Breathing 100% oxygen during water immersion improves postimmersion cardiovascular responses to orthostatic stress

Physiological compensation to postural stress is weakened after long-duration water immersion (WI), thus predisposing individuals to orthostatic intolerance. This study was conducted to compare hemodynamic responses to postural stress following exposure to WI alone (Air WI), hyperbaric oxygen alone in a hyperbaric chamber (O2HC), and WI combined with hyperbaric oxygen (O2WI), all at a depth of 1.35 ATA, and to determine whether hyperbaric oxygen is protective of orthostatic tolerance. Thirty-two healthy men underwent up to 15 min of 70° head-up tilt (HUT) testing before and after a single 6-h resting exposure to Air WI (N = 10), O2HC (N = 12), or O2WI (N = 10). Heart rate (HR), blood pressure (BP), cardiac output (Q), stroke volume (SV), forearm blood flow (FBF), and systemic and forearm vascular resistance (SVR and FVR) were measured. Although all subjects completed HUT before Air WI, three subjects reached presyncope after Air WI exposure at 10.4, 9.4, and 6.9 min. HUT time did not change after O2WI or O2HC exposures. Compared to preexposure responses, HR increased (+10 and +17%) and systolic BP (-13 and -8%), and SV (-16 and -23%) decreased during HUT after Air WI and O2WI, respectively. In contrast, HR and SV did not change, and systolic (+5%) and diastolic BP (+10%) increased after O2HC. Q decreased (-13 and -7%) and SVR increased (+12 and +20%) after O2WI and O2HC, respectively, whereas SVR decreased (-9%) after Air WI. Opposite patterns were evident following Air WI and O2HC for FBF (-26 and +52%) and FVR (+28 and -30%). Therefore, breathing hyperbaric oxygen during WI may enhance post-WI cardiovascular compensatory responses to orthostatic stress

Wearable armband device for daily life electrocardiogram monitoring

A wearable armband electrocardiogram (ECG) monitor has been used for daily life monitoring. The armband records three ECG channels, one electromyogram (EMG) channel, and tri-axial accelerometer signals. Contrary to conventional Holter monitors, the armband-based ECG device is convenient for long-term daily life monitoring because it uses no obstructive leads and has dry electrodes (no hydrogels), which do not cause skin irritation even after a few days. Principal component analysis (PCA) and normalized least mean squares (NLMS) adaptive filtering were used to reduce the EMG noise from the ECG channels. An artifact detector and an optimal channel selector were developed based on a support vector machine (SVM) classifier with a radial basis function (RBF) kernel using features that are related to the ECG signal quality. Mean HR was estimated from the 24-hour armband recordings from 16 volunteers in segments of 10 seconds each. In addition, four classical HR variability (HRV) parameters (SDNN, RMSSD, and powers at low and high frequency bands) were computed. For comparison purposes, the same parameters were estimated also for data from a commercial Holter monitor. The armband provided usable data (difference less than 10% from Holter-estimated mean HR) during 75.25%/11.02% (inter-subject median/interquartile range) of segments when the user was not in bed, and during 98.49%/0.79% of the bed segments. The automatic artifact detector found 53.85%/17.09% of the data to be usable during the non-bed time, and 95.00%/2.35% to be usable during the time in bed. The HRV analysis obtained a relative error with respect to the Holter data not higher than 1.37% (inter-subject median/interquartile range). Although further studies have to be conducted for specific applications, results suggest that the armband device has a good potential for daily life HR monitoring, especially for applications such as arrhythmia or seizure detection, stress assessment, or sleep studies

