• 【确定疑似急性冠脉综合征患者射血分数降低的最重要的心电图预测指标。】 复制标题 收藏 收藏
    DOI:10.1016/j.jelectrocard.2020.06.003 复制DOI
    作者列表:Alhamaydeh M,Gregg R,Ahmad A,Faramand Z,Saba S,Al-Zaiti S
    BACKGROUND & AIMS: BACKGROUND:Non-invasive screening tools of cardiac function can play a significant role in the initial triage of patients with suspected acute coronary syndrome. Numerous ECG features have been previously linked with cardiac contractility in the general population. We sought to identify ECG features that are most predictive for real-time screening of reduced left ventricular ejection fraction (LVEF) in the acute care setting. METHODS:We performed a secondary analysis of a prospective, observational cohort study of patients evaluated for suspected acute coronary syndrome. We included consecutive patients in whom an echocardiogram was performed during indexed encounter. We evaluated 554 automated 12-lead ECG features in multivariate linear regression for predicting LVEF. We then used regression trees to identify the most important predictive ECG features. RESULTS:Our final sample included 297 patients (aged 63 ± 15, 45% females). The mean LVEF was 57% ± 13 (IQR 50%-65%). In multivariate analysis, depolarization dispersion in the horizontal plane; global repolarization dispersion; and abnormal temporal indices in inferolateral leads were all independent predictors of LVEF (R2 = 0.452, F = 6.679, p < 0.001). Horizontal QRS axis deviation and prolonged ventricular activation time in left ventricular apex were the most important determinants of reduced LVEF, while global QRS duration was of less importance. CONCLUSIONS:Poor R wave progression in precordial leads with dominant QS pattern in V3 is the most predictive feature of reduced LVEF in suspected ACS. This feature constitutes a simple visual marker to aid clinicians in identifying those with impaired cardiac function.
    背景与目标: 背景:心脏功能的非侵入性筛查工具在疑似急性冠脉综合征患者的初次分诊中可以发挥重要作用。以前,普通人群中许多心电图特征都与心脏收缩力有关。我们试图确定对急性护理环境中实时筛查左室射血分数减少(LVEF)最具预测性的ECG功能。
    方法:我们对一项前瞻性观察性队列研究进行了二次分析,该研究对评估为可疑急性冠脉综合征的患者进行了研究。我们纳入了连续的患者,在转诊期间进行了超声心动图检查。我们在多元线性回归中评估了554个自动化12导联心电图功能,以预测LVEF。然后,我们使用回归树来确定最重要的ECG预测功能。
    结果:我们的最终样本包括297名患者(年龄63±15,女性45%)。 LVEF平均为57%±13(IQR 50%-65%)。在多变量分析中,去极化色散在水平面中;反极化色散在水平面中。全球极化扩散;下外侧导线的时间指标异常和异常都是LVEF的独立预测因子(R2 = 0.452,F = 6.679,p <0.001)。左室心尖的水平QRS轴偏移和延长的心室激活时间是LVEF降低的最重要决定因素,而整体QRS持续时间的重要性较小。
    结论:在V3中具有占优势的QS模式的心前区导联中R波进展较差是可疑ACS中LVEF降低的最预测特征。此功能构成一个简单的视觉标记,可帮助临床医生识别心脏功能受损的患者。
  • 【正常受试者的体表心电图变异图。】 复制标题 收藏 收藏
    DOI:10.1088/0967-3334/16/4/004 复制DOI
    作者列表:Gramatikov BI
    BACKGROUND & AIMS: A method for quantifying the fluctuations of the QRS electrocardiogram over the flat (unrolled) thoracic surface in normal subjects is presented. Serial comparisons were performed on 32-lead ECG recordings and body surface maps from seven healthy men, using as similarity measures correlation and RMS-difference in both time-signal and 2D map domain. Recordings were made on one and the same day, and on different days. The time-signal correlation and RMS-differences were plotted as 2D distributions. Correlation was higher on the front of the torso and RMS-differences were largest in the precordial area. The average time-signal correlation calculated over the QRS in comparisons of signals taken on different days was 0.9717, whereas the corresponding RMS-difference was 57.8 microV. Additionally, 2D comparisons between reconstructed map frames at different time instants in the QRS were carried out, using the 2D versions of the correlation and RMS-difference. The averaged results of the 2D comparisons were close to the time-signal comparison values (respectively 0.9696 and 68.9 microV). Finally, 2D comparisons between isointegral maps (mapping the QRS signal integral) were performed. They yielded even higher correlations (0.98, 3.453 microV s). Although the number of subjects studied was not large, the investigation brought to light important variability ranges that may serve as a basis when detecting pathologies. In addition, the topology of normal ECG variability on the body surface was revealed. This study confirmed the pertinence of correlation and RMS-difference as measures of time-signal and map similarity.

