Linear and nonlinear measures of fetal heart rate patterns evaluated on very short fetal magnetocardiograms

We analyzed the effectiveness of linear short- and long-term variability time domain parameters, an index of sympatho-vagal balance (SDNN/RMSSD) and entropy in differentiating fetal heart rate patterns (fHRPs) on the fetal heart rate (fHR) series of 5, 3 and 2 min duration reconstructed from 46 fetal magnetocardiograms. Gestational age (GA) varied from 21 to 38 weeks. FHRPs were classified based on the fHR standard deviation. In sleep states, we observed that vagal influence increased with GA, and entropy significantly increased (decreased) with GA (SDNN/RMSSD), demonstrating that a prevalence of vagal activity with autonomous nervous system maturation may be associated with increased sleep state complexity. In active wakefulness, we observed a significant negative (positive) correlation of short-term (long-term) variability parameters with SDNN/RMSSD. ANOVA statistics demonstrated that long-term irregularity and standard deviation of normal-to-normal beat intervals (SDNN) best differentiated among fHRPs. Our results confirm that short-and long-term variability parameters are useful to differentiate between quiet and active states, and that entropy improves the characterization of sleep states. All measures differentiated fHRPs more effectively on very short HR series, as a result of the fMCG high temporal resolution and of the intrinsic timescales of the events that originate the different fHRPs.

Sensitivity, specificity and predictive values of linear and nonlinear indices of heart rate variability in stable angina patients

Abstract Background Decreased heart rate variability (HRV) is related to higher morbidity and mortality. In this study we evaluated the linear and nonlinear indices of the HRV in stable angina patients submitted to coronary angiography. Methods We studied 77 unselected patients for elective coronary angiography, which were divided into two groups: coronary artery disease (CAD) and non-CAD groups. For analysis of HRV indices, HRV was recorded beat by beat with the volunteers in the supine position for 40 minutes. We analyzed the linear indices in the time (SDNN [standard deviation of normal to normal], NN50 [total number of adjacent RR intervals with a difference of duration greater than 50ms] and RMSSD [root-mean square of differences]) and frequency domains ultra-low frequency (ULF) ≤ 0,003 Hz, very low frequency (VLF) 0,003 – 0,04 Hz, low frequency (LF) (0.04–0.15 Hz), and high frequency (HF) (0.15–0.40 Hz) as well as the ratio between LF and HF components (LF/HF). In relation to the nonlinear indices we evaluated SD1, SD2, SD1/SD2, approximate entropy (−ApEn), α1, α2, Lyapunov Exponent, Hurst Exponent, autocorrelation and dimension correlation. The definition of the cutoff point of the variables for predictive tests was obtained by the Receiver Operating Characteristic curve (ROC). The area under the ROC curve was calculated by the extended trapezoidal rule, assuming as relevant areas under the curve ≥ 0.650. Results Coronary arterial disease patients presented reduced values of SDNN, RMSSD, NN50, HF, SD1, SD2 and -ApEn. HF ≤ 66 ms2, RMSSD ≤ 23.9 ms, ApEn ≤−0.296 and NN50 ≤ 16 presented the best discriminatory power for the presence of significant coronary obstruction. Conclusion We suggest the use of Heart Rate Variability Analysis in linear and nonlinear domains, for prognostic purposes in patients with stable angina pectoris, in view of their overall impairment.

Transdiaphragmatic Resuscitative Open Cardiac Massage: Description of the Technique and a First Case-Series of an Alternative Approach to the Heart

Abstract BACKGROUND: The purpose of this paper is to describe the transdiaphragmatic approach to the heart for open CPR in patients that arrest at laparotomy and to present a first case series of patients that have undergone this procedure. METHODS: All patients who had undergone intraperitoneal transdiaphragmatic open CPR between January 1, 2002 and December 31, 2012 were retrieved from the operation registry at Bern University Hospital, Switzerland. Transdiaphragmatic access to the heart is initiated with a 10-cm-long anterocaudal incision in the central tendon of the diaphragm--approximately at 2 o'clock. Internal cardiac compression through the diaphragmatic incision can be performed from both sides of the patient. From the right side of the patient, cardiac massage is performed with the right hand and vice versa. RESULTS: A total of six patients were identified that suffered cardiac arrest during laparotomy with open CPR performed through the transdiaphragmatic approach. Four patients suffered cardiac arrest during orthotopic liver transplantation and two trauma patients suffered cardiac arrest during damage control laparotomy. In three patients, cardiac activity was never reestablished. However, three patients regained a perfusion heart rhythm and two of these survived to the ICU. One patient ultimately survived to discharge. CONCLUSIONS: In patients suffering cardiac arrest during laparotomy, the transdiaphragmatic approach allows for a rapid, technically easy, and almost atraumatic access to the heart, with excellent CPR performance. After this potentially life-saving procedure, pulmonary or surgical site complications are expected to occur much less compared with the conventionally performed emergency department left-sided thoracotomy.

