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The ideal moment to withdraw respiratory supply of patients under Mechanical Ventilation at Intensive Care Units (ICU), is not easy to be determined for clinicians. Although the Spontaneous Breathing Trial (SBT) provides a measure of the patients' readiness, there is still around 15-20% of predictive failure rate. This work is a proof of concept focused on adding new value to the prediction of the weaning outcome. Heart Rate Variability (HRV) and Cardiopulmonary Coupling (CPC) methods are evaluated as new complementary estimates to assess weaning readiness. The CPC is related to how the mechanisms regulating respiration and cardiac pumping are working simultaneously, and it is defined from HRV in combination with respiratory information. Three different techniques are used to estimate the CPC, including Time-Frequency Coherence, Dynamic Mutual Information and Orthogonal Subspace Projections. The cohort study includes 22 patients in pressure support ventilation, ready to undergo the SBT, analysed in the 24 h previous to the SBT. Of these, 13 had a successful weaning and 9 failed the SBT or needed reintubation -being both considered as failed weaning. Results illustrate that traditional variables such as heart rate, respiratory frequency, and the parameters derived from HRV do not differ in patients with successful or failed weaning. Results revealed that HRV parameters can vary considerably depending on the time at which they are measured. This fact could be attributed to circadian rhythms, having a strong influence on HRV values. On the contrary, significant statistical differences are found in the proposed CPC parameters when comparing the values of the two groups, and throughout the whole recordings. In addition, differences are greater at night, probably because patients with failed weaning might be experiencing more respiratory episodes, e.g. apneas during the night, which is directly related to a reduced respiratory sinus arrhythmia. Therefore, results suggest that the traditional measures could be used in combination with the proposed CPC biomarkers to improve weaning readiness., (© 2021. The Author(s).)

Under the hypothesis that sympathetic control of ventricular repolarization may change once the second ventilatory threshold (VT2) has been reached, a novel methodology for non-invasive VT2 estimation based on the analysis of the T wave from the electrocardiogram (ECG) is proposed, and potential underlying physiological mechanisms are suggested. 25 volunteers (33.4 ± 5.2 years) underwent an incremental power cycle ergometer test (25 W/minute). During the test, respiratory gas exchange and multi-lead ECG were acquired. The former was employed to determine VT2, used here as a reference, whereas the latter was used to compute the temporal profiles of an index of ventricular repolarization instability (dT) and its low-frequency (LF) oscillations (LFdT). The sudden increases observed in dT and LFdT profiles above an established heart rate threshold were employed to derive VT2 estimates, referred to as VT2 d T and VT2 LF d T , respectively. Estimation errors of -4.7 ± 25.2 W were obtained when considering VT2 d T . Errors were lower than the one-minute power increment of 25 W in 68% of the subjects and lower than 50 W in 89.5% of them. When using VT2 LF d T , estimation error was of 15.3 ± 32.4 W. Most of the subjects shared common characteristic dT and LFdT profiles, which could be reflecting changes in the autonomic control of ventricular repolarization before and after reaching VT2. The analysis of ventricular repolarization dynamics during exercise allows non-invasive ECG-based estimation of VT2, possibly in relation to changes in the autonomic control of ventricular electrical activity when VT2 is reached., (© 2020 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

This work aims to validate the Polar H7 heart rate (HR) sensor for heart rate variability (HRV) analysis at rest and during various exercise intensities in a cohort of male volunteers with different age, body composition and fitness level. Cluster analysis was carried out to evaluate how these phenotypic characteristics influenced HR and HRV measurements. For this purpose, sixty-seven volunteers performed a test consisting of the following consecutive segments: sitting rest, three submaximal exercise intensities in cycle-ergometer and sitting recovery. The agreement between HRV indices derived from Polar H7 and a simultaneous electrocardiogram (ECG) was assessed using concordance correlation coefficient (CCC). The percentage of subjects not reaching excellent agreement (CCC > 0.90) was higher for high-frequency power (P HF ) than for low-frequency power (P LF ) of HRV and increased with exercise intensity. A cluster of unfit and not young volunteers with high trunk fat percentage showed the highest error in HRV indices. This study indicates that Polar H7 and ECG were interchangeable at rest. During exercise, HR and P LF showed excellent agreement between devices. However, during the highest exercise intensity, CCC for P HF was lower than 0.90 in as many as 60% of the volunteers. During recovery, HR but not HRV measurements were accurate. As a conclusion, phenotypic differences between subjects can represent one of the causes for disagreement between HR sensors and ECG devices, which should be considered specifically when using Polar H7 and, generally, in the validation of any HR sensor for HRV analysis.

