The degree of heart rate asymmetry is crucial for the validity of the deceleration and acceleration capacity indices of heart rate: A model-based study

Pan, Qing; Zhou, Gongzhan; Wang, Ruofan; Yu, Yihua; Li, Feng; Fang, Luping; Yan, Jing; Ning, Gangmin

doi:10.1016/j.compbiomed.2016.06.017

Cited by 7 publications

(3 citation statements)

References 57 publications

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“…Thus, we introduced a new PRSAbased index sensitive to the unbalancing between deceleration and acceleration capacities, which we termed Deceleration Reserve (DR). Apart from the theoretical results reported in the first part of the manuscript, DR was also inspired by the works on the effects of heart rate asymmetry on AC and DC performed by Karmakar et al [12] and Pan et al [13]. In particular, the former study focused on fetal heart rate (FHR) and this is the domain in which we will also test our findings and new index.…”

mentioning

confidence: 82%

Theoretical Value of Deceleration Capacity Points to Deceleration Reserve of Fetal Heart Rate

Rivolta

Stampalija

Frasch

et al. 2020

IEEE Trans. Biomed. Eng.

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The interpretation of Average Acceleration and Deceleration Capacities (AC/DC), computed through Phase-Rectified Signal Averaging (PRSA), in intrapartum fetal heart rate (FHR) monitoring is still matter of investigation. We aimed to elucidate some behaviours of AC/DC. Methods: We derived the theoretical value of PRSA for stationary stochastic Gaussian processes and proved that for these time series AC and DC are necessarily identical in absolute value. The difference between DC and AC, termed Deceleration Reserve (DR), was introduced to detect signals asymmetric trends. DR was tested on FHR signals from: near-term pregnant sheep model of labor consisting of chronically hypoxic and normoxic fetuses with both groups developing acidemia due to umbilical cord occlusions (UCO); and the CTU-UHB dataset containing fetal CTG recordings collected during labor of newborns that resulted acidotic and non-acidotic, respectively. DR was compared with AC and DC in terms of discriminatory power (AUC), between the groups, after correcting for signals power or deceleration area, respectively. Results: DR displayed higher discriminatory power on the animal model during severe acidemia, with respect to AC/DC (p < 0.05) but also distinguished correctly all chronically hypoxic from normoxic fetuses at baseline prior to UCO. DR also outperformed AC/DC on the CTU-UHB dataset in distinguishing acidemic fetuses at birth (AUC: 0.65). Conclusion: Theoretical results motivated the introduction of DR, that proved to be superior than AC/DC for risk stratification during labor. Significance: DR, measured during labor, might permit to distinguish acidemic fetuses due to their different autonomic regulation, paving the way for new monitoring strategies. IndexTerms-phase-rectified signal averaging (PRSA), fetal heart rate variability, fetal monitoring, heart rate variability I. INTRODUCTION A VERAGE Acceleration and Deceleration Capacity (AC, DC) of heart rate [1] are quantified on inter-beat interval series (RR) through the Phase-Rectified Signal Averaging (PRSA) technique, proposed by Bauer et al. [2]. The two indexes gained significant acceptance in the biomedical engineering community for their robustness to signal quality (noise) and for their proven sensitivity to diverse clinical conditions, such as myocardial infarction, fetal distress, heart failure, dilated cardiomyopathy etc. [1], [3], [4], [5], [6], [7].Given the fact that they measure the "capacity" of the heart rate to increase or decrease, it might be tempting to associate AC and DC to the sympathetic and vagal autonomic activity, M. W. Rivolta and R. Sassi are with the

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confidence: 82%

Theoretical Value of Deceleration Capacity Points to Deceleration Reserve of Fetal Heart Rate

Rivolta

Stampalija

Frasch

et al. 2020

IEEE Trans. Biomed. Eng.

