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Yang X, Huang X, Wei C, Yu J, Yu X, Dong C, Chen J, Chen R, Wu X, Yu Z, Sun B, Wang J, Liu H, Han W, Sun B, Jiang Z, Ding J, Liu Z, Peng J, Ni D, Deng X, Liu L, Gou Z. An intelligent quantification system for fetal heart rhythm assessment: A multicenter prospective study. Heart Rhythm 2024; 21:600-609. [PMID: 38266752 DOI: 10.1016/j.hrthm.2024.01.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Revised: 01/04/2024] [Accepted: 01/15/2024] [Indexed: 01/26/2024]
Abstract
BACKGROUND The motion relationship and time intervals of the pulsed-wave Doppler (PWD) spectrum are essential for diagnosing fetal arrhythmia. However, few technologies currently are available to automatically calculate fetal cardiac time intervals (CTIs). OBJECTIVE The purpose of this study was to develop a fetal heart rhythm intelligent quantification system (HR-IQS) for the automatic extraction of CTIs and establish the normal reference range for fetal CTIs. METHODS A total of 6498 PWD spectrums of 2630 fetuses over the junction between the left ventricular inflow and outflow tracts were recorded across 14 centers. E, A, and V waves were manually labeled by 3 experienced fetal cardiologists, with 17 CTIs extracted. Five-fold cross-validation was performed for training and testing of the deep learning model. Agreement between the manual and HR-IQS-based values was evaluated using the intraclass correlation coefficient and Spearman's rank correlation coefficient. The Jarque-Bera test was applied to evaluate the normality of CTIs' distributions, and the normal reference range of 17 CTIs was established with quantile regression. Arrhythmia subset was compared with the non-arrhythmia subset using the Mann-Whitney U test. RESULTS Significant positive correlation (P <.001) and moderate-to-excellent consistency (P <.001) between the manual and HR-IQS automated measurements of CTIs was found. The distribution of CTIs was non-normal (P <.001). The normal range (2.5th to 97.5th percentiles) was successfully established for the 17 CTIs. CONCLUSIONS Using our HR-IQS is feasible for the automated calculation of CTIs in practice and thus could provide a promising tool for the assessment of fetal rhythm and function.
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Affiliation(s)
- Xin Yang
- National-Regional Key Technology Engineering Laboratory for Medical Ultrasound, School of Biomedical Engineering, Health Science Center, Shenzhen University, Shenzhen, Guangdong, China
| | - Xiaoqiong Huang
- National-Regional Key Technology Engineering Laboratory for Medical Ultrasound, School of Biomedical Engineering, Health Science Center, Shenzhen University, Shenzhen, Guangdong, China
| | - Chenchen Wei
- Center for Cardiovascular Disease, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou, Jiangsu, China
| | - Junxuan Yu
- National-Regional Key Technology Engineering Laboratory for Medical Ultrasound, School of Biomedical Engineering, Health Science Center, Shenzhen University, Shenzhen, Guangdong, China; Shenzhen RayShape Medical Technology Co., Ltd, Shenzhen, Guangdong, China
| | - Xuejuan Yu
- Department of Ultrasonography, Suzhou Xiangcheng People's Hospital, Suzhou, Jiangsu, China
| | - Caixia Dong
- Department of Ultrasonography, Wulin Hospital, Hangzhou, Zhejiang, China
| | - Ju Chen
- Department of Ultrasonography, Taicang First People's Hospital, Suzhou, Jiangsu, China
| | - Ruifeng Chen
- Department of Ultrasound Diagnosis, The Affiliated Changsha Central Hospital, Hengyang Medical School, University of South China, Changsha, Hunan, China
| | - Xiafang Wu
- Department of Ultrasonography, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Linhai, Zhejiang, China
| | - Zhuan Yu
- Department of Ultrasonography, The Affiliated Hospital of Jiangsu University, Zhenjiang, Jiangsu, China
| | - Baojuan Sun
- Department of Ultrasonography, Huai'an Maternal and Child Health Hospital, Huai'an, Jiangsu, China
| | - Junli Wang
- Department of Ultrasonography, Wuhu No.2 People's Hospital, Wuhu, Anhui, China
