Multiscale Recurrence Quantification Analysis of Spatial Cardiac Vectorcardiogram Signals , Member, IEEE

IEEE TRANSACTIONS ON BIOMEDICAL ENGINEERING, VOL. 58, NO. 2, FEBRUARY 2011
339
Multiscale Recurrence Quantification Analysis of
Spatial Cardiac Vectorcardiogram Signals
Hui Yang, Member, IEEE
Abstract—Myocardial infarction (MI), also known as a heart
attack, is a leading cause of mortality in the world. Spatial vectorcardiogram (VCG) signals are recorded on the body surface
to monitor the underlying cardiac electrical activities in three orthogonal directions of the body, namely, frontal, transverse, and
sagittal planes. The 3-D VCG vector loops provide a new way to
study the cardiac dynamical behaviors, as opposed to the conventional time-delay reconstructed phase space from a single ECG
trace. However, few, if any, previous approaches studied the relationships between cardiac disorders and recurrence patterns in
VCG signals. This paper presents the recurrence quantification
analysis (RQA) of VCG signals in multiple wavelet scales for the
identification of cardiac disorders. The linear classification models
using multiscale RQA features were shown to detect MI with an average sensitivity of 96.5% and an average specificity of 75% in the
randomized classification experiments of PhysioNet PhysikalischTechnische Bundesanstalt database, which is comparable to the
performance of human experts. This study is strongly indicative
of potential automated MI classification algorithms for diagnostic
and therapeutic purposes.
Index Terms—Myocardial infarction (MI), recurrence quantification analysis (RQA), vectorcardiogram (VCG), wavelet.
I. INTRODUCTION
YOCARDIAL infarction (MI), also known as a heart attack, is the single leading cause of mortality in America.
Typically, MIs are caused by the insufficient blood supply to the
myocardium commonly due to the coronary artery occlusion and
can take place in different portions of the heart, i.e., anterior,
inferior, posterior, inferior–lateral, anterior–septal, posterior–
lateral. The triad of MI is ischemia, injury, and necrosis [1].
Ischemia is due to reduced blood supply; injury indicates acuteness of infarct; and infarction is the symptom of myocardium
necrosis [1]. During MI, the damaged heart muscle tissues either
conduct electrical impulses more slowly or produce an electrical
void, which consequently causes the directional variations in the
heart electrical function (i.e., depolarization and repolarization).
The ECG signals have been widely used as a powerful tool to
assist the detection of abnormal cardiac electrical activities for
more than 100 years [2]. The sequential P, QRS, and T waves
in the ECG signals were denoted by Einthoven to represent the
M
Manuscript received October 25, 2009; revised January 20, 2010, and June
3, 2010; accepted July 27, 2010. Date of publication August 5, 2010; date of
current version January 21, 2011.
The author is with the Department of Industrial and Management Systems
Engineering, University of South Florida, Tampa, FL 33620 USA (e-mail:
[email protected]).
Color versions of one or more of the figures in this paper are available online
at http://ieeexplore.ieee.org.
Digital Object Identifier 10.1109/TBME.2010.2063704
Fig. 1. Different views of human torso showing various coordinate axes and
the positions of the electrodes for acquiring VCG signals [2].
sequences of depolarization and repolarization activities in atria
and ventricles. With technological advancement, researchers
have been using sophisticated methods in time, frequency, or
phase space domains to explore the hidden information from
ECG signals for improving the diagnostics of cardiovascular
diseases [3]. The standard clinical method of MI diagnostic is
an analysis of aberrated patterns in 12-lead ECG signals, for
example, the waveform variations of P, QRS, and T waves.
However, the waveform patterns often vary significantly due
to the locations of ECG electrodes. It may also be noted that
one lead ECG signals can only capture one perspective view of
the 3-D heart electrical activities. Thus, multiple lead ECG systems, e.g., 12-lead ECG and 3-lead vectorcardiogram (VCG),
are designed for a multidirectional view of the cardiac electrical activity. VCG signals monitor the cardiac electrical activity
along three orthogonal X, Y , Z planes of the body, namely,
frontal, transverse, and sagittal. As shown in Fig. 1, the VCG
vector loops contain 3-D recurring, near-periodic patterns of
heart dynamics [4]. Each heart cycle consists of three loops corresponding to P, QRS, and T wave activities. Dower et al. [5]–[7]
showed that a 3-lead VCG can be linearly transformed to a 12lead ECG without a significant loss of clinically useful information pertaining to the heart dynamics. Therefore, the 3-lead
VCG surmounts not only the information loss in one lead ECG
but also the redundant information in 12-lead ECG [8].
