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Liu B, Thilaganathan B, Bhide A. Phase-rectified signal averaging: correlation between two monitors and relationship with short-term variation of fetal heart rate. Ultrasound Obstet Gynecol 2023; 61:765-772. [PMID: 36864541 DOI: 10.1002/uog.26192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 02/10/2023] [Accepted: 02/14/2023] [Indexed: 06/03/2023]
Abstract
OBJECTIVES To establish the correlation between phase-rectified signal averaging (PRSA) outputs obtained from a novel self-applicable non-invasive fetal electrocardiography (NIFECG) monitor with those from computerized cardiotocography (cCTG). A secondary objective was to evaluate the potential for remote assessment of fetal wellbeing by determining the relationship between PRSA and short-term variation (STV). METHODS This was a prospective observational study of women with a singleton pregnancy over 28 + 0 weeks' gestation attending a London teaching hospital for cCTG assessment. Participants underwent concurrent cCTG and NIFECG monitoring for up to 60 min. Averaged accelerative (AAC) and decelerative (ADC) capacities and STV were derived by postprocessing and filtration of signals, generating fully (F) and partially (P) filtered results. Linear correlation and accuracy and precision analysis were performed to assess the relationship between PRSA outputs from cCTG and NIFECG, using varying anchor thresholds, and their association with STV. RESULTS A total of 306 concurrent cCTG and NIFECG traces were collected from 285 women. F-filtered NIFECG PRSA (eAAC/eADC) results were generated from 65% of traces, whereas cCTG PRSA (cAAC/cADC) outputs were generated from all. Strong correlations were observed between cAAC and F-filtered eAAC (r = 0.879, P < 0.001) and between cADC and F-filtered eADC (r = 0.895, P < 0.001). NIFECG anchor detection decreased significantly with increasing signal loss, and NIFECG PRSA indices showed considerable deviation from those of cCTG when derived from traces in which fewer than 100 anchors were detected. Removing anchor filters from NIFECG traces to generate P-filtered PRSA outputs weakened the correlation (AAC: r = 0.505, P < 0.001; ADC: r = 0.560, P < 0.001). Lowering the anchor threshold to 100 increased the yield of eAAC and eADC outputs to approximately 74%, whilst maintaining strong correlation with cAAC (r = 0.839, P < 0.001) and cADC (r = 0.815, P < 0.001), respectively. Both cAAC and cADC showed a very strong linear relationship with cCTG STV (r = 0.928, P < 0.001 and r = 0.911, P < 0.001, respectively). Similar findings were observed with eAAC (r = 0.825, P < 0.001) and eADC (r = 0.827, P < 0.001). CONCLUSIONS PRSA appears to be a method of fetal assessment equivalent to STV, but, due to its innate ability to eliminate artifacts, it generates interpretable NIFECG traces with high accuracy at a higher rate. These findings raise the possibility of self-applied at-home or remote fetal heart-rate monitoring with automated reporting, thus enabling increased surveillance in high-risk women without impacting on service demand. © 2023 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- B Liu
- Fetal Medicine Unit, St George's University Hospitals NHS Foundation Trust, London, UK
- Vascular Biology Research Centre, Molecular and Clinical Sciences Research Institute, St George's University of London, London, UK
| | - B Thilaganathan
- Fetal Medicine Unit, St George's University Hospitals NHS Foundation Trust, London, UK
- Vascular Biology Research Centre, Molecular and Clinical Sciences Research Institute, St George's University of London, London, UK
| | - A Bhide
- Fetal Medicine Unit, St George's University Hospitals NHS Foundation Trust, London, UK
- Vascular Biology Research Centre, Molecular and Clinical Sciences Research Institute, St George's University of London, London, UK
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Chen T, Feng G, Heiselman C, Quirk JG, Djurić PM. IMPROVING PHASE-RECTIFIED SIGNAL AVERAGING FOR FETAL HEART RATE ANALYSIS. Proc IEEE Int Conf Acoust Speech Signal Process 2022; 2022. [PMID: 36035505 PMCID: PMC9415860 DOI: 10.1109/icassp43922.2022.9747860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Low umbilical artery pH is a marker for neonatal acidosis and is associated with an increased risk for neonatal complications. The phase-rectified signal averaging (PRSA) features have demonstrated superior discriminatory or diagnostic ability and good interpretability in many biomedical applications including fetal heart rate analysis. However, the performance of PRSA method is sensitive to values of the selected parameters which are usually either chosen based on a grid search or empirically in the literature. In this paper, we examine PRSA method through the lens of dynamical systems theory and reveal the intrinsic connection between state space reconstruction and PRSA. From this perspective, we then introduce a new feature that can better characterize dynamical systems comparing with PRSA. Our experimental results on an open-access intrapartum Cardiotocography database demonstrate that the proposed feature outperforms state-of-the-art PRSA features in pH-based fetal heart rate analysis.