| | - Hongmei Liu
- Department of Ultrasonography, Panzhou Emerging Hospital, Panzhou, Guizhou, China
| | - Wen Han
- Department of Ultrasonography, Suzhou Gaoxin District People's Hospital, Suzhou, Jiangsu, China
| | - Biyun Sun
- Department of Ultrasonography, The Affiliated Yijishan Hospital of Wannan Medical University, Wuhu, Anhui, China
| | - Zhiyong Jiang
- Department of Ultrasonography, The Huaren Hospital, Wuhu, Zhejiang, China
| | - Jie Ding
- Department of Ultrasonography, The Affiliated Suzhou Hospital of Nanjing University, Suzhou, Jiangsu, China
| | - Zhe Liu
- National-Regional Key Technology Engineering Laboratory for Medical Ultrasound, School of Biomedical Engineering, Health Science Center, Shenzhen University, Shenzhen, Guangdong, China; Shenzhen RayShape Medical Technology Co., Ltd, Shenzhen, Guangdong, China
| | - Jin Peng
- National-Regional Key Technology Engineering Laboratory for Medical Ultrasound, School of Biomedical Engineering, Health Science Center, Shenzhen University, Shenzhen, Guangdong, China; Shenzhen RayShape Medical Technology Co., Ltd, Shenzhen, Guangdong, China
| | - Dong Ni
- National-Regional Key Technology Engineering Laboratory for Medical Ultrasound, School of Biomedical Engineering, Health Science Center, Shenzhen University, Shenzhen, Guangdong, China
| | - Xuedong Deng
- Center for Medical Ultrasound, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou, Jiangsu, China
| | - Lian Liu
- National-Regional Key Technology Engineering Laboratory for Medical Ultrasound, School of Biomedical Engineering, Health Science Center, Shenzhen University, Shenzhen, Guangdong, China; Shenzhen RayShape Medical Technology Co., Ltd, Shenzhen, Guangdong, China.
| | - Zhongshan Gou
- Center for Cardiovascular Disease, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou, Jiangsu, China.
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Kim MS, Choi HK, Park SH, Lee JI, Lee J. Poncirus trifoliata Aqueous Extract Protects Cardiomyocytes against Doxorubicin-Induced Toxicity through Upregulation of NAD(P)H Dehydrogenase Quinone Acceptor Oxidoreductase 1. Molecules 2023; 28:8090. [PMID: 38138580 PMCID: PMC10745630 DOI: 10.3390/molecules28248090] [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: 10/29/2023] [Revised: 12/11/2023] [Accepted: 12/13/2023] [Indexed: 12/24/2023] Open
Abstract
Doxorubicin (DOX), an anthracycline-based chemotherapeutic agent, is widely used to treat various types of cancer; however, prolonged treatment induces cardiomyotoxicity. Although studies have been performed to overcome DOX-induced cardiotoxicity (DICT), no effective method is currently available. This study investigated the effects and potential mechanisms of Poncirus trifoliata aqueous extract (PTA) in DICT. Changes in cell survival were assessed in H9c2 rat cardiomyocytes and MDA-MB-231 human breast cancer cells. The C57BL/6 mice were treated with DOX to induce DICT in vivo, and alterations in electrophysiological characteristics, serum biomarkers, and histological features were examined. The PTA treatment inhibited DOX-induced decrease in H9c2 cell viability but did not affect the MDA-MB-231 cell viability. Additionally, the PTA restored the abnormal heart rate, R-R interval, QT interval, and ST segment and inhibited the decrease in serum cardiac and hepatic toxicity indicators in the DICT model. Moreover, the PTA administration protected against myocardial fibrosis and apoptosis in the heart tissue of mice with DICT. PTA treatment restored DOX-induced decrease in the expression of NAD(P)H dehydrogenase quinone acceptor oxidoreductase 1 in a PTA concentration-dependent manner. In conclusion, the PTA inhibitory effect on DICT is attributable to its antioxidant properties, suggesting the potential of PTA as a phytotherapeutic agent for DICT.
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Affiliation(s)
| | | | | | | | - Jangho Lee
- Korea Food Research Institute, Wanju 55365, Republic of Korea; (M.-S.K.); (H.-K.C.); (S.-H.P.); (J.-I.L.)