Due to the infarction locations and myocardium damage levels, MI shows a variety of changes in cardiac electrical activities.
As aforementioned, MI can occur in various portions of heart
such as anterior, inferior, posterior, etc. There are also three
stages of myocardium damage, namely, ischemia, injury, and
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TABLE I
DIAGNOSTIC PERFORMANCES OF COMPUTER PROGRAMS FOR THE
IDENTIFICATION OF MI [15]
Fig. 2.
necrosis. The necrotic area can be surrounded by injured tissues,
which in turn can be surrounded by ischemic regions. Such diverse conditions generate various complex ECG signal patterns
in the presence of noise, which pose significant challenges to
the identification of MI. Most of previous computer programs
computed time-domain features from 12-lead ECG signals, e.g.,
variations in the ST wave segments, depth of Q-wave, ST elevation, inversion of T-wave, and other event intervals for the
identification of MI. It may also be noted that some of the previous MI diagnostic approaches considered statistical analysis of
QRS, T waves’ morphology, angles and magnitudes [9]–[14] in
the ECG or VCG signals. But few of these traditional automated
MI diagnostic algorithms were shown to achieve performances
exceeding 90% in both specificity and sensitivity. As shown in
Table I, these algorithms have considerably low overall classification accuracy. Cardiologists were shown to be the best performance group in identifying MI with a sensitivity of 80.3%
and a specificity of 97.1%.
Few, if any, of the previous approaches considered recurrence
dynamics underlying the three-lead VCG signals and used recurrence quantification analysis (RQA) for the identification
of cardiac disorders. Additionally, most of the previous RQA
methods only considered the time-delay reconstructed phase
space from one-lead ECG signals for the investigation of cardiovascular dynamics [16], [17]. The multiscale RQA analysis
of more intuitive three-lead VCG signals has not been reported
in the literature. In this paper, we report the variations of the
multiscale recurrence dynamics in the measured VCG loops between healthy control (HC) versus MI subjects. RQA was found
to be a useful means to detect cardiac disorders, such as atrial
fibrillation [16].
The objective of this study is to explore the underlying hidden
recurrence patterns buried in the massive physiological time series and develop a novel classification methodology to identify
cardiovascular disorders. The remainder of this paper is organized as follows: Section II introduces the research methodology of multiscale RQA analysis, feature selection, and classification; the ECG data description and experimental design
are presented in Section III, Section IV contains the implementation results for the PhysioNet Physikalisch-Technische Bundesanstalt (PTB) database, Section V includes discussion and
conclusions arising out of this investigation.
Procedure of the research methodology used.
II. RESEARCH METHODOLOGY
It is commonly known that human heart is essentially an
autonomous electromechanical blood pump that provides indispensable supplies for maintaining vital living organisms and
disposes waste materials. Such autonomous control mechanisms
generate noteworthy dynamical behaviors and structure patterns
in the ECG signals with the presence of high-level nonlinearity,
nonstationarity, and noise. The inherent complex characteristics from living organisms pose significant challenges to the
conventional cardiac disorder identification approaches based
on temporal-domain inspections or classical statistical methods
with linear and stationary assumptions [18].
Recent advancements in nonlinear dynamics for exploring the
hidden patterns and relationships in complex physical systems
provides a great opportunity to better understand cardiovascular
functions from the new perspectives, e.g., wavelet domain and
phase-space domain. Wavelet representation can provide an effective time-frequency analysis for nonstationary signals with
both steady and transient parts. RQA was shown to be a powerful tool for the dynamical system analysis, which can provide
the quantitative characterization of complexity and randomness
for the nonlinear and nonstationary signals such as physiological time series [17]. The combined multiscale RQA analysis
can lead to effective features, which are more sensitive to the
underlying pathological variations and less sensitive to noise or
other extraneous variations.
