Publications

A major challenge in cardiac research is the limited translatability of drug screening and toxicity assays due to the use of in vitro models that poorly mimic the native cardiac environment. Human induced pluripotent stem cell-derived cardiomyocytes (hiPSC-CMs) offer a promising route forward, but conventional 2D culture on rigid substrates hinders their functional maturation and predictive accuracy. This study addresses this problem by investigating the effect of hybrid fibronectin-based hydrogels with tunable stiffness on the mechanical and electrical properties of hiPSC-CMs. We engineered hydrogels with stiffness mimicking the lowest range of neonatal heart tissue stiffness (2-4 kPa) and compared hiPSC-CM behavior on these substrates to that on standard fibronectin-coated glass. Our results demonstrate that hydrogel culture promotes more uniform and stable cardiomyocyte contractions, as evidenced by increased single peak percentages and altered contraction duration. Electrophysiological analysis revealed that hydrogel stiffness influences action potential duration and signal amplitude. Furthermore, hiPSC-CMs on hydrogels exhibited enhanced cell-matrix and cell-cell adhesion, indicating improved structural and functional connectivity. Drug testing with known cardioactive compounds, including isoproterenol and nifedipine, revealed distinct differences in drug responses between hydrogel and glass cultures, suggesting that hydrogels provide a more physiologically relevant platform for assessing drug effects. This work highlights the potential of engineered hydrogel substrates to enhance the functional maturity and predictive accuracy of hiPSC-CMs for cardiac research and drug development.

JTD Keywords: Beat, Cells, Contraction, Guinea-pig, Hydrogels, Ipsc-cardiomyocytes, Maturation, Mechanical properties, Platform, Sensitive dye di-4-anepps

Neural respiratory drive as measured by the electromyography allows the study of the imbalance between the load on respiratory muscles and its capacity. Surface respiratory electromyography (sEMG) is a non-invasive tool used for indirectly assessment of NRD. It also provides a way to evaluate the level and pattern of respiratory muscle activation. The prevalence of electrocardiographic activity (ECG) in respiratory sEMG signals hinders its proper evaluation. Moreover, the occurrence of abnormal heartbeats or cardiac arrhythmias in respiratory sEMG measures can make even more challenging the NRD estimation. Respiratory sEMG can be evaluated using the fixed sample entropy (fSampEn), a technique which is less affected by cardiac artefacts. The aim of this work was to investigate the performance of the fSampEn, the root mean square (RMS) and the average rectified value (ARV) on respiratory sEMG signals with supraventricular arrhythmias (SVA) for NRD estimation. fSampEn, ARV and RMS parameters increased as the inspiratory load increased during the test. fSampEn was less influenced by ECG with SVAs for the NRD estimation showing a greater response to respiratory sEMG, reflected with a higher percentage increase with increasing load (228 % total increase, compared to 142 % and 135 % for ARV and RMS, respectively).

JTD Keywords: Electrocardiography, Muscles, Electrodes, Estimation, Band-pass filters, Electromyography, Heart beat

In this paper, a non-linear HRV analysis was performed to assess fragmentation signatures observed in heartbeat time series after intermittent hypoxia (IH). Three markers quantifying short-term fragmentation levels, PIP, IALS and PSS, were evaluated on R-R interval series obtained in a rat model of recurrent apnea. Through airway obstructions, apnea episodes were periodically simulated in six anesthetized Sprague-Dawley rats. The number of apnea events per hour (AHI index) was varied during the first half of the experiment while apnea episodes lasted 15 s. For the second part, apnea episodes lasted 5, 10 or 15 s, but the AHI index was fixed. Recurrent apnea was repeated for 15-min time intervals in all cases, alternating with basal periods of the same duration. The fragmentation markers were evaluated in segments of 5 minutes, selected at the beginning and end of the experiment. The impact of the heart and breathing rates (HR and BR, respectively) on the parameter estimates was also investigated. The results obtained show a significant increase (from 5 to 10%, p <; 0.05) in fragmentation measures of heartbeat time series after IH, indicating a clear deterioration of the initial conditions. Moreover, there was a strong linear relationship (r > 0.9) between these markers and BR, as well as with the ratio given by HR/BR. Although fragmentation may be impacted by IH, we found that it is highly dependent on HR and BR values and thus, they should be considered during its calculation or used to normalize the fragmentation estimates.

