Beruflich Dokumente
Kultur Dokumente
Llenguatges i Sistemes Informa`tics, Uni6ersitat Polite`cnica de Catalunya, Mo`dul C6 Campus Nord, Jordi Girona Salgado, 1 -3,
Barcelona 08034, Spain
b
Department of Electrical and Computer Engineering, The Uni6ersity of Arizona, Tucson, AZ 85721, USA
c
Institut de Ciberne`tica, Uni6ersitat Polite`cnica de Catalunya, Diagonal 647, 2na. planta, Barcelona 08028, Spain
Received 15 February 1996; received in revised form 5 May 1997; accepted 4 September 1997
Abstract
The cardiovascular system is composed of the hemodynamical system and the central nervous system (CNS)
control. Whereas the structure and functioning of the hemodynamical system are well known and a number of
quantitative models have already been developed that capture the behavior of the hemodynamical system fairly
accurately, the CNS control is, at present, still not completely understood and no good deductive models exist that
are able to describe the CNS control from physical and physiological principles. The use of qualitative methodologies
may offer an interesting alternative to quantitative modeling approaches for inductively capturing the behavior of the
CNS control. In this paper, a qualitative model of the CNS control of the cardiovascular system is developed by
means of the fuzzy inductive reasoning (FIR) methodology. FIR is a fairly new modeling technique that is based on
the general system problem solving (GSPS) methodology developed by G.J. Klir (Architecture of Systems Problem
Solving, Plenum Press, New York, 1985). Previous investigations have demonstrated the applicability of this approach
to modeling and simulating systems, the structure of which is partially or totally unknown. In this paper, five separate
controller models for different control actuations are described that have been identified independently using the FIR
methodology. Then the loop between the hemodynamical system, modeled by means of differential equations, and the
CNS control, modeled in terms of five FIR models, is closed, in order to study the behavior of the cardiovascular
system as a whole. The model described in this paper has been validated for a single patient only. 1998 Elsevier
Science Ireland Ltd. All rights reserved.
Keywords: Cardiovascular system; Inductive reasoning; Fuzzy systems; Quantitative/qualitative modeling
128
Fig. 1. Simplified diagram of the cardiovascular system model, composed of the hemodynamic system and the CNS control.
1. Introduction
In this paper, a model of the human cardiovascular system is described. It consists of a quantitative highly non-linear ordinary differential
equation-based detailed model of the hemodynamical system, described earlier in [1], and a
qualitative inductive reasoning-based model of the
central nervous system (CNS) control, developed
in this paper. A simplified diagram of the cardiovascular system is shown in Fig. 1.
As the hemodynamic model is not central to the
research effort discussed in this paper, it is only
briefly being touched upon in Appendix A to this
paper. For more detail, the reader is referred to
[1,2].
trol mechanisms that pertain to the central nervous system control operate in a significant way,
causing hemodynamical changes in a short time
span.
The four phases that comprise the Valsalva
maneuver are usually referred to as phases I, II,
III, and IV. Phase I occurs just after the onset of
the maneuver, phase II takes place just before the
effort is concluded, phase III corresponds to the
ending of the maneuver, and finally, phase IV
occurs shortly after the maneuver has been completed. The model validation is done by comparing the four simulated output variables with the
same quantities available from measurements
prior to the onset of the Valsalva maneuver (the
Pre-Valsalva phase), as well as during phases II
and IV of the Valsalva maneuver.
The qualitative modeling methodology used in
the research described in this paper is the fuzzy
inductive reasoning (FIR) approach that had first
been reported in [3]. Another biomedical application of this modeling methodology for the purpose of modeling the control of an anaesthetic
agent (isoflurane) was previously reported in [4].
FIR proved to be excellently suited for modeling
observed input/output behavior of systems for
which no quantitative model is available. FIR
models are synthesized rather than trained, which
drastically speeds up the modeling phase in comparison with other inductive modeling techniques,
such as neural networks (NN) or NARMAX
(Nonlinear AutoRegressive Moving Average with
eXternal inputs). The models obtained by the FIR
methodology are characterized by a high quality
of their predictions. In addition, the methodology
offers an important self-assessment capability that
prevents it from overgeneralizing, i.e. from making predictions that are not justified on the basis
of the available facts.
In this paper, the FIR models will be compared
with NARMAX models obtained for the same
five subsystems, and the two modeling methodologies will be compared with each other.
