Challenge Open Access

# RR Interval Time Series Modeling: The PhysioNet/Computing in Cardiology Challenge 2002

Published: Feb. 14, 2002. Version: 1.0.0

Goldberger, A., Amaral, L., Glass, L., Hausdorff, J., Ivanov, P. C., Mark, R., ... & Stanley, H. E. (2000). PhysioBank, PhysioToolkit, and PhysioNet: Components of a new research resource for complex physiologic signals. Circulation [Online]. 101 (23), pp. e215–e220.

### Introduction

We are pleased to announce the third in our annual series of challenges from PhysioNet and Computers in Cardiology. We received many suggestions for challenge topics, and encourage you to contact us with further suggestions. We chose the topic for this year's challenge not only for its intrinsic interest, but also because it is quite different from the previous two challenges.

Heart rate variability has attracted much attention from researchers since the early 1980s. It has long been understood that a metronomic heart rate is pathological, and that the healthy heart is influenced by multiple neural and hormonal inputs that result in variations in interbeat (RR) intervals, at time scales ranging from less than a second to 24 hours. Even after 20 years of study, new analytic techniques continue to reveal properties of the time series of RR intervals. Much research in this area aims to discover or to explain how specific changes in variability can be related to specific pathologies.

Given how much is known about heart rate variability, it might be thought that simulating a realistic sequence of RR intervals would be an easy task. The intricate interdependencies of variations at different scales, however, make it difficult to create a simulation of sufficient realism to mislead an experienced observer, and it may be even harder to deceive a program designed to quantify these subtle features.

Each of the figures below shows a 10 hour time series of RR intervals at the same scale (the range of heart rates is roughly 70 to 120 bpm in each case). Can you identify which of these time series is synthetic? (rr1.png and rr2.png)

It may be difficult to identify the synthetic data based on the figures; you may download the RR interval time series in text form for series 1 and series 2 if you wish to inspect the data in more detail. (Click here for the answer.)

Our challenge is therefore twofold: Can you construct a simulation of the RR interval time series spanning a full 24 hours with sufficient verisimilitude to be taken as real? Can you classify a mixed set of real and simulated RR interval time series? As in previous challenges, we awarded prizes of US$500 to the most successful entrant in each of two events. ### Organization of the Challenge During the first eight weeks of the challenge, participants in event 1 created software that can generate synthetic RR interval time series. Participants entered event 1 of the challenge by submitting a generator (model) in source form by email (see the rules below). The period for submitting entries for event 1 ended at noon GMT on Monday, 22 April 2002; no late entries can be accepted. We created two synthetic 24-hour RR interval time series using each generator entered into the challenge. We also created a number of additional synthetic series using generators not entered into the challenge. We have provided an approximately equal number of real 24-hour RR interval time series. These were derived from long-term ECG recordings of adults between the ages of 20 and 50 who have no known cardiac abnormalities, similar to those included in the MIT-BIH Normal Sinus Rhythm Database. These recordings typically begin and end in the early morning (within an hour or two of the subject's awakening). Small numbers of ectopic beats are common in such recordings, as are short intervals of artifacts that may cause false beat detections or missed beat detections. We have excluded recordings with significant amounts of noise or ectopy. The synthetic and real series have been assigned random identification numbers in the challenge dataset, which was posted on PhysioNet on Wednesday, 24 April 2002, marking the start of event 2. Participants in event 2 have classified each series in the challenge dataset as real, synthetic, or unknown (see the rules below). An autoscorer received entries submitted using a web browser, and returned scores by email to participants. To qualify for an award in either event 1 or event 2, participants must have submitted a valid set of classifications to the autoscorer no later than noon GMT on Tuesday, 30 April 2002. All of the event 1 participants did so. To be eligible for an award, participants in event 1 were also required to submit an abstract describing their work to Computers in Cardiology 2002, using the topic D1 SYSTEMS: Heart rate variability when submitting their abstracts. Participants in event 2 were encouraged but not required to do this as well. The abstract submission deadline has now passed and no further abstracts may be submitted. At Computers in Cardiology 2002 (in Memphis, 22-25 September 2002), a prize of US$500 was awarded to the top-scoring eligible participant in each event. Immediately following the conference, the sources for the models submitted for event 1 were posted on PhysioNet (here). We welcome contributions of software for classifying series in event 2.

