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Heartbeat detector from ECG and PPG signals based on wavelet transform and upper envelopes. Phys Eng Sci Med 2023; 46:597-608. [PMID: 36877361 DOI: 10.1007/s13246-023-01235-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 02/13/2023] [Indexed: 03/07/2023]
Abstract
The analysis of cardiac activity is one of the most common elements for evaluating the state of a subject, either to control possible health risks, sports performance, stress levels, etc. This activity can be recorded using different techniques, with electrocardiogram and photoplethysmogram being the most common. Both techniques make significantly different waveforms, however the first derivative of the photoplethysmographic data produces a signal structurally similar to the electrocardiogram, so any technique focusing on detecting QRS complexes, and thus heartbeats in electrocardiogram, is potentially applicable to photoplethysmogram. In this paper, we develop a technique based on the wavelet transform and envelopes to detect heartbeats in both electrocardiogram and photoplethysmogram. The wavelet transform is used to enhance QRS complexes with respect to other signal elements, while the envelopes are used as an adaptive threshold to determine their temporal location. We compared our approach with three other techniques using electrocardiogram signals from the Physionet database and photoplethysmographic signals from the DEAP database. Our proposal showed better performances when compared to others. When the electrocardiographic signal was considered, the method had an accuracy greater than 99.94%, a true positive rate of 99.96%, and positive prediction value of 99.76%. When photoplethysmographic signals were investigated, an accuracy greater than 99.27%, a true positive rate of 99.98% and positive prediction value of 99.50% were obtained. These results indicate that our proposal can be adapted better to the recording technology.
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Koponen M, Marjamaa A, Väänänen H, Tuiskula AM, Kontula K, Swan H, Viitasalo M. Effects of beta-blockers on ventricular repolarization documented by 24-h electrocardiography in long-QT syndrome type 2. Heart Rhythm 2022; 19:1491-1498. [PMID: 35525424 DOI: 10.1016/j.hrthm.2022.04.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Revised: 04/11/2022] [Accepted: 04/27/2022] [Indexed: 11/04/2022]
Abstract
BACKGROUND Long QT syndrome (LQTS) is an inherited arrhythmia disorder characterized by ventricular repolarization abnormalities and a risk of sudden cardiac death. The electrophysiological components generating the high risk of arrhythmias in LQTS are prolonged repolarization, increased dispersion of repolarization, and early afterdepolarizations, which are clinically estimated as QT interval, T-wave peak to end (TPE) interval, and T2/T1-wave amplitude ratio, respectively. In experimental LQTS type 2 (LQT2) models, beta-blockers decrease dispersion of repolarization and prevent early afterdepolarizations. In clinical studies among LQT2 patients beta-blockers are more effective against exercise-induced than arousal-induced cardiac events. OBJECTIVES AND METHODS The aim of the study was to investigate the effects of beta-blocker therapy on QT and TPE intervals, and maximal T2/T1-wave amplitude ratios recorded by 24-h electrocardiograms (ECG) among 25 LQT2 patients. RESULTS Beta-blocker therapy decreased the maximal T2/T1-wave amplitude ratio from 2.9±1.1 to 1.8±0.7 (p<0.001), but did not change pause-induced T2/T1-wave amplitude ratio. Under medication abrupt maximal TPE intervals were shorter at heart rates of 75 beats/min or over, and maximal QT intervals were shorter at a heart rate of 100 beats/min. CONCLUSIONS Beta-blockers stabilize ventricular repolarization in LQT2 by reducing electrocardiographic early afterdepolarizations, and by reducing abrupt prolongation of electrocardiographic dispersion of repolarization and ventricular repolarization duration at elevated heart rates. The effect of beta-blockers on pause-induced electrocardiographic early afterdepolarizations is weak. The findings provide electrocardiographic explanation for the protective effects of beta-blockers against exercise-induced cardiac events in LQT2.
