Detection of U wave activity in healthy volunteers by high-resolution magnetocardiography.

INTRODUCTION: The purpose of our study was to prove the existence of the U wave using magnetocardiograms (MCGs). METHODS: The 31-channel MCGs of 25 healthy volunteers were recorded. The onset of the U wave was defined by newly developed spatial correlation analysis; and the end, by different approaches. RESULTS: A U wave could be proved in all volunteers. In 10 volunteers (heart rate, 57 +/- 19 beats/min) in whom the U wave was found to be separated from the following P wave, the U wave's end could be determined as a threshold value (U wave duration, 310 +/- 24 milliseconds). In 15 volunteers (heart rate, 70 +/- 38 beats/min), the end of the U waves was concealed by a continuous transition of the U waves into the following P waves. CONCLUSIONS: The U wave seems to be a regular phenomenon and has a distinct spatiotemporal assembly.

Influence of anisotropic compartments on magnetic field and electric potential distributions generated by artificial current dipoles inside a torso phantom.

The purpose of this study is the analysis of the influence of anisotropic conductivity on magnetic fields and electric potentials by means of phantom measurements. An artificial rotating current dipole was placed in the middle of an anisotropic skein arrangement in a torso phantom filled with saline solution. The signal strength and the change of the shape of potential and field patterns due to anisotropic volume conduction were investigated. Different directions of the dipole were compared to corresponding orientations of measured fields and potentials (angle difference). For electric and magnetic data, the angle difference between observed signal orientations and true dipole orientations continuously increased with the angle between dipole and anisotropy (up to 80 degrees ) and then decreased back to zero at their orthogonal orientation. Both signal strengths decreased about 10% with an increasing angle between dipole and anisotropy. While the magnetic field showed a generally stronger shape change, the changed shape of the electric potential showed similarity to an extended source. Our phantom study demonstrated that anisotropic compartments influence directions, amplitudes and shapes of potentials and fields at different degrees. We concluded that anisotropic structures should be considered in volume conductor modelling, when source orientation, extension and strength are of interest.

Stress testing in coronary artery disease by Magnetic Field Imaging: a 3D current distribution model.

OBJECTIVE: Magnetic field imaging (MFI) combines depolarization and repolarization registration of the cardiac electromagnetic field with a 3D current distribution model. An interesting application for MFI is the possibility to detect myocardial ischemia under stress. METHODS: Using a new reconstruction technique, it is possible to generate a pseudo-current distribution on the epicardial surface: the comparison of the time evolution of such current distributions at rest and under stress shows difference in coronary artery disease (CAD). The model works with a realistic epicardial surface generate on the basis of computerised tomography or magnetic resonance tomography data or with a standardized ellipsoidal model. To take into account the vectorial character of the epicardial current distribution, the current flow in the epicardial surface element is represented in the graphic display by a cone. Thus indicating the direction of current flow the height of the cone represents the current intensity. RESULTS: As an example of the method, data of pharmacological stress MFI on a CAD patient will be presented. The newly developed algorithm operates in different segments of the electromagnetic heart beat. The indicated myocardial area strongly correlated to invasive coronary angiography results. In such a situation the advantage provided by the "friendly" ellipsoidal surface on the numerical solution of the inverse problem seems to overcome the advantage of a realistic heart model. CONCLUSION: We conclude MFI is a promising procedure for a non-invasive stress testing as well as screening method as for localization of myocardial ischemia.

Fetal heart rate variability in growth restricted fetuses.

Intrauterine growth restriction (IUGR) remains a major problem in perinatal medicine because of the variety of its underlying causes and the prediction of its outcome. Characteristics of heartbeat interval patterns are associated with neuro-vegetative and humoral regulatory processes. Fetal magnetocardiography allows non-invasive assessment of these processes with high precision throughout the second half of gestation. The aim of our study was the analysis of linear and non-linear parameters of fetal heart rate fluctuations to distinguish between IUGR fetuses and a cohort of normal subjects, both pre-selected from heart-rate traces representing a quiet state of activity in the third trimester of gestation.

Spatiotemporal correlation analyses: a new procedure for standardisation of DC magnetocardiograms.

There is a lack of standard methods for the analysis of magnetocardiograms (MCGs). MCG signals have a shape similar to the ECG (P wave, QRS complex, T wave). High-quality multichannel recordings can indicate even slight disturbances of de- and repolarisation. The purpose of our study was to apply a new approach in the analysis of signal-averaged DC-MCGs. DC-MCGs (31-channel) were recorded in 182 subjects: 110 patients after myocardial infarction and 72 controls. Spatiotemporal correlation analysis of the QRS complex and T wave patterns throughout the entire heart cycle was used to analyse homogeneity of de- and repolarisation. These plots were compared to standard ECG analyses (electrical axis, Q wave, ST deviation, T polarity and shape). Spatiotemporal correlation analyses seem to be applicable in assessing the course of electrical repolarisation with respect to homogeneity. MCG provided all diagnostic information contained in common ECG recordings at high significance levels. The ECG patterns were included in 5/8 of our parameters for electrical axis, 6/8 for Q-wave, 7/8 for ST deviation and 5/8 for T-polarity based on two time series of correlation coefficients. We conclude that our spatiotemporal correlation approach provides a new tool for standardised analysis of cardiac mapping data such as MCG.

