| 1. |
- Bacharova, Ljuba, et al.
(författare)
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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
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Ingår i: Journal of Electrocardiology. - : Elsevier BV. - 1532-8430 .- 0022-0736. ; 42:2, s. 172-180
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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.
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| 2. |
- Bacharova, L, et al.
(författare)
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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
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Ingår i: Journal of Electrocardiology. - : Elsevier BV. - 1532-8430 .- 0022-0736. ; 38:2, s. 119-127
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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.
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| 3. |
- Billgren, Therese, et al.
(författare)
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Grade 3 ischemia on the admission electrocardiogram predicts rapid progression of necrosis over time and less myocardial salvage by primary angioplasty
- 2005
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Ingår i: Journal of Electrocardiology. - : Elsevier BV. - 1532-8430 .- 0022-0736. ; 38:3, s. 187-194
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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.
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| 4. |
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| 5. |
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| 6. |
- Carlsson, Marcus, et al.
(författare)
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Magnetic resonance imaging as a potential gold standard for infarct quantification.
- 2008
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Ingår i: Journal of Electrocardiology. - : Elsevier BV. - 1532-8430 .- 0022-0736. ; 41, s. 614-620
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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.
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| 7. |
- Davis, TH, et al.
(författare)
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Problem-based learning of research skills
- 2006
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Ingår i: Journal of Electrocardiology. - : Elsevier BV. - 1532-8430 .- 0022-0736. ; 39:1, s. 120-128
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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.
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| 8. |
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| 9. |
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| 10. |
- Floyd, James S, et al.
(författare)
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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
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Ingår i: Journal of electrocardiology. - : Elsevier BV. - 1532-8430 .- 0022-0736. ; 42:1, s. 19-26
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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.
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| 11. |
- Forberg, Jakob L, et al.
(författare)
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In search of the best method to predict acute coronary syndrome using only the electrocardiogram from the emergency department.
- 2009
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Ingår i: Journal of Electrocardiology. - : Elsevier BV. - 1532-8430 .- 0022-0736. ; 42:1, s. 58-63
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Tidskriftsartikel (refereegranskat)abstract
- INTRODUCTION: The aim of this study was to compare different methods to predict acute coronary syndrome (ACS) using only data from a single electrocardiogram (ECG) in the emergency department (ED). METHOD: We compared the ACS prediction abilities of classical ECG criteria, human expert ECG interpretation, a logistic regression model and an artificial neural network ensemble (ANN). The ED ECG and discharge diagnoses were retrieved for 861 patient visits to the ED for chest pain. Cross-validation was used to estimate the generalization performance of the logistic regression and the ANN model. RESULTS: The logistic regression model had the overall best performance in predicting ACS with an area under the receiver operating characteristic curve of 0.88. The sensitivities of logistic regression, ANN, expert physicians, and classical ECG criteria were 95%, 95%, 82%, and 75%, respectively, and the specificities were 54%, 44%, 63%, and 69%. CONCLUSION: Our logistic regression model was the best overall method to predict ACS, followed by our ANN. Decision support models have the potential to improve even experienced ECG readers' ability to predict ACS in the ED.
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| 12. |
- Galeotti, Loriano, et al.
(författare)
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Development of an automated method for display of ischemic myocardium from simulated electrocardiograms.
- 2009
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Ingår i: Journal of Electrocardiology. - : Elsevier BV. - 1532-8430 .- 0022-0736. ; 42, s. 204-212
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Knowledge of the size and location of ischemic myocardium during acute coronary occlusion could provide decision support before reperfusion therapy. Electrocardiogram (ECG) scores based on the number of leads and the sum of ST-segment elevation have been unreliable in quantifying ischemia. We aimed to develop a new method to graphically display ischemic myocardium from simulated ECGs (DIMS-ECG) associated with known ischemic regions. METHODS: Twenty-one patterns of ischemia based on normal coronary anatomy were programmed into the freely available program ECGSIM (www.ecgsim.org). Minor variations of these patterns and 5 levels of ischemia severity produced 45 455 ECGs; 1000 normal ECGs were also added. Given a de novo ECG (an ECG from a patient), ST-segment and T-wave measurements are compared with ECG measurements in the database. The closest 200 matches are selected, and the corresponding ischemic areas are "averaged" to create a graphical display of the ischemic myocardium. RESULTS: Three patients are presented who underwent elective coronary angioplasty with continuous ECG recording and scintigraphically defined ischemic myocardium. Based on ECG analysis, the program graphically displays the ischemic myocardium with close agreement to the scintigraphic images. The program's source code and the ECG database will be made freely available. CONCLUSIONS: The DIMS-ECG method graphically displays ischemic myocardium from information contained in the 12-lead ECG based on a novel approach to use a large simulated database instead of rule- or score-based method. After further development and testing, the DIMS-ECG method could be used to risk stratify patients with acute myocardial infarction.
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| 13. |
- Green, Michael, et al.
(författare)
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Best leads in the standard electrocardiogram for the emergency detection of acute coronary syndrome.
- 2007
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Ingår i: Journal of Electrocardiology. - : Elsevier BV. - 1532-8430 .- 0022-0736. ; 40:3, s. 251-256
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Tidskriftsartikel (refereegranskat)abstract
- Background and Purpose: The purpose of this study was to determine which leads in the standard 12-lead electrocardiogram (ECG) are the best for detecting acute coronary syndrome (ACS) among chest pain patients in the emergency department. Methods: Neural network classifiers were used to determine the predictive capability of individual leads and combinations of leads from 862 ECCs from chest pain patients in the emergency department at Lund University Hospital. Results: The best individual lead was aVL, with an area under the receiver operating characteristic curve of 75.5%. The best 3-lead combination was III, aVL, and V-2, with a receiver operating characteristic area of 82.0%, compared with the 12-lead ECG performance of 80.5%. Conclusions: Our results indicate that leads III, aVL, and V2 are sufficient for computerized prediction of ACS. The present results are likely important in situations where the 12-lead ECG is impractical and for the creation of clinical decision support systems for ECG prediction of ACS.