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Affiliation(s)
- Mikael Koponen
- Heart and Lung Center, Helsinki University Hospital, Helsinki, Finland.
| | - Annukka Marjamaa
- Heart and Lung Center, Helsinki University Hospital, Helsinki, Finland
| | - Heikki Väänänen
- Department of Neuroscience and Biomedical Engineering, Aalto University, Espoo, Finland
| | - Annukka M Tuiskula
- Department of Medicine, Helsinki University Hospital and University of Helsinki, Helsinki, Finland; HUS Diagnostic Center, Laboratory of Genetics, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Kimmo Kontula
- Department of Medicine, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Heikki Swan
- Heart and Lung Center, Helsinki University Hospital, Helsinki, Finland
| | - Matti Viitasalo
- Heart and Lung Center, Helsinki University Hospital, Helsinki, Finland
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Meta-analysis of T-wave indices for risk stratification in myocardial infarction. JOURNAL OF GERIATRIC CARDIOLOGY : JGC 2018; 14:776-779. [PMID: 29581718 PMCID: PMC5863057 DOI: 10.11909/j.issn.1671-5411.2017.12.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
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Hu Y, Jiang S, Lu S, Xu R, Huang Y, Zhao Z, Qu Y. Echocardiography and Electrocardiography Variables Correlate With the New York Heart Association classification: An Observational Study of Ischemic Cardiomyopathy Patients. Medicine (Baltimore) 2017; 96:e7071. [PMID: 28658100 PMCID: PMC5500022 DOI: 10.1097/md.0000000000007071] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
The aim of our study was to determine whether combinations of ultrasound echocardiography (UCG) and electrocardiography (EKG) parameters correlated with the functional status of ischemic cardiomyopathy (ICM) patients according to the New York Heart Association (NYHA) classification system.We assessed 536 elderly Chinese ICM patients according to the NYHA criteria, which included 196 patients with type 2 diabetes mellitus (T2DM). All of the patients underwent UCG. Transmural dispersion of ventricular repolarization was examined using EKG. Cumulative odds logistic regression was performed to evaluate associations between NYHA class and the demographic, clinical, UCG, and EKG variables based on the odds ratio (OR) and 95% confidence interval (CI). A Pearson analysis was also performed to examine correlations between the NYHA classification and the UCG and EKG variables.Based on the NYHA assessment, 140, 147, 138, and 111 patients were identified as class I, II, III and IV, respectively. A comparison of UCG and EKG variables based on T2DM status showed that CO and Tp-e differed significantly between all NYHA classes (P < .05 for all), with values of each increasing with increasing NYHA class regardless of T2DM status. Multivariate logistic regression analysis showed that the disease course (OR: 1.30; 95% CI: 1.20-1.40), heart rate (OR: 1.16; 95% CI: 1.12-1.21), T wave peak to endpoint (Tp-e; OR: 1.22; 95% CI: 1.18-1.27), dispersion of the QT interval (OR: 0.98; 95% CI: 0.95-1.22), left ventricular fractional shortening (OR: 0.82; 95% CI: 0.78-0.87), cardiac output (CO; OR: 5.58; 95% CI: 3.08-10.13) were significantly associated with the NYHA class (P < .0001 for all). A Pearson correlation analysis showed that Tp-e (r = 0.75982, P < .0001), CO (r = 0.56072, P < .0001), and stroke volume (r = -0.14839, P = .0006) significantly correlated with the NYHA class.An index consisting of Tp-e and CO will be useful for corroborating the results of the NYHA assessment of ICM patients.