    背景与目标: 提出了一种在正常受试者中平坦(展开)的胸廓表面上QRS心电图波动的量化方法。对来自七个健康男性的32导联心电图记录和身体表面图进行系列比较,使用相似性度量在时间信号和二维图域中的相关性和均方根差。记录是在同一天,同一天和不同日期进行的。将时间信号相关性和RMS差绘制为2D分布。躯干前部的相关性较高,并且前胸区的RMS差异最大。通过QRS计算出的不同时间的信号比较中的平均时间信号相关性为0.9717,而相应的RMS差为57.8 microV。此外,使用相关性和RMS差异的2D版本,在QRS中不同时刻重建的地图帧之间进行了2D比较。二维比较的平均结果接近时间信号比较值(分别为0.9696和68.9 microV)。最后,进行了等积分图之间的二维比较(映射QRS信号积分)。他们产生了更高的相关性(0.98,3.453 microV s)。尽管研究的对象数量并不多,但这项研究揭示了重要的可变性范围,可以作为检测病理的基础。另外,揭示了正常ECG在体表上的变异性的拓扑结构。这项研究证实了相关性和RMS差作为时间信号和地图相似性的度量的相关性。

  • 【用于运动心电图测试的综合性ST段压低/心率分析的计算机程序。】 复制标题 收藏 收藏
    DOI:10.1016/0169-2607(96)01732-4 复制DOI
    作者列表:Lehtinen R,Vänttinen H,Sievänen H,Malmivuo J
    BACKGROUND & AIMS: The ST-segment depression/heart rate (ST/HR) analysis has been found to improve the diagnostic accuracy of the exercise ECG test in detecting myocardial ischemia. Recently, three different continuous diagnostic variables based on the ST/HR analysis have been introduced; the ST/HR slope, the ST/HR index and the ST/HR hysteresis. The latter utilises both the exercise and recovery phases of the exercise ECG test, whereas the two former are based on the exercise phase only. This present article presents a computer program which not only calculates the above three diagnostic variables but also plots the full diagrams of ST-segment depression against heart rate during both exercise and recovery phases for each ECG lead from given ST/HR data. The program can be used in the exercise ECG diagnosis of daily clinical practice provided that the ST/HR data from the ECG measurement system can be linked to the program. At present, the main purpose of the program is to provide clinical and medical researchers with a practical tool for comprehensive clinical evaluation and development of the ST/HR analysis.

    背景与目标: 已发现ST段抑郁/心率(ST / HR)分析可提高运动ECG测试在检测心肌缺血中的诊断准确性。最近,基于ST / HR分析的三种不同的连续诊断变量已被引入; ST / HR斜率,ST / HR指数和ST / HR磁滞。后者利用运动心电图测试的运动和恢复阶段,而前两者仅基于运动阶段。本文介绍了一种计算机程序,该程序不仅可以计算上述三个诊断变量,还可以根据给定的ST / HR数据,针对每个ECG导线在运动和恢复阶段绘制ST段压低相对于心率的完整图。该程序可用于日常临床实践的运动ECG诊断,前提是可将来自ECG测量系统的ST / HR数据链接到该程序。目前,该计划的主要目的是为临床和医学研究人员提供实用的工具,以进行全面的临床评估和ST / HR分析的开发。

  • 【心电图门控三维血管内超声:人体冠状动脉腔和动脉粥样硬化斑块尺寸自动分析的可行性和可重复性。】 复制标题 收藏 收藏
    DOI:10.1161/01.cir.96.9.2944 复制DOI
    作者列表:von Birgelen C,de Vrey EA,Mintz GS,Nicosia A,Bruining N,Li W,Slager CJ,Roelandt JR,Serruys PW,de Feyter PJ
    BACKGROUND & AIMS: BACKGROUND:Automated systems for the quantitative analysis of three-dimensional (3D) sets of intravascular ultrasound (IVUS) images have been developed to reduce the time required to perform volumetric analyses; however, 3D image reconstruction by these nongated systems is frequently hampered by cyclic artifacts.

    METHODS AND RESULTS:We used an ECG-gated 3D IVUS image acquisition workstation and a dedicated pullback device in atherosclerotic coronary segments of 30 patients to evaluate (1) the feasibility of this approach of image acquisition, (2) the reproducibility of an automated contour detection algorithm in measuring lumen, external elastic membrane, and plaque+media cross-sectional areas (CSAs) and volumes and the cross-sectional and volumetric plaque+media burden, and (3) the agreement between the automated area measurements and the results of manual tracing. The gated image acquisition took 3.9+/-1.5 minutes. The length of the segments analyzed was 9.6 to 40.0 mm, with 2.3+/-1.5 side branches per segment. The minimum lumen CSA measured 6.4+/-1.7 mm2, and the maximum and average CSA plaque+media burden measured 60.5+/-10.2% and 46.5+/-9.9%, respectively. The automated contour-detection required 34.3+/-7.3 minutes per segment. The differences between these measurements and manual tracing did not exceed 1.6% (SD<6.8%). Intraobserver and interobserver differences in area measurements (n=3421; r=.97 to.99) were <1.6% (SD<7.2%); intraobserver and interobserver differences in volumetric measurements (n=30; r=.99) were <0.4% (SD<3.2%).

    CONCLUSIONS:ECG-gated acquisition of 3D IVUS image sets is feasible and permits the application of automated contour detection to provide reproducible measurements of the lumen and atherosclerotic plaque CSA and volume in a relatively short analysis time.

