user manual - ecgauto v3.0 rev1- april 2012

ecgAUTO v 3.0 software for automated ecg analysisuser manual version 1

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emka TECHNOLOGIES

table of contentschapter 1. introduction chapter 2. installation2.1 2.2 2.3 2.4 2.5 2.6 3.1 3.2 3.3 3.4 3.5 supplied items minimumconfiguration user privileges release notes configuringtheusersmanagement runningecgAUTOforthefirsttime toolbar customization panels display general setting tab creatingandhandlingconfigurationfiles precision

7 99 9 9 10 13 16

chapter 3. general information

1717 18 18 20 21

chapter 4. quick start chapter 5. loading data5.1 5.2 6.1 6.2 6.3 6.4 6.5 6.6 7.1 7.2 7.3 loading raw data viewing loaded data (main screen) how ecgAUTO analyzes data overview of settings settings for Intervals mode settings for RR-only mode settings for average beat mode settings for rhythm and stability mode how analysis is done making settings slow analyzer (SLOW)

23 2525 47

chapter 6. ecg analysis settings

5353 56 58 87 90 90

chapter 7. non-ecg analysis

9394 95 97www.emka.fr

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ecgAUTO version 3.0 user manual

7.4 7.5 7.6 7.7 7.8 7.9 7.10 7.11 7.12 8.1 8.2 9.1 9.2 9.3 10.1 10.2 10.3 10.4 10.5 11.1 11.2 11.3 11.4 11.5 11.6 11.7 11.84

blood pressure analyzer (BP) bloodflowanalyzer(BF) left ventricular pressure analyzer (LVP) monophasic action potential analyzer (MAP) respiratory inductive plethysmography (RIP) noninvasive blood pressure analyzer (NIBP) electroencephalogram analyzer (EEG) sleep scoring module (EEG) epilepsy seizure detection module (EEG) building a library display settings building a protocol example protocol behaviour of protocol-based analysis local analysis using a protocol to perform an analysis reviewing and processing results recompute function notes about display of data epochs in hrv studies getting started general information header settings panels delta vs data panel fftpanel(fastFouriertransform) hrv test signal viewing video signal performing batch analysis

99 101 103 107 109 110 122 136 146

chapter 8. libraries (for ecg analysis)

159159 172

chapter9. definingandrunningprotocols

175175 185 186

chapter 10. analysis

189189 194 199 228 229

chapter 11. HRV studies (variability module)

231231 231 232 233 235 246 247 255

chapter 12. advanced features12.1 12.2

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12.3 12.4 13.1 13.3 13.4 13.6 14.1 14.2 14.3 14.4 14.5 14.6 15.1 15.2 16.1 16.2 16.3

reading the key events log-book summary of keyboard shortcuts creatingresultsfiles select steps to be saved saving loadingresultsfiles(Reviewmode) types of print-outs settings customizing print-outs exporttextfiles exportxmlfiles exportxlsfiles uninstall via the control panel uninstall with the installer overview make settings user interaction

260 262

chapter13.resultsfiles

267268 275 276 279

chapter 14. presenting your data

281281 284 286 290 295 295

chapter 15. uninstalling ecgAUTO

297297 297

chapter 16. usersMANAGEMENT

301301 302 305

chapter 17. troubleshooting

307

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chapter 1. introductionecgAUTO

data.

is post-processing software for the analysis of ecg data and several other types of

ecgAUTOanalyzesecgdatausingshaperecognitiontechniques.Forthis,itrequiresalibraryof

reference waveforms. Each reference waveform has markers for key points such as onset of Pwave,Rwavepeak,endofTwave...

Withtheaidofthesereferencewaveforms,ecgAUTO can process ecg data and position markers,andthencalculateparameterssuchasintervaldurations,amplitudes,areasetc.,whichare based on the markers. can analyze any type of ecg signal - from any species and from any lead. It also provides the user with full control of the analysis:ecgAUTO

topreciselydefinehowthesoftwareshouldanalyze to check the beat-by-beat results of the analysis to modify the position of markers Theanalysisisnormallybeatbybeat,butitcanalsobebasedonaveragebeatsifthisimproves the quality of the results.ecgAUTO

can also analyze non-ecg signals1,namely:

slowly varying rhythmic signals (SLOW analyzer) blood pressure (BP analyzer) bloodflow(BFanalyzer) left ventricular pressure (LVP analyzer) monophasic action potentials (MAP analyzer) lungvolume,basedonsignalfromthoracicandabdomenbelts(RIPanalyzer) electroencephalogram (EEG analyzer) blood pressure measured noninvasively (NIBP analyzer)

71 the non-ecg analyzers are available as options. An analyzer will only be available to you if it is included in the license you purchased.

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user privileges

chapter 2. installationThis chapter describes the installation procedure for ecgAUTO with users management. Several GLP options are available when you buy ecgAUTO: usersMANAGEMENT,amodulethatprovidescontrolledaccesstoemkaTECHNOLOGIES software. studyMANAGEMENT,amodulethathelpsusersorganizeasetofexperiments,configurationsand

corresponding data into objects called studies. electronic signature module

audit trail software (either auditCENTRAL or auditSERVER)

If you have purchased ecgAUTO with studyMANAGEMENT, audit trail or electronicsignaturemodule, please refer to the GLP module user manual for the complete installation procedure (ecgAUTO and GLP modules).

2.1 supplied itemsYour ecgAUTO package should consist of: an installation kit (CD-ROM and license key) a user manual

2.2 minimumconfigurationYou can install ecgAUTO on any PC-compatible computer running underWindows 98, NT, 2000,XPorWindows7.However,werecommendthefollowingminimumconfigurationfor optimal performances: core i3 class computer 8 Gbytes of RAM 200 Gbytes hard disk storage space Windows 7

2.3 user privilegesWhen running ecgAUTOonacomputeroperatedwithWindows7,anyuserneedstohave administrator privileges. ecgAUTO application must also be lauched with administrator privileges. 9

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ecgAUTO version 3.0 user manual installation

2.4 release notesEach emkaTECHNOLOGIES software distribution kit is provided with release notes. Releasenotesdetailthecorrections,additionsorimprovementsbetweentwoversions/updates of the software. Three different documents exist: version release notes:modificationsbetweenmajorversionsofasoftware update release notes: contains the minor updates made on the current major version of a software master update release notes:thisdocumentisthesameasthepreviousone,but includestheupdatereleasenotesofoptionalmodules,e.g.usersMANAGEMENT Beforeinstallation,releasenotescanbefoundinthesoftwareinstallationdirectoryofthe CD-ROM.Afterinstallation,releasenotescanbefoundinaRelease notes folder in the installation folder.Insert the ecgAUTO installation DVD-Rom in your computer. LaunchWindowsexplorer,thenopentheecgAUTO folder on the DVD drive.

figuren1. install.exefileicon

Double-click on the ECG-Install.exefiletolaunchtheinstaller. The welcome panel displays:

figuren2. install welcome panel

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Then the user information panel displays.

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release notes

Enteryourpersonaldetails,selectAnyonewhousesthiscomputer,thenclickNext.

figuren3. install - personal information

Inthedestinationfolderpanel,adefaultinstallationfolderisproposed:

figuren4. install - installation folder

Click Browsetochangethedestinationfolderifrequired,andNext when done. important!Ifyouacceptthedefaultfolderandlocation,yourpreviousinstallationofecgAUTO will be overwritten. For example, if you install ecgAUTO v2.8.1.5, it will overwrite files and folders created during installation of ecgAUTOv.2.8.1.4,ecgAUTOv.2.8.1.3,ecgAUTO v. 2.8.1.2 or ecgAUTOv.2.8.1.1.Ifyoudonotwantthis,createaninstallationfolderwithauniquename, for example ECG_2_8_1_5 which contains the three version numbers (2.8.1) and the build number (5). Intheselectinstallationtypepanel,selectthetypeofinstallationthenclickNext. 11

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Unless advised otherwise by emkaTECHNOLOGIE, do not change the default option (typical) .

figuren5. install - installation type

IntheReadytoinstalltheApplicationscreen,clicknext to begin the installation.

figuren6. install - ready to install

Amessageconfirmssuccessfulinstallation.

12figuren7. install - successful install

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configuringtheusersmanagement

Click on Finish. Whenprompted,clickYes to restart the computer.

figuren8. install - restart system

2.5 configuringtheusersmanagement2.5.1 introduction to glp modulesVarious glp modules are available for use with emka TECHNOLOGIES software,namely: theaudittrailmodule,whichwillbeeitherauditCENTRAL or auditSERVER depending on the characteristics of your installation theusermanagementmodule,calledusersMANAGEMENT thestudymanagementmodule,calledstudyMANAGEMENT the electronic signature module called eSIGN These modules were developed for researchers to be able to perform studies in compliance with glp and 21 cfr part 11 requirements. Audittrail, studyMANAGEMENT and eSIGNareoptionalmodules,thatcanbeactivatedifthey are included into the package you bought.The procedure to activate and configure these modules is explained into the glp modules User Manual.usersMANAGEMENT is anoptionalmodule,thatcanbeactivatedornotatthefirstlaunchof ecgAUTO.Theproceduretoconfigurethismodulesisexplainedinthenextchapter. usersMANAGEMENTpurposeistocontrolaccesstoeachprogram,byforcinguserstoenter

their login name and password.

The key component of usersMANAGEMENTistheusersbase,adatabasefilecontaining encrypted information about users and their access rights. When usersMANAGEMENT is activated,ecgAUTO will ask for a login name and password at launch. If you want to activate usersMANAGEMENT,gotochapter2.5.2. If you dont want to activate usersMANAGEMENT,godirectlytochapterchapter3. 13

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2.5.2 firstrunofecgAUTOsoftware1. Be sure that your USB software license key is plugged in. 2. Launch ecgAUTO by double-clicking the icon or via the start menu. 3. The GLP administrators panel appears as shown below. Read carefully the following sectionforanexplanationonthedifferentoptions.Ifyouhaveanydoubts,please contact your customer service representative at emka TECHNOLOGIES for further assistance.ecgAUTO ecgAUTO.

can be run with a number of options :

with or without usersMANAGEMENT to possibly control who is allowed to run withorwithoutaudit-trail,studymanagementandelectronicsignature.Ifyourpackagedoesnotincludethesemodules,theyaredimmedintheGLPadministrators panel.Ifyourepackageincludesthesemodulesandyouwhichtoactivatethem, please refer to the glp modules User Manual and skip the following procedure.

figuren9. 1st run of ecgAUTO software panel

4. To activate usersMANAGEMENT,clicktheYes check box. If you do not want to activate chapter chapter 3.usersMANAGEMENT,clickthe No

check box and go directly to

If you activated usersMANAGEMENT,thefieldcontainingthenameandlocationoftheusers base becomes accessible. Bydefault,theusersbaseisnamed users.umb and its path is the folder of the launched program.Ifthisfiledoesnotexist,thesoftwarewillproposetocreateit,answer Yes.