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| 14. |
- Haney, Michael F, et al.
(författare)
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ST changes and temporal relation to the J point during heart rate increase and myocardial ischemia.
- 2009
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Ingår i: Journal of electrocardiology. - : Elsevier BV. - 1532-8430 .- 0022-0736. ; 42:1, s. 6-11
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Tidskriftsartikel (refereegranskat)abstract
- There is no concensus concerning where in the ST segment to measure. We studied the relation between different J point intervals to ST results during tachycardia and ischemia. Symptomatic (anesthetized) patients with coronary artery disease were paced at ascending incremental levels until they became ischemic. ST vector magnitude and ST vector change from baseline (STC-VM) as well as the sum of ST changes from all 12 electrocardiogram (ECG) leads (ECG ST sum) were measured at J point 0 millisecond, J + 20, J + 60, and J + 80 milliseconds for 34 patients. ST segments increased in similar fashion during pacing and ischemia. There was no difference in ST results when measurement was performed at different time intervals for both STC-VM and ECG ST sum. We conclude that ST assessment by ST change from baseline is not affected by different J point intervals during increased heart rate and ischemia in this clinical model of pacing-induced ischemia and vectorcardiographic ST analysis.
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| 15. |
- Häggmark, Sören, et al.
(författare)
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Vectorcardiographic ST deviations related to increased heart rate in the absence of ischemia in an experimental pig model.
- 2006
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Ingår i: J Electrocardiol. - : Elsevier BV. - 0022-0736 .- 1532-8430. ; 39:2, s. 169-76
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Tidskriftsartikel (refereegranskat)abstract
- The electrocardiographic ST segment may change when heart rate (HR) increases. We aimed to analyze vectorcardiographic ST relation and myocardial conditions during controlled HR increases in anesthetized pigs. The relative parameters ST change vector magnitude and ST change vector angle were calculated at paced HRs ranging from 85 to 175 beats per minute. ST change vector magnitude increased from baseline 6.3 +/- 1.3 to 26.0 +/- 3.1 microV (P < .01; range, 4-50 microV) at HR 175 beats per minute with similar changes in ST change vector angle, whereas the absolute parameter ST vector magnitude demonstrated a heterogeneous pattern without any systematic relation to HR changes. Microdialysis results from left ventricular wall, with analysis of glucose, lactate, and pyruvate, showed no sign of ischemia during pacing. Potassium concentrations did not change during pacing. We conclude that significant HR-related ST vector changes can occur in the absence of myocardial ischemia.
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| 16. |
- Hörnsten, Rolf, et al.
(författare)
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Ventricular late potentials in familial amyloidotic polyneuropathy
- 2006
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Ingår i: Journal of Electrocardiology. - : Elsevier BV. - 0022-0736 .- 1532-8430. ; 39:1, s. 57-62
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Tidskriftsartikel (refereegranskat)abstract
- It is well known that cytokines are highly involved in the disease process of rheumatoid arthritis (RA). Recently, targeting of neuropeptides has been suggested to have potential therapeutic effects in RA. The aim of this study was to investigate possible interrelations between five neuropeptides (bombesin/gastrin-releasing peptide (BN/GRP), substance P (SP), vasoactive intestinal peptide, calcitonin-gene-related peptide, and neuropeptide Y) and the three cytokines tumour necrosis factor (TNF)-alpha, IL-6, and monocyte chemoattractant protein-1 in synovial fluid of patients with RA. We also investigated possible interrelations between these neuropeptides and soluble TNF receptor 1 in serum from RA patients. Synovial fluid and sera were collected and assayed with ELISA or RIA. The most interesting findings were correlations between BN/GRP and SP and the cytokines. Thus, in synovial fluid, the concentrations of BN/GRP and SP grouped together with IL-6, and SP also grouped together with TNF-alpha and monocyte chemoattractant protein-1. BN/GRP and SP concentrations in synovial fluid also grouped together with the erythrocyte sedimentation rate. In the sera, BN/GRP concentrations and soluble TNF receptor 1 concentrations were correlated. These results are of interest because blocking of SP effects has long been discussed in relation to RA treatment and because BN/GRP is known to have trophic and growth-promoting effects and to play a role in inflammation and wound healing. Furthermore, the observations strengthen a suggestion that combination treatment with agents interfering with neuropeptides and cytokines would be efficacious in the treatment of RA. In conclusion, BN/GRP and SP are involved together with cytokines in the neuroimmunomodulation that occurs in the arthritic joint.
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| 17. |
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| 18. |
- Kronander, Håkan, et al.
