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Article ; Online: Ischemic Stroke Risk Assessment by Multiscale Entropy Analysis of Heart Rate Variability in Patients with Persistent Atrial Fibrillation

Ghina Chairina / Kohzoh Yoshino / Ken Kiyono / Eiichi Watanabe

Entropy, Vol 23, Iss 918, p

2021 Volume 918

Abstract: It has been recognized that heart rate variability (HRV), defined as the fluctuation of ventricular response intervals in atrial fibrillation (AFib) patients, is not completely random, and its nonlinear characteristics, such as multiscale entropy (MSE), ... ...

Abstract	It has been recognized that heart rate variability (HRV), defined as the fluctuation of ventricular response intervals in atrial fibrillation (AFib) patients, is not completely random, and its nonlinear characteristics, such as multiscale entropy (MSE), contain clinically significant information. We investigated the relationship between ischemic stroke risk and HRV with a large number of stroke-naïve AFib patients (628 patients), focusing on those who had never developed an ischemic/hemorrhagic stroke before the heart rate measurement. The <math xmlns="http://www.w3.org/1998/Math/MathML" display="inline"><semantics><mrow><msub><mrow><mi>CHA</mi></mrow><mn>2</mn></msub><msub><mrow><mi>DS</mi></mrow><mn>2</mn></msub><mo>−</mo><mi>VASc</mi></mrow></semantics></math> score was calculated from the baseline clinical characteristics, while the HRV analysis was made from the recording of morning, afternoon, and evening. Subsequently, we performed Kaplan–Meier method and cumulative incidence function with mortality as a competing risk to estimate the survival time function. We found that patients with sample entropy ( <math xmlns="http://www.w3.org/1998/Math/MathML" display="inline"><semantics><mrow><msubsup><mi>S</mi><mi>E</mi><mrow><mrow><mo>(</mo><mi>s</mi><mo>)</mo></mrow></mrow></msubsup></mrow></semantics></math> ) <math xmlns="http://www.w3.org/1998/Math/MathML" display="inline"><semantics><mo>≥</mo></semantics></math> 0.68 at 210 s had a significantly higher risk of an ischemic stroke occurrence in the morning recording. Meanwhile, the afternoon recording showed that those with <math xmlns="http://www.w3.org/1998/Math/MathML" ...<br />
Keywords	atrial fibrillation ; ischemic stroke ; heart rate variability ; multiscale entropy ; Science ; Q ; Astrophysics ; QB460-466 ; Physics ; QC1-999
Subject code	511
Language	English
Publishing date	2021-07-01T00:00:00Z
Publisher	MDPI AG
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Prediction of Short-Term Mortality of Cardiac Care Unit Patients Using Image-Transformed ECG Waveforms

Terumasa Kondo / Atsushi Teramoto / Eiichi Watanabe / Yoshihiro Sobue / Hideo Izawa / Kuniaki Saito / Hiroshi Fujita

IEEE Journal of Translational Engineering in Health and Medicine, Vol 11, Pp 191-

2023 Volume 198

Abstract: Objective: The early detection of cardiac disease is important because the disease can lead to sudden death and poor prognosis. Electrocardiograms (ECG) are used to screen for cardiac diseases and are useful for the early detection and determination of ... ...

