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Sensors (Basel, Switzerland) Feb 2023Intervals of low-quality photoplethysmogram (PPG) signals might lead to significant inaccuracies in estimation of pulse arrival time (PAT) during polysomnography (PSG)...
Intervals of low-quality photoplethysmogram (PPG) signals might lead to significant inaccuracies in estimation of pulse arrival time (PAT) during polysomnography (PSG) studies. While PSG is considered to be a "gold standard" test for diagnosing obstructive sleep apnea (OSA), it also enables tracking apnea-related nocturnal blood pressure fluctuations correlated with PAT. Since the electrocardiogram (ECG) is recorded synchronously with the PPG during PSG, it makes sense to use the ECG signal for PPG signal-quality assessment. (1) Objective: to develop a PPG signal-quality assessment algorithm for robust PAT estimation, and investigate the influence of signal quality on PAT during various sleep stages and events such as OSA. (2) Approach: the proposed algorithm uses R and T waves from the ECG to determine approximate locations of PPG pulse onsets. The MESA database of 2055 PSG recordings was used for this study. (3) Results: the proportions of high-quality PPG were significantly lower in apnea-related oxygen desaturation (matched-pairs rc = 0.88 and rc = 0.97, compared to OSA and hypopnea, respectively, when < 0.001) and arousal (rc = 0.93 and rc = 0.98, when < 0.001) than in apnea events. The significantly large effect size of interquartile ranges of PAT distributions was between low- and high-quality PPG ( < 0.001, rc = 0.98), and regular and irregular pulse waves ( < 0.001, rc = 0.74), whereas a lower quality of the PPG signal was found to be associated with a higher interquartile range of PAT across all subjects. Suggested PPG signal quality-based PAT evaluation reduced deviations (e.g., rc = 0.97, rc = 0.97, rc = 0.99 in hypopnea, oxygen desaturation, and arousal stages, respectively, when < 0.001) and allowed obtaining statistically larger differences between different sleep stages and events. (4) Significance: the implemented algorithm has the potential to increase the robustness of PAT estimation in PSG studies related to nocturnal blood pressure monitoring.
Topics: Humans; Polysomnography; Photoplethysmography; Heart Rate; Sleep Apnea, Obstructive; Oxygen
PubMed: 36850820
DOI: 10.3390/s23042220 -
International Journal of Cardiology Aug 2023Photoplethysmography (PPG) is an established technology for detecting pulse rate and pulse wave irregularities. However, whether temporal variations in pulse wave...
OBJECTIVES
Photoplethysmography (PPG) is an established technology for detecting pulse rate and pulse wave irregularities. However, whether temporal variations in pulse wave amplitudes, reflecting a combination of acute hemodynamic or autonomic responses to changes in overall vascular function, carry prognostic information remains unclear. To quantify nocturnal temporal pulse wave amplitude (PWA) attenuations and evaluate its association with long-term cardiovascular (CV) events in a large, racially diverse sample of men and women.
METHODS
Temporal PWA attenuations were determined based on the slopes between the upper and lower envelopes of PPGs derived from overnight polysomnography of 1957 participants (899 men, 1058 women, mean age 68.2 ± 9.1 years) of the Multi-Ethnic Study of Atherosclerosis. The nocturnal PWA attenuation index was defined as the cumulative duration of all PWA attenuation events relative to total sleep duration.
RESULTS
Nocturnal PWA attenuation index was greater in men than in women by almost 13% (16.3 ± 8.9% vs. 14.4 ± 7.9%, p < 0.001). The nocturnal PWA attenuation index was highest in Chinese-American participants (17.9 ± 9.2%) and lowest in African-Americans (13.5 ± 8.1%). During a median follow-up of 4.9 years, 94 CV events occurred. In multivariable Cox proportional hazard analysis adjusted for typical confounders, the nocturnal PWA attenuation index <15.2% was associated with CV events (HR = 1.58 [1.02-2.45], p = 0.042).
CONCLUSIONS
Nocturnal PWA attenuation index is inversely associated with the risk of CV events, particularly in men and African-Americans. The PPG-derived nocturnal PWA attenuation index could be simply obtained from smart wearable consumer devices and may provide a low-cost, accessible and scalable CV risk marker.