As shown in Fig. 2, the acquired VCG signals are first decomposed into multiple wavelet filter banks, using the discrete
wavelet transformation (DWT). Then cardiac recurrence dynamics are quantified for the VCG signal components within
each wavelet scale. Thus, RQA statistics are not only computed from the original global scale but also multiple wavelet
scales, which can thus more effectively capture the local scaledependent transient and intermittent behaviors. Finally, the extracted large group of multiscale RQA features is further reduced into a small subset to avoid the problem of “curse of
dimensionality” in classification models.
A. Wavelet Signal Representation
Wavelet is an effective time-frequency decomposition tool,
which elucidates the steady and transient components of the
YANG: MULTISCALE RECURRENCE ANALYSIS OF SPATIAL CARDIAC VCG SIGNALS
nonstationary signals into various frequency bands while preserving the time information. The time-varying, transients, and
nonstationary characteristics in the nature of physiological signals have fueled increasing interests in applying wavelet transformation for the analysis of ECG signals. Such analysis includes characteristic points (QRST) detection [19]–[21], local
abnormality analysis [9], noise cancellation [22], cardiac arrhythmias [23], compact representation [24], and ECG data
compression [25], [26]. But few, if any, of previous approaches
employed wavelet transformation toward the nonlinear dynamics quantification of ECG signals, especially the more intuitive
VCG signals.
In this investigation, DWTs are used to decompose the VCG
signal characteristics in both time and frequency domains. The
full spectrum of VCG signals is divided into multiple frequency
bands in the form of separated components fa (t) and da (t).
Such a multiresolution analysis is formulated based upon the
compactly supported orthonormal wavelet functions ψa,b (t)
and scaling functions ϕa,b (t). The DWT generally employs the
dyadic grid form to achieve the zero redundancy. The dyadic
grid wavelet and scaling functions can be written as follows:
ψa,b (t) = 2
ϕa,b (t) = 2
−a
2
ψ(2−a t − b)
−a
2
ϕ(2−α t − b).
The wavelet (or detail) coefficients and approximation coefficients can be computed by taking the inner products of the
signal f (t) with the wavelet functions and scaling functions
respectively as
+∞
Wa,b = f (t), ψa,b (t) =
f (t)ψa,b (t)dt
−∞
Aa,b = f (t), ϕa,b (t) =
+∞
−∞
f (t)ϕa,b (t)dt
where Wa,b is the wavelet coefficients at scale and location
indices (a, b) and Aa,b is the approximation coefficients. Therefore, the signal f (t) can be expressed as the summation of
approximation and detail series as
f (t) = fan (t) +
an
da (t)
a=−∞
=
∞
b=−∞
Aan ,b ϕan ,b (t) +
∞
an
Wa,b ψa,b (t)
a=−∞ b=−∞
where fan (t) is the signal approximation at scale an and da (t)
is the signal details at scale a.
But there are several existing families of standard wavelets,
such as Daubechies, Coiflet, Symlet, and so on. The choice of
wavelet basis functions can play a significant role in determining
the compactness of the resulting wavelet representation [24]. It
is generally understood that the closer the basis functions match
the signal patterns, the more compact the representation will
be [24]. Therefore, the Daubechies wavelets db4 is selected in
this present investigation since its wavelet function has a very
similar shape to the ECG signal pattern.
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Fig. 3. Graphical illustration of relationship among (a) VCG X, Y, Z time
series; (b) VCG trajectory; (c) UTRP; (d) TRP.
B. Recurrence Quantification of Cardiovascular Dynamics
Dynamical system phase space exhibits recurrence characteristics, even in different wavelet scales. Poincare recurrence
theorem [27] shows that if one has a measure preserving transformation, the trajectories eventually reappear at the neighborhood of former points. As shown in Fig. 3(c), the unthreshold
recurrence plot (UTRP) delineates the distances of every point
x(i), the state vector realized at time i, to all the others in the
phase space, i.e., Dist(i, j) = ϑ(x(i) − x(j)), where · is
a distance measurement (e.g., the Euclidean norm) and ϑ(·) is
the color code that maps the distance to a color scale. Fig. 3(c)
shows that the color code of the distance between the cardiac
vectors x(i) and x(j) is located in coordinate (i, j) of the recurrence plot. If the color code at the point is blue, then the points
are located close to each other in the VCG, and if the color code
is red, the points are located farther apart. While the thresholded
recurrence plot (TRP) [see Fig. 3(d)] only draws points when the
distance x(i) − x(j) between two cardiac vectors is below a
cutoff distance r: T (i, j) = Θ(r − x(i) − x(j)), where Θ is
the Heaviside function [28].
