| 1. |
- Bacharova, Ljuba, et al.
(författare)
-
The Dipolar ElectroCARdioTOpographic (DECARTO)-like method for graphic presentation of location and extent of area at risk estimated from ST-segment deviations in patients with acute myocardial infarction
- 2009
-
Ingår i: Journal of Electrocardiology. - : Elsevier BV. - 1532-8430 .- 0022-0736. ; 42:2, s. 172-180
-
Tidskriftsartikel (refereegranskat)abstract
- A graphic method was developed for presentation of the location and extent of the myocardium at risk in patients with acute myocardial infarction (AMI). This method is based on a mathematical processing of ST-segment deviations of standard 12-lead electrocardiogram following the concept of Titomir and Ruttkay-Nedecky in their dipolar electrocardiotopographic method. The center of the location of the area at risk is given by the spatial orientation of the resultant spatial ST vector, and the extent of the area at risk is derived from the Aldrich score. The areas at risk are projected on a spherical image surface, on which a texture of the anatomical quadrants of the ventricular surface and its coronary artery supply are projected. The method was tested in 10 patients with AMI with single-vessel disease, including 6 patients with an occlusion in the proximal left anterior descending coronary artery (LAD), 3 patients with an occlusion in the right coronary artery, and one patient with occlusion in the left circumflex coronary artery. The estimated areas at risk were compared with myocardial perfusion single photon emission computed tomography. Eight (80%) patients of 10 were correctly localized according to the Aldrich decision rules for the location of AMI. The areas at risk in patients with LAD occlusion correctly localized by the Aldrich score were situated in the anteroseptal and anterosuperior quadrants. In the inferior AMI group, the area at risk was localized in the posterolateral and inferior quadrants. The visual comparison with myocardial perfusion single photon emission computed tomography (SPECT) showed best agreement in patients with LAD involvement. The initial testing showed that this method allows a graphic presentation of estimated area at risk using clinically defined diagnostic rules. The area at risk can be displayed in images that are familiar for clinicians and can be compared with or superimposed on results of other imaging methods used in cardiology. (C) 2009 Elsevier Inc. All rights reserved.
|
|
| 2. |
- Bacharova, L, et al.
(författare)
-
Where is the central terminal located? In search of understanding the use of the Wilson central terminal for production of 9 of the standard 12 electrocardiogram leads
- 2005
-
Ingår i: Journal of Electrocardiology. - : Elsevier BV. - 1532-8430 .- 0022-0736. ; 38:2, s. 119-127
-
Tidskriftsartikel (refereegranskat)abstract
- The aim of this study was to evaluate the understanding of the term central terminal (CT) and to consider the consequences of this level of understanding. A total of 150 questionnaires was distributed during the 30th International Congress of Electrocardiology 2003, Helsinki, Finland; 42 (28%) of the anonymous questionnaires returned were considered adequate for the purpose of this study. The questionnaire addressed the following areas of interest: (1) the location of the CT; (2) the location of the negative poles of unipolar leads; (3) the naming of the electrocardiogram lead groups; (4) the relationship between the leads and cardiac electrical views; and (5) impact on accuracy of clinical diagnosis. The findings revealed diversity in understanding the basic term, a shift in understanding the term CT to abstract/theoretical understanding, and gaps in understanding the concept of CT and the more recent theories of the cardiac electric field.
|
|
| 3. |
- Billgren, Therese, et al.
(författare)
-
Grade 3 ischemia on the admission electrocardiogram predicts rapid progression of necrosis over time and less myocardial salvage by primary angioplasty
- 2005
-
Ingår i: Journal of Electrocardiology. - : Elsevier BV. - 1532-8430 .- 0022-0736. ; 38:3, s. 187-194
-
Tidskriftsartikel (refereegranskat)abstract
- Background: Among patients with ST-elevation acute myocardial infarction, those with terminal QRS distortion (grade 3 ischemia) have higher mortality and larger infarct size (IS) than patients without QRS distortion (grade 2 ischemia). Methods: We assessed the relation of baseline electrocardiographic ischemia grades to area at risk (AR) and myocardial salvage [100 (AR - IS)/AR] in 79 patients who underwent primary angioplasty for first ST-elevation acute myocardial infarction and had technetium Tc 99m sestamibi single-photon emission computed tomography before angioplasty (AR) and at predischarge (IS). Patients were classified as having grade 2 ischemia (ST elevation without terminal QRS distortion in any of the leads, n = 48), grade 2.5 ischemia (ST elevation with terminal QRS distortion in 1 lead, n = 16), or grade 3 ischemia (ST elevation with terminal QRS distortion in > 2 adjacent leads, n = 15). Results: Time to treatment was comparable among groups. AR was comparable among groups (38% +/- 20%, 33% +/- 23%, and 34% +/- 23%, respectively; P = .70). There were no differences among groups in residual myocardial perfusion (severity index 0.28 +/- 0.12, 0.29 +/- 0.16, and 0.30 +/- 0.15 in grades 2, 2.5, and 3 ischemia, respectively; P = .97). In contrast, there was a trend toward lower myocardial salvage (45% +/- 32%) in the grade 3 group than in the grade 2 (65% +/- 33%) and grade 2.5 (65% +/- 40%) groups (P = .16). Salvage was dependent on time only in the grade 3 group. Spearman rank correlation coefficients between time to treatment and percentage salvage were 0.003 (P = .99), -0.24 (P = .38), and -0.63 (P = .022) for grades 2, 2.5, and 3, respectively. Conclusions: Patients with grade 3 ischemia have rapid progression of necrosis over time and less myocardial salvage. This admission pattern is a predictor of myocardial salvage by primary angioplasty.
|
|
| 4. |
|
|
| 5. |
|
|
| 6. |
- Carlsson, Marcus, et al.