The models described in this paper have been
validated for a single patient only. No attempts
have been made to achieve a generalization that
would allow the models to be used for other
patients as well. This facet of the research effort
129
130
plete deductive CNS control descriptions currently available. The NARMAX model is an
inductive model that shares many of the advantages and shortcomings of NN models. Just like
the NN models, the NARMAX model is basically
a quantitative model with slow training capabilities but easy adaptation possibilities. Neither NN
nor NARMAX models have any inbuilt self-validation capabilities. They will predict output values even when presented with input stimuli for
which they have not been trained.
The signals obtained from the simulation of the
CNS control modeled with differential equations
were used by Vallverdu as initial data for the
identification of NARMAX models for a set of
different patients. These NARMAX models share
the same structure for each of the identified patients, but are characterized by different parameter values. The same signals were also used as
initial data for the identification of the five FIR
models for a single patient.
The CNS control model is composed of five
separate controllers: the heart rate controller
(HRC), the peripheric resistance controller (PRC),
the myocardiac contractility controller (MCC),
the venous tone controller (VTC), and the coronary resistance controller (CRC). All five controller models are single-input/single-output
(SISO) models driven by the same input variable,
namely the carotid sinus pressure as shown in Fig.
1. However, the carotid sinus pressure was not
one of the measured variables. It is a variable that
has been extracted from the differential equation
model describing the hemodynamics of the cardiovascular system.
The five output variables of the controller models are not even amenable to a physiological interpretation, except for the HRC variable, which is
the inverse heart rate, measured in seconds between beats.
Why were these variables chosen as the interface points between the quantitative and qualitative parts of the model? Would it not have been
more meaningful to rely on measured quantities
as interface variables? The answer to the last
question must clearly be yes! It would have made
more sense to proceed in this way. However, by
the time this research started, measurements had
already been made, and the structure of the overall model with its decomposition into a hemodynamical and a CNS subsystem including the
interface variables as shown in Fig. 1 had already
been determined. Under those circumstances, it
was deemed more reasonable to continue with the
previously established model structure, because
this approach allowed us to inherit the hemodynamics model without need for a further modification, made new measurements unnecessary, and
furthermore enabled us to compare our results
with those obtained previously.
Clearly, the drawback of this solution is the
fact that the qualitative models must rely on the
previously made differential equation model, and
therefore, it cannot be expected that the FIR
models will perform better than the differential
equation models on which they are based. However, it is important to notice that this drawback
is not a deficiency of the proposed methodology
itself, only one of the adopted model structure as
it refers to the unmeasured and even non-physical
character of the interface variables between the
quantitative and qualitative parts of the overall
model.
It is always a virtue to work with the simplest
models possible that explain the available data in
order to make potentially necessary patient-specific adjustments to the models as quick and
painless as possible. It serves no purpose whatsoever to carry in the models highly sophisticated
parameters that are conceptually satisfying, the
values of which are, however, impossible to determine either through direct measurements or
through indirect parameter identification techniques. The NARMAX models are extremely simple in their internal structure, and therefore satisfy
the requirement for simple models. The FIR models are less simple, but they are non-parametric
anyway, and setting up a new FIR model can be
done easily and quickly. Both types of inductive
models are much more manageable than the differential equation model, they were derived from.
The input and output signals of the CNS control, shown in Figs. 2 and 3, have been recorded
with a sampling rate of 0.12 s from simulations of
the purely differential equation model. The model
had been tuned to represent a specific patient
131
suffering from at least 70% coronary arterial obstruction, by making the four different physiological variables: right auricular pressure, aortic
pressure, coronary blood flow, and heart rate of
the simulation model agree with the measurement
data taken from the patient.
In the modeling process, the normalized mean
square error (in percentage) between the simulated output, y (t), and the system output, y(t), is
used to determine the validity of each of the
models. The error equation is given in Eq. (1).
MSE=
E[(y(t) y (t))2]
100%
yvar
(1)
(2)
132
Fig. 2. Carotid sinus pressure, heart rate, and peripheric resistance control signals used to obtain inductive NARMAX and FIR
models.
133
Fig. 3. Myocardiac contractility, venous tone, and coronary resistance control signals used to obtain inductive NARMAX and FIR
models.
134
Fig. 4. Schematic representation of the two primary engines of the FIR methodology: qualitative modeling and qualitative
simulation, as well as of the two interface engines: fuzzification and defuzzification.