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Affiliation(s)
- Tong Chen
- Department of Electrical and Computer Engineering, Stony Brook University
| | - Guanchao Feng
- Department of Electrical and Computer Engineering, Stony Brook University
| | - Cassandra Heiselman
- Department of Obstetrics/Gynecology, Renaissance School of Medicine, Stony Brook University
| | - J Gerald Quirk
- Department of Obstetrics/Gynecology, Renaissance School of Medicine, Stony Brook University
| | - Petar M Djurić
- Department of Electrical and Computer Engineering, Stony Brook University
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López-Justo C, Pliego-Carrillo AC, Ledesma-Ramírez CI, Mendieta-Zerón H, Peña-Castillo MÁ, Echeverría JC, Rodríguez-Arce J, Reyes-Lagos JJ. Differences in the Asymmetry of Beat-to-Beat Fetal Heart Rate Accelerations and Decelerations at Preterm and Term Active Labor. Sensors (Basel) 2021; 21:s21248249. [PMID: 34960343 PMCID: PMC8704786 DOI: 10.3390/s21248249] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 11/30/2021] [Accepted: 12/06/2021] [Indexed: 11/29/2022]
Abstract
The fetal autonomic nervous system responds to uterine contractions during active labor as identified by changes in the accelerations and decelerations of fetal heart rate (FHR). Thus, this exploratory study aimed to characterize the asymmetry differences of beat-to-beat FHR accelerations and decelerations in preterm and term fetuses during active labor. In an observational study, we analyzed 10 min of fetal R-R series collected from women during active preterm labor (32–36 weeks of pregnancy, n = 17) and active term labor (38–40 weeks of pregnancy, n = 27). These data were used to calculate the Deceleration Reserve (DR), which is a novel parameter that quantifies the asymmetry of the average acceleration and deceleration capacity of the heart. In addition, relevant multiscale asymmetric indices of FHR were also computed. Lower values of DR, calculated with the input parameters of T = 50 and s = 10, were associated with labor occurring at the preterm condition (p = 0.0131). Multiscale asymmetry indices also confirmed significant (p < 0.05) differences in the asymmetry of FHR. Fetuses during moderate premature labor may experience more decaying R-R trends and a lower magnitude of decelerations compared to term fetuses. These differences of FHR dynamics might be related to the immaturity of the fetal cardiac autonomic nervous system as identified by this system response to the intense uterine activity at active labor.
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Affiliation(s)
- Carolina López-Justo
- Facultad de Medicina (School of Medicine), Universidad Autónoma del Estado de México (Autonomous University of Mexico State), Toluca de Lerdo 50180, Mexico; (C.L.-J.); (A.C.P.-C.); (C.I.L.-R.); (H.M.-Z.)
| | - Adriana Cristina Pliego-Carrillo
- Facultad de Medicina (School of Medicine), Universidad Autónoma del Estado de México (Autonomous University of Mexico State), Toluca de Lerdo 50180, Mexico; (C.L.-J.); (A.C.P.-C.); (C.I.L.-R.); (H.M.-Z.)
| | - Claudia Ivette Ledesma-Ramírez
- Facultad de Medicina (School of Medicine), Universidad Autónoma del Estado de México (Autonomous University of Mexico State), Toluca de Lerdo 50180, Mexico; (C.L.-J.); (A.C.P.-C.); (C.I.L.-R.); (H.M.-Z.)
| | - Hugo Mendieta-Zerón
- Facultad de Medicina (School of Medicine), Universidad Autónoma del Estado de México (Autonomous University of Mexico State), Toluca de Lerdo 50180, Mexico; (C.L.-J.); (A.C.P.-C.); (C.I.L.-R.); (H.M.-Z.)
