Columbia University Validation study report
Research Holtcr Laboratory Columbia University
A COMPARISON OF NERVE EXPRESS AND CHRONOS ALGORITHMS
A. Statement of Study Purpose
Heart Rhythm Instruments, Inc. has developed algorithms for power spectral analysis of
RR intervals (the Nerve Express algorithms). Heart Rhythm Instruments, Inc. has packaged
the Nerve Express algorithms in an instrument suitable for stand-alone office use. The
purpose of this evaluation was to compare the Nerve Express algorithms with the "gold
standard" CHRONOS algorithms to test the reliability of the Nerve Express algorithms for
power spectral analysis of RR intervals. The CHRONOS algorithms have been shown to
predict death in coronary heart disease and to quantify physical fitness, but they are
accessed via Holter technology and are not packaged as a stand-alone office instrument.
The Nerve Express algorithms are conveniently packaged for office use. If they are
equivalent to CHRONOS, they would constitute a reliable office system useful for many
purposes: assessment of risk in cardiovascular disorders; assessment of physical
fitness; documentation of benefit for cardiac, chiropractic, or orthopedic
rehabilitation; and quantification of drug effects on the autonomic nervous system.
B. Background and Rationale
Power spectral measures of normal RR intervals recorded for a short (5 minute)
or long (24-hour) period of time predict cardiac death in patients with coronary heart
disease or valvular heart disease and in random samples of middle-aged persons (1-10).
Power spectral measures of normal RR intervals also provide an excellent measure of
physical fitness (11-14). Short-term recordings of the ECG show cyclic fluctuations that
are well characterized by frequency domain methods, either non-parametric fast Fourier
transforms or parametric autoregression (15-17). These methods are capable of
quantifying the energy of cyclic fluctuations in RR intervals. The joint Task Force on
Heart Rate Variability of the European Society of Cardiology and the North American
Society for Electrophysiology and Pacing recommended that, for assessment of autonomic
modulation of RR intervals, frequency domain methods be applied to 5-minute ECG
recordings (17). Frequency domain analysis reveals two peaks of energy (power) in the
power spectra obtained with these methods: a low frequency peak (LF) that represents
modulation of RR intervals by baroreflex activity and a high frequency peak (HF) that
represents modulation of RR intervals by breathing. The vagus nerve carries efferent
impulses in both cases. High values for measures of RR interval variability indicate
greater physical fitness and a prognosis.
The CHRONOS algorithms developed jointly by The Research Holter Laboratory at
Columbia University and Dr. Jeffrey N. Rottman are the best-documented algorithms for
predicting cardiac death in patients with coronary heart disease (18). However, data for
the landmark studies with the CHRONOS algorithms were acquired using Holter recorders, a
cumbersome way to acquire short-term data in the office. Also, highly trained research
technicians have extensively edited ECG recordings before the CHRONOS algorithms are
applied to them.
Nerve Express is a PC-based system for assessing the state of the autonomic nervous
system using proprietary power spectral technology developed over a 15-year period. The
algorithms are packaged for convenient office use, but the ability of the Nerve Express
algorithms to predict cardiac death or physical fitness has not been validated. The
purpose of the current research is to test the reliability of the Nerve Express
algorithms for power spectral analysis of RR intervals by comparing them with the CHRONOS
If the Nerve Express algorithms prove reliable for predicting death and/or predicting
physical fitness, this system will be the first convenient,
inexpensive tool for the office assessment of cardiovascular risk and physical fitness
will finally be available.
Research Holler Laboratory Columbia University
The Research Holter Laboratory at Columbia University has conducted many studies to
document the ability of the CHRONOS algorithms to predict cardiac death and/or physical
fitness. Heart Rhythm Instruments, Inc. has developed Nerve Express algorithms to
analysis fluctuations in RR intervals. Among these are routines to process artifact and
ectopic beats in the RR data stream. These routines have the potential to make Nerve
Express more fully automated which will not only broaden the venues in which the
instrument can be used but also decrease the cost of assessing the autonomic nervous
system by reducing expensive technician time.
The results of our comparison of the Nerve Express algorithms with the CHRONOS algorithms indicate that the results obtained are similar and suggest that the Nerve Express algorithms should predict death in coronary heart disease and level of physical fitness.
original names of Fitness Score product.
Copy of full study report available upon request.