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Ferdowsi M, Kwan BH, Tan MP, Saedon NI, Subramaniam S, Abu Hashim NFI, Mohd Nasir SS, Zainal Abidin I, Chee KH, Goh CH. Classification of vasovagal syncope from physiological signals on tilt table testing. Biomed Eng Online 2024; 23:37. [PMID: 38555421 PMCID: PMC10981362 DOI: 10.1186/s12938-024-01229-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 03/06/2024] [Indexed: 04/02/2024] Open
Abstract
BACKGROUND The diagnostic test for vasovagal syncope (VVS), the most common cause of syncope is head-up tilt test (HUTT) assessment. During the test, subjects experienced clinical symptoms such as nausea, sweating, pallor, the feeling of palpitations, being on the verge of passing out, and fainting. The study's goal is to develop an algorithm to classify VVS patients based on physiological signals blood pressure (BP) and electrocardiography (ECG) obtained from the HUTT. METHODS After 10 min of supine rest, the subject was tilted at a 70-degree angle on a tilt table for approximately a total of 35 min. 400 µg of glyceryl trinitrate (GTN) was administered sublingually after the first 20 min and monitoring continued for another 15 min. Mean imputation and K-nearest neighbors (KNN) imputation approaches to handle missing values. Next, feature selection techniques were implemented, including genetic algorithm, recursive feature elimination, and feature importance, to determine the crucial features. The Mann-Whitney U test was then performed to determine the statistical difference between two groups. Patients with VVS are categorized via machine learning models including Support Vector Machine (SVM), Gaussian Naïve Bayes (GNB), Multinomial Naïve Bayes (MNB), KNN, Logistic Regression (LR), and Random Forest (RF). The developed model is interpreted using an explainable artificial intelligence (XAI) model known as partial dependence plot. RESULTS A total of 137 subjects aged between 9 and 93 years were recruited for this study, 54 experienced clinical symptoms were considered positive tests, while the remaining 83 tested negative. Optimal results were obtained by combining the KNN imputation technique and three tilting features with SVM with 90.5% accuracy, 87.0% sensitivity, 92.7% specificity, 88.6% precision, 87.8% F1 score, and 95.4% ROC (receiver operating characteristics) AUC (area under curve). CONCLUSIONS The proposed algorithm effectively classifies VVS patients with over 90% accuracy. However, the study was confined to a small sample size. More clinical datasets are required to ensure that our approach is generalizable.
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Affiliation(s)
- Mahbuba Ferdowsi
- Department of Mechatronics and Biomedical Engineering, Lee Kong Chian Faculty of Engineering and Science, Universiti Tunku Abdul Rahman, 43000, Kajang, Malaysia
- Centre for Healthcare Science and Technology, Universiti Tunku Abdul Rahman, 43000, Kajang, Malaysia
| | - Ban-Hoe Kwan
- Department of Mechatronics and Biomedical Engineering, Lee Kong Chian Faculty of Engineering and Science, Universiti Tunku Abdul Rahman, 43000, Kajang, Malaysia
- Centre for Healthcare Science and Technology, Universiti Tunku Abdul Rahman, 43000, Kajang, Malaysia
| | - Maw Pin Tan
- Ageing and Age-Associated Disorders Research Group, Department of Medicine, Faculty of Medicine, Universiti Malaya, 50603, Kuala Lumpur, Malaysia
| | - Nor' Izzati Saedon
- Ageing and Age-Associated Disorders Research Group, Department of Medicine, Faculty of Medicine, Universiti Malaya, 50603, Kuala Lumpur, Malaysia
| | - Sukanya Subramaniam
- Cardiorespiratory Laboratories, Universiti Malaya Medical Center, 50603, Petaling Jaya, Malaysia
| | | | - Siti Sakinah Mohd Nasir
- Cardiorespiratory Laboratories, Universiti Malaya Medical Center, 50603, Petaling Jaya, Malaysia
| | - Imran Zainal Abidin
- Department of Cardiology, Department of Medicine, Faculty of Medicine, Universiti Malaya, 50603, Kuala Lumpur, Malaysia
| | - Kok Han Chee
- Department of Cardiology, Department of Medicine, Faculty of Medicine, Universiti Malaya, 50603, Kuala Lumpur, Malaysia
| | - Choon-Hian Goh
- Department of Mechatronics and Biomedical Engineering, Lee Kong Chian Faculty of Engineering and Science, Universiti Tunku Abdul Rahman, 43000, Kajang, Malaysia.
- Centre for Healthcare Science and Technology, Universiti Tunku Abdul Rahman, 43000, Kajang, Malaysia.
