Evaluation of respiratory- and postural-induced changes on the ballistocardiogram signal by time warping averaging.

OBJECTIVE: The aim of this work was to evaluate the potential changes in the ballistocardiogram (BCG) signal induced by different respiratory patterns and posture, by using the dynamic time warping (DTW) technique. APPROACH: BCG signals were recorded in a group of 20 healthy volunteers, simultaneously with an electrocardiogram (ECG). Two recordings, one in a supine (SUP) and one in a standing (ST) position, including spontaneous breathing, two 1 min apneas (at full and empty-lungs, respectively) and 30 s of Valsalva, were analyzed. A warped averaged waveform was computed for each phase, from which amplitude and temporal parameters were extracted to characterize each condition. MAIN RESULTS: Variations were found in both amplitude and duration of BCG-derived parameters among manoeuvres, especially when compared to spontaneous breathing, suggesting a complex interaction between intra-thoracic pressure changes acting on venous return, together with the autonomic nervous system modulation on heart rate. The effect of a hydrostatic pressure gradient elicited by postural conditions was also evident. SIGNIFICANCE: Posture and respiratory manoeuvres affect the BCG signal in different ways, probably as a result of changes induced in preload and afterload. This supports the need to define separate normality ranges for each posture and/or breathing conditions, as well as the importance of applying specific manoeuvres to highlight any pathological response in the computed BCG parameters.

Beat-to-beat heart rate detection by smartphone's accelerometers: validation with ECG.

Mobile phones offer the possibility to monitor and track health parameters. Our aim was to test the feasibility and accuracy of measuring beat-to-beat heart rate using smartphone accelerometers by recording the vibrations generated by the heart during its function and transmitted to the chest wall, i.e. the so-called seismocardiographic signal (SCG). METHODS: 9 healthy male volunteers were studied in supine (SUP) and in standing (ST) posture. A smartphone (iPhone6, Apple) was positioned on the thorax (POS1) to acquire SCG signal. While supine, a second smartphone was positioned on the navel (POS2). The SCG signal was recorded for 3 minutes during spontaneous respiration, synchronous with 3-leads ECG. Using a fully automated algorithm based on amplitude thresholding after rectification, the characteristic peak of the SCG signal (IVC) was detected and used to compute beat-to-beat heart duration, to be compared with the corresponding RR intervals extracted from the ECG. RESULTS: A 100% feasibility of the approach resulted for POS1 in SUP, while 89% in POS2, and 78% for POS1 in ST. In supine, for each smartphones' position, the automated algorithm correctly identified the cardiac beats with >98% accuracy. Linear correlation (r2) with RR was very high (>0.98) in each posture and position, with no bias and narrow limits of agreement. CONCLUSIONS: The obtained results proved the feasibility of the proposed approach and the robustness of the applied algorithm in measuring the beat-to-beat heart rate from smartphone-derived SCG, with high accuracy compared to conventional ECG-derived measure.

eAMI: a qualitative quantification of periodic breathing based on amplitude of oscillations.

STUDY OBJECTIVES: Periodic breathing is sleep disordered breathing characterized by instability in the respiratory pattern that exhibits an oscillatory behavior. Periodic breathing is associated with increased mortality, and it is observed in a variety of situations, such as acute hypoxia, chronic heart failure, and damage to respiratory centers. The standard quantification for the diagnosis of sleep related breathing disorders is the apnea-hypopnea index (AHI), which measures the proportion of apneic/ hypopneic events during polysomnography. Determining the AHI is labor-intensive and requires the simultaneous recording of airflow and oxygen saturation. In this paper, we propose an automated, simple, and novel methodology for the detection and qualification of periodic breathing: the estimated amplitude modulation index (eAMI). PATIENTS OR PARTICIPANTS: Antarctic Cohort (3800 meters): 13 normal individuals. Sleep Clinic Cohort: 39 different patients suffering from diverse sleep-related pathologies. MEASUREMENTS AND RESULTS: When tested in a population with high levels of periodic breathing (Antarctic Cohort), eAMI was closely correlated with AHI (r = 0.95, P < 0.001). When tested in the clinical setting, the proposed method was able to detect portions of the signal in which subclinical periodic breathing was validated by an expert (n = 93; accuracy = 0.85). Average eAMI was also correlated with the loop gain for the combined clinical and Antarctica cohorts (r = 0.58, P < 0.001). CONCLUSIONS: In terms of quantification and temporal resolution, the eAMI is able to estimate the strength of periodic breathing and the underlying loop gain at any given time within a record. The impaired prognosis associated with periodic breathing makes its automated detection and early diagnosis of clinical relevance.