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Affiliation(s)
- Ying Hu
- Department of Geriatrics, Xuhui District Central Hospital
| | - Shifeng Jiang
- Department of Geriatrics, Qingpu Branch of Zhongshan Hospital, Fudan University
| | - Siyuan Lu
- Department of Geriatrics, Xuhui District Central Hospital
| | - Rong Xu
- Department of Geriatrics, Xuhui District Central Hospital
| | - Yunping Huang
- Department of Geriatrics, Xuhui District Central Hospital
| | - Zongliang Zhao
- Geriatric Nursing Services, Xuhui District Tianlin Street Community Health Service Center General, Shanghai, China
| | - Yi Qu
- Department of Geriatrics, Xuhui District Central Hospital
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Merino M, Gómez IM, Molina AJ. Envelopment filter and K-means for the detection of QRS waveforms in electrocardiogram. Med Eng Phys 2015; 37:605-9. [DOI: 10.1016/j.medengphy.2015.03.019] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2014] [Revised: 01/14/2015] [Accepted: 03/23/2015] [Indexed: 11/30/2022]
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Del Rio CL, Clymer BD, Billman GE. Myocardial electrotonic response to submaximal exercise in dogs with healed myocardial infarctions: evidence for β-adrenoceptor mediated enhanced coupling during exercise testing. Front Physiol 2015; 6:25. [PMID: 25698976 PMCID: PMC4318283 DOI: 10.3389/fphys.2015.00025] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2014] [Accepted: 01/15/2015] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION Autonomic neural activation during cardiac stress testing is an established risk-stratification tool in post-myocardial infarction (MI) patients. However, autonomic activation can also modulate myocardial electrotonic coupling, a known factor to contribute to the genesis of arrhythmias. The present study tested the hypothesis that exercise-induced autonomic neural activation modulates electrotonic coupling (as measured by myocardial electrical impedance, MEI) in post-MI animals shown to be susceptible or resistant to ventricular fibrillation (VF). METHODS Dogs (n = 25) with healed MI instrumented for MEI measurements were trained to run on a treadmill and classified based on their susceptibility to VF (12 susceptible, 9 resistant). MEI and ECGs were recorded during 6-stage exercise tests (18 min/test; peak: 6.4 km/h @ 16%) performed under control conditions, and following complete β-adrenoceptor (β-AR) blockade (propranolol); MEI was also measured at rest during escalating β-AR stimulation (isoproterenol) or overdrive-pacing. RESULTS Exercise progressively increased heart rate (HR) and reduced heart rate variability (HRV). In parallel, MEI decreased gradually (enhanced electrotonic coupling) with exercise; at peak exercise, MEI was reduced by 5.3 ± 0.4% (or -23 ± 1.8Ω, P < 0.001). Notably, exercise-mediated electrotonic changes were linearly predicted by the degree of autonomic activation, as indicated by changes in either HR or in HRV (P < 0.001). Indeed, β-AR blockade attenuated the MEI response to exercise while direct β-AR stimulation (at rest) triggered MEI decreases comparable to those observed during exercise; ventricular pacing had no significant effects on MEI. Finally, animals prone to VF had a significantly larger MEI response to exercise. CONCLUSIONS These data suggest that β-AR activation during exercise can acutely enhance electrotonic coupling in the myocardium, particularly in dogs susceptible to ischemia-induced VF.
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Affiliation(s)
- Carlos L Del Rio
- Department of Physiology and Cell Biology, The Ohio State University Columbus, OH, USA ; Department of Electrical and Computer Engineering, The Ohio State University Columbus, OH, USA ; Safety Pharmacology, QTest Labs Columbus, OH, USA
| | - Bradley D Clymer
- Department of Electrical and Computer Engineering, The Ohio State University Columbus, OH, USA ; Biomedical Engineering, The Ohio State University Columbus, OH, USA
| | - George E Billman
- Department of Physiology and Cell Biology, The Ohio State University Columbus, OH, USA ; Davis Heart and Lung Research Institute, The Ohio State University Columbus, OH, USA
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Prevalence and prognostic significance of long QT interval in patients with acute coronary syndrome: review of the literature. J Cardiovasc Nurs 2014; 29:271-9. [PMID: 23839573 DOI: 10.1097/jcn.0b013e31829bcf1a] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
BACKGROUND Sympathetic hyperactivity is linked with several adverse cardiovascular events in patients with acute coronary syndrome (ACS). Sympathetic activity increases early in the process of ischemia through 2 mechanisms. One originates from the central nervous system and leads to enhanced sympathetic activity. The other mechanism originates at the infarct zone and leads to B receptor up-regulation and catecholamine supersensitivity. Nevertheless, sympathetic hyperactivity accompanied by an underlying myocardial structural damage is likely to increase the ventricular repolarization duration measured as QT interval on the body surface electrocardiogram. PURPOSE The aims of the current review of the literature were to examine the physiological processes underlying the use of long QT interval as a risk prediction tool in patients with ACS and to critically review and critique the existing evidence related to this matter. CONCLUSION The available evidence is contradictory and includes serious limitations in design and QT measurement and correction. Until accurate and reliable data are available, it is difficult to determine the additional clinical value and prognostic significance of long QT interval in patients with ACS beyond that in other patients. CLINICAL IMPLICATIONS Long QT interval is not uncommon among patients with ACS. Automated continuous QT interval monitoring is superior to manual QT interval measurement with the standard 10-second electrocardiogram. Optimum care for patients with ACS requires nurses to keep monitoring the QT interval several days after the initial event.
