Dr.

Aniruddha Joshi

Joshi.aniruddha@gmail.com

Outline
Background y Brief introduction to Heart and established ECG signal y Various theories of generation of the pulse y Motivation and Specific goals of the computerized diagnosis Acquisition y Data Acquisition [Nadi Tarangini] y Typical pulse waveform and its nature Analysis y Need and approach of the Analysis y Results, Applications and Future directions Conclusion

Heart
y Blood is circulated throughout our bodies, carrying oxygen and nutrients to

every cell y The heart gets messages from the body that tell it when to pump more or less blood depending on an individual's needs

Hrudaya y Hru : To bring back y Da : To give y Ya (for Yamyati) : To control give and take events

Modulating systems
y Autonomous nervous system : y Sympathetic system enhances

automaticity y Parasympathetic system inhibits it

y Mechanical factors : y Peripheral resistance of

the blood vessels

y Respiratory system : y Periodic changes y The heart rate is increased y Electrical factors : y Ectopic pacemaker

during inspiration and decreased during expiration. and many more

cells y Conduction problems

Electrocardiogram (ECG)
Interpretation

of the electrical activity of the heart over a period of time

To measure the

rate and regularity of heartbeats To know the presence of any damage to the heart And so on

Electrocardiogram (ECG)
Interpretation

of the electrical activity of the heart over a period of time

To measure the

rate and regularity of heartbeats To know the presence of any damage to the heart And so on

What if P-wave is deformed

P-wave is generated

due to various actions at Sinus node, Atrial muscule, A-V node

If P-wave is

deformed, it means there are issues in one of the three parts of the heart (Assuming one-to-one relation)

What if P-wave is deformed

It is possible that the

valve at Sinus node is not functioning properly since the birth or some accident
In such cases,

how to obtain the relative deformation ?

This is the real issue or challenge in the study

!!

!!

Challenges in data: Varying patterns

y Variations in ECG beats : Need of pattern recognition y Which mathematical indices best capture the variations in patterns?

Formation of the pulse signal

y The maintenance of the blood flow and pressure gradients in the arterial circulation is managed from the energy transfer between the heart and arteries y There are many ways to explain the complex behavior of the pulse y These theories have different approaches with their own assumptions and explanations

1. Elastic Property of the Arterial Wall

y Blood is incompressible y When piston is pressed, elastic walls are distended y When the elastic wall comes back, it results in next pressure build up y This means that the pulse is actually a wave set-up in the walls of the

vessels by the systole of the ventricles and it is not only due to the passage of blood along the arteries

2. Forward-backward wave

y At the beginning of each cardiac systole, an individual forward-traveling

wavefront initiates the flow y Although most of the wave energy in this initial compression wave travels distally into smaller arteries y Some is reflected back toward the heart at sites of impedance mismatch (such as bifurcations and the blockages in the arteries)

3. Law of Conservation of Mass

Flow at any given point in a closed system will be equal to the flow at any other point Q = A1 x V1 = A2 x V2 = A3 x V3

y Velocity is inversely proportional to the cross-sectional area y If the cross-section area of an artery changes at one location in the body
y It affects the velocity at that location y It also affects velocities at other locations y And finally, it thus also affects the cross-section areas at other locations

Vedic literature
y Hindu Rishis were y Philosophers y Mathematicians y Scientists y They made fundamental discoveries y Reported in the great Vedic literature y Need of re-validation and re-establishment of many of

these discoveries

Position of the pulse in Vedic science

y Vedic Science y Ayurveda: Science of Life
y Dealt with the ways of staying

healthy y Sub section attached to the AtharvaVeda and y Upaveda of Rigveda and Antharveda (internal part) of Atharvana veda
y Pulse-based diagnosis
Is a DVD of digital information possible ?

