The Experts below are selected from a list of 22749 Experts worldwide ranked by ideXlab platform
Georg Schmidt - One of the best experts on this subject based on the ideXlab platform.
-
influence of gestational diabetes on fetal autonomic nervous system a study using phase rectified Signal Averaging analysis
Ultrasound in Obstetrics & Gynecology, 2018Co-Authors: Sm Lobmaier, Alexander Muller, Georg Schmidt, Ju Ortiz, Dino A Giussani, Bernhard Haller, M Sewald, Renate Oberhoffer, K T M Schneider, A WackergussmannAbstract:Objectives Maternal gestational diabetes (GDM) is known to influence fetal physiology. Phase-rectified Signal Averaging (PRSA), an innovative Signal processing technique, can be used to investigate Signals obtained from fetal heart. The PRSA calculated variables “average acceleration capacity” (AAC) and “average deceleration capacity” (ADC) are established indices of autonomic nervous system (ANS) function. The aim of this study was to evaluate the influence of gestational diabetes on the fetal ANS in human pregnancy using PRSA. Methods In a prospective human clinical case-control study during the third trimester of pregnancy, 58 mothers with diagnosed GDM and 58 gestational-age matched healthy controls were included. Fetal CTG registrations were performed in all cases at study entry and in 19 cases of gestational diabetes the registration was repeated again close to delivery. The ultrasound technique based innovative CTG parameters AAC, ADC as well as fetal heart rate short-term variation (STV) according to Dawes/Redman criteria were calculated. Results Mean gestational age of both groups at study entry was 35.7 ± 2.3 weeks. There was a significant difference in AAC (mean ± SD: 1.97 ± 0.33 vs. 2.42 ± 0.57 bpm; p<0.001) and ADC (1.94 ± 0.32 vs. 2.28 ± 0.46, p<0.001) between controls and fetuses of diabetic mothers. This difference between groups could not be demonstrated using standard computerized fetal CTG analysis (STV controls 10.8 ± 3.0 vs. cases 11.3 ± 2.5 ms; p=0.32). The longitudinal measurements in the diabetes group did not show significantdifferences to measurements at study entry. Conclusions These data show increased ANS activity in late gestation fetuses of diabetic mothers. Analysis of human fetal cardiovascular and autonomic nervous system function by PRSA may offer improved surveillance over conventional techniques linking gestational diabetes pregnancy with future cardiovascular dysfunction in the offspring.
-
spontaneous baroreflex sensitivity prospective validation trial of a novel technique in survivors of acute myocardial infarction
Heart Rhythm, 2012Co-Authors: Petra Barthel, Marek Malik, Axel Bauer, Alexander Muller, Katharina M Huster, Jorgen K Kanters, Vijayapraveena Paruchuri, Xiaoyun Yang, Georg SchmidtAbstract:flex sensitivity assessed by means of the correlation method; BRSPRSA baroreflex sensitivity assessed by means of phase-rectified Signal Averaging; BRSSEQ baroreflex sensitivity assessed by means of the sequence method; BRSTF baroreflex sensitivity assessed by means of the transfer function method; CI confidence interval; ECG electrocardiogram; GRACE Global Registry of Acute Coronary Events; HR hazard ratio; LVEF left ventricular ejection fraction; MI myocardial infarction; ROC receiver-operator characteristic; SBP systolic blood pressure
-
phase rectified Signal Averaging as a new method for surveillance of growth restricted fetuses
Journal of Maternal-fetal & Neonatal Medicine, 2012Co-Authors: Sm Lobmaier, Alexander Muller, Georg Schmidt, Ju Ortiz, E A Huhn, Pildner S Von Steinburg, T Schuster, K T M SchneiderAbstract:Objective: This study aims to compare average acceleration capacity (AAC), a new parameter to assess the dynamic capacity of the fetal autonomous nervous system, and short term variation (STV) in fetuses affected by intrauterine growth restriction (IUGR) and healthy fetuses. Methods: A prospective observational study was performed, including 39 women with IUGR singleton pregnancies (estimated fetal weight 95th percentile) and 43 healthy control pregnancies matched according to gestational age at recording. Ultrasound biometries and Doppler examination were performed for identification of IUGR and control fetuses, with subsequent analysis of fetal heart rate, resulting in STV and AAC. Follow-up for IUGR and control pregnancies was done, with perinatal outcome variables recorded. Results: AAC [IUGR mean value 2.0 bpm (interquartile range = 1.6–2.1), control 2.7 bpm (2.6–3.0)] differentiates better than STV [IUGR 7.4 ms (5.3–8.9), control 10.9 ms (9.2–1...
-
bivariate phase rectified Signal Averaging for assessment of spontaneous baroreflex sensitivity normalization of the results
Journal of Electrocardiology, 2012Co-Authors: Alexander Muller, Marek Malik, Petra Barthel, Axel Bauer, Adrian Morleydavies, Katerina Hnatkova, Kurt Ulm, Georg SchmidtAbstract:Abstract Background Previously proposed technique for assessment of spontaneous baroreflex sensitivity (BRS) based on bivariate phase-rectified Signal Averaging measures averaged R-R interval (RRI) changes triggered by beat-to-beat increases in systolic blood pressure (SBP). In this study, we investigate a normalized version of the method that relates the averaged RRI changes to the triggering blood pressure changes, thus providing the results in measurement units comparable with existing literature. Methods Data of previously reported prospective observational study were used. In each of 146 heart failure patients presenting with sinus rhythm, 10-minute recordings of electrocardiogram and arterial and blood pressures were obtained in the supine resting position. The averaged RRI increases initiated by beat-to-beat SBP increases were measured (original BRS result in milliseconds) and normalized for the averaged beat-to-beat SBP increases (normalized BRS result in milliseconds per millimeters of mercury). Both results were compared in terms of predicting all-cause mortality during a mean follow-up of 2.7 ± 1.1 years when 42 patients (28.8%) died. Results Both types of results were highly correlated ( r = 0.938, P Conclusion The results might question the concept of a linear relationship between the SBP changes and RRI changes. The phase-rectified Signal Averaging–based assessment of BRS may be used with equal legitimacy in the nonnormalized and normalized forms; the normalized form provides results in conventional measurement units.