MRI-based aortic blood flow model in 3D ballistocardiography.

Ballistocardiography (BCG) is a non-invasive technique which measures the acceleration of a body induced by cardiovascular activity, namely the force exerted by the beating heart. A one dimensional aortic flow model based on the transmission lines theory is developped and applied to the simulation of three dimensional BCG. A four-element Windkessel model is used to generate the pressure-wave. Using transverse MRI slices of a human subject, a reconstruction of the aorta allows the extraction of parameters used to relate the local change in mass of the 1D flow model to 3D acceleration BCG. Simulated BCG curves are then compared qualitatively with the ensemble average curves of the same subject recorded in sustained microgravity. Confirming previous studies, the main features of the y-axis are well simulated. The simulated z-axis, never attempted before, shows important similarities. The simulated x-axis is less faithful and suggests the presence of reflections.

Evaluation of ensemble averaging methods in 3D ballistocardiography.

Ballistocardiography (BCG) is a non-invasive technique which measures the acceleration of a body induced by cardiovascular activity, namely the force exerted by the beating heart. Measuring a BCG in a gravity-free environment provides ideal conditions where the subject is completely decoupled from its environment. Furthermore, because gravity constrains the motion in two dimensions, the non-negligible accelerations taking place in the third dimension are lost. In every experimental situation, the measured BCG signal contains artifacts pertaining to different causes. One of them is the undesirable involuntary movements of the subject. Ensemble averaging (EA) tackles the issue of constructing a typical one cardiac cycle BCG signal which best represents a longer recording. The present work compares state-of-the-art EA methods and proposes two novel techniques, one taking into account the ECG sub-intervals and the other one based on Dynamic Time Warping. The effects of lung volume are also assessed.

Three dimensional Ballistocardiogram and Seismocardiogram: what do they have in common?

3D-body accelerations, i.e. Ballistocardiograms (BCG) and Seismocardiograms (SCG), ECG and Impedance-cardiograms (ICG) were recorded on healthy volunteers participating to the European Space Agency (ESA) 59th parabolic flight campaign. In the present paper we document the similarities and differences that can be seen in the seismo- and ballisto-cardiogram signals in different positions (standing and supine) under normal gravity condition as well as during the weightlessness phases (0G) of a parabolic flight. Our results demonstrate that SCG and BCG both present a similar three dimensional (3D) nature, with components of the BCG having lower frequency content than the SCG. The recordings performed in the 0G environment are the one with the smoothest shape and largest maximum magnitude of the Force vector. The differences seen between SCG and BCG stress further the importance for the need of using different nomenclature for the identification of peaks in both signals.

Cardiovascular changes in parabolic flights assessed by ballistocardiography.

This paper presents a comparison of the cardiovascular changes observed in microgravity as compared to ground based measurements. The ballistocardiogram (BCG), the electrocardiogram (ECG) and the transthoracic impedance cardiogram (ICG) were recorded on five healthy subjects during the 57th-European Space Agency (ESA) parabolic flight campaign. BCG is analyzed though its most characteristic wave, the IJ wave complex that can be identified along the longitudinal component of BCG and which has been demonstrated to be linked to cardiac ejection. The timings between the contraction of the heart and the ejection of blood in the aorta are analyzed via the time delay between the R-wave of the ECG and the I and J-waves of BCG (RI and RJ intervals respectively). Our results show that the IJ complex presents a larger amplitude in weightlessness and suggest that stroke volume (SV) increases in microgravity. We assume that ballistocardiography is an efficient method to assess the ventricular performance.

Estimating the center of mass of a free-floating body in microgravity.

This paper addresses the issue of estimating the position of the center of mass (CoM) of a free-floating object of unknown mass distribution in microgravity using a stereoscopic imaging system. The method presented here is applied to an object of known mass distribution for validation purposes. In the context of a study of 3-dimensional ballistocardiography in microgravity, and the elaboration of a physical model of the cardiovascular adaptation to weightlessness, the hypothesis that the fluid shift towards the head of astronauts induces a significant shift of their CoM needs to be tested. The experiments were conducted during the 57th parabolic flight campaign of the European Space Agency (ESA). At the beginning of the microgravity phase, the object was given an initial translational and rotational velocity. A 3D point cloud corresponding to the object was then generated, to which a motion-based method inspired by rigid body physics was applied. Through simulations, the effects of the centroid-to-CoM distance and the number of frames of the sequence are investigated. In experimental conditions, considering the important residual accelerations of the airplane during the microgravity phases, CoM estimation errors (16 to 76 mm) were consistent with simulations. Overall, our results suggest that the method has a good potential for its later generalization to a free-floating human body in a weightless environment.