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Finding a rhythm: Relating ultra-short-term heart rate variability measures in healthy young adults during rest, exercise, and recovery. Auton Neurosci 2022; 239:102953. [DOI: 10.1016/j.autneu.2022.102953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 02/01/2022] [Accepted: 02/04/2022] [Indexed: 11/20/2022]
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3
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Choudhary MK, Penninkangas RM, Eräranta A, Niemelä O, Mangani C, Maleta K, Ashorn P, Ashorn U, Pörsti I. Posture-Related Differences in Cardiovascular Function Between Young Men and Women: Study of Noninvasive Hemodynamics in Rural Malawi. J Am Heart Assoc 2022; 11:e022979. [PMID: 35195013 PMCID: PMC9075090 DOI: 10.1161/jaha.121.022979] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Background Cardiovascular risk is higher in men than in women, but little information exists about sex‐related differences in cardiovascular function from low‐income countries. We compared hemodynamics between sexes in rural Malawi in a cohort followed up since their birth. Methods and Results Supine, seated, and standing hemodynamics were recorded from 251 women and 168 men (mean age, 21 years; body mass index, 21 kg/m2) using oscillometric brachial waveform analyses (Mobil‐O‐Graph). The results were adjusted for estimated glomerular filtration rate, and plasma potassium, lipids, and glucose. Men had higher brachial and aortic systolic blood pressure and stroke index regardless of posture (P<0.001), and higher upright but similar supine diastolic blood pressure than women. Regardless of posture, heart rate was lower in men (P<0.001), whereas cardiac index did not differ between sexes. Women presented with lower supine and standing systemic vascular resistance index (P<0.001), whereas supine‐to‐standing increase in vascular resistance (P=0.012) and decrease in cardiac index (P=0.010) were higher in women. Supine left cardiac work index was similar in both sexes, whereas standing and seated left cardiac work index was higher in men than in women (P<0.001). Conclusions In young Malawian adults, men had higher systolic blood pressure, systemic vascular resistance, and upright cardiac workload, whereas women presented with higher posture‐related changes in systemic vascular resistance and cardiac output. These findings show systematic sex‐related differences in cardiovascular function in a cohort from a low‐income country with high exposure to prenatal and postnatal malnutrition and infectious diseases.
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Affiliation(s)
| | | | - Arttu Eräranta
- Faculty of Medicine and Health Technology Tampere University Tampere Finland
| | - Onni Niemelä
- Faculty of Medicine and Health Technology Tampere University Tampere Finland.,Department of Laboratory Medicine and Medical Research Unit Seinäjoki Central Hospital Seinäjoki Finland
| | - Charles Mangani
- School of Public Health and Family Medicine College of Medicine University of Malawi Blantyre Malawi
| | - Kenneth Maleta
- School of Public Health and Family Medicine College of Medicine University of Malawi Blantyre Malawi
| | - Per Ashorn
- Faculty of Medicine and Health Technology Tampere University Tampere Finland.,Department of Pediatrics Tampere University Hospital Tampere Finland
| | - Ulla Ashorn
- Faculty of Medicine and Health Technology Tampere University Tampere Finland
| | - Ilkka Pörsti
- Faculty of Medicine and Health Technology Tampere University Tampere Finland.,Department of Internal Medicine Tampere University Hospital Tampere Finland
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4
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Santiago-Fuentes LM, Charleston-Villalobos S, González-Camarena R, Voss A, Mejía-Avila ME, Buendía-Roldan I, Reulecke S, Aljama-Corrales T. Effects of Supplemental Oxygen on Cardiovascular and Respiratory Interactions by Extended Partial Directed Coherence in Idiopathic Pulmonary Fibrosis. FRONTIERS IN NETWORK PHYSIOLOGY 2022; 2:834056. [PMID: 36926096 PMCID: PMC10013060 DOI: 10.3389/fnetp.2022.834056] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Accepted: 02/07/2022] [Indexed: 11/13/2022]
Abstract
Idiopathic pulmonary fibrosis (IPF) is a chronic and restrictive disease characterized by fibrosis and inflammatory changes in lung tissue producing a reduction in diffusion capacity and leading to exertional chronic arterial hypoxemia and dyspnea. Furthermore, clinically, supplemental oxygen (SupplO2) has been prescribed to IPF patients to improve symptoms. However, the evidence about the benefits or disadvantages of oxygen supplementation is not conclusive. In addition, the impact of SupplO2 on the autonomic nervous system (ANS) regulation in respiratory diseases needs to be evaluated. In this study the interactions between cardiovascular and respiratory systems in IPF patients, during ambient air (AA) and SupplO2 breathing, are compared to those from a matched healthy group. Interactions were estimated by time series of successive beat-to-beat intervals (BBI), respiratory amplitude (RESP) at BBI onset, arterial systolic (SYS) and diastolic (DIA) blood pressures. The paper explores the Granger causality (GC) between systems in the frequency domain by the extended partial directed coherence (ePDC), considering instantaneous effects. Also, traditional linear and nonlinear markers as power in low (LF) and high frequency (HF) bands, symbolic dynamic indices as well as arterial baroreflex, were calculated. The results showed that for IPF during AA phase: 1) mean BBI and power of BBI-HF band, as well as mean respiratory frequency were significantly lower (p < 0.05) and higher (p < 0.001), respectively, indicating a strong sympathetic influence, and 2) the RESP → SYS interaction was characterized by Mayer waves and diminished RESP → BBI, i.e., decreased respiratory sinus arrhythmia. In contrast, during short-term SupplO2 phase: 1) oxygen might produce a negative influence on the systolic blood pressure variability, 2) the arterial baroreflex reduced significantly (p < 0.01) and 3) reduction of RSA reflected by RESP → BBI with simultaneous increase of Traube-Hering waves in RESP → SYS (p < 0.001), reflected increased sympathetic modulation to the vessels. The results gathered in this study may be helpful in the management of the administration of SupplO2.
