ECG Information Research Articles

Sharing and Interaction of ECG Information Based on HL7 Standard

The application of mobile ECG detection plays an important role in finding out what the heart conditions are. It will prevent and treat the cardiovascular disease. At present, it is hard to exchange the information in various heterogeneous systems. HL7 standard specifies the medical information transfer format, and improves the degree to share the data among the medical information systems. Based on HL7 standard and web service technology, this paper designed HL7 engine to realize the seamless data transfer among the heterogeneous systems, and enable sharing and interaction of ECG information, as well as improve the working efficiency and competitiveness of medical system.

Mobile health–monitoring system through visible light communication

Promising development in the light emitting diode (LED) technology has spurred the interest to adapt LED for both illumination and data transmission. This has fostered the growth of interest in visible light communication (VLC), with on-going research to utilize VLC in various applications. This paper presents a mobile-health monitoring system, where healthcare information such as biomedical signals and patient information are transmitted via the LED lighting. A small and portable receiver module is designed and developed to be attached to the mobile device, providing a seamless monitoring environment. Three different healthcare information including ECG, PPG signals and HL7 text information is transmitted simultaneously, using a single channel VLC. This allows for a more precise and accurate monitoring and diagnosis. The data packet size is carefully designed, to transmit information in a minimal packet error rate. A comprehensive monitoring application is designed and developed through the use of a tablet computer in our study. Monitoring and evaluation such as heart rate and arterial blood pressure measurement can be performed concurrently. Real-time monitoring is demonstrated through experiment, where non-hazardous transmission method can be implemented alongside a portable device for better and safer healthcare service.

Conditional fluctuation characteristics of heart rate variability

Heart rate variability (HRV) has the characteristics of non stationary and transient fluctuation. In this paper, we propose using the autoregressive conditional heteroskedasticity (ARCH) to analyze such fluctuations. Analytical methods include using auto-regressive moving average model to eliminate sequence trends and correlativity, using the F-test method to determine whether there is ARCH effect in residual sequence, while giving an acceptance probability of ARCH effect. The fluctuations of HRV in congestive heart failure (CHF) patients and normal people are analyzed in this paper. The large difference in statistics value of acceptance probability between CHF patients and normal people indicates that the method can well distinguish between different groups. It provides a new method for the study of ECG information.

Safe Nurse-Led Pre-CTCA Beta-Blockade Administration can be Achieved Without Intensive Medical Supervision

Adjustments to the standard oral Beta Blocker protocol always reect a reduction in the dosage. Protocol deviation is often used in patients where there is either not enough time from preparation to scanning time for the oral BB to take effect or in patients where we are cautious of excessive BB effects for a clinical reason. In these cases it is understandable that the use of IV BB is increased as the onset is quick and the half life is minutes rather than hours. Best care for everyone Jo.wickham@waitematadhb.govt.nz This table shows the standard oral BB dosage protocol (per heart rate in beats per minute) versus the actual dosage given. Highlighted boxes indicate where the standard protocol dose was administered. Nurse specialists play an important role in the delivery of CT coronary angiography (CTCA) in the acute chest pain setting. The appropriate dosing of oral and intravenous beta-blockers is crucial to achieve the required heart rate at time of scan of 60 bpm or less. A beta blocker dosing protocol was developed at North Shore Hospital as a guideline for prescription. Nurse specialists worked with the developed dosing protocol over 18 months and found that it was necessary, at times, to deviate from the protocol due to patient history, timing of the scan or ECG information to achieve a safe and effective scan.

IPhone ECG monitoring — the gateway to the new paradigm of STEMI therapy

iPhone ECG monitoring — the gateway to the new paradigm of STEMI therapy

Aborting STEMI: What treatment opportunities may Smart-Phone ECGs give us prior to first medical contact to facilitate primary PCI?