3.1. Fuzzification
The fuzzification engine converts quantitative
values into qualitative triples. The first element of
the triple is the class value, the second element is
the fuzzy membership value, and the third element is the side value. The class value represents
a coarse discretization of the original real-valued
variable. The fuzzy membership value denotes the
level of confidence expressed in the class value
chosen to represent a particular quantitative
value. Finally, the side value indicates whether the
quantitative value is to the left or to the right of
the peak value of the associated membership function. The side value, which is a specialty of the
FIR technique since it is not commonly used in
fuzzy logic, is responsible for preserving, in the
qualitative triple, the complete knowledge that
had been contained in the original quantitative
value. Fig. 5 illustrates the process of fuzzification
by means of an example. A temperature of 23C
would hence be fuzzified into the class normal
with a side value of right and a fuzzy membership value of 0.89.
Most fuzzy inferencing approaches preserve the
total knowledge by associating with each quantitative data value multiple fuzzy rules consisting of
135
u1
0
0
4
u2
0
2
0
y1
0
3
+1
y2
0
0
0
y3
1
0
0
(4)
136
Fig. 6. Process of flattening dynamic relationships into pseudo-static relationships using a mask.
has the same number of columns as the qualitative behavior to which it should be applied, and it
has a certain number of rows, the depth of the
mask. The mask can be used to flatten dynamic
relationships into pseudo-static relationships.
This process is illustrated in Fig. 6. The left side
of Fig. 6 shows an excerpt of the class value
matrix, one of the three matrices belonging to the
qualitative data model. It shows the numerical
rather than the symbolic class values. In the example shown in Fig. 6, the first and second variables, u1 and u2, were discretized into two classes,
whereas the remaining variables, y1, y2, and y3
have been discretized into three classes each. The
dashed box symbolizes the mask that is shifted
downwards along the class value matrix. The
round shaded holes in the mask denote the
positions of the m-inputs, whereas the square
shaded hole indicates the position of the m-output. The class values are read out from the class
value matrix through the holes of the mask, and
are placed next to each other in the input/output
matrix that is shown on the right side of Fig. 6.
Here, each row represents one position of the
mask along the class value matrix. It is lined up
u1
1
1
1
u2
1
1
1
y1
1
1
+1
y2
1
1
0
y3
1
1
0
(5)
(6)
137
(7)
138
Or =
5 n5 +4 n4 +3 n3 +2 n2 +n1
5 nleg
(9)
(10)
(11)
(12)
where the index j denotes the jth previous observation of the same input state. Also the posij
values are stored in a vector, posj. Then, the L2
norms of the difference between the pos vector of
the new input state and the posj vectors of all
previous recordings of the same input state are
computed:
disj =
'
% (posi posij )2
(13)
i=1
(14)
sd = % dj
(15)
j=1
dj
sd
(16)
wabsj =
1.0
drelj
(17)
sw = % wabsj
(18)
j=1
wabsj
sw
(19)
(20)
j=1
3.4. Defuzzification
The defuzzification engine of the FIR methodology is responsible for converting each qualitative predicted output triple back to a quantitative
output value. It is the inverse operation of the
previously described fuzzification engine. Since
the qualitative triples retain complete knowledge
of the quantitative variables they represent, the
defuzzification operation is unambiguous.
In a mixed quantitative and qualitative simulation, the fuzzification and defuzzification modules
play the roles of interface points between the
quantitative and qualitative submodels.
For a deeper and more detailed insight into the
FIR methodology, the reader is referred to [18
21].
139
CSP HRC
0
0
1
2
3
+1
(21)
140
Fig. 7. Heart rate control: FIR worst data set forecast and NARMAX forecast for the same data set.
141
Table 1
MSE errors obtained for the six validation data sets using FIR to predict the HR, PR, MC, VT and CR control variables
Data
Data
Data
Data
Data
Data
set
set
set
set
set
set
1
2
3
4
5
6
Average Error
HRC (%)
PRC (%)
MCC (%)
VTC (%)
CRC (%)
2.86
1.43
1.10
2.61
0.09
0.12
1.06
0.03
2.71
0.07
4.88
0.17
2.22
0.08
0.16
0.14
5.69
0.20
1.77
0.05
4.34
0.55
1.86
0.23
0.02
0.04
0.02
0.48
0.01
0.00
1.37
1.49
1.41
1.47
0.09
(23)
142
Fig. 8. Peripheric resistance control: FIR worst data set forecast and NARMAX forecast for the same data set.
(24)
MCC(t)
= 0.0177+ 0.9897MCC(t 1)
6.5093 10 7CSP(t 1)CSP(t 7)
(25)
(26)
143
Fig. 9. Myocardiac contractility control: FIR worst data set forecast and NARMAX forecast for the same data set.