Atrial Fibrillation Prediction from Critically Ill Sepsis Patients

Sepsis is defined by life-threatening organ dysfunction during infection and is the leading cause of death in hospitals. During sepsis, there is a high risk that new onset of atrial fibrillation (AF) can occur, which is associated with significant morbidity and mortality. Consequently, early prediction of AF during sepsis would allow testing of interventions in the intensive care unit (ICU) to prevent AF and its severe complications. In this paper, we present a novel automated AF prediction algorithm for critically ill sepsis patients using electrocardiogram (ECG) signals. From the heart rate signal collected from 5-min ECG, feature extraction is performed using the traditional time, frequency, and nonlinear domain methods. Moreover, variable frequency complex demodulation and tunable Q-factor wavelet-transform-based time-frequency methods are applied to extract novel features from the heart rate signal. Using a selected feature subset, several machine learning classifiers, including support vector machine (SVM) and random forest (RF), were trained using only the 2001 Computers in Cardiology data set. For testing the proposed method, 50 critically ill ICU subjects from the Medical Information Mart for Intensive Care (MIMIC) III database were used in this study. Using distinct and independent testing data from MIMIC III, the SVM achieved 80% sensitivity, 100% specificity, 90% accuracy, 100% positive predictive value, and 83.33% negative predictive value for predicting AF immediately prior to the onset of AF, while the RF achieved 88% AF prediction accuracy. When we analyzed how much in advance we can predict AF events in critically ill sepsis patients, the algorithm achieved 80% accuracy for predicting AF events 10 min early. Our algorithm outperformed a state-of-the-art method for predicting AF in ICU patients, further demonstrating the efficacy of our proposed method. The annotations of patients\u27 AF transition information will be made publicly available for other investigators. Our algorithm to predict AF onset is applicable for any ECG modality including patch electrodes and wearables, including Holter, loop recorder, and implantable devices

Using the redundant convolutional encoder–decoder to denoise QRS complexes in ECG signals recorded with an armband wearable device

Long-term electrocardiogram (ECG) recordings while performing normal daily routines are often corrupted with motion artifacts, which in turn, can result in the incorrect calculation of heart rates. Heart rates are important clinical information, as they can be used for analysis of heart-rate variability and detection of cardiac arrhythmias. In this study, we present an algorithm for denoising ECG signals acquired with a wearable armband device. The armband was worn on the upper left arm by one male participant, and we simultaneously recorded three ECG channels for 24 h. We extracted 10-s sequences from armband recordings corrupted with added noise and motion artifacts. Denoising was performed using the redundant convolutional encoder–decoder (R-CED), a fully convolutional network. We measured the performance by detecting R-peaks in clean, noisy, and denoised sequences and by calculating signal quality indices: signal-to-noise ratio (SNR), ratio of power, and cross-correlation with respect to the clean sequences. The percent of correctly detected R-peaks in denoised sequences was higher than in sequences corrupted with either added noise (70–100% vs. 34–97%) or motion artifacts (91.86% vs. 61.16%). There was notable improvement in SNR values after denoising for signals with noise added (7–19 dB), and when sequences were corrupted with motion artifacts (0.39 dB). The ratio of power for noisy sequences was significantly lower when compared to both clean and denoised sequences. Similarly, cross-correlation between noisy and clean sequences was significantly lower than between denoised and clean sequences. Moreover, we tested our denoising algorithm on 60-s sequences extracted from recordings from the Massachusetts Institute of Technology-Beth Israel Hospital (MIT-BIH) arrhythmia database and obtained improvement in SNR values of 7.08 ± 0.25 dB (mean ± standard deviation (sd)). These results from a diverse set of data suggest that the proposed denoising algorithm improves the quality of the signal and can potentially be applied to most ECG measurement devices

Analysis of Consistency of Transthoracic Bioimpedance Measurements Acquired with Dry Carbon Black PDMS Electrodes, Adhesive Electrodes, and Wet Textile Electrodes

