Validity of the Pneumonitor for RR intervals acquisition for short-term heart rate variability analysis extended with respiratory data in pediatric cardiac patients.

BACKGROUND: Breathing pattern alterations change the variability and spectral content of the RR intervals (RRi) on electrocardiogram (ECG). However, there is no method to record and control participants' breathing without influencing its natural rate and depth in heart rate variability (HRV) studies. AIM: This study aimed to assess the validity of the Pneumonitor for acquisition of short-term (5 minutes) RRi in comparison to the reference ECG method for analysis of heart rate (HR) and HRV parameters in the group of pediatric patients with cardiac disease. METHODS: Nineteen patients of both sexes participated in the study. An ECG and Pneumonitor were used to record RRi in 5-minute static rest conditions, the latter also to measure the relative tidal volume and respiratory rate. The validation comprised Student's t-test, Bland-Altman analysis, intraclass correlation coefficient, and Lin's concordance correlation. The possible impact of respiratory activity on the agreement between ECG and the Pneumonitor was also assessed. RESULTS: An acceptable agreement for the number of RRi, mean RR, hazard ratio (HR), and HRV measures calculated based on RRi acquired using the ECG and Pneumonitor was presented. There was no association between the breathing pattern and RRi agreement between devices. CONCLUSIONS: The Pneumonitor might be considered appropriate for cardiorespiratory studies in the group of pediatric cardiac patients in rest condition.

Causality in cardiorespiratory signals in pediatric cardiac patients.

Four different Granger causality-based methods - one linear and three nonlinear (Granger Causality, Kernel Granger Causality, large-scale Nonlinear Granger Causality, and Neural Network Granger Causality) were used for assessment and causal-based quantification of the respiratory sinus arrythmia (RSA) in the group of pediatric cardiac patients, based on the single-lead ECG and impedance pneumography signals (the latter as the tidal volume curve equivalent). Each method was able to detect the dependency (in terms of causal inference) between respiratory and cardiac signals. The correlations between quantified RSA and the demographic parameters were also studied, but the results differ for each method. Clinical relevance- The presented methods (among which NNGC seems to be the most valid) allow for quantification of RSA and study of dependency between tidal volume and RR intervals which may help to better understand association between respiratory and cardiovascular systems in different populations.

Granger causality test with nonlinear neural-network-based methods: Python package and simulation study.

BACKGROUND AND OBJECTIVE: Causality defined by Granger in 1969 is a widely used concept, particularly in neuroscience and economics. As there is an increasing interest in nonlinear causality research, a Python package with a neural-network-based causality analysis approach was created. It allows performing causality tests using neural networks based on Long Short-Term Memory (LSTM), Gated Recurrent Unit (GRU), or Multilayer Perceptron (MLP). The aim of this paper is to present the nonlinear method for causality analysis and the created Python package. METHODS: The created functions with the autoregressive (AR) and Generalized Radial Basis Functions (GRBF) neural network models were tested on simulated signals in two cases: with nonlinear dependency and with absence of causality from Y to X signal. The train-test split (70/30) was used. Errors obtained on the test set were compared using the Wilcoxon signed-rank test to determine the presence of the causality. For the chosen model, the proposed method of study the change of causality over time was presented. RESULTS: In the case when X was a polynomial of Y, nonlinear methods were able to detect the causality, while the AR model did not manage to indicate it. The best results (in terms of the prediction accuracy) were obtained for the MLP for the lag of 150 (MSE equal to 0.011, compared to 0.041 and 0.036 for AR and GRBF, respectively). When there was no causality between the signals, none of the proposed and AR models did indicate false causality, while it was detected by GRBF models in one case. Only the proposed models gave the expected results in each of the tested scenarios. CONCLUSIONS: The proposed method appeared to be superior to the compared methods. They were able to detect non-linear causality, make accurate forecasting and not indicate false causality. The created package enables easy usage of neural networks to study the causal relationship between signals. The neural-networks-based approach is a suitable method that allows the detection of a nonlinear causal relationship, which cannot be detected by the classical Granger method. Unlike other similar tools, the package allows for the study of changes in causality over time.

Device for Controlling Stimulus Self-Application During Autonomic Nervous System Tests.

Assessment of autonomic nervous system (ANS) functioning may be performed non-invasively using autonomic tests which are based on evaluation of response of cardiovascular system to the applied stimuli, such as increased air pressure during Valsalva maneuver, skeletal muscle contraction during static handgrip or deep slow breathing. The cardiovascular response depends, besides ANS reaction and test protocol, also on the way stimulus is self-applied by the test subject. We present a versatile device for controlling stimulus self-application during three ANS tests: Valsalva maneuver, static handgrip, and deep breathing. It integrates two different gauges and a pace setter for breathing into one device. The core of the device is a linear LED display which, using green, yellow, and red diodes, informs the subject about the correctness of self-application of respective stimulus. The settings of the device can be adjusted to the needs of the protocol chosen. The device can record the duration of mouth air pressure or the force produced by the subject during ANS tests, which assures correctness of the tests, thus allowing to track individual variability changes in the response to the test. The device was verified during ANS tests and its use was intuitive for patients, reducing the time needed for training before tests and decreasing the effort of the physician.