The diagnosis of STEMI is based classically on a “cross-sectional” examination of the presenting ECG at first medical contact. This approach may be modified as patients can now record ECG strips on an iPhone [1]. In the near future, multi-electrode recordings with electrodes embedded on a pad or a vest which the patient places or wears over the chest may provide “longitudinal” information to the evolutionary ECG changes of STEMI prior to first medical contact. A recent article forecasted that with Smart Phone ECG monitoring the longitudinal ECG information will allow STEMI to be categorized on a gray-scale ranging from large rapidly progressive STEMI to small stuttering STEMI [1].

Research on Heart Rate Detection Algorithm Based on Bipolar Movement ECG Signals

Abstract The heart rate indicates the important indicator of the movement and physical body enginery, so this paper design and use the bi-polar ECG signal collection system. The traditional method to accurately get the heart rate from the bi-polar ECG information under the movement status is not very effective. Two mainstream time-domain—frequency-domain analysis method is used to analyze and compare the ECG signals. The results indicate that the discrete wavelet transfer can effectively recover the heart rate information from the ECG information with noises. After discrete wavelet transfer and reestablishment, the heart rate can be accurately computed.

Latency of ECG Displays of Hospital Telemetry Systems

Recent observations indicate that some hospital telemetry systems used for monitoring of patient heart rhythm have clinically significant latency, or delay between the real-time status of the patient and the ECG information displayed on the patient monitor. If these systems are used for clinical care that requires instantaneous monitoring, then patient safety may be compromised. The purpose of this advisory is to inform healthcare providers about this potential problem, clarify the intended use of the systems, detail measures to reduce risk, and recommend steps to manufacturers and stakeholders to minimize this problem in current and future telemetry systems. Wireless telemetry electrocardiographic monitoring is a cornerstone of hospital management for patients with cardiovascular conditions or at risk for cardiovascular conditions. Since the first transmission of an ECG by telephone wire by Willem Einthoven was reported in 1906,1,2 advances in signal processing and communications have led to rapid innovation in wireless communication for telemetry systems in acute care settings.3 The first wireless systems introduced in the 1970s were fairly simple in design. They transmitted analog telemetry signals using 1 dedicated frequency channel for each patient.4 In the 1980s, networked telemetry systems led to the creation of centralized telemetry viewing stations in intensive and acute care units. Starting in the 1990s, digital telemetry systems allowed for computerized signal recording, storage, and retrieval.5,6 As computing power increased, the networking capability of these systems increased, allowing for monitoring of electrocardiographic, hemodynamic, and other clinical data from multiple patients on a single networked system. By 2000, wireless communication in the hospital extended beyond telemetry systems, and the US Federal Communications Commission established a protected range of frequencies for wireless medical devices to minimize electromagnetic interference from other in-band radiofrequency sources.7,8 Today, networked wireless telemetry systems …

Feasibility and Reproducibility of a Standard Protocol for 2D Speckle Tracking and Tissue Doppler-Based Strain and Strain Rate Analysis of the Fetal Heart

