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In clinical datasets, missing data often occur due to various reasons including non-response, data corruption, and errors in data collection or processing. Such missing values can lead to biased statistical analyses, reduced statistical power, and potentially misleading findings, making effective imputation critical. Traditional imputation methods, such as Zero Imputation, Mean Imputation, and k-Nearest Neighbors (KNN) Imputation, attempt to address these gaps. However, these methods often fall short of accurately capturing the underlying data complexity, leading to oversimplified assumptions and errors in prediction. This study introduces a novel Imputation model employing transformer-based architectures to address these challenges. Notably, the model distinguishes between complete EEG signal amplitude data and incomplete data in two datasets: PhysioNet and CHB-MIT. By training exclusively on complete amplitude data, the TabTransformer accurately learns and predicts missing values, capturing intricate patterns and relationships inherent in EEG amplitude data. Evaluation using various error metrics and R2 score demonstrates significant enhancements over traditional methods such as Zero, Mean, and KNN imputation. The Proposed Model achieves impressive R2 scores of 0.993 for PhysioNet and 0.97 for CHB-MIT, highlighting its efficacy in handling complex clinical data patterns and improving dataset integrity. This underscores the transformative potential of transformer models in advancing the utility and reliability of clinical datasets.

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The primary objective of this study was to enhance the operational efficiency of the current healthcare system by proposing a quicker and more effective approach for healthcare providers to deliver services to individuals facing acute heart failure (HF) and concurrent medical conditions. The aim was to support healthcare staff in providing urgent services more efficiently by developing an automated decision-support Patient Prioritization (PP) Tool that utilizes a tailored machine learning (ML) model to prioritize HF patients with chronic heart conditions and concurrent comorbidities during Urgent Care Unit admission. The study applies key ML models to the PhysioNet dataset, encompassing hospital admissions and mortality records of heart failure patients at Zigong Fourth People's Hospital in Sichuan, China, between 2016 and 2019. In addition, the model outcomes for the PhysioNet dataset are compared with the Healthcare Cost and Utilization Project (HCUP) Maryland (MD) State Inpatient Data (SID) for 2014, a secondary dataset containing heart failure patients, to assess the generalizability of results across diverse healthcare settings and patient demographics. The ML models in this project demonstrate efficiencies surpassing 97.8% and specificities exceeding 95% in identifying HF patients at a higher risk and ranking them based on their mortality risk level. Utilizing this machine learning for the PP approach underscores risk assessment, supporting healthcare professionals in managing HF patients more effectively and allocating resources to those in immediate need, whether in hospital or telehealth settings.

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Objective.The EPHNOGRAM project aimed to develop a low-cost, low-power device for simultaneous electrocardiogram (ECG) and phonocardiogram (PCG) recording, with additional channels for environmental audio to enhance PCG through active noise cancellation. The objective was to study multimodal electro-mechanical activities of the heart, offering insights into the differences and synergies between these modalities during various cardiac activity levels.Approach.We developed and tested several hardware prototypes of a simultaneous ECG-PCG acquisition device. Using this technology, we collected simultaneous ECG and PCG data from 24 healthy adults during different physical activities, including resting, walking, running, and stationary biking, in an indoor fitness center. The data were annotated using a robust software that we developed for detecting ECG R-peaks and PCG S1 and S2 components, and overseen by a human expert. We also developed machine learning models using ECG-based, PCG-based, and joint ECG-PCG features, like R-R and S1-S2 intervals, to classify physical activities and analyze electro-mechanical dynamics.Main results.The results show a significant coupling between ECG and PCG components, especially during high-intensity exercise. Notable micro-variations in S2-based heart rate show differences in the heart's electrical and mechanical functions. The Lomb-Scargle periodogram and approximate entropy analyses confirm the higher volatility of S2-based heart rate compared to ECG-based heart rate. Correlation analysis shows stronger coupling between R-R and R-S1 intervals during high-intensity activities. Hybrid ECG-PCG features, like the R-S2 interval, were identified as more informative for physical activity classification through mRMR feature selection and SHAP value analysis.Significance.The EPHNOGRAM database, is available on PhysioNet. The database enhances our understanding of cardiac function, enabling future studies on the heart's mechanical and electrical interrelationships. The results of this study can contribute to improved cardiac condition diagnoses. Additionally, the designed hardware has the potential for integration into wearable devices and the development of multimodal stress test technologies.