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A users base can be local or distant. To change the default folder or to select an existing users base click at the right of the field.Anexplorerappears,allowingyoutoselectthefolderwhereyouwanttostoretheusers base or where the existing base you want to select is located.emka TECHNOLOGIES

configuringtheusersmanagement

caution! You must select a folder in which simple users have read and write access. 5. Click Ok. The following panel appears.

figuren10. usersidentificationpanel

6. Click on Userstobringuptheaccesscontrolpanelfortheusersbase(figure n11)

figuren11.

access control panel

7. Enter the Login (Administrator) and Password (userscontrol) then click Ok. important! emka TECHNOLOGIES strongly recommends that the user administrator modify the default password of the administrator account; otherwise, anyone who knows the default passwordwillbeabletoeditthecurrentusersbase.Tomodifythedefaultpassword,please refer to chapter 16. 8. The users base editing panel appears.

15figuren12. users base edition panel

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9. Add a user to the list of users (on the left): click on Add in the Users section. The Add new emkas software user panel appears.

Select the authentication method EMKAthendefinethelogin name and user name fortheuserinstall1. 10. Click OK to return to the ecgAUTO: users management window. The user has been added. 11. Add Authorized softwares to the user: click the Add button under Authorized software. The name of the currently used emka TECHNOLOGIESsoftwareappears,select ecgAUTO in the scrolling list. ensure that Status is Active and select User level Administrator Tosuppressasoftwareofthelist,selectthesoftware,andclickonDel. Pleaserefertochapterchapter16forinformationabouttheotherfields,includingtheuser level (which determines which functionalities the user can access in the program).

2.6 runningecgAUTOforthefirsttimeAtthefirstlaunchofecgAUTO, the following alert messages will appear:

Click OK.

16

1

Thisisafictitioususer,createdforinstallationpurpose.Toaddrealusers,seechapter16

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toolbar customization

chapter 3. general informationThis chapter gives general information about ecgAUTO:

ecgAUTO

toolbar customization and panels display

General settings tab Configurationfiles Precision tabThis chapter is intended to be a reference chapter. Do not worry if you do not fully understand the explanations below - items are described in more detail in relevant chapters.

3.1 toolbar customizationAtthefirstecgAUTOlaunch,mainpanelpresentsthefollowingtoolbar:

Thistoolbariscomposedofdifferentmodules,correspondingtoeachmenuitem. Eachmodulecanbemovedandcustomized.Tomoveamodule,clickontheleftpartand move it at the same time:

figuren13. moving a module

Tocustomizeamodule,clickontherightpartandselecttheitemyouwanttobedisplayed:

17figuren14. module customization

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ecgAUTO version 3.0 user manual general information

3.2 panels displayWhenseveralpanelsareopened,youcanchoosetodisplayonepanelinfrontoftheothers,with the pin window option. Pin window

3.3 general setting tabSelect Tune General Settings from the main screen to open the General Settings panel (see figuren15).

figuren15. general settings panel

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The different settings are as follows:Send .x text file to secondary directory Send .z text file to secondary directory Send .xx archive text file to secondary directoryemka TECHNOLOGIES

general setting tab

.x.z.andxxfilesarethethreetypesofresultsfilesproducedbyecgAUTO.

IfOFF,theresultsfileissavedinthefolderfromwhichtherawdatafile(typesubject.dnnor subject.mkt) was loaded. IfON,youmustspecifywheretheresultsfileissaved. Thisfunctionalityisusefulindifferentsituations:forexample,whenthesourcefolderisaCD (onwhichnodatacanbeimmediatelytransferred)ortoseparaterawdatafilesfromresults files.Seek.mkt or .d file in secondary directory from .z file

This setting determines where ecgAUTOlooksfortherawdatafilewhenyouloada.zfile. IfOFF,ecgAUTOwilllookinthefolderspecifiedinthe.zfile. IfON,ecgAUTO will look in the folder you specify here.Seek .mkt or .d file in secondary directory from config

This setting determines where ecgAUTOlooksfortherawdatafilewhenyouloadaconfigurationfile. IfOFF,ecgAUTOwilllookinthefolderspecifiedinthe.configurationfile. IfON,ecgAUTO will look in the folder you specify here.Create .xx archive text file when saving .x fileIfON,ecgAUTOsystematicallygeneratesan.xxarchivetextfileeverytimeyousaveresults.

All result text files with read-only attribute

IfON,all.xand.xxfileswillberead-only.Results file name appended with lead label

IfON,theleadname(asdefinediniox)willbeappendedtothenameoftheresultsfile.Beat edition and invalidation/revalidation require comment Allow multiple simultaneous ECG sessions. Specific extension to append to text file name.IfON,enteraspecificextensioninthefield.Thisextensionwillthenbeappendedtothetext

filenamewhenyoudoananalysisonthisPC.

ThisfunctionalityallowsyoutodefineuniquefilenamesforeachPC-itisthereforeuseful when analyses will be performed on different PCs.

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ecgAUTO version 3.0 user manual general information

Limit to text file line number.

IfON,enterthemaximumnumberoflinesinyourtextfile. Thisfunctionalitymaybeusedtoensurecompatibilitywiththird-partysoftware(forexample, somespreadsheetpackagesmaynotbeabletoimporttextfilesthathavemorethanacertain number of lines. This limit is usually imposed to avoid too long refresh time).Force software to run in single screen mode.

Ifyouusetwoscreensfordisplay,clickingONwillensurethat ecgAUTO only dsiplays in the primary screen.Protocol analysis skips inactive streaming zones. Beat # above which trend graphs require manual refresh Step # above which average beat plot requires manual refresh Allow to load renamed iox2 raw data files

Bydefault, ecgAUTOmakesitimpossibletoloadioxdatafilesthathavebeenrenamed(thus ensuring GLP compliance). IfyouarenotworkinginaGLPenvironment,clicktoONtoremovethisrestriction.Single point correlation increment (low sampling rate only) Produces native Excel file during save results operation Produces ASCII text file during save results operation

3.4 creatingandhandlingconfigurationfilesAllsoftwaresettingsaresavedinaconfigurationfilewiththeextension .ecg.cfg. Theconfigurationfilecontainsthisinformation: settings about calculation modes settings about software operation a protocol 20 display settings a library

emka TECHNOLOGIES

precision

Whenyoufirstinstallthesoftware,adefaultconfigurationfilenamednoname.ecg.cfgisloaded.Itisveryunlikelythatthedefaultconfigurationfileissuitabletoyourneeds-youwillneed to modify it as desired. The following options are available from the main screen:File Save configuration File Save configuration as(thenameofthecurrentdatafileisproposedasadefaultname) File Load configuration File Load default configuration

Theconfigurationissystematicallyattachedtothebinaryresultfile:whenyoureloadananalysisfile,youalsoreloadtheconfigurationusedwhenthefilewascreated.

3.5 precisionOpen the List Display and text export settings panel by selecting Tune Parameters in list/tofile.

Inthedisplaycolumnoftheprecisiontab(figuren16),youcanmodifytheprecisionofdisplayed data (number of digits after the decimal point).

figuren16. setting precision of displyed values

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emka TECHNOLOGIES

chapter 4. quick startHere is a brief overview of the key steps to perform successful ecg analysis: 1. Start the software with a valid username and password. 2. Loadadatafile,thenselecttheinput(s)youwanttoanalyze. 3. Makesureanappropriatelibraryispresentintheconfiguration. 4. Intheconfigurationsettingspanelmakesuretheexpectedbpmvalueissuitable: adjust other settings as required. 5. Run a local analysis to check that things work as expected. 6. Adjust the display selection of parameters in the main table. 7. Build a protocol and make sure it produces valid analysis steps where you want them. 8. Start a protocol analysis. 9. Ifsatisfiedwiththeresults,savethem.

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loading raw data

chapter 5. loading dataecgAUTOcandirectlyanalyzerawdatafilesproducedbyemka TECHNOLOGIES data acquisition software,iox or eACQ.ItcanalsoanalyzefilesproducedbyDSItelemetryimplantsandotherthird-party

acquisitionsystems,afterconvertingthesefilestoaniox-compatibleformat. This chapter describes: howtoloadrawdatafilesofdifferentformats how to view loaded data

5.1 loading raw dataThemainscreen(figuren17,thescreenthatappearsonstartup)containstwosections.These sections are empty until you load raw data.

figuren17. main screen (before raw data loaded)

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ecgAUTO version 3.0 user manual loading data

Sections below describe how: toloadrawdatafilesgeneratedbyiox(section5.1.1).Foreachsubjectineach experiment,ioxcreatesamastersitefilewithextension.dmm(ioxversion1,mmisa 2-digit number) or .mkt (version 2). toconvertandloadnon-ioxrawdatafiles. toconvertandloadtextfiles(describedinsection5.1.1). Typically,textfilesarerawdatafilesacquiredbyanotheracquisitionsystem(otherthanemka TECHNOLOGIES or DSI) and converted to text format to make them accessible to other systems.Giventheinherentvariationoftextfiles,youmustteachecgAUTO how to process the textfilecreatedbyaparticularsystem. The module required to do this is only available as an option. If this option was included in yourset-up,themainscreencontainsthe File Raw data from converter Convert to text file item.