Members and affiliates of our research groups at MIT, Boston University, Harvard Medical School, Beth Israel Deaconess Medical Center, and McGill University are not eligible for awards, although all are welcome to participate.

### Event 1 - Generating RR Interval Series

Participants in this event created and submitted programs that can generate at least two distinct 24-hour simulated RR interval time series. The qualified participant whose generator produces the most realistic time series, as defined below, received an award of US$500 (see the challenge results). To avoid bias, the realism of the series was judged by the challenge participants themselves, in event 2. The most recent set of classifications from each qualified participant in event 2 received by noon GMT on 30 April 2002 was used to score the generators. Participants who have entered more than one generator will receive a separate score for each generator. Update (25 February 2002): The overall accuracy, a, of each event 2 participant (defined as the number of correct classifications made by that participant divided by the number of series to be classified) defines a weight w = (a - 0.5)2 + 0.05 given to that participant's classifications. Each generator receives 2w points for each "real" classification if a > 0.5, 2w points for each "synthetic" classification if a ≤ 0.5, and w points for each "unknown" classification. To qualify for an award in event 1, a participant must do all of the following: 1. Submit a valid entry for event 1 no later than noon GMT on Monday, 22 April 2002. 2. Submit a valid entry for event 2 no later than noon GMT on Tuesday, 30 April 2002. 3. Submit an abstract describing his or her generator to Computers in Cardiology, no later than Friday, 3 May 2002. 4. Attend Computers in Cardiology 2002, 22-25 September 2002, in Memphis, Tennessee. Please note point 2 above! You must enter event 2 in order to qualify for an award in event 1. This rule was intended to insure that participants in event 1 received feedback on the success of their generators before the CinC abstract deadline. Each participant was allowed to submit up to five generators, and each was treated as a separate entry. Participants were permitted to replace any of their previous entries with an improved version at any time until noon GMT on Monday, 22 April 2002. A prize of US$500 will be awarded to the qualified participant whose generator has received the highest score. If a tie had occured, scores for the tying generators only would have been recalculated using all classifications (not only the final classifications) from each qualified participant. If a tie had remained, the date and time of submission would have been the final tiebreaker.

### How to Submit a Valid Entry for Event 1

The deadline for submitting entries for event 1 has passed, and no more entries can be accepted. If you have missed the deadline, however, we encourage you to submit your generator anyway. If there is sufficient interest, we will rerun the challenge at a later date.

You will need to write functions in standard (ANSI/ISO) C to replace the initialize and generate functions in the example:

• initialize is called once, before generate is called the first time. Its first argument is a 32-bit (long) integer, which will be given a different random value each time this program is run as part of the challenge. Its second argument specifies the length of the simulation, in seconds.
• generate is called once per RR interval. It should return the length of the next (simulated) RR interval in seconds.

In the challenge, your generator will be used to generate two series that should be different (otherwise they will be rather easy to recognize as synthesized!). Use the arguments to initialize to set up the initial conditions for your simulation. You might use the first argument as a seed for a random number generator as in the example.

If you prefer, you can do the entire simulation within initialize, saving the results to an array; then generate can return one value from the array each time it is invoked by main. Make sure the array is long enough if you take this approach; you can use the second argument of initialize to help determine the array length.

Although the challenge will be based on 24-hour simulations, make sure that your generator can create longer time series (of at least 48 hours).

You may, if necessary:

• define global variables
• include other ANSI/ISO C standard header (.h) files
• allocate memory as needed using malloc or similar functions
• invoke other functions from the ANSI/ISO C standard library and math library
• create temporary files in the current directory

If you create temporary files, do so within the current directory only, and use file names beginning with temp. Any files created will be removed between runs (you cannot save information from one run to use in another).

You may not:

• modify main
• write to the standard output (main does this, but your code may not)
• use chdir or any other means to change the current directory
• invoke fork, system, or any of the exec family of functions to start another program or another process
• incorporate portions of real (physiologic) RR interval sequences in the output
• incorporate code or data that cannot be made freely available after the conclusion of the Challenge

All code will be reviewed before being compiled or run. Please keep your code neat. If we can't figure out what your program does, we won't run it!

All code must compile cleanly using:

             gcc -Wall rrgen.c -lm


There must be no errors or warnings of any kind.