Assessment of calibration methods on impedance pneumography accuracy.

The aim was to assess accuracy of tidal volumes (TV) calculated by impedance pneumography (IP), reproducibility of calibration coefficients (CC) between IP and pneumotachometry (PNT), and their relationship with body posture, breathing rate and depth. Fourteen students performed three sessions of 18 series: normal and deep breathing at 6, 10, 15 breaths/min rates, while supine, sitting and standing; 18 CC were calculated for every session. Session 2 was performed 2 months after session 1, session 3 1-3 days after session 2. TV were calculated using full or limited set of CC from current session, in case of sessions 2 and 3 also using CC from session 1 and 2, respectively. When using full set of CC from current session, IP underestimated TV by -3.2%. Using CC from session 2 for session 3 measurements caused decrease of relative difference: -3.9%, from session 1 for session 2: -5.3%; for limited set of CC: -5.0%. The body posture had significant effect on CC. The highest accuracy was obtained when all factors influencing CC were considered. The application of CC related only to body posture may result in shortening of calibration and moderate accuracy loss. Using CC from previous session compromises accuracy moderately.

Body position classification for cardiorespiratory measurement.

Heart activity, or at least heart rate variability, is associated with body position. Our previous studies have confirmed that impedance pneumography may be used to record respiratory function, but the calibration coefficients for this method depend on position. Data were collected from 24 students (12 male, 12 female), who alternated positions between lying (on front, back, and right side), sitting and standing. Signals from an attached iPhone's internal sensors (accelerometer, gyroscope, magnetometer) were recorded and attitude relative to gravity was calculated. The signals were subsequently segmented and marked. Five algorithms were trained and cross-validated for different sensor combinations. Without differentiation of sitting and standing, 100% accuracy was achieved using all algorithms. The classifier best differentiating these two states was based on random forests, with overall accuracy of 90%. Simple methods based on a proposed hybrid classifier were tested for online measurement without the need for signal segmentation, with 99% accuracy. The prospect of the algorithms' use in long-term studies (particularly cardiorespiratory monitoring) was assessed.

Automatic cough episode detection using a vibroacoustic sensor.

Cough monitoring is an important element of the diagnostics of respiratory diseases. The European Respiratory Society recommends objective assessment of cough episodes and the search for methods of automatic analysis to make obtaining the quantitative parameters possible. The cough "events" could be classified by a microphone and a sensor that measures the vibrations of the chest. Analysis of the recorded signals consists of calculating the features vectors for selected episodes and of performing automatic classification using them. The aim of the study was to assess the accuracy of classification based on an artificial neural networks using vibroacoustic signals collected from chest. Six healthy, young men and eight healthy, young women carried out an imitated cough, hand clapping, speech and shouting. Three methods of parametrization were used to prepare the vectors of episode features - time domain, time-frequency domain and spectral modeling. We obtained the accuracy of 95% using artificial neural networks.

In aged men, central vessel transmural pressure is reduced by brief Valsalva manoeuvre during strength exercise.

A brief Valsalva manoeuvre, lasting 2-3 s, performed by young healthy men during strength exercise reduces transmural pressure acting on intrathoracic arteries. In this study, we sought to verify this finding in older men. Twenty normotensive, prehypertensive and moderately hypertensive otherwise healthy men 46-69 years old performed knee extensions combined with inspiration or with brief Valsalva manoeuvre performed at 10, 20 and 40 mmHg mouth pressure. Same respiratory manoeuvres were also performed at rest. Non-invasively measured blood pressure, knee angle, respiratory airflow and mouth pressure were continuously registered. In comparison to inspiration, estimated transmural pressure acting on thoracic arteries changed slightly and insignificantly during brief Valsalva manoeuvre at 10 and 20 mmHg mouth pressure. At 40 mmHg mouth pressure, transmural pressure declined at rest (-8·8 ± 11·4 mmHg) and during knee extension (-12·1 ± 11·9 mmHg). This decline ensued, as peak systolic pressure increase caused by this manoeuvre, was distinctly <40 mmHg. Only a main effect of mouth pressure was revealed (P<0·001) and neither exercise nor interaction between these factors, what suggests that transmural pressure decline, depended mainly on intrathoracic pressure developed during brief Valsalva manoeuvre. Resting blood pressure did not influence the effect of brief Valsalva manoeuvre on transmural pressure.

Early hemodynamic response to the tilt test in patients with syncope.

