Reduced System Complexity of Heart Rate Dynamics in Patients with Hyperthyroidism: A Multiscale Entropy Analysis

Studying heart rate dynamics would help understand the effects caused by a hyperkinetic heart in patients with hyperthyroidism. By using a multiscale entropy (MSE) analysis of heart rate dynamics derived from one-channel electrocardiogram recording, we aimed to compare the system complexity of heart rate dynamics between hyperthyroid patients and control subjects. A decreased MSE complexity index (CI) computed from MSE analysis reflects reduced system complexity. Compared with the control subjects (n = 37), the hyperthyroid patients (n = 37) revealed a significant decrease (p < 0.001) in MSE CI (hyperthyroid patients 10.21 ± 0.37 versus control subjects 14.08 ± 0.21), sample entropy for each scale factor (from 1 to 9), and high frequency power (HF) as well as a significant increase (p < 0.001) in low frequency power (LF) in normalized units (LF%) and ratio of LF to HF (LF/HF). In conclusion, besides cardiac autonomic dysfunction, the system complexity of heart rate dynamics is reduced in hyperthyroidism. This finding implies that the adaptability of the heart rate regulating system is impaired in hyperthyroid patients. Additionally, it might explain the exercise intolerance experienced by hyperthyroid patients. In addition, hyperthyroid patients and control subjects could be distinguished by the MSE CI computed from MSE analysis of heart rate dynamics.     

Multiscale Entropy Analysis of Short Signals: The Robustness of Fuzzy Entropy-Based Variants Compared to Full-Length Long Signals

Multiscale entropy (MSE) analysis is a fundamental approach to access the complexity of a time series by estimating its information creation over a range of temporal scales. However, MSE may not be accurate or valid for short time series. This is why previous studies applied different kinds of algorithm derivations to short-term time series. However, no study has systematically analyzed and compared their reliabilities. This study compares the MSE algorithm variations adapted to short time series on both human and rat heart rate variability (HRV) time series using long-term MSE as reference. The most used variations of MSE are studied: composite MSE (CMSE), refined composite MSE (RCMSE), modified MSE (MMSE), and their fuzzy versions. We also analyze the errors in MSE estimations for a range of incorporated fuzzy exponents. The results show that fuzzy MSE versions—as a function of time series length—present minimal errors compared to the non-fuzzy algorithms. The traditional multiscale entropy algorithm with fuzzy counting (MFE) has similar accuracy to alternative algorithms with better computing performance. For the best accuracy, the findings suggest different fuzzy exponents according to the time series length.     

Quantitative analysis of heart rate variability

In the modern industrialized countries every year several hundred thousands of people die due to sudden cardiac death. The individual risk for this sudden cardiac death cannot be defined precisely by common available, noninvasive diagnostic tools like Holter monitoring, highly amplified ECG and traditional linear analysis of heart rate variability (HRV). Therefore, we apply some rather unconventional methods of nonlinear dynamics to analyze the HRV. Especially, some complexity measures that are based on symbolic dynamics as well as a new measure, the renormalized entropy, detect some abnormalities in the HRV of several patients who have been classified in the low risk group by traditional methods. A combination of these complexity measures with the parameters in the frequency domain seems to be a promising way to get a more precise definition of the individual risk. These findings have to be validated by a representative number of patients. (c) 1995 American Institute of Physics.     

Bispectral Analysis of Heart Rate Variability to Characterize and Help Diagnose Pediatric Sleep Apnea

Pediatric obstructive sleep apnea (OSA) is a breathing disorder that alters heart rate variability (HRV) dynamics during sleep. HRV in children is commonly assessed through conventional spectral analysis. However, bispectral analysis provides both linearity and stationarity information and has not been applied to the assessment of HRV in pediatric OSA. Here, this work aimed to assess HRV using bispectral analysis in children with OSA for signal characterization and diagnostic purposes in two large pediatric databases (0–13 years). The first database (training set) was composed of 981 overnight ECG recordings obtained during polysomnography. The second database (test set) was a subset of the Childhood Adenotonsillectomy Trial database (757 children). We characterized three bispectral regions based on the classic HRV frequency ranges (very low frequency: 0–0.04 Hz; low frequency: 0.04–0.15 Hz; and high frequency: 0.15–0.40 Hz), as well as three OSA-specific frequency ranges obtained in recent studies (BW1: 0.001–0.005 Hz; BW2: 0.028–0.074 Hz; BWRes: a subject-adaptive respiratory region). In each region, up to 14 bispectral features were computed. The fast correlation-based filter was applied to the features obtained from the classic and OSA-specific regions, showing complementary information regarding OSA alterations in HRV. This information was then used to train multi-layer perceptron (MLP) neural networks aimed at automatically detecting pediatric OSA using three clinically defined severity classifiers. Both classic and OSA-specific MLP models showed high and similar accuracy (Acc) and areas under the receiver operating characteristic curve (AUCs) for moderate (classic regions: Acc = 81.0%, AUC = 0.774; OSA-specific regions: Acc = 81.0%, AUC = 0.791) and severe (classic regions: Acc = 91.7%, AUC = 0.847; OSA-specific regions: Acc = 89.3%, AUC = 0.841) OSA levels. Thus, the current findings highlight the usefulness of bispectral analysis on HRV to characterize and diagnose pediatric OSA.     

