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ABSTRACT Objective: to assess the incidence of complications related to peripherally inserted central catheters in hospitalized adult patients with Covid-19 and to discuss the potential benefits of employing insertion technologies to prevent complications. Method: a descriptive, exploratory and cross-sectional study was conducted from March 2020 to December 2021 at a high-complexity hospital. The study included patients over 18 years old with a positive diagnosis for Covid-19 who made use of peripherally inserted central catheters for venous infusion. Data collection included sociodemographic and clinical information regarding catheter insertion and use. The analysis involved Chi-square and Fisher's Exact tests, with a significance level of 0.05. Results: a total of 123 inserted catheters were analyzed. The patients' mean age was 50 years old (SD=16.37), most of them male and in the acute phase of infection (59.3%). The following significant complications related to the insertion process were identified: catheter material (p=0.01); use of Sherlock (p=0.03); need for traction (p<0.001); number of punctures (p<0.001); and difficulty in catheter progression (p<0.001). Conclusion: the study identified the main complications related to the insertion and use of PICCs and showed that employing vascular visualization technologies such as ultrasound and Sherlock 3CG® can mitigate complications, as well as maximize patient comfort, experience and safety. The research provides support for the implementation of protocols for insertion and management of peripherally inserted central catheters, thus avoiding the occurrence of adverse events.
RESUMEN Objetivo: evaluar la incidencia de complicaciones relacionadas a catéteres centrales de inserción periférica en pacientes adultos hospitalizados con Covid-19 y debatir el potencial de emplear tecnologías de inserción en la prevención de complicaciones. Método: estudio descriptivo, exploratorio y transversal, realizado entre marzo de 2020 y diciembre de 2021 en un hospital de alta complejidad. En el estudio se incluyó a pacientes mayores de 18 años con diagnóstico positivo de Covid-19 y que utilizaran catéteres centrales de inserción periférica para infusiones venosas. Se recolectaron datos sociodemográficos y clínicos sobre la inserción y el uso de los catéteres. El análisis implicó las pruebas de Chi-cuadrado y Exacta de Fischer, con 0,05 como nivel de significancia. Resultados: se analizó un total de 123 catéteres insertados. La media de edad de los pacientes fue de 50 años (DE=16,37), con mayoría del sexo masculino y en la fase aguda de la infección (59,3%). Se hicieron evidentes las siguientes complicaciones significativas vinculadas al proceso de inserción: material del catéter (p=0,01), uso de Sherlock (p=0,03), necesidad de tracción (p<0,001), cantidad de punciones (p<0,001) y dificultad de avance del catéter (p<0,001). Conclusión: el estudio identificó las principales complicaciones relacionadas a la inserción y el uso de catéteres PICC y demostró que utilizar tecnologías de visualización vascular como ultrasonido y Sherlock 3CG® puede mitigar las complicaciones, además de maximizar la comodidad, experiencia y seguridad del paciente. El trabajo de investigación presenta aportes para implementar protocolos de inserción y manejo de los catéteres centrales de inserción periférica, evitando así la incidencia de eventos adversos.
RESUMO Objetivo: avaliar a incidência de complicações relacionadas ao cateter central de inserção periferica em pacientes adultos hospitalizados com Covid-19 e discutir o potencial do uso de tecnologias de inserção na prevenção de complicações. Método: estudo descritivo e exploratório, transversal, realizado no período de março de 2020 a dezembro de 2021, em um hospital de alta complexidade. Foram incluídos no estudo pacientes maiores de 18 anos com diagnóstico positivo para Covid-19 e que fizeram uso do cateter central de inserção periférica para infusão venosa. Fez-se coleta de dados sociodemográficos e clínicos sobre a inserção e uso do cateter. A análise envolveu os testes qui-quadrado e exato de Fischer, com nível de significância de 0,05. Resultados: analisou-se um total de 123 cateteres inseridos. A média de idade dos pacientes foi de 50 anos (DP=16,37 anos), sendo a maioria do sexo masculino e na fase aguda da infecção (59,3%). Foram evidenciadas as seguintes complicações significativas atreladas ao processo de inserção: material do cateter (p=0,01), uso de Sherlock (p=0,03), necessidade de tração (p<0,001), número de punções (p<0,001) e dificuldade de progressão do cateter (p<0,001). Conclusão: o estudo identificou as principais complicações relacionadas à inserção e uso do PICC e mostrou que o uso de tecnologias de visualização vascular como o ultrassom e Sherlock 3CG® pode mitigar complicações, além de maximizar conforto, experiência e segurança do paciente. A investigação apresenta subsídios para implementação de protocolos de inserção e manejo do cateter central de inserção periférica, evitando a ocorrência de eventos adversos.
