Journal of electrocardiology最新文献_第6页

12 lead surface ECGs as a surrogate of atrial electrical remodeling - a deep learning based approach 12导联表面心电图作为心房电重构的替代品-一种基于深度学习的方法。

IF 1.3 4区医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of electrocardiology

Pub Date : 2024-12-25 DOI: 10.1016/j.jelectrocard.2024.153862

Ishan Vatsaraj , Yazan Mohsen , Lukas Grüne , Lucas Steffens , Shane Loeffler , Marc Horlitz , Florian Stöckigt , Natalia Trayanova

Background and purpose

Atrial fibrillation (AF), a common arrhythmia, is linked with atrial electrical and structural changes, notably low voltage areas (LVAs) which are associated with poor ablation outcomes and increased thromboembolic risk. This study aims to evaluate the efficacy of a deep learning model applied to 12‑lead ECGs for non-invasively predicting the presence of LVAs, potentially guiding pre-ablation strategies and improving patient outcomes.

Methods

A retrospective analysis was conducted on 204 AF patients, who underwent catheter ablation. Pre-procedural sinus rhythm ECGs and electroanatomical maps (EAM) were utilized alongside demographic data to train a deep learning model combining Long Short-Term Memory networks and Convolutional Neural Networks with a cross-attention layer. Model performance was evaluated using a 5-fold cross-validation strategy.

Results

The model effectively identified the presence of LVA on the examined atrial walls, achieving accuracies of 78 % for both the anterior and posterior walls, and 82 % for the LA roof. Moreover, it accurately predicted the global left atrial (LA) average voltage <0.7 mV, with an accuracy of 88 %.

Conclusion

The study showcases the potential of deep learning applied to 12‑lead ECGs to effectively predict regional LVAs and global LA voltage in AF patients non-invasively. This model offers a promising tool for the pre-ablation assessment of atrial substrate, facilitating personalized therapeutic strategies and potentially enhancing ablation success rates.

背景和目的：心房颤动（AF）是一种常见的心律失常，与心房电和结构改变有关，特别是低电压区（lva），与不良消融结果和血栓栓塞风险增加有关。本研究旨在评估应用于12导联心电图的深度学习模型的有效性，该模型用于无创预测LVAs的存在，可能指导消融前策略并改善患者预后。方法：对204例房颤患者行导管消融的临床资料进行回顾性分析。术前窦性心律心电图和电解剖图（EAM）与人口统计学数据一起用于训练深度学习模型，该模型结合了长短期记忆网络和具有交叉注意层的卷积神经网络。使用5倍交叉验证策略评估模型性能。结果：该模型有效地识别了被检查心房壁上LVA的存在，对前壁和后壁的准确率均为78%，对左房顶的准确率为82%。结论：该研究展示了深度学习应用于12导联心电图的潜力，可以有效地预测房颤患者的局部lva和整体LA电压。该模型为消融前心房底物评估提供了一个有前景的工具，促进了个性化的治疗策略，并有可能提高消融成功率。

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引用次数: 0

Tracking autonomic nervous system activity using surface ECG: Personalized, multiparametric evaluation 利用体表心电图跟踪自主神经系统活动：个性化、多参数评估

IF 1.3 4区医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of electrocardiology

Pub Date : 2024-11-22 DOI: 10.1016/j.jelectrocard.2024.153837

Vladimir Shusterman , Cees A. Swenne , Stacy Hoffman , Patrick J. Strollo , Barry London