- Hospital Materno Perinatal Mónica Pretelini Sáenz, Instituto de Salud del Estado de México (Health Institute of Mexico State), Toluca de Lerdo 50010, Mexico
| | - Miguel Ángel Peña-Castillo
- División de Ciencias Básicas e Ingeniería (Basic Science and Engineering Division), Universidad Autónoma Metropolitana Unidad Iztapalapa (Metropolitan Autonomous University Campus Iztapalapa), Iztapalapa 09340, Mexico; (M.Á.P.-C.); (J.C.E.)
| | - Juan Carlos Echeverría
- División de Ciencias Básicas e Ingeniería (Basic Science and Engineering Division), Universidad Autónoma Metropolitana Unidad Iztapalapa (Metropolitan Autonomous University Campus Iztapalapa), Iztapalapa 09340, Mexico; (M.Á.P.-C.); (J.C.E.)
| | - Jorge Rodríguez-Arce
- Facultad de Ingeniería (School of Engineering), Universidad Autónoma del Estado de México (Autonomous University of Mexico State), Toluca de Lerdo 50100, Mexico;
| | - José Javier Reyes-Lagos
- Facultad de Medicina (School of Medicine), Universidad Autónoma del Estado de México (Autonomous University of Mexico State), Toluca de Lerdo 50180, Mexico; (C.L.-J.); (A.C.P.-C.); (C.I.L.-R.); (H.M.-Z.)
- Correspondence:
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Georgieva A, Lear CA, Westgate JA, Kasai M, Miyagi E, Ikeda T, Gunn AJ, Bennet L. Deceleration area and capacity during labour-like umbilical cord occlusions identify evolving hypotension: a controlled study in fetal sheep. BJOG 2021; 128:1433-1442. [PMID: 33369871 DOI: 10.1111/1471-0528.16638] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/18/2020] [Indexed: 12/20/2022]
Abstract
OBJECTIVE Cardiotocography is widely used to assess fetal well-being during labour. The positive predictive value of current clinical algorithms to identify hypoxia-ischaemia is poor. In experimental studies, fetal hypotension is the strongest predictor of hypoxic-ischaemic injury. Cohort studies suggest that deceleration area and deceleration capacity of the fetal heart rate trace correlate with fetal acidaemia, but it is not known whether they are indices of fetal arterial hypotension. DESIGN Prospective, controlled study. SETTING Laboratory. SAMPLE Near-term fetal sheep. METHODS One minute of complete umbilical cord occlusions (UCOs) every 5 minutes (1:5 min, n = 6) or every 2.5 minutes (1:2.5 min, n = 12) for 4 hours or until fetal mean arterial blood pressure fell <20 mmHg. MAIN OUTCOME MEASURES Deceleration area and capacity during the UCO series were related to evolving hypotension. RESULTS The 1:5 min group developed only mild metabolic acidaemia, without hypotension. By contrast, 10/12 fetuses in the 1:2.5-min group progressively developed severe metabolic acidaemia and hypotension, reaching 16.8 ± 0.9 mmHg after 71.2 ± 6.7 UCOs. Deceleration area and capacity remained unchanged throughout the UCO series in the 1:5-min group, but progressively increased in the 1:2.5-min group. The severity of hypotension was closely correlated with both deceleration area (P < 0.001, R2 = 0.66, n = 18) and capacity (P < 0.001, R2 = 0.67, n = 18). Deceleration area and capacity predicted development of hypotension at a median of 103 and 123 minutes before the final occlusion, respectively. CONCLUSIONS Both deceleration area and capacity were strongly associated with developing fetal hypotension, supporting their potential to improve identification of fetuses at risk of hypotension leading to hypoxic-ischaemic injury during labour. TWEETABLE ABSTRACT Deceleration area and capacity of fetal heart rate identify developing hypotension during labour-like hypoxia.