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The conventional noninvasive biological current detection such as electrocardiogram, electroencephalography and surface electromyography can provide electrical reference for diseases diagnosis. Because the bioelectrical signals are the mixed result of the common discharge of sell populations, the spatial resolution of the above bioelectrical detection is relatively limited. In recent years, the acoustoelectric imaging (AEI) has been introduced to spatially code biological current through noninvasive focused ultrasound. Then the electrical signal with precise focus position can be obtained. It can achieve noninvasive detection of biological electrical signals with millimeter-level spatial resolution and millisecond-level temporal resolution which is expected to develop into a new imaging technology for accurately detecting deep electrical activities of living organisms. We firstly describe AEI principle, including acoustoelectric effect and the derivation of acoustoelectric signal equation. Then we briefly introduce characteristics of acoustoelectric signal. It can be seen from the equation of acoustoelectric signal that the acoustoelectric signal depends on the current field and the ultrasonic field. Furtherly, the typical studies of AEI are introduced including acoustoelectric coupling mechanism, AEI methods, acoustoelectric brain imaging (ABI) and acoustoelectric cardiac imaging (ACI). In terms of the acoustoelectric coupling mechanism, the researchers found that the acoustoelectric effect of electrolyte solution is caused by the change of ion molar concentration, ion migration rate and ion viscosity with pressure and temperature, and the acoustoelectric effect coefficient of normal saline is accurate to (0.034±0.003)% MPa–1. In terms of AEI methods, researchers improved the detection sensitivity, spatial resolution, signal to noise ratio and other performance indicators by improving AEI methods and optimizing AEI systems. In terms of ABI, it can utilize the acoustoelectric coupling mechanism to endow the target area with spatial features of ultrasound, and achieve noninvasive high resolution EEG detection. We review the important research achievements and significance layer by layer from the perspectives of feasibility verification, method system optimization, and clinical application exploration in acoustoelectric imaging. In terms of ACI, it can be used to quantitatively evaluate the spatial distribution and dynamic changes of cardiac current field, providing a new idea for real-time monitoring of cardiac electrophysiological state before and after surgery. We summarize and review the important research achievements and significance of ACI at each stage: in phantom, in vitro and in vivo. Finally, we discuss the future research direction by focusing on the challenges faced by key technical links such as focused ultrasound targeting, ultrasonic spatial coding and decoding, acoustoelectric sensing detection, and imaging system integration, in order to provide basis and inspiration for AEI technology system and clinical transformation.
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Objective:To understand the electrocardiogram and echocardiography examination results of population in key areas of unexplained sudden death in Yunnan Province (referred to as Yunnan sudden death).Methods:From 2014 to 2022, electrocardiogram examination was performed on population (including same incident cases, relatives of the cases, villagers of the affected villages, and control individuals) in key areas of Yunnan sudden death from May to October each year. Echocardiography examination was performed on relatives of the cases and villagers of the affected villages, and the types of electrocardiogram and echocardiography changes were sorted out and analyzed.Results:Electrocardiogram examination was conducted on 1 same incident case, 241 relatives of the cases, 464 villagers of the affected villages, and 99 control individuals, respectively. The types of electrocardiogram changes in the same incident case were Q-T interval prolongation and sinus tachycardia. A total of 17 types of electrocardiogram changes were detected in the relatives of the cases, mainly including sinus arrhythmia (12.45%, 30/241), sinus bradycardia (11.20%, 27/241), and left axis deviation (8.30%, 20/241). A total of 21 types of electrocardiogram changes were detected in the villagers of the affected villages, mainly including left axis deviation (9.48%, 44/464), sinus bradycardia (8.19%, 38/464), and T-wave abnormalities (7.76%, 36/464). A total of 10 types of electrocardiogram changes were detected in the control individuals, mainly including sinus arrhythmia (12.12%, 12/99), T-wave abnormalities (9.09%, 9/99), and sinus bradycardia (7.07%, 7/99). Echocardiography examination was conducted on 49 relatives of the cases and 365 villagers of the affected villages, respectively. A total of 12 types of echocardiography changes were detected in the relatives of the cases, mainly including tricuspid regurgitation (18.37%, 9/49), decreased right ventricular diastolic function (8.16%, 4/49), aortic regurgitation (6.12%, 3/49), and atrial septal defect (6.12%, 3/49). A total of 15 types of echocardiography changes were detected in the villagers of the affected villages, mainly including tricuspid regurgitation (8.77%, 32/365), aortic regurgitation (6.85%, 25/365), and decreased left ventricular diastolic function (6.58%, 24/365).Conclusion:There are many types of changes in electrocardiogram and echocardiography in the population of key areas of Yunnan sudden death.