(författare)
-
Magnetic resonance imaging as a potential gold standard for infarct quantification.
- 2008
-
Ingår i: Journal of Electrocardiology. - : Elsevier BV. - 1532-8430 .- 0022-0736. ; 41, s. 614-620
-
Tidskriftsartikel (refereegranskat)abstract
- Accurate diagnosis, characterization, and quantification of myocardial infarction (MI) is essential to assess the impact of therapy and to aid in predicting prognosis of patients with ischemic heart disease. Delayed contrast-enhanced magnetic resonance (DE-MR) imaging has the potential of being the gold standard for quantification of MI. It has also been useful in correlating electrocardiography abnormalities with the location and transmurality of infarction. The focus of this review is to address the strengths and limitations of DE-MR imaging in the detection and quantification of MI for clinicians and investigators in the field of electrocardiology. The biological rationale and technical background for detecting MI by DE-MR imaging were reviewed as well as the different approaches for quantification of the DE-MR images, exemplified by patient cases.
|
|
| 7. |
- Davis, TH, et al.
(författare)
-
Problem-based learning of research skills
- 2006
-
Ingår i: Journal of Electrocardiology. - : Elsevier BV. - 1532-8430 .- 0022-0736. ; 39:1, s. 120-128
-
Tidskriftsartikel (refereegranskat)abstract
- Purpose: To determine whether a short-term, problem-based educational intervention leads to increased research activity among health care practitioners. Subjects and Methods: Participant's success was evaluated as a composite of 2 outcomes. These were (1) reporting results for the project designed during the practicum and (2) conducting subsequent research activities. The study population included 36 clinical research outcomes projects developed by clinical practitioners, postgraduate trainees, and medical students during 6 separate practicums. All project teams received the same educational intervention, an "outcomes research practicum" that was divided into 4 primary learning modules administered over a I to 4 month period. Each module included a preparatory videotape lecture, supplemental readings, and a 90-minute interactive laboratory session during which faculty members worked with participants to develop answers to a series of predefined questions relating to the design of clinical outcomes research projects. Follow-up continued for a minimum of 12 months and a maximum of 36 months. Results: Eighty-three percent of project teams completed all 4 practicum modules, and 69% completed one of the study outcomes (50% completed their research project and 47% completing a subsequent research activity). Practitioners were more likely to complete subsequent research activities, whereas trainees were more likely to complete their study project. Discussion: This short-term, problem-based educational intervention was successful in increasing the collective research activities of participants. Further, more rigorous structured research is needed to determine the ultimate impact on practice change and patient outcomes. (c) 2006 Elsevier Inc. All rights reserved.
|
|
| 8. |
|
|
| 9. |
|
|
| 10. |
- Floyd, James S, et al.
(författare)
-
Effects of ischemic preconditioning and arterial collateral flow on ST-segment elevation and QRS complex prolongation in a canine model of acute coronary occlusion.
- 2009
-
Ingår i: Journal of electrocardiology. - : Elsevier BV. - 1532-8430 .- 0022-0736. ; 42:1, s. 19-26
-
Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: During acute myocardial infarction, both ST elevation and QRS distortion on the initial electrocardiogram (ECG) have been correlated with poorer prognosis. Studies in dogs and humans suggest that these ECG markers provide information about myocardial protection from both collateral blood flow and ischemic preconditioning. METHODS: In a protocol designed to precondition the heart with ischemia, we examined both ST-segment elevation and QRS complex prolongation in lead II of the ECG in 23 mongrel dogs during the first and fourth episode of 5 minutes of left circumflex artery occlusion. Myocardial collateral flow was measured during each of these episodes by injection of radioactive microspheres 2.5 minutes into the episode of ischemia. RESULTS: During ischemia, the degree of elevation of the ST segments was reduced markedly in hearts preconditioned with ischemia and/or in hearts with the greatest amounts of collateral arterial flow. During the first episode of ischemia, the ST segments increased to a similar extent in severe and moderate ischemia, but less in hearts in which the ischemia was mild. However, marked QRS prolongation was present only in hearts with severe ischemia, and decreased when the hearts were preconditioned. In addition, large ischemic beds exhibited the most marked QRS prolongation, whereas small but even severely ischemic beds showed little or no change in QRS duration. CONCLUSION: Both ST elevation and QRS prolongation are reduced by the presence of collateral flow and ischemic preconditioning. The QRS complex merits further study as an important marker of the degree of myocardial protection during human acute myocardial ischemia/infarction.
|
|