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Affiliation(s)
| | | | | | - Andreas Voss
- Institute of Biomedical Engineering and Informatics, University of Technology Ilmenau, Ilmenau, Germany
| | | | | | - Sina Reulecke
- Electrical Engineering Department, Universidad Autónoma Metropolitana, Mexico City, Mexico
| | - Tomás Aljama-Corrales
- Electrical Engineering Department, Universidad Autónoma Metropolitana, Mexico City, Mexico
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5
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Fares S, Bakkar NMZ, Alami R, Lakkis I, Badr K. Longitudinal study on the effect of surgical weight loss on beat-to-beat blood pressure variability in patients undergoing bariatric surgery: a study protocol. BMJ Open 2021; 11:e050957. [PMID: 34667007 PMCID: PMC8527146 DOI: 10.1136/bmjopen-2021-050957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Alterations in linear and non-linear parameters of beat-to-beat blood pressure variability (BPV) have been shown to predict disease prognosis and distinguish between risk categories in various pathological conditions, independently of average blood pressure levels. Obesity places subjects at elevated risk of vascular diseases, including hypertension, resulting in serious cardiac, respiratory and cerebral events. However, little is known about the status of vascular dynamics in obese and morbidly obese adults. METHODS AND ANALYSIS In this present quasi-experimental longitudinal study, changes in beat-to-beat BPV, using continuous, non-invasive blood pressure monitoring, in obese subjects undergoing bariatric surgery are characterised. The capacity of linear and non-linear measures of BPV to detect differences between hypertensive, prehypertensive and normotensive obese subjects prebariatric and postbariatric surgery are tested. Additionally, potential correlations between beat-to-beat BPV and age, body mass index, gender and comorbidities will be investigated. In parallel, the impact of the unsteady fluctuations of beat-to-beat blood pressure on the dynamic stresses imparted by blood flow on blood vessel walls will be explored. We expect to find altered BPV profiles in hypertensive and prehypertensive subjects as compared with normotensive subjects. We also expect to see differential normalisation in BPV profiles between hypertensive, prehypertensive and normotensive subjects over time. ETHICS AND DISSEMINATION The study has been approved by the Institutional Review Board at the American University of Beirut (IRB ID: BIO-2018-0040). Study results will be made available to the public through publications in peer-reviewed journals and conference papers and/or presentations.
