Analysis of the four heart sounds statistical study and spectro-temporal characteristics

Abstract

Heart auscultation has been recognised for a long time as an important tool for the diagnosis of heart disease; it is the most common and widely recommended method to screen for structural abnormalities of the cardiovascular system. Detecting relevant characteristics and forming a diagnosis based on the sounds heard through a stethoscope, however, is a skill that can take years to be acquired and refine. The efficiency and accuracy of diagnosis based on heart sound auscultation can be improved considerably by using digital signal processing techniques to analyse phonocardiographic (PCG) signals. The study of the functioning of the heart is very important for the diagnosis of different cardiac pathologies. The phonocardiogram signal (PCG) is the signal generated after conversion of the sound noises coming from the heart into an electrical signal, it groups together a set of four cardiac noises (S1, S2, S3, S4) which are in direct correlation with cardiac activity. The short-term Fourier Transform (STFT) is an analytical technique that describes the evolution of the time and frequency behaviour of these four heart sounds. A statistical study has been carried out in this direction in order to better highlight the characteristics of the PCG signal. A fairly high number of cycles (twenty) was used to further refine the expected results. The objective of this paper is to use a statistical analysis based on the results obtained by the use of The STFT technic this in order to find statistical parameters (mean, standard deviation, etc.) which can give us a clear vision of the electrophysiological behaviour of the phonocardiogram signal. This aspect has not been done so far and which however can give appreciable practical results.     

Wertigkeit der EKG-Telefon-Telemetrie in der Erfassung symptomatischer Herzrhythmus-Störungen

Summary The ECG-telephone-transmission (TTM) was used to record an ECG-strip during a typical symptomatic period in patients complaining of symptoms possibly caused by arrhythmias (palpitations, dizziness, paroxysm tachycardia, pulse irregularities; angina and dyspnea only if other reasons could be excluded). Patients complaining of syncope only were not admitted, because of the inability to make a telephon call successfully during such a symptomatic period. The ECG was transmitted to the CCU using a frequency modulation technique. In 60% of 196 patients an ECG-TTM could be achieved during a typical symptomatic period, whereas arrhythmias as cause for the symptoms could be excluded in 51 patients (26%). The remaining 66 patients (34%) demonstrated various arrhythmias ranging from simple SVPB and PVC to total AV-block and sustained VT.TTM, an easy-to-perform and cost-effective method allowed a successful ECG registration during a symptomatic period in almost two-thirds of symptomatic patients. In these patients arrhythmias could be verified or excluded as cause of the symptoms.

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Abkürzungsverzeichnis TTM EKG-Telefon-Telemetrie - HF Herzfrequenz - SA-Block sinu-aurikulärer Block - AV-Block atrio-ventrikulärer Block - SVES supraventrikuläre Extrasystole(n) - VES ventrikuläre Extrasysteole(n) - KHK koronare Herzkrankheit - VH-Flimmern Vorhof-Flimmern - parox. paroxysmal - C.C.I.T.T. Internationale Post-Organisation - Ö.P.T. Österreichische Post- u. Telegraphen-Verwaltung - LZ-EKG Langzeit-EKG     

Variability of thoracic impedance cardiograms in man

The variability of thoracic impedance cardiogram signals was studied in a normal population with the objective of determining the effect of different respiratory manoeuvres and the optimal criteria for acquisition of this type of physiological signal. The variability of the first derivative of the thoracic impedance signal (dZ/dt) was determined at each 5ms intervals along the signal as the ensemble confidence limits of 3% and 97% around the coherent average. The results obtained indicate that: (a) signal variability is minimum during respiratory apnea (p<0.05) as compared with apneusis or normal respiration, (b) signal patterns are different during apnea and apneusis, and (c) during normal respiration the cardiac component of the thoracic impedance signal can be extracted from the respiratory noise by coherent average yielding a signal with the same pattern obtained during apnea.     

