Heart Rate Variability Monitoring Using a Wearable Armband

A wearable electrocardiogram (ECG) monitor is evaluated as heart rate variability (HRV) monitor. The device consists of an armband designed to be worn on the left upper arm which provides 3 ECG channels based on 3 pairs of dry (no hydrogel) electrodes. Armband-ECG and conventional-Holter-ECG signals were simultaneously recorded from 14 subjects during 5 minutes in supine position. Spacial principal component analysis was used to obtain a unique armband ECG signal in which the electromyogram contribution is attenuated. QRS complexes were automatically detected. Five traditional HRV parameters were derived: SDNN, RMSSD, pNN50, and powers within low frequency (LF, [0.04, 0.15] Hz) and high frequency (HF, [0.15, 0.4] Hz) bands. The Pearson''s correlation coefficient between the measurements from the armband device and the measures from the Holter device was computed. Results show very high correlations (1.0000, 0.9999, 0.9984, 1.0000, and 0.9999 for SDNN, RMSSD, pNN50, and powers at LF and HF, respectively), suggesting that the quality of armband-ECG signals is enough to estimate HRV parameters during stationary movement restricted conditions

Electrocardiogram Derived Respiration for Tracking Changes in Tidal Volume from a Wearable Armband

A pilot study on tracking changes in tidal volume (TV) using ECG signals acquired by a wearable armband is presented. The wearable armband provides three ECG channels by using three pairs of dry electrodes, resulting in a device that is convenient for long-term daily monitoring. An additional ECG channel was derived by computing the first principal component of the three original channels (by means of principal component analysis). Armband and spirometer signals were simultaneously recorded from five healthy subjects who were instructed to breathe with varying TV. Three electrocardiogram derived respiration (EDR) methods based on QRS complex morphology were studied: the QRS slopes range (SR), the R-wave angle (), and the R-S amplitude (RS). The peak-to-peak amplitudes of these EDR signals were estimated as surrogates for TV, and their correlations with the reference TV (estimated from the spirometer signal) were computed. In addition, a multiple linear regression model was calculated for each subject, using the peak-to-peak amplitudes from the three EDR methods from the four ECG channels. Obtained correlations between TV and EDR peak-to-peak amplitude ranged from 0.0448 up to 0.8491. For every subject, a moderate correlation (>0.5) was obtained for at least one EDR method. Furthermore, the correlations obtained for the subject-specific multiple linear regression model ranged from 0.8234 up to 0.9154, and the goodness of fit was 0.73±0.07 (median ± standard deviation). These results suggest that the peak-to-peak amplitudes of the EDR methods are linearly related to the TV. opening the possibility of estimating TV directly from an armband ECG device.Clinical Relevance - This opens the door to possible continuous monitoring of TV from the armband by using EDR

Dynamic Assessment of Baroreflex Control of Heart Rate During Induction of Propofol Anesthesia Using a Point Process Method

In this article, we present a point process method to assess dynamic baroreflex sensitivity (BRS) by estimating the baroreflex gain as focal component of a simplified closed-loop model of the cardiovascular system. Specifically, an inverse Gaussian probability distribution is used to model the heartbeat interval, whereas the instantaneous mean is identified by linear and bilinear bivariate regressions on both the previous R−R intervals (RR) and blood pressure (BP) beat-to-beat measures. The instantaneous baroreflex gain is estimated as the feedback branch of the loop with a point-process filter, while the RRBP feedforward transfer function representing heart contractility and vasculature effects is simultaneously estimated by a recursive least-squares filter. These two closed-loop gains provide a direct assessment of baroreflex control of heart rate (HR). In addition, the dynamic coherence, cross bispectrum, and their power ratio can also be estimated. All statistical indices provide a valuable quantitative assessment of the interaction between heartbeat dynamics and hemodynamics. To illustrate the application, we have applied the proposed point process model to experimental recordings from 11 healthy subjects in order to monitor cardiovascular regulation under propofol anesthesia. We present quantitative results during transient periods, as well as statistical analyses on steady-state epochs before and after propofol administration. Our findings validate the ability of the algorithm to provide a reliable and fast-tracking assessment of BRS, and show a clear overall reduction in baroreflex gain from the baseline period to the start of propofol anesthesia, confirming that instantaneous evaluation of arterial baroreflex control of HR may yield important implications in clinical practice, particularly during anesthesia and in postoperative care.National Institutes of Health (U.S.) (Grant R01-HL084502)National Institutes of Health (U.S.) (Grant K25-NS05758)National Institutes of Health (U.S.) (Grant DP2- OD006454)National Institutes of Health (U.S.) (Grant T32NS048005)National Institutes of Health (U.S.) (Grant T32NS048005)National Institutes of Health (U.S.) (Grant R01-DA015644)Massachusetts General Hospital (Clinical Research Center, UL1 Grant RR025758

Linear and nonlinear parametric model identification to assess granger causality in short-term cardiovascular interactions

We assessed directional relationships between short RR interval and systolic arterial pressure (SAP) variability series according to the concept of Granger causality. Causality was quantified as the predictability improvement (PI) of a time series obtained when samples of the other series were used for prediction, i.e. moving from autoregressive (AR) to AR exogenous (ARX) prediction. AR and ARX predictions were performed both by linear and nonlinear parametric models. The PIs of RR given SAP and of SAP given RR, measuring baroreflex and mechanical couplings, were calculated in 15 healthy subjects in the resting supine and upright tilt positions. Using nonlinear models we found a bilateral interaction between the two series, unbalanced towards the mechanical direction at rest and balanced after tilt. The utilization of linear AR and ARX models led to higher prediction accuracy but comparable trends of predictability and causality measures