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Objective:To explore the value of cardiodynamicsgram (CDG) obtained from electrocardiogram (ECG) data by radial basis functionradial basis function (RBF) neural network in early diagnosis of patients with acute coronary syndrome (ACS).Methods:Retrospective analysis method was used. Patients with chest pain as the main initial symptom in the emergency department of Baoan District People's Hospital of Shenzhen from October 2021 to September 2022 were enrolled. Baseline data were collected, including gender, age, smoking history, family history of coronary heart disease and history of hypertension, diabetes, hyperlipidemia, and atherosclerosis. The first 12-lead ECG was recorded after admission to the emergency department, and electrocardiodynamics analysis was performed to generate CDG. Receiver operator characteristic curve (ROC curve) was plotted to analyze the value of CDG and ECG in the early diagnosis of ACS and non-ST segment elevation ACS (NSTE-ACS). Sensitivity, specificity, area under the ROC curve (AUC), and 95% confidence interval (95% CI) were calculated. CDG and coronary angiography results of 3 patients with ACS with normal ECG were observed and analyzed. Non-ACS patients with normal ECG but positive CDG were followed for 30 days for adverse cardiovascular events. Results:A total of 384 patients with chest pain were included, including 169 patients with ACS and 215 patients without ACS. The proportion of male (87.0% vs. 53.0%), smoking history (37.9% vs. 12.1%), hypertension (46.2% vs. 22.3%), diabetes (24.3% vs. 7.9%), hyperlipidemia (55.0% vs. 14.0%) and history of atherosclerosis (22.5% vs. 2.3%) in ACS group were significantly higher than those in non-ACS group (all P < 0.05). The ROC curve showed that the AUC of CDG diagnosis of ACS was higher than that of ECG [AUC (95% CI): 0.88 (0.66-0.76) vs. 0.71 (0.84-0.92)], the sensitivity was 92.8%, 78.6%, and the specificity was 83.3%, 64.2%, respectively. The AUC of CDG diagnosis of NSTE-ACS was higher than that of ECG [AUC (95% CI): 0.85 (0.80-0.90) vs. 0.63 (0.56-0.69)], the sensitivity was 87.1%, 61.3%, and the specificity was 83.3%, 64.2%, respectively. CDG of 3 patients with ACS with normal ECG showed disordered state, and coronary angiography showed ≥70% stenosis of major coronary branches. Of 215 non-ACS patients, 20 had a normal ECG but positive CDG, and 3 developed ST segment elevation myocardial infarction (STEMI) within 30 days, and 2 developed unstable angina (UA) within 30 days. Conclusion:CDG has high value in early diagnosis of ACS patients and is expected to become an important means of early diagnosis of ACS in emergency.
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Objective To explore the correlations between image quality of prospective and retrospective electrocardiogram(ECG)-gated CT coronary angiogram and radiation dose in patients with different heart rates.Methods A total of 135 patients undergoing 256-slice spiral CT coronary angiography were enrolled in the study.Among them,66 cases received prospective ECG-gated scanning(prospective ECG-gated group)and further divided into two subgroups with heart rate≤80 beats/min(prospective ECG-gated+low heart rate subgroup,n=39)and>80 beats/min(prospective ECG-gated+high heart rate subgroup,n=27).The other 69 cases underwent retrospective ECG-gated scanning(retrospective ECG-gated group),including 45 cases with heart rate≤80 beats/min(retrospective ECG-gated+low heart rate subgroup)and 24 with heart rate>80 beats/min(retrospective ECG-gated+high heart rate subgroup).The baseline data,image quality[mean CT value,image noise,signal-to-noise ratio(SNR),subjective image quality score]and radiation dos[CT volume dose index(CTDIvol),dose length product(DLP),effective dose(ED)]were compared among 4 subgroups.The correlations of image quality with heart rate and radiation dose in prospective and retrospective ECG-gated groups were analyzed.Results The heart rates in prospective and retrospective ECG-gated+low heart rate subgroups were lower than those in prospective and retrospective ECG-gated+high heart rate subgroups(P<0.05).When comparing the mean CT value,image noise,SNR and subjective image quality score among 4 subgroups,no statistically significant differences were observed(P>0.05).The CTDIvol,DLP and ED in prospective ECG-gated+low heart rate subgroup were significantly lower than those in the other 3 subgroups(P<0.05),and the indicators in prospective ECG-gated+high heart rate subgroup were lower than those in retrospective ECG-gated group(including low and high heart rate subgroups)(P<0.05).Pearson correlation coefficient analysis revealed that the mean CT value,image noise,SNR,subjective image quality score had no significant correlation with heart rate,CTDIvol,DLP and ED in prospective and retrospective ECG-gated groups(P>0.05).Conclusion The subjective and objective image quality of 256-slice spiral CT coronary angiography is not correlated with radiation dose.Prospective ECG-gated scanning can reduce the radiation dose and ensure the image quality as compared with retrospective ECG-gated scanning.This holds true for eligible patients with high heart rate,and the former can effectively reduce radiation exposure.Therefore,prospective ECG-gated scanning is worthy to be promoted in clinic.