(författare)
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Improved capacity of exercise electrocardiography in the detection of coronary artery disease by focusing on diagnostic variables during the early recovery phase
- 2005
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Ingår i: Journal of Electrocardiology. - : Elsevier BV. - 0022-0736 .- 1532-8430. ; 38:2, s. 130-138
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Tidskriftsartikel (refereegranskat)abstract
- The temporal distribution of the diagnostic information for the detection of coronary artery disease (CAD) provided by exercise-induced electrocardiographic (ECG) ST-segment amplitude changes in different ECG leads in men and women has not been fully investigated. To shed further light in this area, 1877 electrocardiograms selected from 8322 patients undergoing a routine exercise test on a bicycle ergometer were evaluated. ST-segment amplitude and the difference between heart rate-matched recovery and exercise ST-segment amplitudes (ST/HR difference) were measured. Coronary artery disease was verified angiographically in 669 patients and excluded in 1208 patients by angiography (n = 119), by myocardial scintigraphy (n = 250), or on clinical grounds (n = 839). The diagnostic performance of the 2 ECG methods used was assessed by constructing receiver operating characteristic curves for each sampling point every 12 seconds during 10 minutes of recovery as well as the last 4 minutes of exercise for the ST-segment amplitude. ST-segment amplitude performed better after exercise than during exercise and best within the first 2 minutes of recovery. Its diagnostic ability did not differ from the ST-amplitude hysteresis assessed by the difference between recovery ST-segment amplitude and exercise ST-segment amplitude at matched heart rate. Both methods performed better in men and the diagnostic information appeared mainly in leads I, -aVR, II, V-4, V-5, and V-6. The best discrimination of CAD is provided by analysis of ST-segment amplitude changes in 6 specific leads early during the recovery phase. This information should be targeted by exercise ECG diagnostic methods.
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| 19. |
- Liang, YC, et al.
(författare)
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QT dispersion failed to estimate the global dispersion of ventricular repolarization measured using monophasic action potential mapping technique in swine and patients
- 2005
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Ingår i: Journal of Electrocardiology. - : Elsevier BV. - 1532-8430 .- 0022-0736. ; 38:1, s. 19-27
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Tidskriftsartikel (refereegranskat)abstract
- The aim of this study was to evaluate whether the QT dispersion measured from 12-lead electrocardiogram (ECG) can estimate the global dispersion of ventricular repolarization (DVR) measured using a monophasic action potential (MAP) mapping technique. Monophasic action potentials were recorded from 75 +/- 12 left ventricular sites in 10 pigs and from 48 +/- 16 left or right ventricular sites in 15 patients using the CARTO mapping system. The maximum DVRs in both end-of-repolarization and MAP duration among all the mapped sites were calculated and termed as global DVR for each measurement. QT intervals, QT(peak) and QT(end), were measured from the 12-lead ECG, and QT dispersions; namely the differences between the maximum and the minimum of the QTpeak and QT(end) were calculated. We found that QT dispersions were significantly smaller than (P < .05) and poorly correlated with the global DVRs both in pigs and patients. Bland-Altman agreement analysis demonstrated a marked variation of the differences and an obvious lack of agreement between the results obtained using the ECG and the MAP methods. In our patients, the global DVR increased markedly during ventricular tachycardia as compared with that during sinus rhythm (P < .05), whereas there was no significant difference in QT dispersion between these 2 subgroups. In conclusion, QT dispersion on the surface ECG could not estimate the global DVR measured using the MAP mapping technique. These findings are not consistent with some previously reported observations, suggesting the need for reappraisal of the electrophysiological implications of QT dispersion.
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| 20. |
- Martinez, Juan Pablo, et al.
(författare)
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Assessment of QT-measurement accuracy using the 12-lead electrocardiogram derived from EASI leads
- 2007
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Ingår i: Journal of Electrocardiology. - : Elsevier BV. - 1532-8430 .- 0022-0736. ; 40:2, s. 172-179
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Tidskriftsartikel (refereegranskat)abstract
- The purpose of the present study is to assess QT-interval measurements from the EASI 12-lead electrocardiogram (ECG) as compared with the standard 12-lead ECG. The QT interval was automatically determined in simultaneously recorded standard and EASI 12-lead ECGs, using a validated wavelet-based delineator. The agreement between the 2 sets of measurements was quantified both on a lead-by-lead basis and a multilead basis with global definitions of QRS onset and T-wave end. The results show that the agreement between QT-interval measurements from the 2 lead systems is acceptable, with negligible mean differences and with correlation coefficients ranging from 0.91 to 0.98 depending on the lead studied. Although the SD shows a clear dependence on the selected lead (ranging from 9.2 to 26.4 milliseconds), differences are within the accepted tolerances for automatic delineation. In a few patients, large differences were found, mainly because of changes in morphology present in both lead systems. QT intervals measured by the multilead approach were considerably more stable than single-lead measurements and resulted in a much better agreement between the 2 lead systems (correlation coefficient, 0.98; QT difference, 1.1 +/- 9.8 milliseconds). Thus, the EASI 12-lead ECG may be used for reliable QT monitoring when the multilead delineation approach is adopted. (c) 2007 Elsevier Inc. All rights reserved.
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| 21. |
- Odenstedt, Jacob, 1968, et al.
(författare)
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Distorted T-vector loop and increased heart rate are associated with ventricular fibrillation in a porcine ischemia-reperfusion model
- 2009
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Ingår i: Journal of Electrocardiology. - : Elsevier BV. - 0022-0736 .- 1532-8430. ; 42:3, s. 267-73
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: The ventricular repolarization (VR) response to short-lasting coronary occlusion has been characterized by 3-dimensional vectorcardiography during angioplasty in humans; the T-vector loop becomes distorted (increased T(avplan)) and more circular (decreased T(eigenvalue)), but these changes have not been related to ventricular arrhythmias. PURPOSE: The VR response was therefore explored in a porcine ischemia-reperfusion model and compared in pigs with (n = 16) vs without (n = 17) ventricular fibrillation (VF). METHODS: Different aspects of VR were evaluated at baseline, at maximum ischemia, before reperfusion and at the subsequent ST maximum, after 1 hour of reperfusion, and before VF. Three aspects of the VR response were assessed: the ST-segment, the T-vector angles, and the T-vector loop morphology. RESULTS: All parameters changed significantly from baseline during ischemia and/or reperfusion. The early changes were similar to those previously observed in humans during angioplasty. The VF episodes were preceded by a significantly exaggerated T-loop distortion (increased T(avplan)) and increased heart rate. CONCLUSION: Aggravated T-loop distortion might, in this porcine ischemia-reperfusion model, reflect aspects of VR relevant to arrhythmogenesis.