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Comani S, Van Leeuwen P, Lange S, Geue D, Grönemeyer D. Influence of gestational age on the effectiveness of spatial and temporal methods for the reconstruction of the fetal magnetocardiogram. ACTA ACUST UNITED AC 2009; 54:29-37. [PMID: 19182871 DOI: 10.1515/bmt.2009.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Fetal magnetocardiography (fMCG) has been shown to augment fetal ultrasound evaluation for high-risk conditions, but the clinical utility of fMCG depends on the reliability of the cardiac traces reconstructed. We performed a methodological study to examine the influence of gestational age on the properties of the fetal magnetocardiograms extracted with two methods of signal reconstruction: the template matching technique (TMT), which extracts the maternal components from the signal using only temporal information, and independent component analysis (ICA), which separates the fetal signals by using information on the spatial distribution of the mixed source signals in addition to higher order temporal statistics. Efficiency and accuracy were evaluated in terms of fetal beat detection, signal characteristics, and duration of cardiac time intervals (CTIs) on the averaged traces. ICA outperformed TMT with regard to beat detection and signal-to-noise ratio. The timing of the heartbeats and the duration of the CTIs were essentially the same, whereas some alterations in signal morphology were observed in the ICA traces. We conclude that ICA may be useful in early gestation when the signals are noisy, while TMT may be preferred when accurate beat morphology is required for diagnostic purposes.
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Affiliation(s)
- Silvia Comani
- Behavioral Imaging and Neural Dynamics (BIND) Center, University of Chieti-Pescara, Chieti, Italy.
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Comani S, Alleva G. Fetal cardiac time intervals estimated on fetal magnetocardiograms: single cycle analysis versus average beat inspection. Physiol Meas 2006; 28:49-60. [PMID: 17151419 DOI: 10.1088/0967-3334/28/1/005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Fetal cardiac time intervals (fCTI) are dependent on fetal growth and development, and may reveal useful information for fetuses affected by growth retardation, structural cardiac defects or long QT syndrome. Fetal cardiac signals with a signal-to-noise ratio (SNR) of at least 15 dB were retrieved from fetal magnetocardiography (fMCG) datasets with a system based on independent component analysis (ICA). An automatic method was used to detect the onset and offset of the cardiac waves on single cardiac cycles of each signal, and the fCTI were quantified for each heartbeat; long rhythm strips were used to calculate average fCTI and their variability for single fetal cardiac signals. The aim of this work was to compare the outcomes of this system with the estimates of fCTI obtained with a classical method based on the visual inspection of averaged beats. No fCTI variability can be measured from averaged beats. A total of 25 fMCG datasets (fetal age from 22 to 37 weeks) were evaluated, and 1768 cardiac cycles were used to compute fCTI. The real differences between the values obtained with a single cycle analysis and visual inspection of averaged beats were very small for all fCTI. They were comparable with signal resolution (+/-1 ms) for QRS complex and QT interval, and always <5 ms for the PR interval, ST segment and T wave. The coefficients of determination between the fCTI estimated with the two methods ranged between 0.743 and 0.917. Conversely, inter-observer differences were larger, and the related coefficients of determination ranged between 0.463 and 0.807, assessing the high performance of the automated single cycle analysis, which is also rapid and unaffected by observer-dependent bias.
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Affiliation(s)
- Silvia Comani
- ITAB, Institute of Advanced Biomedical Technologies, University Foundation 'G. D'Annunzio', Italy.
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Comani S, Mantini D, Alleva G, Di Luzio S, Romani GL. Optimal filter design for shielded and unshielded ambient noise reduction in fetal magnetocardiography. Phys Med Biol 2005; 50:5509-21. [PMID: 16306648 DOI: 10.1088/0031-9155/50/23/006] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
The greatest impediment to extracting high-quality fetal signals from fetal magnetocardiography (fMCG) is environmental magnetic noise, which may have peak-to-peak intensity comparable to fetal QRS amplitude. Being an unstructured Gaussian signal with large disturbances at specific frequencies, ambient field noise can be reduced with hardware-based approaches and/or with software algorithms that digitally filter magnetocardiographic recordings. At present, no systematic evaluation of filters' performances on shielded and unshielded fMCG is available. We designed high-pass and low-pass Chebychev II-type filters with zero-phase and stable impulse response; the most commonly used band-pass filters were implemented combining high-pass and low-pass filters. The achieved ambient noise reduction in shielded and unshielded recordings was quantified, and the corresponding signal-to-noise ratio (SNR) and signal-to-distortion ratio (SDR) of the retrieved fetal signals was evaluated. The study regarded 66 fMCG datasets at different gestational ages (22-37 weeks). Since the spectral structures of shielded and unshielded magnetic noise were very similar, we concluded that the same filter setting might be applied to both conditions. Band-pass filters (1.0-100 Hz) and (2.0-100 Hz) provided the best combinations of fetal signal detection rates, SNR and SDR; however, the former should be preferred in the case of arrhythmic fetuses, which might present spectral components below 2 Hz.
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Affiliation(s)
- S Comani
- Department of Clinical Sciences and Bio-imaging, Chieti University, Italy.
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