Electrocardiogram Tests Research Articles

Medical care of acute myocardial infarction patients in a resource limiting country, Trinidad: a cross-sectional retrospective study

BackgroundCardiovascular disease remains the most common cause of death. However, effective and timely secondary care contributes to improved quality of life, decreased morbidity and mortality. This study analyzed the medical care of patients in a resource limiting country with a first presentation of acute myocardial infarction (AMI).MethodsA cross-sectional retrospective study was conducted on first time AMI patients admitted between March 1st 2011 and March 31st 2015 to the only tertiary public hospital in a resource limiting country, Trinidad. Relevant data were obtained from all confirmed AMI patients.ResultsData were obtained from 1106 AMI patients who were predominantly male and of Indo Trinidadian descent. Emergency treatment included aspirin (97.2%), clopidogrel (97.2%), heparin (81.3%) and thrombolysis (70.5% of 505 patients with ST elevation MI), but none of the patients had primary angioplasty. Thrombolysis was higher among younger patients and in men. There were no differences in age, sex, and ethnicity in all other treatments. Of the 360 patients with recorded times, 41.1% arrived at the hospital within 4 h. The proportion of patients receiving thrombolysis (door to needle time) within 30 min was 57.5%. In-patient treatment medication included: aspirin (87.1%), clopidogrel (87.2%), beta blockers (76.5%), ACEI (72.9%), heparin (80.6%), and simvastatin (82.5%). Documentation of risk stratification, use of angiogram and surgical intervention, initiation of cardiac rehabilitation (CR), and information on behavioral changes were rare. Electrocardiogram (ECG) and cardiac enzyme tests were universally performed, while echocardiogram was performed in 57.1% of patients and exercise stress test was performed occasionally. Discharge treatment was limited to medication and referrals for investigations. Few patients were given lifestyle and activity advice and referred for CR. The in-hospital death rate was 6.5%. There was a significantly higher relative risk of in-hospital death for non-use of aspirin, clopidogrel, simvastatin, beta blockers, and heparin, but not ACE inhibitors and nitrates.ConclusionsMedication usage was high among AMI patients. However, there was very minimal use of non-pharmacological measures. No differences were found in prescribed medication by age, sex, or ethnicity, with the exception of thrombolysis.

Compressed Segmented Beat Modulation Method using Discrete Cosine Transform.

Currently used 24-hour electrocardiogram (ECG) monitors have been shown to skip detecting arrhythmias that may not occur frequently or during standardized ECG test. Hence, online ECG processing and wearable sensing applications have been becoming increasingly popular in the past few years to solve a continuous and long-term ECG monitoring problem. With the increase in the usage of online platforms and wearable devices, there arises a need for increased storage capacity to store and transmit lengthy ECG recordings, offline and over the cloud for continuous monitoring by clinicians. In this work, a discrete cosine transform (DCT) compressed segmented beat modulation method (SBMM) is proposed and its applicability in case of ambulatory ECG monitoring is tested using Massachusetts Institute of Technology-Beth Israel Deaconess Medical Center (MIT-BIH) ECG Compression Test Database containing Holter tape normal sinus rhythm ECG recordings. The method is evaluated using signal-to-noise (SNR) and compression ratio (CR) considering varying levels of signal energy in the reconstructed ECG signal. For denoising, an average SNR of 4.56 dB was achieved representing an average overall decline of 1.68 dBs (37.9%) as compared to the uncompressed signal processing while 95 % of signal energy is intact and quantized at 6 bits for signal storage (CR=2) compared to the original 12 bits, hence resulting in 50% reduction in storage size.

Familial hypercholesterolemia with early coronary atherosclerotic heart disease: A case report.

Patients with familial hypercholesterolemia usually present with high levels of serum low-density lipoprotein, xanthomas and early coronary artery disease. A 13 years old female patient was admitted to Children's Hospital of Chongqing Medical University presenting symptoms of heart failure. Laboratory tests showed that her cholesterol and low-density lipid levels were extremely high. Electrocardiogram test revealed that she had sinus tachycardia, QT lengthening and ST-T change. Multiple cardiac function abnormalities were diagnosed by echocardiogram. Multiple coronary artery stenosis was determined by computed tomography angiography. After the combination of lipid lowering, anti-thrombosis, and cardiac remodeling therapies, the patient's symptoms were significantly improved and the patient was discharged.