We present a concise review of the background, pitfalls, and potential solutions for the noninvasive evaluation and continuous tracking of cardiac autonomic nervous system activity (ANSA), using surface-ECG-accessible parameters, including heart rate (HR), heart-rate variability (HRV), and cardiac repolarization. These parameters have provided insights into the dynamics of cardiac ANSA in controlled experiments and have proved useful in risk assessment with respect to sudden cardiac death and all-cause mortality in some patient populations, as well as in implantable device programming. Yet attempts to translate these parameters from the laboratory environment to ambulatory settings have been hampered by the presence of multiple uncontrolled factors, including changes in blood pressure, body position, physical activity, and respiration frequency. We show that a single-parameter-based, simplified cardiac ANSA evaluation in an uncontrolled ambulatory setting could be inaccurate, and we discuss several approaches to improve accuracy. Discerning cardiac ANSA effects in uncontrolled ambulatory environments requires tracking multiple physiological processes, preferably using multisensor, multiparametric monitoring and controlling some physiological variables (e.g., respiration frequency); data fusion and machine-learning-based analytics are instrumental for developing more accurate personalized ANSA evaluation.

我们简要回顾了无创评估和持续跟踪心脏自主神经系统活动（ANSA）的背景、缺陷和潜在解决方案，使用表面心电图可获得的参数，包括心率（HR）、心率变异性（HRV）和心脏复极。这些参数在对照实验中提供了对心脏ANSA动态的见解，并已被证明在某些患者群体中心脏性猝死和全因死亡率的风险评估以及植入式装置规划中有用。然而，由于存在多种不受控制的因素，包括血压、体位、身体活动和呼吸频率的变化，将这些参数从实验室环境转化为门诊环境的尝试受到了阻碍。我们表明，单参数为基础的，简化心脏ANSA评估在不受控制的门诊设置可能是不准确的，我们讨论了几种方法来提高准确性。在不受控制的动态环境中识别心脏ANSA效应需要跟踪多个生理过程，最好使用多传感器，多参数监测和控制一些生理变量（例如，呼吸频率）；数据融合和基于机器学习的分析有助于开发更准确的个性化ANSA评估。

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引用次数: 0

Ease and accuracy of ECG interpretation using 12-lead ECG versus a combination of 12-lead and vector ECG (electro-vectorcardiogram) by medical students: A prospective, randomised controlled study 医学生使用 12 导联心电图与 12 导联和矢量心电图（矢量心电图）组合进行心电图解读的难易程度和准确性：前瞻性随机对照研究

IF 1.3 4区医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of electrocardiology

Pub Date : 2024-11-22 DOI: 10.1016/j.jelectrocard.2024.153830

Tipparaju Hasitha MBBS Intern , Nikhil Singhania MBBS, MD , Suresh Kumar Sukumaran MBBS, MD, DM , Raja J. Selvaraj MBBS, MD, DNB, PDF in Cardiac Electrophysiology

Background

The Electrocardiogram (ECG) can be visualised either in a scalar form, as waves in the standard 12‑lead ECG, or vectorially, as vector loops in different planes in the Vectorcardiogram (VCG). An Electro-Vectorcardiogram (ECG-VCG) is a graphic visualization combining scalar and vector ECGs. We aimed to assess if integrating the scalar 12‑lead ECG and vector ECG makes ECG interpretation by medical students more accurate, faster, and easier than using 12‑lead ECG alone.

Methods

Undergraduate medical students were randomised into ECG group and ECG-VCG group. The students received a web-based tutorial followed by a test. The ECG group were taught with and had to interpret standard 12‑lead ECG images, while the ECG-VCG group were taught and had to interpret ECG-VCG images with two-dimensional VCG panels (frontal and horizontal) of the same diagnosis. On completion, participants reported their ease of interpretation as grades. Test scores, time taken and ease were compared between the groups.

Results

The study included 296 medical students. The primary outcome, interpretation accuracy (test score out of 10), was significantly greater in the ECG-VCG group (7.34 ± 2.13 vs 6.09 ± 2.34, p < 0.001). The time taken for interpretation was significantly lower and ease of interpretation was significantly greater in the ECG-VCG group.

Conclusion

The use of ECG-VCG to teach undergraduate medical students can outperform the 12‑lead ECG in terms of accuracy, speed and ease.

