Abstract

Exercise stress testing is used in the diagnosis of obstructive coronary artery disease (CAD), ischemia. Such diseases show symptoms when the patient is subjected to stress. Exercycle test serves as an alternative to Treadmill test for those patients who have orthopedic, peripheral vascular or neurological issues that hamper the ability to bear their own weight. Electrocardiographic (ECG) recording system is essential for continuous monitoring of heart rhythm and evaluation of ischemic ECG, which changes during exercise and recovery. The functional ECG acquired is analyzed for ST segment alterations. Any deviation in the ST segment detects the presence of cardiac abnormalities such as cardiac ischemia. In this paper, the design for a cheaper and more portable alternative to stress ECG analysis is proposed. The ECG is acquired from the patients body through chest leads while the patient performs rigorous exercise using a cycle. ECG is then sampled and fed to the serial port of the PC. The stress analysis of the ECG is done by using wavelet transform. Wavelet transform is applied for Denoising, Correction of Baseline Wander & Identification of ECG Fiducial Point. The wavelet being used is the Daubechies orthogonal wavelet (D6). It is being used because it is concentrated around low frequencies. D6 encodes 3-polynomials, i.e. constant, linear and quadratic signal components. Decomposition of wavelet up to level 8 is performed. After the identification of Fiducial points, an isoelectric line between P offsets and QRS complex is identified. Subsequently a T wave onset is identified to determine the variation from the isoelectric line. A variation exceeding 1mV is a symptom of CAD. This occurrence is indicated by an alarm raised by the system. Methodology The bipolar ECG signal at 200 sample/s is read via the serial port. The serial port allows asynchronous error free transmission and reception of data to the computer.The received data is divided ito number of ECG cycles and this is passed on for processing.Here ECG is corrected for baseline and dc shift and is de noised.ECG fiducial points nad various timing intervals are determined.Now the ST shift is calculated to determine the presence of ischemia. Denoising When using wavelets to remove noise from a signal requires identifying which component or components containing the noise and then reconstructing the signal without those components. Optimal de noising requires a more subtle approach called threshold. This involves only discarding only portion of details that exceeds certain limits. This would have the effect of cutting back the noise while leaving the details unaffected through most of their durations.Threshold is given by setting each element to some fraction of the vectors peak or average value.

Baseline wander correction The wavelet reduction baseline wandering system has three steps:the first step is DWT signal decomposing, the second is wavelet averaging filter(WAF) and the last step is reconstruction of the original signal by IDWT.The choice of the wavelet function depends on application.Selecting a wavelet function which closely matches the signal to be processed is of at most importance in wavelet application.Daubechies concentrated around low frequencies.The D6 is implemented here.Decomposition up to level 8 is performed. The signal is approximated by omitting the signals details beginning from scale 21 to 2 8.The details are responsible for high frequency and the approximation is responsible for the low frequency noise which should be filtered. This average approximation signal (previous 5 ECG signals) is taken to cancel out the drift present in the signal. The lower details are combined with the averaged signal to reconstruct the corrected signal. ECG Signal Fiducial point detection 1. QRS Complex: Continuous wavelet transforms using first derivative Gaussian Smoothing Function, Wf(2J, T) at scale 2J (for j =1,2,3 4) is used. The detection of the QRS complex is based on the modulus maximum of the wavelet transform. It is defined as any point Wf(2j , T) such that mod(Wf(2J, T))<mod(Wf(2J, T0)) when T belongs to either the left or right neighborhood of T0.This is because modulus maxima and zero crossing s of the wavelet transform correspond to the sharp edges in the signal.The QRS complex produces two modulus maxima with opposite signs of Wf(2J,T), with a zero crossing between them.Therefore, it is determined by applying detection rules (thresholds) to the wavelet transform of the ECG signal. Most of the energy of the QRS complex lies between scales of 2^3 and 2^4, with the largest at 24.The energy decreases if the scale is larger than 2^4.The energy of motion artifacts and baseline wander increases for scales greater than 25.Therefore,we chose to two modulus maxima with opposite signs of the wavelet transform i.e biphasic shape. The modulus maxima that correspond to the R wave are determined by the following steps: Step 1: The modulus maxima at the largest scale 24, that crosses the threshold Th4 are determined (Thj is the threshold for wavelet transform at scale 2j) and their positions (nk4;k =1N) are marked. Step 2: The modulus maxima in the neighborhood of the nk4 at scale 23 is determined and its location is marked as nk3.If several modulus maxima exist, then the largest one is selected. If no modulus maxima exist, then nk4,nk3,nk2 are set to zero.

