ECG 分析工具

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最新推荐文章于 2022-05-15 15:02:16 发布

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Heart Rate Variability Analysis with the HRV Toolkit

Basic Time and Frequency Domain Measures

Background: Joseph E. Mietus, B.S. and Ary L. Goldberger, M.D.
Software and related material: Joseph E. Mietus, B.S.

Margret and H.A. Rey Institute for Nonlinear Dynamics in Physiology and Medicine
Division of Interdisciplinary Medicine and Biotechnology and Division of Cardiology
Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, MA

I. Background

Heart rate variability (HRV) analysis attempts to assess cardiac autonomic regulation through quantification of sinus rhythm variability. The sinus rhythm times series is derived from the QRS to QRS (RR) interval sequence of the electrocardiogram (ECG), by extracting only normal sinus to normal sinus (NN) interbeat intervals. Relatively high frequency variations in sinus rhythm reflect parasympathetic (vagal) modulation, and slower variations reflect a combination of both parasympathetic and sympathetic modulation and non-autonomic factors [1-5].

Traditional heart rate variability (HRV) measures are usually divided into two broad categories: time domain measures and frequency domain measures [3,4]. The time domain heart rate variability statistics commonly calculated are defined in Table 1. Note, however, that computing pNNx with x < 50 ms in both long- and short-term recordings may provide a more robust index of fluctuations due to vagal tone than the standard pNN50 statistic [6]. Commonly used frequency domain measures are defined in Table 2.

The low frequency band (0.04 - 0.15 Hz) includes physiologic oscillations associated with baroreceptor reflexes and the high frequency band (0.15 - 0.40 Hz) encompasses respiratory sinus arrhythmia. The powers in these bands has been used to provide indexes of autonomic function. Such measures must be interpreted with caution, however. As noted, oscillations in the "low" frequency bands appear to be mediated by parasympathetic and sympathetic components, while the "high" frequency power is mediated exclusively by the vagus.

Traditionally, frequency domain measures are calculated by resampling the original NN interval series and then applying the fast Fourier transform or autoregressive spectral estimation (the maximum entropy method). This resampling, however, can cause an attenuation in the high frequency components. If discontinuities exist in the NN interval series, either because of the presence of abnormal beats or because of gaps or extreme noise in the original ECG recording, traditional approaches require either discarding the data or guesswork to estimate the locations of missing normal beats. To eliminate the need for evenly sampled data required by Fourier or maximum entropy methods, frequency domain spectra can be calculated using the Lomb periodogram for unevenly sampled data [7,8] (the method used in this toolkit).

Although the long term (24-hour) statistics of SDANN, SDNNIDX and ULF power can be calculated for shorter data lengths, they will become increasingly unreliable. For short-term data (less than 15 minutes in length), only the time domain measures of AVNN, SDNN, rMSSD and pNN50 and the frequency domain measures of total power, VLF power, HF power and LF/HF ratio should be used.

A number of the HRV measures are highly correlated with each other. These include SDNN, SDANN, total power and ULF power; SDNNIDX, VLF power and LF power; and rMSSD, pNN50 and HF power. The LF/HF ratio does not correlate strongly with any other HRV measures [4].

Heart rate variability (HRV) has been widely applied in basic and clinical research studies. Its clinical application is very limited at present, however. These limitations are due to lack of standardization of methodology and application to different non-comparable subsets of subjects, as well as to the confounding effects of age, gender, drugs, health status, and chronobiologic variations, among others. Furthermore, outliers due to ectopy and artifact can have major effects on computed HRV values. In elderly subjects, especially, a spuriously high value of certain measures may be due to the effects of "erratic supraventricular rhythm" [9] due to subtle atrial ectopy, wandering atrial pacemaker, or sinus node conduction abnormalities. Additional information on heart rate dynamics and analysis techniques, including non-linear and complexity based measures, can be found in the HRV 2006 course notes and elsewhere on PhysioNet (see for example:Detrended Fluctuation Analysis, Multiscale Entropy Analysis, and Information-Based Similarity, among others).

PhysioNet's HRV Toolkit, available here, is a rigorously validated package of open source software for HRV analysis, including visualization of NN interval time series, automated outlier removal, and calculation of the basic time- and frequency-domain HRV statistics widely used in the literature, including all of those listed in the tables below.

Several other high-quality, freely available HRV toolkits may also be of interest to researchers; links to them are provided at the end of this page.

Table 1: Commonly used time-domain measures