Similarity Changes Analysis for Heart Rate Fluctuation Regularity as a New Screening Method for Congestive Heart Failure

Congestive heart failure (CHF) is a chronic cardiovascular condition associated with dysfunction of the autonomic nervous system (ANS). Heart rate variability (HRV) has been widely used to assess ANS. This paper proposes a new HRV analysis method, which uses information-based similarity (IBS) transformation and fuzzy approximate entropy (fApEn) algorithm to obtain the fApEn_IBS index, which is used to observe the complexity of autonomic fluctuations in CHF within 24 h. We used 98 ECG records (54 health records and 44 CHF records) from the PhysioNet database. The fApEn_IBS index was statistically significant between the control and CHF groups (p < 0.001). Compared with the classical indices low-to-high frequency power ratio (LF/HF) and IBS, the fApEn_IBS index further utilizes the changes in the rhythm of heart rate (HR) fluctuations between RR intervals to fully extract relevant information between adjacent time intervals and significantly improves the performance of CHF screening. The CHF classification accuracy of fApEn_IBS was 84.69%, higher than LF/HF (77.55%) and IBS (83.67%). Moreover, the combination of IBS, fApEn_IBS, and LF/HF reached the highest CHF screening accuracy (98.98%) with the random forest (RF) classifier, indicating that the IBS and LF/HF had good complementarity. Therefore, fApEn_IBS effusively reflects the complexity of autonomic nerves in CHF and is a valuable CHF assessment tool.     

Neurofeedback Training Based on Motor Imagery Strategies Increases EEG Complexity in Elderly Population

Neurofeedback training (NFT) has shown promising results in recent years as a tool to address the effects of age-related cognitive decline in the elderly. Since previous studies have linked reduced complexity of electroencephalography (EEG) signal to the process of cognitive decline, we propose the use of non-linear methods to characterise changes in EEG complexity induced by NFT. In this study, we analyse the pre- and post-training EEG from 11 elderly subjects who performed an NFT based on motor imagery (MI–NFT). Spectral changes were studied using relative power (RP) from classical frequency bands (delta, theta, alpha, and beta), whilst multiscale entropy (MSE) was applied to assess EEG-induced complexity changes. Furthermore, we analysed the subject’s scores from Luria tests performed before and after MI–NFT. We found that MI–NFT induced a power shift towards rapid frequencies, as well as an increase of EEG complexity in all channels, except for C3. These improvements were most evident in frontal channels. Moreover, results from cognitive tests showed significant enhancement in intellectual and memory functions. Therefore, our findings suggest the usefulness of MI–NFT to improve cognitive functions in the elderly and encourage future studies to use MSE as a metric to characterise EEG changes induced by MI–NFT.     

Effects of Cardiac Resynchronization Therapy on Cardio-Respiratory Coupling

In this study, the effect of cardiac resynchronization therapy (CRT) on the relationship between the cardiovascular and respiratory systems in heart failure subjects was examined for the first time. We hypothesized that alterations in cardio-respiratory interactions, after CRT implantation, quantified by signal complexity, could be a marker of a favorable CRT response. Sample entropy and scaling exponents were calculated from synchronously recorded cardiac and respiratory signals 20 min in duration, collected in 47 heart failure patients at rest, before and 9 months after CRT implantation. Further, cross-sample entropy between these signals was calculated. After CRT, all patients had lower heart rate and CRT responders had reduced breathing frequency. Results revealed that higher cardiac rhythm complexity in CRT non-responders was associated with weak correlations of cardiac rhythm at baseline measurement over long scales and over short scales at follow-up recording. Unlike CRT responders, in non-responders, a significant difference in respiratory rhythm complexity between measurements could be consequence of divergent changes in correlation properties of the respiratory signal over short and long scales. Asynchrony between cardiac and respiratory rhythm increased significantly in CRT non-responders during follow-up. Quantification of complexity and synchrony between cardiac and respiratory signals shows significant associations between CRT success and stability of cardio-respiratory coupling.     