JTD Keywords: Rats, Time series analysis, Radio access technologies, Protocols, Heart beat

Cardiorespiratory Phase Synchronization (CRPS) is a manifestation of coupling between cardiac and respiratory systems complementary to Respiratory Sinus Arrhythmia. In this work, we investigated CRPS during wake and sleep stages in Polysomnographic (PSG) recordings of 30 subjects suspected from Obstructive Sleep Apnea (OSA). The population was classified into three severity groups according to the Apnea Hypopnea Index (AHI): G1 (AHI<;15), G2 (15<;=AHI<;30) and G3 (AHI>30). The synchrogram between single lead ECG and respiratory abdominal band signals from PSG was computed with the Hilbert transform technique. The different phase locking ratios (PLR) m:n were monitored throughout the night. Ratio 4:1 was the most frequent and it became more dominant as OSA severity increased. CRPS was characterized by the percentage of synchronized time (%Sync) and the average duration of synchronized epochs (AvDurSync) using three different thresholds. Globally, we observed that %Sync significantly decreased and AvDurSync slightly increased with OSA severity. A high synchronization threshold enhanced these population differences. %Sync was significantly higher in NREM than in REM sleep in G2 and G3 groups. Population differences observed during sleep did not translate to the initial wake state. Reduced CRPS could be an early marker of OSA severity during sleep, but further studies are needed to determine whether CRPS is also present during wakefulness.

JTD Keywords: Band-pass filters, Electrocardiography, Heart beat, Sleep apnea, Sociology, Statistics, Synchronization

The lack of physiological motion compensation is a major problem in robotic-assisted cardiac surgery. Since the heart is beating while the surgeon carried out the procedure, dexterity of the surgeon’s and precision are compromised. Due to the operative space and the visibility of the surgical field are reduced, the most practical solution is the use of computer vision techniques. The lack of efficiency and robustness of the existing proposals make physiological motion compensation to be considered an open problem. In this work a novel solution to solve this problem based on the minimization of an energy functional is presented. It is described in the three-dimensional space using the l1−regularized optimization class in which cubic b-splines are used to represent the changes produced on the heart surface. Moreover, the logarithmic barrier function is applied to create an approximation of the total energy in order to avoid its non-differentiability. According to the results, this proposal is able to deal with complex deformations, requires a short computational time and gives a small error.

JTD Keywords: Beating heart surgery, Image analysis, Motion compensation

Compensating physiological motion in the context of minimally invasive cardiac surgery has become an attractive issue since it outperforms traditional cardiac procedures offering remarkable benefits. Owing to space restrictions, computer vision techniques have proven to be the most practical and suitable solution. However, the lack of robustness and efficiency of existing methods make physiological motion compensation an open and challenging problem. This work focusses on increasing robustness and efficiency via exploration of the classes of l1- and l2-regularized optimization, emphasizing the use of explicit regularization. Both approaches are based on natural features of the heart using intensity information. Results pointed out the l1-regularized optimization class as the best since it offered the shortest computational cost, the smallest average error and it proved to work even under complex deformations.

JTD Keywords: Motion Compensation, Optimization, Regularization, Beating Heart Surgery, Ill-posed problem

Heart motion compensation is a challenging problem within medical robotics and it is still considered an open research area due to the lack of robustness. As it can be formulated as an energy minimization problem, an optimization technique is needed. The selection of an adequate method has a significant impact over the global solution. For this reason, a new methodology is presented here for solving heart motion compensation in which the central topic is oriented to increase robustness with the goal of achieving a balance between efficiency and efficacy. Particularly, genetic algorithms are used as optimization technique since they can be adapted to any real application, complex and oriented to work in real-time problems.

JTD Keywords: Genetic Algorithms, Deformation, Stochastic Optimization, Beating Heart Surgery, Robotic Assisted Surgery

Statistical analysis, power spectral density, and Lempel Ziv complexity, are used in a multi-parameter approach to analyze four temporal series obtained from the Electrocardiographic and Respiratory Flow signals of 126 patients on weaning trials. In which, 88 patients belong to successful group (SG), and 38 patients belong to failure group (FG), i.e. failed to maintain spontaneous breathing during trial. It was found that mean values of cardiac inter-beat and breath durations give higher values for SG than for FG; Kurtosis coefficient of the spectrum of the rapid shallow breathing index is higher for FG; also Lempel Ziv complexity mean values associated with the respiratory flow signal are bigger for FG. Patients were then classified with a pattern recognition neural network, obtaining 80% of correct classifications (81.6% for FG and 79.5% for SG).

JTD Keywords: Electrocardiography, Medical signal processing, Neural nets, Pattern recognition, Pneumodynamics, Signal classification, Statistical analysis, ECG, Kurtosis coefficient, Lempel Ziv complexity, Breath durations, Cardiac interbeat durations, Electrocardiography, Multiparameter analysis, Pattern recognition neural network, Power spectral density, Respiratory flow signals, Signal classification, Spontaneous breathing, Statistical analysis, Weaning trials