Skip to main content
SpringerLink
Log in

Determination of heart rate variability with an electronic stethoscope

  • Research Article
  • Published:
Clinical Autonomic Research Aims and scope Submit manuscript

Abstract

Introduction

Heart rate variability (HRV) is widely used to characterize cardiac autonomic function by measuring beat-to-beat alterations in heart rate. Decreased HRV has been found predictive of worse cardiovascular (CV) outcomes. HRV is determined from time intervals between QRS complexes recorded by electrocardiography (ECG) for several minutes to 24 h. Although cardiac auscultation with a stethoscope is performed routinely on patients, the human ear cannot detect heart sound time intervals. The electronic stethoscope digitally processes heart sounds, from which cardiac time intervals can be obtained.

Methods

Accordingly, the objective of this study was to determine the feasibility of obtaining HRV from electronically recorded heart sounds. We prospectively studied 50 subjects with and without CV risk factors/disease and simultaneously recorded single lead ECG and heart sounds for 2 min.

Results

Time and frequency measures of HRV were calculated from R–R and S1–S1 intervals and were compared using intra-class correlation coefficients (ICC).

Conclusion

The majority of the indices were strongly correlated (ICC 0.73–1.0), while the remaining indices were moderately correlated (ICC 0.56–0.63). In conclusion, we found HRV measures determined from S1–S1 are in agreement with those determined by single lead ECG, and we demonstrate and discuss differences in the measures in detail. In addition to characterizing cardiac murmurs and time intervals, the electronic stethoscope holds promise as a convenient low-cost tool to determine HRV in the hospital and outpatient settings as a practical extension of the physical examination.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Kleiger RE, Stein PK, Bigger JT (2005) Heart rate variability: measurement and clinical utility. Ann Noninvasive Electrocardiol 10:88–101

    Article  PubMed  Google Scholar 

  2. Lahiri MK, Kannankeril PJ, Goldberger JJ (2008) Assessment of autonomic function in cardiovascular disease: physiological basis and prognostic implications. J Am Coll Cardiol 51:1725–1733

    Article  PubMed  Google Scholar 

  3. Task Force of the European Society of Cardiology and North American Society of Pacing and Electrophysiology: Heart rate variability (1996) Standards of measurement, physiological interpretation, and clinical use. Eur Heart J 17:354–381

    Article  Google Scholar 

  4. Sandercock GR, Bromley PD, Brodie DA (2005) The reliability of short-term measurements of heart rate variability. Int J Cardiol 103(3):238–247

    Article  PubMed  Google Scholar 

  5. Licht CM, de Geus EJ, van Dyck R, Penninx BW (2009) Association between anxiety disorders and heart rate variability in The Netherlands Study of Depression and Anxiety (NESDA). Psychosom Med 71(5):508–518 (Epub 2009 May 4)

    Article  PubMed  Google Scholar 

  6. Sandercock GR, Grocott-Mason R, Brodie DA (2007) Changes in short-term measures of heart rate variability after eight weeks of cardiac rehabilitation. Clin Auton Res 17(1):39–45

    Article  PubMed  Google Scholar 

  7. Wheat AL, Larkin KT (2010) Biofeedback of heart rate variability and related physiology: a critical review. Appl Psychophysiol Biofeedback 35(3):229–242

    Article  PubMed  Google Scholar 

  8. Steeds R, Fletcher J, Smith M, West J, Channer K, Townend J (2004) Prognostic significance of early short-term measurements of heart rate variability following acute myocardial infarction. Am J Cardiol 94:1275–1278

    Article  PubMed  Google Scholar 

  9. Koskinen T, Kähönen M, Jula A, Laitinen T, Keltikangas-Järvinen L, Viikari J, Välimäki I, Raitakari OT (2009) Short-term heart rate variability in healthy young adults: the Cardiovascular Risk in Young Finns Study. Auton Neurosci 145(1–2):81–88

    Article  PubMed  Google Scholar 

  10. Nunan D, Sandercock GR, Brodie DA (2010) A quantitative systematic review of normal values for short-term heart rate variability in healthy adults. Pacing Clin Electrophysiol 33(11):1407–1417

    Article  PubMed  Google Scholar 

  11. Tavel ME (2006) Cardiac auscultation: a glorious past–and it does have a future! Circulation 113:1255–1259

    Article  PubMed  Google Scholar 

  12. Tavel ME, Brown DD, Shander D (1994) Enhanced auscultation with a new graphic display system. Arch Intern Med 154:893–898

