Development of QRS detection algorithm designed for wearable cardiorespiratory system

Uncertainties in the Analysis of Heart Rate Variability: A Systematic Review

Heart rate variability (HRV) is an important metric with a variety of applications in clinical situations such as cardiovascular diseases, diabetes mellitus, and mental health. HRV data can be potentially obtained from electrocardiography and photoplethysmography signals, then computational techniques such as signal filtering and data segmentation are used to process the sampled data for calculating HRV measures. However, uncertainties arising from data acquisition, computational models, and physiological factors can lead to degraded signal quality and affect HRV analysis. Therefore, it is crucial to address these uncertainties and develop advanced models for HRV analysis. Although several reviews of HRV analysis exist, they primarily focus on clinical applications, trends in HRV methods, or specific aspects of uncertainties such as measurement noise. This paper provides a comprehensive review of uncertainties in HRV analysis, quantifies their impacts, and outlines potential solutions. To the best of our knowledge, this is the first study that presents a holistic review of uncertainties in HRV methods and quantifies their impacts on HRV measures from an engineer's perspective. This review is essential for developing robust and reliable models, and could serve as a valuable future reference in the field, particularly for dealing with uncertainties in HRV analysis.

Automation of classification of sleep stages and estimation of sleep efficiency using actigraphy

Introduction

Sleep is a fundamental and essential physiological process for recovering physiological function. Sleep disturbance or deprivation has been known to be a causative factor of various physiological and psychological disorders. Therefore, sleep evaluation is vital for diagnosing or monitoring those disorders. Although PSG (polysomnography) has been the gold standard for assessing sleep quality and classifying sleep stages, PSG has various limitations for common uses. In substitution for PSG, there has been vigorous research using actigraphy.

Methods

For classifying sleep stages automatically, we propose machine learning models with HRV (heart rate variability)-related features and acceleration features, which were processed from the actigraphy (Maxim band) data. Those classification results were transformed into a binary classification for estimating sleep efficiency. With 30 subjects, we conducted PSG, and they slept overnight with wrist-type actigraphy. We assessed the performance of four proposed machine learning models.

Results

With HRV-related and raw features of actigraphy, Cohen's kappa was 0.974 (p < 0.001) for classifying sleep stages into five stages: wake (W), REM (Rapid Eye Movement) (R), Sleep N1 (Non-Rapid Eye Movement Stage 1, S1), Sleep N2 (Non-Rapid Eye Movement Stage 2, S2), Sleep N3 (Non-Rapid Eye Movement Stage 3, S3). In addition, our machine learning model for the estimation of sleep efficiency showed an accuracy of 0.86.

Discussion

Our model demonstrated that automated sleep classification results could perfectly match the PSG results. Since models with acceleration features showed modest performance in differentiating some sleep stages, further research on acceleration features must be done. In addition, the sleep efficiency model demonstrated modest results. However, an investigation into the effects of HRV-derived and acceleration features is required.

AF episodes recognition using optimized time-frequency features and cost-sensitive SVM

Although atrial fibrillation (AF) Arrhythmia is highly prevalent within a wide range of populations with major associated risks and due to its episodic occurrence, its recognition remains a challenge for doctors. This paper aims to present and experimentally validate a new efficient approach for the detection and classification of this cardiac anomaly using multiple Electrocardiogram (ECG) signals. This work consists of applying Stockwell transform (ST) with compact support kernel (ST-CSK) for ECG time-frequency analysis. The estimation of the atrial activity (AA) is then achieved after analyzing P-waves of the ECG signals for each heartbeat. ECG signals segmentation allows characterizing the AA by making use of its (t, f) flatness, (t, f) flux, energy concentration and heart rate variability. The features matrix is employed as an input of the support vector machines (SVM) working in binary and asymmetrical mode with an embedded reject option. The proposed algorithm is trained and then tested using different ECG sources namely two databases provided by PhysionNet (MIT-BIH Arrhythmia, MIT-BIH Atrial Fibrillation) and recorded ECG signals using MySignals HW development platform with raspberry Pi 3 model B[Formula: see text]. The used method has achieved [Formula: see text] and [Formula: see text] as sensitivity and specificity, respectively. The obtained results confirm that the proposed approach represents a promising tool for Atrial Fibrillation Episodes (AFE) recognition with significant separability between Normal atrial activity and atrial activity with AF even under real and clinical conditions.

