A multivariate time-frequency approach for tracking QT variability changes unrelated to heart rate variability

The beat-to-beat variability of the QT interval (QTV) is a marker of ventricular repolarization (VR) dynamics and it has been suggested as an index of sympathetic ventricular outflow and cardiac instability. However, QTV is also affected by RR (or heart rate) variability (RRV), and QTV due to RRV may reduce QTV specificity as a VR marker. Therefore, it would be desirable to separate QTV due to VR dynamics from QTV due to RRV. To do that, previous work has mainly focused on heart rate corrections or time-invariant autoregressive models. This paper describes a novel framework that extends classical multiple inputs/single output theory to the time-frequency (TF) domain to quantify QTV and RRV interactions. Quadratic TF distributions and TF coherence function are utilized to separate QTV into two partial (conditioned) spectra representing QTV related and unrelated to RRV, and to provide an estimates of intrinsic VR dynamics. In a simulation study, a time-varying ARMA model was used to generate signals representing realistic RRV and VR dynamics with controlled instantaneous frequencies and powers. The results demonstrated that the proposed methodology is able to accurately track changes in VR dynamics, with a correlation between theoretical and estimated patterns higher than 0.88. Data from healthy volunteers undergoing a tilt table test were analyzed and representative examples are discussed. Results show that the QTV unrelated to RRV dynamics quickly increased during orthostatic challenge

Putting (One's) Heart into Music

International audienc

Optimization of the global re-entry vulnerability index to minimise cycle length dependency and prediction of ventricular arrhythmias during human epicardial sock mapping

The re-entry vulnerability index (RVI) is an activation-repolarization marker recently proposed to predict sites of ventricular tachycardia (VT) initiation. RVI is inversely related to the probability of establishing a re-entry. The aim of this study was to characterize the CL dependency of RVI, assess different methods for CL-dependency corrections and test the capability of RVI to predict ventricular arrhythmias. Twenty-four subjects underwent whole heart epicardial mapping using a multi-electrode sock enabling the recording of 240 unipolar electrograms. Ventricular pacing was delivered at CLs decreasing from 600 to 350 ms in steps of 50 ms. In a separate study, 1 patient went into VT during steady state pacing. Predisposition to VT was assessed by using the 10th percentile RVI, termed global RVI. The results show that own to CL dependency of local repolarization, there was a strong positive association between RVI and CL. Local repolarization detrending and correction with the Bazett's formula eliminated the CL dependency, while a weak association was found after correction with the Fredericia's formula. In the patient who developed VT, global RVI was significantly lower than in the patients who did not develop VT. Corrections for CL dependency enhanced these differences. In conclusion, de-trending and Bazett's corrections effectively compensated for the CL dependency of RVI and global RVI may reveal predisposition to ventricular arrhythmias. Further analysis is necessary to establish the role of RVI for risk stratification

Heart Rate Variability Synchronizes When Non-experts Vocalize Together

Singing and chanting are ubiquitous across World cultures. It has been theorized that such practices are an adaptive advantage for humans because they facilitate bonding and cohesion between group members. Investigations into the effects of singing together have so far focused on the physiological effects, such as the synchronization of heart rate variability (HRV), of experienced choir singers. Here, we study whether HRV synchronizes for pairs of non-experts in different vocalizing conditions. Using time-frequency coherence (TFC) analysis, we find that HRV becomes more coupled when people make long (> 10 s) sounds synchronously compared to short sounds (< 1 s) and baseline measurements (p < 0.01). Furthermore, we find that, although most of the effect can be attributed to respiratory sinus arrhythmia, some HRV synchronization persists when the effect of respiration is removed: long notes show higher partial TFC than baseline and breathing (p < 0.05). In addition, we observe that, for most dyads, the frequency of the vocalization onsets matches that of the peaks in the TFC spectra, even though these frequencies are above the typical range of 0.04–0.4 Hz. A clear correspondence between high HRV coupling and the subjective experience of “togetherness" was not found. These results suggest that since autonomic physiological entrainment is observed for non-expert singing, it may be exploited as part of interventions in music therapy or social prescription programs for the general population

The periodic repolarization dynamics index identifies changes in ventricular repolarization oscillations associated with music-induced emotions

The effect of music on cardiovascular dynamics may be useful in a variety of clinical settings. The aim of this study was to assess whether listening to music characterized by different emotional valence affected ventricular periodic repolarization dynamics (PRD), a recently-proposed non-invasive index of sympathetic ventricular modulation. The 12 lead ECG was recorded in 71 healthy volunteers exposed to six 90 s excerpts of pleasant music and unpleasant acoustic stimuli as well as six 90 s intervals of silence. A 20 s interval was allowed between excerpts during which the participants were asked to evaluate the previous excerpt. A simulation study was carried out to assess the capability of the algorithm of tracking fast small changes in PRD. The simulation study shows that the algorithm implemented in this study has a time-frequency resolution sufficient to capture the fast dynamics observed in this study. PRD were higher during listening to both pleasant and unpleasant music than during silence. There was a (weak) trend for the PRD to be higher during listening to pleasant than unpleasant music that may indicate the existence of a (weak) interaction between the valence of music-induced emotions and sympathetic ventricular response. The PRD significantly increased during the 20 s interval in between conditions, possibly reflecting a sympathetic response to the evaluation task and/or to the expectation of the following excerpt

Comparison of ECG T-wave Duration and morphology restitution markers for sudden cardiac death prediction in chronic heart Failure