基于多尺度熵的交通流复杂性分析

交通流演化复杂性的研究有助于深刻理解交通系统的内在演化规律,为交通流的预测和控制提供理论依据.多尺度熵方法在生理时间序列和计算机网络流量的分析中得到了广泛的应用.考虑到交通流中的车辆到达和计算机网络中的分组到达具有类似特性,本文以刹车灯模型的车头时距为分析对象,利用多尺度熵方法来分析交通流演化的复杂性.分析结果表明:1)车头时距的复杂性随着时间尺度的增加而降低,反映了交通流的短时间难预测性;2)当时间尺度较小时,车头时距复杂性在自由流时和同步流时差异不大,但是,随着时间尺度的增加,自由流时车头时距的熵值迅速下降,而同步流时车头时距的熵值下降较慢.这一特性对于识别自由流中是否产生了同步流有非常重要的参考价值.本文的研究可以为揭示交通流演化的复杂性提供新的思路和方法.     

Brain Dynamics Altered by Photic Stimulation in Patients with Alzheimer’s Disease and Mild Cognitive Impairment

Individuals with mild cognitive impairment (MCI) are at high risk of developing Alzheimer’s disease (AD). Repetitive photic stimulation (PS) is commonly used in routine electroencephalogram (EEG) examinations for rapid assessment of perceptual functioning. This study aimed to evaluate neural oscillatory responses and nonlinear brain dynamics under the effects of PS in patients with mild AD, moderate AD, severe AD, and MCI, as well as healthy elderly controls (HC). EEG power ratios during PS were estimated as an index of oscillatory responses. Multiscale sample entropy (MSE) was estimated as an index of brain dynamics before, during, and after PS. During PS, EEG harmonic responses were lower and MSE values were higher in the AD subgroups than in HC and MCI groups. PS-induced changes in EEG complexity were less pronounced in the AD subgroups than in HC and MCI groups. Brain dynamics revealed a “transitional change” between MCI and Mild AD. Our findings suggest a deficiency in brain adaptability in AD patients, which hinders their ability to adapt to repetitive perceptual stimulation. This study highlights the importance of combining spectral and nonlinear dynamical analysis when seeking to unravel perceptual functioning and brain adaptability in the various stages of neurodegenerative diseases.     

The Systematic Bias of Entropy Calculation in the Multi-Scale Entropy Algorithm

Entropy indicates irregularity or randomness of a dynamic system. Over the decades, entropy calculated at different scales of the system through subsampling or coarse graining has been used as a surrogate measure of system complexity. One popular multi-scale entropy analysis is the multi-scale sample entropy (MSE), which calculates entropy through the sample entropy (SampEn) formula at each time scale. SampEn is defined by the “logarithmic likelihood” that a small section (within a window of a length m) of the data “matches” with other sections will still “match” the others if the section window length increases by one. “Match” is defined by a threshold of r times standard deviation of the entire time series. A problem of current MSE algorithm is that SampEn calculations at different scales are based on the same matching threshold defined by the original time series but data standard deviation actually changes with the subsampling scales. Using a fixed threshold will automatically introduce systematic bias to the calculation results. The purpose of this paper is to mathematically present this systematic bias and to provide methods for correcting it. Our work will help the large MSE user community avoiding introducing the bias to their multi-scale SampEn calculation results.     

Influence of Ectopic Beats on Heart Rate Variability Analysis

The analysis of heart rate variability (HRV) plays a dominant role in the study of physiological signal variability. HRV reflects the information of the adjustment of sympathetic and parasympathetic nerves on the cardiovascular system and, thus, is widely used to evaluate the functional status of the cardiovascular system. Ectopic beats may affect the analysis of HRV. However, the quantitative relationship between the burden of ectopic beats and HRV indices, including entropy measures, has not yet been investigated in depth. In this work, we analyzed the effects of different numbers of ectopic beats on several widely accepted HRV parameters in time-domain (SDNN), frequency-domain (LF/HF), as well as non-linear features (SampEn and Pt-SampEn (physical threshold-based SampEn)). The results showed that all four indices were influenced by ectopic beats, and the degree of influence was roughly increased with the increase of the number of ectopic beats. Ectopic beats had the greatest impact on the frequency domain index LF/HF, whereas the Pt-SampEn was minimally accepted by ectopic beats. These results also indicated that, compared with the other three indices, Pt-SampEn had better robustness for ectopic beats.     