-
bivariate phase rectified Signal Averaging for assessment of spontaneous baroreflex sensitivity pilot study of the technology
Journal of Electrocardiology, 2010Co-Authors: Marek Malik, Petra Barthel, Axel Bauer, Alexander Muller, Adrian Morleydavies, Kurt Ulm, Georg SchmidtAbstract:Abstract Background Assessment of spontaneous baroreflex sensitivity (BRS), an index of autonomic function, poses practical challenges. In this pilot study, we propose a novel technique for assessment of spontaneous BRS based on bivariate phase-rectified Signal Averaging (PRSA). This is an extension of the monovariate PRSA technology used for calculation of deceleration capacity. Methods A prospective, observational study was conducted in a training cohort of 146 patients with heart failure (New York Heart Association class 2.7 ± 0.8, left ventricular ejection fraction 23.6% ± 9.0%) presenting with sinus rhythm. In all patients, 10-minute recordings of ECG and arterial and blood pressure were obtained in the supine resting position. The algorithm for BRS assessment based on bivariate PRSA (BRS PRSA ) included (1) identification of heartbeat intervals occurring at the time of systolic pressure increases, (2) selection of heartbeat adjacent interval sections, (3) alignment and (4) Averaging of these segments, and (5) quantification of the average heart beat interval change by Haar wavelet analysis. Primary end point was death of any cause. During mean follow-up of 2.7 ± 1.1 years, 42 patients (28.8%) died. Results BRS PRSA was significantly associated with the primary end point (3.7 ± 5.3 ms vs −0.33 ± 6.6 ms in survivors and nonsurvivors, respectively). BRS PRSA yielded an area under the receiver operating characteristics curve of 69.8% (95% confidence interval, 59.9-79.7), which was comparable to the area under the curve of left ventricular ejection fraction (70.4%; 95% confidence interval, 61.3-79.5). Using the optimum dichotomy for BRS PRSA of 1.14 milliseconds, 52 (36%) patients had an abnormal BRS PRSA . The 3-year mortality risk of these patients was 45.3% compared to 19.0% in patients with normal BRS PRSA . On multivariate analysis, abnormal BRS PRSA was an independent risk factor from left ventricular ejection fraction ≤ 30% and New York Heart Association class > II. Conclusion BRS PRSA is an independent and strong predictor of mortality in patients with heart failure. Prospective validation and comparisons with standard measures of BRS are needed.
Axel Bauer - One of the best experts on this subject based on the ideXlab platform.
-
a methodological assessment of phase rectified Signal Averaging through simulated beat to beat interval time series
Computing in Cardiology Conference, 2014Co-Authors: Roberto Sassi, Axel Bauer, E Ferrazzi, Tamara Stampalija, D Casati, Massimo W RivoltaAbstract:Average cardiac acceleration (AC) and deceleration (DC) capacity, as computed by Phase-Rectified Signal Averaging (PRSA), were introduced to detect quasi-periodic oscillations in RR series. Calculation of AC and DC depends on three parameters (T, L and s). The aim of the study was to provide further insights on AC/DC and on the appropriate selection of these parameters.
-
assessment of coupling between trans abdominally acquired fetal ecg and uterine activity by bivariate phase rectified Signal Averaging analysis
PLOS ONE, 2014Co-Authors: D Casati, E Ferrazzi, Tamara Stampalija, Konstantinos D Rizas, C Mastroianni, E Rosti, M Quadrifoglio, Axel BauerAbstract:Couplings between uterine contractions (UC) and fetal heart rate (fHR) provide important information on fetal condition during labor. At present, couplings between UC and fHR are assessed by visual analysis and interpretation of cardiotocography. The application of computerized approaches is restricted due to the non-stationarity of the Signal, missing data and noise, typical for fHR. Herein, we propose a novel approach to assess couplings between UC and fHR, based on a Signal-processing algorithm termed bivariate phase-rectified Signal Averaging (BPRSA). Methods: Electrohysterogram (EHG) and fetal electrocardiogram (fECG) were recorded non-invasively by a trans-abdominal device in 73 women at term with uneventful singleton pregnancy during the first stage of labor. Coupling between UC and fHR was analyzed by BPRSA and by conventional cross power spectral density analysis (CPSD). For both methods, degree of coupling was assessed by the maximum coefficient of coherence (C-PRSA and C-RAW, respectively) in the UC frequency domain. Coherence values greater than 0.50 were consider significant. C-PRSA and C-RAW were compared by Wilcoxon test. Results: At visual inspection BPRSA analysis identified coupled periodicities in 86.3% (63/73) of the cases. 11/73 (15%) cases were excluded from further analysis because no 30 minutes of fECG recording without Signal loss was available for spectral analysis. Significant coupling was found in 90.3% (56/62) of the cases analyzed by BPRSA, and in 24.2% (15/62) of the cases analyzed by CPSD, respectively. The difference between median value of CPRSA and CRAW was highly significant (0.79 [IQR 0.69-0.90] and 0.29 [IQR 0.17-0.47],respectively;p<0.0001). Conclusion: BPRSA is a novel computer-based approach that can be reliably applied to trans-abdominally acquired EHG-fECG. It allows the assessment of correlations between UC and fHR patterns in the majority of labors, overcoming the limitations of non-stationarity and artifacts. Compared to standard techniques of cross-correlations, such as CPSD, BPRSA is significantly superior.
