Heart rate variability (HRV) plays an important role in medicine and psychology because it is used to quantify imbalances of the autonomic nervous system (ANS). An important manifestations of the ANS on HRV is also directly related to respiration and it is called respiratory sinus arrhythmia (RSA). This is a controlled phenomenon that leads to a synchronized coupling between respiration and instantaneous heart rate. Thus, the portion of HRV that is not related to respiration, and could potentially contain undiscovered diagnostic value, is overlapped and remains hidden in a standard HRV analysis. In such cases, a decoupling procedure would deliver a discriminated HRV analysis and possible new insights about the regulation of the cardiovascular system. In this work, we propose an algorithm based on Granger's causality to measure coupling between respiration and HRV. In the case of significant coupling, we estimate and cancel the respiration driven HRV component using a linear filtering approach. We tested the method using synthetic signals and prove it to deliver a reliable coupling measurement in 96.3% of the cases and reconstruct respiration free signals with a median correlation coefficient of 0.992. Afterwards, we applied our method to signals recorded during paced respiration and during natural breathing. We demonstrated that coupling is dependent on respiratory frequency and that it maximizes at 0.3 Hz. Furthermore, the HRV parameters measured during paced respiration tend to level among subjects after decoupling. The intersubject variability of HRV parameter is also decreased after the separation process. During natural breathing, coupling is notoriously lower to non-existing and decoupling has little impact on HRV. We conclude that the method proposed here can be used to investigate the diagnostic value of respiration independent HRV parameters.
Conference Contributions (4)
M. Kircher, R. Menges, G. Lenis, and O. Dössel. Respiratory influence on HRV parameters analyzed during controlled respiration, spontaneous respiration and apnoe. In Current Directions in Biomedical Engineering, vol. 3(2) , pp. Abstract, 2017
The heart rate variability (HRV) is a measure which is commonly used to assess sympathetic and parasympathetic auto-nomic function. It is well known, that respiration can have a strong influence on HRV. Especially, a phenomenon called Respiratory Sinus Arrythmia (RSA) modulates the RR intervals and is a major contributor to the HRV. The interpreta-tion of common HRV parameters can be ambiguous due to different respiration rates and patterns. To assess this ambi-guity, the coupling of RSA on HRV was quantified and the HRV parameters were compared during different respirato-ry states.A pilot study with five healthy subjects was performed. A three lead ECG was acquired and the respiration was estimat-ed by measuring the aeration of the lungs using the PulmoVista 500 by Dräger. This device uses Electrical Impedance Tomography (EIT) to monitor impedance changes due to the changing amount of air within the lungs during respira-tion. The subjects were asked to breath at controlled respiration rates of 8, 15 and 24 breaths per minute as well as spon-taneously for 1 min each. In addition, to analyze HRV during apnoic phases without any respiration, the subjects were asked to hold their breath for 40s at end-inspiration and end-expiration. After preprocessing of the ECG and the respiration signal, the coupling between the measured respiration and the RR intervals was quantified using the Granger causality. If significant coupling was present, the HRV was separated from its respiratory influence using an ARMAX model. The measured respiration hereby formed the exogeneous input to the filter. Finally, common HRV parameters were calculated for the original and the decoupled RR intervals.We showed, that coupling strength depends on respiratory rates, which might complicate HRV interpretation. Moreo-ver, the coupling is decreased during spontaneous breathing in comparison to controlled respiration. Additionally we found, that HRV parameters during apnoic phases differ from decoupled HRV parameters during spontaneous or con-trolled respiration.
Lung ventilation and perfusion analyses using chest imaging methods require a correct segmentation of the lung to offer anatomical landmarks for the physiological data. An automatic segmentation approach simplifies and accelerates the analysis. However, the segmentation of the lungs has shown to be difficult if collapsed areas are present that tend to share similar gray values with surrounding non-pulmonary tissue. Our goal was to develop an automatic segmentation algorithm that is able to approximate dorsal lung boundaries even if alveolar collapse is present in the dependent lung areas adjacent to the pleura. Computed tomography data acquired in five supine pigs with injured lungs were used for this purpose. First, healthy lung tissue was segmented using a standard 3D region growing algorithm. Further, the bones in the chest wall surrounding the lungs were segmented to find the contact points of ribs and pleura. Artificial boundaries of the dorsal lung were set by spline interpolation through these contact points. Segmentation masks of the entire lung including the collapsed regions were created by combining the splines with the segmentation masks of the healthy lung tissue through multiple morphological operations. The automatically segmented images were then evaluated by comparing them to manual segmentations and determining the Dice similarity coefficients (DSC) as a similarity measure. The developed method was able to accurately segment the lungs including the collapsed regions (DSCs over 0.96).
Radiofrequency ablation is the gold standard for treating cardiac arrhythmias. However, the success rate of this procedure depends on numerous parameters. Wet lab experiments provide the opportunity to investigate cardiac electrophysiology under reproducible conditions. To evaluate the electrophysiological changes of ablated myocardium in these studies it is necessary to consider the three-dimensional (3D) geometry of the lesions. For this purpose, we investigated the usage of different magnetic resonance imaging (MRI) sequences as well as an image processing procedure to analyze in-vitro preparations. To differentiate signal intensities between nonablated and ablated tissue we evaluated FISP (fast imaging with steady-state precession; delivering dominantly T1-weighted images) and RARE (rapid acquisition with relaxation enhancement; delivering dominantly T2-weighted images). After image processing, the ablated tissue was segmented in each image slice forming a 3D volume. The geometry of the lesion was modeled by the boundary of this volume. It was generally feasible to distinguish between healthy myocardium and ablated tissue as well as to determine lesion transmurality. The analysis of the reconstructed lesion geometries from FISP and RARE MRI showed a high agreement, however T2-weighted sequences showed larger lesion volumes as well as higher variations in segmentation compared to T1- mapping. FISP with higher quality may be used to reconstruct the 3D geometry of the ablation lesions.
Electrical impedance tomography (EIT) can trace ventilation and perfusion related changes in electrical properties of lung tissue. So far, the ability of EIT to assess lung perfusion has been examined experimentally by electron-beam and single-photon-emission computerized tomography (CT) in healthy or globally injured lungs [1,2].