    背景与目标: 背景:已开发出用于对三维(3D)血管内超声(IVUS)图像进行定量分析的自动化系统,以减少执行体积分析所需的时间;但是,这些非门控系统进行的3D图像重建经常会受到循环伪像的干扰。评估30位患者的动脉粥样硬化性冠状动脉节段(1)这种图像采集方法的可行性,(2)自动轮廓检测算法在测量管腔,外部弹性膜和斑块介质横截面积(CSA)时的可重复性,以及体积,横截面和体积斑块介质负荷,以及(3)自动化面积测量与手动追踪结果之间的一致性。门控图像采集耗时3.9 /-1.5分钟。分析的片段的长度为9.6至40.0mm,每个片段具有2.3 / -1.5个侧分支。最小内腔CSA的大小为6.4 /-1.7 mm2,最大和平均CSA斑块的介质负荷分别为60.5 /-10.2%和46.5 /-9.9%。自动轮廓检测每段需要34.3 /-7.3分钟。这些测量值和手动跟踪之间的差异不超过1.6%(SD <6.8%)。观察者之间和观察者之间的面积测量差异(n = 3421; r ​​= .97至0.99)<1.6%(SD <7.2%);观察者内部和观察者之间的体积测量差异(n = 30; r = .99)<0.4%(SD <3.2%)。

    结论:ECG门控采集3D IVUS图像集是可行的,并允许应用自动轮廓检测,以在相对较短的分析时间内对管腔和动脉粥样硬化斑块CSA和体积进行可重复的测量。

  • 【使用超声心动图,心电图和右心导管检查对心脏淀粉样变性患者进行评估。】 复制标题 收藏 收藏
    DOI:10.3109/13506129.2012.761967 复制DOI
    作者列表:Granstam SO,Rosengren S,Vedin O,Kero T,Sörensen J,Carlson K,Flachskampf FA,Wikström G
    BACKGROUND & AIMS: AIMS:To characterize patients with cardiac amyloidosis using echocardiography, electrocardiogram (ECG) and right heart catheterization (RHC). METHODS AND RESULTS:Fourteen patients with biopsy verified light chain or transthyretin cardiac amyloidosis were included. All patients had heart failure with markedly elevated NT-proBNP. Echocardiography demonstrated biventricular hypertrophy, left atrial enlargement and normal to slightly reduced left ventricular ejection fraction. Tissue Doppler septal é was low and median E/é was high. Within 6 months RHC was performed in eight of the patients. The restrictive filling pattern demonstrated by echocardiography corresponded well to median pulmonary wedge pressure (21 mmHg). Systolic pulmonary artery pressure (SPAP) was increased, whereas cardiac output and stroke volume were seen to be decreased with both methods. ECG demonstrated: low voltage (36%), abnormal R-progression (65%), ST-T abnormalities (71%) and high incidence of fibrillation (36%). In addition, a case report following the treatment of melphalan and dexamethasone is presented with improvement of hypertrophy, SPAP, left ventricular mass and é. CONCLUSION:These findings should lead to a suspicion of cardiac amyloidosis and suggest further investigation.
    背景与目标: 目的:使用超声心动图,心电图(ECG)和右心导管检查(RHC)来表征患有心脏淀粉样变性的患者。
    方法与结果:包括14例经活检证实为轻链或运甲状腺素蛋白心脏淀粉样变性的患者。所有患者均患有心力衰竭,NT-proBNP明显升高。超声心动图显示双心室肥大,左心房增大以及左心室射血分数正常至轻度降低。组织多普勒间隔é低,中位E /é高。在6个月内,对8位患者进行了RHC。超声心动图显示的限制性填充模式与中位肺楔形压(21 mmHg)很好对应。两种方法均使收缩期肺动脉压(SPAP)升高,而心输出量和中风量降低。心电图显示:低电压(36%),R进程异常(65%),ST-T异常(71%)和高颤动发生率(36%)。此外,治疗美法仑和地塞米松后的一例病例报告显示肥厚,SPAP,左心室质量和é改善。
    结论:这些发现应引起对心脏淀粉样变性病的怀疑,并建议进一步研究。
  • 【使用小波和特征提取改进的ECG信号分析。】 复制标题 收藏 收藏
    DOI: 复制DOI
    作者列表:Matsuyama A,Jonkman M,de Boer F
    BACKGROUND & AIMS: OBJECTIVES:Automatic detection of arrhythmias is important for diagnosis of heart problems. However, in ECG signals, there is significant variation of waveforms in both normal and abnormal beats. It is this phenomenon, which makes it difficult to analyse ECG signals. The aim of developing methodology is to distinguish between normal beats and abnormal beats in an ECG signal. METHODS:ECG signals were first decomposed using wavelet transform. The feature vectors were then extracted from these decomposed signals as normalised energy and entropy. To improve the classification of the feature vectors of normal and abnormal beats, the normal beats which occur before and after the abnormal beats were eliminated from the group of normal beats. RESULTS:With our proposed methods, the normal beats and abnormal beats formed different clusters of vector points. By eliminating normal beats which occur before and after the abnormal beats, the clusters of different types of beats showed more apparent separation. CONCLUSIONS:The combination of wavelet decomposition and the classification using feature vectors of the beats in ECG signals separate abnormal beats from normal beats. The elimination of the normal beats which occur before and after the abnormal beats succeeded in minimising the size of normal beats cluster.