The recurrence plot provides a convenient means to capture
the topological relationships existing in the 3-D VCG vector
space in the form of 2-D images. It shows the times at which a
state of the dynamical system exhibits recurrence, i.e., the time
pairs at which the trajectories of a system evolution come within
a specified neighborhood. The structures of a recurrence plot
have distinct topology and texture patterns [see Figs. 3(c) and
3(d)]. The ridges locate the nonstationarity and/or the switching
between local behaviors. The recurring dark (blue) diagonal
(45◦ ) lines indicate the near periodicity of the system behaviors
over given time segments with a period, heart rate, equal to the
separations between successive diagonal lines [28].
C. Multiscale RQA
Features extracted based on conventional statistical approaches and linear system perspectives alone tend to have limitations for capturing signal variations resulting from changes in
the cardiovascular system dynamics, especially considering the
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Fig. 5.
Fig. 4.
Flow chart of the forward feature selection algorithm.
Flow diagram of multiscale RQA.
D. Feature Selection
aforementioned different infarction locations and myocardium
damage levels. The use of rigorous nonlinear dynamics principles based on multiscale RQA can lead to extraction of effective
features, which are more sensitive to pathological variations and
less sensitive to noises or other extraneous variations. As shown
in Fig. 3(a) and (b), three lead VCG time series record the spatial heart electrical activities in the form of a 3-D attractor. The
recurrence dynamics in the original global scale VCG attractor
[see Fig. 3(c)] were explored in our previous investigation [4].
It was found that MI pathological patterns are closely related to
the variations in the recurrence dynamics.
However, some pathological characteristics can be buried
in such a single-scale view. Hence, this present investi−−→
gation decomposes the 3-D VCG signals f (t)|V x,V y .V z −−−→
into multiple scales, namely, An : (fan (t)|)V x,V y ,V z , D1 :
−−−→
−−→
(d1 (t)|)V x,V y ,V z , . . ., (Dn : dan (t)|)V x,V y ,V z . Nonstationary characteristics can be approximately separated from the
steady behaviors for studying the pathological properties of
underlying complex cardiovascular dynamics. As shown in
Fig. 4, the 3-D VCG signal components in the same scale
are presented in the form of a 2-D UTRP so that mathematical description of the salient patterns contained can be compactly captured, and quantitative recurrence quantifiers that describe the specific recurring patterns in the VCG can be efficiently extracted. The cutoff distance r was selected to be
0.005 × Dist(i, j)m ax for the TRPs in all the MI and HC
cases. The six typical RQA features, namely, recurrence rate
(RR), determinism (DET), linemax (LMAX), entropy (ENT),
laminarity (LAM), and trapping time (TT) are extracted to
characterize the VCG signal [29]. The unanimously selected
threshold does not necessarily calculate proper dynamical invariants for some of the subjects, but the resulted RQA statistics are utilized to reveal the underlying pathological behaviors due to MI. In total, 6 × (an + 2) recurrence quantifiers
are extracted in the an level decomposition for the identifi−−−→
cation of MI pathological clues, including (fan (t)|)V x,V y ,V z ,
−−→
−−−→
(d1 (t)|)V x,V y ,V z , . . ., (dan (t)|)V x,V y ,V z , and original global
−−→
scale (f (t)|)V x,V y ,V z .
In the previous section of feature extraction, we used transformation functions, i.e., nonlinear recurrence and wavelet methods, to obtain a group of quantifiers that can track the underlying pathological variations from the massive VCG dataset.
But such a high-dimensional feature space cannot only bring
model complexity and overfitting problems to the classification
stage but also hinder the deeper understanding of the underlying
processes. Therefore, feature selection is further employed to reduce the dimensionality of feature space by selecting a smaller
subset from existing multiscale RQA quantifiers without a transformation. Feature selection techniques have been successfully
applied in many areas including the classification of microarray
expression data [30], protein structures [31], and physiological
signals, [32] etc.