Purpose: Assessment of cardiac function in the fetal heart is challenging because of its small size and high heart rate, restricted physical access to the fetus, and impossibility of fetal ECG recording. We aimed to standardize the acquisition and postprocessing of fetal echocardiography for deformation analysis and to assess its feasibility, reproducibility, and correlation for longitudinal strain and strain rate measurements by tissue Doppler imaging (TDI) and 2D speckle tracking (2D-strain) during pregnancy. Methods: Echocardiography was performed in 56 fetuses. 2D and color TDI in apical or basal four-chamber views were recorded for subsequent analysis. Caution was taken to achieve a frame rate >70 Hz for speckle tracking and >150 Hz for TDI analysis. For each acquisition, 7.5 s of noncompressed data were stored in cine loop format and analyzed offline. Since fetal ECG information is by definition not available, aortic valve closure was marked from aortic flow and the onset of each cardiac cycle was manually indicated in the 2D images. Sample volume length was standardized at the minimum size. Two observers measured the left and right ventricular peak systolic longitudinal strain and strain-rate. Results: Strain and strain rate measurements were feasible in 93% of the TDI and 2D-strain acquisitions. The mean time spent on analyzing TDI images was 18 min, with an intraclass agreement coefficient of 0.86 (95% CI 0.77–0.92), 0.83 (95% CI 0.72–0.90), 0.96 (95% CI 0.93–0.98), and 0.86 (95% CI 0.76–0.92) for basal left and right free wall peak systolic strain and strain rate, respectively. Agreement between observers using tissue Doppler also showed high reliability. The mean time spent for 2D-strain analysis was 15 min, with an intraclass agreement coefficient of 0.97 (95% CI 0.95–0.98), 0.94 (95% CI 0.89–0.96), 0.96 (95% CI 0.93–0.98), and 0.84 (95% CI 0.73–0.90) for basal left and right free wall peak systolic strain and strain rate, respectively. Agreement between observers also showed a high reliability that was similar for TDI and 2D-strain. There was a weak correlation between TDI and 2D-strain measurements. Conclusions: A standard protocol with fixed acquisition and processing settings, including manual indication of the timing events of the cardiac cycle to correct for the lack of ECG, was feasible and reproducible for the evaluation of longitudinal ventricular strain and strain rate of the fetal heart by TDI as well as 2D-strain analysis. However, both techniques are not interchangeable as the correlation between them is relatively poor.

Predictors of cardiovascular magnetic resonance-derived microvascular obstruction on patient admission in STEMI

BackgroundEarly stratification of patients according to the risk for developing microvascular obstruction (MVO) after ST-segment elevation myocardial infarction (STEMI) is desirable. We aimed to identify predictors of cardiovascular magnetic resonance (CMR)-derived MVO from clinical+ECG, laboratory and angiographic parameters available on admission. MethodsCharacteristics available on admission were documented in 97 STEMI patients referred for primary angioplasty. MVO was determined using contrast-enhanced CMR. ResultsMVO was present in 44 patients (45%). The C-statistic for predicting MVO was: clinical+ECG (.832), laboratory (.743), and angiographic parameters (.669). Adding laboratory to clinical+ECG information did not improve the C-statistic (.873 vs. .832, p=.2). Further addition of angiographic data (.904) improved the C-statistic of clinical+ECG (p=.04) but not of clinical+ECG and laboratory (p=.2). Independent predictors of MVO using clinical and ECG parameters were: Killip class >1 (OR 15.97 95%CI [1.37–186.76], p=.03), diabetes (OR 6.15 95%CI [1.49–25.39], p=.01), age <55years (OR 4.70 95%CI [1.56–14.17], p=.006), sum of ST-segment elevation >10mm (OR 4.5 95%CI [1.58–12.69], p=.005) and delayed presentation >3h (OR 3.80 95%CI [1.19–12.1], p=.02). A score was constructed assigning Killip class >1 2 points and the remaining indexes 1 point. The incidence of MVO increased with the score: 0 point: 8.7%; 1 point: 28.1%; 2 points: 71.4%; and 3+ points: 93% (p<.0001). ConclusionsMVO can be predicted using parameters already available on patient admission. We developed a clinical-ECG score allowing for early and reliable classification of STEMI patients according to the risk of MVO.

A Classification Tree Approach for Cardiac Ischemia Detection Using Spatiotemporal Information From Three Standard ECG Leads

The accurate noninvasive diagnosis of cardiac ischemia remains a great challenge. To this end, the ECG is the main source of information, and personal health systems may now embed intelligence for enabling any citizen to self-record an ECG anywhere at any time. Our objective is to find a decision-support approach that makes best use of these resources. A new classification tree based on conditions combinations competition (T-3C) is proposed for building a multibranch tree of combined decision rules, and its performance is compared to usual methods based either on discriminant analysis or on classification trees. Moreover, we assessed with these methods, the diagnosis content for ischemia detection of the spatiotemporal ECG information that can be retrieved either from the standard 12-lead ECG or from only the three orthogonal leads subset (I, II, and V2), easy to set-up in self-care. The diagnostic accuracy of 14 decision-making strategies was compared for ischemia detection induced by angioplasty on a test set from a study population of 90 patients. The best performance is obtained with the T-3C algorithm on three-lead ECG, reaching 98% of sensitivity and of specificity, thus exceeding 23% of the diagnostic accuracy of the recommended and currently used standard ECG criteria.

