Parameters influence on acceleration and deceleration capacity based on trans-abdominal ECG in early fetal growth restriction at different gestational age epochs

OBJECTIVE

Intrauterine growth restriction (IUGR) is characterized by chronic nutrient deprivation and hypoxemia that alters the autonomous nervous system regulation of fetal heart rate variability (fHRV). Phase-rectified signal averaging (PRSA) is a new algorithm capable to identify periodic and quasi-periodic patterns of HR, and which is used to quantify the average acceleration and deceleration capacity (AC/DC) of the heart. The computation of AC/DC depends on the parameters T and s, which we set so that s=T. T and s determine the periodicities that can be detected (the larger T the smaller the frequency of oscillations for which the method is most sensitive). The aim of the study was to evaluate the influence of the parameter T on PRSA computation, based on trans-abdominally acquired fetal ECG (ta-fECG), in early IUGR (<34 weeks of gestation) at two different gestational age epochs.

STUDY DESIGN

AC/DC were calculated for different T values (1÷45) on fetal RR intervals derived from ta-fECG in 22 IUGR and in 37 appropriate for gestational age (AGA) fetuses matched for gestational age, in two gestational age epochs: very preterm group (≥26÷<30 weeks), and preterm group (≥30÷<34 weeks), respectively.

RESULTS

AC/DC were significantly lower in IUGR than in AGA fetuses for all T≥5 values (p<0.05). The best area under the receiver operating characteristic curve (AUC) in identifying IUGR at time of recording was observed for T9 [AUC AC-T9 0.87, 95% confidence interval (CI) 0.77-0.96; and AUC DC-T9 0.89, 95% CI 0.81-0.98), and in range of T 7÷15. In the same T interval, AC/DC were significantly lower in very preterm than in preterm IUGR group (p<0.05), while there were no differences in AGA fetuses at two gestational age epochs (p>0.05), respectively. The AUCs of AC-T9 and DC-T9 significantly outperformed that obtained by short-term variation (AUC 0.77, 95% CI 0.65-0.90; p=0.009 and p=0.003, respectively).

CONCLUSIONS

Our study shows that within the range of T parameter 1÷45, T=9 proved to be the best value to discriminate the AC and DC of the fetal heart rate of IUGR from AGA fetuses prior to 34 weeks of gestation. These significant differences are emphasized in very preterm gestational age epochs.

Preschool children without 7-repeat DRD4 gene more likely to develop disorganized attachment style

BACKGROUND

The current paper aimed to explore the effects of birth weight and the 7-repeat allele in Exon III of the dopamine D4 receptor (DRD4) gene on the development of disorganized attachment, a potential endophenotype of depression. Infants born with low birth weight have been shown to be at higher risk for later neurological impairments, psychological disorders or behavioural problems. The DRD4 gene is critical for the cognitive and emotional processes that are sub-served by neural circuits in the prefrontal cortex. This paper examined the main effect of birth weight and DRD4 on the development of disorganized attachment.

METHODS

Data was used from the Maternal Adversity, Vulnerability and Neurodevelopment (MAVAN) project. The sample consisted of 251 mother-child dyads with complete data. Attachment style was assessed using the modified separation-reunion procedure.

RESULTS

There was no main effect for birth weight on disorganized attachment, (b = -0.001, p = 0.998). There was, however, a main effect for the DRD4 7-repeat polymorphism on disorganized attachment (b = -1.120, p = 0.004).

LIMITATIONS

Compared to studies of similar design, the sample size in this study was relatively small. Additionally, a significant number of subjects did not have complete data.

CONCLUSIONS

Children without the DRD4 7-repeat allele were more likely to have disorganized attachment than children with the DRD4 7-repeat allele. This indicates that the 7-repeate allele of the DRD4 gene may actually serve as a protective factor against disorganized attachment.

Polymorphisms in VDR gene in Tunisian postmenopausal women are associated with osteopenia phenotype

OBJECTIVES

Osteopenia is characterized by intermediate values of bone mineral density (BMD) as compared to normal and osteoporotic subjects. BMD, a surrogate phenotype for osteoporosis, is influenced in part by genetic factors. Among the genes associated with BMD, the vitamin D receptor (VDR) was the first gene studied as a potential candidate associated with BMD in adult and postmenopausal bone loss. However, results are controversial.

METHODS

To determine whether VDR polymorphisms ApaI and TaqI are associated with BMD, osteopenia, osteoporosis and low-impact fracture risk in North Africans, these genotypes were analyzed in 566 postmenopausal Tunisian women.

