基于AR模型的过速型室性心律失常的短时心率变异性预测分析
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摘要
目的:基于短时(5 min)心率变异信号的频域分析,探究过速型室性心律失常[包括室性心动过速(ventricular tachycardia,VT)和室颤(ventricular fibrillation,VF)]的发生机理及有效预测方法。方法:以78名患者体内心脏复律除颤器记录的VT/VF事件发生前5 min的RR间期序列(作为VT/VF样本组)和来自同一患者的正常窦性节律(作为正常对照组)构成的样本对为分析序列,对分析序列预处理后,基于AR模型方法计算其功率谱,提取相应的频谱能量特征,并进行统计分析。结果:与正常对照组序列相比较,VT/VF样本组的功率谱总功率、甚低频功率、低频功率、高频功率及低频功率峰值显著降低,统计检验概率分别为P<0.003、P<0.003、P<0.002、P<0.005、P<0.002。结论:研究表明VT/VF发生前患者的心率变异性明显降低,说明其自主神经系统调节功能受损和失衡,频谱能量特征的改变或许是VT/VF发生的某种生理预兆,对于短时预报恶性室性心律失常有重要意义。
Objective To explore the occurrence mechanism and effective forecast methods for ventricular tachyarrhythmia based on frequency domain analysis of 5 min HRV signal, including ventricular tachycardia(VT) and ventricular fibrillation,(VF). Methods Totally 78 patients had their 5 min RR interval sequences preceding the onset of VT/VF events divided into a VT/VF sample group and normal sinus rhythm sequences into a control group, which were both recorded with by implantable cardioverter defibrillators(ICD). Power spectra were calculated with AR model after all the sequences were pretreated, and corresponding spectrum energy features were extracted, then statistical analysis was carried out. Results The VT/VF group had the total power, very-low-frequency power, low-frequency power, high-frequency power and low-frequency power peak decreased significantly when compared with the control group, whose statistical test probabilities( P) were respectively lower than 0.003, 0.003, 0.002, 0.005 and 0.002. Conclusion The heart rate variability of the patient decreases significantly before the onset of VT/VF, which means the automatic nervous system gains damage or imbalance in regulation; the changes of spectrum energy features may be physiological signs for VT/VF, which is of great value for short-term prediction of malignant ventricular arrhythmia. [Chinese Medical Equipment Journal,2019,40(5)1-6]
Objective To explore the occurrence mechanism and effective forecast methods for ventricular tachyarrhythmia based on frequency domain analysis of 5 min HRV signal, including ventricular tachycardia(VT) and ventricular fibrillation,(VF). Methods Totally 78 patients had their 5 min RR interval sequences preceding the onset of VT/VF events divided into a VT/VF sample group and normal sinus rhythm sequences into a control group, which were both recorded with by implantable cardioverter defibrillators(ICD). Power spectra were calculated with AR model after all the sequences were pretreated, and corresponding spectrum energy features were extracted, then statistical analysis was carried out. Results The VT/VF group had the total power, very-low-frequency power, low-frequency power, high-frequency power and low-frequency power peak decreased significantly when compared with the control group, whose statistical test probabilities( P) were respectively lower than 0.003, 0.003, 0.002, 0.005 and 0.002. Conclusion The heart rate variability of the patient decreases significantly before the onset of VT/VF, which means the automatic nervous system gains damage or imbalance in regulation; the changes of spectrum energy features may be physiological signs for VT/VF, which is of great value for short-term prediction of malignant ventricular arrhythmia. [Chinese Medical Equipment Journal,2019,40(5)1-6]
引文
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[2]MASON P,MCPHERSON C.Implantable cardioverter defibrillator:a review[J].Heart Lung,1992,21(2):141-148.
[3]鲁洋,李淑梅.无创检查方法预测恶性心律失常的研究进展[J].中国老年学杂志,2009,29(21):2 827-2 828.
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[16]JOO S,CHOI K J,HUH S J.Prediction of spontaneous ventricular tachyarrhythmia by an artificial neural network using parameters gleaned from short-term heart rate variability[J].Expert Syst Appl,2012,39(3):3 862-3 866.
[17]KHEDER G,KACHOURI A,SAMET M.HRV analysis using wavelet package transform and Least Square Support Vector Machine[J].International Journal of Circuits,Systems and Signal Processing,2008,2(1):18-25.
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[20]MIGLIARO E R,CONTRERAS P,BECH S,et al.Relative influence of age,resting heart rate and sedentary life style in short-term analysis of heart rate variability[J].Braz J Med Biol Res,2001,34(4):493-500.