Abstract	Objective: The early detection of cardiac disease is important because the disease can lead to sudden death and poor prognosis. Electrocardiograms (ECG) are used to screen for cardiac diseases and are useful for the early detection and determination of treatment strategies. However, the ECG waveforms of cardiac care unit (CCU) patients with severe cardiac disease are often complicated by comorbidities and patient conditions, making it difficult to predict the severity of further cardiac disease. Therefore, this study predicts the short-term prognosis of CCU patients to detect further deterioration in CCU patients at an early stage. Methods: The ECG data (II, V3, V5, aVR induction) of CCU patients were converted to image data. The transformed ECG images were used to predict short-term prognosis with a two-dimensional convolutional neural network (CNN). Results: The prediction accuracy was 77.3%. Visualization by GradCAM showed that the CNN tended to focus on the shape and regularity of waveforms, such as heart failure and myocardial infarction. Conclusion: These results suggest that the proposed method may be useful for short-term prognosis prediction using the ECG waveforms of CCU patients. Clinical impact: The proposed method could be used to determine the treatment strategy and choose the intensity of treatment after admission to the CCU.
Keywords	Deep learning ; electrocardiogram ; GradCAM ; mortality prediction ; Computer applications to medicine. Medical informatics ; R858-859.7 ; Medical technology ; R855-855.5
Subject code	610
Language	English
Publishing date	2023-01-01T00:00:00Z
Publisher	IEEE
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Multifractal foundations of biomarker discovery for heart disease and stroke

Madhur Mangalam / Arash Sadri / Junichiro Hayano / Eiichi Watanabe / Ken Kiyono / Damian G. Kelty-Stephen

Scientific Reports, Vol 13, Iss 1, Pp 1-

2023 Volume 20

Abstract: Abstract Any reliable biomarker has to be specific, generalizable, and reproducible across individuals and contexts. The exact values of such a biomarker must represent similar health states in different individuals and at different times within the same ...

Abstract	Abstract Any reliable biomarker has to be specific, generalizable, and reproducible across individuals and contexts. The exact values of such a biomarker must represent similar health states in different individuals and at different times within the same individual to result in the minimum possible false-positive and false-negative rates. The application of standard cut-off points and risk scores across populations hinges upon the assumption of such generalizability. Such generalizability, in turn, hinges upon this condition that the phenomenon investigated by current statistical methods is ergodic, i.e., its statistical measures converge over individuals and time within the finite limit of observations. However, emerging evidence indicates that biological processes abound with nonergodicity, threatening this generalizability. Here, we present a solution for how to make generalizable inferences by deriving ergodic descriptions of nonergodic phenomena. For this aim, we proposed capturing the origin of ergodicity-breaking in many biological processes: cascade dynamics. To assess our hypotheses, we embraced the challenge of identifying reliable biomarkers for heart disease and stroke, which, despite being the leading cause of death worldwide and decades of research, lacks reliable biomarkers and risk stratification tools. We showed that raw R-R interval data and its common descriptors based on mean and variance are nonergodic and non-specific. On the other hand, the cascade-dynamical descriptors, the Hurst exponent encoding linear temporal correlations, and multifractal nonlinearity encoding nonlinear interactions across scales described the nonergodic heart rate variability more ergodically and were specific. This study inaugurates applying the critical concept of ergodicity in discovering and applying digital biomarkers of health and disease.
Keywords	Medicine ; R ; Science ; Q
Subject code	612
Language	English
Publishing date	2023-10-01T00:00:00Z
Publisher	Nature Portfolio
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Automated detection scheme for acute myocardial infarction using convolutional neural network and long short-term memory.

Ryosuke Muraki / Atsushi Teramoto / Keiko Sugimoto / Kunihiko Sugimoto / Akira Yamada / Eiichi Watanabe

PLoS ONE, Vol 17, Iss 2, p e

2022 Volume 0264002

Abstract: The early detection of acute myocardial infarction, which is caused by lifestyle-related risk factors, is essential because it can lead to chronic heart failure or sudden death. Echocardiography, among the most common methods used to detect acute ... ...

