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We sought to validate an ICG noise removal method, three\u2010stage ensemble\u2010average algorithm (TEA), in data acquired from a clinical trial comparing active versus sham non\u2010invasive vagal nerve stimulation (tcVNS) after standardized speech stress. We first compared TEA's performance versus the standard conventional ensemble\u2010average algorithm (CEA) approach to classify noisy ICG segments. We then analyzed ECG and ICG data to measure PEP and compared group\u2010level differences in stress states with each approach. We evaluated 45 individuals, of whom 23 had post\u2010traumatic stress disorder (PTSD). We found that the TEA approach identified artifact\u2010corrupted beats with intraclass correlation coefficient\u00a0&gt;\u00a00.99 compared to expert adjudication. TEA also resulted in higher group\u2010level differences in PEP between stress states than CEA. PEP values were lower in the speech stress (vs. baseline rest) group using both techniques, but the differences were greater using TEA (12.1\u00a0ms) than CEA (8.0\u00a0ms). PEP differences in groups divided by PTSD status and tcVNS (active vs. sham) were also greater when using the TEA versus CEA method, although the magnitude of the differences was lower. In conclusion, TEA helps to accurately identify noisy ICG beats during speaking stress, and this increased accuracy improves sensitivity to group\u2010level differences in stress states compared to CEA, suggesting greater clinical utility.<\/jats:p>","DOI":"10.1111\/psyp.14013","type":"journal-article","created":{"date-parts":[[2022,2,12]],"date-time":"2022-02-12T15:24:48Z","timestamp":1644679488000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Validation of a new impedance cardiography analysis algorithm for clinical classification of stress states"],"prefix":"10.1111","volume":"59","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2503-7187","authenticated-orcid":false,"given":"Shafa\u2010at Ali","family":"Sheikh","sequence":"first","affiliation":[{"name":"Department of Biomedical Informatics Emory University  Atlanta Georgia USA"},{"name":"School of Electrical and Computer Engineering Georgia Institute of Technology  Atlanta Georgia USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3702-0449","authenticated-orcid":false,"given":"Nil Z.","family":"Gurel","sequence":"additional","affiliation":[{"name":"Neurocardiology Research Center of Excellence and Cardiac Arrhythmia Center David Geffen School of Medicine at UCLA  Los Angeles California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shishir","family":"Gupta","sequence":"additional","affiliation":[{"name":"Department of Epidemiology, Rollins School of Public Health Emory University  Atlanta Georgia USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ikenna V.","family":"Chukwu","sequence":"additional","affiliation":[{"name":"Department of Epidemiology, Rollins School of Public Health Emory University  Atlanta Georgia USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Oleksiy","family":"Levantsevych","sequence":"additional","affiliation":[{"name":"Department of Epidemiology, Rollins School of Public Health Emory University  Atlanta Georgia USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mhmtjamil","family":"Alkhalaf","sequence":"additional","affiliation":[{"name":"Department of Epidemiology, Rollins School of Public Health Emory University  Atlanta Georgia USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Majd","family":"Soudan","sequence":"additional","affiliation":[{"name":"Department of Epidemiology, Rollins School of Public Health Emory University  Atlanta Georgia USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rami","family":"Abdulbaki","sequence":"additional","affiliation":[{"name":"Department of Epidemiology, Rollins School of Public Health Emory University  Atlanta Georgia USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ammer","family":"Haffar","sequence":"additional","affiliation":[{"name":"Department of Epidemiology, Rollins School of Public Health Emory University  Atlanta Georgia USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gari D.","family":"Clifford","sequence":"additional","affiliation":[{"name":"Department of Biomedical Informatics Emory University  Atlanta Georgia USA"},{"name":"Department of Biomedical Engineering Georgia Institute of Technology and Emory University  Atlanta Georgia USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Omer T.","family":"Inan","sequence":"additional","affiliation":[{"name":"School of Electrical and Computer Engineering Georgia Institute of Technology  Atlanta Georgia USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9099-9687","authenticated-orcid":false,"given":"Amit J.","family":"Shah","sequence":"additional","affiliation":[{"name":"Department of Epidemiology, Rollins School of Public Health Emory University  Atlanta Georgia USA"},{"name":"Department of Medicine, Division of Cardiology Emory University School of Medicine  Atlanta Georgia USA"},{"name":"Atlanta Veterans Affairs Health Care System  Atlanta Georgia USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2022,2,12]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.1111\/psyp.12799"},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10439\u2010014\u20100993\u20109"},{"key":"e_1_2_8_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140\u20106736(86)90837\u20108"},{"key":"e_1_2_8_5_1","doi-asserted-by":"publisher","DOI":"10.1097\/PSY.0000000000000597"},{"key":"e_1_2_8_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.brs.2018.12.417"},{"key":"e_1_2_8_7_1","volume-title":"Closed loop vagal nerve stimulation for patients with posttraumatic stress disorder","author":"Bremner J. 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