[21]GOLDBERGER A L,AMARAL L A,GLASS L,et al.PhysioBank,PhysioToolkit,and PhysioNet:components of a new research resource for complex physiologic signals[J].Circulation,2000,101(23):215-220.
[22]WESSEL N,VOSS A,MALBERG H,et al.Nonlinear analysis of complex phenomena in cardiological data[J].Herzschrittmachertherapie&Elektrophysiologie,2000,11(3):159-173.
[23]TARVAINEN M P,RANTA-AHO P O,KARJALAINEN PA.An advanced detrending method with application to HRVanalysis[J].IEEE Trans Biomed Eng,2002,49(2):172-175.
[24]邱天爽,唐洪,刘海龙.统计信号处理:医学信号分析与处理[M].北京:科学出版社,2012:125-127.
[25]柴晓珂,王步青,张政波.心率变异性自回归模型分析中确定最佳阶数的方法研究[J].生物医学工程学杂志,2015,32(5):958-964.
[26]MANI V,WU X,WOOD M A,et al.Variation of spectral power immediately prior to spontaneous onset of ventricular tachycardia/ventricular fibrillation in implantable cardioverter defibrillator patients[J].J Cardiovasc Electrophysiol,1999,10(12):1 586-1 596.
[27]LERMA C,WESSEL N,SCHIRDEWAN A,et al.Ventricular arrhythmias and changes in heart rate preceding ventricular tachycardia in patients with an implantable cardioverter defibrillator[J].Med Biol Eng Comput,2008,46(7):715-727.
[28]HUIKURI H V,VALKAMA J Q,AIRAKSINEN K E,et al.Frequency domain measures of heart rate variability before the onset of nonsustained and sustained ventricular tachycardia in patients with coronary artery disease[J].Circulation,1993,87(4):1 220-1 228.
[29]GORENEK B,KUDAIBERDIEVA G,BIRDANE A,et al.Initiation of monomorphic ventricular tachycardia:electrophysiological,clinical leatures,and drug therapy in patients with implantable defibrillators[J].J Electroeardiol,2003,36(3):213-221.
[30]MAKIKALLIO T H,KOISTINEN J,JORDAENS L,et al.Heart rate dynamics before spontaneous onset of ventricular fibrillation in patients with healed myocardial infarcts[J].Am J Cardiol,1999,83(6):880-884.
[2]MASON P,MCPHERSON C.Implantable cardioverter defibrillator:a review[J].Heart Lung,1992,21(2):141-148.
[3]鲁洋,李淑梅.无创检查方法预测恶性心律失常的研究进展[J].中国老年学杂志,2009,29(21):2 827-2 828.
[4]DABROWSKI A,KRAMARZ E,KUBIK L.Prolongation of QT interval corrected for heart rate by Bazett’s equation and linear formula as predictor of arrhythmic events after myocardial infarction[J].Am J Cardiol,2000,86:469-472.
[5]COSTANTINI O,HOHNLOSER S H,KIRK M M,et al.The ABCD(Alternans Before Cardioverter Defibrillator)Trial:strategies using T-wave alternans to improve efficiency of sudden cardiac death prevention[J].J Am Coll Cardiol,2009,53(6):471-479.
[6]LA ROVERE M T,PINNA G D,MAESTRI R,et al.Shortterm heart rate variability strongly predicts sudden cardiac death in chronic heart failure patients[J].Circulation,2003,107(4):565-570.
[7]BATTIPAGLIA I,BARONE L,MARIANI L,et al.Relationship between cardiac autonomic function and sustained ventricular tachyarrhythmias in patients with an implantable cardioverter defibrillators[J].Europace,2010,12:1 725-1 731.
[8]ACHARYA U R,JOSEPH K P,KANNATHAL N,et al.Heart rate variability:a review[J].Med Bio Eng Comput,2006,44:1 031-1 051.
[9]KLEIGER R E,STEIN P K,BIGGER J T,Jr.Heart rate variability:measurement and clinical utility[J].Ann Noninvasive Electrocardiol,2005,10(1):88-101.
[10]GALINIER M,PATHAK A,FOURCADE J,et al.Depressed low frequency power of heart rate variability as an independent predictor of sudden death in chronic heart failure[J].Eur Heart J,2000,21:475-482.
[11]BARRON H V,LESH M D.Autononmic nervous system and sudden cardiac death[J].J Am Coll Cardiol,1996,27(5):1 053-1 060.