Optimal Electrocardiographic Lead Systems: Practical Scenarios in Smart Clothing and Wearable Health Systems

Advances in wearable health systems, from a smart textile, signal processing, and wireless communications perspective, have resulted in the recent deployment of such systems in real clinical and healthcare settings. Nevertheless, the problem of identifying the most appropriate sites from which biological parameters can be recorded still remains unsolved. This paper aims to asses the effects of various practical constraints that may be encountered when choosing electrocardiographic recording sites for wearable health systems falling within the category of smart shirts for cardiac monitoring and analysis. We apply a lead selection algorithm to a set of 192 lead body surface potential maps (BSPM) and simulate a number of practical constraints by only allowing selection of recording sites from specific regions available in the 192 lead array. Of the various scenarios that were investigated, we achieved the best results when the selection process to identify the recording sites was constrained to an area around the precordial region. The top ten recording sites chosen in this region exhibited an rms voltage error of 25.8 mu V when they were used to estimate total ECG information. The poorest performing scenario was that which constrained the selection to two vertical strips on the posterior surface. The top ten recording sites chosen in this scenario exhibited an rms voltage error of 41.1 muV. In general, it was observed that out of all the scenarios investigated, those which constrained available regions to the posterior and lateral surfaces performed less favorably than those where electrodes could also be chosen on the anterior surface. The overall results from our approach have validated the proposed algorithm and its ability to select optimal recording sites taking into consideration the practical constraints that may exist with smart shirts.

Analysis of myocardial perfusion or myocardial function for detection of regional myocardial abnormalities. An echocardiographic multicenter comparison study using myocardial contrast echocardiography and 2D echocardiography

Echocardiography based myocardial perfusion imaging and regional wall motion analysis are used for evaluation of coronary artery disease and regional myocardial abnormalities. This study sought to compare myocardial contrast echocardiography (MCE) and 2D echocardiography with regard to interobserver variability and detection of regional myocardial abnormalities. In 70 patients evenly distributed between three ejection fraction groups based on biplane cineventriculography ( > 55%, 35-55%, < 35%), unenhanced and contrast enhanced 2D echocardiography and myocardial contrast echocardiography (MCE; SonoVue; Bracco) were performed. Regional wall motion and myocardial perfusion were assessed referring to a 16 segment model. Interobserver agreement (IOA) among 2 readers was determined within each imaging modality. To define a standard of truth for the presence of segmental myocardial disease an independent expert-panel decision was obtained based on clinical data, ECG, coronary angiography and blinded information from the imaging modalities. Regional wall motion assessment was possible in 98.1% of segments using contrast enhanced 2D echocardiography and in 87.2% using unenhanced 2D echocardiography (p < 0.001), while perfusion assessment was possible in 90.1% of segments (p < 0.001). IOA on presence of any regional wall motion abnormality expressed as Kappa coefficient was 0.71 (95% CI 0.53-0.89) for contrast enhanced echocardiography and 0.37 (95% CI 0.14-0.59) for unenhanced echocardiography. IOA on presence of any perfusion abnormality was 0.53 (95% CI 0.34-0.73). For MCE there was high IOA for the apical segments (kappa = 0.57) and lower IOA for the basal segments (kappa=0.14), while no such gradient was found for the IOA on wall motion abnormalities. Mean accuracy to detect expert-panel defined myocardial abnormalities was 80.6% for unenhanced echocardiography, 85.0% for contrast enhanced 2D echocardiography and 80.6% for MCE. MCE is inferior to contrast enhanced 2D echocardiography with regard to visibility of all LV segments and appears slightly inferior with regards to IOA, while both are superior to unenhanced 2D echocardiography. The methods demonstrated high accuracy in detection of panel defined regional myocardial abnormalities.

