| 1. |
- Cortez, Daniel, et al.
(författare)
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ECG-derived spatial QRS-T angle is strongly associated with hypertrophic cardiomyopathy
- 2017
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Ingår i: Journal of Electrocardiology. - : Elsevier BV. - 0022-0736 .- 1532-8430. ; 50:2, s. 195-202
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Tidskriftsartikel (refereegranskat)abstract
- Introduction: ECG-derived vectorcardiography (VCG) has diagnostic and prognostic value in various diseases. Hypertrophic cardiomyopathy (HCM), a genetic disease with unexplained left ventricular hypertrophy, is one of the most common causes of sudden cardiac death (SCD) in young persons. Genotype positive status is associated with increased risk of systolic dysfunction, heart failure, and (SCD). Herein, we aimed to determine the diagnostic utility of derived VCG parameters in a large cohort of genotyped HCM patients. Methods: Between 1997 and 2007, genetic testing was performed on 1053 unrelated patients with HCM. Of these, 967 had 12-lead ECGs suitable for computerized derivation of VCG parameters, including the spatial mean and peaks QRS-T angles, spatial ventricular gradient (SVG), spatial QRS, QT, and Tpeak-Tend (TpTe) intervals. ECGs were also evaluated using Seattle ECG criteria. Differences between HCM patients and healthy controls as well as between genotype positive versus genotype negative HCM patients were assessed. Results: Spatial peaks (129.3. ±. 26.4 vs.30.5. ±. 24.2 degrees) and spatial mean QRS-T angles (121.8. ±. 38.6 vs. 47.3. ±. 27.6 degrees) were significantly higher in patients with HCM than in controls (P. <. 0.001). The spatial peaks and mean QRS-T angles identified 94% and 84% of HCM patients, respectively, while Seattle criteria identified 70.7% of patients (P. <. 0.001). Genotype positive patients had higher spatial mean QRS-T angles, spatial TpTe (P. <. 0.001 respectively), spatial peaks QRS-T angles (P. =0.017) and lower SVG (P. <. 0.001) than genotype negative patients. Conclusions: ECG-derived spatial QRS-T angles can differentiate patients with HCM from controls and could provide a better tool than traditional Seattle criteria. Clinical usefulness of VCG to differentiate genotype-negative from genotype-positive patients has yet to be established.
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| 2. |
- Fernlund, Eva, et al.
(författare)
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Peripheral microvascular function is altered in young individuals at risk for hypertrophic cardiomyopathy and correlates with myocardial diastolic function
- 2015
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Ingår i: American Journal of Physiology. Heart and Circulatory Physiology. - : American Physiological Society. - 0363-6135 .- 1522-1539. ; 308:11, s. H1351-H1358
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Tidskriftsartikel (refereegranskat)abstract
- Hypertrophic cardiomyopathy (HCM) is a major cause of sudden cardiac death in the young. Based on previous reports of functional abnormalities in not only coronary but also peripheral vessels in adults with HCM, we aimed to assess both peripheral vascular and myocardial diastolic function in young individuals with an early stage of HCM and in individuals at risk for HCM. Children, adolescents, and young adults (mean age: 12 yr) with a family history of HCM who either had (HCM group; n = 36) or did not have (HCM-risk group; n = 30) echocardiography-documented left ventricular (LV) hypertrophy as well as healthy matched controls (n = 85) and healthy young athletes (n = 12) were included in the study. All underwent assessment with 12-lead electrocardiography, two-dimensional echocardiography, tissue Doppler imaging and laser Doppler with transdermal iontophoresis of ACh and sodium nitroprusside. LV thickness and mass were increased in HCM and athlete groups compared with control and HCM-risk groups. The mitral E-to-e ratio, measured via tissue Doppler, was increased in HCM (P less than 0.0001) and HCM-risk (P less than 0.01) groups compared with control and athlete groups, as were microvascular responses to ACh (HCM group: P less than 0.045 and HCM- risk group: P less than 0.02). Responses to ACh correlated with the E-to-e ratio (r = 0.5, P = 0.001). Microvascular responses to sodium nitroprusside were similar in all groups (P = 0.2). HCM-causing mutations or its familial history are associated with changes in cardiac diastolic function and peripheral microvascular function even before the onset of myocardial hypertrophy. Tissue Doppler can be used to differentiate HCM from physiological LV hypertrophy in young athletes.
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| 3. |
- Lindow, Thomas, et al.