Background: This study examined the effects of a mountain ultra-marathon (MUM) on the activity of the autonomous nervous system through heart rate variability (HRV) monitoring and determined whether this variable related to final performance., Methods: Heart rate and HRV were measured in eight male amateur runners (aged 37-60 years). Measurements were recorded before and after the event, in resting conditions, as well as continuously throughout the whole MUM. In addition, percentage (%) of heart rate reserve (HRres) and partial and total times during the race were analyzed., Results: Average heart rate (HRavg) measured at rest was increased after the event (+37%). Standard deviation of successive differences (SDSD) and the square root of the mean squared differences of successive NN intervals (RMSSD) were reduced after the MUM (-56% and -59%, respectively). There was a positive relationship between the frequency-domain index normalized low frequency power (PLFn) measured at rest before the event and race time (0.79) while there was a negative relationship between race time and the difference in HRavg before and after the event. In the last half of the event, there was a high correlation (Spearman coefficient of correlation >0.9) between race time and the standard deviation of the NN intervals (SDNN) registered during the race., Conclusions: Autonomous cardiac regulation can be related to the performance in a mountain ultra-marathon. HRV monitoring could represent a practical tool for the evaluation of the relationship between the autonomous nervous system activity and performance in a mountain ultra-marathon.

Objective: Interest in emotion recognition has increased in recent years as a useful tool for diagnosing psycho-neural illnesses. In this study, the auto-mutual and the cross-mutual information function, AMIF and CMIF respectively, are used for human emotion recognition., Approach: The AMIF technique was applied to heart rate variability (HRV) signals to study complex interdependencies, and the CMIF technique was considered to quantify the complex coupling between HRV and respiratory signals. Both algorithms were adapted to short-term RR time series. Traditional band pass filtering was applied to the RR series at low frequency (LF) and high frequency (HF) bands, and a respiration-based filter bandwidth was also investigated ([Formula: see text]). Both the AMIF and the CMIF algorithms were calculated with regard to different time scales as specific complexity measures. The ability of the parameters derived from the AMIF and the CMIF to discriminate emotions was evaluated on a database of video-induced emotion elicitation. Five elicited states i.e. relax (neutral), joy (positive valence), as well as fear, sadness and anger (negative valences) were considered., Main Results: The results revealed that the AMIF applied to the RR time series filtered in the [Formula: see text] band was able to discriminate between the following: relax and joy and fear, joy and each negative valence conditions, and finally fear and sadness and anger, all with a statistical significance level p -value [Formula: see text] 0.05, sensitivity, specificity and accuracy higher than 70% and area under the receiver operating characteristic curve index AUC [Formula: see text]0.70. Furthermore, the parameters derived from the AMIF and the CMIF allowed the low signal complexity presented during fear to be characterized in front of any of the studied elicited states., Significance: Based on these results, human emotion manifested in the HRV and respiratory signal responses could be characterized by means of the information-content complexity.