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Traditionally, heart murmurs are diagnosed through cardiac auscultation, which requires specialized training and experience. The purpose of this study is to predict patients' clinical outcomes (normal or abnormal) and identify the presence or absence of heart murmurs using phonocardiograms (PCGs) obtained at different auscultation points. A semi-supervised model tailored to PCG classification is introduced in this study, with the goal of improving performance using time-frequency deep features. The study begins by investigating the behavior of PCGs in the time-frequency domain, utilizing the Stockwell transform to convert the PCG signal into two-dimensional time-frequency maps (TFMs). A deep network named AlexNet is then used to derive deep feature sets from these TFMs. In feature reduction, redundancy is eliminated and the number of deep features is reduced to streamline the feature set. The effectiveness of the extracted features is evaluated using three different classifiers using the CinC/Physionet challenge 2022 dataset. For Task I, which focuses on heart murmur detection, the proposed approach achieved an average accuracy of 93%, sensitivity of 91%, and F1-score of 91%. According to Task II of the CinC/Physionet challenge 2022, the approach showed a clinical outcome cost of 5290, exceeding the benchmark set by leading methods in the challenge.

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This study investigates the use of atrioventricular (AV) synchronization as an important diagnostic criterion for atrial fibrillation and flutter (AF) using one to twelve ECG leads. Heart rate, lead-specific AV conduction time, and P-/f-wave amplitude were evaluated by three representative ECG metrics (mean value, standard deviation), namely RR-interval (RRi-mean, RRi-std), PQ-interval (PQi-mean, PQI-std), and PQ-amplitude (PQa-mean, PQa-std), in 71,545 standard 12-lead ECG records from the six largest PhysioNet CinC Challenge 2021 databases. Two rhythm classes were considered (AF, non-AF), randomly assigning records into training (70%), validation (20%), and test (10%) datasets. In a grid search of 19, 55, and 83 dense neural network (DenseNet) architectures and five independent training runs, we optimized models for one-lead, six-lead (chest or limb), and twelve-lead input features. Lead-set performance and SHapley Additive exPlanations (SHAP) input feature importance were evaluated on the test set. Optimal DenseNet architectures with the number of neurons in sequential [1st, 2nd, 3rd] hidden layers were assessed for sensitivity and specificity: DenseNet [16,16,0] with primary leads (I or II) had 87.9-88.3 and 90.5-91.5%; DenseNet [32,32,32] with six limb leads had 90.7 and 94.2%; DenseNet [32,32,4] with six chest leads had 92.1 and 93.2%; and DenseNet [128,8,8] with all 12 leads had 91.8 and 95.8%, indicating sensitivity and specificity values, respectively. Mean SHAP values on the entire test set highlighted the importance of RRi-mean (100%), RR-std (84%), and atrial synchronization (40-60%) for the PQa-mean (aVR, I), PQi-std (V2, aVF, II), and PQi-mean (aVL, aVR). Our focus on finding the strongest AV synchronization predictors of AF in 12-lead ECGs would lead to a comprehensive understanding of the decision-making process in advanced neural network classifiers. DenseNet self-learned to rely on a few ECG behavioral characteristics: first, characteristics usually associated with AF conduction such as rapid heart rate, enhanced heart rate variability, and large PQ-interval deviation in V2 and inferior leads (aVF, II); second, characteristics related to a typical P-wave pattern in sinus rhythm, which is best distinguished from AF by the earliest negative P-peak deflection of the right atrium in the lead (aVR) and late positive left atrial deflection in lateral leads (I, aVL). Our results on lead-selection and feature-selection practices for AF detection should be considered for one- to twelve-lead ECG signal processing settings, particularly those measuring heart rate, AV conduction times, and P-/f-wave amplitudes. Performances are limited to the AF diagnostic potential of these three metrics. SHAP value importance can be used in combination with a human expert's ECG interpretation to change the focus from a broad observation of 12-lead ECG morphology to focusing on the few AV synchronization findings strongly predictive of AF or non-AF arrhythmias. Our results are representative of AV synchronization findings across a broad taxonomy of cardiac arrhythmias in large 12-lead ECG databases.