Abstract	The early detection of acute myocardial infarction, which is caused by lifestyle-related risk factors, is essential because it can lead to chronic heart failure or sudden death. Echocardiography, among the most common methods used to detect acute myocardial infarction, is a noninvasive modality for the early diagnosis and assessment of abnormal wall motion. However, depending on disease range and severity, abnormal wall motion may be difficult to distinguish from normal myocardium. As abnormal wall motion can lead to fatal complications, high accuracy is required in its detection over time on echocardiography. This study aimed to develop an automatic detection method for acute myocardial infarction using convolutional neural networks (CNNs) and long short-term memory (LSTM) in echocardiography. The short-axis view (papillary muscle level) of one cardiac cycle and left ventricular long-axis view were input into VGG16, a CNN model, for feature extraction. Thereafter, LSTM was used to classify the cases as normal myocardium or acute myocardial infarction. The overall classification accuracy reached 85.1% for the left ventricular long-axis view and 83.2% for the short-axis view (papillary muscle level). These results suggest the usefulness of the proposed method for the detection of myocardial infarction using echocardiography.
Keywords	Medicine ; R ; Science ; Q
Subject code	610
Language	English
Publishing date	2022-01-01T00:00:00Z
Publisher	Public Library of Science (PLoS)
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Circulating miR-20b-5p and miR-330-3p are novel biomarkers for progression of atrial fibrillation

Masahide Harada / Daisuke Okuzaki / Akemi Yamauchi / Shiho Ishikawa / Yoshihiro Nomura / Asuka Nishimura / Yuji Motoike / Masayuki Koshikawa / Keisuke Hitachi / Kunihiro Tsuchida / Kentaro Amano / Atsuo Maekawa / Yasushi Takagi / Eiichi Watanabe / Yukio Ozaki / Hideo Izawa

PLoS ONE, Vol 18, Iss 4, p e

Intracardiac/extracardiac plasma sample analysis by small RNA sequencing.

2023 Volume 0283942

Abstract: Background Circulating microRNAs (miRNAs, miR) have been considered as biomarkers reflecting the underlying pathophysiology in atrial fibrillation (AF). Nevertheless, miRNA expression in the peripheral blood samples might not reflect a cardiac phenomenon ...

Abstract	Background Circulating microRNAs (miRNAs, miR) have been considered as biomarkers reflecting the underlying pathophysiology in atrial fibrillation (AF). Nevertheless, miRNA expression in the peripheral blood samples might not reflect a cardiac phenomenon since most miRNAs are expressed in numerous organs. This study aimed to identify the cardiac-specific circulating miRNAs as biomarkers for AF. Methods Plasma samples were obtained from a luminal coronary sinus catheter (CS, cardiac-specific samples) and femoral venous sheath (FV, peripheral samples) in patients with AF and paroxysmal supraventricular tachycardia (control, CTL) undergoing catheter ablation. The circulating miRNA profiles were analyzed by small RNA sequencing. Differently expressed miRNAs between AF and CTL were identified in each sample of the CS and FV; miRNAs exhibiting similar expression patterns in the CS and FV samples were selected as candidates for cardiac-specific biomarkers. The selected miRNAs were related to the outcome of catheter ablation of AF. Results Small RNA sequencing detected 849 miRNAs. Among the top 30 most differently expressed miRNAs between AF and CTL, circulating hsa-miR-20b-5p, hsa-miR-330-3p, and hsa-miR-204-5p had a similar pattern in the CS and FV samples. Another set of peripheral blood samples was obtained from AF patients undergoing catheter ablation (n = 141). The expression of the miR-20b-5p and miR-330-3p, but not the miR-204-5p, negatively correlated with the echocardiographic left-atrial dimension and was decreased in patients with AF recurrence as compared to those without AF recurrence during a 1-year follow-up. Conclusion Circulating miR-20b-5p and miR-330-3p can be cardiac-specific biomarkers for atrial remodeling progression and arrhythmia recurrence after catheter ablation in AF patients.
Keywords	Medicine ; R ; Science ; Q
Subject code	500
Language	English
Publishing date	2023-01-01T00:00:00Z
Publisher	Public Library of Science (PLoS)
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Association between Multiscale Entropy Characteristics of Heart Rate Variability and Ischemic Stroke Risk in Patients with Permanent Atrial Fibrillation

Ryo Matsuoka / Kohzoh Yoshino / Eiichi Watanabe / Ken Kiyono

Entropy, Vol 19, Iss 12, p

2017 Volume 672

Abstract: Multiscale entropy (MSE) profiles of heart rate variability (HRV) in patients with atrial fibrillation (AFib) provides clinically useful information for ischemic stroke risk assessment, suggesting that the complex properties characterized by MSE profiles ...

