High-frequency QRS analysis in the evaluation of chest pain in the emergency department.

OBJECTIVES: High frequency QRS (HFQRS) analysis has been shown to be an accurate marker for myocardial ischemia. Our objective was to test the use of HFQRS in diagnosing ACS in the emergency department. METHODS: 324 patients presenting to the ED with chest pain were enrolled. Resting ECG was recorded and later analyzed by an HFQRS algorithm. Results were compared to the conventional ECG diagnosis by 3 independent interpretations: treating physician, expert cardiologist and an automated computer program. RESULTS: The HFQRS analysis demonstrated improved sensitivity (67.5%) for the NSTE-ACS group compared to the human interpreters (59.7% and 53.2% for the treating physician and cardiologist respectively) with similar specificity. The automatic program had significantly lower sensitivity (31%) with a higher specificity (77%). CONCLUSIONS: HFQRS which has shown great promise in diagnosing stable CAD may also be helpful in the ED for diagnosing ACS.

Quantifying QRS changes during myocardial ischemia: Insights from high frequency electrocardiography.

Over four decades of high frequency electrocardiography research have provided a body of knowledge about QRS changes during myocardial ischemia, and the techniques to measure and quantify them. High-frequency QRS (HFQRS) components, being closely related to the pattern of ventricular depolarization, carry valuable clinical information. Changes in HFQRS amplitude and morphology have been shown to be sensitive diagnostic markers of myocardial ischemia, often superior to measures of ST-T segment changes. Clinical studies in patients undergoing exercise testing have consistently demonstrated the incremental diagnostic value of HFQRS analysis in detection of demand ischemia. In 6 studies that evaluated the HyperQ™ technology, the average sensitivity and specificity of HFQRS analysis were 75%±6% and 80%±6%, respectively, compared to average sensitivity 48%±16% and average specificity 70%±15% of ST segment analysis. In patients with acute supply ischemia, recent studies characterized and quantified the ischemic HFQRS patterns. HFQRS morphology index was found to be higher in patients with acute coronary syndrome (ACS), compared to non-ischemic, with good sensitivity in patients without ST elevation. These research findings may be translated into commercially-available ECG systems and be used in clinical practice for improved diagnosis and monitoring of myocardial ischemia.

High-frequency QRS analysis in patients with acute myocardial infarction: a preliminary study.

BACKGROUND: The 12-lead electrocardiogram (ECG) is a primary tool in the evaluation and risk stratification of patients with suspected acute myocardial infarction (AMI), even though the initial ECG of these patients is often normal or nondiagnostic. Myocardial ischemia induces depolarization changes that can be quantified by analysis of high-frequency QRS (HFQRS) components. We aimed to demonstrate the potential usefulness of HFQRS analysis in diagnosing myocardial ischemia by characterizing the morphological patterns of the HFQRS signals in patients with AMI before and following reperfusion. METHODS: Five-minute high-resolution ECG was acquired from 30 patients with AMI (age 55 ± 11 years, 26 men) upon their admission to the intensive coronary care unit (ICCU). Serial ECGs were acquired following coronary revascularization and after additional 24 hours (24h). High-frequency morphology index (HFMI), quantifying the extent of ischemic patterns was computed by a custom software, and its values were compared between the serial ECG measurements. RESULTS: HFMI values were significantly higher on the admission ECG as compared to the post intervention ECG (4.6 ± 2.9% vs 3.4 ± 2.3%, P < 0.05) and to the 24h ECG (4.6 ± 2.9% vs 2.8 ± 2.1%, P < 0.01). In 79% of the patients who were successfully revascularized HFMI value decreased from admission ECG to 24h ECG. CONCLUSIONS: Analysis of HFQRS morphology in patients with AMI provides information about the existence and severity of myocardial ischemia. HFQRS analysis may aid in risk stratification of patients with suspected myocardial ischemia, complementarily to conventional ECG.

Changes in High-Frequency Intracardiac Electrogram Indicate Cardiac Ischemia.

High-frequency QRS (HFQRS) analysis of surface ECG is a reliable marker of cardiac ischemia (CI). This study aimed to assess the response of HFQRS signals from standard intracardiac electrodes (iHFQRS) to CI in swine and compare them with conventional ST-segment deviations. Devices with three intracardiac leads were implanted in three swine in a controlled environment. CI was induced by inflating a balloon in epicardial coronary arteries. A designated signal-processing algorithm was applied to quantify the iHFQRS content before, during, and after each occlusion. iHFQRS time responses were compared to conventional ST-segment deviations. Thirty-three over thirty-nine (85%) of the occlusions presented significant reduction in the iHFQRS signal, preceding ST-segment change, being the only indicator of CI in brief occlusions. iHFQRS was found to be an early indicator for the onset of CI and demonstrated superior sensitivity to conventional ST-segment deviations during brief ischemic episodes.