3D-ballistocardiography in microgravity: comparison with ground based recordings.

3D-Ballistocardiograms ECG and Impedancecardiograms (ICG) were recorded on 5 healthy volunteers participating to the European Space Agency (ESA) 57(th) parabolic flights campaigns. Comparisons are made between the baseline recordings performed on the ground and the recordings made during the microgravity phases of a parabolic flight. The spatial curves of the displacement, velocity and acceleration vectors, instead of their individual components are used to compute the magnitude of the force vector, kinetic energy and work during the cardiac cycle. Our hypothesis is that the 3D-BCG provides parameters correlated with the timings of ejection (PEP, LVET). Although our subject population is limited (N=5), this is the first study of BCG to be performed with N>1. Our results suggest that microgravity decrease the complexity of the 3D displacement curve and that peaks in curvature are consistently present in microgravity and on the ground. However they do not seem to be perfectly related to the classical cardiac ejection timings from ICG.

Physiological insights from gravity-free ballistocardiography.

Terrestrial ballistocardiographic (BCG) measurements are typically performed in only one or two axes because of the coupling between the subject and the ground. An appropriate physiological interpretation of these BCG signals therefore assumes that the information in the unmeasured axis is either understood, or able to be ignored. BCG signals from measurements in microgravity can be made in all three axes and permit examination of these assumptions. Such microgravity measurements show that lung volume significantly affects the BCG signals, predominately in the head-to-foot direction. Further, the maximum accelerations recorded following systole are poorly captured by coronal plane measurements as the greatest displacements occur in the sagittal plane. These results suggest a need to carefully consider the influence of the motion in the unmeasured plane when interpreting terrestrial BCG signals.

Timing and source of the maximum of the transthoracic impedance cardiogram (dZ/dt) in relation to the H-I-J complex of the longitudinal ballistocardiogram under gravity and microgravity conditions.

The transthoracic impedance cardiogram (ICG) and the acceleration ballistocardiogram (BCG) measured close to the center of mass of the human body are generated by changes of blood distribution. The transthoracic ICG is an integrated signal covering the whole thorax and spatial resolution is poor. Comparison between both signals can be used to elucidate the source of the ICG signal. We recorded the ECG, ICG, and BCG simultaneously in healthy subjects under resting and microgravity conditions during parabolic flights. The time interval between the R-peak of the ECG and the maximum of the ICG (R-dZ/dtmax) and the time interval between the R-peak of the ECG and the I-peak in the BCG (R-I) differed significantly (p<0.0001). The I-peak in the BCG always occurred earlier during systole than dZ/dtmax. The delay of dZ/dtmax ranged between 23 and 28 ms at rest and was lowest under microgravity conditions (12 ± 4 ms, p<0.02). Our results suggest that both signals have different sources. Combination of modern imaging techniques with classical non invasive approaches to detect changes of blood distribution may provide new insights into the complex interaction between blood flow and mechanocardiographic signals like the BCG.

Validation of centrifugation as a countermeasure for otolith deconditioning during spaceflight: preliminary data of the ESA SPIN study.

In the framework of further space exploration, countermeasures to combat the drawbacks of human space flights are essential. The present study focuses on the influence of microgravity on the otolith-ocular reflex and aims to test the hypothesis of artificial gravity being an adequate countermeasure for the deconditioning of the aforementioned reflex. The so-called SPIN study, commissioned by the European Space Agency, can be considered as a control experiment in the broad sense for the Neurolab mission (STS-90) during which 4 crewmembers of the space shuttle were subjected to in-flight centrifugation on the visual and vestibular investigation system (VVIS). After their nearly 16-day mission, they did not suffer from orthostatic intolerance and spatial disorientation. In addition, the relevant parameters of the otolith-ocular interaction remained unaffected. For this study cosmonauts from a long duration stay in the International Space Station that were not centrifuged in-flight were tested on the VVIS (1 g centripetal interaural acceleration) on 6 different days. Three measurements were taken about 1.5-2 months prior to launch and 3 were taken at 1, 4 and 9 days after return from space. Ocular counter-rolling was measured before, during and after rotation on the VVIS using infrared video goggles and compared pair wise using Friedman tests. The perception of verticality was monitored using an ultrasound system for perceptual evaluation. The preliminary results of 4 cosmonauts showed a surprisingly large inter-individual variability of the measurements. Although OCR and perception of verticality appeared to be influenced overall by the exposure to microgravity, the wide variability among the cosmonauts obscured any statistical significance, in particular due to one cosmonauts being inconsistent with the other 3. Despite the specificity of the tests under normal conditions, the diverse response to spaceflight of our subjects exposes the complexity of the peripheral and central neural adaptive processes.

