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Register a new userDistance to healthy cardiovascular dynamics from fetal heart rate scale-dependent features in pregnant sheep model of human labor predicts cardiovascular decompensation
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The overarching goal of the present work is to contribute to the understanding of the relations between fetal heart rate (FHR) temporal dynamics and the well-being of the fetus, notably in terms of predicting cardiovascular decompensation (CVD). It makes uses of an established animal model of human labor, where fourteen near-term ovine fetuses subjected to umbilical cord occlusions (UCO) were instrumented to permit regular intermittent measurements of metabolites, pH, and continuous recording of electrocardiogram (ECG) and systemic arterial blood pressure (to identify CVD) during UCO. ECG-derived FHR was digitized at the sampling rate of 1000 Hz and resampled to 4Hz, as used in clinical routine. We focused on four FHR variability features which are tunable to temporal scales of FHR dynamics, robustly computable from FHR sampled at $4$Hz and within short-time sliding windows, hence permitting a time-dependent, or local, analysis of FHR which helps dealing with signal noise. Results show the sensitivity of the proposed features for early detection of CVD, correlation to metabolites and pH, useful for early acidosis detection and the importance of coarse time scales (2.5 to 8 seconds) which are not disturbed by the low FHR sampling rate. Further, we introduce the performance of an individualized self-referencing metric of the distance to healthy state, based on a combination of the four features. We demonstrate that this novel metric, applied to clinically available FHR temporal dynamics alone, accurately predicts the time occurrence of CVD which heralds a clinically significant degradation of the fetal health reserve to tolerate the trial of labor.
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We demonstrate the robust scale-invariance in the probability density function (PDF) of detrended healthy human heart rate increments, which is preserved not only in a quiescent condition, but also in a dynamic state where the mean level of heart rate is dramatically changing. This scale-independent and fractal structure is markedly different from the scale-dependent PDF evolution observed in a turbulent-like, cascade heart rate model. These results strongly support the view that healthy human heart rate is controlled to converge continually to a critical state.
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Hybrid modeling, the combination of first principle and machine learning models, is an emerging research field that gathers more and more attention. Even if hybrid models produce formidable results for academic examples, there are still different technical challenges that hinder the use of hybrid modeling in real-world applications. By presenting NeuralFMUs, the fusion of a FMU, a numerical ODE solver and an ANN, we are paving the way for the use of a variety of first principle models from different modeling tools as parts of hybrid models. This contribution handles the hybrid modeling of a complex, real-world example: Starting with a simplified 1D-fluid model of the human cardiovascular system (arterial side), the aim is to learn neglected physical effects like arterial elasticity from data. We will show that the hybrid modeling process is more comfortable, needs less system knowledge and is therefore less error-prone compared to modeling solely based on first principle. Further, the resulting hybrid model has improved in computation performance, compared to a pure first principle white-box model, while still fulfilling the requirements regarding accuracy of the considered hemodynamic quantities. The use of the presented techniques is explained in a general manner and the considered use-case can serve as example for other modeling and simulation applications in and beyond the medical domain.
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