5.1.1 loadingrawdatafilesgeneratedbyiox5.1.1.1 loadthefileFromthemainmenu,selectFile Load IOXdatafileorclickon A standard Windows explorer panel appears. Topreselectafile,selectitthenclickLoadtobringuptheDatapreviewscreen(figuren18). Youmustrespectcertainruleswhenloadingthedatafileandselectingtheinputs(Datapreview panel): ifthereareanyecginputs,theymustbeselectedfirst, the same sampling rate must be used on all ecg leads (this rule also applies to analysis ofecginputsonly), thesamplingfrequenciesofnon-ecginputsdoesnothavetobethesame, you can load each type of non-ecg analyzer up to three times. Different selection rules apply for nibp analysis (see section 7.9). 26 Alltheinputsofthepreselectedfilesareloaded(twoinputsloadedinfiguren18).Foreach input,thereisapreviewpanelcontainingrawdata. Ifyourselectedinputsareinvalid(e.g.ecginputshavedifferentsamplingrate,nonecginputis selectedbeforeanecginput),thebackgroundcolorsbecomespale.emka TECHNOLOGIES

loading raw data

Whenyourselectionbecomesvalid,thebackgroundcolorsarestrong.andanadditionalfield appears (the analyzer drop-down menu). 1 5 6

2

3

4 6

7

figuren18. Data preview screen

The different parts of the Data preview screen are: toolbar 1

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withthistoolbar,youcan: moverawdatabackwardby1screenor1/2screen moverawdataforwardsby1screenor1/2screen zoomin/out(decrease/increasescreenwidth) adjust screen width (number of seconds of raw data in preview panel; the default is 5) reset panel size select all inputs as ecg leads addtherawdatafiletothebatchanalysisfileselectionpanel pin the window print the data preview panel slide 2

Drag the slide cursor or click anywhere on the slide to move to that point in the data within the preview panel. file information about the preselected file Specifically: fullfilename,includingfullpath, dateandtimethatfilewascreated durationofexperiment, studytag(iftheexperimentwasnotlinkedtoaspecificstudy,nostudyappears) other readable files in folder 4 3

Thispanelcontainsalistofall.d**ormktfilesinthesamefolderasthefileyouselected.You canclickonanyfiletoloadit. input information about preselected file Foreachinput,youcansee: alabelintheformatS-n(l-n)inputname,wherenisanindexappliedbyecgAUTO and inputnameistheinputnamedefinediniox sampling rate inputindex(firstinputselectedisinput1,secondoneisinput2) 28 analyzer to be used for that input theconversionformula,iftheinputhasaconversionapplied(seebelow);otherwise thisfieldcontainsnoconversion 5

emka TECHNOLOGIES

loading raw data

preview panel

6

There are 3 ways to move forwards and backwards along the data: toolbar buttons; the slider; via the study schema panel. study schema panel 7

This panel contains a schema of the entire experiment: periodsappearwiththeirname,dose,andcolorascreatedwhenrunningtheexperiment in iox; comments the bottom-most bar is colored green where raw data are available; ifaprotocolexists,stepsareshownasredrectanglesonthelowerpartofthe schema. The study schema is described in more detail in section 9.1.1 Althoughthereisnopredefinedupperlimittotheamountofdatawhichcanbedisplayed,it may take a few seconds to display long stretches of data. Thereisdynamicinteractionbetweenthecursoronthestudyschemapanel,theslideandthe raw data preview.

5.1.1.2 select input(s) to analyzeClick on the preview panel of an input to select it for analysis. The background color of selected input(s) turns from gray to green. Inputsarenumberedintheorderthatyouselectthem,i.e.thefirstleadyouselectwillbecomeinput1(ortheprimarylead),thesecondoneinput2,thethirdoneinput3etc(see figuren20inwhichfourleadsareselected).Ifyouchangeyourmindabouttheorder,click again on the primary lead to deselect all leads. Make sure that the correct analyzer is selected for each input:ECG SLOW BP BF LVP MAP RIP RIP sum RIP calib figuren19. list of available analyzers in ecgAUTO EEG EPL RF NIBP NIBPecg

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All selected ecg leads (inputs with ecg analyzer) must have the same sampling rate. If this is notthecase,thebackgroundcolorofallselectedinputsbecomespale. The icon is available (not dimmed) when the current selection is valid.

input numbers selected analysers

figuren20.

selecting non-ecg and ecg inputs

5.1.1.3 applyconversionand/ortimeshift(optional)When ecgAUTOloadsdataproducedbyiox,itloadsrawdataaswellastheassociatedcalibrationvalues.Inaccordancewithglp,thecalibrationvaluescannotbeedited. Onsomeoccasions,youmaywanttoconvertthedata,forexampleifincorrectelectrode placementhasproducedaninvertedecgsignal,orifanincorrectgainsettingisused.ecgAUTO can apply a simple linear correction to the signal as follows: ConvertedValue=axOriginalValue+bwhereaandbareuser-definedparameters Onotheroccasions,itisdesirabletoapplyatimeshift.Forexample,inacardiovascularexperimentusingseveraldifferentdevices(amplifiers,flowmeters),eachdevicewillleadtoa small but different time shift. You may decide that proper analysis requires that some inputs areshiftedinrelationtoothers,tocorrectlyreflecttruephysiologicalsituation.ecgAUTO allows you to apply a conversion and/or time shift via the raw data conversion

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panel.

Toaccessthispanel,right-clicktheconversionfieldintheDatapreviewpanel(figuren21).If aconversionisapplied,thisfieldisblueandcontainstheconversionformula;ifnoconversion isapplied,thisfieldisgrayandsaysnoconversion.emka TECHNOLOGIES

loading raw data

right-clickinconversionfieldtoaccessrawdataconversionpanel

figuren21. accessing the raw data conversion panel

Intheconversionpanel(figuren22): enter a and b for the conversion formula selectwhetheryouwanttoapplytheconversionbeforeorafterfiltering foratimeshift,enterintheoffset(sample)fieldthenumberofacquisitionsamples you wish to shift the input. The offset(ms)fieldgivesyouthetimeequivalentofthe chosen offset (in ms). ifnecessary,enternewlabel and unitsintheprovidedfields The changes you make in the conversion panel are immediately visible in the Data preview panel-originaldatainred,converteddatainblue(figuren22).

figuren22. changes in conversion panel (left) are instantly applied to the Data preview panel (right)

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Information about this conversion and time-shift is: includedintheheaderoftextfiles(seesection5.1.2) included in the calibrated input header savedwiththeconfiguration. Inthisway,whenyouloadabinaryfile(atypeofresultsfile),theconversionisautomatically appliedtothedatafilewhichissubsequentlyloaded.

5.1.1.4 load data into main screenSelect whenyouaresatisfiedwithyourinputselectionandsettings.

The Data preview panel closes and the signal appears in the main screen.

5.1.2 convertandloadnon-ioxrawdatafilesThistaskisdonethroughaseparateprogramcalledFileconversionutility.Toopenthisprogram select File Raw data from converter Convert non-iox raw data. The main panel appears(1)(figuren23).

figuren23. mainpanelofFileconversionutility

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TheFileconversionutilityisabletoconvertseveralfileformats. Youshouldreadthefirsttwosectionsbelow,discussinggeneralaspectsoffileconversion.(1) ifthepaneldoesnotappear,itisprobablyhiddeninthebackground.Usethekeycombination alt-tab to cycle through open applications.emka TECHNOLOGIES

loading raw data

Subsequentsectionsrefertospecificfileformats-youonlyneedtoreadthesectionrelevant to your needs. TheactualconversionprocedureisgiveninfullonlyforDataquest3filesasitissimilarforall filetypes. conversion of non-iox files You should be aware of the following points: TheFileconversionutilitycreatesd00files(thenativeformatofioxversion1). d00fileshaveamaximumrecordingdurationgivenbytheformula2,147,483,647 dividedbythesamplingrate.At500Hz,thisgivesamaximumrecordingdurationof just over 49 days. TheFileconversionutilitycannotconvertfileslargerthan2Gb(thisisbecausefiles are read using 32-bit signed integers) file options Click Options toopentheOptionspanel,consistingoftabs(figuren24). Settings under the File NamestabdeterminethedefaultfilenamesproposedbytheFile conversion utility. UndertheTimeFormattab,youshouldselecttheoptionECGAuto only (unless there is an absoluteneedtorunthedatafileiniox).Thisallowsyoutoconvertdatafileswithatotaldata duration (excluding zones where no data recording took place) of around 21 days if sampled at 1 kHz.

figuren24. defaultfilenamingoptionsmenu

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5.1.2.1 conversionofdataquestv.3filesTheFileconversionutilityhasitsownversionnumber(distincttothatofecgAUTO ). Different versionsareusedtoconvertdifferentversionsofDataquestfiles: conversion utility version 2.2.0.3 or earlier converts data produced by Dataquest version 3 or earlier (described in this section). conversion utility version 2.2.0.5 or higher (supplied with ecgAUTO version 2.4.0.3 or higher)isalsoabletoconvertfilesproducedbyDataquestversion4orearlier (described in next section). requirements ToconvertDataquestv.3files,youneed: an appropriate version of ecgAUTO an emka TECHNOLOGIES license to use the convertor. file types DatafilesproducedbyDSIsoftwareinclude:waveform files(e.g.RatM01.100,RatM01.101,RatF03.100,RatF03.101)

Thefilenameformatissubject.nxx,wheresubject isthesubjectname,n is the input channel (0-F)andxx is the alphanumeric recording index (00 to ZZ) .parameter files

(e.g.,RatM01.P00,RatF03.P00)

Thefilenameformatis subject.Pxx,wheresubject isthesubjectname,andxx is the alphanumeric index (00 to ZZ) .log files (e.g.RatM01.R00,RatF03.R00)

Thefilenameformatissubject.Rxx, where subjectisthesubjectname,andxx is the alphanumeric index (00 to ZZ). Fortheconversionyouneedonlythewaveformfiles. procedure From the menu panel of the conversion utility panel, select File Load DSI data file (for DataquestT).

figuren39.

a fully processed waveform

Sometimesasufficientlysimilarwaveformcannotbefound(segmentanalysisfailure)because, forexample,thereisnosufficientlysimilarlibrarywaveformorthesignalistoonoisy.Inthis case,ecgAUTO does not position any markers and moves to the next segment.

6.1.2 findpreviousRpeakFirst, ecgAUTO considers the most recent analyzed waveform. If this waveform is not too far awayintimeandsignalfluctuationisacceptable,RRiscalculated. SignalfluctuationisdeterminedbycomparingtheamplitudeofthepreviousRpeakandthe currentRpeak.Itisconsideredacceptableifamplitudedifferenceisbelowauser-specified threshold. 54 Iftheabovestrategydoesnotreturnaresult, ecgAUTO looks just before the current waveform for a non-analyzed waveform similar in shape. If such a waveform is found and the signal fluctuationisacceptable,RRiscalculated.

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how ecgAUTO analyzes data

Ifthissecondstrategydoesnotreturnaresult,thecurrentwaveformisrejected1.