Heart rate variability (HRV) analysis is a noninvasive tool widely used to assess autonomic nervous system state. The market for wearable devices that measure the heart rate has grown exponentially, as well as their potential use for healthcare and wellbeing applications. Still, there is a lack of validation of these devices. In particular, this work aims to validate the Apple Watch in terms of HRV derived from the RR interval series provided by the device, both in temporal (HRM (mean heart rate), SDNN, RMSSD and pNN50) and frequency (low and high frequency powers, LF and HF) domain. For this purpose, a database of 20 healthy volunteers subjected to relax and a mild cognitive stress was used. First, RR interval series provided by Apple Watch were validated using as reference the RR interval series provided by a Polar H7 using Bland-Altman plots and reliability and agreement coefficients. Then, HRV parameters derived from both RR interval series were compared and their ability to identify autonomic nervous system (ANS) response to mild cognitive stress was studied. Apple Watch measurements presented very good reliability and agreement (>0.9). RR interval series provided by Apple Watch contain gaps due to missing RR interval values (on average, 5 gaps per recording, lasting 6.5 s per gap). Temporal HRV indices were not significantly affected by the gaps. However, they produced a significant decrease in the LF and HF power. Despite these differences, HRV indices derived from the Apple Watch RR interval series were able to reflect changes induced by a mild mental stress, showing a significant decrease of HF power as well as RMSSD in stress with respect to relax, suggesting the potential use of HRV measurements derived from Apple Watch for stress monitoring.

Objective: The growing interest to integrate consumer smart wristbands in eHealth applications spawns the need for novel approaches of data parametrization which account for the technology-specific constraints. The present study aims to investigate the feasibility of a consumer smart wristband to be used for computing pulse rate parameters during free-living activities., Approach: The feasibility of computing pulse rate variability (PRV) as well as pulse rate and physical activity-related parameters using the smart wristband was investigated, having an electrocardiogram as a reference. The parameters were studied on the pulse rate and step data from 54 participants, diagnosed with various cardiovascular diseases. The data were acquired during free-living activities with no user lifestyle intervention., Main Results: The comparison results show that the smart wristband is well-suited for computing the mean interbeat interval and the standard deviation of the averaged interbeat intervals. However, it is less reliable when estimating frequency domain and nonlinear parameters. Heart recovery time, estimated by fitting an exponential model to the events, satisfying the conditions of the 3 min step test, showed satisfactory agreement (relative error  <20%) with the reference ECG in one-third of all cases. On the other hand, the heart's adaptation to physical workload, expressed as the slope of the linear regression curve, was underestimated in most cases., Significance: The present study demonstrates that pulse rate parametrization using a consumer smart wristband is in principle feasible. The results show that the smart wristband is well suited for computing basic PRV parameters which have been reported to be associated with poorer health outcomes. In addition, the study introduces a methodology for the estimation of post-exercise heart recovery time and the heart's adaptation to physical workload during free-living activities.

Standard methodologies of heart rate variability analysis and physiological interpretation as a marker of autonomic nervous system condition have been largely published at rest, but not so much during exercise. A methodological framework for heart rate variability (HRV) analysis during exercise is proposed, which deals with the non-stationary nature of HRV during exercise, includes respiratory information, and identifies and corrects spectral components related to cardiolocomotor coupling (CC). This is applied to 23 male subjects who underwent different tests: maximal and submaximal, running and cycling; where the ECG, respiratory frequency and oxygen consumption were simultaneously recorded. High-frequency (HF) power results largely modified from estimations with the standard fixed band to those obtained with the proposed methodology. For medium and high levels of exercise and recovery, HF power results in a 20 to 40% increase. When cycling, HF power increases around 40% with respect to running, while CC power is around 20% stronger in running.