    背景与目标: 目的:心律失常的自动检测对于心脏问题的诊断很重要。但是,在ECG信号中,正常和异常心跳中的波形都有很大的变化。正是这种现象,使得难以分析ECG信号。开发方法的目的是在ECG信号中区分正常搏动和异常搏动。
    方法:首先使用小波变换分解心电信号。然后从这些分解信号中提取特征向量,作为归一化能量和熵。为了改善正常节拍和异常节拍的特征向量的分类,从正常节拍的组中消除了在异常节拍之前和之后出现的正常节拍。
    结果:利用我们提出的方法,正常心跳和异常心跳形成了不同的矢量点簇。通过消除出现在异常拍子之前和之后的正常拍子,不同类型拍子的簇表现出更明显的分离。
    结论:小波分解和使用心电信号搏动特征向量的分类相结合,可以将异常搏动与正常搏动区分开。消除在异常拍子之前和之后发生的正常拍子成功地减小了正常拍子簇的大小。
  • 【比较心电图成像和心电图预测流出道室性心律失常的起源。】 复制标题 收藏 收藏
    DOI:10.1177/0300060520913132 复制DOI
    作者列表:Zhou X,Fang L,Wang Z,Liu H,Mao W
    BACKGROUND & AIMS: -2
    背景与目标: -2
  • 【心电图标志着心室复极离散度的局部而非整体增加(模拟研究)。】 复制标题 收藏 收藏
    DOI:10.1016/j.jelectrocard.2020.03.009 复制DOI
    作者列表:Arteyeva NV,Azarov JE
    BACKGROUND & AIMS: BACKGROUND:An increase in local dispersion of repolarization (DOR) may contribute more to arrhythmogenesis as compared to changes of global DOR. The aim of this simulation study was to find ECG markers of local increase in DOR in conditions where global DOR remains normal. METHODS:In the framework of van Oosterom and Oostendorp ECGSIM model, the local DOR was increased in 10 different ventricular locations by (1) action potential duration (APD) shortening/lengthening both on epi- and endocardium, (2) epicardial APD shortening, and (3) endocardial APD shortening. The simulation cases where the increase in local DOR was accompanied by increase in global DOR were excluded from consideration. T-wave parameters were analyzed in the simulated precordial and anatomically ordered limb leads. RESULTS:The increase in local DOR resulted in increased lead-to‑lead differences in Tpeak and Tend instants in 28 out of 32 simulated scenarios, and in an increased dispersion of Tpeak-Tend interval throughout 12 standard leads in 8 out of 32 simulated scenarios. In all simulations, the global DOR measured as a difference between earliest and latest repolarization times and standard APD deviation was the same. CONCLUSIONS:The local increase in DOR was expressed in increased lead-to‑lead differences in Tpeak and Tend instants between adjacent anatomically ordered standard leads (aVL, I, aVR(-), II, aVF, III, and V1-V6), even if global DOR, Tpeak-Tend interval and Tpeak-Tend dispersion were within a normal range.
    背景与目标: 背景:与整体DOR的变化相比,局部复极化(DOR)的增加可能对心律失常的贡献更大。这项模拟研究的目的是寻找在整体DOR保持正常的情况下DOR局部增加的ECG标记。
    方法:在van Oosterom和Oostendorp ECGSIM模型的框架内,通过(1)心外膜和心内膜上的动作电位持续时间(APD)缩短/延长,(2)心外膜APD缩短,10个不同心室位置增加局部DOR。 (3)心内膜APD缩短。排除了局部DOR增加伴随整体DOR增加的模拟情况。在模拟的心前区和解剖学上有序的肢体导联中分析了T波参数。
    结果:本地DOR的增加导致32个模拟场景中的28个模拟场景中Tpeak和Tend瞬间的铅对引线差异增加,并且Tpeak-Tend间隔在32个模拟场景中的8个在12条标准引线中的分散性增加。在所有模拟中,以最早和最新复极化时间与标准APD偏差之间的差异衡量的总体DOR相同。
    结论:DOR的局部增加表现为相邻解剖学上有序的标准导线(aVL,I,aVR(-),II,aVF,III和V1-V6)之间的Tpeak和Tend瞬间铅对铅差异的增加,即使全局DOR,Tpeak-Tend间隔和Tpeak-Tend色散在正常范围内。
  • 【使用反向ECG建模和时空规则化来表征心肌梗塞的位置和范围。】 复制标题 收藏 收藏
    DOI:10.1109/JBHI.2017.2768534 复制DOI
    作者列表:Yao B,Zhu R,Yang H
    BACKGROUND & AIMS: :Myocardial infarction (MI) is among the leading causes of death in the United States. It is imperative to identify and characterize MIs for timely delivery of life-saving medical interventions. Cardiac electrical activity propagates in space and evolves over time. Traditional works focus on the analysis of time-domain ECG (e.g., 12-lead ECG) on the body surface for the detection of MIs, but tend to overlook spatiotemporal dynamics in the heart. Body surface potential mappings (BSPMs) provide high-resolution distribution of electric potentials over the entire torso, and therefore provide richer information than 12-lead ECG. However, BSPM are available on the body surface. Clinicians are in need of a closer look of the electric potentials in the heart to investigate cardiac pathology and optimize treatment strategies. In this paper, we applied the method of spatiotemporal inverse ECG (ST-iECG) modeling to map electrical potentials from the body surface to the heart, and then characterize the location and extent of MIs by investigating the reconstructed heart-surface electrograms. First, we investigate the impact of mesh resolution on the inverse ECG modeling. Second, we solve the inverse ECG problem and reconstruct heart-surface electrograms using the ST-iECG model. Finally, we propose a wavelet-clustering method to investigate the pathological behaviors of heart-surface electrograms, and thereby characterize the extent and location of MIs. The proposed methodology is evaluated and validated with real data of MIs from human subjects. Experimental results show that negative QRS waves in heart-surface electrograms indicate potential regions of MI, and the proposed ST-iECG model yields superior characterization results of MIs on the heart surface over existing methods.