Comparison of different durations of mild hypothermia on neuroprotection in septic rats

Objective To investigate the protective effect of mild hypothermia on septic rats and to find suitable hypothermia duration time. Methods After cecal ligation and puncture (or sham), male Sprague-Dawley rats were divided into a sham operation group(Sham group, n=20), a normal temperature group[Norm group, (37.0±0.2) °C, n=43], and hypothermia group (34.0±0.5) °C[a hypothermia 6 h group (Hypo 6 group, n=41), a hypothermia 12 h group (Hypo 12 group, n=33), a hypothermia 24 h group (Hypo 24 group, n=27)], and the electrodes were placed on the head 10 days before the operation. Electrocardiogram (EEG) and behavioral tests were performed before and 24 h after surgery. The blood samples were collected 24 h after surgery. The blood levels of S100β protein were detected by enzyme-linked immunosorbent assay (ELISA) to determine the degree of brain damage. Results Twenty rats in each group survived. The survival rates of Sham group, Norm group and Hypo 6, 12 and 24 groups were 100% (20/20), 46.51% (20/43), 48.78% (20/41), 60.61% (20/33) and 74.07% (20/27), the survival rate of Hypo 24 group was significantly higher than that of Norm group and Hypo 6 group (P 0.05). Compared with the Sham group, rats in Norm group and Hypo groups presented remarkably lowerd neurobiological scores 24 h after surgery(P 0.05), and no significant difference was found between Hypo 12 and Hypo 6 groups (P>0.05). Compared with the sham groups, remarkly higher levels of plasma S100β protein and EEG δ waves were detected in the operation group(P 0.05), and no significant difference between Hypo 6 and Hypo 12 groups (P>0.05). According to the biological score and EEG monitoring results, sepsis-associated encephalopathy was was detected in 13(65%), 13(65%), 11(55%), and 8(40%) rats in the Norm group, Hypo 6, 12, 24 groups, and no statistically significant differences in the incidence was found among the groups(P>0.05). Conclusions Although mild hypothermia cannot reduce the incidence of sepsis-associated encephalopathy in rats with sepsis, it can reduce there brain damage, and protect the brain as hypothermia time extends. Key words: Hypothermia; Sepsis; Sepsis-associated encephalopathy; Neuroprotection

Electrocardiogram generation with a bidirectional LSTM-CNN generative adversarial network

Heart disease is a malignant threat to human health. Electrocardiogram (ECG) tests are used to help diagnose heart disease by recording the heart’s activity. However, automated medical-aided diagnosis with computers usually requires a large volume of labeled clinical data without patients' privacy to train the model, which is an empirical problem that still needs to be solved. To address this problem, we propose a generative adversarial network (GAN), which is composed of a bidirectional long short-term memory(LSTM) and convolutional neural network(CNN), referred as BiLSTM-CNN,to generate synthetic ECG data that agree with existing clinical data so that the features of patients with heart disease can be retained. The model includes a generator and a discriminator, where the generator employs the two layers of the BiLSTM networks and the discriminator is based on convolutional neural networks. The 48 ECG records from individuals of the MIT-BIH database were used to train the model. We compared the performance of our model with two other generative models, the recurrent neural network autoencoder(RNN-AE) and the recurrent neural network variational autoencoder (RNN-VAE). The results showed that the loss function of our model converged to zero the fastest. We also evaluated the loss of the discriminator of GANs with different combinations of generator and discriminator. The results indicated that BiLSTM-CNN GAN could generate ECG data with high morphological similarity to real ECG recordings.

THE EFFECT OF ELECTROCARDIOGRAM ON ARRHYTHMIA USING A DIGITAL PROCESSING APPLICATION

The analytical process of Electrocardiogram (ECG) is an important area of study in health science while handling digital signs. The reason is as a result of the rapid growth of medical activities going on in the world and the advancement in computing technology which plays a great role to the recognition of abnormalities at different phases from bio-medical signals. The heart is usually examined by Electrocardiogram device. Its productivity is in waveform as well as in a P-Q-R-S slope form. Q-R-S is an important characteristic of the waveform. This paper seeks to study and demonstrate ECG indicators for arrhythmia using a digital processing application, MatLAB to showcase its non-linear signal processing structure. The Q-R-S duration, RR interval and heart rate of clients are most vital parameters to consider during an ECG test. .

