Assessment of spontaneous cardiovascular oscillations in Parkinson's disease

Parkinson's disease (PD) has been reported to involve postganglionic sympathetic failure and a wide spectrum of autonomic dysfunctions including cardiovascular, sexual, bladder, gastrointestinal and sudo-motor abnormalities. While these symptoms may have a significant impact on daily activities, as well as quality of life, the evaluation of autonomic nervous system (ANS) dysfunctions relies on a large and expensive battery of autonomic tests only accessible in highly specialized laboratories. In this paper we aim to devise a comprehensive computational assessment of disease-related heartbeat dynamics based on instantaneous, time-varying estimates of spontaneous (resting state) cardiovascular oscillations in PD. To this end, we combine standard ANS-related heart rate variability (HRV) metrics with measures of instantaneous complexity (dominant Lyapunov exponent and entropy) and higher-order statistics (bispectra). Such measures are computed over 600-s recordings acquired at rest in 29 healthy subjects and 30 PD patients. The only significant group-wise differences were found in the variability of the dominant Lyapunov exponent. Also, the best PD vs. healthy controls classification performance (balanced accuracy: 73.47%) was achieved only when retaining the time-varying, non-stationary structure of the dynamical features, whereas classification performance dropped significantly (balanced accuracy: 61.91%) when excluding variability-related features. Additionally, both linear and nonlinear model features correlated with both clinical and neuropsychological assessments of the considered patient population. Our results demonstrate the added value and potential of instantaneous measures of heartbeat dynamics and its variability in characterizing PD-related disabilities in motor and cognitive domains

Autonomic Nervous System Dynamics for Mood and Emotional-State Recognition: Wearable Systems, Modeling, and Advanced Biosignal Processing

This thesis aims at investigating how electrophysiological signals related to the autonomic nervous system (ANS) dynamics could be source of reliable and effective markers for mood state recognition and assessment of emotional responses. In-depth methodological and applicative studies of biosignals such as electrocardiogram, electrodermal response, and respiration activity along with information coming from the eyes (gaze points and pupil size variation) were performed. Supported by the current literature, I found that nonlinear signal processing techniques play a crucial role in understanding the underlying ANS physiology and provide important quantifiers of cardiovascular control dynamics with prognostic value in both healthy subjects and patients. Two main applicative scenarios were identified: the former includes a group of healthy subjects who was presented with sets of images gathered from the International Affective Picture System hav- ing five levels of arousal and five levels of valence, including both a neutral reference level. The latter was constituted by bipolar patients who were followed for a period of 90 days during which psychophysical evaluations were performed. In both datasets, standard signal processing techniques as well as nonlinear measures have been taken into account to automatically and accurately recognize the elicited levels of arousal and valence and mood states, respectively. A novel probabilistic approach based on the point-process theory was also successfully applied in order to model and characterize the instantaneous ANS nonlinear dynamics in both healthy subjects and bipolar patients. According to the reported evidences on ANS complex behavior, experimental results demonstrate that an accurate characterization of the elicited affective levels and mood states is viable only when non- linear information are retained. Moreover, I demonstrate that the instantaneous ANS assessment is effective in both healthy subjects and patients. Besides mathematics and signal processing, this thesis also contributes to pragmatic issues such as emotional and mood state mod- eling, elicitation, and noninvasive ANS monitoring. Throughout the dissertation, a critical review on the current state-of-the-art is reported leading to the description of dedicated experimental protocols, reliable mood models, and novel wearable systems able to perform ANS monitoring in a naturalistic environment

Characterization of the autonomic nervous system response under emotional stimuli through linear and non-linear analysis of physiological signals