RESULTS

In postmenopausal Tunisian women, the GT ApaI genotype seems to be protective against osteoporosis development (p = 0.02; odds ratio = 0.54). Moreover, the presence of the combined GT/TT genotype of ApaI and TaqI polymorphisms is more frequent in normal BMD women than in osteoporotic women (p = 0.00; odds ratio = 0.41). Interestingly, the GG ApaI genotype is associated with osteopenia development (p = 0.02; odds ratio = 1.86) and also the TT TaqI polymorphism (p = 0.02; odds ratio = 1.53). The GG ApaI genotype is associated with a three times risk of vertebral fracture.

CONCLUSIONS

The ApaI polymorphism showed an association with osteopenia and low-impact vertebral fracture incidence but not with osteoporosis. The TaqI polymorphism is associated specifically with the osteopenia phenotype. The presence of the two polymorphisms increases the risk to develop osteopenia in postmenopausal Tunisian women. Osteopenia seems to be genetically determined. However, osteoporosis is the result of interaction between genetic and environmental factors.

Prenatal depression and 5-HTTLPR interact to predict dysregulation from 3 to 36 months--a differential susceptibility model

BACKGROUND

Childhood dysregulation, which reflects deficits in the capacity to regulate or control one's thoughts, emotions and behaviours, is associated with psychopathology throughout childhood and into adulthood. Exposures to adversity during the prenatal period, including prenatal depression, can influence the development of dysregulation, and a number of candidate genes have been suggested as moderators of prenatal exposure, including polymorphisms in the promoter region of the serotonin transporter gene (5-HTTLPR). We examined whether prenatal depression and child 5-HTTLPR interact to predict childhood dysregulation.

METHOD

Sample of N = 213 mother-child pairs from the Maternal Adversity, Vulnerability and Neurodevelopment (MAVAN) project. Mothers reported the IBQ-R at 3 and 6 months, and the ECBQ at 18 and 36 months, from which measures of dysregulation were extracted. Mothers' self-reported symptoms of depression on the CES-D at 24-36 weeks of gestation, and at 6, 12, 24 and 36 months postnatal. 5-HTTLPR genotype was extracted from buccal swabs. Mixed-model and confirmatory analyses were conducted.

RESULTS

Prenatal depression and 5-HTTLPR interacted to predict dysregulation from 3 to 36 months, within a model of strong differential susceptibility.

CONCLUSION

Children with S or LG alleles, when exposed to prenatal depression, have higher levels of dysregulation, and when exposed to lower or little prenatal depression, have higher capacity for regulation. Our findings support efforts to identify, support and treat prenatal depression.

A new algorithm for estimating the ν-index using sinusoidal basis functions

Recently it was shown that the spatial dispersion of ventricular repolarization (SHVR) can be assessed from the surface ECG using a metric termed ν-index. In this paper, a new algorithm is presented for estimating the ν-index, allowing the inclusion of higher order terms with ease, even in the presence of noise, leading to more accurate estimates. We first introduced a new analytical model for the derivative of the average transmembrane potentials during repolarization (the dominant T-wave) based on trigonometric functions. This functional set is closed under the operation of derivation. Therefore, the nonlinear iterative optimization required by previous methods is no longer necessary. Then, we suggested an iterative linear matrix factorization method to properly estimate the leads factors and the ν-index. Several synthetic SHVR (in the range 20 to 70 ms) were simulated, employing a publicly-available forward electrophysiological model (ECGSIM), leading to a total of 240 synthetic 8-lead electrocardiographical recordings (ECG), each composed of 128 beats. Then the ν-index was estimated with the newly introduced method and compared (root mean square error, RMSE) with the theoretical values, available for each series. The simulation results confirmed the theoretical expectations and indeed showed that the ν-index estimates were improved by increasing the number of lead factors included (RMSE=0:295±0:037 vs 0:280±0:038 for 2 and 8 lead factors respectively).

Accuracy of GPS devices for measuring high-intensity running in field-based team sports

We compared the accuracy of 2 GPS systems with different sampling rates for the determination of distances covered at high-speed and metabolic power derived from a combination of running speed and acceleration. 8 participants performed 56 bouts of shuttle intermittent running wearing 2 portable GPS devices (SPI-Pro, GPS-5 Hz and MinimaxX, GPS-10 Hz). The GPS systems were compared with a radar system as a criterion measure. The variables investigated were: total distance (TD), high-speed distance (HSR>4.17 m·s(-1)), very high-speed distance (VHSR>5.56 m·s(-1)), mean power (Pmean), high metabolic power (HMP>20 W·kg(-1)) and very high metabolic power (VHMP>25 W·kg(-1)). GPS-5 Hz had low error for TD (2.8%) and Pmean (4.5%), while the errors for the other variables ranged from moderate to high (7.5-23.2%). GPS-10 Hz demonstrated a low error for TD (1.9%), HSR (4.7%), Pmean (2.4%) and HMP (4.5%), whereas the errors for VHSR (10.5%) and VHMP (6.2%) were moderate. In general, GPS accuracy increased with a higher sampling rate, but decreased with increasing speed of movement. Both systems could be used for calculating TD and Pmean, but they cannot be used interchangeably. Only GPS-10 Hz demonstrated a sufficient level of accuracy for quantifying distance covered at higher speeds or time spent at very high power.