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Objective. This paper introduces a winning solution (team ISIBrno-AIMT) to the official round of PhysioNet Challenge 2021. The main goal of the challenge was a classification of ECG recordings into 26 multi-label pathological classes with a variable number of leads (e.g. 12, 6, 4, 3, 2). The main objective of this study is to verify whether the multi-head-attention mechanism influences the model performance.Approach. We introduced an ECG classification method based on the ResNet architecture with a multi-head attention mechanism for the official round of the challenge. However, empirical findings collected during model development suggested that the multi-head attention layer might not significantly impact the final classification performance. For this reason, during the follow-up round, we removed a multi-head attention layer to test the influence on model performance. Like the official round, the model is optimized using a mixture of loss functions, i.e. binary cross-entropy, custom challenge score loss function, and custom sparsity loss function. Probability thresholds for each classification class are estimated using the evolutionary optimization method. The final architecture consists of three submodels forming a majority voting classification ensemble.Main results. The modified model without the multi-head attention layer increased the overall challenge score to 0.59 compared to the 0.58 from the official round.Significance. Our findings from the follow-up submission support the fact that the multi-head attention layer in the proposed architecture does not significantly affect the classification performance.

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Background. Twelve lead ECGs are a core diagnostic tool for cardiovascular diseases. Here, we describe and analyse an ensemble deep neural network architecture to classify 24 cardiac abnormalities from 12 lead ECGs.Method. We proposed a squeeze and excite ResNet to automatically learn deep features from 12-lead ECGs, in order to identify 24 cardiac conditions. The deep features were augmented with age and gender features in the final fully connected layers. Output thresholds for each class were set using a constrained grid search. To determine why the model made incorrect predictions, two expert clinicians independently interpreted a random set of 100 misclassified ECGs concerning left axis deviation.Results. Using the bespoke weighted accuracy metric, we achieved a 5-fold cross-validation score of 0.684, and sensitivity and specificity of 0.758 and 0.969, respectively. We scored 0.520 on the full test data, and ranked 2nd out of 41 in the official challenge rankings. On a random set of misclassified ECGs, agreement between two clinicians and training labels was poor (clinician 1:κ= -0.057, clinician 2:κ= -0.159). In contrast, agreement between the clinicians was very high (κ= 0.92).Discussion. The proposed prediction model performed well on the validation and hidden test data in comparison to models trained on the same data. We also discovered considerable inconsistency in training labels, which is likely to hinder development of more accurate models.

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Athletes often have training-induced remodeling of the heart, and this can sometimes be seen as abnormal but non-pathological changes in the electrocardiogram. However, these changes can be confused with severe cardiovascular diseases that, in some cases, can cause cardiovascular death. Electrocardiogram data from athletes is therefore important to learn more about the difference between normal athletic remodeling and pathological remodeling of the heart. This work provides a dataset of electrocardiograms from 28 Norwegian elite endurance athletes. The electrocardiograms are standard 12-lead resting ECGs, recorded for 10 seconds while the athlete's lay supine on a bench. The electrocardiograms were then interpreted by an interpretation algorithm and by a trained cardiologist. The electrocardiogram waveform data and the interpretations were stored in Python Waveform Database format and made publicly available through PhysioNet.

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Considering the significant burden to patients and healthcare systems globally related to atrial fibrillation (AF) complications, the early AF diagnosis is of crucial importance. In the view of prominent perspectives for fast and accurate point-of-care arrhythmia detection, our study optimizes an artificial neural network (NN) classifier and ranks the importance of enhanced 137 diagnostic ECG features computed from time and frequency ECG signal representations of short single-lead strips available in 2017 Physionet/CinC Challenge database. Based on hyperparameters' grid search of densely connected NN layers, we derive the optimal topology with three layers and 128, 32, 4 neurons per layer (DenseNet-3@128-32-4), which presents maximal F1-scores for classification of Normal rhythms (0.883, 5076 strips), AF (0.825, 758 strips), Other rhythms (0.705, 2415 strips), Noise (0.618, 279 strips) and total F1 relevant to the CinC Challenge of 0.804, derived by five-fold cross-validation. DenseNet-3@128-32-4 performs equally well with 137 to 32 features and presents tolerable reduction by about 0.03 to 0.06 points for limited input sets, including 8 and 16 features, respectively. The feature reduction is linked to effective application of a comprehensive method for computation of the feature map importance based on the weights of the activated neurons through the total path from input to specific output in DenseNet. The detailed analysis of 20 top-ranked ECG features with greatest importance to the detection of each rhythm and overall of all rhythms reveals DenseNet decision-making process, noticeably corresponding to the cardiologists' diagnostic point of view.

