Abstract
Objective: In fetal diagnosis the myriad and diversity of heart rate variability (HRV) indices prevents a comparable routine evaluation of disturbances in fetal development and well-being. The work aims at the extraction of a small set of HRV key indices that could help to establish a universal, overarching tool to screen for any disturbance. Approach: HRV indices were organized in categories of short-term (prefix s) and long-term (prefix l) amplitude fluctuations (AMP), complexity (COMP), and patterns (PATTERN) and common representatives for each category were extracted. This procedure was done with respect to the diagnostic value in the evaluation of the maturation age throughout the second and complete third trimester of pregnancy as well as to potential differences associated with maternal life-style factors (physical exercise, smoking), nutrient intervention (docosahexaenoic acid (DHA) supplementation), and complications of pregnancy (gestational diabetes mellitus (GDM), intra-uterine growth restriction (IUGR)). Main results: We found a comprehensive minimal set that includes [lAMP: short term variation (STV), initially introduced in cardiotocography, sAMP: heart rate increase across one interbeat interval of phase rectified averaged signal - acceleration capacity (ACst1), lCOMP: scale 4 multi-scale entropy (MSE4), PATTERN: skewness] for the maturation age prediction, and partly overlapping [lAMP: STV, sAMP: ACst1, sCOMP: Lempel Ziv complexity (LZC)] for the discrimination of the deviations. Significance: The minimal set of category-based HRV representatives allows for a screening of fetal development and well-being. These results are an important step towards a universal and comparable diagnostic tool for the early identification of developmental disturbances.Novelty & SignificanceFetal development and its disturbances have been reported to be associated with a multiplicity of HRV indices. Furthermore, these HRV indices change with maturation. We propose the abstraction of HRV categories defined by short- and long-term fluctuation amplitude, complexity, and pattern indices that cover all relevant aspects of maturational age, behavioral influences and a series of pathological disturbances. The study data are provided by multiple centers. Our approach is an important step towards the goal of a standardized diagnostic tool for early identification of fetal developmental disturbances with respect to the reduction of serious complications in the later life.
Highlights
The focus biological oscillations and health addresses the essential role of fluctuations in the complex dynamic behavior of an organism
In lAMP (AMP, SD, STV, LTV, TP, VLF, LF, ACsl4,ACst4, DCsl4,DCst4) and sAMP, respectively, all members were clearly correlated with correlation coefficients r of about 0.7 to 1.0
In the lAmp category, the lowest correlation coefficient r = 0.55 was observed between Amp and Dcsl4 and in the sAmp category, the lowest correlation was found between P1V and ACst1 (r = 0.46)
Summary
The focus biological oscillations and health addresses the essential role of fluctuations in the complex dynamic behavior of an organism. (Van Leeuwen et al, 1999; David et al, 2007; Ferrario et al, 2009; Amorim-Costa et al, 2017a; Amorim-Costa et al, 2017b) Their results are generally consistent, but the dispersion of the results is high and the HRV indices used are diverse. Developmental progression of fetal cardiac autonomic control can be measured by different HRV indices that reflect critical periods of ANS development across gestation (Schneider et al, 2018). These developmental changes cannot be reflected by linear models which assume a constant development across the total second and third trimester. Based on the redundancy of the multiplicity of HRV indices, identifying a few relevant key parameters would help to propose a feasible, universally manageable and standardized diagnostic tool for early identification of fetal developmental disturbances with a view to the reduction of serious complications in later life
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