    Article  PubMed  CAS  Google Scholar 

  13. Erne P (2008) Beyond auscultation–acoustic cardiography in the diagnosis and assessment of cardiac disease. Swiss Med Wkly 138(31–32):439–452

    PubMed  CAS  Google Scholar 

  14. Xu J, Durand LG, Pibarot P (2002) A new, simple, and accurate method for non-invasive estimation of pulmonary arterial pressure. Heart 88(1):76–80

    Article  PubMed  CAS  Google Scholar 

  15. Collins SP, Lindsell CJ, Kontos MC, Zuber M, Kipfer P, Attenhofer Jost C, Kosmicki D, Michaels AD (2009) Bedside prediction of increased filling pressure using acoustic electrocardiography. Am J Emerg Med 27(4):397–408

    Article  PubMed  Google Scholar 

  16. Abelson D, Kamens EA (1977) Bedside measurement of systolic and diastolic time intervals using the stethometer. Cardiovasc Res 11(3):270–274

    Article  PubMed  CAS  Google Scholar 

  17. Wanderman KL, Hayek Z, Ovsyshcher I, Loutaty G, Cantor A, Gussarsky Y, Gueron M (1981) Systolic time intervals in adolescents. Normal standards for clinical use and comparison with children and adults. Circulation 63(1):204–209

    Article  PubMed  CAS  Google Scholar 

  18. de Oliveira Neto NR, Pinheiro MA, Carriço AS, Santos de Oliveira MM, Camara MF, Lagreca RJ (2008) Abnormalities of the systolic time intervals obtained by electronic stethoscope in heart failure. Internet J Cardiol 5:2

    Google Scholar 

  19. Roos M, Toggweiler S, Zuber M, Jamshidi P, Erne P (2006) Acoustic cardiographic parameters and their relationship to invasive hemodynamic measurements in patients with left ventricular systolic dysfunction. Congest Heart Fail 12(1):19–24

    Article  PubMed  Google Scholar 

  20. Weissler AM (1983) Interpreting systolic time intervals in man. J Am Coll Cardiol 2(5):1019–1020

    Article  PubMed  CAS  Google Scholar 

  21. Gillebert TC, Van de Veire N, De Buyzere ML, De Sutter J (2004) Time intervals and global cardiac function. Use and limitations. Eur Heart J 25(24):2185–2186

    Article  Google Scholar 

  22. Benitez D, Gaydecki PA, Zaidi A, Fitzpatrick AP (2001) The use of the Hilbert transform in ECG signal analysis. Comput Biol Med 31(5):399–406

    Article  PubMed  CAS  Google Scholar 

  23. Lu G, Yang F, Taylor JA, Stein JF (2009) A comparison of photoplethysmography and ECG recording to analyze heart rate variability in healthy subjects. J Med Eng Technol 33(8):634–641

    Article  PubMed  CAS  Google Scholar 

  24. Abrams J (1978) Current concepts of the genesis of heart sounds. JAMA 239(26):2787–2789

    Article  PubMed  CAS  Google Scholar 

  25. Voss A, Schulz S, Schroeder R, Baumert M, Caminal P (2009) Methods derived from nonlinear dynamics for analyzing heart rate variability. Philos Trans A Math Phys Eng Sci 28(367 (1887)):277–296

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Division of Cardiovascular Medicine, State University of New York Downstate Medical Center, 450 Clarkson Avenue, Box 1199, Brooklyn, NY, 11203-2098, USA

    Haroon Kamran, Francisca Oniyuke, Mercy Palomeque, Priya Chokshi, Louis Salciccioli & Jason M. Lazar

  2. Department of Physiology and Pharmacology, State University of New York Downstate Medical Center, 450 Clarkson Avenue, Box 31, Brooklyn, NY, 11203-2098, USA

    Isaac Naggar & Mark Stewart

Authors
  1. Haroon Kamran
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Isaac Naggar
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Francisca Oniyuke
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Mercy Palomeque
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Priya Chokshi
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Louis Salciccioli
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Mark Stewart
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Jason M. Lazar
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Jason M. Lazar.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Kamran, H., Naggar, I., Oniyuke, F. et al. Determination of heart rate variability with an electronic stethoscope. Clin Auton Res 23, 41–47 (2013). https://doi.org/10.1007/s10286-012-0177-3

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10286-012-0177-3

Keywords

Search

Navigation