Your program must run to completion within a reasonable time. A reasonable time is 1 minute or less for a 24-hour simulation running on a 1 GHz Athlon under Linux; we will not disqualify programs that slightly exceed this limit. For reference, the example program generates 24 hours of simulated data in roughly 0.2 seconds, so if your program is no more than about 300 times slower than the example, it should be fine.

All programs entered will be posted with full credit to their authors on PhysioNet following the conclusion of the Challenge, and will be made freely available under the GPL (or another open source license if you prefer).

Test your entry before submitting it. Don't forget to include your name, affiliation, and email address in the comment block at the top of the file. Once you are ready, send a copy of your program (source only; do not send binaries) via email to webmaster@physionet.org with a subject line of rrgen.c. Please send the source file as plain text, not as HTML or as a word-processor formatted attachment.

Participants received an email confirmation of their entry once it had been reviewed. If a generator failed to meet any of the requirements for a valid entry, participants were advised that the email would indicate in general terms the nature of the problem (e.g., compilation error), but that they would be responsible for debugging their programs. Several entries that arrived shortly before the deadline had very minor problems, which were corrected by the challenge organizer and returned to their authors for review. Each generator that met all requirements for a valid entry was assigned an entry number, which was indicated in the email confirmation.

### Event 2 - Classification

Participants in this event attempt to determine which members of the challenge dataset of RR interval time series are synthesized, and which are real.

Participants will classify each series as real, simulated, or unknown, and will submit their classifications to an autoscorer. Scores will be returned by email. Each correct classification increases the score by 2 points, and each incorrect classification reduces the score by 1 point. The qualified participant who received the highest final score (see below) received an award of US\$500. Since a tie occurred, the date and time of submission is the tiebreaker.

To qualify for an award in event 2, a participant must do all of the following:

1. Submit a valid entry for event 2 no later than noon GMT on Tuesday, 30 April 2002.
2. Attend Computers in Cardiology 2002, 22-25 September 2002, in Memphis, Tennessee.

Participants in event 2 were encouraged but not required to submit an abstract describing their methods of classifying the challenge dataset to Computers in Cardiology 2002, no later than Friday, 3 May 2002.

Participants may submit up to five sets of classifications, but only the final score received by each participant will be used to determine the outcome of this event. (Each submission cancels any previous score; scores are not cumulative.) Invalid submissions are not scored and do not count against the limit of five submissions.

If you have missed the 30 April 2002 deadline for submitting your first set of classifications, we still encourage you to participate unofficially. If you receive a high final score, your achievement will be recognized on this web site. If you are able to attend Computers in Cardiology, you will have an opportunity to discuss your work informally with other participants.

### Important Dates

All deadlines are at noon GMT unless otherwise indicated. Late entries will not be accepted.

Monday, 22 April 2002
Deadline for submission of generators in event 1.
Wednesday, 24 April 2002
Event 2 begins when the challenge dataset, consisting of the time series to be classified, is posted.
Tuesday, 30 April 2002
To qualify for an award in either event, submit a valid entry in event 2 by noon GMT on this date.
Friday, 3 May 2002
Deadline for submission of abstracts for Computers in Cardiology 2002.
Sunday-Wednesday, 22-25 September 2002
Computers in Cardiology, Memphis, Tennessee

Must I enter both events in order to participate?

No. Event 1 is optional. Event 2 is required of all participants.

I've entered both events. Do my classifications of my own synthesized series count?

Yes, for both events. If your generator is a good one, you may find it difficult to identify its output, however! Attempts to "watermark" your output so that you can identify it will be rejected.

Does each synthesized series get its own event 1 score?

Each series in the challenge dataset gets a partial score that reflects how it was classified. These will be posted at the conclusion of the challenge.

The partial scores of the two series created using each generator are added to obtain the score for that generator. The generators' scores determine the winner of event 1.

Why did you change the scoring for event 1?

The weighting factor w was introduced so that a generator gets significantly more credit for misleading a really good classifier than for misleading one whose classifications are no better than random. The values of w are symmetric about a = 0.5 because a classifier who misclassifies everything is clearly able to tell the difference between real and synthesized data despite a fundamental confusion about which is which! We've added a small positive bias to w so that even the coin-tossers' contributions will have a (small) effect.

What is the significance of SPS in rrgen.c?

