Energy-Lab Technologies

Innovative Heart and StressScreening Technologies

vicardiocardioscanviport

Company – Who is ELT?

• Innovative medical Technologies company withheadquarters in Hamburg (Germany)

• Providing leading Technologies in ECG-visualization and Stress measurement systemsin Europe and worldwide

• Funded by the government of the city ofHamburg; supported by the oldest privatebank of the world

Company philosophy

Energy-Lab Technologies is working towards one shared vision:

The aim is preventing tens of thousands of sudden, unnecessarydeaths caused by heart- and stress infarcts, sepsis and fallingasleep at the steering wheel and therefore becoming the marketleader in the field of intelligible heart- and stress-screening.

This means:

• Providing physicians and patients with innovative hardware andsoftware tools to lead healthier and better lives.

• Developing intelligent life science technologies for diagnosis andprevention of cardiovascular diseases.

Technology/Patents/Studies

Heart screening & 3-D-Heart-Portrait

Stress level measurement with HRV

Studies

1. SCHWEIZER, M. et al. Multicenter Validation Study. In:Computers in Cardiology 26, 1999.

2. MANZ, H.: Herz-Kreislauf-Untersuchung von fliegendemPersonal. In: Flug- und Reisemedizin 1, 2001.

3. RAPPERT, B.: Gutachten: Anwendungsbeobachtung desCardioScan Version 1.4 in einer kardiologischen Praxis bei51 Patienten. September 2000.

4. SCHLOSSER, A.: Anwendungsbeobachtung des CardioScanVersion 1.4 im längsschnittlichen Verlauf. November 2001.

5. PELTZ, F.: Anwendungsbeobachtung des CardioScan Version2.0 im Deutschen Herzzentrum München. August 2002.

Patents: Europe: EP 1047987 B1; USA: PCT 6,694,178 B1

Patents and brands

Product Lines

cardioscan

viport

vicardio

Competitive Advantage Fitness

Technology

Image

Heart RateMonitors,e.g. Polar

Cardioscantechnology

BPM

Cardio Tests

Benchmark Medical

PolarBrustgurt,

Uhr &PC Software

(HRV)

PolarBrustgurt,

Uhr &PC Software

(HRV)Service Typen

Hardware Signal Quality Artefacts Features

Technical Features Im-/Export Look & Feel Print Options

Medical Features Interpretation Data Analysis Diagnose suggestions

GE Corina &Cardiosoft

GE Corina &Cardiosoft

SchillerCardiovit

AT-10

SchillerCardiovit

AT-10

SchillerVermessungCardioday

SchillerVermessungCardioday

Visualization QRS, RR, HRV CSI ECP

VicardioVicardio

Benchmark Consumer

PolarBrustgurt,

Uhr &PC Software

HR-Monitoring

PolarService Typen

Hardware Signal Quality

Artefacts

Usability

Technical Features Im-/Export

Look & Feel

Algorithms

Medical Features Analysis & Interpretation

Detection

HR-Monitoring

Freeze FramerHearthMate

Mini-ECGOmron

StressballBioSign GmbH

StressballBioSign GmbH

HerzhandyVitaphone

HeartphoneVitaphone

Special Features Cardio Stress measurement (CSI)

Visualization (ECP)

Interpretation

ELTVI-PORT &

Stress-MeterELT-

VIPORT-Technology

-

= 0 % = 100 %

Heart Screening - The “Traffic Light“ Principle

The ECP transforms the curve of an ECG into a three-dimensionalheartportrait. The „Traffic Light“ principle immediately shows thehealth level of the tested person.

Green and blue colours stand for a healthy heart with low stresslevel. Yellow and orange-like colours already call for caution(deviation from the norm ECG curve)

Red and dark purple colours immediately call for alert. Furthercheck up‘s are highly recommended!