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Objetivo: relatar a elaboração de um algoritmo para facilitar a interpretação rápida das principais arritmias cardíacas no eletrocardiograma. Método: estudo descritivo, exploratório, com abordagem qualitativa, do tipo relato de experiência, realizado mediante um projeto de intervenção em educação em saúde durante o ano de 2021. Resultados: a elaboração do algoritmo denominado Scaritmo contribuiu para sistematizar as etapas de identificação de arritmias cardíacas, favorecendo o processo didático e aprendizado dos estudantes e otimizando a interpretação rápida do eletrocardiograma. Conclusão: o uso do algoritmo Scaritmo permite a sistematização teórico-prática das etapas necessárias para a interpretação do eletrocardiograma tornando sua avaliação mais didática e assertiva pelo examinador em treinamento.(AU)
Objective: to report the development of an algorithm to facilitate the rapid interpretation of the main cardiac arrhythmias in electrocardiogram. Method: a descriptive, exploratory study with qualitative approach, of experience report type, conducted through an intervention project in health education during the year 2021. Results: The development of the algorithm called Scaritmo contributed to systematize the steps of cardiac arrhythmia identification, favoring the didactic process and student learning, and optimizing the rapid interpretation of the electrocardiogram. Conclusion: The use of the Scaritm algorithm allows the theoretical and practical systematization of the steps necessary for the interpretation of electrocardiograms, making its evaluation more didactic and assertive by the examiner in training.(AU)
Objetivo: relatar el desarrollo de un algoritmo para facilitar la interpretación rápida de las principales arritmias cardíacas en electrocardiograma. Método: estudio descriptivo, exploratorio, con abordaje cualitativo, de tipo relato de experiencia, realizado a través de un proyecto de intervención en educación para la salud durante el año 2021. Resultados: el desarrollo del algoritmo denominado Scaritmo contribuyó para sistematizar los pasos de identificación de arritmias cardíacas, favoreciendo el proceso didáctico y el aprendizaje de los alumnos y optimizando la rápida interpretación del electrocardiograma. Conclusión: El uso del algoritmo Scaritmo permite la sistematización teórica y práctica de los pasos necesarios para la interpretación del electrocardiograma, tornando su evaluación más didáctica y asertiva por el examinador en formación.(AU)
الموضوعات
Arrhythmias, Cardiac , Health Education , Electrocardiographyالملخص
Background and objective: Only few studies addressed ECG findings in healthy members of the Indian armed forces or the general population of India. The study was conducted to assess the prevalence of abnormal electrocardiogram (ECG) detected during a routine medical examination of healthy members of the Indian armed forces. Method: The ECG of all the healthy members performed during a routine medical examination was initially reported by physicians at various armed forces service hospitals in the Eastern Command (EC) and later perused by the cardiologist at Command Hospital Eastern Command (CHEC). Individuals with abnormal ECG underwent relevant cardiac evaluation at CHEC to determine the underlying pathology. Results: A total of 1,045 members of the Indian armed forces were included in the study and were categorised as follows: 244 in Group-1 (aged < 25years), 478 in Group-2 (aged between 25 to 40 years) and 323 in Group-3 (aged > 40years). Abnormal ECG was found in 108 (10.3%) individuals. Left axis deviation was the most common abnormality detected in 18 (1.2%) individuals, followed by incomplete RBBB and T wave inversion which were each found in 15 subjects (1.43% of all individuals and 13.9% of the subjects with abnormal ECG). The prevalence of ECG abnormalities detected in our study was similar to that reported in previous studies. Only five (0.47%) of the 108 individuals with abnormal ECG were found to have underlying cardiovascular disease. Conclusion: Morphological ECG abnormalities were common in the subjects but did not vary significantly from the general population, and only a minority had underlying pathology. While most of the abnormalities may only represent normal variations and their occurrence in healthy individuals during routine health check-ups should not be alarming. Evaluation of structural heart disease should be done for ECG abnormalities with prognostic significance that has been well-characterised.
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Les anomalies électrocardiographiques sont l'expression d'une atteinte cardiovasculaire lors de la COVID-19. Les troubles du rythme et de la conduction cardiaque peuvent mettre en jeu le pronostic vital à court terme au cours de la COVID -19. Notre objectif principal est de décrire les anomalies électrocardiographiques et leurs fréquences chez les patients atteints de la COVID -19. L'objectif secondaire est de déterminer l'association entre ces anomalies électrocardiographiques et la gravité de la maladie. Méthodes : Il s'agit d'une étude rétrospective à visée descriptive des patients hospitalisés pour COVID-19 dans les centres de traitement COVID -19 de Fianarantsoa sur une période de 14 mois. Résultats : Nous avons retenu 101 patients. Le sex-ratio était de 1,06. La moyenne d'âge était de 59,81ans +/- 11,9. Tous les patients retenus avaient un électrocardiogramme à 12 dérivations et un test positif à la COVID-19. L'électrocardiogramme (ECG) était anormal chez 87 (86,1%) patients. Dans les formes graves et modérées de la maladie nous avons enregistré à l'ECG: 51 (50,5%) tachycardies sinusales, 13 (12,8%) blocs de branche incomplets droits, 13 (12,8%) profil S1Q3T3, 24 (23,7%) ondes Q pathologiques, 19 (18,8%) anomalies du segment ST. Dans les formes graves de la maladie nous avons enregistré à l'ECG: 2 (3,8%) bloc auriculoventriculaire complet (BAV complet), 7 (13,4%) blocs de branche gauche complet (BBG), 5 (9,6%) blocs de branche droit complet (BBD). La tachycardie sinusale avait une association significative avec la gravité de la maladie (p=0,002). Conclusion : Des anomalies électrocardiographiques ont été observées dans notre étude. La tachycardie sinusale était associée à la gravité de la maladie. Une surveillance rythmique, des explorations cardiaques plus pertinentes sont nécessaires pour une meilleure prise charge de la COVID-19
الموضوعات
Humans , Arrhythmias, Cardiac , Electrocardiography, Ambulatory , COVID-19 , Long QT Syndrome , Cardiovascular Diseases , Cardiovascular Abnormalities , Patient Acuityالملخص
Introdução: As síndromes coronarianas agudas decorrem de ruptura de placa coronariana com formação de trombos, embolização e obstrução, dependendo do nível de obstrução, podemos ter infartos e anginas e a nível eletrocardiográfico podemos ter ou não o supra desnivelamento do segmento ST. Para o correto diagnóstico e melhor prognóstico é importante acompanhar suas manifestações clínicas e avaliar as alterações eletrocardiográficas. Objetivo: Estudar uso do eletrocardiograma padrão de 12 derivações, para diagnóstico da oclusão coronariana aguda: uma nova abordagem eletrocardiográfica das síndromes coronarianas. Método: Estudo de revisão integrativa, com dados secundários da Biblioteca Virtual em Saúde (BVS), base eletrônica de dados da Literatura Latino Americana e do Caribe em Ciências da Saúde (Lilacs) e da biblioteca digital Scientific Electronic Library Online (Scielo). Resultados: Descreveu-se 7 achados eletrocardiográficos sugestivos de oclusão coronariana aguda: padrões como os De Winter, Wellens, IAM posterior, distorção final do QRS, Critérios de Sgarbossa- Smith para IAM associado a BRE ou ritmo de marca-passo ventricular, ondas T's hiperagudas e fórmulas matemáticas para diagnóstico da oclusão da descendente anterior. Conclusão: Embora a abordagem que se vale de tais achados no ECG seja mais acurada na detecção da oclusão coronariana aguda do que os critérios milimétricos do segmento ST, essa nova abordagem precisa de mais estudos para avaliação de seu real poder diagnóstico.