Effect of Extensive Ablation on Recurrence in Patients with Persistent Atrial Fibrillation Treated with Pulmonary Vein Isolation (EARNEST-PVI) trial: Design and rationale

BackgroundAlthough extensive substrate modification in addition to pulmonary vein isolation (PVI) has been recommended in catheter ablation for persistent atrial fibrillation (AF), recent randomized controlled trials have not demonstrated efficacy of such additional ablations. Methods and study designThe Osaka Cardiovascular Conference will conduct a multicenter, randomized, open-label trial aiming to examine whether PVI alone is non-inferior to PVI plus additional ablation such as linear ablation and/or complex fractionated atrial electrogram ablation in patients with persistent AF. The primary outcome is recurrence of AF documented by scheduled or symptom-driven electrocardiogram tests during a 1-year follow-up period after the index ablation. The key secondary endpoints include all-cause death, occurrence of symptomatic stroke, complications related to the procedure, and quality of life assessment using the 36-item Short-Form Health Survey. The clinical impact of the presence or absence of AF trigger foci, and their origins in cases with them, on the results of catheter ablation will also be investigated as an exploratory endpoint. A total of 512 patients will be enrolled and followed up to 1 year. ConclusionsThe EARNEST-PVI trial is a randomized controlled trial designed to assess whether PVI alone is non-inferior to extended substrate ablation for patients with persistent AF undergoing a first catheter ablation.

A new analytic tool developed to assess safe use recommendations.

Develop a flexible analytic tool for the Food and Drug Administration's (FDA's) Sentinel System to assess adherence to safe use recommendations with two capabilities: characterize adherence to patient monitoring recommendations for a drug, and characterize concomitant medication use before, during, and/or after drug therapy. We applied the tool in the Sentinel Distributed Database to assess adherence to the labeled recommendation that patients treated with dronedarone undergo electrocardiogram (ECG) testing no less often than every 3months. Measures of length of treatment, time to first ECG, number of ECGs, and time between ECGs were assessed. We also assessed concomitant use of contraception among female users of mycophenolate per label recommendations (concomitancy 4weeks before through 6weeks after discontinuation of mycophenolate). Unadjusted results were stratified by age, month-year, and sex. We identified 21457 new episodes of dronedarone use of greater than or equal to 90days (July 2009 to September 2015); 86% had greater than or equal to one ECG, and 22% met the recommendation of an ECG no less often than every 3months. We identified 21942 new episodes of mycophenolate use among females 12 to 55years (January 2016 to September 2015); 16% had greater than or equal to 1day of concomitant contraception dispensed, 12% had concomitant contraception use for greater than or equal to 50% of the 4weeks before initiation through 6weeks after mycophenolate; younger females had more concomitancy. These results may be underestimates as the analyses are limited to claims data. We developed a tool for use in databases formatted to the Sentinel Common Data Model that can assess adherence to safe use recommendations involving patient monitoring and concomitant drug use over time.

Exercise electrocardiogram testing in asymptomatic patient with type 2 diabetes and left ventricular diastolic dysfunction

Background: Type 2 diabetes mellitus (DM) is an established risk factor for cardiovascular events and the development of congestive heart failure (HF). Diastolic dysfunction is considered a precursor of HF and may be diagnosed noninvasively by echocardiography. Diastolic dysfunction is common in well-controlled type 2 diabetic patients without clinically detectable heart disease. Left ventricular diastolic dysfunction represents the earliest preclinical dysfunction and that it can progress to asymptomatic HF. Aim of the Work: The aim of the study is to evaluate if diastolic dysfunction in diabetic patients is due to silent ischemia. Methods: This study included 80 asymptomatic patients with type 2 DM. Echocardiography was done to all patients to assess systolic and diastolic functions. Exercise electrocardiogram (ECG) was done for all patients to detect ischemic heart disease. Coronary angiography was done to patients with positive exercise ECG test. Results: The incidence of diastolic dysfunction was 75%; among the studied groups. Impaired relaxation was detected in 87 % and pseudo normal pattern was detected in 13 % of subjects with diastolic dysfunction. Patients with normal diastolic function had negative stress exercise test, while those with diastolic dysfunction, 12 patients had positive exercise stress ECG (40%) and 18 patients had negative exercise stress ECG (60%). Conclusion: These findings indicate that coronary artery disease is not uncommon in diabetic patients with diastolic dysfunction and increase markedly in patients with positive stress exercise electrocardiography.