ECG Assessment

1.0 to 0.0Pathologicaldeviations

3.0 to 1.1Beyond physiol.deviations

4.5 to 3.1Physiologicaldeviations

5.0 to 4.6Goodcondition

CSI: Cardio Stress Index

normal

highly increased – furtherexamination is recommended

increased

0 %

35 %

50 %

100 %

20 %

slightly increased

Validation Study at the University of MünsterProf. Dr. med. K. Völker / Dr. P. Rudack

500 600 700 800 900 1000 1100 1200 1300 1400

500

600

700

800

900

1000

1100

1200

1300

1400

RRmw [ms]vicardio

RR

mw

[ms

]c

ard

iovit

AT

-6

72N

,000Signifikanz (2-seitig)

,917Korrelation nach Pearson

1_EKG_RR_1

1_VIC_rrPearson - Korrelation

0 50 100 150 200 250 300 350 400 450

0

50

100

150

200

250

300

350

400

450

RRsd [ms]vicardio

RR

sd

[ms

]P

ola

rV

an

tag

eN

V

66N

,000Signifikanz (2-seitig)

,966Korrelation nach Pearson

1_P_rrsd

1_VIC_rrsdPearson - Korrelation

VIPORT - Technology

• Multichannel-ECG

• Cardio-Stress-Monitor forobservation of Cardio StressIndex (CSI)

• Storage: Up to 20 completedata sets

• Data Transmission via USB

Calculation of Electro Cardio Portrait (ECP)and Cardio Stress Index (CSI)

Heart function and ECG

Stress: HRV

ST U

R

S

T

Q

P

Electro Cardio Portrait

The heart portrait translates the electrocardiograph into a three-dimensional colourful figure

Heart Portraits

No deviation

Deviation requiresfurther analysis by a doctor

Heart function and ECG

The Stress level

Analysis of heart rate variability

889 90280410651034 820

Values in milli-seconds

“If the heart beat gets as steady as thepecking of the woodpecker or as theraindrops on the roof, the patient isgoing to die within four days.“

(Wang Shuhe 300 AC)

835

Heart Rate Variability (HRV)

RR-Intervals as atachogram

RR-Intervals inECG-Record

Heart Rate Variabilty

Short time analysis

24 h Recordings(Holter-ECG)

mainly used for clinicalpurposes

time intensive

2 –15 min Recordings

Screenings i.e. in generalmedicine, sports medicine

quick and feasible

Long time analysis

Analysis in timedomain and

frequency domain

Heart Rate VariabiltyAnalysis in time domain

Basis:

Interval between 2 RR-peaks

Heart Rate VariabiltyAnalysis in time domain

Histogram: Categories of RR-Intervals.- Calculation of the Histogram Baseline(scope) and the distribution of RR-Intervals.

SWSW

Heart Rate VariabiltyAnalysis in time domain

• Basis: Interval between 2 RR-peaks

• Calculation of average value andstandard deviation (SDNN) within acertain time period.

• Calculation of Histogramscope, Histogram ofproportional distribution

Heart Rate VariabiltyAnalysis in time domain

measurement withartefacts (for examplenoise, muscle activity)or arrhythmia

Heart Rate VariabiltyAnalysis in frequency domain

• Basis: Periodical processes of biological systems andtheir signals

• Signal split by spectral analysis

Heart Rate VariabiltyAnalysis in frequency domain

LF – Range(0,04 - 0,15 Hz)

• parasympathic undsympathicInfluence

Heart Rate VariabiltyAnalysis in frequency domain

HF – Range(0,15 - 0,40 Hz)

• ParasympathicInfluence

Heart Rate VariabiltyAnalysis in frequency domain

LF – Range(0,04 - 0,15 Hz)

HF – Range(0,15 - 0,40 Hz)

Ratio LF / HF

• Indicates autonomousbalance

• normal: 1.5 – 2.0

• > 2.0: Indicator of anincreasing sympathicinfluence

The Stress level

Length ofthe

R-R-Intervals

Low Stress level

Number of R-R-Intervals

High Stress level

„Normal“ variations in heartrhythm

Minor variations in heartrhythm

What does Heart Stress mean?