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Affiliation(s)
- Souha Fares
- Rafic Hariri School of Nursing, American University of Beirut, Beirut, Lebanon
| | | | - Ramzi Alami
- Department of Surgery, American University of Beirut Medical Center, Beirut, Lebanon
| | - Issam Lakkis
- Department of Mechanical Engineering, American University of Beirut Faculty of Engineering and Architecture, Beirut, Lebanon
| | - Kamal Badr
- Department of Internal Medicine, American University of Beirut Faculty of Medicine, Beirut, Lebanon
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6
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Torres-Arellano JM, Echeverría JC, Ávila-Vanzzini N, Springall R, Toledo A, Infante O, Bojalil R, Cossío-Aranda JE, Fajardo E, Lerma C. Cardiac Autonomic Response to Active Standing in Calcific Aortic Valve Stenosis. J Clin Med 2021; 10:2004. [PMID: 34067025 PMCID: PMC8124878 DOI: 10.3390/jcm10092004] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2021] [Revised: 04/25/2021] [Accepted: 05/03/2021] [Indexed: 01/02/2023] Open
Abstract
Aortic stenosis is a progressive heart valve disorder characterized by calcification of the leaflets. Heart rate variability (HRV) analysis has been proposed for assessing the heart response to autonomic activity, which is documented to be altered in different cardiac diseases. The objective of the study was to evaluate changes of HRV in patients with aortic stenosis by an active standing challenge. Twenty-two volunteers without alterations in the aortic valve (NAV) and twenty-five patients diagnosed with moderate and severe calcific aortic valve stenosis (AVS) participated in this cross-sectional study. Ten minute electrocardiograms were performed in a supine position and in active standing positions afterwards, to obtain temporal, spectral, and scaling HRV indices: mean value of all NN intervals (meanNN), low-frequency (LF) and high-frequency (HF) bands spectral power, and the short-term scaling indices (α1 and αsign1). The AVS group showed higher values of LF, LF/HF and αsign1 compared with the NAV group at supine position. These patients also expressed smaller changes in meanNN, LF, HF, LF/HF, α1, and αsign1 between positions. In conclusion, we confirmed from short-term recordings that patients with moderate and severe calcific AVS have a decreased cardiac parasympathetic supine response and that the dynamic of heart rate fluctuations is modified compared to NAV subjects, but we also evidenced that they manifest reduced autonomic adjustments caused by the active standing challenge.
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Affiliation(s)
- José M. Torres-Arellano
- Department of Electromechanical Instrumentation, Instituto Nacional de Cardiología Ignacio Chávez, Mexico City 14080, Mexico; (J.M.T.-A.); (O.I.)
- Programa de Doctorado en Ciencias Médicas, Odontológicas y de la Salud, Universidad Nacional Autonoma de Mexico, Mexico City 04510, Mexico
| | - Juan C. Echeverría
- Department of Electrical Engineering, Universidad Autónoma Metropolitana, Unidad Iztapalapa, Mexico City 09340, Mexico
| | - Nydia Ávila-Vanzzini
- Department of Outpatients Clinic, Instituto Nacional de Cardiología Ignacio Chávez, Mexico City 14080, Mexico; (N.Á.-V.); (J.E.C.-A.); (E.F.)
| | - Rashidi Springall
- Department of Immunology, Instituto Nacional de Cardiología Ignacio Chávez, Mexico City 14080, Mexico; (R.S.); (A.T.)
| | - Andrea Toledo
- Department of Immunology, Instituto Nacional de Cardiología Ignacio Chávez, Mexico City 14080, Mexico; (R.S.); (A.T.)
| | - Oscar Infante
- Department of Electromechanical Instrumentation, Instituto Nacional de Cardiología Ignacio Chávez, Mexico City 14080, Mexico; (J.M.T.-A.); (O.I.)
| | - Rafael Bojalil
- Department of Health Care, Universidad Autónoma Metropolitana, Unidad Xochimilco, Mexico City 04960, Mexico;
| | - Jorge E. Cossío-Aranda
- Department of Outpatients Clinic, Instituto Nacional de Cardiología Ignacio Chávez, Mexico City 14080, Mexico; (N.Á.-V.); (J.E.C.-A.); (E.F.)
| | - Erika Fajardo
- Department of Outpatients Clinic, Instituto Nacional de Cardiología Ignacio Chávez, Mexico City 14080, Mexico; (N.Á.-V.); (J.E.C.-A.); (E.F.)
| | - Claudia Lerma
- Department of Electromechanical Instrumentation, Instituto Nacional de Cardiología Ignacio Chávez, Mexico City 14080, Mexico; (J.M.T.-A.); (O.I.)
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7
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Beat-to-beat blood pressure variability: an early predictor of disease and cardiovascular risk. J Hypertens 2021; 39:830-845. [PMID: 33399302 DOI: 10.1097/hjh.0000000000002733] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Blood pressure (BP) varies on the long, short and very-short term. Owing to the hidden physiological and pathological information present in BP time-series, increasing interest has been given to the study of continuous, beat-to-beat BP variability (BPV) using invasive and noninvasive methods. Different linear and nonlinear parameters of variability are employed in the characterization of BP signals in health and disease. Although linear parameters of beat-to-beat BPV are mainly measures of dispersion, such as standard deviation (SD), nonlinear parameters of BPV quantify the degree of complexity/irregularity- using measures of entropy or self-similarity/correlation. In this review, we summarize the value of linear and nonlinear parameters in reflecting different information about the pathophysiology of changes in beat-to-beat BPV independent of or superior to mean BP. We then provide a comparison of the relative power of linear and nonlinear parameters of beat-to-beat BPV in detecting early and subtle differences in various states. The practical advantage and utility of beat-to-beat BPV monitoring support its incorporation into routine clinical practices.