(författare)
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Heart age estimated using explainable advanced electrocardiography
- 2022
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Ingår i: Scientific Reports. - : Springer Science and Business Media LLC. - 2045-2322. ; 12:1
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Tidskriftsartikel (refereegranskat)abstract
- Electrocardiographic (ECG) Heart Age conveying cardiovascular risk has been estimated by both Bayesian and artificial intelligence approaches. We hypothesised that explainable measures from the 10-s 12-lead ECG could successfully predict Bayesian 5-min ECG Heart Age. Advanced analysis was performed on ECGs from healthy subjects and patients with cardiovascular risk or proven heart disease. Regression models were used to predict patients’ Bayesian 5-min ECG Heart Ages from their standard, resting 10-s 12-lead ECGs. The difference between 5-min and 10-s ECG Heart Ages were analyzed, as were the differences between 10-s ECG Heart Age and the chronological age (the Heart Age Gap). In total, 2,771 subjects were included (n = 1682 healthy volunteers, n = 305 with cardiovascular risk factors, n = 784 with cardiovascular disease). Overall, 10-s Heart Age showed strong agreement with the 5-min Heart Age (R2 = 0.94, p < 0.001, mean ± SD bias 0.0 ± 5.1 years). The Heart Age Gap was 0.0 ± 5.7 years in healthy individuals, 7.4 ± 7.3 years in subjects with cardiovascular risk factors (p < 0.001), and 14.3 ± 9.2 years in patients with cardiovascular disease (p < 0.001). Heart Age can be accurately estimated from a 10-s 12-lead ECG in a transparent and explainable fashion based on known ECG measures, without deep neural network-type artificial intelligence techniques. The Heart Age Gap increases markedly with cardiovascular risk and disease.
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| 4. |
- Lindow, Thomas, et al.
(författare)
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Heart age gap estimated by explainable advanced electrocardiography is associated with cardiovascular risk factors and survival
- 2023
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Ingår i: The European Heart Journal - Digital Health. - : Oxford University Press. - 2634-3916. ; 4:5, s. 384-392
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Tidskriftsartikel (refereegranskat)abstract
- AimsDeep neural network artificial intelligence (DNN-AI)-based Heart Age estimations have been presented and used to show that the difference between an electrocardiogram (ECG)-estimated Heart Age and chronological age is associated with prognosis. An accurate ECG Heart Age, without DNNs, has been developed using explainable advanced ECG (A-ECG) methods. We aimed to evaluate the prognostic value of the explainable A-ECG Heart Age and compare its performance to a DNN-AI Heart Age.Methods and resultsBoth A-ECG and DNN-AI Heart Age were applied to patients who had undergone clinical cardiovascular magnetic resonance imaging. The association between A-ECG or DNN-AI Heart Age Gap and cardiovascular risk factors was evaluated using logistic regression. The association between Heart Age Gaps and death or heart failure (HF) hospitalization was evaluated using Cox regression adjusted for clinical covariates/comorbidities. Among patients [n = 731, 103 (14.1%) deaths, 52 (7.1%) HF hospitalizations, median (interquartile range) follow-up 5.7 (4.7-6.7) years], A-ECG Heart Age Gap was associated with risk factors and outcomes [unadjusted hazard ratio (HR) (95% confidence interval) (5 year increments): 1.23 (1.13-1.34) and adjusted HR 1.11 (1.01-1.22)]. DNN-AI Heart Age Gap was associated with risk factors and outcomes after adjustments [HR (5 year increments): 1.11 (1.01-1.21)], but not in unadjusted analyses [HR 1.00 (0.93-1.08)], making it less easily applicable in clinical practice.ConclusionA-ECG Heart Age Gap is associated with cardiovascular risk factors and HF hospitalization or death. Explainable A-ECG Heart Age Gap has the potential for improving clinical adoption and prognostic performance compared with existing DNN-AI-type methods. Graphical Abstract
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| 5. |
- Potter, Samara L. Poplack, et al.
(författare)
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Detection of hypertrophic cardiomyopathy is improved when using advanced rather than strictly conventional 12-lead electrocardiogram
- 2010
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Ingår i: Journal of Electrocardiology. - : Elsevier BV. - 1532-8430 .- 0022-0736. ; 43:6, s. 713-718
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Tidskriftsartikel (refereegranskat)abstract
- Introduction: Twelve-lead electrocardiogram (ECG) is used to screen for hypertrophic cardiomyopathy (HCM), but up to 25% of HCM patients do not have distinctly abnormal ECGs, whereas up to 5% to 15% of healthy athletes do. We hypothesized that an approximately 5-minute resting advanced 12-lead ECG test ("A-ECG score") could detect HCM with greater sensitivity than pooled conventional ECG criteria and distinguish healthy athletes from HCM with greater specificity. Materials and methods: Five-minute 12-lead ECGs were obtained from 56 HCM patients, 56 age/sex-matched healthy controls, and 69 younger endurance-trained athletes. Electrocardiograms were analyzed using recently suggested pooled conventional ECG criteria and also A-ECG scoring techniques that considered results from multiple advanced and conventional ECG parameters. Results: Compared with pooled criteria from the strictly conventional ECG, an A-ECG logistic score incorporating results from just 3 advanced ECG parameters (spatial QRS-T angle, unexplained portion of QT variability, and T-wave principal component analysis ratio) increased the sensitivity of ECG for identifying HCM from 89% (78%-96%) to 98% (89%-100%; P = .025), while increasing specificity from 90% (83%-94%) to 95% (92%-99%; P = .020). Conclusions: Resting 12-lead A-ECG scores that are simultaneously more sensitive than pooled conventional ECG criteria for detecting HCM and more specific for distinguishing healthy athletes and other healthy controls from HCM can be constructed. Pending further prospective validation, such scores may lead to improved ECG-based screening for HCM. Published by Elsevier Inc.
