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Muñoz-Diosdado A et al. Thermodynamic efficiency of the cardiac cycle and irreversibility in the interbeat interval time series 103
REVISTA MEXICANA DE
INGENIERÍA BIOMÉDICA
ARTÍCULO DE INVESTIGACIÓN ORIGINAL
SOMIB Vol. XXXI, Núm. 2
Diciembre 2010
pp 103 - 110
Received article: 26/may/2010 Key words: Efficiency, heart rate variability, irreversibility, time series
Accepted article: 21/november/2010 analysis.
RESUMEN
relax continuously (systole and diastole). The right means that although in the short-term the cycle is
ventricle pumps blood to blood vessels of the lungs quasi-reversible; at long-term the cycle becomes
(pulmonary circulation) and the left ventricle pumps irreversible. If consecutive cycles are plotted it can
blood to all other tissues (systemic circulation). A be observed the formation of a spot around the
valve system ensures that blood flows in the direc- first cycle diagram (Figure 3), this oscillating cycle
tion indicated in Figure 1. To calculate the power means that the cycle is irreversible, but as stated
generated by the heart in a first approach, only the above, both variability and irreversibility are greater
dominant terms are considered17,18. The process of for healthy people. Furthermore, if the efficiency of
filling the left ventricle and the transfer process of the the cycle is calculated, it can be expected smaller
blood out to the vascular system can be described efficiency values of the patient’s cardiac cycle than
with a pressure-volume diagram as the one shown the efficiency of the cardiac cycle of the healthy
in Figure 2, which illustrates the cardiac cycle of subjects. Now, it is going to be briefly described
the left ventricle17. the way to calculate efficiencies and how it was
The DA line describes the filling of the ventricle, retrieved efficiency values for healthy subjects and
where volume increases from VES (final systolic patients with heart failure. Finally, the irreversibility in
volume) to VED (end-diastolic volume). The vertical heartbeat time series will be quantified.
line AB describes the isometric increase with no
volume change because both valves, input and Methodology
output, are closed. Horizontal line BC describes the
output of blood to the vascular system. The output The efficiency of a system is defined as the rate of
volume of blood is the cardiac output. the energy provided to the system to the energy that
Vertical descending line CD describes the isometric the system provides, when the energy is divided by
ventricular pressure decrease. During the filling pro- time we obtain an efficiency definition in terms of
cess, described by the line DA, blood flows from the power, the power is a physical quantity that can be
pulmonary vein to the left ventricle, which is relaxed. measured more easily21. From a thermodynamic
Thus, filling pressure is equal to the pressure of the point of view, the heart can be considered as a
pulmonary vein PV, which is much smaller than the machine that transforms part of the spent power in
blood pressure of the systemic circulation. During external power when it pumps blood17. During the
the output process of the blood, described by the contraction of the heart muscle most of the spent
BC line, the ventricular pressure must be much larger chemical energy converts into heat and a much
than the blood pressure of the systemic circulation, lesser portion becomes work. The ratio of the work
which varies between systolic and diastolic values. and the chemical energy expenditure is called ef-
The average value of ventricular pressure is approxi- ficiency of the cardiac contraction, or simply heart
mately equal to systolic systemic pressure. efficiency. Efficiency can be written as:
Closing the cycle at the same point that starts
implies that it is reversible, otherwise is irreversible. (1)
There is great variability in the cardiac cycle; this
C B Cardiac cycle
Ps 140
A: Input valves
are closed 120
B: Output valves
are opened 100
Left
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P(mmHg)
Where Wf is the average power generated by the sinus rhythm RR interval database» containing 54
heart, W is the energy generated by the heart and cases (28-72 years old) of both sexes; the heart
f is the frequency (number of beats per minute), failure patients were taken of the «congestive heart
P is the expended power. According to scientific failure RR interval database» that has 29 cases
medical literature22 the maximum efficiency of a and the «BIDMC congestive heart failure data-
normal heart yields between 20% and 25%, and base» that has 15 additional cases. Frequencies
the residual energy mainly dissipates as heat. This or heart rates were calculated from these data,
value may decrease up to 5% to 10% in heart failure and appropriate values of pressures and volumes
and it has been hypothesized that the increased were obtained generating random values for each
energy expenditure relative to work contributes to case within windows where appropriate values
the progression of the disease23. It is therefore de- were calculated. For example, when a person is
sirable to quantify efficiency of the heart to study at rest the heart only pumps every minute 4 to 6
disease processes. The average power generated liters of blood. These values change for congestive
by the heart is: heart failure, it ranges from 2 to 4 liters per min-
ute, depending on the pathology. During intense
(2) exercise may be necessary that the heart pumps
4 to 7 times this amount. Sympathetic stimulation
WL = PSS is the external work done by the left ven- increases the force of heart contraction thus in-
tricle in one heart cycle (which is proportional to the creasing the volume of blood that is pumped and
ABCD area) PS and is the blood pressure peak in the increasing pressure from ejection up to twice the
systemic circulation. External work produced by the normal. Thus, often sympathetic stimulation can
right ventricle heart cycle is given approximately by increase the maximum cardiac output up to two
WR = PPS PP is the pulmonary systolic pressure that or three times 22.
is approximately seven times smaller than systolic Regarding the irreversibility in time, the used
systemic pressure24,25. This approach assumes that method is named the multiscale time irreversibil-
the average on time of the ventricular pressure dur- ity method3. First, we mapped the original series,
ing the output is equal to the systolic pressure Ps and denoted as X={x i},1£i£N, to the sequences of
the work done to the heart by the vascular system increments and decrements of the heart rate.