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8
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Delta plot analysis of cardiovascular and cardiorespiratory interactions in young women with orthostatic intolerance. Biomed Signal Process Control 2020. [DOI: 10.1016/j.bspc.2020.101892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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9
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Charleston-Villalobos S, Reulecke S, Voss A, Azimi-Sadjadi MR, González-Camarena R, Gaitán-González MJ, González-Hermosillo JA, Hernández-Pacheco G, Schulz S, Aljama-Corrales T. Time-Frequency Analysis of Cardiovascular and Cardiorespiratory Interactions During Orthostatic Stress by Extended Partial Directed Coherence. ENTROPY (BASEL, SWITZERLAND) 2019; 21:e21050468. [PMID: 33267182 PMCID: PMC7514957 DOI: 10.3390/e21050468] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Revised: 04/24/2019] [Accepted: 04/28/2019] [Indexed: 06/12/2023]
Abstract
In this study, the linear method of extended partial directed coherence (ePDC) was applied to establish the temporal dynamic behavior of cardiovascular and cardiorespiratory interactions during orthostatic stress at a 70° head-up tilt (HUT) test on young age-matched healthy subjects and patients with orthostatic intolerance (OI), both male and female. Twenty 5-min windows were used to analyze the minute-wise progression of interactions from 5 min in a supine position (baseline, BL) until 18 min of the orthostatic phase (OP) without including pre-syncopal phases. Gender differences in controls were present in cardiorespiratory interactions during OP without compromised autonomic regulation. However in patients, analysis by ePDC revealed considerable dynamic alterations within cardiovascular and cardiorespiratory interactions over the temporal course during the HUT test. Considering the young female patients with OI, the information flow from heart rate to systolic blood pressure (mechanical modulation) was already increased before the tilt-up, the information flow from systolic blood pressure to heart rate (neural baroreflex) increased during OP, while the information flow from respiration to heart rate (respiratory sinus arrhythmia) decreased during the complete HUT test. Findings revealed impaired cardiovascular interactions in patients with orthostatic intolerance and confirmed the usefulness of ePDC for causality analysis.
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Affiliation(s)
| | - Sina Reulecke
- Department of Electrical Engineering, Universidad Autónoma Metropolitana, Mexico City 09340, Mexico
| | - Andreas Voss
- Institute of Innovative Health Technologies, Ernst-Abbe-Hochschule Jena, 07745 Jena, Germany
| | - Mahmood R. Azimi-Sadjadi
- Department of Electrical and Computer Engineering, Colorado State University, Fort Collins, CO 80523, USA
| | | | | | | | | | - Steffen Schulz
- Institute of Innovative Health Technologies, Ernst-Abbe-Hochschule Jena, 07745 Jena, Germany
| | - Tomás Aljama-Corrales
- Department of Electrical Engineering, Universidad Autónoma Metropolitana, Mexico City 09340, Mexico
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10
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Buszko K, Piątkowska A, Koźluk E, Fabiszak T, Opolski G. Entropy Measures in Analysis of Head up Tilt Test Outcome for Diagnosing Vasovagal Syncope. ENTROPY 2018; 20:e20120976. [PMID: 33266699 PMCID: PMC7512576 DOI: 10.3390/e20120976] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Revised: 12/11/2018] [Accepted: 12/12/2018] [Indexed: 11/21/2022]
Abstract
The paper presents possible applications of entropy measures in analysis of biosignals recorded during head up tilt testing (HUTT) in patients with suspected vasovagal syndrome. The study group comprised 80 patients who developed syncope during HUTT (57 in the passive phase of the test (HUTT(+) group) and 23 who had negative result of passive phase and developed syncope after provocation with nitroglycerine (HUTT(−) group)). The paper focuses on assessment of monitored signals’ complexity (heart rate expressed as R-R intervals (RRI), blood pressure (sBP, dBP) and stroke volume (SV)) using various types of entropy measures (Sample Entropy (SE), Fuzzy Entropy (FE), Shannon Entropy (Sh), Conditional Entropy (CE), Permutation Entropy (PE)). Assessment of the complexity of signals in supine position indicated presence of significant differences between HUTT(+) versus HUTT(−) patients only for Conditional Entropy (CE(RRI)). Values of CE(RRI) higher than 0.7 indicate likelihood of a positive result of HUTT already at the passive phase. During tilting, in the pre-syncope phase, significant differences were found for: (SE(sBP), SE(dBP), FE(RRI), FE(sBP), FE(dBP), FE(SV), Sh(sBP), Sh(SV), CE(sBP), CE(dBP)). HUTT(+) patients demonstrated significant changes in signals’ complexity more frequently than HUTT(−) patients. When comparing entropy measurements done in the supine position with those during tilting, SV assessed in HUTT(+) patients was the only parameter for which all tested measures of entropy (SE(SV), FE(SV), Sh(SV), CE(SV), PE(SV)) showed significant differences.