Acceleration and deceleration capacity of fetal heart rate in an in-vivo sheep model

Background

Fetal heart rate (FHR) variability is an indirect index of fetal autonomic nervous system (ANS) integrity. FHR variability analysis in labor fails to detect early hypoxia and acidemia. Phase-rectified signal averaging (PRSA) is a new method of complex biological signals analysis that is more resistant to non-stationarities, signal loss and artifacts. It quantifies the average cardiac acceleration and deceleration (AC/DC) capacity.

Objective

The aims of the study were: (1) to investigate AC/DC in ovine fetuses exposed to acute hypoxic-acidemic insult; (2) to explore the relation between AC/DC and acid-base balance; and (3) to evaluate the influence of FHR decelerations and specific PRSA parameters on AC/DC computation.

Methods

Repetitive umbilical cord occlusions (UCOs) were applied in 9 pregnant near-term sheep to obtain three phases of MILD, MODERATE, and SEVERE hypoxic-acidemic insult. Acid-base balance was sampled and fetal ECGs continuously recorded. AC/DC were calculated: (1) for a spectrum of T values (T = 1÷50 beats; the parameter limits the range of oscillations detected by PRSA); (2) on entire series of fetal RR intervals or on “stable” series that excluded FHR decelerations caused by UCOs.

Results

AC and DC progressively increased with UCOs phases (MILD vs. MODERATE and MODERATE vs. SEVERE, p<0.05 for DC  = 2–5, and AC  = 1–3). The time evolution of AC/DC correlated to acid-base balance (0.4<<0.9, p<0.05) with the highest for . PRSA was not independent from FHR decelerations caused by UCOs.

Conclusions

This is the first in-vivo evaluation of PRSA on FHR analysis. In the presence of acute hypoxic-acidemia we found increasing values of AC/DC suggesting an activation of ANS. This correlation was strongest on time scale dominated by parasympathetic modulations. We identified the best performing parameters (), and found that AC/DC computation is not independent from FHR decelerations. These findings establish the basis for future clinical studies.

Spatial repolarization heterogeneity and survival in Chagas disease

OBJECTIVES

We investigated if cardiac spatial repolarization heterogeneity might be associated with an increased risk of death in patients with chronic Chagas disease.

METHODS

Repolarization heterogeneity was assessed using the V-index, a recently introduced metric founded on a biophysical model of the ECG. This metric provides an estimate of the standard deviation of the repolarization times across the heart. We analyzed 113 patients (aged 21- 67 years) enrolled between 1998 and 1999 who had a known serological status showing positive reactions to Trypanosoma cruzi. Fourteen subjects died during a 10-year follow-up period.

RESULTS

The V-index was significantly lower in survivor (S) than in non-survivor (NS) subjects (S: 31.2 ± 13.3 ms vs NS: 41.2 ± 18.6 ms, single-tail t-test: p = 0.009, single-tail Wilcoxon rank sum test: p = 0.029). A V-index larger than 36.3 ms was related to a significantly higher risk of death in a univariate Cox proportional-hazards analysis (hazard ratio, HR = 5.34, p = 0.0046). In addition, V-index > 36.3 ms retained its prognostic value in a multivariate Cox proportional-hazards analysis after adjustment for other three clinical variables (left ventricular ejection factor < 0.50, QRS duration > 133 ms, ventricular tachycardia during stress testing or 24 hours Holter) and for T-wave amplitude variability > 30 μV, even using shrinkage, a statistical procedure that protects against over-fitting due to small sample size.

CONCLUSIONS

The study showed that an increased dispersion of repolarization times in patients with Chagas disease, as measured by the V-index, is significantly correlated with the risk of death in a univariate survival analysis. The V-index captures prognostic information not immediately available from the analysis of other established risk factors.