    背景与目标: :心肌梗塞(MI)是美国的主要死亡原因之一。当务之急是识别和表征心梗,以及时提供挽救生命的医疗干预措施。心脏电活动在空间中传播并随时间发展。传统工作着重于分析体表上的时域心电图(例如12导联心电图)以检测心梗,但往往忽略了心脏的时空动态。体表电位映射(BSPM)可在整个躯干上提供高分辨率的电位分布,因此比12导联ECG可以提供更丰富的信息。但是,BSPM可以在体表上使用。临床医生需要仔细查看心脏中的电势,以研究心脏病理并优化治疗策略。在本文中,我们应用时空逆心电图(ST-iECG)建模方法来绘制从体表到心脏的电势,然后通过研究重建的心脏表面电描记图来描述MI的位置和范围。首先,我们研究了网格分辨率对反ECG建模的影响。其次,我们解决反心电图问题,并使用ST-iECG模型重建心脏表面电图。最后,我们提出了一种小波聚类方法来研究心脏表面电描记图的病理行为,从而表征心梗的程度和位置。利用来自人类受试者的MI的真实数据对提出的方法进行评估和验证。实验结果表明,心脏表面电描记图上的负QRS波指示了MI的潜在区域,与现有方法相比,所提出的ST-iECG模型在心脏表面产生了MI的更好的表征结果。
  • 【ECG指数预测左心室肥大的效果较差,仅适用于心血管风险低的个体。】 复制标题 收藏 收藏
    DOI:10.3390/jcm9051364 复制DOI
    作者列表:Chlabicz M,Jamiołkowski J,Paniczko M,Sowa P,Szpakowicz M,Łapińska M,Jurczuk N,Kondraciuk M,Ptaszyńska-Kopczyńska K,Raczkowski A,Szpakowicz A,Kamiński KA
    BACKGROUND & AIMS: :Background: Left ventricular hypertrophy (LVH) is an important risk factor for cardiovascular events. The electrocardiography (ECG) has poor sensitivity, but it is commonly used to detect LVH. AIM:To evaluate the diagnostic efficacy of known ECG indicators to recognize LVH in subgroups with different cardiovascular risk levels. Methods: 676 volunteers were included. RESULTS:We found that 10.2% of the analyzed population had LVH based on echocardiography. Individuals with LVH were older, had a higher body mass index, higher systolic blood pressure, lower heart rate, higher parameters of insulin resistance, higher cardiovascular risk, and android-type obesity. Variables that remained independently associated with LVH were QRS duration, left atrial volume index, troponin T, and hemoglobin A1c. The receiver operating characteristics (ROC) curve analysis of the Sokolow-Lyon index did not show a significant predictive ability to diagnose LVH in the whole study population including all cardiovascular risk classes. The ROC curves analysis of Cornell and Lewis indices showed a modest predictive ability to diagnose LVH in the general population and in a low cardiovascular class. CONCLUSIONS:There is a need for new, simple methods to diagnose LVH in the general population in order to properly evaluate cardiovascular risk and introduce optimal medical treatment of concomitant disease.
    背景与目标: 背景:左心室肥大(LVH)是心血管事件的重要危险因素。心电图(ECG)灵敏度较差,但通常用于检测LVH。
    目的:评估已知心电图指标在不同心血管风险水平亚组中识别LVH的诊断功效。方法:纳入676名志愿者。
    结果:我们发现,根据超声心动图,所分析的人群中有10.2%患有LVH。 LVH患者年龄较大,体重指数较高,收缩压较高,心率较低,胰岛素抵抗参数较高,心血管疾病风险较高,机器人型肥胖。与LVH保持独立相关的变量包括QRS持续时间,左心房容积指数,肌钙蛋白T和血红蛋白A1c。 Sokolow-Lyon指数的接受者工作特征(ROC)曲线分析未显示出在包括所有心血管风险类别在内的整个研究人群中诊断LVH的显着预测能力。康奈尔和刘易斯指数的ROC曲线分析显示,在一般人群和低心血管疾病人群中,LVH诊断的预测能力中等。
    结论:需要一种新的,简单的方法来诊断普通人群中的LVH,以正确评估心血管疾病的风险并引入伴随疾病的最佳药物治疗。
  • 【使用几何匹配方法进行心电图搏动检测。】 复制标题 收藏 收藏
    DOI:10.1109/TBME.2006.889944 复制DOI
    作者列表:Suárez KV,Silva JC,Berthoumieu Y,Gomis P,Najim M
    BACKGROUND & AIMS: :In the framework of the electrocardiography (ECG) signals, this paper describes an original approach to identify heartbeat morphologies and to detect R-wave events. The proposed approach is based on a "geometrical matching" rule evaluated using a decision function in a local moving-window procedure. The decision function is a normalized measurement of a similarity criterion comparing the windowed input signal with the reference beat-pattern into a nonlinear-curve space. A polynomial expansion model describes the reference pattern. For the curve space, an algebraic-fitting distance is built according to the canonical equation of the unit circle. The geometrical matching approach operates in two stages, i.e., training and detection ones. In the first stage, a learning-method based on genetic algorithms allows us estimating the decision function from training beat-pattern. In the second stage, a level-detection algorithm evaluates the decision function to establish the threshold of similarity between the reference pattern and the input signal. Finally, the findings for the MIT-BIH Arrhythmia Database present about 98% of sensitivity and 99% of positive predictivity for the R-waves detection, using low-order polynomial models.