CRC(t)
= 0.02154.6999 10 5CSP(t 10)
+ 1.0015CRC(t 1)
9.4519 10 7CSP(t 6)CSP(t 8)
+3.0283 10 7CSP(t 10)CSP(t 10)
1.0381 10 4CSP(t 10)CRC(t 1)
(27)
144
Fig. 10. Venous tone control: FIR worst data set forecast and NARMAX forecast for the same data set.
145
Fig. 11. Coronary resistance control: FIR worst data set forecast and NARMAX forecast for the same data set.
The differential equation model of the hemodynamical system was implemented using the advanced continuous simulation language (ACSL)
[22], a convenience software tool for the description of ordinary differential equation-based statespace models, whereas the qualitative central
nervous system control was realized using SAPSII [1821]). ACSL was chosen as the implementation language for the hemodynamical system
primarily because an interface between ACSL and
SAPS-II had already been developed [3]. A simplified scheme of the simulation structure is
shown in Fig. 12.
The hemodynamical system, modeled and simulated in a strictly quantitative fashion, is implemented in full within ACSL. Its differential
equations are implemented as a continuous process within ACSL to be integrated across time
using one of the standard integration algorithms
offered by ACSL. The CNS control, on the other
hand, is implemented inside the ACSL program
as a discrete process to be executed once every
0.24 s.
The simulation process operates in the following way. The hemodynamical system generates a
continuous-time trajectory representing the
carotid sinus pressure. This variable is sampled by
146
Table 2
MSE errors obtained for the six validation data sets using NARMAX to predict the HR, PR, MC, VT and CR control variables
Data
Data
Data
Data
Data
Data
set
set
set
set
set
set
1
2
3
4
5
6
Average Error
HRC (%)
PRC (%)
MCC (%)
VTC (%)
CRC (%)
10.77
7.62
7.08
11.64
13.07
8.60
20.47
8.62
9.20
38.25
3.88
8.91
20.19
7.52
8.18
51.52
6.07
9.77
23.67
8.84
9.15
46.90
3.97
8.81
42.09
21.02
19.07
44.08
43.03
20.87
9.80
14.89
17.21
16.89
31.69
147
Table 3
Comparison of measurment data of the cardiovascular closed-loop system with simulation results obtained by using the FIR,
NARMAX and differential equation CNS control models
Cathet.
Diff. equal
FIR
NARMAX
PADM
Pre-V
II
IV
4
38
5
4
38
5
4
38
5
4
38
5
PAM
Pre-V
II
IV
107
99
119
111
100
118
110
100
117
108
99
117
FCM
Pre-V
II
IV
123
106
118
119
105
125
118
105
125
128
102
118
HRM
Pre-V
II
IV
77
82
70
73
79
74
71
78
73
76
77
70
148
Fig. 12. Schematic showing the structure of the program used to simulate the cardiovascular system.
149
Fig. 13. FIR estimation of the confidence in its ability to forecast the myocardiac contractility controller model.
neighbors that were computed in order to estimate the membership function value of the new
output, Eq. (20). The measure used in FIR to
evaluate the confidence in a prediction made is a
proximity measure based on the proximity of the
input states of the five nearest neighbors to the
new input state.
An average distance to the five nearest neighbors can be computed as:
5
dconf = % vrelj dj
(28)
j=1
'
% (ncli 1)2
(29)
i=1
dconf
dconfmax
(30)
conf is a quality measure, i.e. a real-valued number in the range of (0.0 1.0).
The knowledge provided by the confidence estimator can be further exploited. It is possible to
make parallel predictions using two different
masks, e.g. the optimal mask and one or two
suboptimal masks of high quality. Each prediction will be accompanied by a measure of confidence. It would make sense to choose, at each
point in time, as the final output of the prediction
algorithm, the one prediction that is accompanied
by the highest confidence measure. Thereby, it
should be possible to eliminate the poor forecasting segments almost entirely. However, this has
not been tried yet.
8. Conclusions
In this paper, a portion of the human CNS
control has been modeled using inductive modeling techniques, namely the portion that is responsible for the functioning of the heart, and, more
generally, the blood transport through the body.
Five controller models, for a single patient,
describing different control actions related to cardiovascular control have been identified separately using the NARMAX quantitative inductive
modeling technique and the FIR qualitative inductive modeling approach (Table 4).
150
NARMAXa (%)
FIR (%)
Heart rate
Peripheric res.
Myocardiac cont.
Venous tone
Coronary res.
9.80
14.89
17.21
16.89
31.69
1.37
1.49
1.41
1.47
0.09
of polynomial complexity have recently been implemented and experimented with as described in
[15,16]. Using these new search strategies, it has
become quite feasible to apply FIR to modeling
problems involving many input variables and a
fairly large mask depth.