SPS is the sampling frequency (in samples per second), which determines how the RR intervals are quantized. All RR intervals in the real time series have lengths that are exact multiples of (1/SPS) seconds, but these have then been converted to a decimal representation with 3 digits after the decimal point. If SPS is 128, for example, intervals such as 0.992, 1.000, 1.008, 1.016, and 1.023 seconds are possible in the real time series, but intermediate values such as 1.001 or 1.002 do not occur. rrgen's main function uses SPS in a calculation to ensure that the only RR interval values that appear in the synthesized time series are those that can also occur in the real time series. In most cases, you won't need to refer to SPS explicitly in your code, but it's there if you need it.

The challenge dataset may include real series with a variety of sampling frequencies between 120 and 1000 samples per second. The synthesized series in the challenge data set will be produced using generators compiled with a similar variety of SPS values, so that it will not be possible to identify the real series simply by looking at the distribution of "forbidden" RR interval values. (Update 24 April: All of the series use the same sampling frequency, 128 samples per second.)

I've already entered event 1 five times, and now I have a better generator. Can I enter it?

If you have previously received entry numbers for the maximum of five generators, you may enter another generator only if you replace a previously accepted generator. To do this, simply tell us (at the beginning of your new entry) the entry number for the generator you wish to replace (e.g., "This entry should replace entry number 38.") If your replacement is accepted, it will be assigned a new entry number; otherwise your original entry will remain in the challenge.

There is a limit of 5 trials in event 2, but one can try as many times as one needs, asking friends or using different email addresses. And if there is no limit on the number of trials, since you return immediately the score, one can proceed by trial and error in order to detect what is real and what is not. I wonder if I missed something.

If you are tempted to try submitting many entries in order to learn about the correct classifications, why not play Mastermind instead, where such a strategy is rewarded? We will reject obvious attempts to circumvent the spirit of the challenge in this way.

How old are the "normal" subjects whose RR interval time series are included in the challenge dataset? Are they active over the 24 hours (e.g., were the recordings taken with an ambulatory monitor) or were they bed-bound (but otherwise healthy)?

The normals are men and women between the ages of 20 and 50, engaged in their usual activities of daily life. Interbeat intervals were obtained using automated analysis (with some manual review and corrections) of ambulatory (Holter) ECG recordings.

Could you elaborate on the reference to "manual review and correction" please? I am assuming that the reviewers removed ectopic beats (those with an RR interval <80% or >120% of the previous RR interval) and replaced them with a beat where an expert would have expected one. Should we therefore not worry about generating the odd ectopic beat (or at least removing the odd beat as if an ectopic had occured and an expert/algorithm had removed it without replacing it)?

No, intervals surrounding ectopic beats are not removed or otherwise adjusted in the real time series. The challenge data set includes only series that have very little or no ectopy. Whatever ectopic beats may be present are marked at their times of occurrence, so that you should expect to see (for example) a few short intervals that precede premature atrial or ventricular beats, and long (compensatory) intervals following premature ventricular beats.

The manual review and corrections have been applied to the original ECG recordings, not to the interbeat interval time series. This process typically involves visual inspection of the longest and shortest detected intervals in each case (which tends to reveal not only ectopic beats but also beats that were not detected automatically and detections that were not beats). Ideally, the output of this process includes the times of occurence of each beat, including any ectopic beats. The interbeat interval time series are prepared from these data without further corrections. Update 24 April: Some of the normals have not been manually corrected.

Participants in event 1 should consider these points carefully. You may wish to generate an interbeat interval time series that results from a beat sequence that includes rare isolated ectopic beats and short periods of signal loss.

### Challenge Results

This year's challenge scoring had an unusual twist: scores for event 1 were determined by entries in event 2, and vice versa. The outcome of event 2 was determined very quickly. Rather than continuing both events until 20 September as originally announced, we collected event 2 entries until the deadline for official entrants (noon GMT on 30 April) had passed, and then determined final scores for event 1.

If you did not have a chance to submit an official entry, we encourage you to participate anyway; you can still submit classifications of the challenge dataset and receive an unofficial score. Unofficial event 1 entries are also welcome; if there is sufficient interest, we will run a second round of this challenge, using new RR interval generators and a new dataset.