    背景与目标: 在心电图(ECG)信号的框架中,本文介绍了一种识别心跳形态和检测R波事件的原始方法。所提出的方法基于在本地移动窗口过程中使用决策函数评估的“几何匹配”规则。决策函数是相似性标准的归一化测量,它将加窗的输入信号与参考拍子模式比较成非线性曲线空间。多项式展开模型描述了参考模式。对于曲线空间,根据单位圆的正则方程建立代数拟合距离。几何匹配方法分为两个阶段,即训练和检测两个阶段。在第一阶段,基于遗传算法的学习方法使我们能够从训练节拍模式中估计决策函数。在第二阶段,电平检测算法评估决策函数,以建立参考模式与输入信号之间相似度的阈值。最后,使用低阶多项式模型,MIT-BIH心律失常数据库的发现显示R波检测的灵敏度约为98%,阳性预测值为99%。
  • 【通过下调cAMP / CREB ​​/ MITF信号通路在B16F10黑色素瘤细胞中的表没食子儿茶素-3-没食子酸酯(EGCG),表儿茶素3-没食子酸酯(ECG)和没食子儿茶素3-没食子酸酯(GCG)的抗黑素作用。】 复制标题 收藏 收藏
    DOI:10.1016/j.fitote.2020.104634 复制DOI
    作者列表:Zhang X,Li J,Li Y,Liu Z,Lin Y,Huang JA
    BACKGROUND & AIMS: :Tea catechins, the main bioactive polyphenols in green tea, are well known for their health promoting effects. Previous studies have shown that gallocatechin-3-gallate (GCG), epigallocatechin-3-gallate (EGCG) and epicatechin-3-gallate (ECG) exerted strong inhibitory effects on mushroom tyrosinase activity in vitro, whilst EGCG inhibited melanogenesis in vivo, yet the underlying mechanisms are not entirely clear. In this study, we (i) evaluated and compared the inhibitory effects of the main tea catechins (GCG, EGCG, and ECG) on melanogenesis in B16F10 melanoma cells, and (ii) explain the underlying mechanisms. The results showed that the tea catechins significantly suppressed tyrosinase activity and melanin synthesis in B16F10 cells, where the effects of ECG > EGCG > GCG. Interestingly, the inhibitory effects of the catechins were stronger than those of arbutin (AT), a well-known depigmenting agent. Moreover, GCG, EGCG, and ECG regulated the melanogenesis of B16F10 cells through the cAMP/CREB/MITF pathway. These results revealed catechins could be used as anti-melanogenic agents to protect cells from abnormal melanogenesis.
    背景与目标: 儿茶素是绿茶中的主要生物活性多酚,以其促进健康的作用而闻名。先前的研究表明,加洛儿茶素-3-没食子酸酯(GCG),表没食子儿茶素-3-没食子酸酯(EGCG)和表儿茶素-3-没食子酸酯(ECG)在体外对蘑菇酪氨酸酶活性具有很强的抑制作用,而EGCG却在体内抑制黑素生成。潜在的机制尚不完全清楚。在这项研究中,我们(i)评估并比较了主要茶儿茶素(GCG,EGCG和ECG)对B16F10黑色素瘤细胞中黑色素生成的抑制作用,并且(ii)解释了其潜在机制。结果表明,茶儿茶素能显着抑制B16F10细胞中的酪氨酸酶活性和黑色素合成,其中ECG> EGCG> GCG的作用。有趣的是,儿茶素的抑制作用比众所周知的色素去除剂熊果苷(AT)强。此外,GCG,EGCG和ECG通过cAMP / CREB ​​/ MITF途径调节B16F10细胞的黑色素生成。这些结果表明,儿茶素可以用作抗黑色素生成剂,以保护细胞免受异常黑色素生成的侵害。
  • 【心电图门控计算机断层扫描以评估肺动脉高压中的肺毛细血管楔压。】 复制标题 收藏 收藏
    DOI:10.1007/s00330-013-2911-1 复制DOI
    作者列表:Sauvage N,Reymond E,Jankowski A,Prieur M,Pison C,Bouvaist H,Ferretti GR
    BACKGROUND & AIMS: OBJECTIVE:We propose a non-invasive method for diagnosing post-capillary pulmonary hypertension (PH group 2). We evaluated pulmonary capillary wedge pressure (PCWP) by studying the left atrium (LA) on thoracic ECG-gated CT compared with right heart catheterisation (RHC). METHODS:We retrospectively studied 54 patients with suspected PH or followed for PH who underwent thoracic ECG-gated CT and RHC within 15 days. The diagnostic accuracy of CT morphological and functional data of the LA for the detection of PCWP >15 mmHg, evaluated by two independent readers, was assessed using correlation and receiver-operating characteristic (ROC) analysis. RESULTS:Interobserver agreement was high (r = 0.97-0.99). Correlations were found between PCWP and the morphological criteria of the LA such as anteroposterior diameter at 0 % of the R-R interval (r = 0.70, P ≤ 0.001) as well as at 40 % (r = 0.69, P ≤ 0.001). ROC curves constructed with a threshold value of PCWP > 15 mmHg showed an area under the curve between 0.88 and 0.91. Significant correlations were found between PCWP and functional criteria of the LA, including distensibility (r = -0.49, P ≤ 0.001) and ejection fraction (r = -0.58, P ≤ 0.001). CONCLUSION:Thoracic ECG-gated CT in a PH workup helps distinguish between pre- and post-capillary PH. KEY POINTS:• Computed tomography may help differentiate the various types of pulmonary hypertension (PH). • Post-capillary PH group 2 is due to left heart disease. • Right heart catheterisation is used to separate pre- and post-capillary PH. • Left atrium anteroposterior diameter measured on CT is of value. • ECG-gated CT helps clinicians to assess patients with PH non-invasively.