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| 22. |
- Pahlm, Olle, et al.
(författare)
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Potential solutions for providing standard electrocardiogram recordings from nonstandard recording sites.
- 2008
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Ingår i: Journal of Electrocardiology. - : Elsevier BV. - 1532-8430 .- 0022-0736. ; 41:3, s. 207-210
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Tidskriftsartikel (refereegranskat)abstract
- For a 12-lead resting electrocardiogram (ECG) to be considered "standard," limb electrodes should be placed distally on the limbs. When resting ECGs are taken in conjunction with an ECG-monitoring situation, so-called monitoring sites (as described by Mason and Likar and also others) on the torso are used. Numerous publication have indicated that these ECGs are not identical with those recorded from distal sites, and this prohibits application of visual or computer-based interpretation criteria as well as serial comparison with standard ECGs. Loss of Q waves diagnostic for inferior wall myocardial infarction, as well as marked differences in frontal plane electrical axis, is the most commonly encountered problem with torso-recorded ECGs. This overview suggests 4 possible solutions to this dilemma.
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| 23. |
- Pahlm, Olle, et al.
(författare)
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Proximal placement of limb electrodes: a potential solution for acquiring standard electrocardiogram waveforms from monitoring electrode positions.
- 2008
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Ingår i: Journal of Electrocardiology. - : Elsevier BV. - 1532-8430 .- 0022-0736. ; 41, s. 454-457
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Tidskriftsartikel (refereegranskat)abstract
- There is currently a challenge to produce an electrocardiogram (ECG) recording of waveforms that are "standard" and also achieve the "noise immunity" required for continuous monitoring. The potential solutions that have been considered are to label each torso-recorded ECG as "nonstandard, torso-recorded," designate torso placement as "standard," or to reconstruct the "equivalent distally recorded ECG." The purpose of the present study was to validate an alternative "Lund system" of proximal limb electrode sites as a clinically feasible solution to this challenge. Data were collected from 75 patients referred for exercise testing at the Lund University Hospital. The Lund system produced Q wave dimensions and frontal plane QRS axis measurements that were in much better agreement with the standard ECG than those variables recorded with the Mason-Likar torso limb electrode method. Indeed, the Lund system replicated distal waveforms at a clinically acceptable level. Studies of larger patient cohorts including patients with various cardiac pathologies and studies of the noise immunity attained should be performed, and the acceptability by health care professionals should be determined.
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| 24. |
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| 25. |
- Perron, Annick, et al.
(författare)
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Maximal increase in sensitivity with minimal loss of specificity for diagnosis of acute coronary occlusion achieved by sequentially adding leads from the 24-lead electrocardiogram to the orderly sequenced 12-lead electrocardiogram
- 2007
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Ingår i: Journal of Electrocardiology. - : Elsevier BV. - 1532-8430 .- 0022-0736. ; 40:6, s. 463-469
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: This study investigates whether sequential addition of inverted, (negative) leads from the 24-lead electrocardiogram (ECG) to the orderly sequenced 12-lead ECG would identify a number of leads with which the sensitivity for diagnosis of acute transmural ischemia is significantly increased with minimal loss of specificity. Background: Acute transmural ischemia due to thrombotic coronary occlusion typically progresses to infarction. Its recognition is based on currently accepted ST-elevation myocardial infarction (STEMI) criteria with suboptimal sensitivity, which could be potentially increased by consideration of the principle that each of the 12 ECG leads can be inverted to provide an additional lead with the opposite (180 degrees) orientation, generating a 24-lead ECG. Methods: The study population included 162 patients who underwent prolonged coronary occlusion during elective percutaneoas transluminal coronary angioplasty. Balloon occlusion was performed in the left anterior descending coronary artery (51 patients), in the right coronary artery (67 patients), or in the left circumflex coronary artery (44 patients). To be classified as indicative of the epicardial injury current of acute ischemia, the ECGs had to fulfill either the criteria of a consensus document from the American College of Cardiology or the European Society of Cardiology or thresholds for the inverted leads based on a population study from Scotland. Results: The addition of -V1, -V2, -V3, -aVL, -I, aVR, and -III increased sensitivity from 61% to 78% (P <= .01) and decreased specificity from 96% to 93% (P = .06). Conclusions: Addition of 7 leads from the 24-lead ECG, thus creating a 19-lead ECG, was found optimal for attaining high sensitivity while retaining high specificity when compared with the performance of the standard 12-lead ECG. (C) 2007 Elsevier Inc. All rights reserved.
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| 26. |
- Richter, Ulrike, et al.
(författare)
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Spatial characteristics of atrial fibrillation electrocardiograms
- 2008
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Ingår i: Journal of Electrocardiology. - : Elsevier BV. - 1532-8430 .- 0022-0736. ; 41:2, s. 165-172
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: The present study investigates spatial properties of atrial fibrillation (AF) by analyzing vectorcardiogram loops synthesized from 12-lead electrocardiograms (ECGs). METHODS: After atrial signal extraction, spatial properties are characterized through analysis of successive, fixed-length signal segments and expressed in loop orientation, that is, azimuth and elevation, as well as in loop morphology, that is, planarity and planar geometry. It is hypothesized that more organized AF, expressed by a lower AF frequency, is associated with decreased variability in loop morphology. Atrial fibrillation frequency is determined using spectral analysis. RESULTS: Twenty-six patients with chronic AF were analyzed using 60-second ECG recordings. Loop orientation was similar when determined from either entire 60- or 1-second segments. For 1-second segments, the correlation between AF frequency and the parameters planarity and planar geometry were 0.608 (P < .001) and 0.543 (P < .005), respectively. CONCLUSIONS: Quantification of AF organization based on AF frequency and spatial characteristics from the ECG is possible. The results suggested a relatively weak coupling between loop morphology and AF frequency when determined from the surface ECG.