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“…The motivation to introduce the multiscale asymmetry indices in this research comes from the fact that DR was inspired by studies about the effects of heart rate asymmetry on AAC and ADC performed by Pan et al [29] and Karmakar et al [22].…”

Section: Multiscale Asymmetry Indicesmentioning

confidence: 99%

Differences in the Asymmetry of Beat-to-Beat Fetal Heart Rate Accelerations and Decelerations at Preterm and Term Active Labor

López-Justo

Pliego-Carrillo

Ledesma-Ramírez

et al. 2021

Sensors

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The fetal autonomic nervous system responds to uterine contractions during active labor as identified by changes in the accelerations and decelerations of fetal heart rate (FHR). Thus, this exploratory study aimed to characterize the asymmetry differences of beat-to-beat FHR accelerations and decelerations in preterm and term fetuses during active labor. In an observational study, we analyzed 10 min of fetal R-R series collected from women during active preterm labor (32–36 weeks of pregnancy, n = 17) and active term labor (38–40 weeks or pregnancy, n = 27). These data were used to calculate the Deceleration Reserve (DR), which is a novel parameter that quantifies the asymmetry of the average acceleration and deceleration capacity of the heart. In addition, relevant multiscale asymmetric indices of FHR were also computed. Lower values of DR, calculated with the input parameters of T = 50 and s = 10, were associated with labor occurring at the preterm condition (p = 0.0131). Multiscale asymmetry indices also confirmed significant (p < 0.05) differences in the asymmetry of FHR. Fetuses during moderate premature labor may experience more decaying R-R trends and a lower magnitude of decelerations compared to term fetuses. These differences of FHR dynamics might be related to the immaturity of the fetal cardiac autonomic nervous system as identified by this system response to the intense uterine activity at active labor.

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“…Based on a cardiovascular system model, we recently demonstrated that the degree of heart rate asymmetry (HRA) influences the performance of DC and AC in assessing the activity of ANS [5]. It implies that the performance of DC can be improved by adjusting the HRA level.…”

Section: Introductionmentioning

confidence: 99%

Controlling the Inspiration/Expiration Ratio Benefits the Deceleration Capacity Index of Heart Rate in Assessing the Sympatho:vagal Balance

Pan

Gao

Zhou

et al. 2016

2016 Computing in Cardiology Conference (CinC)

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Deceleration capacity (DC) of heart rate is a novel index for evaluating the activity of the autonomic nervous system (ANS). We examined whether controlling the inspiration/expiration (I/E) ratio benefits the DC analysis based on a model-generated RR interval (RRI)database IntroductionDeceleration capacity (DC) and acceleration capacity (AC) of heart rate are a pair of novel indices for the evaluation of autonomic nervous system (ANS) [1]. They are obtained by applying a phase-rectified signal averaging (PRSA) algorithm to the RR interval (RRI) series [2]. The PRSA selects the decelerating or the accelerating RRIs as the anchor points. The sections around the anchor points are defined and averaged to produce an averaging RRI series. DC or AC is computed as the coefficient of the Haar wavelet at scale two in the center of the averaging RRI series.The performances of DC and AC are distinct [1,3,4]. Based on a cardiovascular system model, we recently demonstrated that the degree of heart rate asymmetry (HRA) influences the performance of DC and AC in assessing the activity of ANS [5]. It implies that the performance of DC can be improved by adjusting the HRA level. As the inspiration/expiration (I/E) ratio influences the HRA level [6,7], we attempted to analyze whether controlling the I/E ratio benefits DC in assessing the ANS activity.Our study was conducted based on a cardiovascular system model. The model can produce a set of RRI time series with controlled levels of ANS activity for DC calculation. It can also control the I/E ratio to examine its role in the performance of DC.. MethodsThe study was conducted in three steps. First, we developed the cardiovascular system model to simulate the RRI time series. Second, we generated a set of RRI time series with random ANS activities and controlled respiratory I/E ratios as the virtual subjects for the study. Third, we computed DC for all the subjects and analyzed the performance of DC under different respiratory patterns. Model developmentThe block diagram of the cardiovascular system model is shown in Figure 1. Details of the model can be referred in the literature [8,9]. It contains a hemodynamic model

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The degree of heart rate asymmetry is crucial for the validity of the deceleration and acceleration capacity indices of heart rate: A model-based study

Cited by 7 publications

References 57 publications

Theoretical Value of Deceleration Capacity Points to Deceleration Reserve of Fetal Heart Rate

Theoretical Value of Deceleration Capacity Points to Deceleration Reserve of Fetal Heart Rate

Differences in the Asymmetry of Beat-to-Beat Fetal Heart Rate Accelerations and Decelerations at Preterm and Term Active Labor

Controlling the Inspiration/Expiration Ratio Benefits the Deceleration Capacity Index of Heart Rate in Assessing the Sympatho:vagal Balance

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