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Affiliation(s)
- Katarzyna Buszko
- Department of Theoretical Foundations of Bio-Medical Science and Medical Informatics, Collegium Medicum, Nicolaus Copernicus University, 85-067 Bydgoszcz, Poland
- Correspondence: ; Tel.: +48-52-585-3428
| | - Agnieszka Piątkowska
- Department of Emergency Medicine, Wroclaw Medical University, 02-091 Wroclaw, Poland
- 1st Department of Cardiology, Medical University of Warsaw, 02-091 Warsaw, Poland
| | - Edward Koźluk
- 1st Department of Cardiology, Medical University of Warsaw, 02-091 Warsaw, Poland
| | - Tomasz Fabiszak
- Department of Cardiology and Internal Diseases, Collegium Medicum, Nicolaus Copernicus University, 85-067 Bydgoszcz, Poland
| | - Grzegorz Opolski
- 1st Department of Cardiology, Medical University of Warsaw, 02-091 Warsaw, Poland
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11
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Towards understanding the complexity of cardiovascular oscillations: Insights from information theory. Comput Biol Med 2018; 98:48-57. [PMID: 29763765 DOI: 10.1016/j.compbiomed.2018.05.007] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Revised: 05/03/2018] [Accepted: 05/03/2018] [Indexed: 11/24/2022]
Abstract
Cardiovascular complexity is a feature of healthy physiological regulation, which stems from the simultaneous activity of several cardiovascular reflexes and other non-reflex physiological mechanisms. It is manifested in the rich dynamics characterizing the spontaneous heart rate and blood pressure variability (HRV and BPV). The present study faces the challenge of disclosing the origin of short-term HRV and BPV from the statistical perspective offered by information theory. To dissect the physiological mechanisms giving rise to cardiovascular complexity in different conditions, measures of predictive information, information storage, information transfer and information modification were applied to the beat-to-beat variability of heart period (HP), systolic arterial pressure (SAP) and respiratory volume signal recorded non-invasively in 61 healthy young subjects at supine rest and during head-up tilt (HUT) and mental arithmetics (MA). Information decomposition enabled to assess simultaneously several expected and newly inferred physiological phenomena, including: (i) the decreased complexity of HP during HUT and the increased complexity of SAP during MA; (ii) the suppressed cardiorespiratory information transfer, related to weakened respiratory sinus arrhythmia, under both challenges; (iii) the altered balance of the information transferred along the two arms of the cardiovascular loop during HUT, with larger baroreflex involvement and smaller feedforward mechanical effects; and (iv) an increased importance of direct respiratory effects on SAP during HUT, and on both HP and SAP during MA. We demonstrate that a decomposition of the information contained in cardiovascular oscillations can reveal subtle changes in system dynamics and improve our understanding of the complexity changes during physiological challenges.
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12
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Javorka M, El-Hamad F, Czippelova B, Turianikova Z, Krohova J, Lazarova Z, Baumert M. Role of respiration in the cardiovascular response to orthostatic and mental stress. Am J Physiol Regul Integr Comp Physiol 2018; 314:R761-R769. [PMID: 29443551 DOI: 10.1152/ajpregu.00430.2017] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The objective of this study was to determine the response of heart rate and blood pressure variability (respiratory sinus arrhythmia, baroreflex sensitivity) to orthostatic and mental stress, focusing on causality and the mediating effect of respiration. Seventy-seven healthy young volunteers (46 women, 31 men) aged 18.4 ± 2.7 yr underwent an experimental protocol comprising supine rest, 45° head-up tilt, recovery, and a mental arithmetic task. Heart rate variability and blood pressure variability were analyzed in the time and frequency domain and modeled as a multivariate autoregressive process where the respiratory volume signal acted as an external driver. During head-up tilt, tidal volume increased while respiratory rate decreased. During mental stress, breathing rate increased and tidal volume was elevated slightly. Respiratory sinus arrhythmia decreased during both interventions. Baroreflex function was preserved during orthostasis but was decreased during mental stress. While sex differences were not observed during baseline conditions, cardiovascular response to orthostatic stress and respiratory response to mental stress was more prominent in men compared with women. The respiratory response to the mental arithmetic tasks was more prominent in men despite a significantly higher subjectively perceived stress level in women. In conclusion, respiration shows a distinct response to orthostatic versus mental stress, mediating cardiovascular variability; it needs to be considered for correct interpretation of heart rate and blood pressure phenomena.