Three dimensional ballisto- and seismo-cardiography: HIJ wave amplitudes are poorly correlated to maximal systolic force vector.

Ballistocardiography was recorded in 3-D on a free floating astronaut in space as well as on healthy volunteers participating to the ESA 55(th) and DLR 19(th) parabolic flights campaigns. In this paper we demonstrate further the usefulness of recording and analyzing ballistocardiograms (BCG) in three dimensions. The spatial curves of the displacement, velocity and acceleration vectors are analyzed instead of their individual 2-D components. The maximum magnitude of the force vector is shown to be poorly correlated to the HI and IJ wave amplitude traditionally computed on the longitudinal (feet-to-head) component of acceleration (uni-dimensional BCG). We also suggest that kinetic energy and work are useful parameters to consider for a physiological interpretation of the 3D-BCG. The technique presented is invariant from the axis of representation and provides important novel physiological information. We stress further the need of 3D recordings and analysis techniques for Ballisto- and Seismo-cardiography.

Comparison between EEMD, wavelet and FIR denoising: influence on event detection in impedance cardiography.

During thoracic impedance signal acquisition, noise is inherently introduced and hence, denoising is required to allow for accurate event detection. This paper investigates the effectiveness of Ensemble Emperical Mode Decomposition to filter random noise. The performance of the EEMD method is compared with an optimal FIR filter and wavelet denoising. The IMF selection for signal reconstruction in the EEMD denoising method is optimized using a sequential search. Denoising performance was evaluated by the SNR and the accuracy in event detection after filtering. When all criteria are taken into account, wavelet seems to outperform both EEMD and FIR denoising.

Three-dimensional ballistocardiography in microgravity: a review of past research.

This paper gives a short review of research on ballistocardiography in microgravity and indicates the benefits from this research for the use of BCG as a terrestrial cardiac monitoring system. In the past, 3-D methods required large devices to decouple the subject from the terrestrial environment and hence, BCG on Earth is usually limited to unidirectional recordings of the motion in the head-to-foot direction. However, microgravity provides a suspension-free environment where accelerations can be measured in all directions without the influence of gravity. Microgravity research indicated that along with the acceleration in the head-to-foot direction, the accelerations in the lateral and dorso-ventral direction are important in understanding the physiological forces during a cardiac cycle. Further, lung volume has a large influence on the transmission of cardiac forces to the surface of the body. To date, only the three separate components of the acceleration vector have been analyzed in 3-D BCG studies. Using the true acceleration and displacement vector (orientation and magnitude), rather than the three separate components, may permit more accurate cardiac event detection.

Three dimensional ballistocardiography: methodology and results from microgravity and dry immersion.

Balistocardiography was recorded in 3-D on a free floating astronaut in space as well as on healthy volunteers participating to a dry immersion study in a terrestrial laboratory. We demonstrate a new technique suitable for the analysis of 3-D BCG. The spatial curve of the displacement vector is analyzed instead of the three components of acceleration. The technique presented is invariant from the axis of representation and provides important novel physiological information.

A new model for utricular function testing using a sinusoidal translation profile during unilateral centrifugation.

The utricle plays an important role in orientation with respect to gravity. The unilateral centrifugation test allows a side-by-side investigation of both utricles. During this test, the subject is rotated about an earth-vertical axis at high rotation speeds (e.g. 400°/s) and translated along an interaural axis to consecutively align the axis of rotation with the left and the right utricle. A simple sinusoidal translation profile (0.013 Hz; amplitude = 4 cm) was chosen. The combined rotation and translation induces ocular counter rolling (OCR), which is measured using 3-D video-oculography. This OCR is the sum of the reflexes generated by both the semicircular canals and the utricles. In this paper, we present a new physiological model that decomposes this total OCR into a canal and a utricular contribution, modelled by a second-order transfer function and a combination of 2 sine functions, respectively. This model yields parameters such as canal gain, cupular and adaptation time constants and a velocity storage component for the canals. Utricular gain, bias, phase and the asymmetry between the left and the right utricle are characteristic parameters generated by the model for the utricles. The model is presented along with the results of 10 healthy subjects and 2 patients with a unilateral vestibular loss due to acoustic neuroma surgery to illustrate the effectiveness of the model.

The impact of chronic primary insomnia on the heart rate--EEG variability link.