Variability in heart rate estimates from different pulse oximeters

Since its introduction, pulse oximetry has become a conventional clinical measure. Besides being arterial blood oxygen saturation (SpO2) measure, pulse oximeters can be used for other cardiovascular measurements, like heart rate (HR) estimations, derived from its photo plethysmographic (PPG) signals. The temporal coherence of the PPG signals and thereby HR estimates are heavily dependent on its minimal phase variability. A Masimo SET Rad-9TM, Novametrix Oxypleth and a custom designed PPG system were investigated for their relative phase variation. R-R intervals from electro-cardiogram (ECG) were recorded concurrently as reference. PPG signals obtained from the 3 systems were evaluated by comparing their respective beat-to-beat (B-B) intervals with the corresponding R-R estimates during a static test. For their relative B-B comparison to the ECG, Novametrix system differed 0.680.52% (p

The dual effect of normobaric hypoxia on heart rate variability and substrate partitioning following interval cycling

Recent studies have shown the importance of the beat-by-beat changes in heart rate influenced by the autonomic nervous system (ANS), or heart rate variability (HRV). The purpose of this study was to examine the lasting effects of hypoxic exercise on HRV, and its influences on substrate usage. Results from this study could lead an increased understanding on this topic. Eight active healthy males (age: 31±11 years; height: 180±7 cm; weight: 83±8 kg; VO₂max (maximal oxygen consumption): 4.4±0.6 L•min⁻¹) underwent normoxic and hypoxic (FᵢO₂= 0.15) conditions during high-intensity interval (HIIT) cycling (70%-high interval, 35%-rest interval). Cycling intensity was determined by a peak power output cycling test. Each experimental session consisted of a basal metabolic rate determination, up to 45-minutes of HIIT cycling, and three 30-minute post-exercise metabolic rate measurements (spanning 3 hours and 15 minutes after exercise). During exercise, RPE was higher (p<0.01) and LAC (lactate) increased (p=0.001) at each point of time in hypoxia, with no change in normoxia. After hypoxic exercise, the SNS/PNS ratio (overall ANS activity) was significantly higher (p<0.01) and significantly decreased through time in both conditions (p<0.01). In addition, a significant interaction between time and conditions (p<0.02) showed a decrease in LAC concentration through time post-hypoxic exercise. The findings showed that a single bout of hypoxic exercise alters ANS activity post-exercise along with shifting substrate partitioning from glycolytic to lipolytic energy production. The significant decrease in LAC concentration post-hypoxic exercise supports the notion that hypoxic HIIT induces a greater muscle glycogen depletion leading to increased fat oxidation to sustain glycogenesis and gluconeogenesis to maintain blood glucose level during recovery.

Phase asymmetry of heart rate variability signal

Heart rate asymmetry (HRA) is considered as a physiological phenomenon in healthy subjects. In this article, we propose a novel HRA index, Slope Index (SI), to quantify phase asymmetry of heart rate variability (HRV) system. We assessed the performance of proposed index in comparison with conventional (Guzik's Index (GI) and Porta's Index (PI)) HRA indices. As illustrative examples, we used two case studies: (i) differentiate physiologic RR series from synthetic RR series; and (ii) discriminate arrhythmia subjects from Healthy using beat-to-beat heart rate time series. The results showed that SI is a superior parameter than GI and PI for both case studies with maximum ROC area of 0.84 and 0.82 respectively. In contrast, GI and PI had ROC areas {0.78, 0.61} and {0.50, 0.56} in two case studies respectively. We also performed surrogate analysis to show that phase asymmetry is caused by a physiologic phenomena rather than a random nature of the signal. In conclusion, quantification of phase asymmetry of HRV provides additional information on HRA, which might have a potential clinical use to discriminate pathological HRV in future.

Tone entropy analysis of foetal heart rate variability

Development of the foetal autonomic nervous system can be indirectly understood by looking at the changes in beat to beat variability in foetal heart rates. This study presents Tone-Entropy (T-E) analysis of foetal heart rate variability (HRV) at multiple lags (1–8) to understand the influence of gestational ages (early and late) on the development of the foetal autonomic nervous system (ANS). The analysis was based on foetal electrocardiograms (FECGs) of 46 healthy foetuses of 20–32 weeks (early group) and 22 foetuses of 35–41 weeks (late group). Tone represents sympatho-vagal balance and entropy the total autonomic activities. Results show that tone increases and entropy decreases at all lags for the late foetus group. On the other hand, tone decreases and entropy increases at lags 1–4 in the early foetus group. Increasing tone in late foetuses might represent significant maturation of sympathetic nervous systems because foetuses approaching to delivery period need increased sympathetic activity. T-E could be quantitative clinical index to determine the early foetuses from late ones on the basis of maturation of autonomic nervous system.