Biomedical subjects

Pablo Laguna

Publications and source records attributed to Pablo Laguna.

12 recordsLinked to original sources

PubMed2006

Assessment of QT-measurement accuracy using the 12-lead electrocardiogram derived from EASI leads.

The purpose of the present study is to assess QT-interval measurements from the EASI 12-lead electrocardiogram (ECG) as compared with the standard 12-lead ECG. The QT interval was automatically determined in simultaneously recorded standard and EASI 12-lead ECGs, using a validated wavelet-based delineator. The agreement between the 2 sets of measurements was quantified both on a lead-by-lead basis and a multilead basis with global definitions of QRS onset and T-wave end. The results show that the agreement between QT-interval measurements from the 2 lead systems is acceptable, with negligible mean differences and with correlation coefficients ranging from 0.91 to 0.98 depending on the lead studied. Although the SD shows a clear dependence on the selected lead (ranging from 9.2 to 26.4 milliseconds), differences are within the accepted tolerances for automatic delineation. In a few patients, large differences were found, mainly because of changes in morphology present in both lead systems. QT intervals measured by the multilead approach were considerably more stable than single-lead measurements and resulted in a much better agreement between the 2 lead systems (correlation coefficient, 0.98; QT difference, 1.1 +/- 9.8 milliseconds). Thus, the EASI 12-lead ECG may be used for reliable QT monitoring when the multilead delineation approach is adopted.

Diagnosis, Computer-Assisted↗

PubMed2006

An efficient method for handling ectopic beats using the heart timing signal.

The problem of analyzing heart rate variability in the presence of ectopic beats is revisited. Based on the integral pulse frequency modulation model and the closely related heart timing signal, a new technique is introduced which corrects for the occasional presence of ectopic beats. The correction technique, which involves the occurrence times of a certain number of beats preceding the ectopic beat, is computationally very efficient. From actual heart rate data, the results show that the new technique is associated with a much lower computational complexity (flops reduced by a factor of about 3000) than the original heart timing technique, while producing similar performance. It is also shown that the power spectrum and related clinical indices obtained by the new technique are more accurately estimated than by other methods.

Algorithms↗

PubMed2006

Characterization of repolarization alternans during ischemia: time-course and spatial analysis.

T-wave alternans (TWA) has been linked to increased vulnerability to ventricular fibrillation in different settings including myocardial ischemia. In this study, we propose a methodology for the characterization of TWA induced by transient, regional ischemia. We studied the prevalence, magnitude and spatio-temporal relationship between TWA and ischemia in 95 patients undergoing percutaneous transluminal coronary angioplasty (PTCA). Two electrocardiogram records of each patient, a control recording before PTCA and the PTCA record, were analyzed using a robust, recently proposed method for TWA analysis. The detected episodes were characterized in terms of their time-course, lead distribution and alternans waveform. One third of the patients (33.7%) showed TWA episodes during PTCA. The highest prevalence (51.7%) and amplitude were found in patients with left anterior descendent artery occlusion. The onset of TWA was detected after the first 1-2 min of occlusion, suggesting that some level of ischemia must be attained before TWA arises, while disappearance of TWA following reperfusion was much more rapid. The TWA lead distributions and waveforms showed distinct distributions according to the occluded artery reflecting the regional nature of the TWA phenomenon.

Adult↗

PubMed2006

A robust method for ECG-based estimation of the respiratory frequency during stress testing.

A robust method is presented for electrocardiogram (ECG)-based estimation of the respiratory frequency during stress testing. Such ECGs contain highly nonstationary noise and exhibit changes in QRS morphology which, when combined with the dynamic nature of the respiratory frequency, make most existing methods break down. The present method exploits the oscillatory pattern of the rotation angles of the heart's electrical axis as induced by respiration. The series of rotation angles, obtained from least-squares loop alignment, is subject to power spectral analysis and estimation of the respiratory frequency. Robust techniques are introduced to handle the nonstationary properties of exercise ECGs. The method is evaluated by means of both simulated signals, and ECG/airflow signals recorded from 14 volunteers and 20 patients during stress testing. The resulting respiratory frequency estimation error is, for simulated signals, equal to 0.5% +/- 0.2%, mean +/- SD (0.002 +/- 0.001 Hz), whereas the error between respiratory frequencies of the ECG-derived method and the airflow signals is 5.9% +/- 4% (0.022 +/- 0.016Hz). The results suggest that the method is highly suitable for analysis of noisy ECG signals recorded during stress testing.

Adult↗

PubMed2006

QT variability and HRV interactions in ECG: quantification and reliability.