Abstract	Multiscale entropy (MSE) profiles of heart rate variability (HRV) in patients with atrial fibrillation (AFib) provides clinically useful information for ischemic stroke risk assessment, suggesting that the complex properties characterized by MSE profiles are associated with ischemic stroke risk. However, the meaning of HRV complexity in patients with AFib has not been clearly interpreted, and the physical and mathematical understanding of the relation between HRV dynamics and the ischemic stroke risk is not well established. To gain a deeper insight into HRV dynamics in patients with AFib, and to improve ischemic stroke risk assessment using HRV analysis, we study the HRV characteristics related to MSE profiles, such as the long-range correlation and probability density function. In this study, we analyze the HRV time series of 173 patients with permanent AFib. Our results show that, although HRV time series in patients with AFib exhibit long-range correlation (1/f fluctuations)—as observed in healthy subjects—in a range longer than 90 s, these autocorrelation properties have no significant predictive power for ischemic stroke occurrence. Further, the probability density function structure of the coarse-grained times series at scales greater than 2 s is dominantly associated with ischemic stroke risk. This observation could provide valuable information for improving ischemic stroke risk assessment using HRV analysis.
Keywords	heart rate variability ; multiscale entropy ; long-range correlation ; Science ; Q ; Astrophysics ; QB460-466 ; Physics ; QC1-999
Subject code	610
Language	English
Publishing date	2017-12-01T00:00:00Z
Publisher	MDPI AG
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Urinary Liver-Type Fatty-Acid-Binding Protein Predicts Long-Term Adverse Outcomes in Medical Cardiac Intensive Care Units

Hiroyuki Naruse / Junnichi Ishii / Hiroshi Takahashi / Fumihiko Kitagawa / Hideto Nishimura / Hideki Kawai / Takashi Muramatsu / Masahide Harada / Akira Yamada / Wakaya Fujiwara / Mutsuharu Hayashi / Sadako Motoyama / Masayoshi Sarai / Eiichi Watanabe / Hideo Izawa / Yukio Ozaki

Journal of Clinical Medicine, Vol 9, Iss 2, p

2020 Volume 482

Abstract: We prospectively investigated the prognostic value of urinary liver-type fatty-acid-binding protein (L-FABP) levels on hospital admission, both independently and in combination with serum creatinine-defined acute kidney injury (AKI), to predict long-term ...

Abstract	We prospectively investigated the prognostic value of urinary liver-type fatty-acid-binding protein (L-FABP) levels on hospital admission, both independently and in combination with serum creatinine-defined acute kidney injury (AKI), to predict long-term adverse outcomes in 1119 heterogeneous patients (mean age; 68 years) treated at medical (non-surgical) cardiac intensive care units (CICUs). Patients with stage 5 chronic kidney disease were excluded from the study. Of these patients, 47% had acute coronary syndrome and 38% had acute decompensated heart failure. The creatinine-defined AKI was diagnosed according to the “Kidney Disease: Improving Global Outcomes” criteria. The primary endpoint was a composite of all-cause death or progression to end-stage kidney disease, indicating the initiation of maintenance dialysis therapy or kidney transplantation. Creatinine-defined AKI occurred in 207 patients, with 44 patients having stage 2 or 3 disease. During a mean follow-up period of 41 months after enrollment, the primary endpoint occurred in 242 patients. Multivariate Cox regression analyses revealed L-FABP levels as independent predictors of the primary endpoint ( p < 0.001). Adding L-FABP to a baseline model with established risk factors further enhanced reclassification and discrimination beyond that of the baseline model alone, for primary-endpoint prediction (both; p < 0.01). On Kaplan−Meier analyses, increased L-FABP (≥4th quintile value of 9.0 ng/mL) on admission or presence of creatinine-defined AKI, correlated with an increased risk of the primary endpoint ( p < 0.001). Thus, urinary L-FABP levels on admission are potent and independent predictors of long-term adverse outcomes, and they might improve the long-term risk stratification of patients admitted at medical CICUs, when used in combination with creatinine-defined AKI.
Keywords	liver-type fatty-acid-binding protein ; long-term outcomes ; cardiac intensive care units ; acute kidney injury ; Medicine ; R
Subject code	610
Language	English
Publishing date	2020-02-01T00:00:00Z
Publisher	MDPI AG
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Combined Assessment of D-Dimer with the Get with the Guidelines—Heart Failure Risk Score and N-Terminal Pro-B-Type Natriuretic Peptide in Patients with Acute Decompensated Heart Failure with Preserved and Reduced Ejection Fraction