Introduction: As acute coronary syndromes due to coronary plaque rupture, with thrombus formation, embolization and obstruction, depending on the degree of obstruction, we may have infarction and angina at the electrocardiographic level, we may have an unevenness or overdevelopment of the ST interval. For a correct diagnosis and prognosis, it is important to monitor its clinical manifestations and assess electrocardiographic changes. Objective: To study the use of a standard 12- lead electrocardiogram for the diagnosis of acute coronary occlusion: a new electrocardiographic approach to coronary syndromes. Method: Integrative review study, secondary data from the Virtual Health Library (VHL), electronic database of the Latin American and Caribbean Literature on Health Sciences (Lilacs) and the Scientific Electronic Library Online (Scielo) digital library. Results: Seven electrocardiographic findings suggestive of acute coronary occlusion were described: patterns such as De Winter, Wellen, posterior AMI, terminal QRS distortion, Sgarbossa-Smith criteria for AMI associated with LBBB or ventricular paced rhythm, hyperacute T waves, and mathematical formulas for diagnosing anterior descending occlusion. Conclusion: Although the approach that makes use of such ECG findings is more accurate in detecting acute coronary occlusion than the millimeter ST-segment criteria, this new approach needs further studies to assess its real diagnostic power.
Introducción: Como síndromes coronarios agudos debidos a rotura de placa coronaria, con formación de trombo, embolización y obstrucción, dependiendo del grado de obstrucción, podemos tener infarto y angina a nivel electrocardiográfico, podemos tener un desnivel o sobredesarrollo del intervalo ST. Para un correcto diagnóstico y pronóstico es importante monitorizar sus manifestaciones clínicas y valorar los cambios electrocardiográficos. Objetivo: Estudiar el uso de un electrocardiograma estándar de 12 derivaciones para el diagnóstico de la oclusión coronaria aguda: una nueva aproximación electrocardiográfica a los síndromes coronarios. Método: Estudio de revisión integradora, datos secundarios de la Biblioteca Virtual en Salud (BVS), base de datos electrónica de la Literatura Latinoamericana y del Caribe en Ciencias de la Salud (Lilacs) y de la biblioteca digital Scientific Electronic Library Online (Scielo). Resultados: Se describieron siete hallazgos electrocardiográficos sugestivos de oclusión coronaria aguda: patrones como De Winter, Wellen, IAM posterior, distorsión terminal del QRS, criterios de Sgarbossa-Smith para IAM asociado a BRIHH o ritmo ventricular estimulado, ondas T hiperagudas y fórmulas matemáticas para el diagnóstico de oclusión de la descendente anterior. Conclusiones: Aunque el enfoque que hace uso de dichos hallazgos ECG es más preciso en la detección de la oclusión coronaria aguda que los criterios milimétricos del segmento ST, este nuevo enfoque necesita más estudios para evaluar su poder diagnóstico real.
الملخص
Myocardial infarction (MI) has the characteristics of high mortality rate, strong suddenness and invisibility. There are problems such as the delayed diagnosis, misdiagnosis and missed diagnosis in clinical practice. Electrocardiogram (ECG) examination is the simplest and fastest way to diagnose MI. The research on MI intelligent auxiliary diagnosis based on ECG is of great significance. On the basis of the pathophysiological mechanism of MI and characteristic changes in ECG, feature point extraction and morphology recognition of ECG, along with intelligent auxiliary diagnosis method of MI based on machine learning and deep learning are all summarized. The models, datasets, the number of ECG, the number of leads, input modes, evaluation methods and effects of different methods are compared. Finally, future research directions and development trends are pointed out, including data enhancement of MI, feature points and dynamic features extraction of ECG, the generalization and clinical interpretability of models, which are expected to provide references for researchers in related fields of MI intelligent auxiliary diagnosis.
