diastole on walking corresponding to 71.3 % and 43.8 % comparing toiii only one sensor. Among the sensor placements, the performance of horizontal placement of the sensors is outstanding comparing with other positions on all motions. There are two detection stages to detect events in the SCG for automatic annotation. First, two algorithms including moving average threshold and interpolation are applied to locate the systolic and diastolic phases. Then, based on those identified phases, cardiac events are found in the searched intervals using two outstanding characteristics of the SCG. The two algorithms of phase detection are examined on the stationary data sets of digital processing and horizontal placement. The total acceleration of only one sensor is also calculated for comparison. With moving average threshold algorithm, the average error and missing rates of total acceleration and z-axis acceleration are 1.8 % and 2.1 % respectively which are lower than using one accelerometer (3.6 %). With interpolation algorithm, the average error and missing rates of total acceleration and z-axis acceleration are in the order of 2.3 % and 2.4 % which are still lower than one accelerometer. The average calculation time of the moving average algorithm is lower than the interpolation counterpart. The real-time mode of detection algorithms is also demonstrated on Matlab framework to prove the possibility of practical applications

Characterization, Classification, and Genesis of Seismocardiographic Signals

Seismocardiographic (SCG) signals are the acoustic and vibration induced by cardiac activity measured non-invasively at the chest surface. These signals may offer a method for diagnosing and monitoring heart function. Successful classification of SCG signals in health and disease depends on accurate signal characterization and feature extraction. In this study, SCG signal features were extracted in the time, frequency, and time-frequency domains. Different methods for estimating time-frequency features of SCG were investigated. Results suggested that the polynomial chirplet transform outperformed wavelet and short time Fourier transforms. Many factors may contribute to increasing intrasubject SCG variability including subject posture and respiratory phase. In this study, the effect of respiration on SCG signal variability was investigated. Results suggested that SCG waveforms can vary with lung volume, respiratory flow direction, or a combination of these criteria. SCG events were classified into groups belonging to these different respiration phases using classifiers, including artificial neural networks, support vector machines, and random forest. Categorizing SCG events into different groups containing similar events allows more accurate estimation of SCG features. SCG feature points were also identified from simultaneous measurements of SCG and other well-known physiologic signals including electrocardiography, phonocardiography, and echocardiography. Future work may use this information to get more insights into the genesis of SCG

Mechanocardiography in the Detection of Acute ST Elevation Myocardial Infarction: The MECHANO-STEMI Study

Novel means to minimize treatment delays in patients with ST elevation myocardial infarction (STEMI) are needed. Using an accelerometer and gyroscope on the chest yield mechanocardiographic (MCG) data. We investigated whether STEMI causes changes in MCG signals which could help to detect STEMI. The study group consisted of 41 STEMI patients and 49 control patients referred for elective coronary angiography and having normal left ventricular function and no valvular heart disease or arrhythmia. MCG signals were recorded on the upper sternum in supine position upon arrival to the catheterization laboratory. In this study, we used a dedicated wearable sensor equipped with 3-axis accelerometer, 3-axis gyroscope and 1-lead ECG in order to facilitate the detection of STEMI in a clinically meaningful way. A supervised machine learning approach was used. Stability of beat morphology, signal strength, maximum amplitude and its timing were calculated in six axes from each window with varying band-pass filters in 2–90 Hz range. In total, 613 features were investigated. Using logistic regression classifier and leave-one-person-out cross validation we obtained a sensitivity of 73.9%, specificity of 85.7% and AUC of 0.857 (SD = 0.005) using 150 best features. As a result, mechanical signals recorded on the upper chest wall with the accelerometers and gyroscopes differ significantly between STEMI patients and stable patients with normal left ventricular function. Future research will show whether MCG can be used for the early screening of STEMI.</p

Seismocardiography - Genesis, and Utilization of Machine Learning for Variability Reduction and Improved Cardiac Health Monitoring

Seismocardiography (SCG) is the measured chest surface vibrations resulting from cardiac activity. Although SCG can contain information that correlate with cardiac health, its utility may be limited by lack of understanding of the signal genesis and a variability that can mask subtle SCG changes. The current research utilized medical imaging reconstruction and finite element method (FEM) to simulate SCG by modeling the propagation of myocardial movements to the chest surface. FEM analysis provided a link between myocardial movements and the SCG signals measured at the chest surface and suggested that myocardial movement is a primary source of SCG. Increased understanding of the sources and propagation of SCG may help increase the utility of SCG as a cardiac monitoring tool. To reduce the variability of SCG measured in human subjects, unsupervised machine learning (ML) was implemented to group SCG beats into clusters with minimal intra-cluster heterogeneity. The clustering helped reduce the SCG variability and unveiled consistent relations with the respiratory phases and SCG morphology. This clustering reduced noise in calculating signal features and provided additional useful features. The study also analyzed longitudinal SCG from heart failure (HF) patients in order to predict HF readmission. Here, many time- and frequency-domain SCG features were extracted. Certain features showed good correlations with readmission. Using supervised ML algorithms, high classification accuracies (up to 100%) were achieved suggesting high SCG utility for monitoring HF patients and possibly other heart conditions. Effective monitoring followed by timely intervention can lead to improved patient management and reduced mortality

Detection and analysis of heartbeats in seismocardiogram signals

This paper presents an unsupervised methodology to analyze SeismoCardioGram (SCG) signals. Starting from raw accelerometric data, heartbeat complexes are extracted and annotated, using a two-step procedure. An unsupervised calibration procedure is added to better adapt to different user patterns. Results show that the performance scores achieved by the proposed methodology improve over related literature: on average, 98.5% sensitivity and 98.6% precision are achieved in beat detection, whereas RMS (Root Mean Square) error in heartbeat interval estimation is as low as 4.6 ms. This allows SCG heartbeat complexes to be reliably extracted. Then, the morphological information of such waveforms is further processed by means of a modular Convolutional Variational AutoEncoder network, aiming at extracting compressed, meaningful representation. After unsupervised training, the VAE network is able to recognize different signal morphologies, associating each user to its specific patterns with high accuracy, as indicated by specific performance metrics (including adjusted random and mutual information score, completeness, and homogeneity). Finally, a Linear Model is used to interpret the results of clustering in the learned latent space, highlighting the impact of different VAE architectural parameters (i.e., number of stacked convolutional units and dimension of latent space)