(during ventricular filling) is insignificant. Y={yi},1£i£N-1, where y Y1=xi+1-xi y N is the data
Power spent by the heart is P = Ew. Where E is the number. To extract information from multiple scales,
released metabolic energy per liter of consumed we analyzed the original series to different resolu-
oxygen and w is the rate of oxygen consumption tions and we constructed a set of coarse grain se-
by the heart that is a fraction of the total average ries. Each coarse grain series is constructed taking
of oxygen consumed by the body, that can be the average within a mobile window with t data,
written as: where t is the scale factor. Each element of the
coarse grain series is defined as
W = cW (3)
(4)
where W is the rate of total oxygen consumption
by the body.
Equation (1) was used to evaluate the efficiency The temporal irreversibility can be measured with
of the cardiac cycle of healthy persons and per- the following variable10:
sons with heart failure. Heart interbeat data were
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taken from Physionet 26. Data from cardiac vari-
ability are signals arising from ECG recordings;
(5)
they were obtained with Holters with a bandwidth
of 0.1-40 Hz. Each set of data was taken in a 24
hour period. Heart interbeat data were obtained
in Physionet from these ECG recordings and these In this equation r is the probability density function.
heart interbeat time series were used in this work. The time series is reversible if and only if A(t)=0. As
The files were divided in one hour-long files to see actual signals are sampled at finite frequencies,
the variability and the efficiency separately in 24 yt is a discrete variable. So the following equation
hours. Healthy cases were taken from the «normal provides an estimator of A(t):
Muñoz-Diosdado A et al. Thermodynamic efficiency of the cardiac cycle and irreversibility in the interbeat interval time series 107
h
0.26 www.medigraphic.org.mx h 0.100
0.095
0.24
0.090
0.22
0.20 0.085
0 2 4 6 8 10 12 14 16 18
0.18 Time (hours)
0 5 10 15 20 25
Time (hours)
Figure 5. Graph of a person with heart failure, the graph
Figure 4. Graph of the efficiency of a healthy person, cal- seems to have as many variations as Figure 4 for a healthy
culated at different hours of the day. person; however, these variations are on a different scale.
108 Revista Mexicana de Ingeniería Biomédica • volumen XXXI • número 2 • Diciembre 2010
spectra were calculated27,28, and the detrended pressure measurements, but do not exactly corre-
fluctuation analysis (DFA method) was applied29 to spond to these patients or these healthy subjects.
the same time series, but it seems to be that these At other hand, the values of variables as S, E and
techniques do not observe irreversibility, because c, should also have variations in the day, but there
they give the same results for series of positive and are not measurements of these variables during
negative changes. 24 hours, there are only reported intervals for the
values of these variables for healthy people or for
Discussion certain kind of patients. For this situation, functions
that generate one random value in the range
Cardiac efficiency calculation shows a variability of values generally accepted were used, each
that in principle might seem too broad, however, it time the efficiency is calculated. However, if the
is not, to do the calculation, there is a variability in randomization is uniform it is possible to obtain
heart rate, this frequency was obtained from the RR huge variation with values that do not even have
heartbeat databases of Physionet, we calculated physical sense (e.g. efficiencies close to zero or
average heart rates per hour for all healthy subjects one). To avoid this problem Gaussian random
and CHF patients, the goal is to show the variability functions were used in the calculation, which give
that have the physiological parameters along the us distribution values at appropriate intervals, but
length of the day even if the person is at rest. If the always more or less close to the average, which
calculated efficiency depends on these variables from a physiological standpoint seems to make
then it is reasonable to expect variable efficiency. much more sense. However, in all cases the sepa-
If for example, all variables are given a constant ration that was shown in Figure 6 is still observed,
value, except the frequency, then obviously ef- i.e. the efficiency values of the healthy are sepa-
ficiency variations reflect the heart rate variations. rated from the patients. Cardiac efficiency is an
On the other hand, it is somewhat difficult to important biomedical research subject with mul-
access actual data showing how is the variability tiple applications, because in pathophysiological
of the other variables involved in the efficiency disease states mechanical efficiency is reduced
calculation, we have time series of 24-hour blood and it has been hypothesized that the increased
energy expenditure relative to work contributes to
progression of the disease 30. For instance, obesity
Efficiency for healthy and CHF persons and insulin resistance cause efficiency reduction31.
0.45 There are a lot of methods to measure mechani-
Mean healthy Healthy cal efficiency of the heart, for instance, in refer-
0.40 ence 30 Knaapen et al. report nine methods, three
invasive and six noninvasive to measure efficiency,
0.35
for healthy persons the reported values ranged
n between 14 to 35%, so the values calculated in
0.30
this work are acceptable in spite of all the ap-
0.25
2.45
0.20 2.40
2.35
2.30
2.25
0.15 2.20
2.15
2.10 y (t)>0
2.05 y (t)<0 CHF
0.10
www.medigraphic.org.mx 2.00
Splnp
5.0 0.9
Healthy
0.8 CHF
4.5 0.7
0.6
Splnp 4.0 0.5
AI 0.4
3.5 0.3
0.2
3.0
0 5 10 15 20 0.1
0.0
t scale factor
-0.1
0 10 20 30 40 50
Figure 8. In this figure we have taken a heartbeat time series Subject
and then we shuffle it, this process cancels the correlations
in the series, now the resulting time series is reversible, there Figure 9. The multiscale asymmetry index for the 54 healthy
is not hysteresis, so A (t ) = 0. subjects and the 44 CHF patients.
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