Topics: Male; Humans; Female; Middle Aged; Aged; Heart Rate; Polysomnography; Autonomic Nervous System; Heart Disease Risk Factors; Cardiovascular Diseases; Pulse Wave Analysis
PubMed: 37257516
DOI: 10.1016/j.ijcard.2023.05.047 -
European Heart Journal May 2002
Topics: Animals; Atrial Fibrillation; Blood Flow Velocity; Blood Pressure; Coronary Circulation; Heart Conduction System; Heart Rate; Humans; Vascular Resistance; Ventricular Function
PubMed: 11977993
DOI: 10.1053/euhj.2001.3024 -
Stroke Oct 2017
Review
Topics: Age Factors; Atrial Fibrillation; Clinical Trials as Topic; Electrocardiography; Heart Rate; Humans; Mass Screening; Stroke; Telemetry
PubMed: 28916671
DOI: 10.1161/STROKEAHA.117.017083 -
The American Journal of Cardiology Oct 2019A man without cardiac symptoms was found to have a slow irregular pulse, and an electrocardiogram revealed sinus bradycardia with escape-capture bigeminy. He was taking...
A man without cardiac symptoms was found to have a slow irregular pulse, and an electrocardiogram revealed sinus bradycardia with escape-capture bigeminy. He was taking verapamil, clonidine, and hydralazine for hypertension. The verapamil was discontinued; he returned to normal sinus rhythm and was discharged on the second hospital day.
Topics: Calcium Channel Blockers; Electrocardiography; Heart Rate; Humans; Hypertension; Male; Middle Aged; Sick Sinus Syndrome; Verapamil
PubMed: 31443901
DOI: 10.1016/j.amjcard.2019.06.034 -
Heart Rhythm Mar 2013Atrial fibrillation (AF) is common and associated with adverse health outcomes. Timely detection of AF can be challenging using traditional diagnostic tools. Smartphone... (Comparative Study)
Comparative Study
BACKGROUND
Atrial fibrillation (AF) is common and associated with adverse health outcomes. Timely detection of AF can be challenging using traditional diagnostic tools. Smartphone use is increasing and may provide an inexpensive and user-friendly means to diagnoseAF.
OBJECTIVE
To test the hypothesis that a smartphone-based application could detect an irregular pulse fromAF.
METHODS
Seventy-six adults with persistent AF were consented for participation in our study. We obtained pulsatile time series recordings before and after cardioversion using an iPhone 4S camera. A novel smartphone application conducted real-time pulse analysis using 2 statistical methods: root mean square of successive RR difference (RMSSD/mean) and Shannon entropy (ShE). We examined the sensitivity, specificity, and predictive accuracy of both algorithms using the 12-lead electrocardiogram as the gold standard.
RESULTS
RMSDD/mean and ShE were higher in participants in AF than in those with sinus rhythm. The 2 methods were inversely related to AF in regression models adjusting for key factors including heart rate and blood pressure (beta coefficients per SD increment in RMSDD/mean and ShE were-0.20 and-0.35; P<.001). An algorithm combining the 2 statistical methods demonstrated excellent sensitivity (0.962), specificity (0.975), and accuracy (0.968) for beat-to-beat discrimination of an irregular pulse during AF from sinus rhythm.
CONCLUSIONS
In a prospectively recruited cohort of 76 participants undergoing cardioversion for AF, we found that a novel algorithm analyzing signals recorded using an iPhone 4S accurately distinguished pulse recordings during AF from sinus rhythm. Data are needed to explore the performance and acceptability of smartphone-based applications for AF detection.
Topics: Aged; Algorithms; Atrial Fibrillation; Cell Phone; Equipment Design; Female; Heart Rate; Humans; Male; Photoplethysmography; Reproducibility of Results; Sensitivity and Specificity
PubMed: 23220686
DOI: 10.1016/j.hrthm.2012.12.001 -
International Journal of Molecular... Aug 2023Atrial fibrillation (AF) is a prevalent cardiac condition predominantly affecting older adults, characterized by irregular heartbeat rhythm. The condition often leads to... (Review)
Review
Atrial fibrillation (AF) is a prevalent cardiac condition predominantly affecting older adults, characterized by irregular heartbeat rhythm. The condition often leads to significant disability and increased mortality rates. Traditionally, two therapeutic strategies have been employed for its treatment: heart rate control and rhythm control. Recent clinical studies have emphasized the critical role of early restoration of sinus rhythm in improving patient outcomes. The persistence of the irregular rhythm allows for the progression and structural remodeling of the atria, eventually leading to irreversible stages, as observed clinically when AF becomes permanent. Cardioversion to sinus rhythm alters this progression pattern through mechanisms that are still being studied. In this review, we provide an in-depth analysis of the pathophysiological mechanisms responsible for maintaining AF and how they are modified during sinus rhythm restoration using existing therapeutic strategies at different stages of clinical investigation. Moreover, we explore potential future therapeutic approaches, including the promising prospect of gene therapy.