背景心电图（ECG）既可以标量形式可视化，如标准 12 导联心电图中的波，也可以矢量形式可视化，如矢量心电图（VCG）中不同平面上的矢量环。矢量心电图（ECG-VCG）是将标量心电图和矢量心电图相结合的图形可视化。我们的目的是评估整合标量 12 导联心电图和矢量心电图是否比单独使用 12 导联心电图更准确、更快速、更方便医学生解读心电图。学生们先接受网络教学，然后进行测试。心电图组通过标准的 12 导联心电图图像进行学习和判读，而心电图-VCG 组则通过二维 VCG 面板（正面和水平）进行学习和判读相同诊断的心电图-VCG 图像。完成后，参与者以分数形式报告解读的难易程度。研究包括 296 名医科学生。主要结果是，心电图-VCG 组的判读准确性（满分 10 分的测试得分）明显更高（7.34 ± 2.13 vs 6.09 ± 2.34，p < 0.001）。结论使用心电图-VCG 对本科医学生进行教学，在准确性、速度和简便性方面均优于 12 导联心电图。

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引用次数: 0

Electrical storm induced by premature ventricular beat with extremely short coupling interval in a patient with long QT syndrome type 3 一名长 QT 综合征 3 型患者因耦合间期极短的室性早搏诱发的电风暴

IF 1.3 4区医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of electrocardiology

Pub Date : 2024-11-22 DOI: 10.1016/j.jelectrocard.2024.153833

Akira Sato , Takuya Takahashi , Seiko Kuwata , Satoshi Nakano , Junichi Koizumi , Hirofumi Saiki , Manami Akasaka

Here we report the case of a 10-year-old boy with long QT syndrome type 3 (LQT3) who developed refractory torsade de pointes (TdP) associated with ventricular arrhythmia with a short coupling time (VASCT). After implantable cardioverter-defibrillator replacement, an electrical storm occurred, which was irresponsive to the ventricular pacing as high as 120 bpm. Close inspection of the intracardiac potential revealed TdP associated with VASCT. Dexmedetomidine and verapamil were effective in controlling TdP, which allowed management with slower ventricular pace. Our case highlights the importance of focusing on ventricular arrhythmias particularly those with short coupling interval, in LQT3 with refractory TdP. (99 words).

我们在此报告了一例患有长 QT3 型综合征（LQT3）的 10 岁男孩的病例，他出现了与短耦合时间室性心律失常（VASCT）相关的难治性抽搐（TdP）。更换植入式心律转复除颤器后，出现了电风暴，对高达 120 bpm 的心室起搏无反应。仔细检查心内电位后发现，TdP 与 VASCT 有关。右美托咪定和维拉帕米能有效控制 TdP，因此可以使用较慢的心室起搏。我们的病例凸显了在患有难治性 TdP 的 LQT3 患者中关注室性心律失常，尤其是那些耦联间期较短的室性心律失常的重要性。(99个字）。

引用次数: 0

A novel electrocardiogram-based model for prediction of dementia—The Atherosclerosis Risk in Communities (ARIC) study 一种新的基于心电图的痴呆预测模型——社区动脉粥样硬化风险（ARIC）研究

IF 1.3 4区医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of electrocardiology

Pub Date : 2024-11-21 DOI: 10.1016/j.jelectrocard.2024.153832

Deling Chen , Yuchen Yao , Ethan D. Moser , Wendy Wang , Elsayed Z. Soliman , Thomas Mosley , Wei Pan

Aim

Create an ECG-based model to predict dementia and compare its performance with the existing Cardiovascular Risk Factors, Aging, and Dementia (CAIDE) model.

Methods and Results

Participants without prevalent dementia in the Atherosclerosis Risk in Communities study were studied. Visit 4 (V4) (1996–98, mean age, 62 years) and V5 (2011–13, mean age, 75 years) were used as baselines. Incident dementia cases were adjudicated through 2019. We created parsimonious ECG models by using Cox regression with a backward selection method. C-statistic (95 % CI) of the ECG-based model (two or three ECG variables and age) was higher than the CAIDE model (seven variables) at V4 (0.72 [0.71–0.74] vs. 0.67 [0.66–0.68]) and V5 (0.70 [0.68–0.72] vs. 0.64 [0.62–0.66]). The ECG-based model was well calibrated, but the CAIDE model was poorly calibrated at V4 (P < 0.001).

