Discrimination between emboli and artifacts for outpatient transcranial Doppler ultrasound data

Ambulatory Monitoring of Cerebrovascular Responses to Upright Posture and Walking in Older Adults With Heart Failure

Background

Insufficient cardiac output in individuals with heart failure (HF) limits daily functioning and reduces quality of life. Although lower cerebral perfusion, secondary to limitations in cardiac output, has been observed during moderate-intensity efforts, individuals with HF also may be at risk for lower perfusion during even low-intensity ambulatory activities.

Methods

We determined whether HF is associated with an altered cerebrovascular response to low-intensity activities representative of typical challenges of daily living. In this study, we monitored central hemodynamics and middle cerebral artery blood velocity (MCAv) and cerebral tissue oxygenation (near-infrared spectroscopy) in 10 individuals with HF (aged 78 ± 4 years; left ventricular ejection fraction 20%-61%) and 13 similar-aged controls (79 ± 8 years; 52%-73%) during 3 randomized transitions, as follows: (i) supine-to-standing; (ii) sitting-to-slow-paced over-ground walking; and (iii) sitting-to-normal-paced over-ground walking.

Results

Throughout supine, sitting, standing, and both walking conditions, individuals with HF had lower cardiac index and cerebral tissue oxygenation than controls (P < 0.05), and MCAv was lower across the range of blood pressure in HF patients (P = 0.051) and during walking only (P = 0.011). Individuals with HF had an attenuated increase in stroke volume index and cardiac index during normal-paced walking, compared to controls (P < 0.01).

Conclusions

The indices of cerebral perfusion from MCAv and cerebral oxygenation were lower during ambulatory activities in individuals with HF; however, relationships between MCAv and blood pressure were not different between those with HF and controls, indicating no difference in static cerebral autoregulation.

Sequential Emboli Detection From Ultrasound Outpatient Data

This paper addresses the detection of emboli from signals acquired with a new miniaturized and portable transcranial Doppler ultrasound device. The use of this device enables outpatient monitoring but increases the number of artifacts. These artifacts usually come from the patient voice and motion and can be superimposed to emboli. For this reason and because of the scarcity of emboli compared to artifacts, reliably detect emboli is a challenging task. As an example, the 11809 s of signal used in this study contained 0.06 % of embolic events and 10.14 % of artifacts. Herein, we propose an automatic and sequential approach. The method is based on sequential determination of high intensity transient signals. We also define efficient features to describe emboli in the time frequency representation. On our database, the number of artifacts detected as emboli is divided by more than 10 compared to the other algorithms reported in the literature.