Hernando, D, Garatachea, N, Almeida, R, Casajús, JA, and Bailón, R. Validation of heart rate monitor Polar RS800 for heart rate variability analysis during exercise. J Strength Cond Res 32(3): 716-725, 2018-Heart rate variability (HRV) analysis during exercise is an interesting noninvasive tool to measure the cardiovascular response to the stress of exercise. Wearable heart rate monitors are a comfortable option to measure interbeat (RR) intervals while doing physical activities. It is necessary to evaluate the agreement between HRV parameters derived from the RR series recorded by wearable devices and those derived from an electrocardiogram (ECG) during dynamic exercise of low to high intensity. Twenty-three male volunteers performed an exercise stress test on a cycle ergometer. Subjects wore a Polar RS800 device, whereas ECG was also recorded simultaneously to extract the reference RR intervals. A time-frequency spectral analysis was performed to extract the instantaneous mean heart rate (HRM), and the power of low-frequency (PLF) and high-frequency (PHF) components, the latter centered on the respiratory frequency. Analysis was done in intervals of different exercise intensity based on oxygen consumption. Linear correlation, reliability, and agreement were computed in each interval. The agreement between the RR series obtained from the Polar device and from the ECG is high throughout the whole test although the shorter the RR is, the more differences there are. Both methods are interchangeable when analyzing HRV at rest. At high exercise intensity, HRM and PLF still presented a high correlation (ρ > 0.8) and excellent reliability and agreement indices (above 0.9). However, the PHF measurements from the Polar showed reliability and agreement coefficients around 0.5 or lower when the level of the exercise increases (for levels of O2 above 60%).

Prophylactic treatment has been proved to reduce hypotension incidence after spinal anesthesia during cesarean labor. However, the use of pharmacological prophylaxis could carry out undesirable side-effects on mother and fetus. Thus, the prediction of hypotension becomes an important challenge. Hypotension events are hypothesized to be related to a malfunctioning of autonomic nervous system (ANS) regulation of blood pressure. In this work, ANS responses to positional changes of 51 pregnant women programmed for a cesarean labor were explored for hypotension prediction. Lateral and supine decubitus, and sitting position were considered while electrocardiographic and pulse photoplethysmographic signals were recorded. Features based on heart rate variability, pulse rate variability (PRV) and pulse transit time (PTT) analysis were used in a logistic regression classifier. The results showed that PRV irregularity changes, assessed by approximate entropy, from supine to lateral decubitus, and standard deviation of PTT in supine decubitus were found as the combination of features that achieved the best classification results sensitivity of 76%, specificity of 70% and accuracy of 72%, being normotensive the positive class. Peripheral regulation and blood pressure changes, measured by PRV and PTT analysis, could help to predict hypotension events reducing prophylactic side-effects in the low-risk population.

It is estimated that 10-30 % of road fatalities are related to drowsy driving. Driver's drowsiness detection based on biological and vehicle signals is being studied in preventive car safety. Autonomous nervous system activity, which can be measured noninvasively from the heart rate variability (HRV) signal obtained from surface electrocardiogram, presents alterations during stress, extreme fatigue and drowsiness episodes. We hypothesized that these alterations manifest on HRV and thus could be used to detect driver's drowsiness. We analyzed three driving databases in which drivers presented different sleep-deprivation levels, and in which each driving minute was annotated as drowsy or awake. We developed two different drowsiness detectors based on HRV. While the drowsiness episodes detector assessed each minute of driving as "awake" or "drowsy" with seven HRV derived features (positive predictive value 0.96, sensitivity 0.59, specificity 0.98 on 3475 min of driving), the sleep-deprivation detector discerned if a driver was suitable for driving or not, at driving onset, as function of his sleep-deprivation state. Sleep-deprivation state was estimated from the first three minutes of driving using only one HRV feature (positive predictive value 0.80, sensitivity 0.62, specificity 0.88 on 30 drivers). Incorporating drowsiness assessment based on HRV signal may add significant improvements to existing car safety systems.

The work presented in this paper aims at assessing human emotion recognition by means of the analysis of the heart rate variability (HRV) with varying spectral bands based on respiratory frequency (RF). Three specific emotional states are compared corresponding to calm-neutral state (Relax), positive elicitation (Joy) and negative elicitation (Fear). Standard HRV analysis in time and frequency domain is performed. In order to better characterize the HRV component related to respiratory sinus arrhythmia, the high frequency (HF) band is centered on RF. Results reveal that the power content in low band (PLF), the normalized power content in HF band (PHFn) and the sympathovagal ratio (LF/HF) can be suitable indices to distinguish Relax and Joy. Mean heart rate and RF are significantly different between Relax and Fear. Different HRV indices show significant differences between Joy and Fear, such as pNN50, PLF, PHFn and LF/HF. Statistical analysis of HRV indices with HF centered in the RF results in a lower p-value than the ones with a HF standard band.