Important steps in biomedical data analysis

Understanding the problem domain

Acquisition of the data

Analysis of the data

Useful information

Biomedical activity (Heart, Pulse, Brain, etc)

Tantra - Yantra - Tantra Mantra Tantra - Mantra

y Tantra : Technique

(Ayurvedic pulse-based feeling )

y Yantra : Machine, Instrument, Tool

(Data acquisition device to record and store the pulse signals)

y Tantra : Technique

( Visualization and matching of patterns in the sensed pulse)

y Mantra : Formula

(Pattern recognition algorithms on pulse database to extract hidden patterns)

y Tantra : Technique

(Based on the visualization & matching, decide rules and analysis towards diagnosis)
y Mantra : Formula

(Machine learning algorithms with training the hidden patterns to extract rules)

Ayurvedic methodology of diagnosis

y Ayurveda: Indian Traditional Medicine y Pulse-based methodology y Vaidyas feel the pulse on the wrist (arterial pulse) with concentration and

correlate the pulse variations with various physiological conditions

Tridosha Theory

Motivation
y Importance of the pulse
y What goes on inside the entire body y What should have caused the disorder in the body
y

What might be done to rectify the problem

y Limitations
y Only qualitative information is available y Subjective observation

Motivation
y Importance of the pulse
y What goes on inside the entire body y What should have caused the disorder in the body
y

What might be done to rectify the problem

y Limitations
y Only qualitative information is available y Subjective observation

Need of quantitative base

Motivation
y Different pulse patterns carry different information contents

Pulse

Frequency spectrums

Need of systematic analysis to extract the useful patterns

Specific goals
(To establish the efficacy of the pulse)
Understanding the problem domain acquisition of the data analysis of the data

useful information

y Understand basic knowledge about Ayurveda, Tridosha theory

y Understand the pulse-based methodology

Specific goals
(To establish the efficacy of the pulse)
Understanding the problem domain Acquisition of the data

y Understand basic knowledge about Ayurveda, Tridosha theory

y Understand the pulse-based methodology

y Design a data acquisition system

y Mimic the Ayurvedic methodology of feeling or sensing the

pressure variations on wrist y Clean, accurate data with high details

Specific goals
(To establish the efficacy of the pulse)
Understanding the problem domain Acquisition of the data Analysis of the data

Useful information

y Understand basic knowledge about Ayurveda, Tridosha theory

y Understand the pulse-based methodology

y Design a data acquisition system

y Mimic the Ayurvedic methodology of feeling or sensing the

pressure variations on wrist y Clean, accurate data with high details y Analyze the pulse y Study its characteristic properties y Obtain useful features and patterns y Study the variations in pulse pattern & features for age and disorders

Data acquisition: Nadi Tarangini

Nadi Tarangini: Schematic

Example of Tridosha pulse

Vata Pitta Kapha

y Typical behavior y A strong main peak y 2 distinct secondary peaks

Differential mode of acquisition

Differential input: Difference between successive pressure values

Pulse beat and its subwaves

y P-T-V-D rhythm y These subwaves should be present in a typical pulse cycle with certain

amplitude and duration to indicate proper functioning of the heart and other body organs.

Pulse examples of different behaviors

Healthy

Stomach pain

We observe variations in amplitudes of main & secondary peaks, the rising & falling slopes, systolic & diastolic energies, velocities, and so on

Fever

Blood pressure problem

Healthy

Thin Nadi

Diabetes

Skin disorder

Slipped disk

Pitta disorder

Cough

Kid, Hypertension

Zodiac signs
y Zodiac signs are made up of bright stars, semi-bright stars and also relatively

dull stars y The combined effects of these stars are observed and have been established in Vedic astrology

Zodiac signs : Pulse

y Zodiac signs are made up of bright stars, semi-bright stars and also relatively

dull stars y The combined effects of these stars are observed and have been established in Vedic astrology
y The pulse has a main peak,

secondary peaks and many more details in the waveform y The combined effect of all these details are sensed by the Ayurvedic vaidya

Zodiac signs : Pulse

y Zodiac signs are made up of bright stars, semi-bright stars and also relatively

dull stars y The combined effects of these stars are observed and have been established in Vedic astrology
y Similar to zodiac signs, the pulse

has different gatis (manduka gati, sarp gati, hans gati, etc) y Gatis are hard to sense and are invisible for a common man y Visualization possible through the devices like Nadi Tarangini y We need to study top-to-bottom details of the pulse signals