Bioelectric and biomagnetic measurements are differentially sensitive to spiral currents.

Observations indicate that different information is contained in electrocardiograms and magnetocardiograms in both patients and healthy volunteers. Closed loop currents could explain this phenomenon. We hypothesized that open loops, such as the spirally shaped currents in the heart, also contribute to these differences. We modeled two types of open spiral-shaped loops, based on the heart geometry, using 12 artificial current dipoles in a physical torso phantom. The electric potentials and magnetic fields were measured simultaneously with increasing numbers of active dipoles in the spiral source geometries. We found a continuous increase in the measured amplitudes of the magnetic fields, up to a plateau value when 10 active dipoles were enabled. For the electric potentials, we found that the amplitudes increased when up to six or eight active dipoles had been enabled, and then decreased thereafter. We conclude that open loop currents also contribute to the experimentally observed differences in magnetocardiograms and electrocardiograms in both patients and healthy volunteers. Combined bioelectric and biomagnetic measurements should provide greater insight into heart activity than do single modality measurements.

Magnetocardiography based spatiotemporal correlation analysis is superior to conventional ECG analysis for identifying myocardial injury.

Electrocardiogram (ECG) particular from tiny, non Q-wave myocardial infarction may lack striking infarct pattern. Spatiotemporal correlation analysis (SCA) of multichannel magnetocardiogram (MCG) is a high-resolution "magnifying glass" to analyze homogeneity of repolarization. SCA involves full 4D spatiotemporal information to identify abnormalities as empirically done by eye in conventional ECG-but on an advanced level of analysis. We compared the discriminatory performance of SCA to ECG analysis in identifying myocardial infarction. Eleven SCA parameters were taken from signal averaged 31-channel MCG and compared to infarct indicators of ECG's in 178 subjects: 108 patients (76 males, mean age 62 years) after myocardial infarction (16-64 d) and 70 controls (36 males, mean age 46 years). SCA improves the detection of myocardial injury: in 72.5% ECG (sensitivity 68.6%, specificity 56%) and in 80.2% SCA parameters (sensitivity 72.6%, specificity 64%) separated patients from controls. SCA is applicable for the analysis of de- and repolarization of cardiac mapping data.

An experimental study on the effect of the anisotropic regions in a realistically shaped torso phantom.

Determination of electrically active regions in the human body by observing generated bioelectric and/or biomagnetic signals is known as source reconstruction. In the reconstruction process, it is assumed that the volume conductor consists of isotropic compartments and homogeneous tissue bioelectric parameters but this assumption introduces errors when the tissue of interest is anisotropic. The aim of this study was to investigate changes in the measured signal strengths and the estimated positions and orientations of current dipoles in a realistically shaped torso phantom having a heart region built from single guar gum skeins. Electric data were recorded with 60 electrodes on the front of the chest and 195 sensors measured the magnetic field 2 cm above the chest. The artificial rotating dipoles were located underneath the anisotropic skeins distant from the sensors. It was found that the signal strengths and estimated dipole orientations were influenced by the anisotropy while the estimated dipole positions were not significantly influenced. The signal strength was reduced between 17% and 43% for the different dipole positions when comparing the parallel alignment of dipole orientation and anisotropy direction with the orthogonal alignment. The largest error in the estimation of dipole orientation was 42 degrees. The observed changes in the magnetic fields and electric potentials can be explained by the fact that the anisotropic skeins force the current along its direction. We conclude that taking into account anisotropic structures in the volume conductor might improve signal analysis as well as source strength and orientation estimations for bioelectric and biomagnetic investigations.

Human fetal heart rate variability-characteristics of autonomic regulation in the third trimester of gestation.

AIM: To describe developmental aspects of the sympatho-vagal heart rate regulation in the human fetus by applying numerics to visual descriptions of fetal heart rate patterns throughout the third trimester of pregnancy. The focus is to determine potential benefits of this alternative means of assessing the maturation of the fetal autonomic nervous system by analysis of fetal heart rate variability (fHRV). SUBJECTS AND METHODS: The magnetocardiograms of 103 normal fetuses between 24+1 and 41+6 weeks of gestation were studied. Fetal heart beat intervals were determined with a temporal precision of 1 ms. The levels of fetal activity were estimated according to characteristic heart rate patterns (I-III) prior to 32, between 32-35 and beyond 35 (groups 1-3) completed weeks. Mean heart rate (mHR), standard deviation of normal-to-normal beat intervals (SDNN) and root mean square of successive differences of normal beats (RMSSD) served as fHRV indices, mean permutation entropy (PE_Mean) as complexity measure. SDNN/RMSSD was introduced as a potential marker for sympatho-vagal balance. RESULTS: Low activity fHRP (I) were characterized by significantly lower level fHRV indices and higher PE_Mean when compared to fHRP II. We found that SDNN/RMSSD decreases with gestation in fHRP I, which suggests increasing vagal influence. In fHRP III (assigned to active awake fetuses only after 32 weeks), highest level SDNN and mHR are associated with a dramatically reduced complexity. fHRV indices cluster characteristically with the activity levels. CONCLUSIONS: We conclude that a combined analysis of fHRV, based on SDNN/RMSSD and PE_Mean, and fHRP is advantageous in the assessment of maturation of the fetal autonomic nervous system.