Changes in myocardial pyrimidine nucleotide levels following repeated injections of isoproterenol in rats

Changes which might lead to the initiation of cardiac hypertrophy include possible variations in the dynamics of nucleotides. In the experiments reported in this paper, changes in the pool sizes of adenine, uracil and cytosine nucleotides were observed during the initial phase of cardiac overload.Repeated subcutaneous injections of isoproterenol (ISO) (5 mg·kg^–1 body weight, s.c.) were performed so as to produce symmetric cardiomegaly in rats. Under these conditions, the dry weight of the heart, on the fifth day of dialy injections of ISO, had increased by 43% and the RNA concentration by 39%. There was no significant change in the DNA concentration. No further changes in weight or in DNA and RNA concentrations were recorded from the fifth to the tenth day of treatment.Changes in UTP and ATP were carefully monitored during the first days following ISO application. The levels of both nucleotides decreased sharply at first. The ATP level remained below the control value for at least 48 h while the UTP level was rapidly restored and a further increase occurred resulting in a maximal enlargement of 82% after the 12th h. At the same time, the uracil nucleotide pool and the cytosine nucleotide pool had increased by 76% and 101%, respectively, while the adenine nucleotide content of the myocardium remained 15% below control level. Repeated injections of ISO induced effects on ATP and UTP levels which were similar in direction but attenuated.The significance of an increase in the pyrimidine nucleotide pools in relation to nucleic acid synthesis is discussed.     

Physiological effects of dynamic work on a bicycle ergometer combined with different types of static contraction

Summary The effects on heart rate, oxygen uptake, and pulmonary ventilation of muscular exercises, including both dynamic contractions, either simple or combined, were studied in 4 male subjects, aged 21 to 23 years. The dynamic work consisted in cycling on an ergometric bicycle at three power levels: 40, 80, and 100 W. The static work consisted in pushing against, pulling and holding with the arms a 6, 9, 12, or 18 kg load. The physiological effects are expressed as cardiac cost (HR), oxygen cost (VO₂) and ventilation cost (V). The physiological cost of the combined work increases according to the cycling power and to the isometric load developed. A statistical analysis shows that the costs of combined work are not different from the sum of the costs of the static and dynamic contractions measured separately. Thus, the physiological responses to the combinations investigated are of an additive type.     

心脏组织工程瓣脉动流培养系统的设计与构建

自行设计和制造平面和三维立体培养室及贮液室等构件,用医用硅胶管连接;转子泵作为动力源,贮液室通气口供给5%CO2 95%空气,恒温水浴箱保持构件37℃恒温,这样组成了种植细胞与生物瓣支架复合体的脉动培养系统,并进行生物力学和生物相容性测试,为心脏组织工程瓣的体外构建提供研究器材。结果显示,该装置密闭性能好,内环境能保持37±1℃、CO2浓度5%±1%、pH值6.8～7.5;流量在0.125～6.0L/min的范围内任意调节;同种瓣膜上的内皮细胞经2周培养后扩增约10倍;瓣膜支架的细菌和霉菌培养均为阴性,说明我们构建的脉动流培养系统能有效地模拟体内脉动流场实现种植细胞在体外的增殖、重塑,为心脏组织工程瓣的体外构建提供了一种新的实验方法。     

Advection and Diffusion of Substances in Biological Tissues With Complex Vascular Networks

For highly diffusive solutes the kinetics of blood–tissue exchange is only poorly represented by a model consisting of sets of independent parallel capillary–tissue units. We constructed a more realistic multicapillary network model conforming statistically to morphometric data. Flows through the tortuous paths in the network were calculated based on constant resistance per unit length throughout the network and the resulting advective intracapillary velocity field was used as a framework for describing the extravascular diffusion of a substance for which there is no barrier or permeability limitation. Simulated impulse responses from the system, analogous to tracer water outflow dilution curves, showed flow-limited behavior over a range of flows from about 2 to 5 ml min^–1 g^–1, as is observed for water in the heart in vivo. The present model serves as a reference standard against which to evaluate computationally simpler, less physically realistic models. The simulated outflow curves from the network model, like experimental water curves, were matched to outflow curves from the commonly used axially distributed models only by setting the capillary wall permeability–surface area (PS) to a value so artifactually low that it is incompatible with the experimental observations that transport is flow limited. However, simple axially distributed models with appropriately high PSs will fit water outflow dilution curves if axial diffusion coefficients are set at high enough values to account for enhanced dispersion due to the complex geometry of the capillary network. Without incorporating this enhanced dispersion, when applied to experimental curves over a range of flows, the simpler models give a false inference that there is recruitment of capillary surface area with increasing flow. Thus distributed models must account for diffusional as well as permeation processes to provide physiologically appropriate parameter estimates. © 2000 Biomedical Engineering Society. PAC00: 8719-j, 8710+e     