الموضوعات
Humans , Electrocardiography , Myocardial Infarction/diagnosis , Recognition, Psychologyالملخص
Electrocardiogram (ECG) monitoring owns important clinical value in diagnosis, prevention and rehabilitation of cardiovascular disease (CVD). With the rapid development of Internet of Things (IoT), big data, cloud computing, artificial intelligence (AI) and other advanced technologies, wearable ECG is playing an increasingly important role. With the aging process of the population, it is more and more urgent to upgrade the diagnostic mode of CVD. Using AI technology to assist the clinical analysis of long-term ECGs, and thus to improve the ability of early detection and prediction of CVD has become an important direction. Intelligent wearable ECG monitoring needs the collaboration between edge and cloud computing. Meanwhile, the clarity of medical scene is conducive for the precise implementation of wearable ECG monitoring. This paper first summarized the progress of AI-related ECG studies and the current technical orientation. Then three cases were depicted to illustrate how the AI in wearable ECG cooperate with the clinic. Finally, we demonstrated the two core issues-the reliability and worth of AI-related ECG technology and prospected the future opportunities and challenges.
الموضوعات
Humans , Artificial Intelligence , Reproducibility of Results , Electrocardiography , Cardiovascular Diseases , Wearable Electronic Devicesالملخص
Objective:To investigate the clinical utility of intracavitary electrocardiogram (IC-ECG) localization technique in locating the tip of umbilical venous catheterization (UVC).Methods:From April 2020 to March 2021, premature infants admitted to the Department of Neonatology of the Third Affiliated Hospital of Guangzhou Medical University and received UVC were collected for a prospective study. According to whether IC-ECG was used to determine the position of umbilical vein catheter tip during catheterization, they were divided into IC-ECG group and control group. The differences of catheterization success rate, total incidence of catheter-related complications were compared between the two groups. The relationship between characteristic P waves and the position of the catheter tip in the IC-ECG group was also analyzed.Results:A total of 104 premature infants were enrolled, including 52 cases in IC-ECG group and 52 cases in control group. The catheter placement accuracy rate of the IC-ECG group was higher than that of the control group (53.8% vs. 28.8%, P<0.05). There was no statistically significant difference of the total incidence of catheter-related complications between the two groups ( P>0.05). Among the 40 cases with characteristic P wave changes in the IC-ECG group, 21 cases had normal P wave, of which 13 cases (61.9%) were with the correct position. And 19 cases had low-amplitude bimodal P waves, of which 15 cases (78.9%) were with the correct position. There was no statistically significant difference of the exact position rate of the catheter tips between the two types of P waves ( P>0.05). Conclusions:The use of IC-ECG localization technique in the process of catheterization of umbilical vein can increase the exact position rate of catheterization. Furthermore, when IC-ECG monitoring shows characteristic P wave changes to normal P wave or low-amplitude bimodal P wave, the tip of the UVC catheter may be located accurately.
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Objective To design and experimentally validate a strobe stimulation experimental system based on LED dimming.Methods The experimental system consisted of a LED dimming system and a physiological data acquisition system.The LED dimming system was composed of a microprocessor system,a LED driver and a LED,which used pulse-width modulation(PWM)technology to modulate the duty cycle and frequency of the drive current to flexibly control the LED light intensity and flicker frequency;Biopac's 16-channel physiological signal recording and analysis system was used as the physiological data acquisition system.Strobe stimulation experiment was carried out to verify the performance of the system developed.Results The strobe stimulation experiment results showed the system developed could control the LED flicker frequency precisely and acquire the electrodermal data and ECG data of the subjects in real time,and the strobe stimulation resulted in changes of the electrodermal data and ECG data.Conclusion The system developed gains advantages in easy operation and can be used for exploring the photobiological effect of the strobe stimulation.[Chinese Medical Equipment Journal,2023,44(10):33-37]
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Objective:To study the iodine nutritional status of pregnant women in the third trimester in the Southwest of Shandong Province, analyze its impact on their cardiac electrical activity, and provide a basis for scientific supplementation of iodine during pregnancy.Methods:From January 2021 to June 2022, a cross-sectional survey was conducted using cluster random sampling method. According to the inclusion and exclusion criteria, 200 pregnant women in the third trimester were selected from 3 tertiary hospitals in three cities in the Southwest of Shandong Province, and were divided into the third trimester group ( n = 600), and 100 non-pregnant women were selected as the control group ( n = 300). The urinary iodine content was detected by arsenic-cerium catalytic spectrophotometry, and the pregnant women in the third trimester group were subdivided into iodine deficiency subgroup [G1 subgroup, median urinary iodine (MUIC) < 150 μg/L] based on the MUIC, iodine excess subgroup (G2 subgroup, MUIC≥500 μg/L) and moderate iodine subgroup (G3 subgroup, 150 μg/L≤MUIC < 500 μg/L). Chemiluminescence immunoassay was used to measure the serum levels of thyroid-stimulating hormone (TSH), free thyroxine (FT 4) and free triiodothyronine (FT 3). The cardiac electrical indexes were detected by a 12-lead surface electrocardiogram (ECG) machine. Results:There was no statistically significant difference in urinary iodine levels between pregnant women in the third trimester group and non-pregnant women in the control group among the 3 tertiary hospitals in the Southwest of Shandong Province ( H = 3.63, 3.27, P > 0.05). In the third trimester group, the proportion of pregnant women in the G1, G2 and G3 subgroups was 27.67% (166/600), 6.83% (41/600) and 65.50% (393/600), respectively. There was a statistically significant difference in urinary iodine levels between the subgroups and the control group ( H = 11.56, P < 0.001). The serum FT 3 and FT 4 levels in the G2 subgroup were lower than those in the G1 and G3 subgroups ( P < 0.001), but there was no statistically significant difference in serum TSH levels among the three subgroups ( P > 0.05). The normal rates of ECG in the G1, G2, G3 subgroups, and the control group were 38.55% (64/166), 41.46% (17/41), 92.37% (363/393), and 95.33% (286/300), respectively. The difference between the groups were statistically significant (χ 2 = 461.25, P < 0.001), the normal rate of ECG in the G1 and G2 subgroups was lower than that in the control group ( P < 0.001). Short P-R intervals and ST-T changes were the most common abnormal ECG in the third trimester group. Conclusions:The incidence of iodine deficiency, iodine excess, and other abnormal iodine nutritional status in pregnant women in the third trimester of the Southwest of Shandong Province is relatively high. Short P-R intervals, ST-T changes, and other arrhythmia caused by this are more common. It is necessary to strengthen monitoring of iodine nutritional status and ECG during pregnancy, and adjust intervention strategies such as iodine supplementation in a timely manner.