Fig. 5 shows the sequential forward feature search algorithm
used for the evaluation and selection of an optimal feature subset
from the complete multiscale RQA feature set. The classification
model is wrapped into the objective function to search the space
of all feature subsets for the best predictive accuracy. Starting
from the empty set S0 , the additional feature s+ that results
in the highest objective classification function J(Sk + s+ ) is
sequentially added into the feature subset Sk that has already
been selected. These steps are repeated until the desired feature
subset size is reached. The step of feature selection cannot only
surmount the aforementioned model complexity and overfitting
problems, but also provide faster and more cost-effective models
with the optimal feature subset.
E. Classification
Three classification models, namely, linear, quadratic, and k
nearest neighbor (KNN), are considered to separate MI from
HC cases in the feature space with linear hyperplane, parabola
hyperplane, and arbitrary boundary, respectively.
Linear discriminant analysis (LDA) assumes that a linear hyperplane serves as a boundary separating HC and MI points in
the feature space, and it uses a least square estimation to determine the coefficients, which give the best fit. The hyperplane
that captures the relationships between the input features and
YANG: MULTISCALE RECURRENCE ANALYSIS OF SPATIAL CARDIAC VCG SIGNALS
the output response is of the form
y = αS + ε = α0 +
n
αi Si + ε
i=1
where αi are the model coefficients and si represents the input
features. The residual error ε of the difference between the actual
value and the model output determines whether the presented
VCG is taken from HC or MI subject.
Quadratic discriminant analysis (QDA) assumes that a
parabola hyperplane serves as a boundary separating HC and
MI points in the feature space. The only difference from LDA is
that it adds the quadratic term to increase the degree of freedom
for the classification boundary. The mathematic form of QDA
model is shown as follows:
n
n n
αi Si +
βij Si Sj + ε
y = αS + S T βS + ε = α0 +
i=1
i=1 j =1
where αi , βij are the coefficients, si represents the input features, and ε is the residual errors.
The KNN rule is a very intuitive method that classifies unlabeled examples based on their similarity to examples in the
training set. For a given unlabeled feature point su , find the k
“closest” labeled feature examples in the training dataset and
assign su to the class that appears most frequently within the
k-subset. The present paper uses the Euclidean metric to measure “closeness” in the KNN classification model.
III. MATERIALS AND EXPERIMENTAL DESIGN
A. Database
Some 448 VCG recordings (368 MIs and 80 HCs) available in
the PTB Database [33], [34] from the PhysioNet 2006 QT Challenge [35], [36] were analyzed in this investigation. Each recording contains 15 simultaneous heart-monitoring signals, namely,
the conventional 12-lead ECG and the 3-lead Frank (XYZ) VCG.
The signals were digitized at 1 kHz sampling rate with a 16-bit
resolution over a range of ±16.384 mV. The 80 HC recordings
are acquired from 54 healthy subjects and the 368 MI recordings
from 148 patients. Within the MI recordings, there are 89 inferior, 56 inferior–lateral, 19 inferior–posterior–lateral, 1 inferior–
posterior, 47 anterior, 43 anterior–lateral, 77 anterior–septal,
2 anterior–septal–lateral, 3 lateral, 4 posterior, 5 posterior–
lateral, and 22 unknown site cases. The VCG recordings were
typically of ∼2 min duration, and all the signals were recorded
for at least 30 s. The present investigation first normalized the
VCG signals into the unit range and collected a segment of
4000 data points starting from the first R-peak. Then, the data
are further resample to 2000 data points to reduce the RQA
computational efforts. These two preprocessing steps can also
ensure that the resulted recurrence plots are aligned uniformly
from the R-peak and reduce the biases from misalignments.
B. Cross-Validation and Performance Evaluation
To reduce the bias and overfitting of classification performance evaluation, both K-fold cross-validation and random
subsampling methods were employed in this investigation.
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K-fold cross-validation totally conducts K experiments, in each
of which K−1 folds are used for the training purpose and the rest
onefold for testing. The true performance estimate is obtained
as the average of those randomly separate error rates on testing
samples. The random subsampling method will further replicate such K-fold cross-validation experiments for 1000 times
by randomly creating the K-fold partitions to obtain the probability distribution of performance statistics. This procedure is
repeated from twofold to tenfold for the identification of MI
subjects in the PTB database. This integration of K-fold crossvalidation and random subsampling methods not only prevent
the biases from the inequitable selection of training datasets,
but also provide the general performances of feature sets and
classification models.