The detection of intrathoracic volume retention could be crucial to the early detection of decompensated heart failure (HF). Transthoracic Bioimpedance (TBI) measurement is an indirect, promising approach to assessing intrathoracic fluid volume. Gel-based adhesive electrodes can produce skin irritation, as the patient needs to place them daily in the same spots. Textile electrodes can reduce skin irritation; however, they inconveniently require wetting before each use and provide poor adherence to the skin. Previously, we developed waterproof reusable dry carbon black polydimethylsiloxane (CB/PDMS) electrodes that exhibited a good response to motion artifacts. We examined whether these CB/PDMS electrodes were suitable sensing components to be embedded into a monitoring vest for measuring TBI and the electrocardiogram (ECG). We recruited N = 20 subjects to collect TBI and ECG data. The TBI parameters were different between the various types of electrodes. Inter-subject variability for copper-mesh CB/PDMS electrodes and Ag/AgCl electrodes was lower compared to textile electrodes, and the intra-subject variability was similar between the copper-mesh CB/PDMS and Ag/AgCl. We concluded that the copper mesh CB/PDMS (CM/CB/PDMS) electrodes are a suitable alternative for textile electrodes for TBI measurements, but with the benefit of better skin adherence and without the requirement of wetting the electrodes, which can often be forgotten by the stressed HF subjects

Premature Atrial and Ventricular Contraction Detection using Photoplethysmographic Data from a Smartwatch

We developed an algorithm to detect premature atrial contraction (PAC) and premature ventricular contraction (PVC) using photoplethysmographic (PPG) data acquired from a smartwatch. Our PAC/PVC detection algorithm is composed of a sequence of algorithms that are combined to discriminate various arrhythmias. A novel vector resemblance method is used to enhance the PAC/PVC detection results of the Poincare plot method. The new PAC/PVC detection algorithm with our automated motion and noise artifact detection approach yielded a sensitivity of 86% for atrial fibrillation (AF) subjects while the overall sensitivity was 67% when normal sinus rhythm (NSR) subjects were also included. The specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy values for the combined data consisting of both NSR and AF subjects were 97%, 81%, 94% and 92%, respectively, for PAC/PVC detection combined with our automated motion and noise artifact detection approach. Moreover, when AF detection was compared with and without PAC/PVC, the sensitivity and specificity increased from 94.55% to 98.18% and from 95.75% to 97.90%, respectively. For additional independent testing data, we used two datasets: a smartwatch PPG dataset that was collected in our ongoing clinical study, and a pulse oximetry PPG dataset from the Medical Information Mart for Intensive Care III database. The PAC/PVC classification results of the independent testing on these two other datasets are all above 92% for sensitivity, specificity, PPV, NPV, and accuracy. The proposed combined approach to detect PAC and PVC can ultimately lead to better accuracy in AF detection. This is one of the first studies involving detection of PAC and PVC using PPG recordings from a smartwatch. The proposed method can potentially be of clinical importance as this enhanced capability can lead to fewer false positive detections of AF, especially for those NSR subjects with frequent episodes of PAC/PVC

Atrial Fibrillation Detection from Wrist Photoplethysmography Signals Using Smartwatches

Detection of atrial fibrillation (AF) from a wrist watch photoplethysmogram (PPG) signal is important because the wrist watch form factor enables long term continuous monitoring of arrhythmia in an easy and non-invasive manner. We have developed a novel method not only to detect AF from a smart wrist watch PPG signal, but also to determine whether the recorded PPG signal is corrupted by motion artifacts or not. We detect motion and noise artifacts based on the accelerometer signal and variable frequency complex demodulation based time-frequency analysis of the PPG signal. After that, we use the root mean square of successive differences and sample entropy, calculated from the beat-to-beat intervals of the PPG signal, to distinguish AF from normal rhythm. We then use a premature atrial contraction detection algorithm to have more accurate AF identification and to reduce false alarms. Two separate datasets have been used in this study to test the efficacy of the proposed method, which shows a combined sensitivity, specificity and accuracy of 98.18%, 97.43% and 97.54% across the datasets

Using support vector machines on photoplethysmographic signals to discriminate between hypovolemia and euvolemia

