Cardiopulmonary exercise testing (CPET) is an important risk stratification tool in patients (pts) with heart failure (HF); measures such as peak VO2, VE/VCO2 slope have prognostic value in HF pts to determine whether a patient needs advanced heart therapy or not. In our previous studies, we have shown that wearable chest patch based seismocardiogram (SCG) signals can be used to estimate features from CPET and SCG can be used to differentiate between compensated (C) and decompensated (D) pts with HF following exercise (6 minute walk test).
We hypothesized that changes in SCG features from rest to peak exercise would be less in D pts compared to C pts, as D pts have less cardiovascular reserve to meet elevated cardiac demand during higher exercise intensity.
We conducted CPET using ramp bicycle in 6 C pts (50% had HF, 100% men, ejection fraction [EF] 0.61 ± 0.18) and 5 D pts (100% had HF, 40% men, EF 0.41 ± 0.29). SCG and ECG signals were simultaneously recorded using our custom-built wearable chest patch (Fig. 1a). We have segmented these signals into heart beats and averaged the beats with a moving average window and extracted features (amplitude, frequency and time domain) from the SCG. We combined the SCG features (beat-by-beat) using dimension reduction techniques and compared the changes in SCG features from rest to different exercise intensity levels, by calculating the distance of a distribution for a particular intensity to rest distribution. We have compared the changes in SCG with exercise intensity between C and D pts (classified based on CPET results).
We found that normalized distance matrix (NDM) increased significantly (p<0.05) for C pts (Fig 1b & c) from anaerobic threshold (AT) to peak exercise and decreased significantly (p<0.05) into recovery (peak NDM of 1.91 ± 0.53 for VO2-max of 17.41 ± 5 mL/kg/min). Whereas for D pts it started a bit higher, increased in the first stage of exercise, and then showed little change (p>0.05) between AT and peak exercise and then decreased slightly (p>0.05) into recovery (peak NDM of 1.73 ± 0.16 for VO2-max of 9.83 ± 1.27 mL/kg/min). Difference in NDM from AT to peak exercise was higher (p=0.08) for C pts (0.29 ± 0.14) compared to D pts (0.09 ± 0.13).
Wearable SCG and ECG measurements can be used to assess clinical status by monitoring hemodynamic responses to exercise. This wearable device can potentially be used as a risk stratifying device in pts with HF by tracking hemodynamic parameters in daily activities.