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Objective:To investigate the relationship between the changes of electrocardiogram QRS duration features and the occurrence of adverse cardiac events in patients with heart failure.Methods:The clinical data of 298 patients with heart failure who received treatment in Lishui City People's Hospital from June 2021 to June 2022 were retrospectively analyzed. According to the type of heart failure, they were divided into the diastolic heart failure group ( n = 158) and the systolic heart failure group ( n= 140). According to whether having cardiac events, they were divided into a cardiac event group ( n = 97) and a non-cardiac event group ( n = 201) group. An additional 120 patients who concurrently received health examinations were included in the control group. QRS wave duration and cardiac function indicators were analyzed. QRS wave duration and cardiac function indicators were compared between heart failure and control groups. Changes in QRS wave duration and cardiac function indicators were compared between diastolic heart failure and systolic heart failure groups. Changes in QRS wave duration and cardiac function indicators were compared between cardiac event and non-cardiac event groups. The value of the receiver operating characteristic curve in predicting adverse cardiac events was analyzed. Pearson correlation analysis was performed to analyze the correlation between QRS wave duration and cardiac function. Results:QRS wave duration in the heart failure group was (125.42 ± 14.35) ms, which was significantly longer than (78.82 ± 6.49) ms in the control group ( t = 34.17, P < 0.001). Left ventricular end-systolic volume (LVESV) and left ventricular end-diastolic volume (LVEDV) in the heart failure group were (156.24 ± 21.42) mL and (78.28 ± 9.43) mL, respectively, which were significantly higher than (107.48 ± 19.23) mL and (45.62 ± 5.42) mL, respectively in the control group ( t = 21.66, 35.63, both P < 0.01). Left ventricular ejection fraction (LVEF) in the heart failure group was (46.98 ± 4.25)%, which was significantly lower than (67.94 ± 5.46)% in the control group ( t = 41.88, P < 0.001). QRS wave duration in the systolic heart failure group was (140.21 ± 18.57) ms, which was significantly longer than (112.31 ± 13.42) ms in the diastolic heart failure group ( t = 16.29, P < 0.001). LVESV and LVEDV in the systolic heart failure group were (183.36 ± 27.67) mL and (95.39 ± 12.13) mL, respectively, which were significantly higher than (132.21 ± 18.98) mL and (63.12 ± 7.84) mL in the diastolic heart failure group ( t = 20.30, 29.61, both P < 0.001). LVEF in the systolic heart failure group was (38.19 ± 4.61)%, which was significantly lower than (54.77 ± 4.92)% in the diastolic heart failure group ( t = 34.18, P < 0.001). QRS wave duration in the cardiac event group was (169.37 ± 17.43) ms, which was significantly longer than (104.21 ± 12.49) ms in the non-cardiac event group ( t = 36.91, P < 0.001). LVESV and LVEDV in the cardiac event group were (199.30 ± 23.41) mL and (105.22 ± 15.64) mL, respectively which were significantly higher than (135.46 ± 15.46) mL and (65.28 ± 6.92) mL in the non-cardiac event group ( t = 28.04, 30.57, both P < 0.001). LVEF in the cardiac event group was (32.97 ± 5.16)%, which was significantly lower than (53.74 ± 4.52)% in the non-cardiac event group ( t = 35.46, P < 0.001). The receiver operating characteristic curve analysis showed that the sensitivity and specificity of QRS wave duration in predicting adverse cardiac events were 88.7% and 86.6%, respectively. Pearson analysis showed that QRS wave duration, LVESV, and LVEDV were positively correlated with the occurrence of adverse cardiac events ( r = 0.684, 0.546, 0.518, all P < 0.05), while LVEF was negatively correlated with the occurrence of adverse cardiac events ( r = -0.627, P < 0.05). Conclusion:QRS wave duration in patients with heart failure is significantly prolonged, and it is obviously related to the occurrence of adverse cardiac events.
