Mozziyar Etemadi

Robust ballistocardiogram acquisition for home monitoring

The ballistocardiogram (BCG) measures the reaction of the body to cardiac ejection forces, and is an effective, non-invasive means of evaluating cardiovascular function. A simple, robust method is presented for acquiring high-quality, repeatable BCG signals from a modified, commercially available scale. The measured BCG waveforms for all subjects qualitatively matched values in the existing literature and physiologic expectations in terms of timing and IJ amplitude. Additionally, the BCG IJ amplitude was shown to be correlated with diastolic filling time for a subject with premature atrial contractions, demonstrating the sensitivity of the apparatus to beat-by-beat hemodynamic changes. The signal-to-noise ratio (SNR) of the BCG was estimated using two methods, and the average SNR over all subjects was greater than 12 for both estimates. The BCG measurement was shown to be repeatable over 50 recordings taken from the same subject over a three week period. This approach could allow patients at home to monitor trends in cardiovascular health.

Ballistocardiography and Seismocardiography: A Review of Recent Advances

In the past decade, there has been a resurgence in the field of unobtrusive cardiomechanical assessment, through advancing methods for measuring and interpreting ballistocardiogram (BCG) and seismocardiogram (SCG) signals. Novel instrumentation solutions have enabled BCG and SCG measurement outside of clinical settings, in the home, in the field, and even in microgravity. Customized signal processing algorithms have led to reduced measurement noise, clinically relevant feature extraction, and signal modeling. Finally, human subjects physiology studies have been conducted using these novel instruments and signal processing tools with promising results. This paper reviews the recent advances in these areas of modern BCG and SCG research.

Non-invasive cardiac output trending during exercise recovery on a bathroom-scale-based ballistocardiograph.

Cardiac ejection of blood into the aorta generates a reaction force on the body that can be measured externally via the ballistocardiogram (BCG). In this study, a commercial bathroom scale was modified to measure the BCGs of nine healthy subjects recovering from treadmill exercise. During the recovery, Doppler echocardiogram signals were obtained simultaneously from the left ventricular outflow tract of the heart. The percentage changes in root-mean-square (RMS) power of the BCG were strongly correlated with the percentage changes in cardiac output measured by Doppler echocardiography (R(2) = 0.85, n = 275 data points). The correlation coefficients for individually analyzed data ranged from 0.79 to 0.96. Using Bland-Altman methods for assessing agreement, the mean bias was found to be -0.5% (+/-24%) in estimating the percentage changes in cardiac output. In contrast to other non-invasive methods for trending cardiac output, the unobtrusive procedure presented here uses inexpensive equipment and could be performed without the aid of a medical professional.

Rapid Assessment of Cardiac Contractility on a Home Bathroom Scale

Analyzing systolic time intervals-specifically the preejection-period (PEP)-is widely accepted as one of the few methods for the noninvasive assessment of cardiac contractility. In this paper, we investigated the ballistocardiogram (BCG) as a way to noninvasively measure myocardial contractility when combined with the ECG. Specifically, we derived a parameter from the BCG and ECG that we hypothesized would be highly correlated to PEP. This is the time delay between the J-wave peak of the BCG and the R-wave of the ECG, which we refer to as the RJ interval. The RJ interval was correlated to PEP (r2 = 0.86) for 2126 heart beats across ten subjects, with a y-intercept of 138 ms and slope of 1.05. This suggests that the RJ interval can be reliably used as a noninvasive assessment of cardiac contractility.

Novel methods for estimating the ballistocardiogram signal using a simultaneously acquired electrocardiogram

The ballistocardiogram (BCG) signal represents the movements of the body in response to cardiac ejection of blood. Recently, many groups have developed low-cost instrumentation for facilitating BCG measurement in the home. The standard method used in the literature for estimating the BCG pulse response has generally been ensemble averaging over several beats. Unfortunately, since the BCG pulse response is likely longer than a typical heartbeat interval, this standard approach does not yield a full-length estimate of the response. This paper describes a simple, novel algorithm for estimating the full-length BCG pulse response using the R-wave timing of a simultaneously acquired electrocardiogram (ECG). With this pulse response, the full signal can be reconstructed, enabling the analysis of slow transient effects in the BCG signal, and of the measurement noise. Additionally, while this paper focuses only on the BCG signal, the same algorithm could be applied to other biomedical signals such as the phonocardiogram or impedance cardiogram, particularly when the heartbeat interval is shorter than the duration of the cpulse response.

Toward Continuous, Noninvasive Assessment of Ventricular Function and Hemodynamics: Wearable Ballistocardiography

Ballistocardiography, the measurement of the reaction forces of the body to cardiac ejection of blood, is one of the few techniques available for unobtrusively assessing the mechanical aspects of cardiovascular health outside clinical settings. Recently, multiple experimental studies involving healthy subjects and subjects with various cardiovascular diseases have demonstrated that the ballistocardiogram (BCG) signal can be used to trend cardiac output, contractility, and beat-by-beat ventricular function for arrhythmias. The majority of these studies has been performed with “fixed” BCG instrumentation-such as weighing scales or chairs-rather than wearable measurements. Enabling wearable, and thus continuous, recording of BCG signals would greatly expand the capabilities of the technique; however, BCG signals measured using wearable devices are morphologically dissimilar to measurements from “fixed” instruments, precluding the analysis and interpretation techniques from one domain to be applied to the other. In particular, the time intervals between the electrocardiogram (ECG) and BCG-namely, the R-J interval, a surrogate for measuring contractility changes-are significantly different for the accelerometer compared to a “fixed” BCG measurement. This paper addresses this need for quantitatively normalizing wearable BCG measurement to “fixed” measurements with a systematic experimental approach. With these methods, the same analysis and interpretation techniques developed over the past decade for “fixed” BCG measurement can be successfully translated to wearable measurements.