    背景与目标: 目的:我们提出了一种非侵入性的方法来诊断毛细血管后肺动脉高压(PH 2组)。我们通过研究胸腔心电图CT上的左心房(LA)与右心导管(RHC)的比较来评估肺毛细血管楔压(PCWP)。
    方法:我们回顾性研究了54例疑似PH或随访PH的患者,这些患者在15天内接受了胸部ECG门控CT和RHC检查。使用相关性和接收者操作特征(ROC)分析评估了两个独立阅读器评估的LA的CT形态学和功能数据对PCWP> 15 mmHg的诊断准确性。
    结果:观察员之间的同意率很高(r = 0.97-0.99)。发现PCWP与LA的形态标准之间存在相关性,例如前后间隙在R-R间隔的0%(r = 0.70,P,≤0.001)和40%(r = 0.69,P≤0.001)时。用PCWP> 15 mmHg的阈值构建的ROC曲线显示曲线下的面积在0.88和0.91之间。发现PCWP与洛杉矶功能标准之间存在显着相关性,包括扩张性(r = -0.49,P≤0.001)和射血分数(r = -0.58,P≤0.001)。
    结论:在胸腔镜检查中,胸心电门控CT有助于区分毛细血管扩张前后。
    要点:•计算机断层扫描可能有助于区分各种类型的肺动脉高压(PH)。 •毛细血管后PH 2组归因于左心疾病。 •右心导管检查可用于分离毛细管前后的PH。 •CT测得的左心房前后直径很重要。 •ECG门控CT帮助临床医生无创地评估PH患者。
  • 【斯坦福心电图左心房标准与国际心电图运动筛查标准的比较。】 复制标题 收藏 收藏
    DOI:10.1097/JSM.0000000000000766 复制DOI
    作者列表:Hock J,Wheeler M,Singh T,Ha LD,Hadley D,Froelicher V
    BACKGROUND & AIMS: OBJECTIVE:Because the International left atrial enlargement electrocardiographic (ECG) screening criteria (ECG-LAE) for athletes are rarely fulfilled in young athletes, we compared it with evidence-based criteria from a recent clinical outcome study of ECG left atrial abnormality (ECG-LAA). DESIGN:Retrospective analyses. SETTING:Routine preparticipation ECG screening in California. PARTICIPANTS:Four thousand four hundred thirty-eight young individuals (18.5 ± 5.4 years, 40% women). ASSESSMENT OF RISK FACTORS:The International criteria for ECG-LAE were applied: prolonged P wave duration of ≥120 ms in leads I or II AND negative portion of ≥1 mm in depth in lead V1. This was compared with Stanford criteria for ECG-LAA: prolonged P wave duration of ≥140 ms odds ratio (OR) negative portion in V1 and V2 greater than 1 mm. MAIN OUTCOME MEASURES:Differences in the classification of abnormal ECGs between the 2 criteria applied to the same population of young athletes. RESULTS:Only 33 (0.7%) of our subjects fulfilled the International criteria for ECG-LAE while 110 (2.5%) fulfilled the ECG-LAA criteria. Adding our new ECG-LAA criterion and considering it a major criterion raised the abnormal ECG prevalence and athletes referred for further evaluation from 2.9% to 4.4%. CONCLUSIONS:The Stanford evidence-based criterion for ECG-LAA incorporating V2 and replacing "or" for "and" regarding P wave duration increased the yield of abnormal classification for P waves. Future follow-up studies are needed to confirm that this new criterion should be included in future ECG screening consensus documents.