Other works in analysis

y Heavy contribution in the area of hemodynamics
y To study the circulation parameters: the interaction between the

physical properties of the arterial circulation and the left ventricle y Cardiac output (CO), augmentation index (Aix)
y Preliminary observations in contour analysis, Fourier coefficients, wavelet

coefficients, Lyapunov exponent-based analysis, Lempel-Ziv complexitybased analysis, fuzzy theory y Output: Peak detection, denoising, removing baseline wander, Variations with age & disorder
y Analysis in India:
y Detecting the peaks and other important points using wavelet method

[Abhinav et al 2008] y A survey driven approach (without actually acquiring the pulse) for knowing the dosha [Rajani Joshi 2004]

Peak-to-peak variability in pulse

y Adjacent pulse cycles seem very similar in shape, but they carry slightly different patterns

Peak-to-peak variability in pulse

y The peak-to-peak intervals usually change in a complex and irregular way
y The variations between consecutive beats are important for the

Ayurvedic practitioners, along with the average values for the diagnosis
y The consecutive pulse intervals form the Arterial Pulse Interval (API) time

series y 696, 678, 700, 718, 724

750 700 650 600

arterial pulse intervals (API) series Pulse series

Pseudo periodicity of the pulse

y Redundancy is present between periods due to similar patterns

occurring after each period

y These signals can be better represented in terms of a periodic trend

plus period-to-period fluctuations

y Conventional wavelet model does not take advantage of the

pseudo-periodicity of the signals y We use pitch synchronous wavelet transform

Pitch synchronous wavelet transform

PS representation consists of synchronizing the pulse segments which are alike.

zero-padding approach for obtaining PS representation

Our approach of computing PSWT

y Advantage of our approach y Period normalization automatically y No need of zero-padding

PSWT coefficients
y 4-level wavelet model y Detail coefficients (D1-D4) y Capture variations across the periods y Contain a very small amount of energy y Approximate coefficients (A4) y Capture the overall behavior y Contain most of the energy

PSWT cycle
y All the A4 coefficient series contain the average behavior of pulse y PSWT cycle: 2nd A4 coefficient series
y Essence of the complete pulse (in just one cycle) y Very smooth

y Useful in studying the overall behavior of the pulse

Essence of the pulse

Fourier spectrum: Rate and Frequency

y The fundamental frequency gives the pulse rate y More subtle second order effects are the secondary peaks within each pulse

cycle y They are primarily reflected in the harmonics H2 H5

H2

Healthy
H3 H4 H5

High BP

PRV Measures: FDM

y Frequency-domain measures y Very low frequency (0-0.04Hz): the thermoregulatory activity y Low frequency (0.04-0.15Hz): the vasomotor activity y High frequency (0.15-0.4Hz): the respiratory activity y Peak frequency, Power in above ranges, ratio of LF/HF

Poincare-based nonlinear PRV measures

y Poincar plot is a graphical presentation of the correlation between

consecutive API y Description of the geometry: centroid and axes SD1, SD2

Poincare-based nonlinear PRV measures

y As age increases, its Poincare y For arrhythmic pulse, the

plot shifts towards top-right corner

Poincare plot splits into three regions

Wavelet transform modulus maxima

API series Pulse series

Branching structure of the WTMM skeleton in the (scale,time)

WTMM based multifractal formalism

y WTMM captures the hierarchical organization of the singularities y For a particular singularity, there will be multiple WTMM coefficients at different scales, which capture different strengths of the singularity y Multifractal spectrum:

(D Vs h) characterizing the singularities through the WTMM coefficients

Studying structures: Topological analysis

y Pulse follows the P-T-V-D form in pseudo-periodic fashion y Poincar has stated that the key to understand such dynamical system lay

in identifying its unstable periodic orbits y Differential phase space embedding X(t) ; Y(t) = dX/dt ; Z(t) = dY/dt

Interaction of Two Periods

y Due to pseudo-periodicity, different pulse cycles have different periods and

follow different trajectories in the attractor y They interact with each other in a particular fashion

y Green arrow: Intersection of red flow with blue flow y Black arrow: Intersection of flow with itself