Hiroyuki Naruse / Junnichi Ishii / Hiroshi Takahashi / Fumihiko Kitagawa / Eirin Sakaguchi / Hideto Nishimura / Hideki Kawai / Takashi Muramatsu / Masahide Harada / Akira Yamada / Wakaya Fujiwara / Mutsuharu Hayashi / Sadako Motoyama / Masayoshi Sarai / Eiichi Watanabe / Hiroyasu Ito / Yukio Ozaki / Hideo Izawa

Journal of Clinical Medicine, Vol 10, Iss 3564, p

2021 Volume 3564

Abstract: The prognostic role of D-dimer in different types of heart failure (HF) is poorly understood. We investigated the prognostic value of D-dimer on admission, both independently and in combination with the Get With The Guidelines—Heart Failure (GWTG-HF) ... ...

Abstract	The prognostic role of D-dimer in different types of heart failure (HF) is poorly understood. We investigated the prognostic value of D-dimer on admission, both independently and in combination with the Get With The Guidelines—Heart Failure (GWTG-HF) risk score and N-terminal pro-B-type natriuretic peptide (NT-proBNP), in patients with preserved left ventricular ejection fraction (LVEF) and acute decompensated HF (HFpEF) or reduced LVEF (HFrEF). Baseline D-dimer levels were measured on admission in 1670 patients (mean age: 75 years) who were hospitalized for worsening HF. Of those patients, 586 (35%) were categorized as HFpEF (LVEF ≥ 50%) and 1084 as HFrEF (LVEF < 50%). During the 12-month follow-up period after admission, 360 patients died. Elevated levels (at least the highest tertile value) of D-dimer, GWTG-HF risk score, and NT-proBNP were all independently associated with mortality in all HFpEF and HFrEF patients (all p < 0.05). Adding D-dimer to a baseline model with a GWTG-HF risk score and NT-proBNP improved the net reclassification and integrated discrimination improvement for mortality greater than the baseline model alone in all populations (all p < 0.001). The number of elevations in D-dimer, GWTG-HF risk score, and NT-proBNP were independently associated with a higher risk of mortality in all study populations (HFpEF and HFrEF patients; all p < 0.001). The combination of D-dimer, which is independently predictive of mortality, with the GWTG-HF risk score and NT-proBNP could improve early prediction of 12-month mortality in patients with acute decompensated HF, regardless of the HF phenotype.
Keywords	D-dimer ; GWTG-HF risk score ; NT-proBNP ; HFpEF ; HFrEF ; risk stratification ; Medicine ; R
Subject code	610
Language	English
Publishing date	2021-08-01T00:00:00Z
Publisher	MDPI AG
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Non-Gaussianity of low frequency heart rate variability and sympathetic activation

YoshiharuYamamoto / KenKiyono / JunichiroHayano / ShinKwak / EiichiWatanabe

Frontiers in Physiology, Vol

lack of increases in multiple system atrophy and Parkinson disease

2012 Volume 3

Abstract: The correlates of indices of long-term ambulatory heart rate variability (HRV) of the autonomic nervous system have not been completely understood. In this study, we evaluated conventional HRV indices, obtained from the daytime (12:00–18:00) Holter ... ...