-
spontaneous baroreflex sensitivity prospective validation trial of a novel technique in survivors of acute myocardial infarction
Heart Rhythm, 2012Co-Authors: Petra Barthel, Marek Malik, Axel Bauer, Alexander Muller, Katharina M Huster, Jorgen K Kanters, Vijayapraveena Paruchuri, Xiaoyun Yang, Georg SchmidtAbstract:flex sensitivity assessed by means of the correlation method; BRSPRSA baroreflex sensitivity assessed by means of phase-rectified Signal Averaging; BRSSEQ baroreflex sensitivity assessed by means of the sequence method; BRSTF baroreflex sensitivity assessed by means of the transfer function method; CI confidence interval; ECG electrocardiogram; GRACE Global Registry of Acute Coronary Events; HR hazard ratio; LVEF left ventricular ejection fraction; MI myocardial infarction; ROC receiver-operator characteristic; SBP systolic blood pressure
-
bivariate phase rectified Signal Averaging for assessment of spontaneous baroreflex sensitivity normalization of the results
Journal of Electrocardiology, 2012Co-Authors: Alexander Muller, Marek Malik, Petra Barthel, Axel Bauer, Adrian Morleydavies, Katerina Hnatkova, Kurt Ulm, Georg SchmidtAbstract:Abstract Background Previously proposed technique for assessment of spontaneous baroreflex sensitivity (BRS) based on bivariate phase-rectified Signal Averaging measures averaged R-R interval (RRI) changes triggered by beat-to-beat increases in systolic blood pressure (SBP). In this study, we investigate a normalized version of the method that relates the averaged RRI changes to the triggering blood pressure changes, thus providing the results in measurement units comparable with existing literature. Methods Data of previously reported prospective observational study were used. In each of 146 heart failure patients presenting with sinus rhythm, 10-minute recordings of electrocardiogram and arterial and blood pressures were obtained in the supine resting position. The averaged RRI increases initiated by beat-to-beat SBP increases were measured (original BRS result in milliseconds) and normalized for the averaged beat-to-beat SBP increases (normalized BRS result in milliseconds per millimeters of mercury). Both results were compared in terms of predicting all-cause mortality during a mean follow-up of 2.7 ± 1.1 years when 42 patients (28.8%) died. Results Both types of results were highly correlated ( r = 0.938, P Conclusion The results might question the concept of a linear relationship between the SBP changes and RRI changes. The phase-rectified Signal Averaging–based assessment of BRS may be used with equal legitimacy in the nonnormalized and normalized forms; the normalized form provides results in conventional measurement units.
-
bivariate phase rectified Signal Averaging for assessment of spontaneous baroreflex sensitivity pilot study of the technology
Journal of Electrocardiology, 2010Co-Authors: Marek Malik, Petra Barthel, Axel Bauer, Alexander Muller, Adrian Morleydavies, Kurt Ulm, Georg SchmidtAbstract:Abstract Background Assessment of spontaneous baroreflex sensitivity (BRS), an index of autonomic function, poses practical challenges. In this pilot study, we propose a novel technique for assessment of spontaneous BRS based on bivariate phase-rectified Signal Averaging (PRSA). This is an extension of the monovariate PRSA technology used for calculation of deceleration capacity. Methods A prospective, observational study was conducted in a training cohort of 146 patients with heart failure (New York Heart Association class 2.7 ± 0.8, left ventricular ejection fraction 23.6% ± 9.0%) presenting with sinus rhythm. In all patients, 10-minute recordings of ECG and arterial and blood pressure were obtained in the supine resting position. The algorithm for BRS assessment based on bivariate PRSA (BRS PRSA ) included (1) identification of heartbeat intervals occurring at the time of systolic pressure increases, (2) selection of heartbeat adjacent interval sections, (3) alignment and (4) Averaging of these segments, and (5) quantification of the average heart beat interval change by Haar wavelet analysis. Primary end point was death of any cause. During mean follow-up of 2.7 ± 1.1 years, 42 patients (28.8%) died. Results BRS PRSA was significantly associated with the primary end point (3.7 ± 5.3 ms vs −0.33 ± 6.6 ms in survivors and nonsurvivors, respectively). BRS PRSA yielded an area under the receiver operating characteristics curve of 69.8% (95% confidence interval, 59.9-79.7), which was comparable to the area under the curve of left ventricular ejection fraction (70.4%; 95% confidence interval, 61.3-79.5). Using the optimum dichotomy for BRS PRSA of 1.14 milliseconds, 52 (36%) patients had an abnormal BRS PRSA . The 3-year mortality risk of these patients was 45.3% compared to 19.0% in patients with normal BRS PRSA . On multivariate analysis, abnormal BRS PRSA was an independent risk factor from left ventricular ejection fraction ≤ 30% and New York Heart Association class > II. Conclusion BRS PRSA is an independent and strong predictor of mortality in patients with heart failure. Prospective validation and comparisons with standard measures of BRS are needed.
Alexander Muller - One of the best experts on this subject based on the ideXlab platform.
-
influence of gestational diabetes on fetal autonomic nervous system a study using phase rectified Signal Averaging analysis
Ultrasound in Obstetrics & Gynecology, 2018Co-Authors: Sm Lobmaier, Alexander Muller, Georg Schmidt, Ju Ortiz, Dino A Giussani, Bernhard Haller, M Sewald, Renate Oberhoffer, K T M Schneider, A WackergussmannAbstract:Objectives Maternal gestational diabetes (GDM) is known to influence fetal physiology. Phase-rectified Signal Averaging (PRSA), an innovative Signal processing technique, can be used to investigate Signals obtained from fetal heart. The PRSA calculated variables “average acceleration capacity” (AAC) and “average deceleration capacity” (ADC) are established indices of autonomic nervous system (ANS) function. The aim of this study was to evaluate the influence of gestational diabetes on the fetal ANS in human pregnancy using PRSA. Methods In a prospective human clinical case-control study during the third trimester of pregnancy, 58 mothers with diagnosed GDM and 58 gestational-age matched healthy controls were included. Fetal CTG registrations were performed in all cases at study entry and in 19 cases of gestational diabetes the registration was repeated again close to delivery. The ultrasound technique based innovative CTG parameters AAC, ADC as well as fetal heart rate short-term variation (STV) according to Dawes/Redman criteria were calculated. Results Mean gestational age of both groups at study entry was 35.7 ± 2.3 weeks. There was a significant difference in AAC (mean ± SD: 1.97 ± 0.33 vs. 2.42 ± 0.57 bpm; p<0.001) and ADC (1.94 ± 0.32 vs. 2.28 ± 0.46, p<0.001) between controls and fetuses of diabetic mothers. This difference between groups could not be demonstrated using standard computerized fetal CTG analysis (STV controls 10.8 ± 3.0 vs. cases 11.3 ± 2.5 ms; p=0.32). The longitudinal measurements in the diabetes group did not show significantdifferences to measurements at study entry. Conclusions These data show increased ANS activity in late gestation fetuses of diabetic mothers. Analysis of human fetal cardiovascular and autonomic nervous system function by PRSA may offer improved surveillance over conventional techniques linking gestational diabetes pregnancy with future cardiovascular dysfunction in the offspring.