6.1.3 detect extra beatsInecgintervalsmode(thestandardanalysismode), ecgAUTO only returns data for a given ecg complex if it has been able to fully analyze it. Ifthesignalisnoisyorthelibrarydoesnotcontainsufficientlysimilarwaveforms,theanalysis willthereforebepartial.However,evenifitisnotpossibletopositionallmarks,itisveryoften feasible to detect the R peak. Ifextrabeatdetectionisactivated,ecgAUTO will attempt to detect the R peak of complexes thatcouldnotbefullyanalyzed.AnextrabeatisdetectedwhenitsQRScomplexissufficiently similar to the QRS complex of adjacent ecg complexes that were fully analyzed. Furthermore,extrabeatdetectionisactivated,themainscreentablewillreportthesetwo parameters: HR_all_RR: an HR value based on all detected R peaks (which is of course a better estimate than the one derived from the RR of the only beats that were fully processed). All_RR#: number of RR intervals Extra beat detection is useful when simultaneous analysis of ecg and heart function (for example,withBP,LVPorBFanalyzer)isperformed.figuren40showstheextrabeatdetection in use.these 5 waveforms with colored background could not be completly processed

withextrabeatdetectionactivated,3of the wavefroms included as extra beats figuren40. extra beat detection: graph report

55

Asaconsequence,nobeatisreportedifanRRintervalcannotbeattachedtoit.

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ecgAUTO version 3.0 user manual ecg analysis settings

6.2 overview of settingsAll settings are made from the Analysis settings panel which can be accessed by: clicking the icon in the main screen toolbar

or,selectingTune Tune analysis from the main screen The settings in the Analysis settings panel vary according to the search mode (which itself is made in the Analysis settingspanel,undertheGeneraltab).Thefoursearchmodesare: search mode intervals from average beat description ecgAUTOperformsstandardecganalysisusingthefilteredsignal as displayed in the main panel as input data. This is the most commonly used mode. ecgAUTO performs ecg analysis on synthetic waveforms produced by adding up a known number of raw data waveforms. This mode can be useful when the signal is very noisy. ecgAUTO performs an ecg analysis limited to detection of R peaks and RR intervals.This mode is based on morphology rather than shape-recognition techniques - this means that it does not use reference libraries. Theanalysisisveryfast,butindifficultsituations(noisysignal)it may become less reliable than the intervals mode. ecgAUTO performs an analysis based on rhythm and stablity.

rr only

rhythm and stability

Please note that the search modes available to you depend on your licence and the software version . Thesettingsaregroupedunderdifferenttabs.Therewillbeonetofourtabs,dependingonthe searchmodeandthenumberofinputs(whetheroneinputorseveralinputs)(figuren41).

figuren41.

analysis settings panel for 1 input (left) or several inputs (right) for intervals search mode

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General ECG tab ThisiswhereyoudefinehowecgAUTO calculatesparameters,includingfiltersettings. Thistabisalwaysavailable,althoughsomesettingsarespecifictocertainsearchmodes.emka TECHNOLOGIES

overview of settings

Single lead ECG tab Thisiswhereyoudefinehowtheanalysisisperformedonallinputsandwhereyoudefine new and edit parameters. This tab is not available for the RR only and rhythm and stability modes. Ifyourconfigurationhasmorethanoneinput,theprimaryinputisthefirstonethatyouselected during input selection (see section 5.1.1). ApartfromRRandHR,whichareonlycomputedontheprimarylead,theparametersyou definehereareavailableinotherleads. Multilead ECG tab Ifyourconfigurationhasmorethanonelead,thisiswhereyoumakesettingsforinputsother than the primary lead. These inputs are sometimes called auxiliary leads. Interlead ECG tab Ifyourconfigurationhasmorethanonelead,thisiswhereyoucandefineparametersbased onallleads,aninterleadparameter.Forexample,youcandefineaninterleadparameterthat isequivalenttotheshortestPRintervalamongtheleads.Toaccesssettings,right-clickonthe text zone of the tab to open corresponding settings panel:

right-click in the text zone to access the settings panel

figuren42.

analysis settings panel

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ecgAUTO version 3.0 user manual ecg analysis settings

6.3 settings for Intervals mode6.3.1 General ECG settingsTheGeneralECGsettingsfortheIntervalssearchmodeareshowninfiguren43

figuren43. ECGmodeandsignalfiltering:Intervalsmode

TheGeneralECGtabiswherethesearchmodeisselected(bluecircleinfigure37).The settingsunderthistabareverysimilarforintervals,fromaveragebeatandrhythmand stability modes. They are very different for rr only mode. This section covers only settings for intervals search mode.:ecgAUTOappliesuptofivefilterstotherawsignaltrace:

derivativefilter23 baselineremovalfilter noiseremovalorsmoothingfilter notchfilter spikeremovalfilter Thederivativefilterisusedtoobtainthederivativesignal. Thefunctionofthebaselineandnoiseremovalfiltersisself-explanatory.Bothcanbeapplied eithermanuallyorautomatically(asafunctionofestimatedheartrate).Forboth,filteringis donebycalculatingacenteredaveragevaluewithtriangularweightingcoefficients(1inthe center,diminishingto0forpointsfurtherawayfromthecenter). 582 Thederivativefilterisnotavailableforecganalyzers.

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settings for Intervals mode

Thenotchfilterfiltersout50Hzor60Hznoise.Suchnoiseisfrequentlyseenonecgtraces, asanartefactproducedbyelectricaldevicesinthelaboratory.Usingthenotchfilterwhenno 50or60Hznoiseispresenthasnoeffect,butneverthelessslowsdowntheanlysisprocess. Thespikeremovalfiltermaybeabletoremovespikesthatarepollutingthesignal.Spikesmay beelectricalartefacts,orcausedbyotherdevices,suchaselectricalstimulators.Spikesare,by definition,ofhighamplitudeandshortduration.Mostoften,spikesaretheonlyfeaturesthat displaysuchamplitudeinsuchashortduration.Thisprovidesthepossibilitytofilterthemout. warning about filter settings Inappropriatefiltersettingscanleadtoanalysisfailureorerrors.Ifthefilterdistortsthesignal totheextentthatlibrarywaveformsandthefilteredsignaldiffertoomuch,analysiswillbe impossible. Evenifanalysisispossible,youmustbeawarethatastrongnoiseremovalfilterwillcausethe QRS complex to spread out and therefore increase its calculated duration. Itisasoundpolicytodecideearlyonwhichfiltersaresuitableforagiventypeofexperiment and to keep the settings unchanged. Ofcourse,anyfilteringdonebyecgAUTOhasnoeffectontherawdataofthemastersitefiles produced by iox. settings expected heart rate In the expected HR field,specifytheexpectedheartrateoftheecgdatatobeanalyzed: txt tab of the List display and text export settings panel. Choose a spectrum export undersampling setting from 1 to 256 (use no export to inhibit export only on that channel). Set a value for spectrum export max frequency (Hz) Validate these settings Run an analysis (changed export settings only take effect for any new analysis) Save the results What this export feature produces: SupposeyourcomputeFFTwith2048inputdatapoints.Bydesign,theFFTalgorithmproduces a spectrum with 1024 output data values. BedesignoftheFFTalgorithm,eachdatapointofthisspectrumrepresentsthepowerwith afrequencybandwidthdf=1/(nXdt)where: df if the band width in Hz n the number of input data points dt the raw data sampling interval in seconds Forexample,ifthedatawassampledat200Hz(dt=0.005s),withthe2048inputdatapoints ofourexample,eachspectrumvaluerepresentspoweroveranintervalof0.0976Hz. Saiddifferently,thismeansthatthefirstvalueofthespectrumrepresentspowerbetween0Hz and0.0976Hz,thesecondpointpowerbetween0.0976Hzand0.195Hzandsoon. Inmostcases,youwillnotneedsuchahighfrequencyresolution(eghavingpowerevery 0.0976Hz),andthisiswhereyoushouldthespectrumexportundersamplingfeature. Forexample,ifyousetthisfactorto8: Spectrumdatapointsnumberwilldropfromtheoriginal1024downto128,eachpointofthe spectrum representing power within a frequency width of 0.78Hz. Similarly,youwillveryoftenhavelittleinterestforspectrumdatainthehighfrequencyrange. Indeed,moststudiesinEEGdonotassessanysignalcomponenthigherthan40to60Hz.To avoidneedlesslyexportingspectrumdataabovesomelimit,usethespectrumexportmax frequency (Hz) setting.

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electroencephalogram analyzer (EEG)

Exported spectrum data shows up in the epoch per epoch data zone (also called beat section)ofthetextfile,totherightofanyotherexporteddata. Ifspectrumdatafrommorethanonechannelisexported,theyareappendedfurthertothe right. Thefirstlabellineindicatechannel(orrawdatainputorlead)index,followedbyspectrum data index. The second label line indicates the frequency (Hz) at the beginning of the frequency zone of the current data column.

Spectrum export example. Spectrumofthefirstdatachannelisexportedwithanundersamplingfactorcreatingafrequency increment per column of 3.125 Hz and export is limited to frequencies below 40Hz. Forexample,thethirdcolumn,labeledch1cl3andsublabelled6.25,containsthedatapower between frequency 6.250Hz and 9.275Hz 135

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ecgAUTO version 3.0 user manual -

Spectrum of the second data channel is exported with an undersampling factor creating a frequency increment per column of 0.781 Hz.

7.11 sleep scoring module (EEG)Sleep in mammals and birds involves two main stages as measured by field potential recordings: slow-wavesleep,characterizedbylarge-amplitudeslowcorticalrhythms REM(rapideyemovement)sleep,whichischaracterizedbylow-amplitudeandfaster cortical rhythms. This stage is also known as paradoxical sleep since the EEG patterns are similar to those present during the alert awake state. These two sleep stages alternate in a highly structured way during natural sleep. Insleepscoring,segmentsoftheeegtraceareanalyzedforthepurposeofcategorizingthem into one of the stages. The sleep scoring scoring module of of four stages: active wake quiet wake slow wave sleep REM sleep Eachsegmentisanepoch,whoselengthisdefinedbytheuserinthe data strip lengthfield. The sleep scoring module uses EEG signals and EMG signals to discriminate between sleep and non-sleep stages.ecgAUTOs

eeg analyzer categorizes segments into one

7.11.1 OverviewThealgorithmusedbythesleepscoringmodulecanberepresentedbyaflowdiagram(figure n92).Boldedtextrepresentstheuser-adjustablesettingsavailableinthesleepscoringmodule(withtheexceptionofthefrequencybands,whichareneverthelessdefinedintheeeg analyser settings). In this example we assume that the 3 parameters used as inputs are: Power from emg Energy from cortex Power in the 3-6hz band from hippocampus But of course any other combination of input parameters may also be used. 136 The software does not apply any check on the validity of the chosen parameters to assess sleepstage,noronthepertinenceofthevalueschosenforthresholds.