Winners of each event received awards during September's Computers in Cardiology conference, where participants presented their work. The RR interval generators submitted by event 1 participants are available in the "generators" folder.

Brief descriptions of the methods used can be viewed by following the links in the tables below to abstracts submitted by many of the entrants for presentation at Computers in Cardiology 2002.

Event 1 (generating RR interval series)

The top scorers in event 1 are:

Place Entry
number
Entrant Score
1 192 DC Lin
3.452
2 171 Dragan Gamberger, Ivan Maric, Tomislav Smuc, Gordan Bosanac, Nikola Bogunovic, Goran Krstacic
Rudjer Boskovic Institute, Institute for Cardiovascular Prevention and Rehabilitation, Zagreb, Croatia
1.494
3 142 Albert C-C Yang, Cheng-Hsi Chang, SS Hseu, Huey-Wen Yien
Taipei Veterans General Hospital
School of Medicine, National Yang-Ming University, Taipei, Taiwan
0.689
4 201 PE McSharry, GD Clifford
Dept Maths & Dept Engineering, University of Oxford, Oxford, UK
0.497
5 (tie) 153 Manojit Roy
University of Michigan, Ann Arbor, Michigan, USA
0.202
5 (tie) 161 Miguel A. García-González, Juan Ramos-Castro
Instrumentation and Bioengineering Division, Electronic Engineering Department, Universitat Politècnica de Catalunya, Barcelona, Spain
0.202

Event 2 (classification)

Six participants received perfect scores in event 2 before the deadline for official entrants had passed. The winner was Albert C-C Yang, who not only achieved a perfect score on his first attempt, but also submitted the first entry received for event 2, only a few hours after the challenge dataset was posted.

Perfect scores of 100 were received by:

Date Entrant Entries
25 Apr
1028 GMT
Albert C-C Yang
National Yang-Ming University, Taipei, Taiwan
1
25 Apr
1505 GMT
Sang H Yi, Seon H Kim, C Yoo, K Park
Inje University, Korea
2
26 Apr
1222 GMT
FE Smith, Emma Bowers, Philip Langley, John Allen, Alan Murray
Freeman Hospital, Newcastle upon Tyne, UK
1
26 Apr
1818 GMT
N Wessel
University of Potsdam, Germany
1
27 Apr
0952 GMT
Tomislav Smuc
Rudjer Boskovic Institute, Zagreb, Croatia
2
28 Apr
1459 GMT
H Malberg
Karlsruhe Research Center, Germany
1

Three other teams of participants, who did not receive perfect scores before the deadline, also used novel automated methods to classify the challenge dataset for their entries in event 2 (follow the links to read the abstracts of the papers describing these methods):

GD Clifford, PE McSharry
University of Oxford, Oxford, UK

M Costa, AL Goldberger, CK Peng
Harvard Medical School, Boston, Massachusetts, USA

JC Echeverría, MS Woolfson, JA Crowe, BR Hayes-Gill
University of Nottingham, UK

### Papers

These papers were presented at Computers in Cardiology 2002.

Classifying Simulated and Physiological Heart Rate Variability Signals
N Wessel, H Malberg, U Meyerfeldt, A Schirdewan, J Kurths

Multiscale Entropy to Distinguish Physiologic and Synthetic RR Time Series
M Costa, AL Goldberger, CK Peng

CinC Challenge 2002 Undertaken by Non-Stationary and Fractal Techniques
C Echeverría, MS Woolfson, JA Crowe, BR Hayes-Gill

A Multifractal Inverse Problem Applied to Heart Rate Data Synthesis
DC Lin, J Thevaril

Method for Generating an Artificial RR Tachogram of a Typical Healthy Human over 24-hours
PE McSharry, G Clifford, L Tarassenko, LA Smith

Simulating Healthy Humans Heart Rate: a Markovian Model
CC Yang, CH Chang, SS Hseu, HW Yien

Simulation of Cardiac RR Interval Time Series
EJ Bowers, P Langley, MJ Drinnan, J Allen, FE Smith, A Murray

Heart Rate Variability Characteristics Required for Simulation of Interval Sequences
FE Smith, EJ Bowers, P Langley, J Allen, A Murray

Dynamic Features of the Normal Heart Rate Variability
T Smuc, I Maric, G Bosanac, D Gamberger, N Bogunovic, G Krstacic

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