-
phase rectified Signal Averaging method to predict perinatal outcome in infants with very preterm fetal growth restriction a secondary analysis of truffle trial
American Journal of Obstetrics and Gynecology, 2016Co-Authors: Sm Lobmaier, Alexander Muller, Ju Ortiz, Nico Mensing A Van Charante, E Ferrazzi, Dino A Giussani, Caroline J Shaw, E Ostermayer, Bernhard Haller, Federico PrefumoAbstract:Background Phase-rectified Signal Averaging, an innovative Signal processing technique, can be used to investigate quasi-periodic oscillations in noisy, nonstationary Signals that are obtained from fetal heart rate. Phase-rectified Signal Averaging is currently the best method to predict survival after myocardial infarction in adult cardiology. Application of this method to fetal medicine has established significantly better identification than with short-term variation by computerized cardiotocography of growth-restricted fetuses. Objective The aim of this study was to determine the longitudinal progression of phase-rectified Signal Averaging indices in severely growth-restricted human fetuses and the prognostic accuracy of the technique in relation to perinatal and neurologic outcome. Study Design Raw data from cardiotocography monitoring of 279 human fetuses were obtained from 8 centers that took part in the multicenter European “TRUFFLE” trial on optimal timing of delivery in fetal growth restriction. Average acceleration and deceleration capacities were calculated by phase-rectified Signal Averaging to establish progression from 5 days to 1 day before delivery and were compared with short-term variation progression. The receiver operating characteristic curves of average acceleration and deceleration capacities and short-term variation were calculated and compared between techniques for short- and intermediate-term outcome. Results Average acceleration and deceleration capacities and short-term variation showed a progressive decrease in their diagnostic indices of fetal health from the first examination 5 days before delivery to 1 day before delivery. However, this decrease was significant 3 days before delivery for average acceleration and deceleration capacities, but 2 days before delivery for short-term variation. Compared with analysis of changes in short-term variation, analysis of (delta) average acceleration and deceleration capacities better predicted values of Apgar scores <7 and antenatal death (area under the curve for prediction of antenatal death: delta average acceleration capacity, 0.62 [confidence interval, 0.19–1.0]; delta short-term variation, 0.54 [confidence interval, 0.13–0.97]; P=.006; area under the curve for prediction Apgar <7: average deceleration capacity <24 hours before delivery, 0.64 [confidence interval, 0.52–0.76]; short-term variation <24 hours before delivery, 0.53 [confidence interval, 0.40–0.65]; P=.015). Neither phase-rectified Signal Averaging indices nor short-term variation showed predictive power for developmental disability at 2 years of age (Bayley developmental quotient, <95 or <85). Conclusion The phase-rectified Signal Averaging method seems to be at least as good as short-term variation to monitor progressive deterioration of severely growth-restricted fetuses. Our findings suggest that for short-term outcomes such as Apgar score, phase-rectified Signal Averaging indices could be an even better test than short-term variation. Overall, our findings confirm the possible value of prospective trials based on phase-rectified Signal Averaging indices of autonomic nervous system of severely growth-restricted fetuses.
-
spontaneous baroreflex sensitivity prospective validation trial of a novel technique in survivors of acute myocardial infarction
Heart Rhythm, 2012Co-Authors: Petra Barthel, Marek Malik, Axel Bauer, Alexander Muller, Katharina M Huster, Jorgen K Kanters, Vijayapraveena Paruchuri, Xiaoyun Yang, Georg SchmidtAbstract:flex sensitivity assessed by means of the correlation method; BRSPRSA baroreflex sensitivity assessed by means of phase-rectified Signal Averaging; BRSSEQ baroreflex sensitivity assessed by means of the sequence method; BRSTF baroreflex sensitivity assessed by means of the transfer function method; CI confidence interval; ECG electrocardiogram; GRACE Global Registry of Acute Coronary Events; HR hazard ratio; LVEF left ventricular ejection fraction; MI myocardial infarction; ROC receiver-operator characteristic; SBP systolic blood pressure
-
phase rectified Signal Averaging as a new method for surveillance of growth restricted fetuses
Journal of Maternal-fetal & Neonatal Medicine, 2012Co-Authors: Sm Lobmaier, Alexander Muller, Georg Schmidt, Ju Ortiz, E A Huhn, Pildner S Von Steinburg, T Schuster, K T M SchneiderAbstract:Objective: This study aims to compare average acceleration capacity (AAC), a new parameter to assess the dynamic capacity of the fetal autonomous nervous system, and short term variation (STV) in fetuses affected by intrauterine growth restriction (IUGR) and healthy fetuses. Methods: A prospective observational study was performed, including 39 women with IUGR singleton pregnancies (estimated fetal weight 95th percentile) and 43 healthy control pregnancies matched according to gestational age at recording. Ultrasound biometries and Doppler examination were performed for identification of IUGR and control fetuses, with subsequent analysis of fetal heart rate, resulting in STV and AAC. Follow-up for IUGR and control pregnancies was done, with perinatal outcome variables recorded. Results: AAC [IUGR mean value 2.0 bpm (interquartile range = 1.6–2.1), control 2.7 bpm (2.6–3.0)] differentiates better than STV [IUGR 7.4 ms (5.3–8.9), control 10.9 ms (9.2–1...
-
bivariate phase rectified Signal Averaging for assessment of spontaneous baroreflex sensitivity normalization of the results
Journal of Electrocardiology, 2012Co-Authors: Alexander Muller, Marek Malik, Petra Barthel, Axel Bauer, Adrian Morleydavies, Katerina Hnatkova, Kurt Ulm, Georg SchmidtAbstract:Abstract Background Previously proposed technique for assessment of spontaneous baroreflex sensitivity (BRS) based on bivariate phase-rectified Signal Averaging measures averaged R-R interval (RRI) changes triggered by beat-to-beat increases in systolic blood pressure (SBP). In this study, we investigate a normalized version of the method that relates the averaged RRI changes to the triggering blood pressure changes, thus providing the results in measurement units comparable with existing literature. Methods Data of previously reported prospective observational study were used. In each of 146 heart failure patients presenting with sinus rhythm, 10-minute recordings of electrocardiogram and arterial and blood pressures were obtained in the supine resting position. The averaged RRI increases initiated by beat-to-beat SBP increases were measured (original BRS result in milliseconds) and normalized for the averaged beat-to-beat SBP increases (normalized BRS result in milliseconds per millimeters of mercury). Both results were compared in terms of predicting all-cause mortality during a mean follow-up of 2.7 ± 1.1 years when 42 patients (28.8%) died. Results Both types of results were highly correlated ( r = 0.938, P Conclusion The results might question the concept of a linear relationship between the SBP changes and RRI changes. The phase-rectified Signal Averaging–based assessment of BRS may be used with equal legitimacy in the nonnormalized and normalized forms; the normalized form provides results in conventional measurement units.