En esta disertación se presentan metodologías lineales y no lineales aplicadas a señales fisiológicas, con el propósito de caracterizar la respuesta del sistema nervioso autónomo bajo estímulos emocionales. Este estudio está motivado por la necesidad de desarrollar una herramienta que identifique emociones en función de su efecto sobre la actividad cardíaca, ya que puede tener un impacto potencial en la práctica clínica para diagnosticar enfermedades psico-neuronales.Las hipótesis de esta tesis doctoral son que las emociones inducen cambios notables en el sistema nervioso autónomo y que estos cambios pueden capturarse a partir del análisis de señales fisiológicas, en particular, del análisis conjunto de la variabilidad del ritmo cardíaco (HRV) y la respiración.La base de datos analizada contiene el registro simultáneo del electrocardiograma y la respiración de 25 sujetos elicitados con emociones inducidas por vídeos, incluyendo las siguientes emociones: alegría, miedo, tristeza e ira.En esta disertación se describen dos estudios metodológicos.En el primer estudio se propone un método basado en el análisis lineal de la HRV guiado por la respiración. El método se basó en la redefinición de la banda de alta frecuencia (HF), no solo centrándose en la frecuencia respiratoria, sino también considerando un ancho de banda que dependiera del espectro respiratorio. Primero, el método se validó con señales de HRV simuladas, obteniéndose errores mínimos de estimación en comparación con la definición de la banda de HF clásica e incluso con la banda de HF centrada en la frecuencia respiratoria pero con un ancho de banda constante, independientemente de los valores del ratio simpático-vagal.Después, el método propuesto se aplicó en una base de datos de elicitación emocional inducida mediante vídeos para discriminar entre emociones. No solo la banda de HF redefinida propuesta superó a las otras definiciones de banda de HF en discriminación emocional, sino también la correlación máxima entre los espectros de la HRV y de la respiración discriminó alegría y relajación, alegría y cada emoción de valencia negativa y entre miedo y tristeza con un p-valor ≤ 0.05 y AUC ≥ 0.70.En el segundo estudio, técnicas no lineales como la Función de Auto Información Mutua y la Función de Información Mutua Cruzada, AMIF y CMIF respectivamente, son también propuestas en esta tesis doctoral para el reconocimiento de emociones humanas. La técnica AMIF se aplicó a las señales de HRV para estudiar interdependencias complejas, y se consideró la técnica CMIF para cuantificar el acoplamiento complejo entre las señales de HRV y de respiración. Ambos algoritmos se adaptaron a las series temporales RR de corta duración. Las series RR fueron filtradas en las bandas de baja y alta frecuencia, y también se investigaron las series RR filtradas en un ancho de banda basado en la respiración.Los resultados revelaron que la técnica AMIF aplicada a la serie temporal RR filtrada en la banda de HF redefinida fue capaz de discriminar entre: relajación y alegría y miedo, alegría y cada valencia negativa y finalmente miedo y tristeza e ira, todos con un nivel de significación estadística (p-valor ≤ 0.05, AUC ≥ 0.70). Además, los parámetros derivados de AMIF y CMIF permitieron caracterizar la baja complejidad que la señal presentaba durante el miedo frente a cualquier otro estado emocional estudiado.Finalmente se investiga, mediante un clasificador lineal, las características lineales y no lineales que discriminan entre pares de emociones y entre valencias emocionales para determinar qué parámetros permiten diferenciar los grupos y cuántos de éstos son necesarios para lograr la mejor clasificación posible. Los resultados extraídos de este capítulo sugieren que pueden ser clasificadas mediante el análisis de la HRV: relajación y alegría, la valencia positiva frente a todas las negativas, alegría y miedo, alegría y tristeza, alegría e ira, y miedo y tristeza.El análisis conjunto de la HRV y la respiración aumenta la capacidad discriminatoria de la HRV, siendo la máxima correlación entre los espectros de la HRV y la respiración uno de los mejores índices para la discriminación de emociones. El análisis de la información mutua, aun en señales de corta duración, añade información relevante a los índices lineales para la discriminación de emociones.<br /