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| 27. |
- Ripa, R S, et al.
(författare)
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Comparison between human and automated electrocardiographic waveform measurements for calculating the Anderson-Wilkins acuteness score in patients with acute myocardial infarction
- 2005
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Ingår i: Journal of Electrocardiology. - : Elsevier BV. - 1532-8430 .- 0022-0736. ; 38:2, s. 96-99
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Tidskriftsartikel (refereegranskat)abstract
- The Anderson-Wilkins (AW) electrocardiographic (ECG) acuteness score complements time from pain onset in prognostic stratification of patients with acute myocardial infarction (AMI). However, for the AW acuteness score to be of practical use in the acute situation, it must be an integral component of a commercial automated ECG analysis program. The objective of this study was to determine the concordance between human and computer measurements and calculation of the AW acuteness score. The mean difference in AW acuteness score was 0.11 +/- 0.66 for anterior and -0.07 +/- 1.24 for inferior AMI. Ninety-nine percent of the differences were found to be 1.0 or less for the anterior AMI group, and 91.7% were 1.0 or less in the inferior AMI group. The differences were primarily caused by minor disagreements in measurements. In conclusion, the AW acuteness score established using manual ECG waveform measurements can be implemented into commercial automated ECG analysis programs to achieve practical use in clinical decision support for patients with AMI.
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| 28. |
- Ripa, Rasmus S., et al.
(författare)
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Consideration of the total ST-segment deviation on the initial electrocardiogram for predicting final acute posterior myocardial infarct size in patients with maximum ST-segment deviation as depression in leads V1 through V3. A FRISC II substudy
- 2005
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Ingår i: Journal of Electrocardiology. - : Elsevier BV. - 0022-0736 .- 1532-8430. ; 38:3, s. 180-6
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Because patients with acute left circumflex occlusion are typically characterized primarily on the standard 12-lead electrocardiogram (ECG) by ST depression, they do not qualify to receive reperfusion therapy. Documentation of a relationship between the quantities of acute ST change and final QRS estimated acute myocardial infarction (AMI) size could form the basis for clinical trials to determine the value of reperfusion therapy. METHOD: The Fragmin and Fast Revascularization during Instability in Coronary artery disease trial included 3214 patients with unstable coronary artery disease. Two percent of the patients (n = 69) had maximum ST-segment depression in leads V 1 through V 3 and were selected for this study. Initial ECG changes were compared to final myocardial infarction size, using the Selvester QRS score as the end point. RESULTS: The quantity of initial ST-segment deviation correlated with the final AMI size (r = 0.43, P < .0005). The formula 3[0.22 (SigmaST downward arrow + SigmaST upward arrow) -0.02], where downward arrow indicates depression and upward arrow elevation, derived from measurements on the initial ECG, predicted the size of the AMI in percentage of the left ventricle as estimated on the final ECG. The study population had a large proportion of AMI (73%) indicated to be in or adjacent to the posterior left ventricular wall. CONCLUSION: The quantitative initial ST-segment deviation correlates linearly to the final AMI size in patients with maximum ST-segment depression in leads V 1 through V 3. The formula derived could be valuable for selecting patients who fail to meet strict ST-elevation AMI criteria for emergency intravenous or intracoronary reperfusion therapy.
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| 29. |
- Rubel, Paul, et al.
(författare)
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Toward personal eHealth in cardiology. Results from the EPI-MEDICS telemedicine project
- 2005
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Ingår i: [Host publication title missing]. - : Elsevier BV. - 1532-8430 .- 0022-0736. ; 38:4, s. 100-106
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Konferensbidrag (refereegranskat)abstract
- The purpose of this study was to develop a method based on artificial neural networks for interpretation of captopril renography tests for the detection of renovascular hypertension caused by renal artery stenosis and to assess the value of different measurements from the test. A total of 250 99mTc-MAG3 captopril renography tests were used in the study. The material was collected from two different patient groups. One group consisted of 101 patients who also had undergone a renal angiography. The angiographies, which were used as gold standard, showed a significant renal artery stenosis in 53 of the 101 cases. The second group consisted of 149 patients, who's captopril renography tests all were interpreted as not compatible with significant renal artery stenosis by an experienced nuclear medicine physician. Artificial neural networks were trained for the diagnosis of renal artery stenosis using eight measures from each renogram. The neural network was then evaluated in separate test groups using an eightfold cross validation procedure. The performance of the neural networks, measured as the area under the receiver operating characteristic curve, was 0.93. The sensitivity was 91% at a specificity of 90%. The lowest performance was found for the network trained without use of a parenchymal transit measure, indicating the importance of this feature. Artificial neural networks can be trained to interpret captopril renography tests for detection of renovascular hypertension caused by renal artery stenosis. The result almost equals that of human experts shown in previous studies.
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| 30. |
- Råmunddal, Truls, 1973, et al.
(författare)
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Antiarrhythmic effects of growth hormone--in vivo evidence from small-animal models of acute myocardial infarction and invasive electrophysiology.
