本文介绍了一个用于心率变异性(HRV)、T波交替(TWA)和心率湍流(HRT)定量评估的软件包。该软件旨在科学研究而非临床诊断，支持多种分析方法并提供中间结果预览，有助于全面研究和训练。通过统一的图形用户界面，可以同时分析ECG记录的多个参数。
- Journal List
- Med Sci Monit
- v.17(9); 2011
- PMC3560502
Computer Software tool for heart rate variability (HRV), T-wave alternans (TWA) and heart rate turbulence (HRT) analysis from ECGs
Summary
Background
This paper presents a software package for quantitative evaluation of heart rate variability (HRV), heart rate turbulence (HRT), and T-wave alternans (TWA) from ECG recordings. The software has been developed for the purpose of scientific research rather than clinical diagnosis.
Material/Methods
The software is written in Matlab Mathematical Language. Procedures for evaluation of HRV, HRT and TWA were implemented. HRV analysis was carried out by applying statistical and spectral parametric and nonparametric methods. HRT parameters were derived using the Schmidt algorithm. TWA analysis was performed both in spectral and in time domain by applying Poincare mapping. A flexibility of choosing from a number of classical modelling approaches and their modifications was foreseen and implemented. The software underwent preliminary verification tests both on ECGs from the Physionet online ECG signal repository and recordings taken at the Department of Electrocardiology of the Medical University Hospital in Lodz.
Results
The result of the research is a program enabling simultaneous analysis of a number of parameters computed from ECG recordings with the use of the indicated analysis methods. The program offers options to preview the intermediate results and to alter the preprocessing steps.
Conclusions
By offering the possibility to cross-validate the results of analyses obtained by several methods and to preview the intermediate analysis steps, the program can serve as a helpful aid for clinicians in comprehensive research studies. The software tool can also be utilized in training programs for students and medical personnel.
Background
Quantitative evaluation of cardiac risk prediction parameters requires implementation of complex computer algorithms. Various commercial applications provide cardiologists with tools that deliver diagnostic parameters, including heart rate variability (HRV) [1–3], heart rate turbulence (HRT) [4], T-wave alternans (TWA) [5–7] and many more. The above-mentioned commercial tools, however, often lack the ability to automatically compare the results with other parameters or to verify the applied methods, thus presenting doctors with a final result without being able to examine or adjust the employed algorithms, and thereby precluding further studies. In order to perform diagnoses based on various parameters, physicians often must use different, incompatible medical equipment and software tools. Some of these tools require advanced programming skills such as C-language programming to take advantage of the offered open source procedures. As a staring point for description of the program reported in this work we provide a short overview of the available toolkits for HRV, HRT and TWA [4] analyses.
The heart rate variability (HRV) toolkits are listed in Table 1 along with their software implementations and main features. All listed packages offer both time and spectral analyses of HRV, but only some of them implement methods derived from non-linear dynamic techniques. Only the Finnish Kubios HRV analysis software is equipped with a graphical user interface (GUI). The toolkit comes with an extensive user guide and provides user support via e-mail.
Heart rate turbulence (HRT) denotes transient fluctuations in the heart rate that directly precede and follow a ventricular premature beat (VPB). The term HRT was coined in 1999 by Schmidt et al, who defined the method in a seminal paper published in Lancet [13]. Currently, many clinical studies have confirmed the significance of HRT as an important predictor of sudden cardiac death risk in patients with myocardial infarction. The computations involved in measurement of HRT parameters are quite simple and rely on measuring geometric relations of the HR signal in the vicinity of the VPB beat. Regrettably, the web page www.h-r-t.org with free software has been discontinued. The HRT analysis program was patented in 2002. Recently, guidelines for HRT measurement standards and physiologic interpretation in clinical studies were published under the supervision of the International Society for Holter and Noninvasive Electrophysiology (ISHNE) [14].
In the case of T-wave alternans (TWA), to the authors’ best knowledge, there is only one TWA analyser toolkit made available as open source software. The toolkit that can be accessed from the Physionet web-page [15] is a suite of Matlab procedures for T-wave analysis [16], which implement the spectral method (SM) and the modified moving average method (MMA). A possible explanation for such limited availability of TWA analysis software tools is the fact that this cardiologic technique requires special ECG measurement protocols and apparatus to detect microvolt T-wave alternans. However, a considerable number of TWA analysis methods have been proposed. For an excellent and comprehensive review of 12 methods see Martinez and Olmos [17]. In 2010 the U.S. Food and Drug Administration gave market clearance for the microvolt TWA spectral method as a viable measure for risk of sudden cardiac death (SCD).
The indicated indices that proved important in risk stratification of patients (e.g., post- infarction patients), unfortunately, are not computed in a single software environment or tool. This makes an overall evaluation of a patient’s cardiac state a time consuming task. It is also difficult to find the relationship between the parameters since the examination registrations are not simultaneous and the conditions may vary significantly.
In this paper a computer program featuring a unified graphical user interface (GUI) for analysis of HRV, HRT and TWA is presented. All of the parameters are computed from the ECG recordings or, alternatively in the case of HRV, from previously computed RR series. At its current development stage, the software is designed predominantly for the purpose of scientific research rather than clinical diagnosis. Different file formats of ECG recordings can be loaded into the program. The user is presented with a graphical interface that enables plotting of ECGs and visual verification of intermediate steps of the analyses.
Material and Methods
The software is written in Matlab Mathematical Language. The test version of the program can be downloaded without charge from http://www.eletel.p.lodz.pl/kudrynski/matlab/. In order to run the program it is necessary to install Matlab Compiler Runtime (MCR) first. A suitable guide is provided for installing the program. The graphical user interface of the program is shown in Figure 1.
The recorded ECG signals or pre-computed RR series can be loaded from binary, text or system-specific format files (e.g. digital ECG Medea, Gliwice, Poland [18], and Finometer, Finapres Medical Systems, Amsterdam, the Netherlands [19]). Suitable filtering procedures are available for denoising the recorded ECGs and beat-by-beat synchronous averaging.
Baseline wandering removal is implemented by detecting signal samples corresponding to PQ segments followed by cubic spline interpolation [20–22]. The QRS complexes are detected using digital filters based on the Haar wavelet [23]. A Haar filter of 20th order is a bandpass linear-phase filter whose passband is centered at f=18.5 Hz (for sampling frequency fs=500 Hz), while its first and second zeros correspond to 0 Hz and 50 Hz, respectively. Therefore, such a filter retains signal frequency components of QRS complex
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