This paper presents a methodological framework for robust estimation of the correlation dimension in HRV signals. It includes (i) a fast algorithm for on-line computation of correlation sums; (ii) log-log curves fitting to a sigmoidal function for robust maximum slope estimation discarding the estimation according to fitting requirements; (iii) three different approaches for linear region slope estimation based on latter point; and (iv) exponential fitting for robust estimation of saturation level of slope series with increasing embedded dimension to finally obtain the correlation dimension estimate. Each approach for slope estimation leads to a correlation dimension estimate, called D₂, D(2(⊥)), and D(2(max)). D₂ and D(2(max)) estimate the theoretical value of correlation dimension for the Lorenz attractor with relative error of 4%, and D(2(⊥)) with 1%. The three approaches are applied to HRV signals of pregnant women before spinal anesthesia for cesarean delivery in order to identify patients at risk for hypotension. D₂ keeps the 81% of accuracy previously described in the literature while D(2(⊥)) and D(2(max)) approaches reach 91% of accuracy in the same database.

The analysis and interpretation of heart rate variability (HRV) during exercise is challenging not only because of the nonstationary nature of exercise, the time-varying mean heart rate, and the fact that respiratory frequency exceeds 0.4 Hz, but there are also other factors, such as the component centered at the pedaling frequency observed in maximal cycling tests, which may confuse the interpretation of HRV analysis. The objectives of this study are to test the hypothesis that a component centered at the running stride frequency (SF) appears in the HRV of subjects during maximal treadmill exercise testing, and to study its influence in the interpretation of the low-frequency (LF) and high-frequency (HF) components of HRV during exercise. The HRV of 23 subjects during maximal treadmill exercise testing is analyzed. The instantaneous power of different HRV components is computed from the smoothed pseudo-Wigner-Ville distribution of the modulating signal assumed to carry information from the autonomic nervous system, which is estimated based on the time-varying integral pulse frequency modulation model. Besides the LF and HF components, the appearance is revealed of a component centered at the running SF as well as its aliases. The power associated with the SF component and its aliases represents 22±7% (median±median absolute deviation) of the total HRV power in all the subjects. Normalized LF power decreases as the exercise intensity increases, while normalized HF power increases. The power associated with the SF does not change significantly with exercise intensity. Consideration of the running SF component and its aliases is very important in HRV analysis since stride frequency aliases may overlap with LF and HF components.

An assessment of the dynamic interactions between cardiovascular signals can provide valuable information to improve the understanding of cardiovascular control. In this study, two methodologies for the characterization of time-frequency (TF) coherence between cardiovascular signals are described. The methodologies are based on the smoothed pseudo-Wigner-Ville distribution (SPWVD) and multitaper spectrogram (MTSP), and include the automatic assessment of the significance level of coherence estimates. The capability to correctly localize TF regions, where signals are locally coupled, is assessed using computer-generated data, and data from healthy volunteers. The SPWVD allows for the localization of these regions with higher accuracy (AC > 96.9% for SNR ≥ 5 dB) than the MTSP (AC > 84.4% for SNR ≥ 5 dB). In 14 healthy subjects, TF coherence analysis was used to describe the changes, which a tilt table test provokes in the cardiovascular control. Orthostatic stress provoked an increase in the coupling between R-R variability (RRV) and systolic arterial pressure variability; it did not provoke any significant changes in the coupling between RRV and respiration. In HF band, it decreased the strength of the coupling between RRV and pulse interval variability estimated from arterial pressure signal.