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sleep scoring module (EEG)

Is the power of the emg signal in the frequency band 15-33 Hz greater than 0.0010 V2/s? no Is the energy of the cortical eeg signal greater than 4400 V2? no Is the power of the hippocampal eeg signal in the frequency band 3-6 Hz greater than 720 V2? no quiet wake yes REM sleepfiguren92. sleep scoring algorithm

yes

active wake yes slow wave sleep

7.11.2 selecting inputsTousethesleepscoringmodule,yourconfigurationmusthavethreeinputs,allofwhichare linkedtotheEEGanalyzer(figuren936).

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figuren93.

three inputs must be selected and EEG analyzer assigned to each

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7.11.3 sleep scoring settingsSleep scoring settings are accessed in the EEG analyzer settings by: activatingFourrieranalysisusingtheFFT toggle switch then,activatingthesleepscoringmoduleusingtheSleep Scoring toggle switch; this displaysanumberofspecificsettingsshowninthefigurehereunder.

figuren94.

accessing the sleep scoring settings (circled in yellow)

Theuser-adjustablesleepscoringsettingsarethoseinboldinthealgorithmflowdiagram (withtheexceptionofthefrequencybands,whichareneverthelessdefinedintheeeganalyser settings): lead (input) parameter threshold

condition 1 condition 2 condition 3 Is the power of the emg signal in the frequency band 15-33 Hz greater than 0.0010 V2/s? no Is the energy of the cortical eeg signal greater than 4400 V2? no Is the power of the hippocampal eeg signal in the frequency band 3-6 Hz greater than 720 V2? no quiet wake yes REM sleep yes slow wave sleep yes active wake

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figuren95. sleep scoring algorithm

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inputs AlthoughallthreeinputsmustbelinkedtoanEEGanalyzer,thesignalmaybeadifferenttype ofbiopotential(intheaboveexample,input3isanEMGsignal). Intheaboveexample,condition1useslead1,condition2useslead2,andcondition3uses lead3,butthisisnotcompulsory.Youmayuseanyleadforeachcondition-itisyourresponsibilitytoensurethatyourconditionswillyieldresultsthatarescientificallymeaningful. Sleep scoring analysis settings It is not possible to recommend a particular choice of parameters for effective sleep scoring. Differentresearchersseemtohavedifferentopinions;often,however,thefollowingconidtions are used: condition1:corticalEEGsignal,usuallypowerratiowithinaspecifiedfrequencyrange condition2:hippocampalEEGsignal,usuallypowerratiowithinaspecifiedfrequency range condition3:anEMGoractivitysignal,usuallymaxvalueortotalpower thresholds Asregardsthethresholds,expertsinthefieldofsleepscoringsaythatitisdifficultorimpossibletodefinethresholdvaluesthatwillproducereliablesleepscoringondifferentsubjects. Ingeneral,researchersdeterminethresholdvaluesbytrialanderror.TheMultitrendpanelhas a special feature for sleep scoring to help users determine optimal threshold values (see next section). multitrend panel provides a special feature in the Multitrend panel to allow you to determine the optimal threshold values. To make use of this feature:ecgAUTO

1. Open the Multitrend graph panel. 2. Set the panel to display 8 graphs. 3. Forgraphs1-3,selecttheSleepscoringcondition(foryourconvenience,theyhave the__SLEEPsuffixattached).

139 Intraces4-8,selectsleepscore,activewake,quietwake,REMsleepandSWsleep: www.emka.fr


4. Trend graphs automatically appear - by default the bar graph display is used (overriding any other choice such as solid circle or small dots):

The current threshold of each input (graphs 1 to 3) is shown as a horizontal dotted red line and its numerical value displayed on the left edge of this line. Each input also has a black triangle at its right side whose tip is initially aligned with the threshold. Movethetriangleupanddowntoadjustthethresholdvalue.Asyoudoso,theanalysisresults in the Multitrend graphs and the main data table are immediately updated. 140 Please note that manually adjusted threshold values are not automatically fed back into analyzer settings. Therefore,ifyouwanttokeepthenewthresholdvaluesintheconfigurationforlateruse,you must return to the EEG analyzer settings panel and enter them manually.emka TECHNOLOGIES


7.11.4 main panel with display optionsfiguren96showsthemainpanelaftersleepscoringanalysis.Inthedatatable,thesleepscore column contains an integer from 1 to 4 and the columns to the right for each state of each input are either empty or contain 1.

figuren96.

main panel after sleep scoring analysis

In the graph settings panel (Graph Settingsorrightclickanywhereinthedatawindow),you cansetspecificcolorstoeachstate(figuren97).Thesecolorsaredisplayedbelowthefirst rawdatatraceofthemainpanel(figuren96).

figuren97.

assigning colors to each state

7.11.5 SLEEP score manual edition from main panelOnceSLEEPscoringanalysishasbeenperformed,themaintableshowsonelineofdataper epoch. 141

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Most researchers wish to perform a visual check of the sleep scores produced by the software and have the ability to edit these values. This is possible. SLEEPscoresvaluestakeany4followingvalues:1,2,3,4 To manually edit: On the main table click on the epoch line to edit; Thisdisplaysthecorrespondingepochinthecenterofgraph,surroundedbyablack rectangle. Fromthekeyboard,typeanynumberfrom1to4accordingtoyournewchoiceof sleep score. This action immediately: Enters the new value in the sleep score column and adapt the individual score columns accordingly Changes the color of the score display on the top trace Updates statistical step values

7.11.6 SLEEP manual scoring from main panelSome researchers also wish to manually assign one of many different types of scores. They also prefer to customize the automated scores. The software provides the ability to have up to 18 manual scores. Asanexample,thesettingsasinthepanelinnextfigure: AttributecustomlabelsaSW,bREM,cQW,dAWdoautomatedscores; Allow the us of 2 custom scores; These 2 custom scores: Are labeled aaa and bbb Are assigned to the epoch by typing keys W and 6. In the present example: Typingkeys1to4,willassignscorevaluesof1to4,withlabelsaSWetc 142 TypingkeyW,willassignscorevalue11withlabelaaa Typingkey6,willassignscorevalue12withlabelbbb

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Custom scores can only be assigned trigger keys in the following ranges: 5 to 9 a to z A to Z

Because it would take a long time the software to refresh all graphs and therefore create inconvenienceintheeaseofuse,editionsdonotautomaticallytriggerrefreshoftrendgraph displays.ThiscanbemanuallytriggeredfromthemultitrendgraphpanelfromtheForceplot allpointsicon. Asoonasyouperformatleastonemanualedition,theblackcursorsusedonthemultitrend graph panel to adjust sleep scoring threshold turn grey and become inactive. You may make these cursors active again from the Multi trend settings panel by clicking on the sleep_arrowon/oftogglebutton.Whenyoudothatyouwillbeaskedtoconfirmyouraction, sinceoncethecursorsbecomeactiveagain,anyactiononthemwillimmediatelyupdateall sleepscorecomputations,includingthoseyouhavemanuallyedited,whichwouldbelost. To conclude on the proper sequence of actions to perform sleep scoring : Run automated analysis; Fromthemultitrendgraph,performthresholdadjustmentswiththecursors; Checktheresultsandifrequiredperformmanual,epochperepocheditionofsleep scores; Save the results.

7.11.7 Effect of score manual edition on multitrend graphOnceyoustartmakingmanualeditionofsleepscores,realizethatanyupdateoftheautomatic scoring would replace any manual edition you might have already made. Topreventfromunwantedsuchlossofmanualeditions,assoonasatleastonemanualedition is performed, the black arrows of the multitrend panel used for adjustment of automated scoring threshold turn from black to grey and become inactive. 143

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Ifyouagreetoloseyourmanualeditionandupdateautomatedscoring,youmustreactivate theadjustmentarrows.Todothat,inthemultitrendpanel,openthesettingspanelandtoggle the sleep arrow button from off to on. Below: Multi trend panel with inactivated adjustement arrows (notice their grey color). Multi trend settings panel, with the sleep arrow button in the centre of the upper section.

7.11.8 Using manual SLEEP scoring onlySomeresearchersmaywishtomanuallyscoreallepochs,egmakenouseofautomatedscoring feature. Todothat,itisbesttorunananalysiswhichcreateepochs,computesdataandspectrums, but does not assign any sleep scores so that the score values remain blank until they have manually be assigned a value. 144

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7.11.9 Main trace display in case of epoch overlappingVeryoften,theuserwillsetupthesoftwaresothatsuccessiveepochsoverlap.Thiscreatesa practicaldifficultyinshowing,onthemaintrace,colorrectanglesrepresentingsleepscores and/orFFTspectrum. Toovercomethis,thedisplayedwidthofcoloredrectanglesandspectrumsisreducedfrom both ends so that they remain centered on epoch centers but do not expend left and right to the end of that epoch. Nextfigureshowsexampleofsuchasituation.Thecurrentactiveepoch,inblue,withalight graybackgroundandlabelledbREMactuallyextendsonthewholegrayarea,overlappingon the previous and following cQW orange epochs. Settingthedisplaymodetoonlyshowmarksontheactiveepoch,asinthenextfigure,makes this easier to understand.

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7.11.10

Main trace display in case of large number of epochs

Whenthenumberofepochsdisplayedonthemaintraceincreases,somefeaturesareprogressively removed: Numeric values of spectrum grid; Spectrum grid; Label of sleep scores; Spectrum; Zooming in again re establishes the displays of these features.

7.12 epilepsy seizure detection module (EEG)The EEG analyzer can also be used to detect epileptic seizures from EEG traces. OnEEGrecordings,epilepticseizuresusuallyshowupasclearlymarkedevents,lastingfrom afewsecondstoafewminutes,duringwhichthesignalconsistentlyshowshigheramplitude variations and low frequency (3 to 8Hz) oscillations. Theaimofthisanalysisistoreporteachseizure,togetherwithitsduration.Thestatistical tools that operate systematically in ecgAUTO analyzed data then provide values such as: Number of seizures within each analysis step Accumulated seizure duration within each analysis step. Manual edition is also possible.

7.12.1 Analyzer settingsEpilepsy seizure (epilepsy in the rest of this text) detection is tuned using controls at the foot of the EEG settings panel. Software performs the analysis in 2 stages: Firststepistodetectepochs(computedasdescribedintheEEGanalysissectionatthebeginningofthischapter)forwhichsomeparametersexceedadefinedthreshold. Thisdetectioncanbeperformedusingoneparameteronly,orusing2parameters.Inthis second case detection can be performed using: OR logic (threshold must be exceeded for parameter 1 OR for parameter 2 for the epoch to be validated) or performed using a AND logic (threshold must be exceeded for both parameter 1ANDforparameter2fortheepochtobevalidated).Thischoiceisdefinedinthe Epilepsy detection setting.