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Motor imagery (MI)-based brain-computer interfaces have gained much attention in the last few years. They provide the ability to control external devices, such as prosthetic arms and wheelchairs, by using brain activities. Several researchers have reported the inter-communication of multiple brain regions during motor tasks, thus making it difficult to isolate one or two brain regions in which motor activities take place. Therefore, a deeper understanding of the brain's neural patterns is important for BCI in order to provide more useful and insightful features. Thus, brain connectivity provides a promising approach to solving the stated shortcomings by considering inter-channel/region relationships during motor imagination. This study used effective connectivity in the brain in terms of the partial directed coherence (PDC) and directed transfer function (DTF) as intensively unconventional feature sets for motor imagery (MI) classification. MANOVA-based analysis was performed to identify statistically significant connectivity pairs. Furthermore, the study sought to predict MI patterns by using four classification algorithms-an SVM, KNN, decision tree, and probabilistic neural network. The study provides a comparative analysis of all of the classification methods using two-class MI data extracted from the PhysioNet EEG database. The proposed techniques based on a probabilistic neural network (PNN) as a classifier and PDC as a feature set outperformed the other classification and feature extraction techniques with a superior classification accuracy and a lower error rate. The research findings indicate that when the PDC was used as a feature set, the PNN attained the greatest overall average accuracy of 98.65%, whereas the same classifier was used to attain the greatest accuracy of 82.81% with the DTF. This study validates the activation of multiple brain regions during a motor task by achieving better classification outcomes through brain connectivity as compared to conventional features. Since the PDC outperformed the DTF as a feature set with its superior classification accuracy and low error rate, it has great potential for application in MI-based brain-computer interfaces.

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The main objective of this study is to propose relatively simple techniques for the automatic diagnosis of electrocardiogram (ECG) signals based on a classical rule-based method and a convolutional deep learning architecture. The validation task was performed in the framework of the PhysioNet/Computing in Cardiology Challenge 2020, where seven databases consisting of 66,361 recordings with 12-lead ECGs were considered for training, validation and test sets. A total of 24 different diagnostic classes are considered in the entire training set. The rule-based method uses morphological and time-frequency ECG descriptors that are defined for each diagnostic label. These rules are extracted from the knowledge base of a cardiologist or from a textbook, with no direct learning procedure in the first phase, whereas a refinement was tested in the second phase. The deep learning method considers both raw ECG and median beat signals. These data are processed via continuous wavelet transform analysis, obtaining a time-frequency domain representation, with the generation of specific images (ECG scalograms). These images are then used for the training of a convolutional neural network based on GoogLeNet topology for ECG diagnostic classification. Cross-validation evaluation was performed for testing purposes. A total of 217 teams submitted 1395 algorithms during the Challenge. The diagnostic accuracy of our algorithm produced a challenge validation score of 0.325 (CPU time = 35 min) for the rule-based method, and a 0.426 (CPU time = 1664 min) for the deep learning method, which resulted in our team attaining 12th place in the competition.

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The electrocardiogram is traditionally used to diagnose a large number of heart pathologies. Research to improve the readability and classification of cardiac signals includes studies geared toward sonification of the electrocardiographic signal and others involving features related to music processing, such as Mel-frequency cepstral coefficients. In terms of music processing features, this study seeks to use music information retrieval (MIR) features as electrocardiographic signal descriptors. The study compares the discriminatory capability of the introduced features in relation to standard groups such as heart rate variability, wavelet transform, descriptive statistics, Mel coefficients and fractal analysis, evaluated using classification algorithms; the signals analyzed were extracted from public databases. The group of features extracted from wavelet transform and the MIR group showed a high level of discrimination; the best representation of the ECG signals in the study was achieved in most cases by the MIR features. Moreover, a correlation coefficient higher than 0.8 was found between a number of MIR and other feature groups, indicating a likely relationship between the electrocardiographic signals and MIR features. These results suggest the feasibility of representing the analyzed signals by music information retrieval descriptors, giving the potential to consider these electrocardiographic signals as analogues to musical signals.