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Affiliation(s)
- A Georgieva
- Nuffield Department of Women's and Reproductive Health, The John Radcliffe Hospital, University of Oxford, Oxford, UK
| | - C A Lear
- Fetal Physiology and Neuroscience Group, Department of Physiology, The University of Auckland, Auckland, New Zealand
| | - J A Westgate
- Fetal Physiology and Neuroscience Group, Department of Physiology, The University of Auckland, Auckland, New Zealand
| | - M Kasai
- Fetal Physiology and Neuroscience Group, Department of Physiology, The University of Auckland, Auckland, New Zealand.,The Department of Obstetrics and Gynecology, Yokohama City University, Yokohama, Japan
| | - E Miyagi
- The Department of Obstetrics and Gynecology, Yokohama City University, Yokohama, Japan
| | - T Ikeda
- Department of Obstetrics and Gynecology, Mie University, Mie, Japan
| | - A J Gunn
- Fetal Physiology and Neuroscience Group, Department of Physiology, The University of Auckland, Auckland, New Zealand
| | - L Bennet
- Fetal Physiology and Neuroscience Group, Department of Physiology, The University of Auckland, Auckland, New Zealand
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De Maria B, Bari V, Cairo B, Vaini E, Esler M, Lambert E, Baumert M, Cerutti S, Dalla Vecchia L, Porta A. Characterization of the Asymmetry of the Cardiac and Sympathetic Arms of the Baroreflex From Spontaneous Variability During Incremental Head-Up Tilt. Front Physiol 2019; 10:342. [PMID: 31001137 PMCID: PMC6454064 DOI: 10.3389/fphys.2019.00342] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2018] [Accepted: 03/13/2019] [Indexed: 11/13/2022] Open
Abstract
Hysteresis of the baroreflex (BR) is the result of the different BR sensitivity (BRS) when arterial pressure (AP) rises or falls. This phenomenon has been poorly studied and almost exclusively examined by applying pharmacological challenges and static approaches disregarding causal relations. This study inspects the asymmetry of the cardiac BR (cBR) and vascular sympathetic BR (sBR) in physiological closed loop conditions from spontaneous fluctuations of physiological variables, namely heart period (HP) and systolic AP (SAP) leading to the estimation of cardiac BRS (cBRS) and muscle sympathetic nerve activity (MSNA) and diastolic AP (DAP) leading to the estimation of vascular sympathetic BRS (sBRS). The assessment was carried out in 12 young healthy subjects undergoing incremental head-up tilt with table inclination gradually increased from 0 to 60°. Two analytical methods were exploited and compared, namely the sequence (SEQ) and phase-rectified signal averaging (PRSA) methods. SEQ analysis is based on the detection of joint causal schemes representing the HP and MSNA burst rate delayed responses to spontaneous SAP and DAP modifications, respectively. PRSA analysis averages HP and MSNA burst rate patterns after aligning them according to the direction of SAP and DAP changes, respectively. Since cBRSs were similar when SAP went up or down, hysteresis of cBR was not detected. Conversely, hysteresis of sBR was evident with sBRS more negative when DAP was falling than rising. sBR hysteresis was no longer visible during sympathetic activation induced by the orthostatic challenge. These results were obtained via the SEQ method, while the PRSA technique appeared to be less powerful in describing the BR asymmetry due to the strong association between BRS estimates computed over positive and negative AP variations. This study suggests that cBR and sBR provide different information about the BR control, sBR exhibits more relevant non-linear features that are evident even during physiological changes of AP, and the SEQ method can be fruitfully exploited to characterize the BR hysteresis with promising applications to BR branches different from cBR and sBR.