Appendix A. Differential equations of the
hemodynamical and the central nervous system
models
In this appendix the differential equations of
the hemodynamical model and the differential
equations of the CNS control model are described.
A.1. The hemodynamical model
The blood flow through the complex network
of vessels in the circulatory system has been described using 15 compartments distributed in the
heart, thorax and abdomen. Each compartment is
an elastic reservoir with lumped hydrodynamic
parameters representing the properties of blood
vessel collection. In order to simulate the Valsalva
maneuver, intrathoracic and intraabdominal pressures are added to the pressure of the arterial and
venous compartments situated in the thorax and
abdomen, respectively.
The heart, composed of four chambers (right
and left atrium, and right and left ventricle), is
modeled as a set of four unidirectional pumps.
The duration of the systole and diastole of each
chamber are described by the following equations:
151
(34)
sin(pt i /TAS)
0,
05 t i B TAS
T AS 5 ti B TTOT
(35)
0
Y(t)= sin[p(t i TAV)/TVS],
0
05t i 5 TAV
T AV B ti B (TAV + TVS)
(T AV + TVS)5 ti B TTOT
(36)
(37)
(38)
VRA(t)=
&
(39)
(31)
(32)
(33)
(40)
(41)
VLV(t)=
&
(42)
where the suffixes LA and LV denote left atrium
and left ventricle, respectively. Similar equations
are developed for the right ventricle describing the
flow through the pulmonary valve.
152
&
(43)
(44)
Fout(t)=
F aux(t),
a F aux(t),
F aux(t)] 0
F aux(t)B 0
(48)
(49)
(50)
P(t) = [V(t)Vu]/C
(46)
C N,
V(t)]V u
20 C N, V(t)B V u
(47)
FPAPV(t)
=
f1(t) =
dP CS(t)/dt,
0,
dP CS(t)/dt ] 0
dP CS(t)/dt B 0
(52)
df2(t) f1(t)f2(t)
=
dt
t2
(53)
df3(t) PCS(t)f3(t)
=
dt
t1
(54)
(55)
BCS(t)=
f 4(t), f 4(t) ] 0
0,
f 4(t) B 0
dP AA(t)/dt, dP AA(t)/dt ] 0
0,
dP AA(t)/dt B 0
(56)
f5(t) =
153
u1(t)=
t3(t)=
!
!
(63)
l 7,
l 8,
(64)
du 1(t)/dt ] 0
du 1(t)/dt B 0
l 11, B(t)]l 11
B(t), B(t)Bl 11
(65)
(57)
u3(t)=
df6(t) f5(t)f6(t)
=
dt
t2
(58)
(67)
(59)
(68)
(60)
f (t), f 8(t) ] 0
BAA(t)= 8
0,
f 8(t) B 0
(69)
(61)
2.0,
u 6(t)] 2.0
TTOT(t)= u 6(t), 0.35 u 6(t)B 2.0
0.3,
u 6(t)B 0.3
(70)
(62)
(66)
l 12, B(t)] l 14
l 13, B(t)Bl 14
(71)
154
dS2(t) S1(t)S2(t)
=
dt
t6
(72)
dS3(t) S1(t)S3(t)
=
dt
t7
(73)
(74)
The dynamics of the peripheral resistance controller feature an on-off element that produces a
bang-bang action, S1(t). This response is divided
into two parallel paths, S2(t), and S3(t), where the
dynamics are approximated by a first-order system. The linear combination of these two paths
represents a continuously varying estimate of the
peripheral resistance controller, Q1(t). This control modifies all peripheral blood flow in the
following manner:
Fout(t)= DP(t)/(R Q1)
(75)
l 16,
l 17,
B(t)] l 18
B(t)Bl 18
dQ2(t) r1(t)Q2(t)
=
dt
t8
(76)
(77)
l 19, B(t)]l 21
l 20, B(t)B l 21
(78)
dh2(t) h1(t)h2(t)
=
dt
t9
(79)
(80)
(81)
(82)
(83)
(84)
(85)
l 28,
B(t)]l 27
g1(t)= l 29, l 25 5 B(t)B l27
l 30,
B(t)Bl 25
(86)
l 28,
B(t)]l 26
g1(t)= l 29, l 24 5 B(t)B l26
l 30,
B(t)Bl 24
(87)
l 28, B(t)] l 27
l 30, B(t)Bl 27
(88)
g1(t) =
l 28, B(t)]l 24
l 30, B(t)B l 24
(89)
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