Comparison of nonlinear methods symbolic dynamics, detrended fluctuation, and Poincare plot analysis in risk stratification in patients with dilated cardiomyopathy

Dilated cardiomyopathy (DCM) has an incidence of about 20100 000 new cases per annum and accounts for nearly 10 000 deaths per year in the United States. Approximately 36% of patients with dilated cardiomyopathy (DCM) suffer from cardiac death within five years after diagnosis. Currently applied methods for an early risk prediction in DCM patients are rather insufficient. The objective of this study was to investigate the suitability of short-term nonlinear methods symbolic dynamics (STSD), detrended fluctuation (DFA), and Poincare plot analysis (PPA) for risk stratification in these patients. From 91 DCM patients and 30 healthy subjects (REF), heart rate and blood pressure variability (HRV, BPV), STSD, DFA, and PPA were analyzed. Measures from BPV analysis, DFA, and PPA revealed highly significant differences (p<0.0011) discriminating REF and DCM. For risk stratification in DCM patients, four parameters from BPV analysis, STSD, and PPA revealed significant differences between low and high risk (maximum sensitivity: 90%, specificity: 90%). These results suggest that STSD and PPA are useful nonlinear methods for enhanced risk stratification in DCM patients.     

心率变异性分析在新生儿疼痛检测中的应用

为了研究疼痛暴露对新生儿自主神经系统的影响,并建立基于心率变异性(heart rate variability,HRV)指标的新生儿疼痛检测模型,采用时域、频域和非线性方法对40名新生儿疼痛暴露前后的心电数据进行短时HRV分析,Wilcoxon符号秩检验用于统计分析,支持向量机(support vector machine,SVM)用于建立检测模型.结果表明,RR间期均值a RR、低频段功率LF、高频段功率HF等3个线性指标和近似熵Ap En、样本熵Samp En、递归率REC等9个非线性指标在疼痛前后具有统计学差异;基于a RR、相邻两个RR间期对差值大于50 ms的百分比p NN50,Ap En,关联维D2和REC等5个指标和SVM的疼痛检测模型检测正确率达到83.75%.HRV的相关指标可反映新生儿自主神经系统对疼痛暴露的应答,基于HRV指标和SVM的模型可用于新生儿疼痛检测.     

Entropy Profiling: A Reduced—Parametric Measure of Kolmogorov—Sinai Entropy from Short-Term HRV Signal

Entropy profiling is a recently introduced approach that reduces parametric dependence in traditional Kolmogorov-Sinai (KS) entropy measurement algorithms. The choice of the threshold parameter r of vector distances in traditional entropy computations is crucial in deciding the accuracy of signal irregularity information retrieved by these methods. In addition to making parametric choices completely data-driven, entropy profiling generates a complete profile of entropy information as against a single entropy estimate (seen in traditional algorithms). The benefits of using “profiling” instead of “estimation” are: (a) precursory methods such as approximate and sample entropy that have had the limitation of handling short-term signals (less than 1000 samples) are now made capable of the same; (b) the entropy measure can capture complexity information from short and long-term signals without multi-scaling; and (c) this new approach facilitates enhanced information retrieval from short-term HRV signals. The novel concept of entropy profiling has greatly equipped traditional algorithms to overcome existing limitations and broaden applicability in the field of short-term signal analysis. In this work, we present a review of KS-entropy methods and their limitations in the context of short-term heart rate variability analysis and elucidate the benefits of using entropy profiling as an alternative for the same.     

Concurrent sympathetic activation and vagal withdrawal in hyperthyroidism: Evidence from detrended fluctuation analysis of heart rate variability

Despite many previous studies on the association between hyperthyroidism and the hyperadrenergic state, controversies still exist. Detrended fluctuation analysis (DFA) is a well recognized method in the nonlinear analysis of heart rate variability (HRV), and it has physiological significance related to the autonomic nervous system. In particular, an increased short-term scaling exponent α1 calculated from DFA is associated with both increased sympathetic activity and decreased vagal activity. No study has investigated the DFA of HRV in hyperthyroidism. This study was designed to assess the sympathovagal balance in hyperthyroidism. We performed the DFA along with the linear analysis of HRV in 36 hyperthyroid Graves’ disease patients (32 females and 4 males; age 30 ± 1 years, means ± SE) and 36 normal controls matched by sex, age and body mass index. Compared with the normal controls, the hyperthyroid patients revealed a significant increase (P<0.001) in α1 (hyperthyroid 1.28±0.04 versus control 0.91±0.02), long-term scaling exponent , overall scaling exponent , low frequency power in normalized units (LF%) and the ratio of low frequency power to high frequency power (LF/HF); and a significant decrease (P<0.001) in the standard deviation of the R-R intervals (SDNN) and high frequency power (HF). In conclusion, hyperthyroidism is characterized by concurrent sympathetic activation and vagal withdrawal. This sympathovagal imbalance state in hyperthyroidism helps to explain the higher prevalence of atrial fibrillation and exercise intolerance among hyperthyroid patients.     