The classification results are evaluated based on two performance statistics, namely, sensitivity and specificity from the
testing dataset. Sensitivity measures the proportion of actual
positives, which are correctly identified as such, and the specificity measures the proportion of negatives, which are correctly
identified [37]. In other words, sensitivity is the indictor, which
gives the percentage of MI subjects that are identified as having
the condition, and specificity is the percentage of healthy control
cases that are identified as not having the condition.
IV. RESULTS
The multiscale recurrence analysis decomposes and characterizes the system recurrence dynamics into various levels,
which effectively capture the system transient, intermittent, and
steady behaviors. As shown in Fig. 6, the VCG attractor recurrence dynamics are analyzed in multiple wavelet scales A7,
D1, D2, D3, D4, D5, D6, D7 using the Daubechies wavelets
db4. For the scale A7, the recurrence plot Dist(i, j)|A 7 =
−→
−→
ϑ(fa7 (i)|V x,V y ,V z − fa7 (j)|V x,V y ,V z ) is computed from
−−−→
the approximation signals A7 : fa7 (t)|V x,V y ,V z . For the
scales from D1 to D7, the recurrence plots are computed
−−→
from the wavelet detail series D1 : d1 (t)|V x,V y ,V z , . . . , Dn :
−−→
d7 (t)|V x,V y ,V z as follows:
−
→
−
→
Dist(i, j)|D n = ϑ(dn (i)|V x,V y ,V z − dn (j)|V x,V y ,V z ),
n = 1, . . . , 7.
The recurrence patterns in the original global scale are shown
in Fig. 3(c), which are decomposed into different frequency
bands (see Fig. 6) using the DWTs. Based on the Nyquist theorem, the highest frequency represented in the VCG signals is
500 Hz that is one-half of the sampling rate 1000 Hz. Therefore, the frequency ranges for this multiscale recurrence analysis are 0–3.9 Hz (A7), 3.9–7.81 Hz (D7), 7.81–15.62 Hz (D6),
15.62–31.25 Hz (D5), 31.25–62.5 Hz (D4), 62.5–125 Hz (D3),
125–250 Hz (D2), and 250–500 Hz (D1) in Fig. 6. The lowest
frequency trend is captured in the scale of A7, and the highest
frequency is basically in the scale of D1. The various frequency
components in the VCG signals are hence partitioned for the
analysis of recurrence dynamics, which greatly facilitate the
study of system transient, intermittent, and steady behaviors.
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IEEE TRANSACTIONS ON BIOMEDICAL ENGINEERING, VOL. 58, NO. 2, FEBRUARY 2011
Fig. 7.
Fig. 6. Multiscale recurrence plots of the VCG signals in A7, D1, . . ., D7
wavelet scales.
In this present investigation, the decomposition level is selected to be 8 for the VCG signals, i.e., A7 is further decomposed into A8 (0–1.45 Hz) and D8 (1.45–3.9 Hz). Six typical
RQA features, including RR, DET, LMAX, ENT, LAM, and
TT, are extracted from the recurrence plot in each scale. In total, 60 = 6 × (8 + 2) recurrence quantifiers are extracted in
this multiscale recurrence analysis for the identification of MI
pathological clues. As shown in Fig. 7, the error rate of classification is varied with respect to feature subset size in the step
of feature selection. The optimal feature subset size is identified
as 6, because it is not only the number of typical RQA features
extracted in each wavelet scale, but also the first local minima
of error rate variations. It may be noted that if the number of
feature chosen is greater than 6, the error rate oscillates rather
than decreases, indicating the possible existence of overfitting.
Fig. 7 also shows that LDA yields the least classification error
rate compared to the QDA and KNN models. The simplicity of
the LDA classification model further signifies the effectiveness
of the multiscale RQA features.
Fig. 8 shows the distribution of the first three selected features, namely, feature 25, 22, and 40 in the 1-D histogram plot,
2-D, and 3-D scatter plots, respectively. The first selected feature is the 25th feature, which is the RR in the scale of D3
(62.5–125 Hz). As shown in Fig. 8(a), the distribution of feature
25 varies significantly between HC (26.9 ± 19.1) and MI (4.2 ±
6.2) groups. The p-value of feature 25 is 5.21 × 10−26 in the two
Variations of classification error rate versus feature subset size.