Part 7.3: Management of Symptomatic Bradycardia and Tachycardia

Cardiac arrhythmias are a common cause of sudden death. ECG monitoring should be established as soon as possible for all patients who collapse suddenly or have symptoms of coronary ischemia or infarction. To avoid delay, apply adhesive electrodes with a conventional or automated external defibrillator (AED) or use the “quick-look” paddles feature on conventional defibrillators. For patients with acute coronary ischemia, the greatest risk for serious arrhythmias occurs during the first 4 hours after the onset of symptoms (see Part 8: “Stabilization of the Patient With Acute Coronary Syndromes”).1 The ECG and rhythm information should be interpreted within the context of total patient assessment. Errors in diagnosis and treatment are likely to occur if ACLS providers base treatment decisions solely on rhythm interpretation and neglect clinical evaluation. Providers must evaluate the patient’s symptoms and clinical signs, including ventilation, oxygenation, heart rate, blood pressure, and level of consciousness, and look for signs of inadequate organ perfusion. These guidelines emphasize the importance of clinical evaluation and highlight principles of therapy with algorithms that have been refined and streamlined since the 2000 edition of the guidelines.2 The principles of arrhythmia recognition and management in adults are as follows:

Frequency and effect of optimal anticoagulation before onset of ischaemic stroke in patients with known atrial fibrillation

The aims of the study were (i) to examine which antithrombotic therapy patients with known atrial fibrillation use at the point of time when they suffer an ischaemic stroke, (ii) to evaluate the effects of optimal antithrombotic treatment on outcome and severity of the stroke. Patients with known atrial fibrillation before onset of acute ischaemic stroke, and age >60 years were included. Antithrombotic therapy on admission was classified into four groups: no antithrombotic therapy, aspirin, sub-optimal anticoagulation (warfarin and international normalized ratio, INR<2.0) and optimal anticoagulation (warfarin and INR>or=2.0). modified Rankin Scale (mRS) 5 or 6 at day 7 poststroke. (i) death or discharge to a nursing home, (ii) death, (iii) stroke severity on admission assessed by Scandinavian Stroke Scale. A total of 394 patients were included. On admission 109 (28%) patients used no antithrombotic therapy, 169 (43%) aspirin, 52 (13%) warfarin and had an INR<2.0, and 64 (16%) used warfarin and had an INR>or=2.0. The proportion of patients with an mRS 5 or 6 and the corresponding odds ratios were: in the warfarin group with INR<2.0, 16 (31%), OR 3.1 (CI: 1.2-8.0), (P=0.019), in the group with no antithrombotic therapy 29 (27%), 2.5 (1.1-5.9), (P=0.034), and in the aspirin group 41(24%), 2.2 (1.0-5.1) (P=0.054), compared with the warfarin group with INR>or=2.0, where eight (13%) patients had a poor outcome. A significantly higher proportion of patients died or were discharged to a nursing home in the warfarin group with an INR<2.0 (P=0.014), in the aspirin group (P=0.018) and in the no-treatment group (P=0.035), compared with the warfarin group with an INR>or=2.0. No significant differences were found regarding death alone and stroke severity on admission. Few patients with known atrial fibrillation who suffer an ischaemic stroke receive optimal antithrombotic therapy prior to the onset of stroke. Optimal anticoagulation does not only reduce the risk of ischaemic stroke, but also appears to reduce death and severe dependency as well as the need for nursing home care, if an ischaemic stroke occurs.

