Review the mechanisms of ECG changes due to respiration. In other words, address the question, why does respiration cause changes in the ECG?
Cardiovascular Devices Assignment
The scenario:
You are employed as a development engineer for a medical devices company. The marketing team have identified an opening in the market arising from the Covid-19 pandemic for extra functionality from the company’s ECG machine. The ECG machine is used in hospitals throughout the UK for routine patient monitoring. For some patients Covid-19 can give rise to acute respiratory distress syndrome, the symptoms for which include increased breathing rate and increased heart rate.
Breathing rate is currently monitored manually, placing a considerable burden on nursing staff in the current pandemic. Since the ECG machine already has the functionality to automatically monitor the patient’s heart rate, the clinical need is for the functionality to be extended to also automatically monitor the patient’s respiratory rate.
ECG derived respiration
It is well known that respiration induces changes in the ECG waveform which can be used to estimate the respiratory rate from the recorded ECG. This is called ECG derived respiration. There are many potential algorithms for deriving the respiratory rate from the ECG, including RR interval analysis and QRS wave amplitude analysis.
The company have acquired ECG data which will allow an evaluation study of these algorithms, before implementing an algorithm in their product. The data comprises ECGs recorded from nine healthy subjects in two recording conditions: i) ECG recorded with subjects breathing normally, and
ii) ECG recorded with subjects breathing as a specific breathing rate (i.e. X breaths per minute).
Your tasks
You have been tasked by the company to do the following.
- Review the mechanisms of ECG changes due to respiration. In other words, address the question, why does respiration cause changes in the ECG?
- Perform a literature search and provide a list of published ECG derived respiration algorithms, supported by appropriate references.
- Perform an evaluation study:
- Using Matlab, the company’s prototyping development software, implement two algorithms for ECG derived respiration, namely: i) RR interval analysis and ii) QRS amplitude analysis.
- Using Spectral analysis determine the dominant breathing rate for each ECG derived respiratory signal from the nine healthy subjects in the two recording conditions (normal breathing and specific breathing rate).
- The Matlab code should have the functionality to automatically determine the dominant breathing rate for each derived respiratory signal. Also, it must be able to plot the ECG, the ECG derived respiratory signals and the Power Spectral Density for each ECG recordings.
- Perform statistical analyses to determine if there are statistically significant differences between the two algorithms for dominant breathing rates in i) normal breathing recordings, ii) specific breathing rate recordings.
Report the results of the above (1 to 3) to the company’s executive board via a pre-recorded PowerPoint video presentation, including your recommendation for the suitability of each of the algorithms for inclusion in the ECG machine functionality.
Evaluation study data.
The evaluation study ECG recordings are available on Box. Each student has a unique dataset and you will be sent a unique link to your dataset. Each dataset comprises 18 ECG recordings from 9 subjects. For each subject there is one recording during normal breathing and the filename is
prefixed with ‘n’, e.g. ‘n01a.num’, and one recording during specific breathing rate and the filename is prefixed with ‘r’, e.g. ‘r01a.num’. Following the prefix is the subject identifier (e.g. ‘01a’, ‘02a’ …). Recordings with the same subject identifier are from the same subject. For example, ‘n01a.num’ and ‘r01a.num’ are from the same subject.
The recordings were stored in ascii format with the extension ‘.num’. ECG were stored digitally at a sample rate of 500 Hz.
IMPORTANT: Only analyse the dataset provided for you and do not exchange recordings since some of the recordings have the same filenames, but are different ECG recordings.
Guidance
- Submit your video presentation to Canvas before the assignment deadline.
- Content and number of slides:
- Title slide and introduction (1 slide)
- Presentation contents (1 slide)
- Review of mechanisms of ECG changes due to respiration (2 slides)
- List of published ECG derived respiration algorithms (2 slides)
- Introduction to the evaluation study (1 slide)
- Evaluation study methods
- Description of your implementations of RR interval and QRS amplitude algorithms (2 slides)
- Description of the evaluation data and study design (1 slide)
- Description of the statistical analysis methods (1 slide)
- Evaluation study results
- Example plots from one subject showing, for normal and specific breathing rate: the ECG; the ECG derived respiration signal; the power spectral density plot (1 slide)
- Boxplots comparing the algorithms in terms of the dominant respiratory rate for each recording condition, annotated with appropriate p values (1 slide)
- Conclusion and your recommendation (1 slide)
- Where appropriate use inline citations in the body of the presentation with the full reference list at the end of the presentation.
- The duration of the video should be no more than 15 minutes.
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