Fig. 8. Multiscale recurrence feature distribution plots; (a) histogram of feature 25; (2) 2-D scatter plot between feature 22 and feature 25; (3) 3-D scatter
plot between feature 22, feature 25, and feature 40.
sample Kolmogorov–Smirnov test, which further proved the existence of distinct distributions between HC and MI. Fig. 8(b)
presents the 2-D scatter plot of feature 25 and feature 22. Feature
22 is the ENT in the scale of D2 (125 ∼ 250 Hz). MI subjects
are visualized in the red circles and HC in the blue triangles.
The majority of MI subjects are found to be in the upper portion and HC in the lower portion of Fig. 8(b). Additionally, the
third feature 40, ENT in the scale of D5 (15.62 ∼ 31.25 Hz), is
added to characterize the 3-D distribution of HC (368) and MI
(80) recordings in the PTB database. It can be seen that these
three features can effectively discriminate HC from MI subjects,
and MI patients are found to cluster, while the healthy controls
spread mostly outside. It may also be noted that HCs are shown
to have a more diverse distribution (i.e., larger mean and standard deviation) than MIs, implying that HC subjects are more
dynamically adaptive. The more variability of heart dynamics
shown in the HC cases was also observed in Goldberger’s study
on fractal dynamics in physiology [18].
The classification results using linear discriminant models
are shown in Fig. 9(a) and (b). The distribution of sensitivity
and specificity are computed from 1000 replicates of the K-fold
cross-validation. The box plot is used to visualize the distribution of classification performance. The red line in the middle
of boxplot represents the median, the blue box shows the lower
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experiments of three aforementioned models, the features extracted from multiscale recurrence analysis are, therefore, found
to be adequately discriminatory to capture the dynamic variations between HC and MI and ensure a high-classification accuracy for the MI subjects. The classification results are shown
to be comparable to the average of the combined scores of eight
experienced cardiologists (sensitivity-80.3%, specificity-97.1%
in Table I, especially considering the sparse HC data in this
investigation.
The average overall classification rate is 92.7% for the LDA
in the present investigation, calculated from (368 × 0.965 +
80 × 0.75)/(368 + 80). The experienced cardiologists were
shown to achieve an average of 87.2% = (547 × 0.803 +
382 × 0.971)/(547 + 382). Few, if any, previous approaches
yield >90% in the overall classification rate for the diagnostic of MI including both various nidus locations and different
myocardium damage levels [9]–[15]. It may be noted that multiscale recurrence method yields a better overall accurate classification rate (>5.5%) compared to human expertise or other
standard methods.
V. DISCUSSION AND CONCLUSION
Fig. 9. Performance results of various classification models using K -fold
cross-validation and random subsampling methods; (a) linear model sensitivity,
(b) linear model specificity, (c) quadratic model sensitivity, (d) quadratic model
specificity, (e) KNN model sensitivity, (f) KNN model specificity.
quartile and upper quartile of data distributions, and the black
dash lines represent the most extreme values within 1.5 times
the interquartile range. Outliers are shown as the red cross in
the box plot. As shown in Fig. 9(a), the median sensitivity is
shown to be higher than 96.5% with small deviations (<0.1%).
The K-fold number is varied from twofold to tenfold, and the
random subsampling method is also used to randomly creating
the K-fold partitions for 1000 times. Despite the randomness
of training data selection, the sensitivity performance is shown
to be fairly high (>96.5%) and yield a stable increase trend.
Fig. 9(b) also demonstrates an average specificity performance
of 75% with small deviations (<0.5%). This indicates that the
features extracted from the multiscale recurrence analysis can
significantly discriminate between MI and HC in the LDA.
The feature selection and classification using linear quadratic
models are shown in Fig. 9(c) and (d). The sensitivity is shown
to increase from 94% to 95% with small deviations (<0.2%)
while raising the K-fold number from twofold to tenfold [see
Fig. 9(c)]. But the specificity performance is found to be around
77% and 77.5%, which is increased 2% from the linear discriminant models (75%). The parabola hyperplane is shown to
achieve a better capability for the identification of healthy control subjects.