Identification of distinct electrocardiographic patterns from the basal left ventricle: Distinguishing medial and lateral sites of origin in patients with idiopathic ventricular tachycardia

Idiopathic ventricular tachycardias (IVTs) can originate from the basal left ventricle (LV). To determine if using magnetic electroanatomic mapping (MEAM) for accurate localization (1) unique ECG morphologies on pace maps from medial and lateral sites in basal LV could be identified and (2) this ECG information would facilitate VT localization. In 12 patients with structurally normal hearts undergoing ablation for IVT, detailed MEAM of LV was constructed in sinus rhythm and pace-mapping was done from the septal-parahisian (S-P) region, aortomitral continuity (AMC), and superior, superolateral, and lateral mitral annular (MA) locations. Pace maps were analyzed for ECG morphologies in limb leads and transition patterns in precordial leads. Medial pacing sites (S-P and AMC) compared with lateral sites (superolateral and lateral MA) demonstrated narrower QRS complexes (134 +/- 24 msec vs. 182 +/- 18 msec; P < .05) with initial negative forces in lead V1 and predominantly positive forces in lead I (amplitude 0.59 +/- 0.27 mV vs. 0.16 +/- 0.34 mV; P < .05). The ratio of QRS complexes in leads II and III was >1 for all (12 of 12) S-P pace maps and 11 of 12 lateral MA pace maps but remained < or =1 for pace maps from 10 of 12 AMC locations, 11 of 12 superior MA locations, and 10 of 11 superolateral MA locations. Using these ECG criteria, a blinded reviewer was able to accurately localize the site of origin (SOO) of clinical arrhythmia (successful ablation site on MEAM) in 10 of 12 cases (83%) of IVT originating from basal LV. Pace maps from basal LV endocardium manifest site-dependent ECG morphologies that can help differentiate medial from lateral locations and can predict the SOO of clinical arrhythmias from this region.

5106 心電情報解析による機械システムの組立容易性評価

5106 心電情報解析による機械システムの組立容易性評価

A comparative study of three techniques for QRS cancellation in the ECG (poster session)

In this paper, the performance-three QRS cancellation techniques compared to obtain a residual ECG information containing only atrial activity (AA), thereby facilitating detection of the P wave in the ECG and/or analysis of atrial arrhythmias. The methods are based on adaptive filters (AdF), neural networks (NN), and the space-time of an averaged beat for subsequent removal from the ECG signal, the comparison is made with reference to the results obtained with the adaptive filtering method by Thakor. The results show that the methods based on NN and AdF are more robust to morphological changes of the signal and in the presence of noise than non-adaptive methods, also have the advantage that they do not require a pre-detection stage of QRST, however, for the average beat alignment method, best results are obtained when there are no QRS detection failures.

Implementation of Algorithms for Identification of QRS-Complexes in Real-Time ECG Systems

Many modern methods of computer electrocardiography involve identification of QRS-complexes by determining the position of their maximums (R-wave). The obtained sequence of R-waves is used for segmentation of the cardiocycle, measurement of amplitude and duration of its elements, determination of the isoline by the ECG method of polynomial approximation, and analysis of the cardiac rhythm variability. Realtime ECG systems provide continuous processing of ECG during recording of the signal. Such systems should rapidly detect all changes in the characteristics of the ECG signal (heart rate, fibrillation, etc.). This imposes stringent requirements on the algorithms for processing of ECG information. The following requirements for the algorithms are especially important: 1) high productivity matching the input data flow rate; 2) efficacious operation during a specified time interval; 3) capability for efficacious operation in the case of limited availability of input data. Fulfillment of the first and second requirements depends on the performance of ECG hardware and software, whereas the third requirement is imposed on the processing algorithm itself.

Using ST-Segment Monitoring to Predict Cardiac Events

Early determination of the likelihood of complications in patients with chest pain would allow emergency physicians to make more appropriate disposition decisions. A safe and efficient risk stratification method would likely include clinical, ECG, and serum marker information. These authors evaluated continuous 12-lead monitoring for 12 hours in 630 patients admitted to a …