INTRODUCTION: Our aim was to evaluate the differences in the early hemodynamic response to the tilt test (HUTT) in patients with and without syncope using impedance cardiography (ICG). MATERIAL AND METHODS: One hundred twenty-six patients (72 female/48 male; 37 ±17 years) were divided into a group with syncope (HUTT(+), n = 45 patients) and a group without syncope (HUTT(-), n = 81 patients). ECG and ICG signals were continuously recorded during the whole examination, allowing the calculation of heart rate (HR), stroke volume (SV), and cardiac output (CO) for every beat. The hemodynamic parameters (averaged over 1 min) were analyzed at the following points of the HUTT: the last minute of resting, the period immediately after the tilt (0 min), 1 min and 5 min after the maneuver. The absolute changes of HR, SV and CO were calculated for 0, 1, and 5 min after the maneuver in relation to the values at rest (ΔHR, ΔSV, ΔCO). Also, the percentage changes were calculated (HRi, SVi, COi). RESULTS: There were no differences between the groups in absolute and percentage changes of hemodynamic parameters immediately after and 1 min after tilting. Significant differences between the HUTT(+) and HUTT(-) groups were observed in the 5(th) min of tilting: for ΔSV (-27.2 ±21.2 ml vs. -9.7 ±27.2 ml; p = 0.03), ΔCO (-1.78 ±1.62 l/min vs. -0.34 ±2.48 l/min; p = 0.032), COi (-30 ±28% vs. -0.2 ±58%; p = 0.034). CONCLUSIONS: In the 5(th) min the decrease of hemodynamic parameters (ΔSV, ΔCO, COi) was significantly more pronounced in HUTT(+) patients in comparison to the HUTT(-) group.

Impedance cardiography: recent advancements.

The aim of this paper is the presentation of recent advancements in impedance cardiography regarding methodical approach, applied equipment and clinical or research implementations. The review is limited to the papers which were published over last 17 months (dated 2011 and 2012) in well recognised scientific journals.

Effects of a brief Valsalva manoeuvre on hemodynamic response to strength exercises.

Strength training is a recommended measure against loss of strength and muscle mass because of age- or illness-induced inactivity. Strength exercises may impose heavy cardiovascular load by increasing heart rate and blood pressure. To increase strength efficiently, a heavy load has to be applied; this, however, leads to a spontaneous Valsalva manoeuvre, which additionally raises blood pressure. Avoidance of this manoeuvre is recommended. If the additional rise in arterial blood pressure caused by Valsalva manoeuvre is smaller than intrathoracic or intracranial pressures during this manoeuvre, Valsalva manoeuvre may actually protect arteries located in the thorax and in the brain by diminishing transmural pressure acting across these vessels. Effect of controlled breathing or brief Valsalva manoeuvre on arterial pressure at rest and during knee extension against 15-repetition maximum resistance was evaluated. In 12 healthy young men blood pressure was measured continuously and non-invasively, knee angle, speed of respiratory air or mouth pressure (MP) were continuously registered. Each combination of respiratory and exercise manoeuvres was repeated six times, for every of last three repetitions peak and trough systolic and diastolic pressure were determined. Strength exercises elevated peak pressures more than trough pressures, systolic more than diastolic. Valsalva manoeuvre increased only peak systolic and peak diastolic pressure. This increase was in average lesser than MP, thus rendering an argument in favour of protective role of brief Valsalva manoeuvre because of decline in transmural pressure acting on thoracic and possibly cerebral arteries. However, there was strong individual variability, and in few instances, arterial pressure increased because of brief Valsalva manoeuvre more than MP; thus in some subjects, the manoeuvre might enhance transmural pressure acting on thorax arteries.

Holter-type impedance cardiography device. A system for continuous and non-invasive monitoring of cardiac haemodynamics.

Impedance cardiography (ICG) enables the non-invasive, reproducible, beat-to-beat estimation of stroke volume (SV) changes, and the measurement of the absolute values of the ejection time (ET) and pre-ejection period (PEP), which allows the indirect evaluation of cardiac contractility. The miniaturised, Holter-type impedance cardiography device with built-in one channel of ECG called ReoMonitor, was constructed. The system allows the long-term, beat-to-beat, automatic evaluation of SV, ET, PEP and heart rate. The measurements obtained by ReoMonitor were verified using on echocardiographic method in supine and tilted positions. A high correlation coefficient (r=0.83) was calculated between the measurements collected using both methods. Speech or vigorous movement distinctly lowered the percentage of properly recognised cardiac cycles (during daytime: 20-80%, during the night: 75-90%). However, during exercise testing on a cycloergometer the quality of recordings was good. The following clinical applications of a system are presented: a) evaluation of hemodynamical abnormalities caused by arrhythmia events, b) vasovagal syncope diagnosis, and c) optimisation of atrio-ventricular delay during dual-chamber pacing.