Fig. 9(e) and (f) presents the results of feature selection and
classification using KNN models. The KNN models utilize the
nonlinear classification boundaries and are found to further improve sensitivity to 98%. But it is at the expense of the specificity,
which is shown to be around 65% and 69%. Based upon the
It is challenging to characterize and identify the ECG signal
pathological patterns of MI, using automated computer methods or human expertise due to the various nidus locations and
different myocardium damage levels. As commonly known, MI
can take place in different portions of the heart, i.e., anterior,
inferior, posterior, inferior–lateral, anterior–septal, posterior–
lateral. Any of the three myocardium damage stages, namely,
ischemia, injury, and necrosis, can occur in combination [1]. The
natural electrical activity exhibitions, like ECG or VCG signals,
from MI are shown to have significantly complex patterns under a different combination of MI conditions. Additionally, the
autonomous control mechanisms in the complex biological system generate the high level of nonlinearity, nonstationarity, and
noise in the signals. Not only the different MI conditions but also
the inherent complexity from the living organisms pose remarkable difficulties for the MI identification, which also defy the
conventional temporal-domain analysis and statistical methods.
In this investigation, an attempt was made to analyze the variations of multiscale recurrence dynamics in the spatial VCG
signals for the identification of MI subjects. The multiscale recurrence plots characterize the system recurrence dynamics in
various frequency bands, which can effectively capture the system transient, intermittent, and steady behaviors. The multiscale
recurrence quantifiers are found to be adequately discriminatory
to capture the dynamic variations between HC and MI. The LDA
is demonstrated to yield a sensitivity around 96.5% with small
deviations (<0.1%) and an average specificity of 75% with 0.5%
deviations. The QDA achieves a sensitivity around 94.5% with
small deviations (<0.2%) and a specificity of 77.5%. It is shown
to have a better specificity but at the expense of sensitivity. The
KNN models identify the nonlinear mapping from the extracted
features to the patient’s condition. It provides a relatively high
sensitivity (∼98%) with a compromise of specificity (≈69%).
The classification results from three models demonstrate
a comparable performance to the average of the combined
346
IEEE TRANSACTIONS ON BIOMEDICAL ENGINEERING, VOL. 58, NO. 2, FEBRUARY 2011
scores of eight experienced cardiologists (sensitivity-80.3%,
specificity-97.1%), considering the relative small MI datasets
and much sparser HC data in this investigation. The overall
classification rate is 92.7% in the present multiscale recurrence
investigation, which is better (>5.5%) than human performance
and other standard methods. Cardiac monitoring algorithms
have been striving to improve the overall classification rate,
sensitivity, and specificity. However, limited by the overall classification rate in a particular approach, researchers can either improve the sensitivity at the expense of specificity or sacrifice the
sensitivity to improve the specificity. This investigation shows
that the VCG features extracted using multiscale RQA analysis are good indicators of the cardiovascular conditions. This
research has great potentials for the development of automated
MI classification and warning system, which can dramatically
reduce the healthcare cost and promote the preventive medicine.
In addition, the results from this study can also be applied in
the understanding of the recurrence dynamics and nonstationary
patterns of other physiological and engineering systems.
ACKNOWLEDGMENT
The author would like to thank anonymous reviewers for
their constructive comments, and also grateful to Dr. S. T. S.
Bukkapatnam (Industrial Engineering), Dr. R. Komanduri (Mechanical Engineering), and Dr. B. Benjamin (Physiology) from
Oklahoma State University for their valuable discussions and
suggestions, and Dr. E. Bennett from the Department of Molecular Pharmacology and Physiology, University of South Florida,
for the comments during the revisions. The author is entirely responsible for the data analysis and conclusions and the material
presented in this paper.
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347
Hui Yang (M’08) was born in Nanjing, P.R. China.
He received the Ph.D. degree from the School of
Industrial Engineering and management, Oklahoma
State University, Stillwater.
He is currently an Assistant Professor at the
Department of Industrial and management Systems
Engineering, University of South Florida, Tampa.
His research interests include sensor-based computational modeling and analysis of complex systems
with special focus on nonlinear stochastic dynamics,
and the resulting multifractal behaviors.