- 2008
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Ingår i: Journal of electrocardiology. - : Elsevier BV. - 1532-8430 .- 0022-0736. ; 41:2, s. 144-51
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Tidskriftsartikel (refereegranskat)abstract
- A growing body of evidence suggests a possible role for growth hormone (GH) in the treatment of congestive heart failure (CHF) and myocardial infarction (MI). The aim of this study was to investigate in vivo the effects of GH treatment on incidence and severity of ventricular arrhythmias normal and MI rats.Male Sprague-Dawley rats weighing approximately 350 g were randomized into 3 groups. Growth hormone-treated rats (n = 6) received 6 mg/kg of human GH. The placebo group (n = 10) received 1 mL of saline. Amiodarone-treated rats (n = 10) were injected with 25 mg/kg and served as positive controls. All animals received a single intraperitoneal injection 6 hours before induction of MI. Myocardial infarction was induced by ligation of the left coronary artery, resulting in a large (approximately 40%) anterolateral MI. A computerized electrocardiographic tracing was obtained continuously before induction of MI and up to 1 hour postinfarction. Invasive hemodynamics including intraventricular and arterial pressure were registered for 60 minutes post-MI. Qualitative as well as quantitative variables of ventricular arrhythmias were analyzed. Invasive electrophysiology with pacing in right atrium and ventricle was performed in normal rats (control, n = 13; GH, n = 6; amiodarone, n = 6) to asses inducibility of supraventricular and ventricular arrhythmias.Growth hormone- and amiodarone-treated rats had lower resting heart rate at baseline before induction of MI. The arrhythmia scores in the GH- (3.8 +/- 1) and amiodarone-treated (3.9 +/- 0.5) animals were significant lower than in the placebo group (5.9 +/- 0.5, P < .05). There was no significant difference in arrhythmia score between the GH and amiodarone groups. The incident of inducible ventricular arrhythmias was lower in the GH (2/6, 33%) and amiodarone (2/6, 33%) groups compared with controls (13/16, 81%; P = .05). There was no difference in inducibility of atrial fibrillation between the GH (5/6, 83%) and control (13/14, 93%) groups, whereas the inducibility of atrial fibrillation was significantly lower in the amiodarone group (2/6, 33%; P < .05).Pretreatment with GH reduces the burden of ventricular arrhythmias in rats with postinfarction CHF due to acute MI. Growth hormone may be useful in the treatment of CHF and acute MI.
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| 31. |
- Sejersten, M, et al.
(författare)
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Comparison of EASI-derived 12-lead electrocardiograms versus paramedic-acquired 12-lead electrocardiograms using Mason-Likar limb lead configuration in patients with chest pain
- 2006
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Ingår i: Journal of Electrocardiology. - : Elsevier BV. - 1532-8430 .- 0022-0736. ; 39:1, s. 13-21
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Tidskriftsartikel (refereegranskat)abstract
- Introduction: Monitoring of serial 12-lead electrocardiogram (ECG) recordings is the accepted requirement for prehospital data acquisition in patients with chest pain. The purpose of this study was to determine whether waveforms and clinical triage decisions are similar for EASI-derived ECGs and paramedic-acquired 12-lead ECGs using Mason-Likar limb lead configuration when compared with standard 12-lead ECGs (stdECG). Method: Twenty patients with chest pain had a prehospital 12-lead ECG recorded in the ambulance, and paramedic-applied electrodes retained in place at hospital arrival. An ECG technician applied standard precordial and EASI electrodes in their Correct positions. Twelve-lead ECGs were obtained from the paramedic-applied electrodes using their Mason-Likar limb lead configuration, and derived from the EASI leads for comparison with the stdECG. Three computer-measured QRS-T waveform parameters were considered, and differences in waveform measurement between EASI and stdECG (EASI Delta stdECG) versus differences in waveform measurements between paramedic Mason-Likar and stdECG (PML Delta stdECG) were calculated. Two emergency physicians determined whether the EASI-derived or the paramedic Mason-Likar ECG contained information that would change their clinical triage decision from that indicated by the stdECG. Results: EASI Delta stdECG and PML Delta stdECG were identical in 28%, whereas EASI Delta stdECG was more than PML Delta stdECG in 35%, and PML Delta stdECG was accurate (both times) than EASI Delta stdECG in 37% (P = .62). The physicians were more likely to change the level of patient care based on the EASI-derived ECGs compared with the paramedic ECGs; however, this difference was not statistically significant (P = .27), but this may only be caused by the small study population. Conclusions: There are similar differences from stdECG waveforms in EASI-derived ECGs and those acquired via paramedic-applied precordial electrodes using Mason-Likar limb lead configuration. Either method can be used as a substitute for monitoring, but neither should be considered equivalent to the stdECG for diagnostic purposes. (c) 2006 Elsevier Inc. All rights reserved.
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| 32. |
- Sejersten, Maria, et al.
(författare)
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Detection of acute ischemia from the EASI-derived 12-lead electrocardiogram and from the 12-lead electrocardiogram acquired in clinical practice
- 2007
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Ingår i: Journal of Electrocardiology. - : Elsevier BV. - 1532-8430 .- 0022-0736. ; 40:2, s. 120-126
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Tidskriftsartikel (refereegranskat)abstract
- ST-segment measurements in the standard 12-lead electrocardiogram (ECG) of patients with acute coronary syndromes are crucial for these patients' management. Our objective was to determine whether the 12-lead ECG derived from the 3-lead EASI system can attain a level of diagnostic performance similar to that of the Mason-Likar (ML) 12-lead ECG acquired in clinical practice (CP) by paramedics and emergency department technicians. Using 120-lead body surface potential maps recorded before and during balloon inflation angioplasty from 88 patients (divided into "responders" and "nonresponders"), and electrode placement data from 60 applications of precordial leads in CP, we generated for the "nonischemic" and "ischemic' states of each patient the following lead sets: the ML 12-lead ECG, the EASI-derived 12-lead ECG, and 60 sets of 12-lead CP ECGs. We extracted ST deviations at J + 60 milliseconds, summed them for all 12 leads of each lead set to obtain Sigma ST, and, by using the bootstrap method, determined the mean sensitivity and specificity for recognizing the "ischemic' state at various thresholds of Sigma ST. Results were displayed as receiver operating characteristics, and the area under these curves (AUC) +/- SE was used as the measure of diagnostic performance. AUC SE for all patients were ML ECG, 0.66 +/- 0.03; EASI ECG, 0.64 +/- 0.03; and CP ECG, 0.67 +/- 0.03. Corresponding results for responders only were 0.81 +/- 0.04 for ML ECG, 0.78 +/- 0.04 for EASI ECG, and 0.81 +/- 0.04 for CP ECG. The differences between the AUCs for the different lead sets were not significant (P >.05). Thus, the EASI-derived 12-lead ECG is as good for detecting acute ischemia as is the 12-lead ECG acquired in CP. (c) 2007 Elsevier Inc. All rights reserved.