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epilepsy seizure detection module (EEG)

Intheexampleshowninthefigure,oneepochwillbedetectedaspossiblecandidatetobe part of a seizure if parameter power from channel 1hSO1+_EEG exceeds value 7.00 OR if parameter band_2_val from channel 1hSO1+_EEG exceeds value 0.6

Once the software has detected a number of epochs that satisfy the indicated criteria (parameters exceed thresholds) it sets the EPL_state parameter to 1 instead of not available. The second analysis step is to search for series of consecutive valid epilepsy epochs which are longenoughtoqualifyasseizures.Intheaboveexample,aseriesisaseizureif: It the series it is at least 8 epochs long (minimum seizure length setting) And if it is separated from earlier and later seizures by an interruption being at least 3 epoch long (minimum break length setting). www.emka.fr 147


Whenaseriesofepochshasbeenqualifiedasaseizure,thesoftwareentersitslength,both asepochnumberandseconds,in2parametersnamedEPL_epochandEPL_Length Withtheserules,anyinterruptioninvalidepochswhichisonly1epochlong(lessthan2) leads to merging the 2 series into one single series. If the resulting series happens to be long enoughtoqualifyfortheminimumseizurelengthrequirement,itbecomesavalidepileptic seizure.

7.12.2 Analysis reviewSeeinthefigurehereundertheresultofaseizuredetectionasshowninthemaintable. Valid epochs appear as 1 in the EPL_state column. The series of consecutive epochs ends with a value in the EPL_epoch# and EPL_length column. When you click on the line indicating the seizure: You see the last epoch of the seizure sequence highlighted in the middle of the screen (here it is epoch 153) A green rectangle surrounding the complete seizure.

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By using menu item View Epilepsy table,youopentheEpilepsypanel(figurebelow). This panel has 3 lists and one graph.

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List_1,totheleft,containsonelineperdetectedseizure.Eachlinecontains: Seizure index Step # to which the seizure belongs Index of last epoch constituting the seizure Site time of this last epoch Length,inepochnumber,oftheseizure Length in seconds of the seizure Number of seizures in the analysis step to which the seizure belongs

List_2,inthemiddle,containsonelineperanalysisepochforthecurrentseizureactiveinlist 1. Epoch index Step # to which the seizure belongs Indexofeachepochconstitutingtheseizure,withinthatseizure(startsat1) Indexofeachepochconstitutingtheseizure,withinglobalanalysisindex. ThisList_2alsocontainsadefinednumberofepochspriorandaftertheseizure.Thesehave alocalepochindexreportedas(-1),(-2)etcforthosebeforetheseizureand(+1),(+2)for thoseaftertheseizure.Thenumberofsuchsurroundingepochsisdefinedasepochextra number,setto5intheprintedexampleabove. List_3,totheright,containsonelineperanalysisstep.Itshows: Step index Number of seizures per step Total seizure length per step www.emka.fr 149


Lists_1and_3are,bydefault,showninchronologicalorder,withthefirstseizureofthefile shownfirst.Twolistboxesletyouchoosetoalsodisplayaccordingto: increasing or decreasing seizure lengths (List_1) increasingordecreasingseizurenumberinthestep,oincreasingordecreasingtotal seizure length in the step (List_3) Theselistsareinteractive.ForexamplewhenyouclickonList_1,List_2updatestoshowthe relevant epoch list. When you click on List_1 you also see the corresponding seizure in the graph. When you click on List_2 you see the corresponding epoch in the graph as well as the status of condition set in the tuning panel for automated detection of the seizures. Forexample,inthefigurebelow,onList_2intheliddle,theactivelineisthatofepoch(-3) thatisthethirdepochbeforethebeginningoftheseizure,andthelineaboveindicatesthat only condition is used for the automated detection (since only one such line is displayed) and thettheconditionisthatpowershouldbegreaterthan12,andthatthisconditionisnot presentlysincepower=1.46,whichiswhythebackgroundispink.

7.12.3 Seizure editionInvalidation: Seizurecanbeinvalidatedbyclickingontheseizuretabletoselect,thenpressingsuppress ordelete.Invalidseizureappearsinpinkinthelist,andasdottedrectangleonthegraph.If the active seizure is invalid it shows in red. The invalidated seizure remains in the list but with a null length (s) value. 150 Revalidation: Pressing delete or suppress on an invalidated seizure toggles it back to valid state.emka TECHNOLOGIES


Editing seizure limits: Itwillhappenthatyouwishtoadjustthebeginningand/orthestartofaseizure.Todothat: Fromthelist,selecttheseizureyouwishtoedit; OntheEpilepsy_panelgraph,positionthecursorwhereyouwanttoindicatethe modifiedseizurebeginning,andpressf2(functionkeyf2)torecordthisposition. OntheEpilepsy_panelgraph,positionthecursorwhereyouwanttoindicatethe modifiedseizureend,andpressf3(functionkeyf3)torecordthisposition. Press f5 to validate and update seizure data. Edited seizure shows in blue in the list and as current seizure on graph. On an edited seizure you will notice that the vertical dotted green lines that indicate the original limits as found by the software are different from the present limits indicatedbythebluerectangle.Seefigurebelow.

Zooming on seizure graph: If you need to zoom on the seizure graph: Right_click on the zone which should be at the center of the zooming action. Right_click again is higher zoom is needed. Double_click to return to initial display.

7.12.4 Seizure manual additionIt may happen that you want to manually add a seizure that was not detected by the software during the initial automated analysis phase. 151

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To do this: Fromthemainpanelgraph(andnotfromtheepilepsypanelgraph),dragthemouse ontheareacontainingtheseizuretocreate.Thiscreatesaredrectangle(figure).

Press Ctrl a (simultaneously the Ctrl and the a keys) to open the beat edition panel.

Whenthepanelappears,thegraphshowstheseizurestartandstopcorresponding to where you made your selection with the mouse on the main graph. Ifyouaresatisfiedwithseizurelimits,simplypress >>Save_beat menu item. If not movethecursortowhatyouthinkshouldbethebeginningoftheseizure,thenclick on the epl_start button. Do the same for the seizure end. Click on menu item >>Save_beat. OntheEpilepsypanel,thenewlycreatedseizureisinsertedintheseizurelistand showninyellow.Whenactiveitalsoshowsinyellowonthegraph(figurebelow). 152 The newly created seizure is arbitrarily attached to one of the epochs closest to its end. It is also assigned an arbitrary value for its length measured in epochs. What is important is the actual length in seconds which the one corresponding to your manual selection of seizure start and stop.

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Youcannotcanceloreraseamanuallycreatedseizure,but,likeforanyotherseizure,youcan invalidate it.

7.12.5 Splitting a seizure in multiple shorter seizuresIf the software has produced a long seizure event which you think should be considered as multiple shorter events you may edit doing the following: shortenthisseizure,endingitwherethefirstoftheshorterseizuresshouldend. use the manual edition possibility to create the other seizure events.

7.12.6 Automatic trimming of beginning and end of seizure events beginning and endIt often happens that automatically detected seizure events are marked as starting a little too earlyandendingalittletoolate.Thisisduetothefactthatthefirstepochsatisfyingthevalidation criteria happens to cover an area with non seizure data and seizure data. The last setting parameter for EPL detection ( extreme_epochs_truncating (%) )at the bottomofthesettingpanel(seefigureabove)allowsyoutosaythat: SeizureeventsstartsatX%ofepochlengthwithinthefirstvalidepoch; SeizureeventsstopatX%ofepochlengthpriortotheendofthelastvalidepoch; Thisfeatureusuallyallowsyoutoreducethenumberofseizureeventsthatyoufindnecessary to edit manually. Ifyoudonotwantthisfeaturetofunction,setthesettingvalueto0(zero). Whenyouuseit,forexamplewitha30%value,seethattheverticalgreendottedlineshowingthebeginningofthefirstvalidepochcomesearlierthantheactualreportedseizureevents in the Epilepsy panel graph: www.emka.fr 153


Also,inthemaingraph,youseethatthegreenrectangleshowingthecurrentseizureevent starts at 30% of the current epoch shown in red dotted lines:

7.12.7 Necessary protocol settingsWhenyourunacontinuousseizuredetectionanalysis,itisbesttoruntheprotocolincontinuous mode (see earlier in the ecgAuto manual details about analysis protocol settings). Seefigureofaprotocolinstructionsitthecontinuous_analysis_featuresettoon.

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Ifyouneedtoperformnoncontinuousanalysis,forexampleoneanalysisstepfo5mnevery hour,youwilldeactivatethecontinuousmode.Insuchcase,makesurethatthemax#of beatsperstepvalueexceedsthenumberofepochyouwillhaveineachstep,oryouwillsee thatanalysishasstoppedmidwayintothestep,whenthenumberofepochsreachestheindicated value. Forexamplewith5mnstepsandepochswhichare2slongwitha50%overlap,youwillhave a301epochsperstep,soyouneedtoenteranumberhigherthan301inthemax#ofbeats per step setting to obtain full analysis.

7.12.8 Seizure events that occur at the junction of analysis protocol stepsWhen you run an analysis made of contiguous analysis steps software is able to properly detect and report seizure evnts which happen to be at the junction of 2 consecutive steps. Whenthishappens,theseizureeventisreportedinthesecondstep(egthesetpthatcontains the last epoch of the seizure event) regardless of respective seizure length on either step. In otherwords,evenifaseizureeventhappenstohave90%ofitslengthinstep3andtheremaining10%onstep4,itisreportedinstep4.

7.12.9 SeizurereportintotextfileSeizures appear in the main table as data lines irregularly distributed within the global lists of all analysis epochs. Ifyouwanttoexportalistthatonlycontainsthedetectedseizures,youmaydoasfollows: Performtheanalysisandalltheeditionyoumightfindnecessary; IntheList_display_and_text_export_settingspanel,openthesection->txttaband make sure that your selection includes the epilepsy table. 155

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Theresultingepilepsytableexportedtothetextfileisasshownbelowinthefigure. step# indicates in which analysis step the epileptic seizure was found; abs# indicates the index of the seizure event within the epileptic seizure table. Theonlyparameterreportedhereistheseizurelengthinseconds,accordingtothe selection made in the beat->txttabsettings(figurebelow).

7.12.10156

Seizurereportstatisticsintotextfile

Itisalsoofteninterestingtoreportthenumberofseizuresaswellastheirtotallength,for each analysis step. Todothat,alsoincludethestepsectionintheexportsettings,and,inthestatisticstab,select theaverage,numberandsumtypes(figurebelow).emka TECHNOLOGIES


Theexportedtextfilewilltheninclude,foreachstep,onecolumnwiththeaveragelengthof seizures of the step, one column with the number of seizures, one column with the total lengthofseizures(figurebelow).