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Affiliation(s)
| | - Vlasta Bari
- Department of Cardiothoracic, Vascular Anesthesia and Intensive Care, IRCCS Policlinico San Donato, Milan, Italy
| | - Beatrice Cairo
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| | - Emanuele Vaini
- Department of Cardiothoracic, Vascular Anesthesia and Intensive Care, IRCCS Policlinico San Donato, Milan, Italy
| | - Murray Esler
- Human Neurotransmitters Laboratory, Baker IDI Heart and Diabetes Institute, Melbourne, VIC, Australia
| | - Elisabeth Lambert
- Human Neurotransmitters Laboratory, Baker IDI Heart and Diabetes Institute, Melbourne, VIC, Australia.,Faculty of Health, Arts and Design, Iverson Health Innovation Research Institute, Swinburne University of Technology, Hawthorn, VIC, Australia
| | - Mathias Baumert
- School of Electrical and Electronic Engineering, The University of Adelaide, Adelaide, SA, Australia
| | - Sergio Cerutti
- Department of Electronics Information and Bioengineering, Politecnico di Milano, Milan, Italy
| | | | - Alberto Porta
- Department of Cardiothoracic, Vascular Anesthesia and Intensive Care, IRCCS Policlinico San Donato, Milan, Italy.,Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
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Lobmaier SM, Ortiz JU, Sewald M, Müller A, Schmidt G, Haller B, Oberhoffer R, Schneider KTM, Giussani DA, Wacker-Gussmann A. Influence of gestational diabetes on fetal autonomic nervous system: a study using phase-rectified signal-averaging analysis. Ultrasound Obstet Gynecol 2018; 52:347-351. [PMID: 28782142 DOI: 10.1002/uog.18823] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Revised: 07/02/2017] [Accepted: 07/28/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVES Maternal gestational diabetes mellitus (GDM) is known to influence fetal physiology. Phase-rectified signal averaging (PRSA) is an innovative signal-processing technique that can be used to investigate fetal heart signals. The PRSA-calculated variables average acceleration capacity (AAC) and average deceleration capacity (ADC) are established indices of autonomic nervous system (ANS) function. The aim of this study was to evaluate the influence of GDM on the fetal cardiovascular and ANS function in human pregnancy using PRSA. METHODS This was a prospective clinical case-control study of 58 mothers with diagnosed GDM and 58 gestational-age matched healthy controls in the third trimester of pregnancy. Fetal cardiotocography (CTG) recordings were performed in all cases at entry to the study, and a follow-up recording was performed in 19 GDM cases close to delivery. The AAC and ADC indices were calculated by the PRSA method and fetal heart rate short-term variation (STV) by CTG software according to Dawes-Redman criteria. RESULTS Mean gestational age of both groups at study entry was 35.7 weeks. There was a significant difference in mean AAC (1.97 ± 0.33 bpm vs 2.42 ± 0.57 bpm; P < 0.001) and ADC (1.94 ± 0.32 bpm vs 2.28 ± 0.46 bpm; P < 0.001) between controls and fetuses of diabetic mothers. This difference could not be demonstrated using standard computerized fetal CTG analysis of STV (controls, 10.8 ± 3.0 ms vs GDM group, 11.3 ± 2.5 ms; P = 0.32). Longitudinal fetal heart rate measurements in a subgroup of women with diabetes were not significantly different from those at study entry. CONCLUSIONS Our findings show increased ANS activity in fetuses of diabetic mothers in late gestation. Analysis of human fetal cardiovascular and ANS function by PRSA may offer improved surveillance over conventional techniques linking GDM pregnancy to future cardiovascular dysfunction in the offspring. Copyright © 2017 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- S M Lobmaier
- Department of Gynecology and Obstetrics, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - J U Ortiz
- Department of Gynecology and Obstetrics, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - M Sewald
- Department of Gynecology and Obstetrics, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - A Müller
- Medizinische Klinik und Deutsches Herzzentrum München, Technical University of Munich, Munich, Germany
| | - G Schmidt
- Medizinische Klinik und Deutsches Herzzentrum München, Technical University of Munich, Munich, Germany
| | - B Haller
- Institute for Medical Statistics and Epidemiology (IMSE), Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - R Oberhoffer
- Deutsches Herzzentrum München, Klinik für Kinderkardiologie und Angeborene Herzfehler, Munich, Germany
- Department of Sport and Health Sciences, Technical University of Munich, Munich, Germany