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Affiliation(s)
- Michal Javorka
- Biomedical Center Martin, Comenius University in Bratislava, Jessenius Faculty of Medicine, Martin, Slovakia.,Department of Physiology, Comenius University in Bratislava, Jessenius Faculty of Medicine, Martin, Slovakia
| | - Fatima El-Hamad
- School of Electrical and Electronic Engineering, The University of Adelaide, South Australia, Australia
| | - Barbora Czippelova
- Biomedical Center Martin, Comenius University in Bratislava, Jessenius Faculty of Medicine, Martin, Slovakia.,Department of Physiology, Comenius University in Bratislava, Jessenius Faculty of Medicine, Martin, Slovakia
| | - Zuzana Turianikova
- Biomedical Center Martin, Comenius University in Bratislava, Jessenius Faculty of Medicine, Martin, Slovakia.,Department of Physiology, Comenius University in Bratislava, Jessenius Faculty of Medicine, Martin, Slovakia
| | - Jana Krohova
- Biomedical Center Martin, Comenius University in Bratislava, Jessenius Faculty of Medicine, Martin, Slovakia.,Department of Physiology, Comenius University in Bratislava, Jessenius Faculty of Medicine, Martin, Slovakia
| | - Zuzana Lazarova
- Biomedical Center Martin, Comenius University in Bratislava, Jessenius Faculty of Medicine, Martin, Slovakia.,Department of Physiology, Comenius University in Bratislava, Jessenius Faculty of Medicine, Martin, Slovakia
| | - Mathias Baumert
- School of Electrical and Electronic Engineering, The University of Adelaide, South Australia, Australia
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13
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Reulecke S, Charleston-Villalobos S, Voss A, Gonzalez-Camarena R, Gonzalez-Hermosillo JA, Gaitan-Gonzalez MJ, Hernandez-Pacheco G, Schroeder R, Aljama-Corrales T, Reulecke S, Charleston-Villalobos S, Voss A, Gonzalez-Camarena R, Gonzalez-Hermosillo JA, Gaitan-Gonzalez MJ, Hernandez-Pacheco G, Schroeder R, Aljama-Corrales T. Temporal Analysis of Cardiovascular and Respiratory Complexity by Multiscale Entropy Based on Symbolic Dynamics. IEEE J Biomed Health Inform 2017; 22:1046-1058. [PMID: 28991754 DOI: 10.1109/jbhi.2017.2761354] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The effect of an orthostatic stress on cardiovascular and respiratory complexity was investigated to detect impaired autonomic regulation in patients with vasovagal syncope (VVS). A total of 16 female patients and 12 age-matched healthy female subjects were enrolled in a passive 70° head-up tilt test. Also, 12 age-matched healthy male subjects were enrolled to study gender differences. Analysis was performed dynamically using various short-term (5 min) windows shifted by 1 min as well as by 20 min of orthostatic phase (OP) to evaluate local and global complexity. Complexity was determined over multiple time scales by the established method of refined composite multiscale entropy (RCMSE) and by a new proposed method of multiscale entropy based on symbolic dynamics (MSE-SD). Concerning heart rate variability (HRV) during OP, both methods revealed the highest complexity for female controls followed by lower complexity in male controls (p < 0.01) and by the lowest complexity in female patients (p < 0.01). For blood pressure variability (BPV), no gender differences in controls were shown by any method. However, MSE-SD demonstrated highly significantly increased BPV complexity in patients during OP (p < 0.01 on 4 time-scales after 7 min, p < 0.001 on 5 time-scales after 11 min) while RCMSE did not reveal considerable differences (p < 0.05 on 2 time scales after 7 min). Respiratory complexity was further increased in patients primary shown by MSE-SD. Findings indicated impaired autonomic regulation in VVS patients characterized by predominantly increased BPV complexity accompanied with decreased HRV complexity. In addition, results suggested extending the concept of complexity loss with disease.