Conclusion

For middle-aged and older adults, a novel ECG-based model has good discrimination that is superior to the CAIDE model in predicting dementia. Since ECG variables are readily obtainable, the ECG-based model will be easy to adopt clinically.

建立一个基于心电图的模型来预测痴呆，并将其与现有的心血管危险因素、衰老和痴呆（CAIDE）模型进行比较。方法和结果对社区动脉粥样硬化风险研究中无流行痴呆的参与者进行研究。随访4 (V4)（1996-98年，平均年龄62岁）和随访5（2011-13年，平均年龄75岁）作为基线。到2019年为止，对偶发性痴呆案件进行了判决。采用Cox回归和逆向选择方法建立了简洁的心电模型。基于ECG的模型（2个或3个ECG变量和年龄）的c -统计量（95% CI）在V4（0.72[0.71-0.74]比0.67[0.66-0.68]）和V5（0.70[0.68-0.72]比0.64[0.62-0.66]）高于CAIDE模型（7个变量）。基于心电图的模型校准良好，但CAIDE模型在V4时校准较差(P <；0.001)。结论对于中老年人，基于脑电图的新模型在预测痴呆方面具有较好的辨别力，优于CAIDE模型。由于心电图变量容易获得，因此基于心电图的模型易于临床应用。

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引用次数: 0

A Case of Post-TAVI: Left Septal Fascicular Block & Right Bundle Branch Block 一例 TAVI 术后病例：左室间隔筋膜阻滞和右束支阻滞

IF 1.3 4区医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of electrocardiology

Pub Date : 2024-11-21 DOI: 10.1016/j.jelectrocard.2024.153827

Gustavo Goldenberg , Shyla Gupta , Nili Schamroth Pravda , Andrés Ricardo Pérez-Riera , Adrian Baranchuk

This paper describes a case of patient post-TAVI who developed Left Septal Fascicular Block (LSFB) and Right Bundle Branch Block (RBBB). This combination has not been previously reported and must be actively sought out, given the possible increased risk of complete atrioventricular block and sudden cardiac death. RBBB following transcatheter aortic valve replacement is rare and is associated with complete atrioventricular block and permanent pacemaker implantation. LFSB on ECG may be a surrogate maker of diffuse conduction systemic damage following TAVI. Therefore, there should be a low threshold for permanent pacing in patients who develop new RBBB and LSFB post-TAVI.

本文描述了一例 TAVI 术后患者出现左室间隔筋膜阻滞（LSFB）和右束支阻滞（RBBB）的病例。鉴于完全性房室传导阻滞和心脏性猝死的风险可能增加，必须积极寻找这种组合。经导管主动脉瓣置换术后出现 RBBB 的情况非常罕见，并且与完全性房室传导阻滞和永久性起搏器植入有关。心电图上的 LFSB 可能是 TAVI 术后弥漫性传导系统损伤的替代指标。因此，对于在 TAVI 术后出现新的 RBBB 和 LSFB 的患者，永久起搏的阈值应较低。

引用次数: 0

Relationship between ECG-derived T-wave amplitude and T/R ratio and Syntax score in patients with acute non-st segment elevation myocardial infarction 急性非ST段抬高型心肌梗死患者心电图得出的 T 波振幅和 T/R 比值与 Syntax 评分之间的关系

IF 1.3 4区医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of electrocardiology

Pub Date : 2024-11-21 DOI: 10.1016/j.jelectrocard.2024.153829

Associate Professor Dr. Erdoğan Sökmen, Dr. Muhammet Salih Ateş, Dr. Zafer Kök, Dr. Bilge Bingöl

Objectives and background

Our objective was to determine the diagnostic significance of a low T-wave amplitude (TWA) and T/R ratio, defined as the amplitude ratio between the T waves and the R waves, in patients with acute non-ST elevation myocardial infarction (ANSTEMI). Syntax score (SS) shows the extension of coronary artery disease. Previously, low TWA and T/R ratios were demonstrated to be inversely proportional to the risk of sudden cardiac arrest in different cardiac disease conditions.