In this paper, a dynamic linear approach was used over QT and RR series measured by an automatic delineator, to explore the interactions between QT interval variability (QTV) and heart rate variability (HRV). A low-order linear autoregressive model allowed to separate and quantify the QTV fractions correlated and not correlated with HRV, estimating their power spectral density measures. Simulated series and artificial ECG signals were used to assess the performance of the methods, considering a respiratory-like electrical axis rotation effect and noise contamination with a signal-to-noise ratio (SNR) from 30 to 10 dB. The errors found in the estimation of the QTV fraction related to HRV showed a nonrelevant performance decrease from automatic delineation. The joint performance of delineation plus variability analysis achieved less than 20% error in over 75% of cases for records presenting SNRs higher than 15 dB and QT standard deviation higher than 10 ms. The methods were also applied to real ECG records from healthy subjects where it was found a relevant QTV fraction not correlated with HRV (over 40% in 19 out of 23 segments analyzed), indicating that an important part of QTV is not linearly driven by HRV and may contain complementary information.

Algorithms↗

PubMed2004

Individual patterns of dynamic QT/RR relationship in survivors of acute myocardial infarction and their relationship to antiarrhythmic efficacy of amiodarone.

INTRODUCTION: Amiodarone is an effective antiarrhythmic drug, but it has serious side effects and conducted trials did not support its prophylactic use in survivors of acute myocardial infarction. It is possible that the prophylactic use of the drug has not been tested effectively. To optimize therapy outcome, markers of drug efficacy might be developed to identify patients who, although at arrhythmic risk, would not benefit from amiodarone treatment. We investigated descriptors of QT/RR relationship for their potential value in predicting inefficient amiodarone treatment. METHODS AND RESULTS: The study used 866 Holter recordings (462 amiodarone, 404 placebo) obtained 1 month after randomization in the European Myocardial Infarct Amiodarone Trial (EMIAT). A commercial Holter system was used to measure RR and QT intervals. Subject-specific descriptors of QT/RR relationship were calculated. Comparison was performed in amiodarone- and placebo-treated patients, distinguishing patients who did and did not suffer from arrhythmic death. QT/RR relationship and individually corrected QTc interval differed significantly, not only between amiodarone- and placebo-treated postmyocardial infarction patients but also between patients with and without arrhythmic death on amiodarone (QTc with vs without arrhythmic death 426.30 +/- 33.93 ms vs 444.23 +/- 36.65 ms, P = 6.5 x 10(-3)). In a multivariate analysis, reduced optimum regression residuum (14.33 +/- 7.08 vs 20.11 +/- 9.39, P = 4.4 x 10(-3)) and flatter slope (0.44 +/- 0.19 vs 0.55 +/- 0.24, P = 4.0 x 10(-2)) of the QT/RR relationship independently predicted arrhythmic death during follow-up. CONCLUSION: Chronic amiodarone treatment markedly affects the QT/RR relationship. The lack of treatment-related QT/RR changes predicts arrhythmic death. Descriptors of complexity of QT/RR relation seem to be potent markers of treatment efficiency.

Adolescent↗

PubMed2004

A wavelet-based ECG delineator: evaluation on standard databases.

In this paper, we developed and evaluated a robust single-lead electrocardiogram (ECG) delineation system based on the wavelet transform (WT). In a first step, QRS complexes are detected. Then, each QRS is delineated by detecting and identifying the peaks of the individual waves, as well as the complex onset and end. Finally, the determination of P and T wave peaks, onsets and ends is performed. We evaluated the algorithm on several manually annotated databases, such as MIT-BIH Arrhythmia, QT, European ST-T and CSE databases, developed for validation purposes. The QRS detector obtained a sensitivity of Se = 99.66% and a positive predictivity of P+ = 99.56% over the first lead of the validation databases (more than 980,000 beats), while for the well-known MIT-BIH Arrhythmia Database, Se and P+ over 99.8% were attained. As for the delineation of the ECG waves, the mean and standard deviation of the differences between the automatic and manual annotations were computed. The mean error obtained with the WT approach was found not to exceed one sampling interval, while the standard deviations were around the accepted tolerances between expert physicians, outperforming the results of other well known algorithms, especially in determining the end of T wave.

Algorithms↗

PubMed2004

Characterization of QT interval adaptation to RR interval changes and its use as a risk-stratifier of arrhythmic mortality in amiodarone-treated survivors of acute myocardial infarction.