Regulation of cytokine synthesis in cardiac surgery: Role of extracorporeal circuit and humoral mediators <Emphasis Type="Italic">in vivo</Emphasis> and <Emphasis Type="Italic">in vitro</Emphasis>

Objective and design: Cardiopulmonary bypass (CPB) impairs monocyte and neutrophil proliferation, cytokine synthesis, and antigen presentation. This study compares in vivo data with results from an extracorporeal circulation (ECC) model, distinguishing direct effects on cytokine synthesis from regulatory mechanisms. Patients and methods: Whole blood from 18 patients prior to, during and after CPB was stimulated with lipopolysaccharide (LPS). Tumor necrosis factor (TNF)-α, interleukin (IL)-6, and IL-8 levels were measured. Additionally, blood from 4 volunteers was circulated in an ECC model. Cytokine levels were measured before and during mock ECC. Results: LPS-induced cytokine synthesis was reduced after CPB (TNF-α: 11 %; IL-6: 29 %; IL-8: 48 % of preoperative values, all p < 0.001). In mock ECC, cytokine production (except IL-8) was suppressed: TNF-α production was lowest 60 min after starting ECC, IL-6 synthesis was lowest at 90 min (33 % and 15 % vs. pre-ECC levels; both p < 0.001). Patient sera contained cytokine-inhibitory activity after CPB, an activity not found in mock ECC. Conclusions: (1) In patients, CPB induces early transient LPS hyporesponsiveness; (2) blood contact with foreign surfaces induces LPS hyporesponsiveness; (3) serum cytokineinhibitory activities are released after CPB, but not in mock ECC. Impaired leukocyte function may explain increased susceptibility to infections after CPB. Received 16 September 2006; accepted without revision by K. Visvanathan 18 October 2006     

Effects of a diet rich in Q-3 fatty acids on left ventricular geometry and dynamics in spontaneously hypertensive rats

Summary The aim of the present study was to investigate the chronic effects of a dietetic antihypertensive treatment on blood pressure, ventricular dynamics and geometry of the pressure loaded heart. Spontaneously hypertensive rats (SHR) received a standard diet enriched with 10% mackerel oil, containing 30% polyunsaturated Q-3 fatty acids, over a period of 70 days. As described previously the diet reduced blood pressure permanently by 40-50 mm Hg. Despite this reduction, the degree of left ventricular hypertrophy was only slightly (statistically insignificantly) reduced. This was probably a result of an increase in sympathetic tone as indicated by a raised pulse rate. On the other hand, the treatment prevented the development of eccentric hypertrophy, typical to the SHR, without changing the elastic material properties of the myocardium. Since the age-matched controls did not show significant degenerative alterations, protective effects at the level of myocardial tissue could not be demonstrated. Furthermore, future investigations need to investigate why myocardial contractility of the treated animals diminishes as observed in this study.     

Effective and safe therapy with coenzyme Q10 for cardiomyopathy

Summary Coenzyme Q₁₀ (CoQ₁₀) is indispensable in mitochondrial bioenergetics and for human life to exist. 88/115 patients completed a trial of therapy with CoQ₁₀ for cardiomyopathy. Patients were selected on the basis of clinical criteria,X-rays, electrocardiograms, echocardiography, and coronary angiography. Responses were monitored by ejection fractions, cardiac output, and improvements in functional classifications (NYHA). Of the 88 patients 75%–85% showed statistically significant increases in two monitored cardiac parameters. Patients with the lowest ejection fractions (approx. 10%–30%) showed the highest increases (115%–210%) and those with higher ejection fractions (50%–80%) showed increases of approx. 10%–25% on therapy. By functional classification, 17/21 in class IV, 52/62 in class III, and 4/5 in class II improved to lower classes. Clinical responses appeared over variable times, and are presumably based on mechanisms of DNA-RNA-protein synthesis of apoenzymes which restore levels of CoQ₁₀ enzymes in a deficiency state. 10/21 (48%) of patients in class IV, 26/62 (42%) in class III, and 2/5 (40%) in class II had exceptionally low control blood levels of CoQ₁₀. Clinical responses on therapy with CoQ₁₀ appear maximal with blood levels of approx. 2.5 µg CoQ₁₀/ml and higher during therapy.Abbreviations CHF Congestive heart failure - CO Cardiac output - CoQ₁₀ Coenzyme Q₁₀ - EF Ejection fraction - IC Impedance cardiography - NYHA New York Heart Association - STI Systolic time interval