| | - K T M Schneider
- Department of Gynecology and Obstetrics, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - D A Giussani
- Department of Physiology, Development and Neuroscience, University of Cambridge, Cambridge, UK
| | - A Wacker-Gussmann
- Deutsches Herzzentrum München, Klinik für Kinderkardiologie und Angeborene Herzfehler, Munich, Germany
- Department of Sport and Health Sciences, Technical University of Munich, Munich, Germany
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7
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Sinnecker D, Dommasch M, Steger A, Berkefeld A, Hoppmann P, Müller A, Gebhardt J, Barthel P, Hnatkova K, Huster KM, Laugwitz KL, Malik M, Schmidt G. Expiration-Triggered Sinus Arrhythmia Predicts Outcome in Survivors of Acute Myocardial Infarction. J Am Coll Cardiol 2017; 67:2213-2220. [PMID: 27173032 DOI: 10.1016/j.jacc.2016.03.484] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Revised: 03/02/2016] [Accepted: 03/07/2016] [Indexed: 11/29/2022]
Abstract
BACKGROUND Respiratory sinus arrhythmia (RSA), a measure of cardiac vagal modulation, provides cardiac risk stratification information. RSA can be quantified from Holter recordings as the high-frequency component of heart rate variability or as the variability of RR intervals in individual respiratory cycles. However, as a risk predictor, RSA is neither exceptionally sensitive nor specific. OBJECTIVES This study aimed to improve RSA determination by quantifying the amount of sinus arrhythmia related to expiration (expiration-triggered sinus arrhythmia [ETA]) from short-term recordings of electrocardiogram and respiratory chest excursions, and investigated the predictive power of ETA in survivors of acute myocardial infarction. METHODS Survivors of acute myocardial infarction (N = 941) underwent 30-min recordings of electrocardiogram and respiratory chest excursions. ETA was quantified as the RR interval change associated with expiration by phase-rectified signal averaging. Primary outcome was 5-year all-cause mortality. Univariable and multivariable Cox regression was used to investigate the association of ETA with mortality. RESULTS ETA was a strong predictor of mortality, both in univariable and multivariable analysis. In a multivariable model including respiratory rate, left ventricular ejection fraction, diabetes mellitus, and GRACE score, ETA ≤0.19 ms was associated with a hazard ratio of 3.41 (95% confidence interval: 1.10 to 5.89, p < 0.0001). In patient subgroups defined by abnormal left ventricular ejection fraction, increased respiratory rate, high GRACE score, or presence of diabetes mellitus, patients were classified as high or low risk on the basis of ETA. CONCLUSIONS Expiration-triggered sinus arrhythmia (ETA) is a potent and independent post-infarction risk marker.
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Affiliation(s)
- Daniel Sinnecker
- 1. Medizinische Klinik und Poliklinik, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Michael Dommasch
- 1. Medizinische Klinik und Poliklinik, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Alexander Steger
- 1. Medizinische Klinik und Poliklinik, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Anna Berkefeld
- 1. Medizinische Klinik und Poliklinik, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Petra Hoppmann
- 1. Medizinische Klinik und Poliklinik, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Alexander Müller
- 1. Medizinische Klinik und Poliklinik, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Josef Gebhardt
- 1. Medizinische Klinik und Poliklinik, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Petra Barthel
- 1. Medizinische Klinik und Poliklinik, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Katerina Hnatkova
- Saint Paul's Cardiac Electrophysiology, University of London and Imperial College, London, London, United Kingdom
| | - Katharina M Huster
- 1. Medizinische Klinik und Poliklinik, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Karl-Ludwig Laugwitz
- 1. Medizinische Klinik und Poliklinik, Klinikum rechts der Isar, Technische Universität München, Munich, Germany; DZHK (German Center for Cardiovascular Research), partner site Munich Heart Alliance, Munich, Germany
| | - Marek Malik
- Saint Paul's Cardiac Electrophysiology, University of London and Imperial College, London, London, United Kingdom
| | - Georg Schmidt
- 1. Medizinische Klinik und Poliklinik, Klinikum rechts der Isar, Technische Universität München, Munich, Germany; DZHK (German Center for Cardiovascular Research), partner site Munich Heart Alliance, Munich, Germany.