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building a library

chapter 8. libraries (for ecg analysis)A library is a group of waveforms used as reference waveforms during ecg analysis. It is saved as part of theconfiguration;howeverlibrariescanalsobemanipulatedasseparateitems.ecgAUTOdoesnotaddwaveformstothelibraryautomatically.Inotherwords,allthewaveformsinany

librarywereoriginallyaddedbyahuman.Ifyouareabeginner,youcanusealibrarythathasalreadybeen created,e.g.alibrarysuppliedbyemkaTECHNOLOGIES. Ifyouareanadvanceduserwiththenecessaryuserprivileges,youcanbuildandeditalibraryfreely. Buildingalibrarymeansaddingwaveformstoit;typically,referencewaveformsareselectedfromwaveformsintherawdatatrace(ifthewaveformsarenoisy,youmayuseanaveragewaveform,whichisthe average of several beats). Wheneverauseraddsawaveformtothelibrary,hemustpositionmarkersforkeypointssuchasonset ofPwave,Rwavepeak,endofTwave.Editingalibrarymeansaddingandremovingwaveforms,and modifying the position of markers. Thereisnolimittothenumberofwaveformsinalibrary-buttypically,alibrarycontains10to30 waveforms. Also there is also no limit to the number of separate libraries that you can create. It is commonpracticetobuildonelibraryforeachspecies.However,insomecases,therearegoodreasons to create one library per subject. A library must be loaded for ecgAUTO tobeabletoperformanalysis.Nevertheless,analysiswillfailifthe referencewaveformsinthelibraryarenotsufficientlysimilartotheecgdata.Inthiscase,youmustedit the library. Thischapterdescribeshowtobuildyourownlibrarytouseforanalysis.Inchronologicalorder,thekey steps are: 1. load existing library waveforms (section 8.1) 2. add waveforms to library (if waveforms are noisy you can use the averaging function) 3. edit marks on library waveforms manually; you may use the prepositioning feature to save time 4.delete,disable,enablelibrarywaveforms Overtime,youcanrepeatanyofthesestepsasoftenasnecessary,torefinethelibraryforexample.

8.1 building a libraryWhen you load raw data into automatically loaded.ecgAUTO, the library in the configuration (if one exists) is

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ecgAUTO version 3.0 user manual libraries (for ecg analysis)

You can continue building this library or start from zero. The following options are available:Library View & edit Library New & replace

This option will delete all waveforms from the loaded library.Library Load library Load & replace

Youmustselectalibraryfile,whichwillnecessarilybeintheformat*.ecg.lib Afterselection,thecurrentlyloadedlibraryisclosed-anyunsavedchangesare lost - then the selected library is loaded.Library Load library Load & append

Youmustselectalibraryfile,whichwillnecessarilybeintheformat*.ecg.lib After selection, the waveforms of the selected library file are added to the currently loaded library.Library Import library Import from config & replace

You must select a configuration file, which will necessarily be in the format*.ecg.cfg

Afterselection,thewaveformsinthecurrentlyloadedlibraryarereplacedby thoseinthelibraryintheconfigurationfile.Library Import library Import from config & append

You must select a configuration file, which will necessarily be in the format*.ecg.cfg

Afterselection,thewaveformsofthelibraryintheconfigurationfileareadded to the currently loaded library.Library Import library Import from .z results & replace

You must select a .z resultsfile. Afterselection,thewaveformsinthecurrentlyloadedlibraryarereplacedby thoseintheresultsfile.Library Import library Import from .z results & append

160

Youmustselecta.zresultsfile. After selection, the waveforms in the results file are added to the currently loaded library.

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building a library

Library Load version 1 library Load & replace

YoumustselectalibraryfileproducedbyecgAUTOversion 1. Afterselection,thewaveformsinthecurrentlyloadedlibraryarereplacedby thoseintheselectedlibraryfile.Library Load version 1 library Load & append

YoumustselectalibraryfileproducedbyecgAUTOversion 1. After selection, the waveforms in the selected library file are added to the currently loaded library.Library Save as *.ecg.lib file

Select to save the current librarty as an ecg.lib.file.

8.1.1 adding waveforms to a libraryIt is assumed that you have already loaded ecg data into ecgAUTO.

8.1.1.1 creating a library waveform from a single waveformInthemainscreen,selectaportionofthesignalfromslightlybeforetheonsetofthePwave toslightlyaftertheendoftheTwave,asfollows: click a point in the data window to designate one side of a selection box whilekeepingtheleftmousebuttonpressed,movethecursortoanotherpoint release the mouse button to designate the other side of the selection box. Please note that the entire signal between the left and right sides of the selection box is actually selected (there will be no cropping at the top and bottom).

figuren98. main screen with red selection box

161

Press the space bar to send the selected portion of the signal to the library panel.

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8.1.1.2 the library panelWe presently suppose that prepositioning is switched off. Theinformationinthelibrarypanelisdividedintoseveralsections(figuren99):averaging mode section

1 Button to activate or deactivate the waveform averaging mode (described further down in this section).waveform origin

2

This section contains: pathandnameofrawdatafile,andinputfromwhichwaveformisderived index of currently displayed waveform (in viewfield) total number of waveforms in the library (in total#field) activestatusofthecurrentwaveform,indicatingwhetherthewaveformiscurrently enabled or disabled authors name creation date label of selected waveform samplerateofrawdatafile site-timeofRpeakmarkwithinthefilemark and cursor data

3 Thefirstcolumncontainsinformationaboutcertaintimeintervals.Thevaluesareupdated dynamically as marks are repositioned (or 0 if the mark is not present). Wavelength is given in ms. The start and end are indicated by the square brackets. Capture length is the duration of the signal in the waveform window (corresponding to the duration of signal that you selected in the main screen). As you move the cursor: cur-R(ms) shows the value between between the cursor and R peak mark (in ms) f(cur) shows the voltage of the signal at the time point of the cursormark list

4 Seelistofmarksinparametersettings,page67 for an explanation of the marks. 162waveform window

5 Theportionofsignalthatyouselectedisdisplayedinthewaveformwindow.Insomecase, ecgAUTO will display more of the original signal at the start or end.

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building a library

The square bracks indicate the start and end of the waveform (ecgAUTO attempts to locate thesepointsitself,butyoumayneedtoeditthem).Thesignalisredinsidethebracketsand black outside.

1 4

2 5

3

figuren99. library panel

8.1.1.3 selecting correct portion of signal for reference waveformsIt is essential that the waveforms in the library are of the correct length. Ideally you should select the signal from slightly before the onset of the P wave to slightly after the end of the T wave(seefiguren100).

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waveform of correct length

waveform starts too early and ends too late

waveform is too long (more than one complex selected!)

figuren100. selecting part of signal for use as a library waveform

8.1.1.4 creating a library waveform from an average waveformallows you to create a library waveform by taking the average of two or more waveforms.ecgAUTO

This is particularly useful when you have a noisy signal. Compared with a non-averaged waveform,theaveragedwaveformwill-inmostcases-belessnoisyandabetterrepresentation of the true ecg complex. 164 The averaging function uses the waveforms which are currently displayed in the data panel of the main screen (either all of these or a subset of these).

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building a library

procedure 1. Bydefault,averagingwillbedoneonthesegmentofsignaldatathatiscurrently displayed in the data panel of the main screen. Ifyouacceptthisdefault,selectLibrary View&Edit in the main screen. If you want to average only part of the segment showing in the data panel: select a portion of signal (using the standard method). then press Ctrl-W to open the library panel. 2. Inthelibrarypanel,click or select Waveform Average to open the Average

figuren101. average Waveform panel (before data loaded)

3. Click Load data! to load the signal data (part or all of the signal currently displayed in the data panel of the main screen).

Display 1 (signal from data panel in main screen)

Display 2 (reference waveform)

Display 3 reference waveform average waveform figuren102. Average Waveform panel (after data loaded)

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There are three displays in the Average Waveform data panel. Display 1containsaportionofthesignal(specificallytheportionthatiscurrentlydisplayedin the data panel of the main screen). will calculate the average waveform using waveforms (data waveforms) in this portion of signal. In the next step, you define criteria to allow ecgAUTO to select which data waveforms to use in this calculation.ecgAUTO

Each data waveform is associated with a bar. The height of the bar indicates the similarity with thereferencewaveform,from0(noresemblance)to1(identical). The bar is grey for data waveforms included in the averaging calculation and green those not included in the averaging calculation. Display 2 contains the reference waveform. Display 3 contains the reference waveform and the average waveform. 4. DefinethecriteriontoallowecgAUTO to select which data waveforms to use in the averagingcalculation.Youmustuseoneoftwomethods,byselectingfromthedropdown list: mincorrel.Inthismethod,ecgAUTO will select data waveforms that are at least x% similartothereferencewaveform,wherexisthevalueinminimumcorrelation (between0.8and1).TheredhorizontallineinDisplay1reflectsthisvalue. best n waves - ecgAUTOwillselectthexmostsimilardatawaveforms,wherexisthe value in wave number. Asyoumodifythecriteria,youcanseeinstantlywhichwaveformsareincludedor not (display 1) and the resulting average waveform (display 3). 5. To use a new set of data waveforms: move along the data in the main screen select Load data! Then select Get wave to update the resulting average waveform. 6. Whenyouaresatisfied,clickSave wave to transfer the average waveform to the Library panel. 7. Enter a name for the average waveform in the wave labelfield. 8. Savetheecgconfiguration,byselecting File Save as or File Save in the main screen. automatic application of averaging Bydefault,youmustapplyaveragingtoeveryreferencewaveform.However,youcantellecgAUTOtoapplyaveragingautomatically.Inthiscase,everytimeyouselectaportionofsignal fromthemainscreen,ecgAUTO opens the Library panel containing the average waveform. It remains possible to go into the Average Waveform panel and adjust the settings manually. 166 Inthetoggleswitch,locatedonthetopleftoftheLibrarypanel(figuren103),selectwhether you want ecgAUTO to always or never apply averating automatically. for

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building a library

figuren103. averaging toggle switch

position marks Duringanalysis,ecgAUTO uses the marks in the reference waveforms to position marks in the ecg data. You do not have to position all the marks on every reference waveform (except R which is compulsory).Forexample,ifyouonlywanttoperformQTmeasurements,youonlyneedto positionmarksR,T(endofTwave).Thisalsospeedsupdata processing. Prepositioning is an ecgAUTOfunctionthatautomaticallypositionsmarkers.However,this processisnot100%effective.Asthenameimplies,youshouldmanuallypositionmarksafter prepositioning.Nevertheless,itcansavetime. The next sections describe how to position marks manually and how to activate prepositioning.