An index ofT-wave morphology restitution, TMR, has previously shown to be a sudden cardiac death (SCD) predictor in a population of chronic heart failure (CHF) patients. The aim of this study is to compare the predictive value of TMR, T-wave width restitution (TWR), T-peak-to-end (Tpe) morphology restitution (TpeMR) and Tpe duration restitution (TpeR) indices in the same CHF population. Holter ECG recordings from 651 CHF patients of the MUSIC study, including SCD victims and survivors, were analyzed. TMR was significantly correlated with TWR (ρ=0.66), TpeMR (ρ=0.70) and TpeR (ρ=0.42). SCD victims showed significantly higher values of TMR, TWR and TpeMR than the rest of patients, with TMR being the index most strongly associated with SCD (p=0.002, p=0.006 and p=0.011, respectively). TpeR values were only borderline significantly higher in SCD victims (p=0.061). Univariate Cox analysis showed that TMR was the restitution index with the strongest predictive value (hazard ratio (HR) of 1.466, p < 0.001), followed by TWR (HR of 1.295, p=0.005), TpeR (HR of 1.297, p=0.004) and TpeMR (HR of 1.164, p=0.020). In conclusion, considering the predictive value of the four T-wave restitution indices, TMR is the preferred index for SCD risk stratification, followed by TpeMR. However, the marker TWR could also be used for SCD prediction when computational efficiency is an issue

A Time-Varying Non-Parametric Methodology for Assessing Changes in QT Variability Unrelated to Heart Rate Variability

OBJECTIVE: To propose and test a novel methodology to measure changes in QT interval variability (QTV) unrelated to RR interval variability (RRV) in non-stationary conditions. METHODS: Time-frequency coherent and residual spectra representing QTV related (QTVrRRV) and unrelated (QTVuRRV) to RRV, respectively, are estimated using time-frequency Cohen's class distributions. The proposed approach decomposes the non-stationary output spectrum of any two-input one-output model with uncorrelated inputs into two spectra representing the information related and unrelated to one of the two inputs, respectively. An algorithm to correct for the bias of the time-frequency coherence function between QTV and RRV is proposed to provide accurate estimates of both QTVuRRV and QTVrRRV. Two simulation studies were conducted to assess the methodology in challenging non-stationary conditions and data recorded during head-up tilt in 16 healthy volunteers were analyzed. RESULTS: In the simulation studies, QTVuRRV changes were tracked with only a minor delay due to the filtering necessary to estimate the non-stationary spectra. The correlation coefficient between theoretical and estimated patterns was >0.92 even for extremely noisy recordings (SNR in QTV =-10dB). During head-up tilt, QTVrRRV explained the largest proportion of QTV, whereas QTVuRRV showed higher relative increase than QTV or QTVrRRV in all spectral bands (P<0.05 for most pairwise comparisons). CONCLUSION: The proposed approach accurately tracks changes in QTVuRRV. Head-up tilt induced a slightly greater increase in QTVuRRV than in QTVrRRV. SIGNIFICANCE: The proposed index QTVuRRV may represent an indirect measure of intrinsic ventricular repolarization variability, a marker of cardiac instability associated with sympathetic ventricular modulation and sudden cardiac death

Interactive effect of beta-adrenergic stimulation and mechanical stretch on low-frequency oscillations of ventricular action potential duration in humans

Ventricular repolarization dynamics are crucial to arrhythmogenesis. Low-frequency oscillations of repolarization have recently been reported in humans and the magnitude of these oscillations proposed to be a strong predictor of sudden cardiac death. Available evidence suggests a role of the sympathetic nervous system. We have used biophysically detailed models integrating ventricular electrophysiology, calcium dynamics, mechanics and β-adrenergic signaling to investigate the underlying mechanisms. The main results were: (1) Phasic beta-adrenergic stimulation (β-AS) at a Mayer wave frequency between 0.03 and 0.15Hz resulted in a gradual decrease of action potential (AP) duration (APD) with concomitant small APD oscillations. (2) After 3-4minutes of phasic β-AS, the mean APD adapted and oscillations of APD became apparent. (3) Phasic changes in haemodynamic loading at the same Mayer wave frequency (a known accompaniment of enhanced sympathetic nerve activity), simulated as variations in the sarcomere length, also induced APD oscillations. (4) The effect of phasic β-AS and haemodynamic loading on the magnitude of APD oscillations was synergistic. (5) The presence of calcium overload and reduced repolarization reserve further enhanced the magnitude of APD oscillations and was accompanied by afterdepolarizations and/or spontaneous APs. In conclusion, low-frequency oscillations of repolarization recently reported in humans were induced by phasic β-AS and phasic mechanical loading, which acted synergistically, and were greatly enhanced by disease-associated conditions, leading to arrhythmogenic events

Quantification of T-wave Morphological Variability Using Time-warping Methods

The aim of this study is to quantify the variation of the T-wave morphology during a 24-hour electrocardiogram (ECG) recording. Two ECG-derived markers are presented to quantify T-wave morphological variability in the temporal, dw, and amplitude, da, domains. Two additional markers, dNLw and dNLa, that only capture the non-linear component of dw and da are also proposed. The proposed markers are used to quantify T-wave time and amplitude variations in 500 24-hour ECG recordings from chronic heart failure patients. Additionally, two mean warped T-waves, used in the calculation of those markers, are proposed to compensate for the rate dependence of the T-wave morphology. Statistical analysis is used to evaluate the correlation between dw, dNLw, da and dNLa and the maximum intra-subject RR range, ΔRR. Results show that the mean warped T-wave is able to compensate for the morphological differences due to RR dynamics. Moreover, the metrics dw and dNLw are correlated with ΔRR, but da and dNLa are not. The proposed dw and dNLw quantify variations in the temporal domain of the T-wave that are correlated with the RR range and, thus, could possibly reflect the variations of dispersion of repolarization due to changes in heart rate