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Cardiovascular diseases (CVDs) are one of the most fatal disease groups worldwide. Electrocardiogram (ECG) is a widely used tool for automatically detecting cardiac abnormalities, thereby helping to control and manage CVDs. To encourage more multidisciplinary researches, PhysioNet/Computing in Cardiology Challenge 2020 (Challenge 2020) provided a public platform involving multi-center databases and automatic evaluations for ECG classification tasks. As a result, 41 teams successfully submitted their solutions and were qualified for rankings. Although Challenge 2020 was a success, there has been no in-depth methodological meta-analysis of these solutions, making it difficult for researchers to benefit from the solutions and results. In this study, we aim to systematically review the 41 solutions in terms of data processing, feature engineering, model architecture, and training strategy. For each perspective, we visualize and statistically analyze the effectiveness of the common techniques, and discuss the methodological advantages and disadvantages. Finally, we summarize five practical lessons based on the aforementioned analysis: (1) Data augmentation should be employed and adapted to specific scenarios; (2) Combining different features can improve performance; (3) A hybrid design of different types of deep neural networks (DNNs) is better than using a single type; (4) The use of end-to-end architectures should depend on the task being solved; (5) Multiple models are better than one. We expect that our meta-analysis will help accelerate the research related to ECG classification based on machine-learning models.

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BACKGROUND: Accurate detection of QRS complexes during mobile, ultra-long-term ECG monitoring is challenged by instances of high heart rate, dramatic and persistent changes in signal amplitude, and intermittent deformations in signal quality that arise due to subject motion, background noise, and misplacement of the ECG electrodes. PURPOSE: We propose a revised QRS detection algorithm which addresses the above-mentioned challenges. METHODS AND RESULTS: Our proposed algorithm is based on a state-of-the-art algorithm after applying two key modifications. The first modification is implementing local estimates for the amplitude of the signal. The second modification is a mechanism by which the algorithm becomes adaptive to changes in heart rate. We validated our proposed algorithm against the state-of-the-art algorithm using short-term ECG recordings from eleven annotated databases available at Physionet, as well as four ultra-long-term (14-day) ECG recordings which were visually annotated at a central ECG core laboratory. On the database of ultra-long-term ECG recordings, our proposed algorithm showed a sensitivity of 99.90% and a positive predictive value of 99.73%. Meanwhile, the state-of-the-art QRS detection algorithm achieved a sensitivity of 99.30% and a positive predictive value of 99.68% on the same database. The numerical efficiency of our new algorithm was evident, as a 14-day recording sampled at 200 Hz was analyzed in approximately 157 s. CONCLUSIONS: We developed a new QRS detection algorithm. The efficiency and accuracy of our algorithm makes it a good fit for mobile health applications, ultra-long-term and pathological ECG recordings, and the batch processing of large ECG databases.

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In this paper, the possibility of using the ECG signal as an unequivocal biometric marker for authentication and identification purposes has been presented. Furthermore, since the ECG signal was acquired from 4 sources using different measurement equipment, electrodes positioning and number of patients as well as the duration of the ECG record acquisition, we have additionally provided an estimation of the extent of information available in the ECG record. To provide a more objective assessment of the credibility of the identification method, some selected machine learning algorithms were used in two combinations: with and without compression. The results that we have obtained confirm that the ECG signal can be acclaimed as a valid biometric marker that is very robust to hardware variations, noise and artifacts presence, that is stable over time and that is scalable across quite a solid (~100) number of users. Our experiments indicate that the most promising algorithms for ECG identification are LDA, KNN and MLP algorithms. Moreover, our results show that PCA compression, used as part of data preprocessing, does not only bring any noticeable benefits but in some cases might even reduce accuracy.

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Coronary artery disease (CAD) is the most common cause of heart disease globally. This is because there is no symptom exhibited in its initial phase until the disease progresses to an advanced stage. The electrocardiogram (ECG) is a widely accessible diagnostic tool to diagnose CAD that captures abnormal activity of the heart. However, it lacks diagnostic sensitivity. One reason is that, it is very challenging to visually interpret the ECG signal due to its very low amplitude. Hence, identification of abnormal ECG morphology by clinicians may be prone to error. Thus, it is essential to develop a software which can provide an automated and objective interpretation of the ECG signal. This paper proposes the implementation of long short-term memory (LSTM) network with convolutional neural network (CNN) to automatically diagnose CAD ECG signals accurately. Our proposed deep learning model is able to detect CAD ECG signals with a diagnostic accuracy of 99.85% with blindfold strategy. The developed prototype model is ready to be tested with an appropriate huge database before the clinical usage.