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| 6. |
- Schlegel, Todd T., et al.
(författare)
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Accuracy of advanced versus strictly conventional 12-lead ECG for detection and screening of coronary artery disease, left ventricular hypertrophy and left ventricular systolic dysfunction
- 2010
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Ingår i: BMC Cardiovascular Disorders. - : Springer Science and Business Media LLC. - 1471-2261. ; 10
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Tidskriftsartikel (refereegranskat)abstract
- Background: Resting conventional 12-lead ECG has low sensitivity for detection of coronary artery disease (CAD) and left ventricular hypertrophy (LVH) and low positive predictive value (PPV) for prediction of left ventricular systolic dysfunction (LVSD). We hypothesized that a similar to 5-min resting 12-lead advanced ECG test ("A-ECG") that combined results from both the advanced and conventional ECG could more accurately screen for these conditions than strictly conventional ECG. Methods: Results from nearly every conventional and advanced resting ECG parameter known from the literature to have diagnostic or predictive value were first retrospectively evaluated in 418 healthy controls and 290 patients with imaging-proven CAD, LVH and/or LVSD. Each ECG parameter was examined for potential inclusion within multi-parameter A-ECG scores derived from multivariate regression models that were designed to optimally screen for disease in general or LVSD in particular. The performance of the best retrospectively-validated A-ECG scores was then compared against that of optimized pooled criteria from the strictly conventional ECG in a test set of 315 additional individuals. Results: Compared to optimized pooled criteria from the strictly conventional ECG, a 7-parameter A-ECG score validated in the training set increased the sensitivity of resting ECG for identifying disease in the test set from 78% (72-84%) to 92% (88-96%) (P < 0.0001) while also increasing specificity from 85% (77-91%) to 94% (88-98%) (P < 0.05). In diseased patients, another 5-parameter A-ECG score increased the PPV of ECG for LVSD from 53% (41-65%) to 92% (78-98%) (P < 0.0001) without compromising related negative predictive value. Conclusion: Resting 12-lead A-ECG scoring is more accurate than strictly conventional ECG in screening for CAD, LVH and LVSD.
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| 7. |
- Starc, Vito, et al.
(författare)
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Can functional cardiac age be predicted from the ECG in a normal healthy population?
- 2012
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Ingår i: Computing in Cardiology 2012, CinC 2012. - 9781467320740 ; 39, s. 101-104
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Konferensbidrag (refereegranskat)abstract
- We hypothesized that in a normal healthy population changes in several ECG parameters together might reliably characterize the functional age of the heart. Data from 377 healthy subjects (209 men, 168 women, aged 4 to 75 years) were included in the study. In all subjects, ECG recordings (resting 5-minute 12-lead high fidelity ECG) were evaluated via custom software programs to calculate up to 120 different conventional and advanced ECG parameters. Using factor analysis, those 5 parameters that exhibited the highest linear correlations with age and that were mutually the least correlated were evaluated by multiple linear regression analysis to predict the functional electrical age of the heart. Ignoring small differences between males and females, functional electrical age was best predicted (R2 of 0.76, P < 0.001) by multiple linear regression analysis incorporating the RR-interval normalized high frequency variability of RRV; the RR-interval normalized value of a QT variability parameter called QTcor; the mean high frequency QRS (150-250 Hz) amplitude; the mean ST segment level at the J point; and the body mass index. In apparently healthy subjects, functional cardiac age can be estimated by multiple linear regression analysis of mostly advanced ECG parameters.
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| 8. |
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| 9. |
- Trägårdh, Elin, et al.
(författare)
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High-frequency QRS electrocardiogram
- 2007
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Ingår i: Clinical Physiology and Functional Imaging. - 1475-0961. ; 27:4, s. 197-204
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Forskningsöversikt (refereegranskat)abstract
- The standard 12-lead electrocardiogram (ECG) is one of the most commonly used methods for diagnosing heart disease. Standard ECG is not always optimal, however, and new ECG methods can provide additional information. Analysis of high-frequency QRS components (HF-QRS) has been shown to increase the diagnostic performance of the ECG. Several investigators have studied HF-QRS in different cardiac conditions, including acute myocardial ischaemia and myocardial infarction, but more knowledge is needed about the characteristics of HF-QRS before clinicians can use it as an adjunct to standard ECG.
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