Step 3: Similarly, the location set of the modulus maxima {nk4,nk3,nk2,nk1; k=0 to N} at remaining scales are determined. The search for the modulus maxima is made first at larger scales (ie 24) and then at finer scales(i.e., 23, 22, 21).This strategy reduces the effect of high frequency noise, which is present more in lower scales, and also there is a smaller number of modulus maxima in larger scales.Following the procedure, appropriate thresholds are applied to modulus maxima at larger scale to detect the modulus maxima corresponding to the QRS complex.Usually a given R wave corresponds to a modulus maxima pair with opposite signs(i.e maxima and a minima) of the wavelet transform. But in some ectopic beats or in the presence of noise, two or more modulus maxima can occur, of which only one is useful. If two negative minima MIN1 and MIN2 are near positive maxima, with A1 and A2 as their absolute values, and L1 and L2 as their respective distances from the maxima, then the rule for judging which minima are extraneous is: To further improve the detection accuracy, the following standard precautions are observed: 1. As no two QRS complexes can occur in less than 200ms, a refractory period is used. 2. If a QRS complex is not found within a certain limit, then a search back is made with lower thresholds(0.5 Thj).During the forward search, the position of modulus maxima pairs, which cross either full thresholds or the lower thresholds and satisfy the conditions for a QRS complex are noted. During the search back, we already have the position of complexes that have been missed by larger thresholds. Therefore, in search back, no extra processing time is required, and the system remains on-line. Onset, Offset and width of QRS complex QRS width is calculated from onset and the offset of the QRS complex. The onset is the beginning of the Q wave (or R wave if the Q wave is missing) and the offset is the ending of the S wave (or R wave if the S wave is missing).Normally, the onset of the QRS complex contains the high frequency components, which are detected at finer scales. The onset is the beginning and the offset is the ending of the first modulus maxima pair. Onset, Offset and width of P and T waves The P and T wave power spectra lie in the range of 0.5Hz to 10Hz, while baseline and motion artifacts have a frequency of 0.5Hz to 7Hz. In order to avoid errors in detecting the onset of these waves due to baseline drift and motion artifact, the 23scale is selected. The P wave generally consists of a modulus maxima pair with opposite signals , and its offset and onset correspond to the onset and offset of this pair. This pair of modulus maxima is searched for within a window prior to the onset of the QRS complex.

The search window starts at 200ms before the onset of the QRS complex.The peak and the width of the P wave are found with the following steps: 1. The modulus maxima is a point where the mod(Wf(23,T) is at a maximum(the slope of mod(Wf(23,T) will be equal to zero). 2. The zero crossing between the modulus maxima pair corresponds to the peak of the P wave. 3. To find the onset, a backward search is made from the point of modulus maxima that is on the left of the zero crossing, to the start of the search window, until a point is reached where mod(Wf(2j,T) becomes equal to or less than 5% of the modulus maximum. This point is marked as the onset of the P wave. Empirically, it has been that this 5% criteria best approximates the onset and offset of the P and the T waves. 4. To find the offset, a forward searh is made from the point of modulus maxima that is on the right of the zero crossing, to the end of the search window, until a point is reached where the mod(mod(Wf(2j ,T)) becomes equal to or less than 5% of the modulus maximum(modulus maximum).This point is marked as the offset of the P wave. The T wave has characteristic similar to the P wave .The detection procedure is the same as that for the P wave, except that the search window follows the QRS complex. The T wave onset is considered to be same as the offset of proceeding QRS complex.

Isoelectric Line The isoelectric line lies between the offset of P wave and the onset of the QRS complex. It can be observed that in the scale 23 this segment is reflected as flat point between offset of P wave and onset of QRS complex. The algorithm searches for a segment which has a minimum (or 0) value of wavelet transform. The search is started from the onset of QRS complex and goes towards to offset of the P wave. Search for this segment in the scale 23 gives more reliable value because at this scale, the noise is suppressed. The onset and the offset of T wave computed by the 0 crossing of the wavelet transform at scale 23.

ST analysis The conventional method for the ST segment analysis are 1)J+x 2)R+x and the 3) windowed approach. Here the J point is defined as the first inflexion point after the S point and in some cases it can be same as the S point. J+x and R+x are the methods commonly used by researchers and in commercial machines. The ST segment is defined as part of ECG located between the points J and J+x ms. The typical measurement is made at J+80ms (use by Philips by graphs).The Marquette machine allows the user to select the ST points at 0,40,60 or 80ms after the J point.

R+x method uses the R peak as the reference point. The presence of noise can severely affect the performance of the above approaches. Additionally, the above formulas are derived from the physiological factors and can be influenced by noise. Also at higher heart rates, ie. in the third or fourth stage of the exercycle test, the value of x must be made smaller to give correct results. In the proposed window approach the ST segment is defined as the segment between the J point and the onset of the T wave. The end point of the ST(T onset) is the inflection point between the J point and the T peak. The algorithm uses the windowed approach to locate this point. The window starts from the first inflection after S point and ends with the point where the slope of the T wave is maximum. The search starts backward from the end of the window and algorithm searches for a point where the value of wavelet transform at scale 2^3 is minimum (or zero).This is taken as the T onset. However, if this inflection point is not present, then the standard empirical formula is used for the detection of T onset. The ST segment is the interval between the J point and the T onset. This approach works well for different morphologies and heart rates.