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Atrial fibrillation,which is closely correlated with stroke and heart failure,is among the most common arrhythmias in clinical practice.The asymptomatic and paroxysmal nature of atrial fibrillation leads to a very high missed diagnosis rate,more than half of misdiagnosed patients are classified as intermediate to high risk population of ischemic stroke and heart failure.With the progress of population aging in China,the prevalence of atrial fibrillation will continue to increase.The prediction model of atrial fibrillation can help screen patients with high risk of atrial fibrillation.Subsequent preventive intervention and intensive monitoring for this population can reduce the incidence of stroke and heart failure.This paper summarizes the research progress of traditional regression model and artificial intelligence in atrial fibrillation prediction,and limitations of current research and future research directions.
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Objective:To analyze the accuracy of a single-lead electrocardiogram (iECG) algorithm based on intelligent wristwatch in identifying sinus tachycardia and atrial fibrillation (AF) with rapid ventricular rate.Methods:In this non-randomized control trial, 642 patients aged ≥18 years were enrolled in the General Hospital of Chinese PLA between December 15, 2020 and May 30, 2022, with sinus tachycardia or rapid ventricular rate of AF (ranging from 111 to 145 beats/min for sinus tachycardia, from 110 to 150 beats/min for rapid ventricular rate of AF, respectively). The patients wore Huawei Watch GT2 Pro smartwatches on their left wrists, and the physiological signals detected by the smartwatches in a relaxed state were used as the measured data. The iECG algorithm developed by Huawei was used for identification. Simultaneously, 12-lead electrocardiograms (12L-ECG) were performed, and two cardiologists served as the gold standard for interpretation. Three participants who did not meet the inclusion criteria were excluded based on the detection results, and a total of 639 participants were included in the study. The accuracy of the algorithm in identifying sinus tachycardia and rapid ventricular rate AF was evaluated using metrics such as recall rate, precision rate, macro F1 score for multi-class classification.Results:Among 639 subjects, there were 469 males and 170 females. There were 389 cases of sinus tachycardia and 250 cases of rapid ventricular rate AF, with a mean age of (46.53±13.32) years. The recall rate, precision rate, and F1 value of iECG algorithm in identifying sinus tachycardia was 98.7%, 99.2% and 99.0%, respectively, while it was 98.8%, 98.0% and 98.4%, respectively for AF with rapid ventricular rate. The macro F1 of AF with rapid ventricular rate and sinus tachycardia was 98.7%. The iECG based on the intelligent wristwatch showed good consistency with the corresponding 12L-ECG waveforms.Conclusion:The intelligent wristwatch-based iECG algorithm can effectively identify sinus tachycardia and rapid ventricular rate AF, demonstrating good accuracy.
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Fetal electrocardiogram (ECG) signals provide important clinical information for early diagnosis and intervention of fetal abnormalities. In this paper, we propose a new method for fetal ECG signal extraction and analysis. Firstly, an improved fast independent component analysis method and singular value decomposition algorithm are combined to extract high-quality fetal ECG signals and solve the waveform missing problem. Secondly, a novel convolutional neural network model is applied to identify the QRS complex waves of fetal ECG signals and effectively solve the waveform overlap problem. Finally, high quality extraction of fetal ECG signals and intelligent recognition of fetal QRS complex waves are achieved. The method proposed in this paper was validated with the data from the PhysioNet computing in cardiology challenge 2013 database of the Complex Physiological Signals Research Resource Network. The results show that the average sensitivity and positive prediction values of the extraction algorithm are 98.21% and 99.52%, respectively, and the average sensitivity and positive prediction values of the QRS complex waves recognition algorithm are 94.14% and 95.80%, respectively, which are better than those of other research results. In conclusion, the algorithm and model proposed in this paper have some practical significance and may provide a theoretical basis for clinical medical decision making in the future.
الموضوعات
Algorithms , Neural Networks, Computer , Electrocardiography , Databases, Factual , Fetusالملخص
In the diagnosis of cardiovascular diseases, the analysis of electrocardiogram (ECG) signals has always played a crucial role. At present, how to effectively identify abnormal heart beats by algorithms is still a difficult task in the field of ECG signal analysis. Based on this, a classification model that automatically identifies abnormal heartbeats based on deep residual network (ResNet) and self-attention mechanism was proposed. Firstly, this paper designed an 18-layer convolutional neural network (CNN) based on the residual structure, which helped model fully extract the local features. Then, the bi-directional gated recurrent unit (BiGRU) was used to explore the temporal correlation for further obtaining the temporal features. Finally, the self-attention mechanism was built to weight important information and enhance model's ability to extract important features, which helped model achieve higher classification accuracy. In addition, in order to mitigate the interference on classification performance due to data imbalance, the study utilized multiple approaches for data augmentation. The experimental data in this study came from the arrhythmia database constructed by MIT and Beth Israel Hospital (MIT-BIH), and the final results showed that the proposed model achieved an overall accuracy of 98.33% on the original dataset and 99.12% on the optimized dataset, which demonstrated that the proposed model can achieve good performance in ECG signal classification, and possessed potential value for application to portable ECG detection devices.