Sm Lobmaier - One of the best experts on this subject based on the ideXlab platform.
-
influence of gestational diabetes on fetal autonomic nervous system a study using phase rectified Signal Averaging analysis
Ultrasound in Obstetrics & Gynecology, 2018Co-Authors: Sm Lobmaier, Alexander Muller, Georg Schmidt, Ju Ortiz, Dino A Giussani, Bernhard Haller, M Sewald, Renate Oberhoffer, K T M Schneider, A WackergussmannAbstract:Objectives Maternal gestational diabetes (GDM) is known to influence fetal physiology. Phase-rectified Signal Averaging (PRSA), an innovative Signal processing technique, can be used to investigate Signals obtained from fetal heart. The PRSA calculated variables “average acceleration capacity” (AAC) and “average deceleration capacity” (ADC) are established indices of autonomic nervous system (ANS) function. The aim of this study was to evaluate the influence of gestational diabetes on the fetal ANS in human pregnancy using PRSA. Methods In a prospective human clinical case-control study during the third trimester of pregnancy, 58 mothers with diagnosed GDM and 58 gestational-age matched healthy controls were included. Fetal CTG registrations were performed in all cases at study entry and in 19 cases of gestational diabetes the registration was repeated again close to delivery. The ultrasound technique based innovative CTG parameters AAC, ADC as well as fetal heart rate short-term variation (STV) according to Dawes/Redman criteria were calculated. Results Mean gestational age of both groups at study entry was 35.7 ± 2.3 weeks. There was a significant difference in AAC (mean ± SD: 1.97 ± 0.33 vs. 2.42 ± 0.57 bpm; p<0.001) and ADC (1.94 ± 0.32 vs. 2.28 ± 0.46, p<0.001) between controls and fetuses of diabetic mothers. This difference between groups could not be demonstrated using standard computerized fetal CTG analysis (STV controls 10.8 ± 3.0 vs. cases 11.3 ± 2.5 ms; p=0.32). The longitudinal measurements in the diabetes group did not show significantdifferences to measurements at study entry. Conclusions These data show increased ANS activity in late gestation fetuses of diabetic mothers. Analysis of human fetal cardiovascular and autonomic nervous system function by PRSA may offer improved surveillance over conventional techniques linking gestational diabetes pregnancy with future cardiovascular dysfunction in the offspring.
-
phase rectified Signal Averaging method to predict perinatal outcome in infants with very preterm fetal growth restriction a secondary analysis of truffle trial
American Journal of Obstetrics and Gynecology, 2016Co-Authors: Sm Lobmaier, Alexander Muller, Ju Ortiz, Nico Mensing A Van Charante, E Ferrazzi, Dino A Giussani, Caroline J Shaw, E Ostermayer, Bernhard Haller, Federico PrefumoAbstract:Background Phase-rectified Signal Averaging, an innovative Signal processing technique, can be used to investigate quasi-periodic oscillations in noisy, nonstationary Signals that are obtained from fetal heart rate. Phase-rectified Signal Averaging is currently the best method to predict survival after myocardial infarction in adult cardiology. Application of this method to fetal medicine has established significantly better identification than with short-term variation by computerized cardiotocography of growth-restricted fetuses. Objective The aim of this study was to determine the longitudinal progression of phase-rectified Signal Averaging indices in severely growth-restricted human fetuses and the prognostic accuracy of the technique in relation to perinatal and neurologic outcome. Study Design Raw data from cardiotocography monitoring of 279 human fetuses were obtained from 8 centers that took part in the multicenter European “TRUFFLE” trial on optimal timing of delivery in fetal growth restriction. Average acceleration and deceleration capacities were calculated by phase-rectified Signal Averaging to establish progression from 5 days to 1 day before delivery and were compared with short-term variation progression. The receiver operating characteristic curves of average acceleration and deceleration capacities and short-term variation were calculated and compared between techniques for short- and intermediate-term outcome. Results Average acceleration and deceleration capacities and short-term variation showed a progressive decrease in their diagnostic indices of fetal health from the first examination 5 days before delivery to 1 day before delivery. However, this decrease was significant 3 days before delivery for average acceleration and deceleration capacities, but 2 days before delivery for short-term variation. Compared with analysis of changes in short-term variation, analysis of (delta) average acceleration and deceleration capacities better predicted values of Apgar scores <7 and antenatal death (area under the curve for prediction of antenatal death: delta average acceleration capacity, 0.62 [confidence interval, 0.19–1.0]; delta short-term variation, 0.54 [confidence interval, 0.13–0.97]; P=.006; area under the curve for prediction Apgar <7: average deceleration capacity <24 hours before delivery, 0.64 [confidence interval, 0.52–0.76]; short-term variation <24 hours before delivery, 0.53 [confidence interval, 0.40–0.65]; P=.015). Neither phase-rectified Signal Averaging indices nor short-term variation showed predictive power for developmental disability at 2 years of age (Bayley developmental quotient, <95 or <85). Conclusion The phase-rectified Signal Averaging method seems to be at least as good as short-term variation to monitor progressive deterioration of severely growth-restricted fetuses. Our findings suggest that for short-term outcomes such as Apgar score, phase-rectified Signal Averaging indices could be an even better test than short-term variation. Overall, our findings confirm the possible value of prospective trials based on phase-rectified Signal Averaging indices of autonomic nervous system of severely growth-restricted fetuses.