Methods

266 patients were retrospectively included with ANSTEMI between July 2021 and December 2022. SS-1 and SS-2 scores were calculated using the angiographic and clinical data of the patients. The patients were stratified into tertiles based on their median SS-1 scores as lower, moderate, and higher SS-1 tertiles. ECG parameters, including TWAs and T/R ratios in leads II and V5, were measured digitally. TWA and T/R ratios were compared with SSs among the tertiles.

Results

TWA and T/R ratios in leads II and V5 were significantly lower across the increasing SS-1 tertiles (p < 0.001 for TWA in lead II) (p < 0.001 for T/R ratio in lead II) (p = 0.014 for TWA in lead V5) (p = 0.002 for T/R ratio in lead V5).ROC analysis identified T/R ratios in leads II and V5 of 0.254 (AUC: 0.758, p < 0.001) and 0.201 (AUC: 0.635, p < 0.015), respectively.

Conclusion

A low T/R ratio, particularly in lead II due to its greater AUC, better predicts moderate-to-high SS-1 in patients with ANSTEMI.

目的和背景我们的目的是确定急性非 ST 段抬高型心肌梗死（ANSTEMI）患者 T 波振幅（TWA）和 T/R 比值（定义为 T 波和 R 波之间的振幅比值）偏低的诊断意义。语法评分（SS）显示冠状动脉疾病的扩展情况。方法回顾性纳入了 2021 年 7 月至 2022 年 12 月期间的 266 例 ANSTEMI 患者。根据患者的血管造影和临床数据计算出 SS-1 和 SS-2 评分。根据中位 SS-1 评分将患者分为低、中、高 SS-1 三等分。以数字方式测量心电图参数，包括 II 和 V5 导联的 TWA 和 T/R 比值。结果TWA和T/R比值在导联II和V5中明显低于SS-1三等分（导联II中的TWA为0.001）（导联II中的T/R比值为0.001）（导联V5中的TWA为0.014）（导联V5中的T/R比值为0.002）。结论 T/R比值较低，尤其是在导联II中，因为其AUC较大，能更好地预测ANSTEMI患者的中度至高度SS-1。