Abstract 17082: ECG Screening in North Texas High School Students: A Randomized, Pilot Feasibility Study

Introduction: The death of young athletes is devastating to families and communities. Despite routine pre-participation screening, 80–100/yr die or suffer cardiac arrest, with 65% occurring in high school athletes. AHA/ACC recommendations for pre-participation screening do not include routine electrocardiogram (ECG), in contrast to some international guidelines. Methods: We designed a pilot study to test feasibility of a larger trial, scaled to 1% of the estimated 800,000 participants required to power for detection of sudden death/arrest. Athletes and band members enrolled in eight high schools in two Texas school districts were randomized in block fashion to standard screening alone versus the addition of ECG. ECGs were interpreted using CardeaScreen software, over-read by an independent expert. Students with abnormal ECGs received cardiology evaluation at no cost. Text messages assessing for cardiac events or hospitalizations were sent to both groups biannually. Results: Of the ~8,000 eligible students, the intervention group enrolled 847 students who received ECG (21%); the non-intervention group enrolled 655 students (16%). CardeaScreen identified 20 of 847 ECGs as abnormal (2.4%) and the expert identified 19 as abnormal (2.2%) Six of 20 ECGs (30%) identified as abnormal by CardeaScreen were over-read as normal, and 5 of 827 ECGs (0.6%) identified as normal by CardeaScreen were over-read as abnormal (PPV 70%, NPV 99.4%). Twenty-five follow up visits were attempted, 22 were completed (88%), and specialist referrals were sent for 6 (29%). New diagnoses included Wolf-Parkinson-White syndrome, coronary anomaly, and depressed LV function. Follow up with SMS surveys yielded 737 responses at 6 months and 441 responses at 16 months. No sudden cardiac death or arrest was reported. Conclusion: Randomized ECG testing and follow-up of high school students is feasible, though with low enrollment and relatively low yield. Automated ECG interpretation is viable but leads to significant false + results. Low participation in enrollment and follow up present challenges to a large-scale ECG screening study powered for clinical events. Possible solutions include an “opt-out” enrollment strategy and use of alternate follow up methods such as social media.

The Preoperative Value for Surgical Cases in Obesity, Aiming at the Result : Zero Death

This is a manuscript that draws the attention of professionals involved with obesity and the dangers of guilt that have fallen on those involved with this pathology. The elaboration of scientific projects with greater participation of doctors, patients and decision making where the main word would be: “to want”. There is no weight loss with excess food, but with several attitudes to achieve the result: to observe the quantity and quality of food eaten. To achieve the final success of surgical procedures, a careful preoperative period is needed, such as hematocrit above 38%; glycemia below 105 mg/dL; blood pressure below 150 × 100 mmHg; vitamin D above 20 ng/ml; normal radiological examinations; compatible electrocardiogram and other tests necessary for each specific case. Because it is a public health problem, the obesity must have special attention by the public agents to have the professional success as a result. Let's imagine how much savings we would make for every kilogram of obese patients, especially those with medication for hypertension and diabetes. Today, we can rely on bariatric surgery and body-relief surgeries. We observe how much improvement we obtain for the work, effective life, clothing, leisure and joy of living of the patients graced with these indicated procedures. With all these preventive actions, the results that most caught our attention were “zero death” and “public health economics”.

Clinical Outcomes after Triple Vessel Angioplasty in Diabetic Patients with Triple Vessel Coronary Artery Disease

Background: This study was intended to evaluate clinical outcomes in diabetic patients who underwent triple vessel angioplasty for treatment of triple vessel coronary artery disease. Methods: This was an observational, single centred study, which included a total of 27 diabetic patients who underwent triple vessel angioplasty at a tertiary care hospital from May 2010 to July 2012. The study describes the clinical profile of the patients and a moderate term clinical follow-up to reassess the symptoms, functional status and left ventricular function by history, electrocardiogram, echocardiogram, and treadmill test. Mortality and morbidity were considered as end-points of the study. Results: Of 27 patients, 18 were males, and 55.6% were hypertensive. 70.4% of patients had normal left ventricular function. Total number lesions were 97 and the total stents implanted were 85. Event-free survival rate was 92.6% at a mean follow-up of 20.3 months. Overall 100% continued success was obtained with triple vessel angioplasty. Conclusion: Triple vessel angioplasty can be applied as favourable therapy as an alternative to surgical revascularization in selected diabetic patients. However, larger studies with long-term follow-up would warrant the effectiveness of triple vessel angioplasty in such patients.