A new method is proposed to evaluate the dynamics of QT interval adaptation in response to heart rate (HR) changes. The method considers weighted averages of RR intervals (RR) preceding each cardiac beat to express RR interval history accounting for the influence on repolarization duration. A global optimization algorithm is used to determine the weight distribution leading to the lowest regression residual when curve fitting the [QT, RR1 data using a patient-specific regression model. From the optimum weight distribution, a memory lag L90 is estimated, expressing the delay in the QT adaptation to HR changes. On average, RR intervals of the past 150 beats (approximately 2.5 min) are required to model the QT response accurately. From a clinical point of view, the interval of the initial tens of seconds to one minute seems to be most important in the majority of cases. A measure of the optimum regression residual (r(opt)) has been calculated, discriminating between post-myocardial infarction patients at high and low risk of arrhythmic death while on treatment with amiodarone. A similar discrimination has been achieved with a variable expressing the character of QT lag behind the RR interval dynamics.

Adaptation, Physiological↗

PubMed2003

Estimation of the QT/RR hysteresis lag.

The process of QT interval adaptation to heart rate (HR) changes was evaluated by considering weighted averages of RR intervals to characterize the influence of previous cardiac cycles. An optimum adaptation pattern was individually derived for each patient and several descriptors of the QT/RR hysteresis were subsequently calculated. The values of these parameters showed that the QT adaptation to HR changes is highly individual and, consequently, any generalized approach may lead to inappropriate conclusions.

Electrocardiography↗

PubMed2003

Analysis of heart rate variability in the presence of ectopic beats using the heart timing signal.

The time-domain signals representing the heart rate variability (HRV) in the presence of an ectopic beat exhibit a sharp transient at the position of the ectopic beat, which corrupts the signal, particularly the power spectral density (PSD) of the HRV. Consequently, there is a need for correction of this type of beat prior to any HRV analysis. This paper deals with the PSD estimation of the HRV by means of the heart timing (HT) signal when ectopic beats are present. These beat occurrence times are modeled from a generalized, continuous time integral pulse frequency modulation model and, from this point of view, a specific method for minimizing the effect of the presence of ectopic beats is presented to work together with the HT signal. By using both, a white noise driven autoregressive model of the HRV signal with artificially introduced ectopic beats and actual heart rate series including ectopic beats, the more usual methods of HRV spectral estimation are compared. Results of the PSD estimation error function of the number of ectopic beats are presented. These results demonstrate that the proposed method has one order of magnitude lower error than usual ectopic beats removal strategies in preserving PSD, thus, this strategy better recovers the original clinical indexes of interest.

Algorithms↗

PubMed2003

ECG-based detection of body position changes in ischemia monitoring.

The purpose of this paper is to analyze and detect changes in body position (BPC) during electrocardiogram (ECG) recording. These changes are often manifested as shifts in the electrical axis and may be misclassified as ischemic changes during ambulatory monitoring. We investigate two ECG signal processing methods for detecting BPCs. Different schemes for feature extraction are used (spatial and scalar), while preprocessing, trend postprocessing and detection are identical. The spatial approach is based on VCG loop rotation angles and the scalar approach is based on the Karhunen-Loève transform (KLT) coefficients. The methods are evaluated on two different databases: a database with annotated BPCs and the STAFF III database with recordings from rest and during angioplasty-induced ischemia but not including BPCs. The angle-based detector results in performance values of detection probability PD = 95%, false alarm probability PF = 3% in the BPC database and false alarm rate in the STAFF III database in control ECGs during rest RF(c) = 2 h(-1) (episodes per hour) and in ischemia recordings during angioplasty RF(a) = 7 h(-1), whereas the KLT-based detector produces values of PD = 89%, PF = 3%, RF(c) = 4 h(-1), and RF(a) = 11 h(-1), respectively. Including information on noise level in the detection process to reduce the number of false alarms, performance values of PD approximately equal to 90%, PF approximately equal to 1%, RF(c) approximately equal to 1 h(-1) and RF(a) approximately equal to 2 h(-1) are obtained with both methods. It is concluded that reliable detection of BPCs may be achieved using the ECG signal and should work in parallel to ischemia detectors.

Artifacts↗

PubMed2002

Remote processing server for ECG-based clinical diagnosis support.

In this paper, we present the development of a remote server that provides a user-friendly access to advanced electrocardiographic (ECG) signal processing techniques. The prototype supplies telemedicine facilities to doctors for clinical indexes remote computation to support diagnosis through the Internet. The user-friendly interface is based on the selection of the desired ECG signal processing tools on a Web browser window. The centralized structure of the system permits unique and user-independent update and management of the software and, therefore, is especially suitable for remote or rural regions to have access to the new ECG information techniques.

Algorithms↗