Topics: Humans; Aged; Atrial Fibrillation; Heart Rate; Tics; Heart Diseases; Heart Atria
PubMed: 37629037
DOI: 10.3390/ijms241612859 -
Annual International Conference of the... Jul 2017Cardiac arrhythmia or irregular heartbeats are an important feature to assess the risk on sudden cardiac death and other cardiac disorders. Automatic classification of...
Cardiac arrhythmia or irregular heartbeats are an important feature to assess the risk on sudden cardiac death and other cardiac disorders. Automatic classification of irregular heartbeats is therefore an important part of ECG analysis. We propose a tensor-based method for single- and multi-channel irregular heartbeat classification. The method tensorizes the ECG data matrix by segmenting each signal beat-by-beat and then stacking the result into a third-order tensor with dimensions channel × time × heartbeat. We use the multilinear singular value decomposition to model the obtained tensor. Next, we formulate the classification task as the computation of a Kronecker Product Equation. We apply our method on the INCART dataset, illustrating promising results.
Topics: Arrhythmias, Cardiac; Electrocardiography; Heart Rate; Humans; Signal Processing, Computer-Assisted
PubMed: 29059904
DOI: 10.1109/EMBC.2017.8036856 -
Journal of Clinical Hypertension... Sep 2019We evaluated the diagnostic value of atrial fibrillation (AF) measured by a wrist-type pulse wave monitor in this case-control study. Six serial pulse wave values (three...
We evaluated the diagnostic value of atrial fibrillation (AF) measured by a wrist-type pulse wave monitor in this case-control study. Six serial pulse wave values (three in the left and three in the right wrist) were measured using a wrist-type monitor in 29 AF patients and 30 subjects with sinus rhythm. We defined "monitor AF in irregular pulse peak (IPP) 15/20/25" as follows: (a) IPP: |interval of pulse peak - the average of the interval of the pulse peak| ≥ the average of the interval of the pulse peak × 15/20/25%; (b) irregular heartbeat (IHB): beats of IPP ≥ total pulse × 20%; and (c) monitor AF: ≥4 IHBs of the six pulse wave measurements. In IPP 15, the sensitivity and specificity were 0.97 and 1.00, respectively. Pulse wave analysis by a wrist-type monitor was shown to have high sensitivity and specificity for the diagnosis of AF.
Topics: Aged; Algorithms; Atrial Fibrillation; Case-Control Studies; Electrocardiography; Heart Rate; Humans; Middle Aged; Monitoring, Physiologic; Photoplethysmography; Predictive Value of Tests; Pulse Wave Analysis; Reproducibility of Results; Sensitivity and Specificity; Wrist
PubMed: 31420946
DOI: 10.1111/jch.13648 -
Obstetrical & Gynecological Survey Jul 2013During routine fetal auscultation, it is not uncommon to encounter an abnormal fetal heart rate. The rate may be abnormally slow or fast, or irregular. This article... (Review)
Review
During routine fetal auscultation, it is not uncommon to encounter an abnormal fetal heart rate. The rate may be abnormally slow or fast, or irregular. This article focuses on fetal dysrhythmias, defined as any irregular fetal cardiac rhythm or a regular rhythm with an abnormal rate outside the range of 120 to 160 beats per minute (Am J Obstet Gynecol. 2000;182:813-819). This article also helps the reader to recognize the most common types of fetal arrhythmias, understand the fetal risks associated with many fetal arrhythmias, and identify some of the pharmacological options used to treat fetal arrhythmias.
Topics: Arrhythmias, Cardiac; Echocardiography, Doppler; Fetal Diseases; Heart Auscultation; Heart Rate, Fetal; Humans; Ultrasonography, Prenatal
PubMed: 23803754
DOI: 10.1097/OGX.0b013e3182947b0e