Adaptive filtering for suppression of respiratory artifact in impedance cardiography

Advanced Computing Methods for Impedance Plethysmography Data Processing

In this paper we are introducing innovative solutions applied in impedance plethysmography concerning improvement of the rheagraph characteristics and the efficiency increase of the developing rheograms using computer methods. The described methods have been developed in order to ensure the stability of parameters and to extend the functionality of the rheographic system based on digital signal processing, which applies to the compensation of the base resistance with a digital potentiometer, digital synthesis of quadrature excitation signals and the performance of digital synchronous detection. The emphasis was put on methods for determination of hemodynamic parameters by computer processing of the rheograms. As a result–three methods for respiratory artifacts elimination have been proposed: based on the discrete cosine transform, the discrete wavelet transform and the approximation of the zero line with spline functions. Additionally, computer methods for physiological indicators determination, including those based on wavelet decomposition, were also proposed and described in this paper. The efficiency of various rheogram compression algorithms was tested, evaluated and presented in this work.

Signal processing techniques applied to impedance cardiography ICG signals - a review

Over the last decade, Computer-Aided Diagnosis (CAD) systems have been provided significant research focus by researchers. CAD systems have been developed in order to minimise visual errors, to compensate manual interpretation, and to help medical staff to take decisions swiftly. These systems have been considered as powerful tools for a reliable, automatic, and low-cost monitoring and diagnosis. CAD systems are based on analysis and classification of several physiological signals for detecting and assessing different diseases related to the corresponding organ. The implementation of these systems requires the application of several advanced signal processing techniques. Specifically, in cardiology, CAD systems have achieved promising results in providing an accurate and rapid detection of cardiovascular diseases (CVDs). Particularly, the number of works on signal processing field for impedance cardiography (ICG) signals starts to grow slowly in recent years. This paper presents a review study of signal processing techniques applied to the ICG signal for the denoising, the analysis, the classification and the characterisation purposes. This review is intended to provide researchers with a broad overview of the currently used signal processing techniques for ICG signal analysis, as well as to improve future research by applying other recent advanced methods.

An open-source automated algorithm for removal of noisy beats for accurate impedance cardiogram analysis

OBJECTIVE

The impedance cardiogram (ICG) is a non-invasive sensing modality for assessing the mechanical aspects of cardiac function, but is sensitive to artifacts from respiration, speaking, motion, and electrode displacement. Electrocardiogram (ECG)-synchronized ensemble averaging of ICG (conventional ensemble averaging method) partially mitigates these disturbances, as artifacts from intra-subject variability (ISVar) of ICG morphology and event latency remain. This paper describes an automated algorithm for removing noisy beats for improved artifact suppression in ensemble-averaged (EA) ICG beats.

APPROACH

Synchronized ECG and ICG signals from 144 male subjects at rest in different psychological conditions were recorded. A 'three-stage EA ICG beat' was formed by passing 60-seconds non-overlapping ECG-synchronized ICG signals through three filtering stages. The amplitude filtering stage removed spikes/noisy beats with amplitudes outside of normal physiological ranges. Cross-correlation was applied to remove noisy beats in coarse and fine filtering stages. The accuracy of the algorithm-detected artifacts was measured with expert-identified artifacts. Agreement between the expert and the algorithm was assessed using intraclass correlation coefficients (ICC) and Bland-Altman plots. The ISVar of the cardiac parameters was evaluated to quantify improvement in these estimates provided by the proposed method.

MAIN RESULTS

The proposed algorithm yielded an accuracy of 96.3% and high inter-rater reliability (ICC > 0.997). Bland-Altman plots showed consistently accurate results across values. The ISVar of the cardiac parameters derived using the proposed method was significantly lower than those derived via conventional ensemble averaging method (p < 0.0001). Enhancement in resolution of fiducial points and smoothing of higher-order time derivatives of the EA ICG beats were observed.

SIGNIFICANCE

The proposed algorithm provides a robust framework for removal of noisy beats and accurate estimation of ICG-based parameters. Importantly, the methodology reduced the ISVar of cardiac parameters. An open-source toolbox has been provided to enable other researchers to readily reproduce and improve upon this work.

Adaptive Filtering Improved Apnea Detection Performance Using Tracheal Sounds in Noisy Environment: A Simulation Study

Objective

Tracheal sounds were used to detect apnea on various occasions. However, ambient noises can contaminate tracheal sounds which result in poor performance of apnea detection. The objective of this paper was to apply the adaptive filtering (AF) algorithm to improve the quality of tracheal sounds and examine the accuracy of the apnea detection algorithm using tracheal sounds after AF.

Method

Tracheal sounds were acquired using a primary microphone encased in a plastic bell, and the ambient noises were collected using a reference microphone resting outside the plastic bell in quiet and noisy environments, respectively. Simultaneously, the flow pressure signals and thoracic and abdominal movement were obtained as the standard signals to determine apnea events. Then, the normalized least mean square (NLMS) AF algorithm was applied to the tracheal sounds mixed with noises. Finally, the algorithm of apnea detection was used to the tracheal sounds with AF and the tracheal sounds without AF. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), accuracy, and Cohen's kappa coefficient of apnea detection were calculated.

Results

Forty-six healthy subjects, aged 18-35 years and with BMI < 21.4, were included in the study. The apnea detection performance using tracheal sounds was as follows: in the quiet environment, the tracheal sounds without AF detected apnea with 97.2% sensitivity, 99.9% specificity, 99.8% PPV, 99.4% NPV, 99.5% accuracy, and 0.982 kappa coefficient. The tracheal sounds with AF detected apnea with 98.2% sensitivity, 99.9% specificity, 99.4% PPV, 99.6% NPV, 99.6% accuracy, and 0.985 kappa coefficient. While in the noisy environment, the tracheal sounds without AF detected apnea with 81.1% sensitivity, 96.9% specificity, 85.1% PPV, 96% NPV, 94.2% accuracy, and 0.795 kappa coefficient and the tracheal sounds with AF detected apnea with 91.5% sensitivity, 97.4% specificity, 88.4% PPV, 98.2% NPV, 96.4% accuracy, and 0.877 kappa coefficient.

Conclusion

The performance of apnea detection using tracheal sounds with the NLMS AF algorithm in the noisy environment proved to be accurate and reliable. The AF technology could be applied to the respiratory monitoring using tracheal sounds.

Impedance cardiography signal denoising using discrete wavelet transform

Impedance cardiography (ICG) is a non-invasive technique for diagnosing cardiovascular diseases. In the acquisition procedure, the ICG signal is often affected by several kinds of noise which distort the determination of the hemodynamic parameters. Therefore, doctors cannot recognize ICG waveform correctly and the diagnosis of cardiovascular diseases became inaccurate. The aim of this work is to choose the most suitable method for denoising the ICG signal. Indeed, different wavelet families are used to denoise the ICG signal. The Haar, Daubechies (db2, db4, db6, and db8), Symlet (sym2, sym4, sym6, sym8) and Coiflet (coif2, coif3, coif4, coif5) wavelet families are tested and evaluated in order to select the most suitable denoising method. The wavelet family with best performance is compared with two denoising methods: one based on Savitzky-Golay filtering and the other based on median filtering. Each method is evaluated by means of the signal to noise ratio (SNR), the root mean square error (RMSE) and the percent difference root mean square (PRD). The results show that the Daubechies wavelet family (db8) has superior performance on noise reduction in comparison to other methods.