    背景与目标: 目的:由于国际上很少针对年轻运动员满足运动员的国际左心房扩大心电图(ECG-LAE)筛查标准(ECG-LAE),因此,我们将其与最近进行的ECG左心室异常(ECG- LAA)。
    设计:回顾性分析。
    地点:加州常规的参与性心电图筛查。
    参与者:448.38个年轻人(18.5±5.4岁,女性占40%)。
    危险因素评估:采用ECG-LAE的国际标准:I或II导线延长P波持续时间≥120ms,V1导线深度≥1 mm负值。将此与ECG-LAA的斯坦福标准进行了比较:V1和V2中延长的P波持续时间≥140 ms比值比(OR)负部分大于1 mm。
    主要观察指标:适用于同一年龄段年轻运动员的2项标准对异常心电图的分类存在差异。
    结果:只有33(0.7%)名受试者符合ECG-LAA的国际标准,而110名(2.5%)符合ECG-LAA的国际标准。添加我们的新ECG-LAA标准并将其视为主要标准会提高异常心电图患病率,运动员转介进一步评估的比例从2.9%增至4.4%。
    结论:斯坦福基于证据的ECG-LAA纳入V2并在P波持续时间上用“或”替换“和”的标准增加了P波异常分类的产生。需要进行进一步的随访研究,以确认该新标准应包括在未来的ECG筛查共识文件中。
  • 【对ECG信号进行统计和频谱分析,以实现无创血糖监测。】 复制标题 收藏 收藏
    DOI:10.1186/s12911-019-0959-9 复制DOI
    作者列表:Tobore I,Li J,Kandwal A,Yuhang L,Nie Z,Wang L
    BACKGROUND & AIMS: BACKGROUND:Globally, the cases of diabetes mellitus (diabetes) have increased in the past three decades, and it is recorded as one of the leading cause of death. This epidemic is a metabolic condition where the body cannot regulate blood glucose, thereby leading to abnormally high blood sugar. Genetic condition plays a significant role to determine a person susceptibility to the condition, a sedentary lifestyle and an unhealthy diet are behaviour that supports the current global epidemic. The complication that arises from diabetes includes loss of vision, peripheral neuropathy, cardiovascular complications and so on. Victims of this condition require constant monitoring of blood glucose which is done by the pricking of the finger. This procedure is painful, inconvenient and can lead to disease infection. Therefore, it is important to find a way to measure blood glucose non-invasively to minimize or eliminate the disadvantages encountered with the usual monitoring of blood glucose. METHOD:In this paper, we performed two experiments on 16 participants while electrocardiogram (ECG) data was continuously captured. In the first experiment, participants are required to consume 75 g of anhydrous glucose solution (oral glucose tolerance test) and the second experiment, no glucose solution was taken. We explored statistical and spectral analysis on HRV, HR, R-H, P-H, PRQ, QRS, QT, QTC and ST segments derived from ECG signal to investigate which segments should be considered for the possibility of achieving non-invasive blood glucose monitoring. In the statistical analysis, we examined the pattern of the data with the boxplot technique to reveal the change in the statistical properties of the data. Power spectral density estimation was adopted for the spectral analysis to show the frequency distribution of the data. RESULTS:HRV segment obtained a statistical score of 81% for decreasing pattern and HR segment have the same statistical score for increasing pattern among the participants in the first quartile, median and mean properties. While ST segment has a statistical score of 81% for decreasing pattern in the third quartile, QT segment has 81% for increasing pattern for the median. From a total change score of 6, ST, QT, PRQ, P-H, HR and HRV obtained 4, 5, 4, 5 and 6 respectively. For spectral analysis, HRV and HR segment scored 81 and 75% respectively. ST, QT, PRQ have 75, 62 and 68% respectively. CONCLUSIONS:The results obtained demonstrate that HR, HRV, PRQ, QT and ST segments under a normal, healthy condition are affected by glucose and should be considered for modelling a system to achieve the possibility of non-invasive blood glucose measurement with ECG.
    背景与目标: 背景:在全球范围内,在过去的三十年中,糖尿病(糖尿病)的病例有所增加,被记录为主要的死亡原因之一。这种流行病是人体无法调节血糖从而导致异常高血糖的一种新陈代谢疾病。遗传病在确定人对疾病的易感性方面起着重要作用,久坐的生活方式和不健康的饮食是支持当前全球流行的行为。糖尿病引起的并发症包括视力丧失,周围神经病变,心血管并发症等。这种情况的受害者需要不断地监测血液中的血糖,这要通过刺破手指来完成。该过程是痛苦的,不便的并且可能导致疾病感染。因此,重要的是找到一种非侵入性地测量血糖的方法,以最小化或消除常规血糖监测中遇到的缺点。
    方法:本文在连续捕获心电图(ECG)数据的同时对16名参与者进行了两个实验。在第一个实验中,要求参与者食用75微克无水葡萄糖溶液(口服葡萄糖耐量试验),而在第二个实验中,不服用葡萄糖溶液。我们探索了从心电图信号得出的HRV,HR,R-H,P-H,PRQ,QRS,QT,QTC和ST段的统计和频谱分析,以研究应考虑哪些段以实现无创血糖监测。在统计分析中,我们使用箱线图技术检查了数据的模式以揭示数据统计特性的变化。功率谱密度估计用于频谱分析,以显示数据的频率分布。
    结果:在第一个四分位数,中位数和均值属性的参与者中,HRV区段的减少模式统计得分为81%,HR区段的增加模式统计得分相同。尽管ST段在第三个四分位数中减少模式的统计得分为81%,但QT段中位数在增加模式中的得分为81%。从总变化得分6中,ST,QT,PRQ,P-H,HR和HRV分别为4、5、4、5和6。对于频谱分析,HRV和HR得分分别为81和75%。 ST,QT和PRQ分别占75%,62%和68%。
    结论:获得的结果表明,正常,健康条件下的HR,HRV,PRQ,QT和ST段受葡萄糖影响,应考虑为系统建模以实现使用ECG进行无创血糖测量的可能性。

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