{"title":"Relationship between ECG-derived T-wave amplitude and T/R ratio and Syntax score in patients with acute non-st segment elevation myocardial infarction","authors":"Associate Professor Dr. Erdoğan Sökmen, Dr. Muhammet Salih Ateş, Dr. Zafer Kök, Dr. Bilge Bingöl","doi":"10.1016/j.jelectrocard.2024.153829","DOIUrl":"10.1016/j.jelectrocard.2024.153829","url":null,"abstract":"<div><h3>Objectives and background</h3><div>Our objective was to determine the diagnostic significance of a low T-wave amplitude (TWA) and T/R ratio, defined as the amplitude ratio between the T waves and the R waves, in patients with acute non-ST elevation myocardial infarction (ANSTEMI). Syntax score (SS) shows the extension of coronary artery disease. Previously, low TWA and T/R ratios were demonstrated to be inversely proportional to the risk of sudden cardiac arrest in different cardiac disease conditions.</div></div><div><h3>Methods</h3><div>266 patients were retrospectively included with ANSTEMI between July 2021 and December 2022. SS-1 and SS-2 scores were calculated using the angiographic and clinical data of the patients. The patients were stratified into tertiles based on their median SS-1 scores as lower, moderate, and higher SS-1 tertiles. ECG parameters, including TWAs and T/R ratios in leads II and V5, were measured digitally. TWA and T/R ratios were compared with SSs among the tertiles.</div></div><div><h3>Results</h3><div>TWA and T/R ratios in leads II and V5 were significantly lower across the increasing SS-1 tertiles (<em>p</em> < 0.001 for TWA in lead II) (<em>p</em> < 0.001 for T/R ratio in lead II) (<em>p</em> = 0.014 for TWA in lead V5) (<em>p</em> = 0.002 for T/R ratio in lead V5).ROC analysis identified T/R ratios in leads II and V5 of 0.254 (AUC: 0.758, p < 0.001) and 0.201 (AUC: 0.635, <em>p</em> < 0.015), respectively.</div></div><div><h3>Conclusion</h3><div>A low T/R ratio, particularly in lead II due to its greater AUC, better predicts moderate-to-high SS-1 in patients with ANSTEMI.</div></div>","PeriodicalId":15606,"journal":{"name":"Journal of electrocardiology","volume":"88 ","pages":"Article 153829"},"PeriodicalIF":1.3,"publicationDate":"2024-11-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142699140","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Time to first nadir of the QRS complex in aVR/time to first nadir of the QRS complex in aVL: A novel method for distinguishing left from right outflow tract premature ventricular complexes (PVCs) with precordial transition in V3 aVR 中 QRS 波群第一基点的时间/aVL 中 QRS 波群第一基点的时间：用于区分左、右流出道室早复合体（PVC）和 V3 心前区转换的新方法

IF 1.3 4区医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of electrocardiology

Pub Date : 2024-11-21 DOI: 10.1016/j.jelectrocard.2024.153831

Alper Kepez , Cagan Yildirim MD , Kamil Gulsen , Kartal Emre Aslanger , Abdulkadir Uslu , Ayhan Kup , Mehmet Celik , Serdar Demir , Ayhan Kol MD , Batur Gonenc Kanar , Kursat Tigen

Background

The aim of the present study was to investigate the value of ‘time to first nadir of the QRS complex in aVR/time to first nadir of the QRS complex in aVL’ for distinguishing left vs. right outflow tract premature ventricular complexes (PVCs) with precordial transition in lead V3.

Methods

Data from 88 eligible consecutive patients (39 males; 48.3 ± 13.4 years of age) who had undergone ablation due to outflow tract PVCs that had transition in V3 were retrospectively evaluated and used in the analysis.

Results

Fifty-one patients (57.9 %) had PVCs with a left ventricular outflow tract (LVOT) origin, and 37 (42.1 %) patients had PVCs with a right ventricular outflow tract (RVOT) origin. There were significant differences between the LVOT and RVOT PVC groups in terms of the V2S/V3R index (0.97 ± 0.70 vs. 1.96 ± 0.80, p < 0.001), V1–V3 transition index (−2.6 ± 4.4 vs. -0.4 ± 4.6, p = 0.026), and ‘aVR/aVL time to first nadir of the QRS complex’ (0.94 ± 0.15 vs. 1.1 ± 0.2, p = 0.001). ROC curve analysis revealed that a ‘aVR/aVL time to first nadir of the QRS complex ratio’ greater than 0.98 predicted the RVOT origin, with 67.6 % sensitivity and 62.7 % specificity. A V1-V3 transition index > − 1.21 predicted an RVOT origin with 75.7 % sensitivity and 72.5 % specificity. A V₂S/V₃R index <1.4 predicted the origin of the LVOT, with a sensitivity of 78.4 % and a specificity of 80.4 %.

Conclusion

Although less precise than other established ECG criteria, the novel parameter ‘time to first nadir of the QRS complex in aVR/aVL’ was able to aid in the differentiation of LVOT vs. RVOT PVCs with V3 precordial transition in our study. Based on this finding, it may be suggested that if an OT PVC has an earlier negative QRS peak on aVL compared with aVR, the probability of it being the RVOT origin is high. This simple observation might aid the preprocedural planning of OT PVC ablation in clinical practice.