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14
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Sunwoo JS, Yang TW, Kim DY, Lim JA, Kim TJ, Byun JI, Moon J, Lee ST, Jung KH, Park KI, Jung KY, Kim M, Lee SK, Chu K. Association of blood pressure variability with orthostatic intolerance symptoms. PLoS One 2017; 12:e0179132. [PMID: 28591231 PMCID: PMC5462414 DOI: 10.1371/journal.pone.0179132] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Accepted: 05/24/2017] [Indexed: 11/18/2022] Open
Abstract
The short-term blood pressure variability (BPV) reflects autonomic regulatory mechanisms. However, the influence of BPV in orthostatic intolerance (OI) is unknown. Herein, we assessed BPV profiles in patients with OI and determined their association with orthostatic symptoms. In this cross-sectional study, we prospectively enrolled 126 patients presenting with OI at the Seoul National University Hospital from December 2014 to August 2016. Among them, those with other neurological diseases (n = 8) and insufficient BP measurements (n = 15) were excluded. The degree of OI symptoms were measured using the self-administered orthostatic intolerance questionnaire (OIQ). All patients underwent ambulatory BP monitoring and we calculated the standard deviation and coefficient of variation as a measure of BPV. The mean age was 48.6 years and the average of the total OIQ score was 11.6. The severe OI group had higher BPV values than the mild group, although mean BP profiles did not differ significantly. Correlation analysis demonstrated that the orthostatic symptoms were positively correlated with diastolic BPV for the total and awake periods. Multiple linear regression analysis revealed that diastolic BPV (B = 0.46, p = 0.031) and current smoking (B = 4.687, p = 0.018) were independent factors for higher OI symptom scores after adjusting for covariates. The results of the current study demonstrated that a positive correlation exists between BPV and OI symptoms. Further studies are required to confirm the present findings and understand the neural mechanisms contributing to the excessive BPV in patients with OI.
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Affiliation(s)
- Jun-Sang Sunwoo
- Department of Neurology, Soonchunhyang University College of Medicine, Seoul, South Korea
| | - Tae-Won Yang
- Department of Neurology, Gyeongsang National University Changwon Hospital, Changwon, South Korea
| | - Do-Yong Kim
- Department of Neurology, Comprehensive Epilepsy Center, Seoul National University Hospital, Seoul, South Korea
- Program in Neuroscience, Seoul National University College of Medicine, Seoul, South Korea
| | - Jung-Ah Lim
- Department of Neurology, National Center for Mental Health, An affiliate of the Ministry for Health & Welfare, Seoul, South Korea
| | - Tae-Joon Kim
- Department of Neurology, Comprehensive Epilepsy Center, Seoul National University Hospital, Seoul, South Korea
- Program in Neuroscience, Seoul National University College of Medicine, Seoul, South Korea
| | - Jung-Ick Byun
- Department of Neurology, Kyung Hee University Hospital at Gangdong, Seoul, South Korea
| | - Jangsup Moon
- Department of Neurology, Comprehensive Epilepsy Center, Seoul National University Hospital, Seoul, South Korea
- Program in Neuroscience, Seoul National University College of Medicine, Seoul, South Korea
| | - Soon-Tae Lee
- Department of Neurology, Comprehensive Epilepsy Center, Seoul National University Hospital, Seoul, South Korea
- Program in Neuroscience, Seoul National University College of Medicine, Seoul, South Korea
| | - Keun-Hwa Jung
- Department of Neurology, Comprehensive Epilepsy Center, Seoul National University Hospital, Seoul, South Korea
- Program in Neuroscience, Seoul National University College of Medicine, Seoul, South Korea
| | - Kyung-Il Park
- Department of Neurology, Seoul National University Hospital Healthcare System Gangnam Center, Seoul, South Korea
| | - Ki-Young Jung
- Department of Neurology, Comprehensive Epilepsy Center, Seoul National University Hospital, Seoul, South Korea
- Program in Neuroscience, Seoul National University College of Medicine, Seoul, South Korea
| | - Manho Kim
- Department of Neurology, Comprehensive Epilepsy Center, Seoul National University Hospital, Seoul, South Korea
- Program in Neuroscience, Seoul National University College of Medicine, Seoul, South Korea
- Protein Metabolism Medical Research Center, Seoul National University College of Medicine, Seoul, South Korea
| | - Sang Kun Lee
- Department of Neurology, Comprehensive Epilepsy Center, Seoul National University Hospital, Seoul, South Korea
- Program in Neuroscience, Seoul National University College of Medicine, Seoul, South Korea
- * E-mail: (SKL); (KC)
| | - Kon Chu
- Department of Neurology, Comprehensive Epilepsy Center, Seoul National University Hospital, Seoul, South Korea
- Program in Neuroscience, Seoul National University College of Medicine, Seoul, South Korea
- * E-mail: (SKL); (KC)
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