Abstract	The correlates of indices of long-term ambulatory heart rate variability (HRV) of the autonomic nervous system have not been completely understood. In this study, we evaluated conventional HRV indices, obtained from the daytime (12:00–18:00) Holter recording, and a recently proposed non-Gaussianity index (λ) (Kiyono et al., 2008) in 12 patients with multiple system atrophy (MSA) and 10 patients with Parkinson disease (PD), known to have varying degrees of cardiac vagal and sympathetic dysfunction. Compared with the age-matched healthy control group, the MSA patients showed significantly decreased HRV, most probably reflecting impaired vagal heart rate control, but the PD patients did not show such reduced variability. In both MSA and PD patients, the low-to-high frequency (LF/HF) ratio and the short-term fractal exponent alpha_1, suggested to reflect the sympathovagal balance, were significantly decreased, as observed in congestive heart failure (CHF) patients with sympathetic overdrive. In contrast, the analysis of the non-Gaussianity index λ showed that a marked increase in intermittent and non-Gaussian HRV observed in the CHF patients was not observed in the MSA and PD patients with sympathetic dysfunction. These findings provide additional evidence for the relation between the non-Gaussian intermittency of HRV and increased sympathetic activity.
Keywords	Multiple System Atrophy ; Parkinson Disease ; Heart rate variability ; ambulatory ECG ; autonomic failure ; Physiology ; QP1-981 ; Science ; Q
Subject code	610
Language	English
Publishing date	2012-02-01T00:00:00Z
Publisher	Frontiers Media S.A.
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Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Predictors of clinical outcome in heart failure patients treated with vasopressin type 2 receptor antagonist

Takehiro Ito / Daiji Yoshikawa / Mutsuharu Hayashi / Masataka Yoshinaga / Tomoya Ishiguro / Ryo Yamada / Sayano Ueda / Wakaya Fujiwara / Yasuchika Kato / Eiichi Watanabe / Junnichi Ishii / Yukio Ozaki / Hideo Izawa

Fujita Medical Journal, Vol 4, Iss 3, Pp 77-

2018 Volume 81

Abstract: Objectives: There are well-established risk prediction models of in-hospital mortality due to heart failure (HF). However, the predictors of mortality during acute hospitalization in individuals with HF receiving tolvaptan, a vasopressin type 2 receptor ... ...

Abstract	Objectives: There are well-established risk prediction models of in-hospital mortality due to heart failure (HF). However, the predictors of mortality during acute hospitalization in individuals with HF receiving tolvaptan, a vasopressin type 2 receptor antagonist, are poorly understood. Methods: Sixty-one hospitalized patients prescribed tolvaptan to treat worsening HF were consecutively enrolled in this study. The study endpoint was death during hospitalization. Results: Compared with survivors, patients who died in hospital had higher Get With The Guidelines-Heart Failure (GWTG-HF) risk scores, decreased albumin levels, increased serum creatinine levels, smaller inferior vena cava (IVC) diameters on echocardiography, and were more likely to have received catecholamine infusion. A multivariate logistic regression analysis revealed that in addition to GWTG-HF risk score >47, albumin level ≤2.4 g/dL, creatinine level >1.5 mg/dL, IVC diameter ≤15 mm, and catecholamine infusion were all novel and significant predictors of in-hospital death. Moreover, combining these novel predictors to the GWTG-HF risk score significantly improved prediction of in-hospital death, as shown by the greater area under the receiver operating characteristic (ROC) curve. Conclusions: In patients with worsening HF receiving oral tolvaptan, we identified novel predictors of in-hospital death. Our findings may be helpful in developing novel treatment strategies for patients receiving tolvaptan for HF in clinical settings.
Keywords	prognostic factor ; heart failure ; diuretics ; vasopressin type 2 receptor antagonist ; Medicine (General) ; R5-920
Language	English
Publishing date	2018-08-01T00:00:00Z
Publisher	Fujita Medical Society
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