OBJECTIVE: To determine if chronic insomnia alters the relationship between heart rate variability and delta sleep determined at the EEG. METHODS: After one night of accommodation, polysomnography was performed in 14 male patients with chronic primary insomnia matched with 14 healthy men. ECG and EEG recordings allowed the determination of High Frequency (HF) power of RR-interval and delta sleep EEG power across the first three Non Rapid Eye Movement (NREM)-REM cycles. Interaction between normalized HF RR-interval variability and normalized delta sleep EEG power was studied by coherency analysis. RESULTS: Patients showed increased total number of awakenings, longer sleep latency and wake durations and shorter sleep efficiency and REM duration than controls (p<.01). Heart rate variability across first three NREM-REM cycles and sleep stages (NREM, REM and awake) were similar between both groups. In each group, normalized HF variability of RR-interval decreased from NREM to both REM and awake. Patients showed decreased linear relationship between normalized HF RR-interval variability and delta EEG power, expressed by decreased coherence, in comparison to controls (p<.05). Gain and phase shift between these signals were similar between both groups. CONCLUSIONS: Interaction between changes in cardiac autonomic activity and delta power is altered in chronic primary insomniac patients, even in the absence of modifications in heart rate variability and cardiovascular diseases. SIGNIFICANCE: This altered interaction could reflect the first step to cardiovascular disorders.

The link between cardiac autonomic activity and sleep delta power is altered in men with sleep apnea-hypopnea syndrome.

We hypothesize that sleep apnea-hypopnea alters interaction between cardiac vagal modulation and sleep delta EEG. Sleep apnea-hypopnea syndrome (SAHS) is related to cardiovascular complications in men. SAHS patients show higher sympathetic activity than normal subjects. In healthy men, non-rapid eye movement (NREM) sleep is associated with cardiac vagal influence, whereas rapid eye movement (REM) sleep is linked to cardiac sympathetic activity. Interaction between cardiac autonomic modulation and delta sleep EEG is not altered across a life span nor is the delay between appearances of modifications in both signals. Healthy controls, moderate SAHS, and severe SAHS patients were compared across the first three NREM-REM cycles. Spectral analysis was applied to ECG and EEG signals. High frequency (HF) and low frequency (LF) of heart rate variability (HRV), ratio of LF/HF, and normalized (nu) delta power were obtained. A coherency analysis between HF(nu) and delta was performed, as well as a correlation analysis between obstructive apnea index (AI) or hypopnea index (HI) and gain, coherence, or phase shift. HRV components were similar between groups. In each group, HF(nu) was larger during NREM, while LF(nu) predominated across REM and wake stages. Coherence and gain between HF(nu) and delta decreased from controls to severe SAHS patients. In SAHS patients, the delay between modifications in HF(nu) and delta did not differ from zero. AI and HI correlated negatively with coherence, while HI correlated negatively with gain only. Apneas-hypopneas affect the link between cardiac sympathetic and vagal modulation and delta EEG demonstrated by the loss of cardiac autonomic activity fluctuations across shifts in sleep stages. Obstructive apneas and hypopneas alter the interaction between both signals differently.

Progressive aging does not alter the interaction between autonomic cardiac activity and delta EEG power.

OBJECTIVE: We tested the hypothesis that the reductions of the changes in the respective influence of the cardiac sympathetic and vagal activity control and delta EEG activity with aging alter the interactions between the heart rate variability (HRV) and the delta sleep EEG power band. METHODS: A polysomnography was performed on 16 healthy young men and 19 healthy middle-aged men across the first 3 NREM-REM cycles. Spectral analysis was applied to electrocardiogram and electroencephalogram recordings. High Frequency (HF(nu)) of HRV as well as the maximum of cross-spectrum, coherency, gain and phase shifts between HF(nu) and delta sleep EEG power band were compared between both groups. RESULTS: Young men experienced more deep sleep than middle-aged men (P<0.001). In middle-aged subjects, HF(nu) was lower than the HF(nu) of their younger counterparts (P<0.001), but they showed similar increases during NREM sleep and similar decreases during REM sleep as the young subjects. Cross-spectrum values, coherency, gain and phase shifts between HF(nu) and delta were identical between the two groups. Modifications in HF(nu) show parallel changes and precede changes in delta EEG band by a similar leads of 11+/-6min in young men and 9+/-7 min in middle-aged men (P=0.23). CONCLUSIONS: Reduced changes in the respective influence of the cardiac sympathetic and vagal activity and delta EEG activity with progressive aging do not alter the relationship and phase difference between changes in the relative predominant cardiac vagal activity and delta power in middle-aged men. SIGNIFICANCE: Interaction between the cardiac sympathetic and vagal activity with delta EEG activity is maintained in middle-aged men.