背景本研究旨在探讨 "aVR 中 QRS 复极第一个基点的时间/aVL 中 QRS 复极第一个基点的时间 "对于区分 V3 导联心前区过渡的左侧和右侧流出道室早复极（PVC）的价值。结果51例患者（57.9%）的PVC起源于左室流出道（LVOT），37例患者（42.1%）的PVC起源于右室流出道（RVOT）。LVOT 和 RVOT PVC 组在 V2S/V3R 指数（0.97 ± 0.70 vs. 1.96 ± 0.80，p < 0.001）、V1-V3 过渡指数（-2.6 ± 4.4 vs. -0.4 ± 4.6，p = 0.026）和 "aVR/aVL 到 QRS 复极第一低点的时间"（0.94 ± 0.15 vs. 1.1 ± 0.2，p = 0.001）方面存在明显差异。ROC 曲线分析显示，"aVR/aVL 到 QRS 波群第一个低点的时间比值 "大于 0.98 可预测 RVOT 起源，灵敏度为 67.6%，特异度为 62.7%。V1-V3 过渡指数> - 1.21 预测 RVOT 起源，灵敏度为 75.7%，特异度为 72.5%。结论在我们的研究中，"aVR/aVL 中 QRS 波群第一个低点的时间 "这一新颖参数虽然不如其他已确立的心电图标准精确，但却能帮助区分 LVOT 和 RVOT PVCs 与 V3 心前区转换。基于这一发现，我们可以认为，如果 OT PVC 在 aVL 上的负 QRS 峰早于 aVR，则其来源于 RVOT 的可能性很高。这一简单的观察结果可能有助于在临床实践中制定 OT PVC 消融术前计划。

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引用次数: 0

Direct mathematical method for real-time ischemic episodes detection from electrocardiograms using the discrete Hermite transform 利用离散埃尔米特变换从心电图中实时检测缺血发作的直接数学方法

IF 1.3 4区医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of electrocardiology

Pub Date : 2024-11-21 DOI: 10.1016/j.jelectrocard.2024.153834

Maiko Arichi PhD , Dale H. Mugler PhD , Stephen Fannin M.D.

A real-time automated identification technique is developed for the detection of ischemic episodes in long-term electrocardiographic (ECG) signals using mathematical expansions involving the Discrete Dilated Hermite Transform. The Discrete Hermite functions could be viewed as a set of orthogonal vectors that resemble a finite Fourier series. They are generated easily as eigenvectors of a symmetric tridiagonal matrix that commutes with the centered Fourier matrix. The Discrete Hermite Transform (DHmT) values are computed from a simple dot product between an individual ECG complex extracted from the European Society of Cardiology (ESC) ST-T database and the corresponding discrete Hermite function. These values are found to contain information about the ECG shape, highlighting changes between ST segment and T wave alterations which are the features of ischemic episodes. This information from the discrete Hermite transform, based on an orthonormal set of n-dimensional digital Hermite functions that serve as shape-identification functions, can be used to identify ischemic episodes from the ECG. The performance measures resulting from applying this method to detect ischemic episodes were Sensitivity 87 %, Specificity 86 %, and positive predictive accuracy 81 %. The computer time to analyze one heartbeat for ischemia with this method is 0.031 seconds on a standard PC.