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8
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Lobmaier SM, Mensing van Charante N, Ferrazzi E, Giussani DA, Shaw CJ, Müller A, Ortiz JU, Ostermayer E, Haller B, Prefumo F, Frusca T, Hecher K, Arabin B, Thilaganathan B, Papageorghiou AT, Bhide A, Martinelli P, Duvekot JJ, van Eyck J, Visser GH, Schmidt G, Ganzevoort W, Lees CC, Schneider KT, Bilardo CM, Brezinka C, Diemert A, Derks JB, Schlembach D, Todros T, Valcamonico A, Marlow N, van Wassenaer-Leemhuis A. Phase-rectified signal averaging method to predict perinatal outcome in infants with very preterm fetal growth restriction- a secondary analysis of TRUFFLE-trial. Am J Obstet Gynecol 2016; 215:630.e1-630.e7. [PMID: 27343566 DOI: 10.1016/j.ajog.2016.06.024] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Revised: 05/25/2016] [Accepted: 06/15/2016] [Indexed: 11/25/2022]
Abstract
BACKGROUND Phase-rectified signal averaging, an innovative signal processing technique, can be used to investigate quasi-periodic oscillations in noisy, nonstationary signals that are obtained from fetal heart rate. Phase-rectified signal averaging is currently the best method to predict survival after myocardial infarction in adult cardiology. Application of this method to fetal medicine has established significantly better identification than with short-term variation by computerized cardiotocography of growth-restricted fetuses. OBJECTIVE The aim of this study was to determine the longitudinal progression of phase-rectified signal averaging indices in severely growth-restricted human fetuses and the prognostic accuracy of the technique in relation to perinatal and neurologic outcome. STUDY DESIGN Raw data from cardiotocography monitoring of 279 human fetuses were obtained from 8 centers that took part in the multicenter European "TRUFFLE" trial on optimal timing of delivery in fetal growth restriction. Average acceleration and deceleration capacities were calculated by phase-rectified signal averaging to establish progression from 5 days to 1 day before delivery and were compared with short-term variation progression. The receiver operating characteristic curves of average acceleration and deceleration capacities and short-term variation were calculated and compared between techniques for short- and intermediate-term outcome. RESULTS Average acceleration and deceleration capacities and short-term variation showed a progressive decrease in their diagnostic indices of fetal health from the first examination 5 days before delivery to 1 day before delivery. However, this decrease was significant 3 days before delivery for average acceleration and deceleration capacities, but 2 days before delivery for short-term variation. Compared with analysis of changes in short-term variation, analysis of (delta) average acceleration and deceleration capacities better predicted values of Apgar scores <7 and antenatal death (area under the curve for prediction of antenatal death: delta average acceleration capacity, 0.62 [confidence interval, 0.19-1.0]; delta short-term variation, 0.54 [confidence interval, 0.13-0.97]; P=.006; area under the curve for prediction Apgar <7: average deceleration capacity <24 hours before delivery, 0.64 [confidence interval, 0.52-0.76]; short-term variation <24 hours before delivery, 0.53 [confidence interval, 0.40-0.65]; P=.015). Neither phase-rectified signal averaging indices nor short-term variation showed predictive power for developmental disability at 2 years of age (Bayley developmental quotient, <95 or <85). CONCLUSION The phase-rectified signal averaging method seems to be at least as good as short-term variation to monitor progressive deterioration of severely growth-restricted fetuses. Our findings suggest that for short-term outcomes such as Apgar score, phase-rectified signal averaging indices could be an even better test than short-term variation. Overall, our findings confirm the possible value of prospective trials based on phase-rectified signal averaging indices of autonomic nervous system of severely growth-restricted fetuses.