Effects of the series length on Lempel-Ziv Complexity during sleep

Lempel-Ziv Complexity (LZC) has been demonstrated to be a powerful complexity measure in several biomedical applications. During sleep, it is still not clear how many samples are required to ensure robustness of its estimate when computed on beat-to-beat interval series (RR). The aims of this study were: i) evaluation of the number of necessary samples in different sleep stages for a reliable estimation of LZC; ii) evaluation of the LZC when considering inter-subject variability; and iii) comparison between LZC and Sample Entropy (SampEn). Both synthetic and real data were employed. In particular, synthetic RR signals were generated by means of AR models fitted on real data. The minimum number of samples required by LZC for having no changes in its average value, for both NREM and REM sleep periods, was 10(4) (p<;0.01) when using a binary quantization. However, LZC can be computed with N >1000 when a tolerance of 5% is considered satisfying. The influence of the inter-subject variability on the LZC was first assessed on model generated data confirming what found (>10(4); p<;0.01) for both NREM and REM stage. However, on real data, without differentiate between sleep stages, the minimum number of samples required was 1.8×10(4). The linear correlation between LZC and SampEn was computed on a synthetic dataset. We obtained a correlation higher than 0.75 (p<;0.01) when considering sleep stages separately, and higher than 0.90 (p<;0.01) when stages were not differentiated. Summarizing, we suggest to use LZC with the binary quantization and at least 1000 samples when a variation smaller than 5% is considered satisfying, or at least 10(4) for maximal accuracy. The use of more than 2 levels of quantization is not recommended.

Some theoretical results on the observability of repolarization heterogeneity on surface ECG

Assessing repolarization heterogeneity (RH) from surface ECG recording is an open issue in modern electrocardiography, despite the fact that several indexes measured on the T-wave have been proposed and tested. To understand how RH occurring at myocite level is reflected on T-wave shapes, in this paper we propose a mathematical framework that combines a simple statistical model of cardiac repolarization times with the dominant T-wave formalism. Within this framework we compare different T-wave features such as T-wave amplitude, T-wave amplitude variability or QT intervals and we describe mathematically how they are linked to the spatial and temporal components of repolarization heterogeneity.

Ventricular activity cancellation in electrograms during atrial fibrillation with constraints on residuals' power

During atrial fibrillation (AF), cancellation of ventricular activity from atrial electrograms (AEG) is commonly performed by template matching and subtraction (TMS): a running template, built in correspondence of QRSs, is subtracted from the AEG to uncover atrial activity (AA). However, TMS can produce poor cancellation, leaving high-power residues. In this study, we propose to modulate the templates before subtraction, in order to make the residuals as similar as possible to the nearby atrial activity, avoiding high-power ones. The coefficients used to modulate the template are estimated by maximizing, via Multi-swarm Particle Swarm Optimization, a fitness function. The modulated TMS method (mTMS) was tested on synthetic and real AEGs. Cancellation performances were assessed using: normalized mean squared error (NMSE, computed on simulated data only), reduction of ventricular activity (VDR), and percentage of segments (PP) whose power was outside the standard range of the atrial power. All testings suggested that mTMS is an improvement over TMS alone, being, on simulated data, NMSE and PP significantly decreased while VDR significantly increased. Similar results were obtained on real electrograms (median values of CS1 recordings PP: 2.44 vs. 0.38 p < 0.001; VDR: 6.71 vs. 8.15 p < 0.001).

Theoretical comments on reproducibility and normalization of TWA measures

Using a simple stochastic model of ventricular repolarization and the equivalent surface source (ESS) model, an electrophysiological formulation relating surface ECG to variations at the myocytes' level, we recently pointed out a few theoretical results regarding T-wave alternans (TWA). In this paper, stimulated by the comments of John E. Madias on our paper (J Electrocardiol, 2012), we further explored the consequences implied by the theoretical model. First, we verified the reproducibility of TWA measures, in clinically stable patients repeatedly tested. The sensitivity to displacement was evaluated simulating lead mislocations of up to 20mm. The numerical simulations were performed on data obtained solving the inverse electrocardiographically problem from three subjects (ECGSIM). The results showed that TWA sensitivity varies across leads, being maximal in V1 and decreases towards V6. Globally, the maximal percent error found was 6.1%. Thus, TWA measures do not seem to add more stringent requirements on lead placement's precision, than the usual diagnostic practice. Finally, we further discussed the implications of normalizing TWA measures. While clinical studies are necessary to sort out the issue, the theoretical model suggests that normalization might be appropriate only is certain cases.

Amplitude of Dominant T-Wave Alternans assessment on ECGs obtained from a biophysical model

The Amplitude of Dominant T-Wave Alternans (ADTWA) is a recently introduced index which quantifies the presence of microvolt T Wave Alternans (TWA) on surface ECG recordings. In this paper we investigate the reliability of ADTWA and its robustness against broadband noise. At this regard, we generated synthetic 12-leads ECG recordings through a forward electrophysiological model and we added TWA, at different extent, by modulating the variation of the repolarization times of transmembrane action potentials across even and odd beats. Using a stochastic model, we derived an analytical relationship between the repolarization variation injected into the model and TWA at the surface, thus offering a strategy to evaluate lead sensitivity. In terms of robustness, the results of the simulations show that ADTWA correctly measured the amplitude of synthetic TWA with an average error of 3.3% ± 5.8% in absence of noise. When a 100 μV peak-to-peak broadband noise is present, its effects on estimation errors were kept limited by singular value decomposition on which ADTWA builds.