Automatic QRS complex detection using two-level convolutional neural network

Background

The QRS complex is the most noticeable feature in the electrocardiogram (ECG) signal, therefore, its detection is critical for ECG signal analysis. The existing detection methods largely depend on hand-crafted manual features and parameters, which may introduce significant computational complexity, especially in the transform domains. In addition, fixed features and parameters are not suitable for detecting various kinds of QRS complexes under different circumstances.

Methods

In this study, based on 1-D convolutional neural network (CNN), an accurate method for QRS complex detection is proposed. The CNN consists of object-level and part-level CNNs for extracting different grained ECG morphological features automatically. All the extracted morphological features are used by multi-layer perceptron (MLP) for QRS complex detection. Additionally, a simple ECG signal preprocessing technique which only contains difference operation in temporal domain is adopted.

Results

Based on the MIT-BIH arrhythmia (MIT-BIH-AR) database, the proposed detection method achieves overall sensitivity Sen = 99.77%, positive predictivity rate PPR = 99.91%, and detection error rate DER = 0.32%. In addition, the performance variation is performed according to different signal-to-noise ratio (SNR) values.

Conclusions

An automatic QRS detection method using two-level 1-D CNN and simple signal preprocessing technique is proposed for QRS complex detection. Compared with the state-of-the-art QRS complex detection approaches, experimental results show that the proposed method acquires comparable accuracy.

A REVIEW OF ECG-BASED DIAGNOSIS SUPPORT SYSTEMS FOR OBSTRUCTIVE SLEEP APNEA

Humans need sleep. It is important for physical and psychological recreation. During sleep our consciousness is suspended or least altered. Hence, our ability to avoid or react to disturbances is reduced. These disturbances can come from external sources or from disorders within the body. Obstructive Sleep Apnea (OSA) is such a disorder. It is caused by obstruction of the upper airways which causes periods where the breathing ceases. In many cases, periods of reduced breathing, known as hypopnea, precede OSA events. The medical background of OSA is well understood, but the traditional diagnosis is expensive, as it requires sophisticated measurements and human interpretation of potentially large amounts of physiological data. Electrocardiogram (ECG) measurements have the potential to reduce the cost of OSA diagnosis by simplifying the measurement process. On the down side, detecting OSA events based on ECG data is a complex task which requires highly skilled practitioners. Computer algorithms can help to detect the subtle signal changes which indicate the presence of a disorder. That approach has the following advantages: computers never tire, processing resources are economical and progress, in the form of better algorithms, can be easily disseminated as updates over the internet. Furthermore, Computer-Aided Diagnosis (CAD) reduces intra- and inter-observer variability. In this review, we adopt and support the position that computer based ECG signal interpretation is able to diagnose OSA with a high degree of accuracy.

Simple and Robust Realtime QRS Detection Algorithm Based on Spatiotemporal Characteristic of the QRS Complex

The purpose of this research is to develop an intuitive and robust realtime QRS detection algorithm based on the physiological characteristics of the electrocardiogram waveform. The proposed algorithm finds the QRS complex based on the dual criteria of the amplitude and duration of QRS complex. It consists of simple operations, such as a finite impulse response filter, differentiation or thresholding without complex and computational operations like a wavelet transformation. The QRS detection performance is evaluated by using both an MIT-BIH arrhythmia database and an AHA ECG database (a total of 435,700 beats). The sensitivity (SE) and positive predictivity value (PPV) were 99.85% and 99.86%, respectively. According to the database, the SE and PPV were 99.90% and 99.91% in the MIT-BIH database and 99.84% and 99.84% in the AHA database, respectively. The result of the noisy environment test using record 119 from the MIT-BIH database indicated that the proposed method was scarcely affected by noise above 5 dB SNR (SE = 100%, PPV > 98%) without the need for an additional de-noising or back searching process.