小波变换的信号分形分析及其在心电信号处理中的应用研究

介绍了一种基于小波变换的分形分析方法,并将它成功地应用于心房纤颤的检测中.该方法提取了一个特征值r,结果表明在心房纤颤开始时,特征值是上升的,心房纤颤结束后,特征值又慢慢恢复到原来的数值,由此可以成功地检测出心房纤颤的开始和结束.此外,由于特征值同时反映了heartratevariability(HRV)信号的复杂程度,所以同时它也表明:心房纤颤开始后,HRV信号的复杂度是下降的 关键词： HRV 小波变换 分形     

Complexity Measures of Heart-Rate Variability in Amyotrophic Lateral Sclerosis with Alternative Pulmonary Capacities

Objective: the complexity of heart-rate variability (HRV) in amyotrophic lateral sclerosis (ALS) patients with different pulmonary capacities was evaluated. Methods: We set these according to their pulmonary capacity, and specifically forced vital capacity (FVC). We split the groups according to FVC (FVC > 50% (n = 29) and FVC < 50% (n = 28)). In ALS, the presence of an FVC below 50% is indicative of noninvasive ventilation with two pressure levels and with the absence of other respiratory symptoms. As the number of subjects per group was different, we applied the unbalanced one-way analysis of variance (uANOVA1) test after three tests of normality, and effect size by Cohen’s d to assess parameter significance. Results: with regard to chaotic global analysis, CFP4 (p < 0.001; d = 0.91), CFP5 (p = 0.0022; d = 0.85), and CFP6 (p = 0.0009; d = 0.92) were enlarged. All entropies significantly increased. Shannon (p = 0.0005; d = 0.98), Renyi (p = 0.0002; d = 1.02), Tsallis (p = 0.0004; d = 0.99), approximate (p = 0.0005; d = 0.97), and sample (p < 0.0001; d = 1.22). Detrended fluctuation analysis (DFA) (p = 0.0358) and Higuchi fractal dimension (HFD) (p = 0.15) were statistically inconsequential between the two groups. Conclusions: HRV complexity in ALS subjects with different pulmonary capacities increased via chaotic global analysis, especially CFP5 and 3 out of 5 entropies.     

Discrimination of Patients with Varying Degrees of Coronary Artery Stenosis by ECG and PCG Signals Based on Entropy

Coronary heart disease (CHD) is the leading cause of cardiovascular death. This study aimed to propose an effective method for mining cardiac mechano-electric coupling information and to evaluate its ability to distinguish patients with varying degrees of coronary artery stenosis (VDCAS). Five minutes of electrocardiogram and phonocardiogram signals was collected synchronously from 191 VDCAS patients to construct heartbeat interval (RRI)–systolic time interval (STI), RRI–diastolic time interval (DTI), HR-corrected QT interval (QTcI)–STI, QTcI–DTI, Tpeak–Tend interval (TpeI)–STI, TpeI–DTI, Tpe/QT interval (Tpe/QTI)–STI, and Tpe/QTI–DTI series. Then, the cross sample entropy (XSampEn), cross fuzzy entropy (XFuzzyEn), joint distribution entropy (JDistEn), magnitude-squared coherence function, cross power spectral density, and mutual information were applied to evaluate the coupling of the series. Subsequently, support vector machine recursive feature elimination and XGBoost were utilized for feature selection and classification, respectively. Results showed that the joint analysis of XSampEn, XFuzzyEn, and JDistEn had the best ability to distinguish patients with VDCAS. The classification accuracy of severe CHD—mild-to-moderate CHD group, severe CHD—chest pain and normal coronary angiography (CPNCA) group, and mild-to-moderate CHD—CPNCA group were 0.8043, 0.7659, and 0.7500, respectively. The study indicates that the joint analysis of XSampEn, XFuzzyEn, and JDistEn can effectively capture the cardiac mechano-electric coupling information of patients with VDCAS, which can provide valuable information for clinicians to diagnose CHD.