Topological invariants
y The pulse cycles with different periods

follow different trajectories in the attractor y They interact with each other in a particular fashion
y We study the topological invariants of the pulse to observe these

interactions y To reveal the hidden patterns of the nonlinear pulse y To reveal the underlying stretching and squeezing mechanisms
y Topological invariants [Mindlin et al 1992]:
y Linking numbers (LN) y Relative rotation rates (RRR) y Templates

Observations: 50x50 LN matrix

Local Hlder exponents

Time domain parameters (TDP)

TDP have important physiological, pathological and psychological significance TDP have been testified (by doctors) to be important for diagnosis

y X-axis related: t1, t2, t3, w, WP (period) y Y-axis related: h1, h2, h3, h4, h5

Challenges in computing TDP

Typical behavior

Challenges in computing TDP

Typical behavior

Vibrating pulse cycles

Pulse cycles with missing subwaves

Hybrid-SVM: Data set

y Feature set: Time-domain parameters (TDP) computed using our novel

PSWT-DTW approach
y Imbalanced pulse database for classification
y 1264 pulse cycles of normal (N) y 437 pulse cycles of muscular pain (MP) y 397 pulse cycles of high BP (HBP) y 426 pulse cycles of diabetes (D) y 401 pulse cycles of slipped disk (SD) y 448 pulse cycles of fits (F) y 427 pulse cycles of skin disorder (S) y 421 pulse cycles of cough (C) y 451 pulse cycles of fever (FV) y 315 pulse cycles of other disorders (O)

y Approximately 66% randomly selected data of each class constituted the

training set, and the remaining constituted the testing set

Hybrid-SVM: Classification Results

Conventional SVM (Hybrid-SVM)

: Improvement in the classification of particular class : Reduction in false negatives

Our Contributions

Applications
y Nadi Tarangini will be useful in future
y As a computer-aided diagnostic tool to offer second opinion y By recording pulse at various body locations and coupling with ECG to

study the hemodynamics of the human body y For 24-hour monitoring purpose, where all the important properties will be displayed
y Our pulse database will be available at www.naditarangini.com, from

where researchers can download, understand and analyze the pulse further

To summarize :
y Limitations of traditional approach
y Only qualitative information is available y Subjective observation

y We have successfully
y Designed a device to acquire and store the pulse signals y Cleaned the signals y Computed the peaks of the pulse signals y Studied the pulse rate variability (PRV) of the pulse y Applied various pattern recognition algorithms to extract visible and hidden

patterns y Observed (preliminary) successful classification results for various agegroups and disorders y Established the efficacy of the pulse-based methodology

To summarize :
y Vaidyas feel the pulse on the wrist (arterial pulse) to correlate the pressure

variations with various physiological conditions to determine:

y What goes on inside the entire body y What should have caused the disorder in the body y What might be done to rectify the problem

y Modern medical sciences are also able to understand: y What goes on inside the entire body y What should have caused the disorder in the body y What might be done to rectify the problem y Many tests and biopsies are required y Lengthy and costly processes y Arterial pulse-based computerized diagnosis (when successfully established)

will be an effective alternative

To summarize :
Still a long way to go. We need :
y Huge well-sampled pulse database with large number of pulse signals of each

disorder
y In the study, we have primarily considered age and gender. We also need to record

and consider other dimensions including profession, stress index, habits, food, sleep, posture, atmospheric details, etc.
y A systematic study to bring different theories of pulse-reading and pulse-based

diagnosis of different Ayurvedic practitioners

y Till now, we were talking about only the physiological conditions through the

pulse. In the traditional literature, it is also said that the pulse reflects brain/mind/soul of the person. Is this establishment possible ?
y Our work is just the beginning !!

Acknowledgements :
y Guide : Dr. B. D. Kulkarni (NCL) y Guide : Prof. Sharat Chandran (IIT Bombay) y Colleagues y Domain expert : Dr. Ashok Bhat and students y Domain expert : Dr. Jategaonkar and students y Patients

Thank you
J os hi . aniruddha@ gmail.com