In this study, the influence of the time-varying mean heart rate (HR) and respiratory frequency in the ability of HR variability (HRV) indices to diagnose coronary artery disease has been studied. The autonomic nervous system activity has been assessed using a methodology that comprises correction of the HRV signal by the time-varying mean HR and redefinition of the classical high-frequency band to include respiratory frequencies above 0.4 Hz. The obtained clinical indices discriminate patients with coronary artery disease from patients with Framingham risk index lower than 5% with a moderate accuracy of 76%, which is lower than the reported in literature for HRV indices. We claim that time-varying mean HR and respiratory frequency, if not taken into account, introduce apparent improvement of diagnostic performance of HRV indices, adding information nonrelated to the autonomic nervous system activity, which is not what HRV is supposed to measure., (Copyright © 2011 Elsevier Inc. All rights reserved.)

In this paper, an approach for heart rate variability analysis during exercise stress testing is proposed based on the integral pulse frequency modulation (IPFM) model, where a time-varying threshold is included to account for the nonstationary mean heart rate. The proposed technique allows the estimation of the autonomic nervous system (ANS) modulating signal using the methods derived for the IPFM model with constant threshold plus a correction, which is shown to be needed to take into account the time-varying mean heart rate. On simulations, this technique allows the estimation of the ANS modulation on the heart from the beat occurrence time series with lower errors than the IPFM model with constant threshold (1.1% ± 1.3% versus 15.0% ± 14.9%). On an exercise stress testing database, the ANS modulation estimated by the proposed technique is closer to physiology than that obtained from the IPFM model with constant threshold, which tends to overestimate the ANS modulation during the recovery and underestimate it during the initial rest.

Interest in therapeutic applications of music has recently increased, as well as the effort to understand the relationship between music features and physiological patterns. In this study, we present a methodology for characterizing music-induced effects on the dynamics of the heart rate modulation. It consists of three steps: (i) the smoothed pseudo Wigner-Ville distribution is performed to obtain a time-frequency representation of HRV; (ii) a parametric decomposition is used to robustly estimate the time-course of spectral parameters; and (iii) statistical population analysis is used to continuously assess whether different acoustic stimuli provoke different dynamic responses. Seventy-five healthy subjects were repetitively exposed to pleasant music, sequences of Shepard tones with the same tempo as the pleasant music and unpleasant sounds overlaid with the same sequences of Shepard tones. Results show that the modification of HRV parameters are characterized by an early fast transient phase (15-20 s), followed by an almost stationary period. All kinds of stimuli provoked significant changes compared to the resting condition, while during listening to pleasant music the heart and respiratory rates were higher (for more than 80% of the duration of the stimuli, p < 10(-5)) and the power of the HF modulation was lower (for more than 70% of the duration of the stimuli, p < 0.05) than during listening to unpleasant stimuli.

Centenarians are the paradigm of human extreme longevity and healthy aging, because they have postponed, if not avoided, mayor age-related diseases. The purpose of this study was to investigate potential differences in resting heart rate variability (HRV) between young adults, octogenarians, and centenarians and assess whether HRV variables are predictors of all-cause mortality in centenarians. To this end, three groups of participants: young adults (N = 20; 20.6 ± 2.3 years), octogenarians (N = 18; 84.1 ± 2.6 years), and centenarians (N = 17; 101.9 ± 1.9 years) were monitored for 15 min at rest (seated, without moving or talking) to measure RR intervals, from which HRV was evaluated. Our results showed a clear decrease with age in the main parasympathetic HRV variables, as well as in the standard deviation (SD) of the RR series [SD of normal-to-normal interval (SDNN)] and in low frequency (LF) heart rate (HR) oscillations, although differences between octogenarians and centenarians did not reach statistical significance. In 14 centenarians followed until death, only SDNN showed significant correlation (ρ = 0.536; p = 0.048) with survival prognosis. Additionally, SDNN <19 ms was associated with early mortality (≤1 year) in centenarians (Hazard Ratio = 5.72). In conclusion, HRV indices reflecting parasympathetic outflow as well as SDNN and LF all present an age-related reduction, which could be representative of a natural exhaustion of allostatic systems related to age. Moreover, low SDNN values (<19 ms) could be associated with early mortality in centenarians. HRV seems to play a role in exceptional longevity, which could be accounted for by centenarians' exposome. [ABSTRACT FROM AUTHOR]