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Wang B, Korhonen P, Tierala I, Hänninen H, Väänänen H, Toivonen L. U Wave Features in Body Surface Potential Mapping in Post-Myocardial Infarction Patients. Ann Noninvasive Electrocardiol 2013; 18:538-46. [DOI: 10.1111/anec.12071] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Affiliation(s)
- Bei Wang
- Department of Cardiology; Helsinki University Central Hospital; Helsinki Finland
- BioMag Laboratory; Helsinki University Central Hospital; Helsinki Finland
| | - Petri Korhonen
- Department of Cardiology; Helsinki University Central Hospital; Helsinki Finland
| | - Ilkka Tierala
- Department of Cardiology; Helsinki University Central Hospital; Helsinki Finland
| | - Helena Hänninen
- Department of Cardiology; Helsinki University Central Hospital; Helsinki Finland
| | - Heikki Väänänen
- Department of Biomedical Engineering and Computational Science; Aalto University; Espoo Finland
| | - Lauri Toivonen
- Department of Cardiology; Helsinki University Central Hospital; Helsinki Finland
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Anttonen O, Väänänen H, Junttila J, Huikuri HV, Viitasalo M. Electrocardiographic transmural dispersion of repolarization in patients with inherited short QT syndrome. Ann Noninvasive Electrocardiol 2008; 13:295-300. [PMID: 18713331 DOI: 10.1111/j.1542-474x.2008.00234.x] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND Short QT syndrome (SQTS) carries an increased risk for sudden cardiac death. However, only a short QT interval does not express the risk of ventricular arrhythmias. Thus, additional evaluation of the repolarization abnormality in SQTS patients is essential. In experimental models of SQTS, increased transmural dispersion of repolarization (TDR) and its electrocardiographic counterpart T-wave peak to T-wave end interval (TPE) appeared critical for induction of polymorphic ventricular tachycardia (PMVT). In a clinical study with acquired long QT syndrome patients, TPE/QT ratio > 0.28 indicated arrhythmia risk. We hypothesized that the TPE/QT ratio would be greater in SQTS patients than in control subjects. METHODS AND RESULTS We compared the behavior of the electrocardiographic TDR in three seriously symptomatic SQTS patients of unknown genotype presenting baseline QTc values < 320 ms and in nine healthy age-matched control subjects. We determined QT and TPE intervals as well as TPE/QT ratio from 24-hour ECG recordings using a computer-assisted program. Diurnal average of TPE/QT ratio was 0.28 +/- 0.03 in SQTS patients and 0.21 +/- 0.02 in control subjects (P = 0.01). SQTS patients had also lesser capacity to change TPE intervals from steady-state conditions to abrupt maximal values than control subjects. CONCLUSION SQTS patients have increased and autonomically uncontrolled electrocardiographic TDR. According to experimental SQTS models, the present results may in part explain increased vulnerability of SQTS patients to ventricular arrhythmias.
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Affiliation(s)
- Olli Anttonen
- Department of Medicine, Päijät-Häme Central Hospital, Lahti, Finland.
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Zareba KM, Shenkman HJ, Bisognano JD. Predictive Value of Admission Electrocardiography in Patients With Heart Failure. ACTA ACUST UNITED AC 2008; 14:173-9. [DOI: 10.1111/j.1751-7133.2008.07528.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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