Guided Test Case Generation for Enhanced ECG Bio-Sensors Functional Verification

Testing and verifying the operation of bio-sensor nodes is essential due to the sensitivity and safety-critical aspects of their applications. Simulation technique is frequently used for this task; however, a proper set of test cases is required in order to carry out the simulation process. This paper focuses on enhancing the verification operations of an ElectroCardioGram (ECG) biomedical sensor node through simulation. It presents a new methodology for guided Test Cases Generation (TCG) of ECG signals from formal design specifications. Event-B invariants are used to specify ECG requirements, and then a new algorithm is used to translate these specifications into proper ECG signal parameters. These parameters are subsequently used to control the required shape of the ECG in order to have a wide range of scenarios. The primary objective of this work is to provide ECG test cases to detect design errors in biomedical algorithms. In addition, it can complement the usage of the limited ECG databases currently available to verify the correct operation of ECG bio-sensors.

Automated characterization of coronary artery disease, myocardial infarction, and congestive heart failure using contourlet and shearlet transforms of electrocardiogram signal

Undiagnosed coronary artery disease (CAD) progresses rapidly and leads to myocardial infarction (MI) by reducing the blood flow to the cardiac muscles. Timely diagnosis of MI and its location is significant, else, it expands and may impair the left ventricular (LV) function. Thus, if CAD and MI are not picked up by electrocardiogram (ECG) during diagnostic test, it can lead to congestive heart failure (CHF). Therefore, in this paper, the characterization of three cardiac abnormalities namely, CAD, MI and CHF are compared. Performance of novel algorithms is based on contourlet and shearlet transformations of the ECG signals. Continuous wavelet transform (CWT) is performed on normal, CAD, MI and CHF ECG beat to obtain scalograms. Subsequently, contourlet and shearlet transformations are applied on the scalograms to obtain the respective coefficients. Entropies, first and second order statistical features namely, mean (Mni), min (Mini), max (Mxi), standard deviation (Dsti), average power (Pavgi), inter-quartile range (IQRi), Shannon entropy (Eshi), mean Tsallis entropy (Emtsi), kurtosis (Kuri), mean absolute deviation (MADi), and mean energy (Ωmi), are extracted from each contourlet and shearlet coefficients. Only significant features are selected using improved binary particle swarm optimization (IBPSO) feature selection method. Selected features are ranked using analysis of variance (ANOVA) and relieff techniques. The highly ranked features are subjected to decision tree (DT) and K-nearest neighbor (KNN) classifiers. Proposed method has achieved accuracy, sensitivity and specificity of (i) 99.55%, 99.93% and 99.24% using contourlet transform, and (ii) 99.01%, 99.82% and 98.75% using shearlet transform. Among the two proposed techniques, contourlet transform method performed marginally better than shearlet transform technique in classifying the four classes. The proposed CWT combined with contourlet-based technique can be implemented in hospitals to speed up the diagnosis of three different cardiac abnormalities using a single ECG test. This technique, minimizes the unnecessary diagnostic tests required to confirm the diagnosis.

Atrial fibrillation trial to evaluate real-world procedures for their utility in helping to lower stroke events (AFTER-PULSE): Study protocol for a randomized controlled trial.

BackgroundEnhancing detection of undiagnosed atrial fibrillation (AF) in hospitalized patients with a recent ischemic stroke is important because of the treatment implications; especially since presence of paroxysmal AF may not be picked up in a single 12-lead electrocardiogram (ECG) test. While several trials have shown improved detection of AF with prolonged ECG monitoring, this strategy is associated with relatively high cost, labor intensity, and patient inconvenience, thereby making it challenging to routinely implement in all hospitals. Fortunately, conventional 24-h Holter monitoring and repeated 12-lead ECGs are readily available to detect paroxysmal AF in all hospitals, but is unclear which is the better strategy for evaluating undiagnosed AF. The objective of his study is to conduct a randomized trial of serial 12-lead ECGs vs. 24-hour Holter monitoring in the detection of AF in ischemic stroke patients without known AF.Methods and analysisWe plan to enroll 1200 participants from six hospitals in Taiwan. Patients will be eligible for enrollment if they are admitted for an acute ischemic stroke within 2 days, are ≥65 years of age, and have no known AF by history or on baseline ECG at admission. We will randomly assign participants in a 1:1 ratio to undergo daily 12-lead ECG once daily for 5 days (intervention group) or 24-h Holter monitoring (control group). Primary outcome is newly detected AF on a 12-lead ECG or AF lasting ≥30 s on Holter monitoring.Trial registration numberClinicalTrials.gov Identifier: NCT02578979.