Intelligent Biosignal Processing in Wearable and Implantable Sensors

This reprint provides a collection of papers illustrating the state-of-the-art of smart processing of data coming from wearable, implantable or portable sensors. Each paper presents the design, databases used, methodological background, obtained results, and their interpretation for biomedical applications. Revealing examples are brain–machine interfaces for medical rehabilitation, the evaluation of sympathetic nerve activity, a novel automated diagnostic tool based on ECG data to diagnose COVID-19, machine learning-based hypertension risk assessment by means of photoplethysmography and electrocardiography signals, Parkinsonian gait assessment using machine learning tools, thorough analysis of compressive sensing of ECG signals, development of a nanotechnology application for decoding vagus-nerve activity, detection of liver dysfunction using a wearable electronic nose system, prosthetic hand control using surface electromyography, epileptic seizure detection using a CNN, and premature ventricular contraction detection using deep metric learning. Thus, this reprint presents significant clinical applications as well as valuable new research issues, providing current illustrations of this new field of research by addressing the promises, challenges, and hurdles associated with the synergy of biosignal processing and AI through 16 different pertinent studies. Covering a wide range of research and application areas, this book is an excellent resource for researchers, physicians, academics, and PhD or master students working on (bio)signal and image processing, AI, biomaterials, biomechanics, and biotechnology with applications in medicine

Heart rate variability used to assess changing autonomic functionin transmissible spongiform encephalopathies

The dorsal vagal nucleus (DMNX) and nucleus ambiguus (NA) are two anatomically distinct regions of the medulla oblongata of the brainstem involved with the control of the heart on a beat to beat basis. The vagus nerve has parasympathetic cell bodies located in the DMNX and NA. The presence of the disease associated prion (PrPD) in the DMNX and NA is used in the post mortem diagnosis of transmissible spongiform encephalopathies (TSEs) in animals. It has been shown that PrPD alters the neuronal discharge properties of infected tissue (Barrow, Holmgren et al.1999; Collinge, Whittington et al. 1994). I wished to investigate whether a change in heart rate variability (HRV) influenced by the presence of PrPD deposits in brainstem areas of animals and people incubating TSEs would be detectable. Recordings from control and infected sheep, cattle and humans, consisting of three hundred-second samples of electrocardiogram (ECG) were collected from species specific healthy controls and subjects incubating TSE disease. Data were digitised at a sampling frequency of 1kHz and were translated and analysed using standard software (CED Spike2 ; IBM SPSS). Artefacts and missed beats were corrected based upon screening by eye. ECG R-wave timings were obtained in order to determine variability in the R-R intervals. An instantaneous tachogram was constructed from which power spectra were calculated. Power spectral analysis along with simpler time domain estimates of HRV, such as RMSSD, were employed to investigate differences between control and infected animals. In addition R wave variability within each breath was utilized to examine the vagal control of the heart in relation to breathing and thus investigate a change in function of the specific neurological areas of the brainstem used as diagnostic criteria for such diseases. It was found there were significant differences (p<0.05) in the HRV of infected sheep, cattle and humans incubating TSE disease compared to control samples. Repeated non-invasive longitudinal tests may provide a means to screen animals and humans for the presence of disease associated prions and may give applications in the objective assessments of putative therapeutics in addition to identifying TSE disease at a preclinical stage.EThOS - Electronic Theses Online ServiceGBUnited Kingdo