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Georgieva A, Papageorghiou AT, Payne SJ, Moulden M, Redman CWG. Phase-rectified signal averaging for intrapartum electronic fetal heart rate monitoring is related to acidaemia at birth. BJOG 2014; 121:889-94. [PMID: 24842087 DOI: 10.1111/1471-0528.12568] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/16/2013] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Recent studies suggest that phase-rectified signal averaging (PRSA), measured in antepartum fetal heart rate (FHR) traces, may sensitively indicate fetal status; however, its value has not been assessed during labour. We determined whether PRSA relates to acidaemia in labour, and compare its performance to short-term variation (STV), a related computerised FHR feature. DESIGN Historical cohort. SETTING Large UK teaching hospital. POPULATION All 7568 Oxford deliveries that met the study criteria from April 1993 to February 2008. METHODS We analysed the last 30 minutes of the FHR and associated outcomes of infants. We used computerised analysis to calculate PRSA decelerative capacity (DC(PRSA)), and its ability to predict umbilical arterial blood pH ≤ 7.05 using receiver operator characteristic (ROC) curves and event rate estimates (EveREst). We compared DC(PRSA) with STV calculated on the same traces. MAIN OUTCOME MEASURE Umbilical arterial blood pH ≤ 7.05. RESULTS We found that PRSA could be measured in all cases. DC(PRSA) predicted acidaemia significantly better than STV: the area under the ROC curve was 0.665 (95% CI 0.632-0.699) for DC(PRSA), and 0.606 (0.573-0.639) for STV (P = 0.007). EveREst plots showed that in the worst fifth centile of cases, the incidence of low pH was 17.75% for DC(PRSA) but 11.00% for STV (P < 0.001). DC(PRSA) was not highly correlated with STV. CONCLUSIONS DC(PRSA) of the FHR can be measured in labour, and appears to predict acidaemia more accurately than STV. Further prospective evaluation is warranted to assess whether this could be clinically useful. The weak correlation between DC(PRSA) and STV suggests that they could be combined in multivariate FHR analyses.
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Affiliation(s)
- A Georgieva
- Nuffield Department of Obstetrics & Gynaecology, University of Oxford, Women's Centre, John Radcliffe Hospital, Oxford, UK; Department of Engineering Science, Institute of Biomedical Engineering, University of Oxford, Oxford, UK
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Zuern CS, Eick C, Rizas KD, Bauer S, Langer H, Gawaz M, Bauer A. Impaired cardiac baroreflex sensitivity predicts response to renal sympathetic denervation in patients with resistant hypertension. J Am Coll Cardiol. 2013;62:2124-2130. [PMID: 23973686 DOI: 10.1016/j.jacc.2013.07.046] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2013] [Revised: 07/11/2013] [Accepted: 07/16/2013] [Indexed: 11/24/2022]
Abstract
OBJECTIVES This study sought to evaluate cardiac baroreflex sensitivity (BRS) as a predictor of response to renal sympathetic denervation (RDN). BACKGROUND Catheter-based RDN is a novel treatment option for patients with resistant arterial hypertension. It is assumed that RDN reduces efferent renal and central sympathetic activity. METHODS Fifty patients (age 60.3 ± 13.8 years [mean ± SD mean systolic blood pressure (BP) on ambulatory blood pressure monitoring (ABPM) 157 ± 22 mm Hg, despite medication with 5.4 ± 1.4 antihypertensive drugs) underwent RDN. Prior to RDN, a 30-min recording of continuous arterial BP (Finapres; TNO-TPD Biomedical Instrumentation, Amsterdam, the Netherlands) and high-resolution electrocardiography (1.6 kHz in orthogonal XYZ leads) was performed in all patients under standardized conditions. Cardiac BRS was assessed by phase-rectified signal averaging (BRSPRSA) according to previously published technologies. Response to RDN was defined as a reduction of mean systolic BP on ABPM by 10 mm Hg or more at 6 months after RDN. RESULTS Six months after RDN, mean systolic BP on ABPM was significantly reduced from 157 ± 22 mm Hg to 149 ± 20 mm Hg (p = 0.003). Twenty-six of the 50 patients (52%) were classified as responders. BRSPRSA was significantly lower in responders than nonresponders (0.16 ± 0.75 ms/mm Hg vs. 1.54 ± 1.73 ms/mm Hg; p < 0.001). Receiver-operator characteristics analysis revealed an area under the curve for prediction of response to RDN by BRSPRSA of 81.2% (95% confidence interval: 70.0% to 90.1%; p < 0.001). On multivariable logistic regression analysis, reduced BRSPRSA was the strongest predictor of response to RDN, which was independent of all other variables tested. CONCLUSIONS Impaired cardiac BRS identifies patients with resistant hypertension who respond to RDN.
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