8.1.1.5 positioning marksInthissection,itisassumedthatprepositioningisnotactive.Onlyonemarkshouldbepresentonthewaveform(R)(figuren104).

167figuren104. positioning marks (start)

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The procedure to position a mark is as follows: 1. Select Waverform Edit or click on the icon available(figuren105). the toolbar. The mark list becoms

The left column contains a list of marks as well as the start and stop marks for the selected waveform. The number in the right column is an index for acquisition points (from the left of thedatawindow,notthestartofthewaveform).0indicatethatthemarkisnotavailable. Marks which are required to calculate the current parameters are highlighted in yellow.

figuren105. mark

2. To position a mark: position the cursor at the correct time by clicking on a point within the data window (the cursor does not have to be on the signal) clickthecorrespondingmarkintheleftcolumn.Forexample,ifyouarepositioning thecomment>>create menu item F3definetheendofaZone F4eraseaComment 222 FunctionkeysF5toF10maybeusedasshortcutsforaddingcomments.Theprocedureto assign a comment to a function key is described below. TousethepredefinedkeysF5toF10theymustfirstbeactivated.emka TECHNOLOGIES

reviewing and processing results

To activate/deactivate a function key or to assign a comment to a function key, open the Assigncommenttokeyspanel(figuren155)byselectingComment Comment function keys in the raw data display or by clicking on the icon

figuren155. function key assignment panel

UsetheON/OFFbuttontoactivate/deactivateeachkey. ForkeysinF5toF10,youcanentertextandacolour.Whenthekeyisactivated,pressingthe key will add the comment where the cursor is .

10.3.7.4 view Comment or Zone informationInthetableofthemainscreen,pressthespacebarwhileamark(CommentorZone)is highlighted to open the Mark information panel.

figuren156. Comment and Zone information

erase a Comment or Zone ProvidedthattheF4keyisactivated(seeprevioussection),pressingF4inthemainscreenor therawdatadisplaywillbringtheclosestComment,Zone-startorZone-stopmarktothe centerofthegraph,andopentheinformationpanelwithaneraseoption(figuren157). 223

figuren157. confirmationpanelbeforeerasingamark

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ecgAUTO version 3.0 user manual analysis

Click erase toerasethemark,orcancel to cancel the operation. Erasing a Zone-stop marks transforms the corresponding Zone-start to a Comment mark. However,erasingaZone-startmarkalsoerasesthecorrespondingZone-stopmark Ifafunctionkeyisactivated,thekeyisonlyeffectivewhentherawdatadisplayisitselfactive, i.e. it is open and the active.

10.3.8 editing markers on beatsIt is possible to edit the position of markers after analysis. This provides users the possibility to make any corrections. Toeditabeat,firsthighlightitinthetableofthemainscreen,thenpressthespacebar.The beatisopenedintheBeatmarkseditingwindow(figuren139). This window is very similar to the window used to position markers of library waveforms (section 0). There are some differences:automatic edit comment

(1): see below.

beat information (2):Theabsoluteandrelative(withinstep)indexnumberofthebeat,andthe

index number of the step in which it occurs.beat editing history

(3): see below.

interval information (4):The duration (in ms) of certain interval parameters is given (unless the

corresponding markers have not been positioned).

1 2

3

4

224figuren158. Marks edition panel

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Reposition the markers as you like (in the same way as you did when editing markers of library waveforms). Whenpositioningmarkers,itissometimesusefultosimultaneouslyseeotherleadsorinputs. Todoso,select Display leads!toopentheDisplayauxiliaryleadspanel(figuren159).Youcan thenselecttheotherleadsorinputstodisplayatthesametime,aswellastheircolor.

figuren159. selecting lead display during beat editing

You may enter a comment. Validateyourmodificationsbyselecting Save beat! effect of a beat edition Onceabeathasbeenedited,thefollowinghappen: intervals and other parameters for that beat are recomputed and the new results appear in the main table as well as in the trend graphs. statisticalvaluesforthesteptowhichthatbeatbelongsarealsorecomputed,and thestatisticalvaluesontrendgraphsmodifiedaccordingly. creates a comment then attaches it to the edited beat. This automatic edit commentincludes:date,timeandauthorofthebeatedit;descriptionoftheedit (whichmarkerwasmoved,byhowmanymillisecondsinwhichdirection).This commentappearsinthetableofthemainscreen(theexampleinfiguren160 informs us that the beat has been edited twice).ecgAUTO

225figuren160. beat editing information in table

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beat edition history Itispossiblethatabeatwillundergosuccessiveeditsorinvalidation/revalidation(theuser changeshismind,thestudydirectorwantstoeditchangesalreadymadebyothers,etc). This is how ecgAUTO helps you to keep track of successive beat edits: thecommentattachedtothebeatcontainstheindexnumberoftheedit(1,2,3etc). in the Beat marks editing window: the second modiffielddisplaysthetotalnumberofeditsperformed. inthesamewindow,thefirstmodif fieldcontainstheindexnumberofthewaveform edit (0 is the unedited waveform). Enter a number to view the results of that waveform edit the automatic edit comment is provided (from software for the unedited beat). foreachedit,themarkersonthegraphareshownastheywereaftertheeditcurrently under examination. you can only edit the last state of the beat. Intheexampleoffiguren161, the user is viewing edit 1.There are 2 edits in total so the editing functionality is not available.

figuren161. viewing beat edit history

10.3.9 validating/invalidatinganalyzedecgcomplexes226 There might be cases where ecgAUTOhasproducedquestionableanalysisresults.Forexample, a segment of data may be so noisy that you decide that no measurements at all should be done. In this case you can choose to invalidate these beats rather than correct them. You cannot delete beats.You may consider invalidated beats as deleted beats. The difference is that invalidation is reversible.emka TECHNOLOGIES


to invalidate a complex Inthetableofthemainscreen,selectthelineofthebeattobeinvalidated. Pressdeletetoopentheinvalidate/revalidatepanelfiguren162.

figuren162. invalidate/revalidatepanel

Comments are optional (unless you have made them mandatory - see below). If you enter an invalidationcomment,ecgAUTO proposes to make it a default comment for complex invalidation.Youcanreuseacommentalreadydefinedinthecurrentsessionbyusingthedrop-down menu( ) Then: select Invalidate beat!toinvalidatethebeat.Alternatively,ifthepanelhasremained active(youhavenotdoneanythingelseonanotherwiththekeyboardormouse), you can press delete . select Invalidate step! to invalidate all beats of the step. When a complex is invalidated: the beat parameters in the table are replaced by inv a Comment is automatically inserted the complex has a blue background in the main screen display ().

227figuren163. main window after beat invalidation

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to revalidate a complex Torevalidateacomplex(i.e.torestoreitthetoitsoriginalstateofvalidbeat),selecttheline ofthebeattoberevalidatedinthetableofthemainscreen,thenpressdeletetoopenthe invalidate/revalidate panel. Proceed as for validation (the appropriate options are now available). mandatory comments (GLP) IfyouworkinafullGLPenvironment,yourrulesmayrequirethataspecificcommentisattachedtoanyinvalidationorrevalidationoperation.IntheGeneralsettings(section3.3),you can make such comment mandatory. Iftheoptionisactivated,pressingdeletetwicewillnotautomaticallyinvalidateorrevalidate a beat.You will have to enter a comment before being able to complete the operation.

10.4 recompute functionRecompute

used.

is a menu item of the Analysis settings panel. Here is why and when it can be

Whenyourunanecganalysis,themosttimeconsumingpartoftheprocessisthedetection of the markers on the signal trace. This takes up about 80% to 95% of the processing time. Oncealonganalysishasbeencompleted,youmaywishtomodifysomeanalysissettings,for examplebyaddingnewintervalparameters,oradifferenttypesofQTcorrection,orcustom parametersbasedonalreadydefinedparameters. Inthiscase,ifyoupress recompute, ecgAUTO will perform another full analysis in a shorter time because it will only calculate parameters based on the new settings (and use the previously detected markers). An example of the recompute function: ThefirstanalysishasparametersRR,HR,PRandQT,whichrequirepositioningof markersPwasnotincludedinthefirstanalysis).

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notes about display of data

10.5 notes about display of data10.5.1 null valuesIt happens that some or all values in the result tables are null. Here are some possible causes and remedies: Thisisprimarilycausedbythefactthatsomeofmarkerswerenotfound,becausethesoftware used a waveform library which did not contain this marker. Then,ifagivenparameterisnotcomputed,anyotherparameterwhichusesitasreference parameter will also not be computed. Forexample,ifQTisdefinedasintervalfrom,andif50,000),theremaybeashortdelaybeforechangesto settings are taken into account. hrv graphs settings

figuren168.

graph settings

Inthispanel,youcanselectbetweenautomaticormanualscaling.Beawarethatinautoscaling mode,anoutlyingpointononeepochaffectsthescaleonallgraphs(toavoidsuchissues,use manual scaling). 234 Thedatasettingsareappliedtoallaxesdisplayingdatavalues.Forexample,theYaxiswhen showingdatavsepochtime,butboththeX&YaxeswhendisplayingPoincarplots. The delta settings are applied to all axes displaying data delta values.

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panels

note: the same axes are applied to all graphs from all epochs. This makes it easier to assess changes from one epoch to another. Xaxesdisplayingtimewithintheepochareinautomatedscalingmodeacrossallepochs.If epochsareofdifferentlengths,allwillbedisplayedusingthelongestepochasreferenceand the shorter epochs will have a blue zone after the end of the epoch (figure n169).

figuren169.

blue zone at the end of a shorter epoch

11.5 panels11.5.1 Data panelThe Data panel shows the data points (parameter values) plotted according to their time within the epoch. Theredlineisthemeanvalue,andthetwobluelinesshowmean1standarddeviation.

mean + 1 s.d. mean mean - 1 s.d 235figuren170. Data panel

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ecgAUTO version 3.0 user manual - HRV studies (variability module)

It is possible to exclude data points from the epoch - these points are not deleted but are not involved in the calculation of variability parameters. Excluded points are shown as red on the graph. The Filtered data of a current epoch refers to the original data minus any excluded data points. In the top-left is information about the points. Calculated time domain parameters are shown in the lower left corner of the data panel (all parametersarerelati

user manual - ecgauto v3.0 rev1- april 2012

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