Long-term prognostic value of peak exercise echocardiogram in patients hospitalized with acute chest pain

Peak exercise echocardiogram (EEcho) has shown reasonable sensitivity and specificity in detecting significant coronary artery disease (CAD). The objective was to evaluate the prognostic value of EEcho in patients hospitalized for acute chest pain (CP) and its additional prognostic information regarding exercise electrocardiogram test (EECG). Prospective observational study performed between May 2011 and September 2013, including 250 patients consecutively admitted for acute CP with normal cardiac biomarkers and nondiagnostic electrocardiogram. All patients were prospectively followed for 1year, and major adverse cardiovascular events (MACE) were recorded: cardiac death, nonfatal myocardial infarction (MI), or angina with coronary revascularization. EEcho was positive in 16%. Patients with positive EEcho had a higher incidence of hypertension and higher TIMI risk score, showing significant CAD in 66%. We observed contradictory results (EECG-EEcho) in 20%. Patients with positive EEcho and negative EECG had significant CAD in the 66%, and patients undergoing coronary angiography with negative EEcho and positive EECG did not show significant coronary artery disease. Only positive EEcho (P<.001, HR 0.169; 95% CI, 0.088-0.250) and atrial fibrillation (P<.025, HR 0.125; 95% CI, 0.016-0.233) were independently associated with MACE during follow-up. In patients with negative EEcho, the presence of MACE was 2%. EEcho in patients hospitalized for acute chest pain presents good ability to diagnose acute coronary syndrome, while providing additional information when combined with an EECG in up to 20% of cases. Moreover, a negative EEcho in this cohort seems to provide prognostic information beyond the acute event to predict long-term MACE.

Isolated rhabdomyolysis caused by olanzapine: About a clinical case

IntroductionAtypical anti-psychotics are increasingly prescribed, given their tolerance. Among these anti-psychotic olanzapine, known for its adverse metabolic effects. By against an adverse event type rhabdomyolysis with olanzapine appears uncommon (&lt;1%) and few clinical cases have been reported in the literature.AimThe aim of our study is to illustrate with a clinical case the occurrence of an isolated rhabdomyolysis with olanzapine.Materiel and methodStarting from the study of the case of a patient with rhabdomyolysis with olanzapine we studied the literature data. Clinical vignette: it is about a patient aged 25 followed for bipolar disorder type I. He responded to the association olanzapine and valproic acid then to valproic acid only. His last hospitalization for manic relapse dating to September 9, 2015 occurred in a context of treatment discontinuation. Upon admission the patient underwent an oral treatment based olanzapine and valproic acid. A dosage of creatine phosphokinase (CPK) done systematically, on September 11 showed high levels of (CPK) to 973 (U/L) without clinical signs of neuroleptic malignant syndrome. The electrocardiogram and biological tests results were normal. Other etiologies can lead to elevated (CPK) were eliminated. The persistent elevation of CPK motivated the arrest of olanzapine. The evolution was marked by a return to normal CPK rates after 15 days. The olanzapine was replaced by haloperidol and vaproic acid maintained. The pharmacovigilance investigation conclude to the accountability of olanzapine in this rhabdomyolysis.ConclusionSecond generation, anti-psychotics are known for their better tolerance compared to conventional antipsychotics. However, they are not devoid of side effects.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Nonspecific ST-T changes associated with unsatisfactory blood pressure control among adults with hypertension in China: Evidence from the CSPTT study.