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Using BRAVO algorithm (AMPS-LLC, NY, v4.4.0), 5223 ECGs from a publicly available annotated dataset from a randomized clinical trial on four different compounds and placebo were analyzed. ECGs were automatically processed and JTp interval was computed on: 12 standard ECG leads, Vector Magnitude (VM), and root mean square (RMS) leads. On VM and RMS, JTp intervals were nearly identical (228 ± 29 vs. 227 ± 30 ms respectively, with correlation of 0.99, p < 0.0001). On lead II, JTp interval was about 10 ms longer, but highly correlated with that measured on VM (0.94, p < 0.0001). Similarly, on lead V5, JTp was about 8 ms longer than on VM, with a correlation of 0.95, p < 0.0001. When compared to the public available annotations, JTp by BRAVO generated longer (about 8 ms) measurement and evidenced outliers conducible to both the T-wave peak (in few ECGs presenting notched shapes) and, to a lesser degree, to the J point, due to variability of the two algorithms. Differences on the drug-induced effect from the four compounds were negligible.

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In this Letter, the authors propose an efficient and robust method for automatically determining the VT and VF events in the electrocardiogram (ECG) signal. The proposed method consists of: (i) discrete cosine transform (DCT)-based noise suppression; (ii) addition of bipolar sequence of amplitudes with alternating polarity; (iii) zero-crossing rate (ZCR) estimation-based VTVF detection; and (iv) peak-to-peak interval (PPI) feature based VT/VF discrimination. The proposed method is evaluated using 18,000 episodes of different ECG arrhythmias taken from 6 PhysioNet databases. The method achieves an average sensitivity (Se) of 99.61%, specificity (Sp) of 99.96%, and overall accuracy (OA) of 99.92% in detecting VTVF and non-VTVF episodes by using a ZCR feature. Results show that the method achieves a Se of 100%, Sp of 99.70% and OA of 99.85% for discriminating VT from VF episodes using PPI features extracted from the processed signal. The robustness of the method is tested using different kinds of ECG beats and various types of noises including the baseline wanders, powerline interference and muscle artefacts. Results demonstrate that the proposed method with the ZCR, PPI features can achieve significantly better detection rates as compared with the existing methods.

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A novel algorithm based on forward search is developed for real-time electrocardiogram (ECG) signal processing and implemented in application specific integrated circuit (ASIC) for QRS complex related cardiovascular disease diagnosis. The authors have evaluated their algorithm using MIT-BIH database and achieve sensitivity of 99.86% and specificity of 99.93% for QRS complex peak detection. In this Letter, Physionet PTB diagnostic ECG database is used for QRS complex related disease detection. An ASIC for cardiovascular disease detection is fabricated using 130-nm CMOS high-speed process technology. The area of the ASIC is 0.5 mm(2). The power dissipation is 1.73 µW at the operating frequency of 1 kHz with a supply voltage of 0.6 V. The output from the ASIC is fed to their Android application that generates diagnostic report and can be sent to a cardiologist through email. Their ASIC result shows average failed detection rate of 0.16% for six leads data of 290 patients in PTB diagnostic ECG database. They also have implemented a low-leakage version of their ASIC. The ASIC dissipates only 45 pJ with a supply voltage of 0.9 V. Their proposed ASIC is most suitable for energy efficient telemetry cardiovascular disease detection system.

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While PhysioNet is a large database for standard clinical vital signs measurements, such a database does not exist for unobtrusively measured signals. This inhibits progress in the vital area of signal processing for unobtrusive medical monitoring as not everybody owns the specific measurement systems to acquire signals. Furthermore, if no common database exists, a comparison between different signal processing approaches is not possible. This gap will be closed by our UnoViS database. It contains different recordings in various scenarios ranging from a clinical study to measurements obtained while driving a car. Currently, 145 records with a total of 16.2 h of measurement data is available, which are provided as MATLAB files or in the PhysioNet WFDB file format. In its initial state, only (multichannel) capacitive ECG and unobtrusive PPG signals are, together with a reference ECG, included. All ECG signals contain annotations by a peak detector and by a medical expert. A dataset from a clinical study contains further clinical annotations. Additionally, supplementary functions are provided, which simplify the usage of the database and thus the development and evaluation of new algorithms. The development of urgently needed methods for very robust parameter extraction or robust signal fusion in view of frequent severe motion artifacts in unobtrusive monitoring is now possible with the database.