Cardiovascular risk factors for perioperative myocardial injury

PhDBackground: Myocardial injury affects up to one in three patients undergoing non-cardiac surgery. However, very little is known about the underlying pathophysiology. In the general population, patients with elevated resting heart rate are at increased risk of cardiac events, mortality, heart failure and autonomic dysfunction, while hypertension is a well described risk factor for cardiovascular disease. I hypothesised that common abnormalities of heart rate or blood pressure were associated with myocardial injury after non-cardiac surgery. Methods: This thesis comprises a series of secondary analyses of data from five prospective multi-centre epidemiological studies of surgical patients. The main outcome of interest was myocardial injury, defined using objective measurement of cardiac troponin. I used logistic regression analysis to test for association between exposures and outcomes. Results: In a large international cohort, patients with high preoperative heart rate had increased risk of myocardial injury and patients with very low preoperative heart rate had reduced risk of myocardial injury. Patients with elevated preoperative pulse pressure had increased risk of myocardial injury, independent of existing hypertension or systolic blood pressure. High heart rate, or high or low systolic blood pressure during surgery, was associated with increased risk of myocardial injury. In a separate study, elevated preoperative heart rate was associated with cardiopulmonary and autonomic dysfunction, and reduced left ventricular stroke volume, suggestive of heart failure. Finally, autonomic dysfunction, identified using cardiopulmonary exercise testing, was associated with elevated preoperative heart rate, elevated plasma NT-Pro-BNP (indicative of heart failure) and postoperative myocardial injury. Conclusions: Elevated preoperative heart rate, autonomic dysfunction and subclinical heart failure may be part of a common phenotype associated with perioperative myocardial injury. Further research is needed to characterise the pathological processes responsible for myocardial injury, and to identify potential therapeutic targets.Medical Research Council British Journal of Anaesthesia Clinical Research Training Fellowship (grant number MR/M017974/1)

Blood

This book examines both the fluid and cellular components of blood. After the introductory section, the second section presents updates on various topics in hemodynamics. Chapters in this section discuss anemia, 4D flow MRI in cardiology, cardiovascular complications of robot-assisted laparoscopic pelvic surgery, altered perfusion in multiple sclerosis, and hemodynamic laminar shear stress in oxidative homeostasis. The third section focuses on thalassemia with chapters on diagnosis and screening for thalassemia, high blood pressure in beta-thalassemia, and hepatitis C infection in thalassemia patients

Validation of instantaneous bispectral high-frequency power of heartbeat dynamics as a marker of cardiac vagal activity

Nonlinear analysis has been advocated as a very powerful methodological framework to study physiological signals, particularly when applied to heartbeat dynamics. To this extent, estimation of high-frequency (0.15-0.40 Hz) power from bispectra of cardiovascular variability series has been engaged as a marker of nonlinear vagal activity. Nevertheless, a proper validation of this specific measure has not been yet performed. In this study, we estimate instantaneous, nonlinear bispectral indices during postural changes under sympathetic and parasympathetic nervous system blockade. The analysis was performed on data from 14 healthy subjects undergoing a control supine-to-upright routine where they were selectively administered either atropine or propanolol. Instantaneous bispectra were obtained through Laguerre-transformed, linear and nonlinear kernels of a Wiener-Volterra model applied to heartbeat dynamics, embedded into a recently proposed inhomogeneous point-process framework. Results demonstrate that the integration of bispectra accounting for nonlinear cardiovascular control dynamics within the high-frequency band provides potentially reliable markers of vagal activity

Emotion and Stress Recognition Related Sensors and Machine Learning Technologies

This book includes impactful chapters which present scientific concepts, frameworks, architectures and ideas on sensing technologies and machine learning techniques. These are relevant in tackling the following challenges: (i) the field readiness and use of intrusive sensor systems and devices for capturing biosignals, including EEG sensor systems, ECG sensor systems and electrodermal activity sensor systems; (ii) the quality assessment and management of sensor data; (iii) data preprocessing, noise filtering and calibration concepts for biosignals; (iv) the field readiness and use of nonintrusive sensor technologies, including visual sensors, acoustic sensors, vibration sensors and piezoelectric sensors; (v) emotion recognition using mobile phones and smartwatches; (vi) body area sensor networks for emotion and stress studies; (vii) the use of experimental datasets in emotion recognition, including dataset generation principles and concepts, quality insurance and emotion elicitation material and concepts; (viii) machine learning techniques for robust emotion recognition, including graphical models, neural network methods, deep learning methods, statistical learning and multivariate empirical mode decomposition; (ix) subject-independent emotion and stress recognition concepts and systems, including facial expression-based systems, speech-based systems, EEG-based systems, ECG-based systems, electrodermal activity-based systems, multimodal recognition systems and sensor fusion concepts and (x) emotion and stress estimation and forecasting from a nonlinear dynamical system perspective