[12]蒋科,葛宏,刘威.基于心率变异性生物反馈方法的应用研究[J].医疗卫生装备,2013,34(4):12-13.
[13]LOMBARDI F,PORTA A,MARZEGALLI M,et al.Heart rate variability patterns before ventricular tachycardia onset in patients with an implantable cardioverter defibrillator[J].Am J Cardiol,2000,86(9):959-963.
[14]PRUVOT E,THONET G,Vesin J M,et al.Heart rate dynamics at the onset of ventricular tachyarrhythmias as retrieved from implantable cardioverter-defibrillators in patients with coronary artery disease[J].Circulation,2000,101(20):2 398-2 404.
[15]VYBIRAL T,GLAESER D H,GOLDBERGER A L,et al.Conventional heart rate variability analysis of ambulatory electrocardiographic recordings fails to predict imminent ventricular fibrillation[J].J Am Coll Cardiol,1993,22(2):557-565.
[16]JOO S,CHOI K J,HUH S J.Prediction of spontaneous ventricular tachyarrhythmia by an artificial neural network using parameters gleaned from short-term heart rate variability[J].Expert Syst Appl,2012,39(3):3 862-3 866.
[17]KHEDER G,KACHOURI A,SAMET M.HRV analysis using wavelet package transform and Least Square Support Vector Machine[J].International Journal of Circuits,Systems and Signal Processing,2008,2(1):18-25.
[18]BURRI H,CHEVALIER P,ARZI M,et al.Wavelet transform for analysis of heart rate variability preceding ventricular arrhythmias in patients with ischemic heart disease[J].Int JCardiol,2006,109(1):101-107.
[19]REED M J,ROBERTSON C E,ADDISON P S.Heart rate variability measurements and the prediction of ventricular arrhythmias[J].Q J Med,2005,98:87-95.
[20]MIGLIARO E R,CONTRERAS P,BECH S,et al.Relative influence of age,resting heart rate and sedentary life style in short-term analysis of heart rate variability[J].Braz J Med Biol Res,2001,34(4):493-500.
[21]GOLDBERGER A L,AMARAL L A,GLASS L,et al.PhysioBank,PhysioToolkit,and PhysioNet:components of a new research resource for complex physiologic signals[J].Circulation,2000,101(23):215-220.
[22]WESSEL N,VOSS A,MALBERG H,et al.Nonlinear analysis of complex phenomena in cardiological data[J].Herzschrittmachertherapie&Elektrophysiologie,2000,11(3):159-173.
[23]TARVAINEN M P,RANTA-AHO P O,KARJALAINEN PA.An advanced detrending method with application to HRVanalysis[J].IEEE Trans Biomed Eng,2002,49(2):172-175.
[24]邱天爽,唐洪,刘海龙.统计信号处理:医学信号分析与处理[M].北京:科学出版社,2012:125-127.
[25]柴晓珂,王步青,张政波.心率变异性自回归模型分析中确定最佳阶数的方法研究[J].生物医学工程学杂志,2015,32(5):958-964.
[26]MANI V,WU X,WOOD M A,et al.Variation of spectral power immediately prior to spontaneous onset of ventricular tachycardia/ventricular fibrillation in implantable cardioverter defibrillator patients[J].J Cardiovasc Electrophysiol,1999,10(12):1 586-1 596.
[27]LERMA C,WESSEL N,SCHIRDEWAN A,et al.Ventricular arrhythmias and changes in heart rate preceding ventricular tachycardia in patients with an implantable cardioverter defibrillator[J].Med Biol Eng Comput,2008,46(7):715-727.
[28]HUIKURI H V,VALKAMA J Q,AIRAKSINEN K E,et al.Frequency domain measures of heart rate variability before the onset of nonsustained and sustained ventricular tachycardia in patients with coronary artery disease[J].Circulation,1993,87(4):1 220-1 228.
[29]GORENEK B,KUDAIBERDIEVA G,BIRDANE A,et al.Initiation of monomorphic ventricular tachycardia:electrophysiological,clinical leatures,and drug therapy in patients with implantable defibrillators[J].J Electroeardiol,2003,36(3):213-221.
[30]MAKIKALLIO T H,KOISTINEN J,JORDAENS L,et al.Heart rate dynamics before spontaneous onset of ventricular fibrillation in patients with healed myocardial infarcts[J].Am J Cardiol,1999,83(6):880-884.