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| 33. |
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| 34. |
- Strauss, David G, et al.
(författare)
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Vectorcardiogram synthesized from the 12-lead electrocardiogram to image ischemia.
- 2009
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Ingår i: Journal of Electrocardiology. - : Elsevier BV. - 1532-8430 .- 0022-0736. ; 42:2, s. 190-197
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Knowledge of the location and size of ischemic myocardium at risk for infarction could impact prehospital patient triage and reperfusion therapy. The 12-lead electrocardiogram (ECG) can roughly estimate ischemia size; however, individual precordial ECG leads are at different distances from the left ventricle (LV) and certain LV walls have greater effects on the ECG. Vectorcardiographic corrected orthogonal lead systems can display the magnitude and direction of the ST-segment "injury current" vector in 3-dimensional space. We assessed whether the vectorcardiographic ST-vector direction and magnitude derived from the ECG by the inverse-Dower method can estimate the location and size of ischemia. METHODS AND RESULTS: Thirty-two patients underwent elective coronary angioplasty with control and 5-minute balloon-occlusion ECG and sestamibi injection followed by single photon emission computed tomography (SPECT). The ST-vector direction derived from the inverse-Dower method was projected to an LV model with normal coronary artery anatomy. The graphical display of ST-vector location could discriminate among occlusions of the different coronaries. The ST-vector located ischemia within the SPECT defect in 75% (24/32) of all patients and 96% (24/25) of patients with ischemia in more than 12% of the LV. ST-vector magnitude had a Spearman correlation of r = 0.68 (P < .0001) with SPECT ischemia size. CONCLUSIONS: The 3-dimensional ST vector derived from the ECG can be graphically projected onto an LV model to localize ischemia, and ST-vector magnitude correlates with ischemia size. Further study is warranted to assess the ability of vectorcardiographic imaging to risk-stratify and provide decision-support for patients with acute myocardial infarction.
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| 35. |
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| 36. |
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| 37. |
- Trägårdh, Elin, et al.
(författare)
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Reduced high-frequency QRS components in electrocardiogram leads facing an area of the heart with intraventricular conduction delay due to bundle branch block.
- 2007
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Ingår i: Journal of Electrocardiology. - : Elsevier BV. - 1532-8430 .- 0022-0736. ; 40:2, s. 127-132
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Tidskriftsartikel (refereegranskat)abstract
- Background: The mechanisms underlying high-frequency QRS components (HF-QRS) are incompletely understood. One theory is that HF-QRS are related to the conduction velocity of the heart. The purpose was to test this hypothesis by comparing HF-QRS in patients with left or right bundle branch block (LBBB and RBBB, respectively) to those in healthy subjects and in patients with ischemic heart disease (IHD). Methods: Twenty-two patients with LBBB, 19 patients with RBBB, 63 normal subjects, and 64 patients with IHD were included. Twelve-lead electrocardiograms were analyzed in the frequency interval 150 to 250 Hz. Results: The study showed reduced HF-QRS in patients with LBBB compared with healthy subjects and patients with IHD. The difference, however, was small in lead V-1 and V-2. In patients with RBBB, no differences in HF-QRS could be detected except in few leads; among those is lead V-1. Conclusion: The results support the theory that HF-QRS are related to the conduction velocity of the heart. (c) 2007 Elsevier Inc. All rights reserved.
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| 38. |
- Ubachs, Joey, et al.
(författare)
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Location of myocardium at risk in patients with first-time ST-elevation infarction: comparison among single photon emission computed tomography, magnetic resonance imaging, and electrocardiography.
- 2009
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Ingår i: Journal of Electrocardiology. - : Elsevier BV. - 1532-8430 .- 0022-0736. ; 42, s. 198-203
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: The amount of myocardium at risk (MaR) during acute coronary occlusion and the duration of occlusion are important determinants of final infarct size. The main goal of early reperfusion therapy is to salvage ischemic myocardium, thereby preserving left ventricular function. The aims of the present study were to test the feasibility of developing polar plot representations of MaR, for perfusion single photon emission computed tomography (SPECT), regional wall thickening by magnetic resonance imaging (MRI), and distribution of ST-segment changes. A second aim was to test the hypothesis that these different modalities display similar localization of the MaR in patients with reperfused first-time myocardial infarction. METHODS: Eleven patients with first-time myocardial infarction with ST-elevation received (99m)Tc tetrofosmin before primary percutaneous coronary intervention, SPECT imaging within 3 hours, and cardiac MRI of the left ventricle within 24 hours. The results for SPECT, MRI, and electrocardiogram (ECG) were developed into polar plots, and two expert observers designated the culprit coronary artery as assessed by angiography. RESULTS: The perfusion SPECT, MRI wall thickening, and ST changes are presented in side-by-side polar plots. In total, the culprit artery, based on the location of the MaR, was correctly designated in 91%, 82%, and 91% of cases by SPECT, MRI, and ECG, respectively. CONCLUSIONS: Polar representation for localization of the MaR by SPECT perfusion, MRI wall thickening, and ECG ST-segment deviation is feasible. All 3 modalities have the potential to be used for indirect visual designation of the culprit artery in patients with first-time acute coronary occlusion.