-
Phase-rectified Signal Averaging method to predict perinatal outcome in infants with very preterm fetal growth restriction- a secondary analysis of TRUFFLE-trial
'Elsevier BV', 2016Co-Authors: Sm Lobmaier, Mensing Van Charante, N, Ferrazzi E, Da Giussani, Cj Shaw, Müller A, Ju Ortiz, Ostermayer E, Haller B, Prefumo FAbstract:Background Phase-rectified Signal Averaging, an innovative Signal processing technique, can be used to investigate quasi-periodic oscillations in noisy, nonstationary Signals that are obtained from fetal heart rate. Phase-rectified Signal Averaging is currently the best method to predict survival after myocardial infarction in adult cardiology. Application of this method to fetal medicine has established significantly better identification than with short-term variation by computerized cardiotocography of growth-restricted fetuses. Objective The aim of this study was to determine the longitudinal progression of phase-rectified Signal Averaging indices in severely growthrestricted human fetuses and the prognostic accuracy of the technique in relation to perinatal and neurologic outcome. Study Design Raw data from cardiotocography monitoring of 279 human fetuses were obtained from 8 centers that took part in the multicenter European “TRUFFLE” trial on optimal timing of delivery in fetal growth restriction. Average acceleration and deceleration capacities were calculated by phase-rectified Signal Averaging to establish progression from 5 days to 1 day before delivery and were compared with short-term variation progression. The receiver operating characteristic curves of average acceleration and deceleration capacities and short-term variation were calculated and compared between techniques for short- and intermediate-term outcome. Results Average acceleration and deceleration capacities and short-term variation showed a progressive decrease in their diagnostic indices of fetal health from the first examination 5 days before delivery to 1 day before delivery. However, this decrease was significant 3 days before delivery for average acceleration and deceleration capacities, but 2 days before delivery for short-term variation. Compared with analysis of changes in short-term variation, analysis of (delta) average acceleration and deceleration capacities better predicted values of Apgar scores Conclusion The phase-rectified Signal Averaging method seems to be at least as good as short-term variation to monitor progressive deterioration of severely growth-restricted fetuses. Our findings suggest that for short-term outcomes such as Apgar score, phase-rectified Signal Averaging indices could be an even better test than short-term variation. Overall, our findings confirm the possible value of prospective trials based on phase-rectified Signal Averaging indices of autonomic nervous system of severely growth-restricted fetuses.
-
Phase-rectified Signal Averaging method to predict perinatal outcome in infants with very preterm fetal growth restriction- a secondary analysis of TRUFFLE-trial
'Elsevier BV', 2016Co-Authors: Sm Lobmaier, Mensing Van Charante, N, Ferrazzi E, Da Giussani, Cj Shaw, Müller A, Ju Ortiz, Ostermayer E, Haller B, Prefumo FAbstract:Background Phase-rectified Signal Averaging, an innovative Signal processing technique, can be used to investigate quasi-periodic oscillations in noisy, nonstationary Signals that are obtained from fetal heart rate. Phase-rectified Signal Averaging is currently the best method to predict survival after myocardial infarction in adult cardiology. Application of this method to fetal medicine has established significantly better identification than with short-term variation by computerized cardiotocography of growth-restricted fetuses. Objective The aim of this study was to determine the longitudinal progression of phase-rectified Signal Averaging indices in severely growthrestricted human fetuses and the prognostic accuracy of the technique in relation to perinatal and neurologic outcome. Study Design Raw data from cardiotocography monitoring of 279 human fetuses were obtained from 8 centers that took part in the multicenter European “TRUFFLE” trial on optimal timing of delivery in fetal growth restriction. Average acceleration and deceleration capacities were calculated by phase-rectified Signal Averaging to establish progression from 5 days to 1 day before delivery and were compared with short-term variation progression. The receiver operating characteristic curves of average acceleration and deceleration capacities and short-term variation were calculated and compared between techniques for short- and intermediate-term outcome. Results Average acceleration and deceleration capacities and short-term variation showed a progressive decrease in their diagnostic indices of fetal health from the first examination 5 days before delivery to 1 day before delivery. However, this decrease was significant 3 days before delivery for average acceleration and deceleration capacities, but 2 days before delivery for short-term variation. Compared with analysis of changes in short-term variation, analysis of (delta) average acceleration and deceleration capacities better predicted values of Apgar scores <7 and antenatal death (area under the curve for prediction of antenatal death: delta average acceleration capacity, 0.62 [confidence interval, 0.19e1.0]; delta short-term variation, 0.54 [confidence interval, 0.13e0.97]; P¼.006; area under the curve for prediction Apgar <7: average deceleration capacity <24 hours before delivery, 0.64 [confidence interval, 0.52e0.76]; short-term variation <24 hours before delivery, 0.53 [confidence interval, 0.40e0.65]; P¼.015). Neither phase-rectified Signal Averaging indices nor short-term variation showed predictive power for developmental disability at 2 years of age (Bayley developmental quotient, <95 or <85). Conclusion The phase-rectified Signal Averaging method seems to be at least as good as short-term variation to monitor progressive deterioration of severely growth-restricted fetuses. Our findings suggest that for short-term outcomes such as Apgar score, phase-rectified Signal Averaging indices could be an even better test than short-term variation. Overall, our findings confirm the possible value of prospective trials based on phase-rectified Signal Averaging indices of autonomic nervous system of severely growth-restricted fetuses.
-
Phase-rectified Signal Averaging method to predict perinatal outcome in infants with very preterm fetal growth restriction- a secondary analysis of TRUFFLE-trial
'Elsevier BV', 2016Co-Authors: Sm Lobmaier, Da Giussani, Cj Shaw, Ju Ortiz, E Ferrazzi, E Ostermayer, Bernhard Haller, Mensing N. Van Charante, A. Mü, Federico PrefumoAbstract:Background Phase-rectified Signal Averaging, an innovative Signal processing technique, can be used to investigate quasi-periodic oscillations in noisy, nonstationary Signals that are obtained from fetal heart rate. Phase-rectified Signal Averaging is currently the best method to predict survival after myocardial infarction in adult cardiology. Application of this method to fetal medicine has established significantly better identification than with short-term variation by computerized cardiotocography of growth-restricted fetuses. Objective The aim of this study was to determine the longitudinal progression of phase-rectified Signal Averaging indices in severely growth-restricted human fetuses and the prognostic accuracy of the technique in relation to perinatal and neurologic outcome. Study Design Raw data from cardiotocography monitoring of 279 human fetuses were obtained from 8 centers that took part in the multicenter European \u201cTRUFFLE\u201d trial on optimal timing of delivery in fetal growth restriction. Average acceleration and deceleration capacities were calculated by phase-rectified Signal Averaging to establish progression from 5 days to 1 day before delivery and were compared with short-term variation progression. The receiver operating characteristic curves of average acceleration and deceleration capacities and short-term variation were calculated and compared between techniques for short- and intermediate-term outcome. Results Average acceleration and deceleration capacities and short-term variation showed a progressive decrease in their diagnostic indices of fetal health from the first examination 5 days before delivery to 1 day before delivery. However, this decrease was significant 3 days before delivery for average acceleration and deceleration capacities, but 2 days before delivery for short-term variation. Compared with analysis of changes in short-term variation, analysis of (delta) average acceleration and deceleration capacities better predicted values of Apgar scores
Ju Ortiz - One of the best experts on this subject based on the ideXlab platform.
