title: Echocardiography without electrocardiogram using nonlinear dimensionality reduction methods.
abstract: OBJECTIVE
  The aim of this study is to evaluate the efficiency of a new automatic image processing technique, based on nonlinear dimensionality reduction (NLDR) to separate a cardiac cycle and also detect end-diastole (ED) (cardiac cycle start) and end-systole (ES) frames on an echocardiography system without using ECG.
  
  
  METHODS
  Isometric feature mapping (Isomap) and locally linear embeddings (LLE) are the most popular NLDR algorithms. First, Isomap algorithm is applied on recorded echocardiography images. By this approach, the nonlinear embedded information in sequential images is represented in a two-dimensional manifold and each image is characterized by a symbol on the constructed manifold. Cyclicity analysis of the resultant manifold, which is derived from the cyclic nature of the heart motion, is used to perform cardiac cycle length estimation. Then, LLE algorithm is applied on extracted left ventricle (LV) echocardiography images of one cardiac cycle. Finally, the relationship between consecutive symbols of the resultant manifold by the LLE algorithm, which is based on LV volume changes, is used to estimate ED (cycle start) and ES frames. The proposed algorithms are quantitatively compared to those obtained by a highly experienced echocardiographer from ECG as a reference in 20 healthy volunteers and 12 subjects with pathology.
  
  
  RESULTS
  Mean difference in cardiac cycle length, ED, and ES frame estimation between our method and ECG detection by the experienced echocardiographer is approximately 7, 17, and 17 ms (0.4, 1, and 1 frame), respectively.
  
  
  CONCLUSIONS
  The proposed image-based method, based on NLDR, can be used as a useful tool for estimation of cardiac cycle length, ED and ES frames in echocardiography systems, with good agreement to ECG assessment by an experienced echocardiographer in routine clinical evaluation.
authors.affiliation: Department of Biomedical Engineering, Science and Research Branch, Islamic Azad University, Tehran, Iran. shalbaf@iust.ac.ir.
authors.forename: Ahmad
authors.initials: A
authors.lastname: Shalbaf
authors.affiliation: Cardiovascular Imaging, Shaheed Rajaei Cardiovascular Medical and Research Center, Iran University of Medical Science, Tehran, Iran. drzas@rhc.ac.ir.
authors.forename: Zahra
authors.initials: Z
authors.lastname: AlizadehSani
authors.affiliation: Department of Biomedical Engineering, School of Electrical Engineering, Iran University of Science and Technology, Tehran, Iran. behnam@iust.ac.ir.
authors.forename: Hamid
authors.initials: H
authors.lastname: Behnam
mesh_terms: D000465:Algorithms; D004452:Echocardiography / Q000379:methods*; D006321:Heart / Q000502:physiology / Q000503:physiopathology; D006339:Heart Rate / Q000502:physiology; D006801:Humans; D007091:Image Processing, Computer-Assisted / Q000379:methods*; D017202:Myocardial Ischemia / Q000000981:diagnostic imaging / Q000503:physiopathology; D017711:Nonlinear Dynamics; D010363:Pattern Recognition, Automated / Q000379:methods*
keywords: Cardiac cycle; ECG; Echocardiography; End-diastole; End-systole; Nonlinear dimensionality reduction