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| 39. |
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| 40. |
- Wagner, Galen S, et al.
(författare)
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Use of the 24-lead "standard" electrocardiogram to identify the site of acute coronary occlusion
- 2008
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Ingår i: Journal of Electrocardiology. - : Elsevier BV. - 1532-8430 .- 0022-0736. ; 41:3, s. 238-244
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Tidskriftsartikel (refereegranskat)abstract
- This review presents the added value for diagnosis of acute ischemia/infarction of considering ST elevation in the 12 inverted leads (-I, -II, -II, -aVR, etc) of the standard electrocardiogram in addition to ST elevation in 12 positive leads. A small number of studies have been published showing substantial increases in sensitivity at the "cost of' slight decreases in specificity. One recent study indicated that only 7 of the inverted leads should be considered, yielding a "19-lead electrocardiogram" encompassing the following leads (presented here in the logical secquences): -III, aVL, I, -aVR, II, aVF, III, -aVL, -I, aVR; and V1, V2, V3, V4, V5, V6, -V1, -V2, -V3. Studies have to be performed to establish the thresholds that should be applied to these leads for achievement of sensitivity/specificity.
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| 41. |
- Wall, Kent, et al.
(författare)
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Thirty-year electrocardiographic follow-up after repair of tetralogy of Fallot or atrial septal defect
- 2007
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Ingår i: Journal of Electrocardiology. - South Burlington, Vt. : Research in Electrocardiology, Inc.. - 0022-0736 .- 1532-8430. ; 40:2, s. 214-217
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND AND PURPOSE: Knowledge about long-term electrocardiographic changes after surgery for congenital heart disease is limited. METHODS: Eleven patients with corrected tetralogy of Fallot (ToF) and 14 with corrected atrial septal defect (ASD) were followed up at 20 and 30 years after surgery. RESULTS: Approximately 50% of the ASD group developed prolonged QRS duration. In the ToF group, 7 increased QRS duration by more than 20 milliseconds. Nearly all had right bundle-branch block, and 30% of them also had bifascicular block. Two in the ASD group developed first grade atrioventricular block. Five ASD and 6 ToF had prolonged corrected QT duration in the late postoperative phase. CONCLUSIONS: Even after primarily good results of surgery in congenital heart disease, unknown late effects may occur not only in complex lesions such as ToF but also after ASD correction. Regular medical checkups are important after surgical correction in congenital heart disease.
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| 42. |
- Welinder, Annika, et al.
(författare)
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EASI-Derived vs standard 12-lead electrocardiogram for Selvester QRS score estimations of chronic myocardial infarct size, using cardiac magnetic resonance imaging as gold standard.
- 2009
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Ingår i: Journal of Electrocardiology. - : Elsevier BV. - 1532-8430 .- 0022-0736. ; 42, s. 145-151
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: The size of myocardial infarction (MI) is of significance for the prognosis. Selvester scores might be valuable for this estimation. OBJECTIVE: To compare the differences in Selvester scores for chronic MI provided from standard and EASI-derived 12-lead electrocardiograms (ECGs) and to compare these scores to the MI size measured by delayed-enhancement magnetic resonance imaging (DE-MRI). METHODS: Thirty-seven patients were studied. In connection with their DE-MRI scan follow-up after chest pain, body surface potential mapping was performed. Standard and EASI 12-lead ECGs were constructed from the maps. Two investigators manually performed the measurements required for scoring with the Selvester system using quad-plot format of the ECGs. One of the investigators repeated this once for the standard leads. RESULTS: Neither the association nor the agreement between MRI and EASI leads or between MRI and standard leads was very strong. CONCLUSIONS: The Selvester QRS scoring system needs further improvement.
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| 43. |
- Xia, Yunlong, et al.
(författare)
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Activation recovery time measurements in evaluation of global sequence and dispersion of ventricular repolarization
- 2005
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Ingår i: Journal of Electrocardiology. - : Elsevier BV. - 1532-8430 .- 0022-0736. ; 38:1, s. 28-35
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Tidskriftsartikel (refereegranskat)abstract
- Introduction: Activation recovery time (ART), defined as the time from the earliest ventricular activation time to the end of T wave on unipolar electrograms, has been used as an index of myocardial repolarization time. However, it is unknown whether the ART can be used to estimate the global sequence and dispersion of ventricular repolarization as determined by the monophasic action potential (MAP) mapping technique. Methods and Results: Endocardial MAPs and unipolar electrograms were simultaneously recorded using the CARTO system from 34 +/- 12 left (n = 6) or right (n = 9) ventricular sites in 12 patients. End-of-repolarization (EOR) times from the MAPs and ARTs from the unipolar electrograms were calculated, based on which 15 sets of 3-dimensional maps of global EOR sequence and ART sequence were reconstructed. The ART sequence was consistent with the EOR sequence in 14 of 15 maps. In the 473 paired measurements obtained, the differences between the ART and the EOR time were 2 +/- 22 milliseconds (NS). A significant positive correlation between the ART and the EOR time was found in all the maps (r = 0.58 +/- 0.22). Agreement analyses showed that the differences between these 2 measurements were almost all within the range of mean difference +/- 2 SD for each individual map and for all the 473 recordings. The global dispersion of ART was 79 +/- 35 milliseconds, as compared with that of EOR time of 78 +/- 35 milliseconds (NS). Conclusion: The ART from unipolar electrograms is a good estimate of EOR time measured from MAPs, suggesting the usefulness of the former in evaluation of global sequence and dispersion of ventricular repolarization.
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