Identifying trauma patients at risk of imminent hemorrhagic shock is a challenging task in intraoperative and battlefield settings given the variability of traditional vital signs, such as heart rate and blood pressure, and their inability to detect blood loss at an early stage. To this end, we acquired N = 58 photoplethysmographic (PPG) recordings from both trauma patients with suspected hemorrhage admitted to the hospital, and healthy volunteers subjected to blood withdrawal of 0.9 L. We propose four features to characterize each recording: goodness of fit (r2), the slope of the trend line, percentage change, and the absolute change between amplitude estimates in the heart rate frequency range at the first and last time points. Also, we propose a machine learning algorithm to distinguish between blood loss and no blood loss. The optimal overall accuracy of discriminating between hypovolemia and euvolemia was 88.38%, while sensitivity and specificity were 88.86% and 87.90%, respectively. In addition, the proposed features and algorithm performed well even when moderate blood volume was withdrawn. The results suggest that the proposed features and algorithm are suitable for the automatic discrimination between hypovolemia and euvolemia, and can be beneficial and applicable in both intraoperative/emergency and combat casualty care

Acceptability of a Novel Smartphone Application for Rhythm Evaluation in Patients with Atrial Fibrillation

Background: Investigators at UMass Medical School and WPI co-developed a novel smartphone application (app), PULSESMART, that detects atrial fibrillation (AF). AF is the world’s most common, serious heart rhythm problem. In its early stages, most cases of AF are paroxysmal (pAF), making them difficult to identify early in the course of disease. Long-term cardiac monitoring is frequently needed to diagnose and prevent complications from AF, such as stroke. Home monitoring for AF can be clinically impactful but existing technologies have cost or methodological limitations. Data are needed on the potential acceptability and usability of heart rhythm monitoring applications. Aim: Our aim was to examine patient acceptability of using a pAF detection app. Methods: 52 patients with pAF underwent rhythm assessment using the app and completed a standardized questionnaire. We looked specifically at responses to 3 questions: 1) how easy was it to use? 2) How important could it be for you? And 3) to what extent does it fit into your daily life? Results: The mean age was 68.5 years and 69% female. The majority of patients reported the app was easy to use (73%), could be important to them and their health (84%), and would fit into their daily lives (78%). Conclusions: After use of the pAF detection app, most patients reported positively. The results suggest that older persons with, or at risk for, pAF may benefit from smartphone-based arrhythmia detection platforms. Further work is needed to assess the feasibility of at-home or in-clinic app use

Feasibility of atrial fibrillation detection from a novel wearable armband device

BACKGROUND: Atrial fibrillation (AF) is the world’s most common heart rhythm disorder and even several minutes of AF episodes can contribute to risk for complications, including stroke. However, AF often goes undiagnosed owing to the fact that it can be paroxysmal, brief, and asymptomatic. OBJECTIVE: To facilitate better AF monitoring, we studied the feasibility of AF detection using a continuous electrocardiogram (ECG) signal recorded from a novel wearable armband device. METHODS: In our 2-step algorithm, we first calculate the R-R interval variability–based features to capture randomness that can indicate a segment of data possibly containing AF, and subsequently discriminate normal sinus rhythm from the possible AF episodes. Next, we use density Poincaré plot-derived image domain features along with a support vector machine to separate premature atrial/ventricular contraction episodes from any AF episodes. We trained and validated our model using the ECG data obtained from a subset of the MIMIC-III (Medical Information Mart for Intensive Care III) database containing 30 subjects. RESULTS: When we tested our model using the novel wearable armband ECG dataset containing 12 subjects, the proposed method achieved sensitivity, specificity, accuracy, and F1 score of 99.89%, 99.99%, 99.98%, and 0.9989, respectively. Moreover, when compared with several existing methods with the armband data, our proposed method outperformed the others, which shows its efficacy. CONCLUSION: Our study suggests that the novel wearable armband device and our algorithm can be used as a potential tool for continuous AF monitoring with high accuracy