利用离散扩张埃尔米特变换的数学展开，开发了一种实时自动识别技术，用于检测长期心电图（ECG）信号中的缺血性发作。离散埃尔米特函数可以看作是一组正交向量，类似于有限傅里叶级数。它们很容易被生成为对称三对角矩阵的特征向量，与中心傅里叶矩阵交换。离散埃尔米特变换（DHmT）值是从欧洲心脏病学会（ESC） ST-T数据库中提取的单个ECG复合体与相应的离散埃尔米特函数之间的简单点积计算得到的。发现这些值包含有关ECG形状的信息，突出了ST段和T波改变之间的变化，这是缺血性发作的特征。基于一组标准正交的n维数字Hermite函数作为形状识别函数，该信息来自离散Hermite变换，可用于识别ECG中的缺血性发作。应用该方法检测缺血性发作的性能指标灵敏度为87%，特异性为86%，阳性预测准确率为81%。用这种方法分析一次心跳缺血的计算机时间在标准PC上为0.031秒。

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引用次数: 0

The feasibility of a serial 12‑lead ECG wireless patch in the hospital setting 在医院环境中使用串行 12 导联心电图无线贴片的可行性

IF 1.3 4区医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of electrocardiology

Pub Date : 2024-11-20 DOI: 10.1016/j.jelectrocard.2024.153828

Mary G. Carey PhD, RN, FAHA, FAAN , Sudhir K. Mummidi MBBS, RN , Amanda Kammer BS, RN , Dillon J. Dzikowicz PhD, RN, PCCN

Background

Chest pain is the second most common reason to present to the emergency department in the United States, and the ECG is a first-line diagnostic tool for myocardial ischemia assessment. For patients with ongoing symptoms or unclear initial ECGs, guidelines recommend performing multiple standard ECGs at 15–30-min intervals during the first 1–2 h, which improves acute coronary syndrome (ACS) detection by 15 % and accelerates triage of high-risk ACS patients. However, obtaining serial ECG is not consistently practiced due to overcrowding and the limited technical abilities of current 12‑lead ECG machines. This study aimed to evaluate an FDA-approved wireless 12‑lead ECG patch for serial cardiac monitoring in the hospital setting.

Methods

Prospectively, ECG patch was applied in the Mason-Likar electrode configuration after obtaining consent. The patch remained in place for at least one hour. Clinical Utility of the ECGs was categorized from 1 to 3: 1 = uninterpretable, 2 = borderline, and 3 = interpretable.

Results

Among hospitalized cardiac patients, 28 consented to wear the ECG patch for at least one hour and patients were free to ambulate during the study. Most (70 %) patients were in sinus rhythm, and an episode of asymptomatic TMI was captured. The clinical utility of the ECGs (n = 364) was mostly interpretable, 64 % (n = 231), while 15 % (n = 55) were uninterpretable and 18 % (n = 65) were borderline. Most (69 %) preferred the patch, while 12 % preferred telemetry. The hospitalized cardiac patients reported significantly better ability to ambulate with the ECG patch (Z = −3.607, p < 0.001).

Conclusion

Thus, this experiment demonstrated that the ECG patch provides quality serial ECG monitoring and captures TMI of hospitalized cardiac patients without increasing burden.

背景在美国，胸痛是急诊科第二大常见病因，而心电图是评估心肌缺血的一线诊断工具。对于有持续症状或初始心电图不明确的患者，指南建议在最初的 1-2 小时内以 15-30 分钟的间隔进行多次标准心电图检查，这样可将急性冠状动脉综合征（ACS）的检出率提高 15%，并加快高危 ACS 患者的分流。然而，由于过度拥挤和目前 12 导联心电图机的技术能力有限，获取连续心电图的做法并不普遍。本研究旨在评估一种经 FDA 批准的用于医院环境中连续心脏监测的无线 12 导联心电图贴片。贴片放置至少一小时。结果在住院心脏病患者中，有 28 人同意佩戴心电图贴片至少一小时，研究期间患者可以自由活动。大多数患者（70%）处于窦性心律，并记录了一次无症状的 TMI。心电图（364 人）的临床实用性大部分可以解释，占 64%（231 人），15%（55 人）不可解释，18%（65 人）处于边缘状态。大多数人（69%）更喜欢贴片，而 12% 的人更喜欢遥测。结论本实验证明，心电图贴片可提供高质量的连续心电图监测，并在不增加负担的情况下捕捉住院心脏病患者的 TMI。

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引用次数: 0