Smart ECG Monitoring Patch with Built-in R-Peak Detection for Long-Term HRV Analysis

Since heart rate variability (HRV) analysis is widely used to evaluate the physiological status of the human body, devices specifically designed for such applications are needed. To this end, we developed a smart electrocardiography (ECG) patch. The smart patch measures ECG using three electrodes integrated into the patch, filters the measured signals to minimize noise, performs analog-to-digital conversion, and detects R-peaks. The measured raw ECG data and the interval between the detected R-peaks can be recorded to enable long-term HRV analysis. Experiments were performed to evaluate the performance of the built-in R-wave detection, robustness of the device under motion, and applicability to the evaluation of mental stress. The R-peak detection results obtained with the device exhibited a sensitivity of 99.29%, a positive predictive value of 100.00%, and an error of 0.71%. The device also exhibited less motional noise than conventional ECG recording, being stable up to a walking speed of 5 km/h. When applied to mental stress analysis, the device evaluated the variation in HRV parameters in the same way as a normal ECG, with very little difference. This device can help users better understand their state of health and provide physicians with more reliable data for objective diagnosis.

New real-time heartbeat detection method using the angle of a single-lead electrocardiogram

This study presents a new real-time heartbeat detection algorithm using the geometric angle between two consecutive samples of single-lead electrocardiogram (ECG) signals. The angle was adopted as a new index representing the slope of ECG signal. The method consists of three steps: elimination of high-frequency noise, calculation of the angle of ECG signal, and detection of R-waves using a simple adaptive thresholding technique. The MIT-BIH arrhythmia database, QT database, European ST-T database, T-wave alternans database and synthesized ECG signals were used to evaluate the performance of the proposed algorithm and compare with the results of other methods suggested in literature. The proposed method shows a high detection rate-99.95% of the sensitivity, 99.95% of the positive predictivity, and 0.10% of the fail detection rate on the four databases. The result shows that the proposed method can yield better or comparable performance than other literature despite the relatively simple process. The proposed algorithm needs only a single-lead ECG, and involves a simple and quick calculation. Moreover, it does not require post-processing to enhance the detection. Thus, it can be effectively applied to various real-time healthcare and medical devices.

QRS detection by lifting scheme constructing multi-resolution morphological decomposition

QRS complex detecting algorithm is core of ECG auto-diagnosis method and deeply influences cardiac cycle division for signal compression. However, ECG signals collected by noninvasive surface electrodes areusually mixed with several kinds of interference, and its waveform variation is the main reason for the hard realization of ECG processing. This paper proposes a QRS complex detecting algorithm based on multi-resolution mathematical morphological decomposition. This algorithm possesses superiorities in R peak detection of both mathematical morphological method and multi-resolution decomposition. Moreover, a lifting constructing method with Maximizationupdating operator is adopted to further improve the algorithm performance. And an efficient R peak search-back algorithm is employed to reduce the false positives (FP) and false negatives (FN). The proposed algorithm provides a good performance applying to MIT-BIH Arrhythmia Database, and achieves over 99% detection rate, sensitivity and positive predictivity, respectively, and calculation burden is low. Therefore, the proposed method is appropriate for portable medical devices in Telemedicine system.

Fast QRS detection with an optimized knowledge-based method: evaluation on 11 standard ECG databases

The current state-of-the-art in automatic QRS detection methods show high robustness and almost negligible error rates. In return, the methods are usually based on machine-learning approaches that require sufficient computational resources. However, simple-fast methods can also achieve high detection rates. There is a need to develop numerically efficient algorithms to accommodate the new trend towards battery-driven ECG devices and to analyze long-term recorded signals in a time-efficient manner. A typical QRS detection method has been reduced to a basic approach consisting of two moving averages that are calibrated by a knowledge base using only two parameters. In contrast to high-accuracy methods, the proposed method can be easily implemented in a digital filter design.

Multi-lead QRS detection using window pairs

We designed a novel approach for multi-lead QRS detection. The algorithm uses one equation with two different window widths to generate a feature signal and a detection threshold. This enables it to adapt to various changes in QRS morphology and noise levels, resulting in a detection error rate of just 0.29% on the MIT-BIH Arrhythmia Database. The algorithm is also computationally efficient and capable of resolving differences between multiple leads by automatically attaching a confidence value to each QRS detection.