Nonspecific ST-segment and T-wave (ST-T) changes represent one of the most prevalent electrocardiographic abnormalities in hypertensive patients. However, a limited number of studies have investigated the association between nonspecific ST-T changes and unsatisfactory blood pressure (BP) control in adults with hypertension.The study population comprised 15,038 hypertensive patients, who were selected from 20,702 participants in the China Stroke Primary Prevention Trial. The subjects were examined with electrocardiogram test at the initial visit in order to monitor baseline heart activity. According to the results of the electrocardiogram (defined by Minnesota coding), the subjects were divided into 2 groups: ST-T abnormal and ST-T normal. Unsatisfactory BP control was defined as systolic BP ≥140 mm Hg or diastolic BP ≥90 mm Hg following antihypertensive treatment during the 4.5-year follow-up period. Multivariate analysis was used to analyze the association between nonspecific ST-T abnormalities and unsatisfactory BP control.Nonspecific ST-T changes were common in hypertensive adults (approximately 8.5% in the study), and more prevalent in women (10.3%) and diabetic patients (13.9%). The unsatisfactory BP control rate was high in the total population (47.0%), notably in the ST-T abnormal group (55.5%). The nonspecific ST-T abnormal group exhibited a significantly greater rate of unsatisfactory BP control (odds ratio [OR] 1.20, 95% confidence interval [CI] [1.06, 1.36], P = 0.005]), independent of traditional risk factors, as demonstrated by multivariate regression analysis. Notable differences were further observed in male subjects (OR 1.51, 95% CI [1.17, 1.94], P = 0.002) and in patients with comorbid diabetes (OR 1.47, 95% CI [1.04, 2.07], P = 0.029).Greater rates of unsatisfactory BP control in hypertensive patients with electrocardiographic nonspecific ST-T abnormalities were observed, notably in the subcategories of the male subjects and the diabetic patients.

Computerized electrocardiogram in agoutis (Dasyprocta prymnolopha Wagler, 1831) anesthetized with ketamine and midazolam

ABSTRACT: An electrocardiogram is a test that assesses heart electrical activity and is applied more frequently in the veterinary care of wild animals. The present study aimed to define the electrocardiogram pattern of agoutis (Dasyprocta prymnolopha Wagler, 1831) anesthetized with ketamine and midazolam. Eighteen clinically healthy agoutis (D. prymnolopha) were used from the Nucleus for Wild Animal Studies and Conservation (NEPAS) of the Federal University of Piauí, Brazil. The animals were chemically restrained with 5% ketamine hydrochloride at a dose of 15mg/kg and midazolam at a dose of 1mg/kg by intramuscular injection. Electrocardiogram tests were carried out by a computerized method with the veterinary electrocardiogram [Acquisition Model for Computer (ECG - PC version Windows 95) Brazilian Electronic Technology (TEB) consisting of an electronic circuit externally connected to a notebook computer with ECGPC-VET (TEB) software installed on the hard disc. In analysing the EKG results, significant differences were observed for QRS complex duration, PR and QT intervals and for R wave millivoltage between the genders; but we observed a significant influence of weight despite the gender. In the present experiment, the anaesthetic protocol was shown to be well tolerated by the agoutis, and no arrhythmias occurred during the time the animals were monitored. The reference values obtained should be used to better understand the cardiac electrophysiology of the species and for its clinical and surgical management.

The value of predischarge exercise ECG testing in chest pain patients in the era of high-sensitivity troponins.

The aim of this study was to examine the value of predischarge exercise electrocardiogram (ECG) testing of chest pain patients in whom acute myocardial infarction (MI) had been ruled out by means of high-sensitivity troponins, ECG and history. All patients hospitalised for chest pain who underwent exercise ECG testing before discharge from the Department of Cardiology, Södersjukhuset, Stockholm, Sweden from January 2011 to June 2012 were included. Endpoints were death, MI and post-discharge revascularisation within 90 and 365 days, respectively. The background one-year risk of death and MI for a corresponding age, gender and calendar time-matched Swedish population was also examined. A total of 951 patients were included. In 585 patients (61.5%) the exercise ECG test was negative, in 94 (9.9%) positive and in 272 (28.6%) inconclusive. There were no significant differences regarding death or MI between patients with a positive or a negative test, neither at 90 ( n=1 (1.1%) vs. n=1 (0.2%)) nor at 365 days ( n=2 (2.1%) vs. n=4 (0.7%)) of follow-up. In total there were nine (0.9%) deaths and 10 (1.1%) MIs within 365 days. The one-year rates of death (1.3%) and MI (0.5%) in a matched Swedish population were comparable. Predischarge exercise ECG testing after rule out of MI did not predict subsequent death or MI in a population of patients hospitalised for chest pain. Furthermore, the risks of death and MI in this population were comparable to a matched Swedish population. These findings suggest that patients could be discharged without this test.