-
influence of gestational diabetes on fetal autonomic nervous system a study using phase rectified Signal Averaging analysis
Ultrasound in Obstetrics & Gynecology, 2018Co-Authors: Sm Lobmaier, Alexander Muller, Georg Schmidt, Ju Ortiz, Dino A Giussani, Bernhard Haller, M Sewald, Renate Oberhoffer, K T M Schneider, A WackergussmannAbstract:Objectives Maternal gestational diabetes (GDM) is known to influence fetal physiology. Phase-rectified Signal Averaging (PRSA), an innovative Signal processing technique, can be used to investigate Signals obtained from fetal heart. The PRSA calculated variables “average acceleration capacity” (AAC) and “average deceleration capacity” (ADC) are established indices of autonomic nervous system (ANS) function. The aim of this study was to evaluate the influence of gestational diabetes on the fetal ANS in human pregnancy using PRSA. Methods In a prospective human clinical case-control study during the third trimester of pregnancy, 58 mothers with diagnosed GDM and 58 gestational-age matched healthy controls were included. Fetal CTG registrations were performed in all cases at study entry and in 19 cases of gestational diabetes the registration was repeated again close to delivery. The ultrasound technique based innovative CTG parameters AAC, ADC as well as fetal heart rate short-term variation (STV) according to Dawes/Redman criteria were calculated. Results Mean gestational age of both groups at study entry was 35.7 ± 2.3 weeks. There was a significant difference in AAC (mean ± SD: 1.97 ± 0.33 vs. 2.42 ± 0.57 bpm; p<0.001) and ADC (1.94 ± 0.32 vs. 2.28 ± 0.46, p<0.001) between controls and fetuses of diabetic mothers. This difference between groups could not be demonstrated using standard computerized fetal CTG analysis (STV controls 10.8 ± 3.0 vs. cases 11.3 ± 2.5 ms; p=0.32). The longitudinal measurements in the diabetes group did not show significantdifferences to measurements at study entry. Conclusions These data show increased ANS activity in late gestation fetuses of diabetic mothers. Analysis of human fetal cardiovascular and autonomic nervous system function by PRSA may offer improved surveillance over conventional techniques linking gestational diabetes pregnancy with future cardiovascular dysfunction in the offspring.
-
phase rectified Signal Averaging method to predict perinatal outcome in infants with very preterm fetal growth restriction a secondary analysis of truffle trial
American Journal of Obstetrics and Gynecology, 2016Co-Authors: Sm Lobmaier, Alexander Muller, Ju Ortiz, Nico Mensing A Van Charante, E Ferrazzi, Dino A Giussani, Caroline J Shaw, E Ostermayer, Bernhard Haller, Federico PrefumoAbstract:Background Phase-rectified Signal Averaging, an innovative Signal processing technique, can be used to investigate quasi-periodic oscillations in noisy, nonstationary Signals that are obtained from fetal heart rate. Phase-rectified Signal Averaging is currently the best method to predict survival after myocardial infarction in adult cardiology. Application of this method to fetal medicine has established significantly better identification than with short-term variation by computerized cardiotocography of growth-restricted fetuses. Objective The aim of this study was to determine the longitudinal progression of phase-rectified Signal Averaging indices in severely growth-restricted human fetuses and the prognostic accuracy of the technique in relation to perinatal and neurologic outcome. Study Design Raw data from cardiotocography monitoring of 279 human fetuses were obtained from 8 centers that took part in the multicenter European “TRUFFLE” trial on optimal timing of delivery in fetal growth restriction. Average acceleration and deceleration capacities were calculated by phase-rectified Signal Averaging to establish progression from 5 days to 1 day before delivery and were compared with short-term variation progression. The receiver operating characteristic curves of average acceleration and deceleration capacities and short-term variation were calculated and compared between techniques for short- and intermediate-term outcome. Results Average acceleration and deceleration capacities and short-term variation showed a progressive decrease in their diagnostic indices of fetal health from the first examination 5 days before delivery to 1 day before delivery. However, this decrease was significant 3 days before delivery for average acceleration and deceleration capacities, but 2 days before delivery for short-term variation. Compared with analysis of changes in short-term variation, analysis of (delta) average acceleration and deceleration capacities better predicted values of Apgar scores <7 and antenatal death (area under the curve for prediction of antenatal death: delta average acceleration capacity, 0.62 [confidence interval, 0.19–1.0]; delta short-term variation, 0.54 [confidence interval, 0.13–0.97]; P=.006; area under the curve for prediction Apgar <7: average deceleration capacity <24 hours before delivery, 0.64 [confidence interval, 0.52–0.76]; short-term variation <24 hours before delivery, 0.53 [confidence interval, 0.40–0.65]; P=.015). Neither phase-rectified Signal Averaging indices nor short-term variation showed predictive power for developmental disability at 2 years of age (Bayley developmental quotient, <95 or <85). Conclusion The phase-rectified Signal Averaging method seems to be at least as good as short-term variation to monitor progressive deterioration of severely growth-restricted fetuses. Our findings suggest that for short-term outcomes such as Apgar score, phase-rectified Signal Averaging indices could be an even better test than short-term variation. Overall, our findings confirm the possible value of prospective trials based on phase-rectified Signal Averaging indices of autonomic nervous system of severely growth-restricted fetuses.