Arrhythmia identification with two-lead electrocardiograms using artificial neural networks and support vector machines for a portable ECG monitor system

An automatic configuration that can detect the position of R-waves, classify the normal sinus rhythm (NSR) and other four arrhythmic types from the continuous ECG signals obtained from the MIT-BIH arrhythmia database is proposed. In this configuration, a support vector machine (SVM) was used to detect and mark the ECG heartbeats with raw signals and differential signals of a lead ECG. An algorithm based on the extracted markers segments waveforms of Lead II and V1 of the ECG as the pattern classification features. A self-constructing neural fuzzy inference network (SoNFIN) was used to classify NSR and four arrhythmia types, including premature ventricular contraction (PVC), premature atrium contraction (PAC), left bundle branch block (LBBB), and right bundle branch block (RBBB). In a real scenario, the classification results show the accuracy achieved is 96.4%. This performance is suitable for a portable ECG monitor system for home care purposes.

Improved ECG pre-processing for beat-to-beat QT interval variability measurement

The aim of this study was to enhance the ECG pre-processing modalities for beat-to-beat QT interval variability measurement based on template matching. The R-peak detection algorithm has been substituted and an efficient baseline removal algorithm has been implemented in existing computer software. To test performance we used simulated ECG data with fixed QT intervals featuring Gaussian noise, baseline wander and amplitude modulation and two alternative algorithms. We computed the standard deviation of beat-to-beat QT intervals as a marker of QT interval variability (QTV). Significantly a lower beat-to-beat QTV was found in the updated approach compared the original algorithm. In addition, the updated template matching computer software outperformed the previous version in discarding fewer beats. In conclusion, the updated ECG preprocessing algorithm is recommended for more accurate quantification of beat-to-beat QT interval variability.

An R-peak detection method that uses an SVD filter and a search back system

In this paper, we present a method for detecting the R-peak of an ECG signal by using an singular value decomposition (SVD) filter and a search back system. The ECG signal was detected in two phases: the pre-processing phase and the decision phase. The pre-processing phase consisted of the stages for the SVD filter, Butterworth High Pass Filter (HPF), moving average (MA), and squaring, whereas the decision phase consisted of a single stage that detected the R-peak. In the pre-processing phase, the SVD filter removed noise while the Butterworth HPF eliminated baseline wander. The MA removed the remaining noise of the signal that had gone through the SVD filter to make the signal smooth, and squaring played a role in strengthening the signal. In the decision phase, the threshold was used to set the interval before detecting the R-peak. When the latest R-R interval (RRI), suggested by Hamilton et al., was greater than 150% of the previous RRI, the method of detecting the R-peak in such an interval was modified to be 150% or greater than the smallest interval of the two most latest RRIs. When the modified search back system was used, the error rate of the peak detection decreased to 0.29%, compared to 1.34% when the modified search back system was not used. Consequently, the sensitivity was 99.47%, the positive predictivity was 99.47%, and the detection error was 1.05%. Furthermore, the quality of the signal in data with a substantial amount of noise was improved, and thus, the R-peak was detected effectively.

A new approach of QRS complex detection based on matched filtering and triangle character analysis

QRS complex detection usually provides the fundamentals to automated electrocardiogram (ECG) analysis. In this paper, a new approach of QRS complex detection without the stage of noise suppression was developed and evaluated, which was based on the combination of two techniques: matched filtering and triangle character analysis. Firstly, a template of QRS complex was selected automatically by the triangle character in ECG, and then it was time-reversed after removing its direct current component. Secondly, matched filtering was implemented at low computational cost by finite impulse response, which further enhanced QRS complex and attenuated non-QRS regions containing P-wave, T-wave and various noise components. Subsequently, triangle structure-based threshold decision was processed to detect QRS complexes. And RR intervals and triangle structures were further analyzed for the reduction of false-positive and false-negative detections. Finally, the performance of the proposed algorithm was tested on all 48 records of the MIT-BIH Arrhythmia Database. The results demonstrated that the detection rate reached 99.62 %, the sensitivity got 99.78 %, and the positive prediction was 99.85 %. In addition, the proposed method was able to identify QRS complexes reliably even under the condition of poor signal quality.

Detecting specific health-related events using an integrated sensor system for vital sign monitoring

In this paper, a new method for the detection of apnea/hypopnea periods in physiological data is presented. The method is based on the intelligent combination of an integrated sensor system for long-time cardiorespiratory signal monitoring and dedicated signal-processing packages. Integrated sensors are a PVDF film and conductive fabric sheets. The signal processing package includes dedicated respiratory cycle (RC) and QRS complex detection algorithms and a new method using the respiratory cycle variability (RCV) for detecting apnea/hypopnea periods in physiological data. Results show that our method is suitable for online analysis of long time series data.