Magnetic nanoparticle imaging by means of minimum norm estimates from remanence measurements.

In magnetic nanoparticle imaging, magnetic nanoparticles are coated and functionalized to bind to specific targets. After measuring their magnetic relaxation or remanence, their distribution can be determined by means of inverse methods. The reconstruction algorithm presented in this paper includes first a dipole fit using a Levenberg-Marquardt optimizer to determine the reconstruction plane. Secondly, a minimum norm estimate is obtained on a regular grid placed in that plane. Computer simulations involving different parameter sets and conditions show that the used approach allows for the reconstruction of distributed sources, although the reconstructed shapes are distorted by blurring effects. The reconstruction quality depends on the signal-to-noise ratio of the measurements and decreases with larger sensor-source distances and higher grid spacings. In phantom measurements, the magnetic remanence of nanoparticle columns with clinical relevant sizes is determined with two common measurement systems. The reconstructions from these measurements indicate that the approach is applicable for clinical measurements. Our results provide parameter sets for successful application of minimum norm approaches to Magnetic Nanoparticle Imaging.

Vortex shaped current sources in a physical torso phantom.

Recent studies reported differential information in human magnetocardiogram and in electrocardiogram. Vortex currents have been discussed as a possible source of this divergence. With the help of physical phantom experiments, we quantified the influence of active vortex currents on the strength of electric and magnetic signals, and we tested the ability of standard source localization algorithms to reconstruct vortex currents. The active vortex currents were modeled by a set of twelve single current dipoles arranged in a circle and mounted inside a phantom that resembles a human torso. Magnetic and electric data were recorded simultaneously while the dipoles were switched on stepwise one after the other. The magnetic signal strength increased continuously for an increasing number of dipoles switched on. The electric signal strength increased up to a semicircle and decreased thereafter. Source reconstruction with unconstrained focal source models performed well for a single dipole only (less than 3-mm localization error). Minimum norm source reconstruction yielded reasonable results only for a few of the dipole configurations. In conclusion active vortex currents might explain, at least in part, the difference between magnetically and electrically acquired data, but improved source models are required for their reconstruction.

Alternans of blood pressure and heart rate in dilated cardiomyopathy.

Impaired myocardial performance is known to be associated with electrical and mechanical beat-to-beat alternans phenomena. The alternans in blood pressure and heart rate and their interdependency in idiopathic dilated cardiomyopathy (IDC) were studied. The arterial blood pressure and the electrocardiograph (ECG) were continuously recorded in 22 patients suffering from IDC (age 49 +/- 13 years, ejection fraction 0.33 +/- 0.13, left ventricular diameter of 67 +/- 8 mm) and in 21 healthy controls (age 52 +/- 15 years). The beat-to-beat variations of the interbeat intervals (IBI) and of the blood pressure amplitudes (AMP) were measured. An alternans beat was defined as a beat preceded and followed by beats that had higher or lower values in the respective modality. The percentages of singular and repetitive alternans patterns, and the interdependency of the alternans patterns in AMP and IBI were assessed. The study found significantly more singular and repetitive alternans patterns in the IDC group compared to the control group both in the analysis of AMP and IBI (singular alternans in IBI: 55 +/- 11 vs 47 +/- 7%, P < 0.01; singular alternans in AMP: 61 +/- 15 vs 45 +/- 6%, P < 0.01; triple alternans in IBI: 29 +/- 18 vs 16 +/- 9%, P < 0.01; triple alternans in AMP: 34 +/- 24 vs 12 +/- 7%, P < 0.01). The amplitudes of the AMP alternans patterns were higher in IDC compared to controls (9 +/- 7 vs 4 +/- 2% of AMP, P = 0.01) whereas they did not differ in IBI. The correlation analysis revealed a significant interdependency of the alternans pattern in IBI and AMP in 18 of 22 IDC patients and in 12 of 21 controls (r = 0.50 +/- 0.21 [IDC]; r = 0.26 +/- 0.05 [controls]). The slope of the linear regression (delta AMP vs delta IBI) was steeper in the IDC group compared to the control group (62 +/- 50 vs 20 +/- 22 mmHg/s, P < 0.01). The percentages of alternans patterns appearing in IBI and AMP were positively correlated to the left ventricular diameter (r = 0.70 in the IBI, and r = 0.30 in the AMP). The blood pressure amplitude and the heart rate did not differ between the two groups. Patients suffering from IDC have a higher prevalence, stability, amplitude, and interdependency of alternans patterns in IBI and AMP compared to the control group. The amount of alternans patterns indicates the stage of disease. The alternans analysis may have impact on the functional assessment of patients suffering from heart failure.