Considerations about HRV related Science

Herzfrequenzvariabilität

Usage Areas of Heart Rate Variabilty

Heart RateVariability

CARDIOLOGYCHD, Arryhthmia

NEUROLOGYAlzheimer´s disease

ENDOKRINOLOGYHyperthyroidism

PATHOPSYCHOLOGY

Depression

PHARMAKOLOGY

Drugs, Medication Control

DIABETES MEDICINE

Cardiac Neuropathy

PRENATAL HEALTH CARE

Sudden child death

GENERAL MEDICIN

Physical and mental Stress

Stress

psychological stress physical stress

internal stressors

- Inner tension

- Infection

- former diseases

- …

external stressors

- Heat / Cold

- Hypoxy

- Noise

- …

Stress causes for the heart

Augmentation

Possible causes for high stress load:

• Chronic mental stress

• Cold or flu infection

• Cardiovascular disease

• Type II diabetes

• Drugs and certain medication (e.g. Thyroxin)

• Over-exertion and excessive training

• close correlation between reduced HRV and critical state of thepatient

HRV

• Recovery of intensivecare patients

HRV

• Sepsis• Early detection of

sepsis• Possible Complications

after Operation

HRV as a prognosis factor in intensivecare

Usage areas of Heart Rate Variability:Intensive Care

Buchman TG et al. Curr Opin Crit Care 8 (2002) 311-315Winchell RJ et al. J Trauma 43 (1997) 927-933

• close inverse correlation between HRV and mortality in patients withCHD

Usage areas of Heart Rate Variability:CHD

Tsuji H et al. Circulation 90 (1994) 878-883Janszky I et al. J Intern Med 255 (2004) 13-21

• Suitable for risk estimation after myocardiac infarct

• Close correlation between reduced HRV and post infarct arrythmia

• Inverse correlation between HRV und mortality

HRV as a prognosis factor in patientswith CHD

Kleiger RE et al. Am J Cardiol 59 (1987) 256-262Sosnowski M et al. Int J Cardiol 86 (2002) 249-258

• reduced life expectancy with neuropathic patients

• Increased mortality rate: +29 %

• Correlation between HRV and risk of CHD in diabetes patients

Usage areas of Heart Rate Variability:Autonomous diabetic Neuropathy

HRV as a Prognosis- and Diagnosisfactor indiabteic neuropathy

Ziegler D et al. Deutsches Ärzteblatt 93 (1996) A1262-1268

Ewing DJ et al. Diabetologia 34 (1991) 182-185; Navarro X et al. Diabetes 39 (1990) 802-806; O‘'Brien IA et al. Q J Med 179 (1991) 495-502; Rathmann W et al. Diabetic Med 10 (1993) 820-824; Sampson MJ et al. Q J Med 75 (1990) 635-646

Liao D et al. Diabetes Res Clin Pract 30 (1995) 211-221

Ziegler D et al. Deutsches Ärzteblatt 93(1996) A1262-1268

• reduced HRV with depressed patients

Usage areas of Heart Rate Variability:Depression

HRV as a risk- and therapy marker inpsychological therapy

• Risk of heart diseases increased with depressionMück-Weymann M. German J Psychiatry 5 (2002) 67-69

Carney RM et al. Am J Cardiol 79 (1995) 562-564 - Hughes JW et Stoney.Psychosom Med 62 (2000) 796-803 -Krittayaphong R et al. Psychosom Med 59 (1997) 231– 235 - Mück-Weymann M. German J Psychiatry 5 (2002) 67-69

• Increase of HRV by improving the psychological condition throughsuccessful psychological healthcare [Carney 2000]

Carney RM et al. Am J Cardiol 79 (1995) 562-564Follick MJ et al. Am Heart J 116 (1998) 32–36

Cardio Stress Index: Single parameters

- Histogram of RR-Intervals

- Tachogram

- Fast Fourié Transformation

- Poincaré-Plot

- Spectral Analysis

- pNN 50 and pNN 100

Mobile ECG

Overview: viport raw data

- CSI = Current cardiac stress load

- Duration of QRS in ms indicates the stimulus conductionthrough the ventricles

- Rhythmic or non rhythmic

- Heart rate

- RRSD = standard deviation as an absolute degree of HRV

Usage areas

- Coronary patients

- Psychosomatic patients

- Active people

- Corporate Healthcare

- Measurement of vegetative

dysbalance

Benefits for patients

- Quick and easy to use

- results are intuitively

comprehensible

- Information about a global health

indicator

- Documentation of progress

VIPORT - Screen

VIPORT - Technology

• Multichannel-ECG

• Cardio-Stress-Monitor forobservation of Cardio StressIndex (CSI)

• Storage: Up to 20 completedata sets

• Data Transmission via USB

Check your heart!