Adaptive Cancellation of Floor Vibrations in Standing Ballistocardiogram Measurements Using a Seismic Sensor as a Noise Reference

An adaptive noise canceller was used to reduce the effect of floor vibrations on ballistocardiogram (BCG) measurements from a modified electronic bathroom scale. A seismic sensor was placed next to the scale on the floor and used as the noise reference input to the noise canceller. BCG recordings were acquired from a healthy subject while another person stomped around the scale, thus causing increased floor vibrations. The noise canceller substantially eliminated the artifacts in the BCG signal due to these vibrations without distorting the morphology of the measured BCG. Additionally, recordings were obtained from another subject standing inside a parked bus while the engine was running. The artifacts due to the vibrations of the engine, and the other vehicles moving on the road next to the bus, were also effectively eliminated by the noise canceller. The system with automatic floor vibration cancellation could be used to increase BCG measurement robustness in home monitoring applications. Additionally, the noise cancellation approach may enable BCG recording in ambulances-or other transport vehicles-where noninvasive hemodynamic monitoring may otherwise not be feasible.

A Wearable Patch to Enable Long-Term Monitoring of Environmental, Activity and Hemodynamics Variables

We present a low power multi-modal patch designed for measuring activity, altitude (based on high-resolution barometric pressure), a single-lead electrocardiogram, and a tri-axial seismocardiogram (SCG). Enabled by a novel embedded systems design methodology, this patch offers a powerful means of monitoring the physiology for both patients with chronic cardiovascular diseases, and the general population interested in personal health and fitness measures. Specifically, to the best of our knowledge, this patch represents the first demonstration of combined activity, environmental context, and hemodynamics monitoring, all on the same hardware, capable of operating for longer than 48 hours at a time with continuous recording. The three-channels of SCG and one-lead ECG are all sampled at 500 Hz with high signal-to-noise ratio, the pressure sensor is sampled at 10 Hz, and all signals are stored to a microSD card with an average current consumption of less than 2 mA from a 3.7 V coin cell (LIR2450) battery. In addition to electronic characterization, proof-of-concept exercise recovery studies were performed with this patch, suggesting the ability to discriminate between hemodynamic and electrophysiology response to light, moderate, and heavy exercise.

Non-invasive measurement of Valsalva-induced hemodynamic changes on a bathroom scale Ballistocardiograph

Unobtrusive and compact methods for monitoring time varying hemodynamic trends can allow physicians to monitor heart failure of outpatients at home. In this paper, the ballistocardiogram (BCG), measured on a modified commercial bathroom scale, is proposed as a viable option for this important need. The BCG measures the reaction force of the body to cardiac ejection of blood and is a non-invasive tool for evaluating cardiovascular function. The Valsalva maneuver was used to modulate the hemodynamics in a well documented manner, and BCG signals were acquired from 15 subjects. The electrocardiogram (ECG) was simultaneously obtained to measure the electrical to mechanical delay in ventricular contraction: the interval from the ECG R-wave peak to the BCG J-wave peak. This interval, called the RJ interval, decreased for all subjects following the release of intrathoracic strain compared to the resting value, suggesting that it is inversely correlated to cardiac contractility. The power spectrum magnitude of the BCGs showed that the high frequency content increased after release, also consistent with increased contractility (faster ejection). Additionally, J-wave amplitudes increased following release, suggesting that it is correlated to stroke volume. Since RJ interval computation required the ECG, BCG J-wave rise time was proposed as an alternative for evaluating cardiac contractility. The correlation between this rise time and RJ interval was high (R2 = 0.78).

Non-invasive assessment of cardiac contractility on a weighing scale

Myocardial contractility, the intrinsic ability of the heart muscle to produce force, has been difficult to quantify non-invasively. Pre-ejection-period (PEP), the time the ventricles spend in isovolumetric contraction, is widely accepted as a way to measure contractility. This work presents a way by which the ballistocardiogram — a readily accessible non-invasive cardiovascular signal — can be used in tandem with the electrocardiogram to obtain a parameter highly correlated to PEP and thus to myocardial contractility. This parameter is the delay from the electrocardiogram R-wave to the peak (the J-wave) of the ballistocardiogram. In this work, we showed that this delay, the RJ interval, was correlated to PEP (r2 = 3D 0.75) for 709 heartbeats across 4 subjects, with a slope of 1.11, and a y-intercept of 151 ms. This suggests that the RJ interval can be used in place of the PEP for a reliable, practical, and non-invasive assessment of myocardial contractility.