-
Phase-rectified Signal Averaging method to predict perinatal outcome in infants with very preterm fetal growth restriction- a secondary analysis of TRUFFLE-trial
'Elsevier BV', 2016Co-Authors: Sm Lobmaier, Mensing Van Charante, N, Ferrazzi E, Da Giussani, Cj Shaw, Müller A, Ju Ortiz, Ostermayer E, Haller B, Prefumo FAbstract:Background Phase-rectified Signal Averaging, an innovative Signal processing technique, can be used to investigate quasi-periodic oscillations in noisy, nonstationary Signals that are obtained from fetal heart rate. Phase-rectified Signal Averaging is currently the best method to predict survival after myocardial infarction in adult cardiology. Application of this method to fetal medicine has established significantly better identification than with short-term variation by computerized cardiotocography of growth-restricted fetuses. Objective The aim of this study was to determine the longitudinal progression of phase-rectified Signal Averaging indices in severely growthrestricted human fetuses and the prognostic accuracy of the technique in relation to perinatal and neurologic outcome. Study Design Raw data from cardiotocography monitoring of 279 human fetuses were obtained from 8 centers that took part in the multicenter European “TRUFFLE” trial on optimal timing of delivery in fetal growth restriction. Average acceleration and deceleration capacities were calculated by phase-rectified Signal Averaging to establish progression from 5 days to 1 day before delivery and were compared with short-term variation progression. The receiver operating characteristic curves of average acceleration and deceleration capacities and short-term variation were calculated and compared between techniques for short- and intermediate-term outcome. Results Average acceleration and deceleration capacities and short-term variation showed a progressive decrease in their diagnostic indices of fetal health from the first examination 5 days before delivery to 1 day before delivery. However, this decrease was significant 3 days before delivery for average acceleration and deceleration capacities, but 2 days before delivery for short-term variation. Compared with analysis of changes in short-term variation, analysis of (delta) average acceleration and deceleration capacities better predicted values of Apgar scores Conclusion The phase-rectified Signal Averaging method seems to be at least as good as short-term variation to monitor progressive deterioration of severely growth-restricted fetuses. Our findings suggest that for short-term outcomes such as Apgar score, phase-rectified Signal Averaging indices could be an even better test than short-term variation. Overall, our findings confirm the possible value of prospective trials based on phase-rectified Signal Averaging indices of autonomic nervous system of severely growth-restricted fetuses.
-
Phase-rectified Signal Averaging method to predict perinatal outcome in infants with very preterm fetal growth restriction- a secondary analysis of TRUFFLE-trial
'Elsevier BV', 2016Co-Authors: Sm Lobmaier, Mensing Van Charante, N, Ferrazzi E, Da Giussani, Cj Shaw, Müller A, Ju Ortiz, Ostermayer E, Haller B, Prefumo FAbstract:Background Phase-rectified Signal Averaging, an innovative Signal processing technique, can be used to investigate quasi-periodic oscillations in noisy, nonstationary Signals that are obtained from fetal heart rate. Phase-rectified Signal Averaging is currently the best method to predict survival after myocardial infarction in adult cardiology. Application of this method to fetal medicine has established significantly better identification than with short-term variation by computerized cardiotocography of growth-restricted fetuses. Objective The aim of this study was to determine the longitudinal progression of phase-rectified Signal Averaging indices in severely growthrestricted human fetuses and the prognostic accuracy of the technique in relation to perinatal and neurologic outcome. Study Design Raw data from cardiotocography monitoring of 279 human fetuses were obtained from 8 centers that took part in the multicenter European “TRUFFLE” trial on optimal timing of delivery in fetal growth restriction. Average acceleration and deceleration capacities were calculated by phase-rectified Signal Averaging to establish progression from 5 days to 1 day before delivery and were compared with short-term variation progression. The receiver operating characteristic curves of average acceleration and deceleration capacities and short-term variation were calculated and compared between techniques for short- and intermediate-term outcome. Results Average acceleration and deceleration capacities and short-term variation showed a progressive decrease in their diagnostic indices of fetal health from the first examination 5 days before delivery to 1 day before delivery. However, this decrease was significant 3 days before delivery for average acceleration and deceleration capacities, but 2 days before delivery for short-term variation. Compared with analysis of changes in short-term variation, analysis of (delta) average acceleration and deceleration capacities better predicted values of Apgar scores <7 and antenatal death (area under the curve for prediction of antenatal death: delta average acceleration capacity, 0.62 [confidence interval, 0.19e1.0]; delta short-term variation, 0.54 [confidence interval, 0.13e0.97]; P¼.006; area under the curve for prediction Apgar <7: average deceleration capacity <24 hours before delivery, 0.64 [confidence interval, 0.52e0.76]; short-term variation <24 hours before delivery, 0.53 [confidence interval, 0.40e0.65]; P¼.015). Neither phase-rectified Signal Averaging indices nor short-term variation showed predictive power for developmental disability at 2 years of age (Bayley developmental quotient, <95 or <85). Conclusion The phase-rectified Signal Averaging method seems to be at least as good as short-term variation to monitor progressive deterioration of severely growth-restricted fetuses. Our findings suggest that for short-term outcomes such as Apgar score, phase-rectified Signal Averaging indices could be an even better test than short-term variation. Overall, our findings confirm the possible value of prospective trials based on phase-rectified Signal Averaging indices of autonomic nervous system of severely growth-restricted fetuses.
-
Phase-rectified Signal Averaging method to predict perinatal outcome in infants with very preterm fetal growth restriction- a secondary analysis of TRUFFLE-trial
'Elsevier BV', 2016Co-Authors: Sm Lobmaier, Da Giussani, Cj Shaw, Ju Ortiz, E Ferrazzi, E Ostermayer, Bernhard Haller, Mensing N. Van Charante, A. Mü, Federico PrefumoAbstract:Background Phase-rectified Signal Averaging, an innovative Signal processing technique, can be used to investigate quasi-periodic oscillations in noisy, nonstationary Signals that are obtained from fetal heart rate. Phase-rectified Signal Averaging is currently the best method to predict survival after myocardial infarction in adult cardiology. Application of this method to fetal medicine has established significantly better identification than with short-term variation by computerized cardiotocography of growth-restricted fetuses. Objective The aim of this study was to determine the longitudinal progression of phase-rectified Signal Averaging indices in severely growth-restricted human fetuses and the prognostic accuracy of the technique in relation to perinatal and neurologic outcome. Study Design Raw data from cardiotocography monitoring of 279 human fetuses were obtained from 8 centers that took part in the multicenter European \u201cTRUFFLE\u201d trial on optimal timing of delivery in fetal growth restriction. Average acceleration and deceleration capacities were calculated by phase-rectified Signal Averaging to establish progression from 5 days to 1 day before delivery and were compared with short-term variation progression. The receiver operating characteristic curves of average acceleration and deceleration capacities and short-term variation were calculated and compared between techniques for short- and intermediate-term outcome. Results Average acceleration and deceleration capacities and short-term variation showed a progressive decrease in their diagnostic indices of fetal health from the first examination 5 days before delivery to 1 day before delivery. However, this decrease was significant 3 days before delivery for average acceleration and deceleration capacities, but 2 days before delivery for short-term variation. Compared with analysis of changes in short-term variation, analysis of (delta) average acceleration and deceleration capacities better predicted values of Apgar scores