Diagnosing and monitoring pleural effusion using parametric electrical impedance tomography - a computational 3D model and preliminary experimental results.

PURPOSE: Diagnosing and monitoring pleural effusion (PE) is challenging due unsuitability of existing modalities. In the present study, a novel parametric electrical impedance tomography (pEIT) technique, tailored to a clinically feasible system to diagnose PE is presented. METHODS: An electrical impedance tomography (EIT) numeric solver was applied to a 3D realistic normal model and five PE models to simulate sets of surface measurements. Simulations were triggered by a series of eight independent projections using five electrodes positioned around the thorax. The relative changes in the potential between the PE models and the normal model were assessed and the error in the estimated PE volume was examined at varying signal to noise ratio (SNR) levels. For experimental feasibility, measurements were performed in four healthy subjects and were correlated with the potentials that were calculated from the normal model. RESULTS: Relative potential changes were notable (reached until ~55%) and increased with the increasing PE volumes. Maximal error of ± 20 [mL] was obtained for SNR levels >50 [dB]. The feasibility real measurements in healthy subjects showed a strong linear correlation (R2 > 0.85) and a successful diagnosis for all subjects. CONCLUSION: The proposed technique can estimate PE volumes from a redundant set of measurements in a realistic 3D human model and may be utilized for monitoring PE patients.

Detection of stress-induced myocardial ischemia from the depolarization phase of the cardiac cycle--a preliminary study.

BACKGROUND: Electrocardiogram (ECG)-based detection of ischemia is typically dependent on identifying changes in repolarization. Analysis of high-frequency QRS (HFQRS) components, related to the depolarization phase of the cardiac action potential, has been reported to better identify ischemia. Our aim was to test the hypothesis that HFQRS analysis is both more sensitive and specific than standard ECG for detecting exercise-induced ischemia in patients undergoing exercise myocardial perfusion imaging (MPI). METHODS: Exercise MPI was performed in 133 consecutive patients (age, 63 +/- 12; 100 males) and used as the gold standard for ischemia. Patients with QRS duration more than 120 milliseconds (n = 20), technical problems (n = 8), or inconclusive MPI (n = 4) were excluded, leaving 101 patients for analysis. Conventional ECG was combined with high-resolution ECG acquisition that was digitized and analyzed using the HyperQ System (BSP, Tel Aviv, Israel). The relative HFQRS intensity change during exercise was used as an index of ischemia. RESULTS: Of the 101 patients who were included in the analysis, 19 exhibited MPI ischemia. The HFQRS index of ischemia was found to be more sensitive (79% vs 41%; P < .05) and more specific (71% vs 57%; P < .05) than conventional ST analysis. CONCLUSIONS: The HFQRS analysis was more sensitive and specific than conventional ECG interpretation in detecting exercise-induced ischemia and exhibited enhanced diagnostic performance in both women and men. Thus, it may aid in the noninvasive diagnosis of ischemic heart disease.

A novel telemedicine system for monitoring congestive heart failure patients.

Congestive heart failure is a widespread cardiac disease in western countries. At present, the main measure for monitoring the level of pulmonary edema in telemedicine systems is weight, which is not a reliable indicator. The authors propose a novel bioimpedance telemedical system to monitor these patients. The system measures the resistivity of each lung using optimization methods and transmits the measurements via a modem to a call center. Preliminary results show that the measured resistivity values among healthy young patients are consistent and reproducible within 48 hours. The mean resistivity values in patients with pulmonary congestion were lower than those of the healthy patients: 887 [Omega*cm]+/-117 vs 1244 [Omega*cm]+/-87 (P<.01). The system is noninvasive, safe, and portable. It retrieves unique information correlated with the amount of fluid in the lungs and transmits the data to a medical call center in order to improve the diagnostics and treatment of congestive heart failure.

Parametric electrical impedance tomography for measuring bone mineral density in the pelvis using a computational model.

Osteoporosis is defined as bone microstructure deterioration resulting a decrease of bone's strength. Measured bone mineral density (BMD) constitutes the main tool for Osteoporosis diagnosis, management, and defines patient's fracture risk. In the present study, parametric electrical impedance tomography (pEIT) method was examined for monitoring BMD, using a computerized simulation model and preliminary real measurements. A numerical solver was developed to simulate surface potentials measured over a 3D computerized pelvis model. Varying cortical and cancellous BMD were simulated by changing bone conductivity and permittivity. Up to 35% and 16% change was found in the real and imaginary modules of the calculated potential, respectively, while BMD changes from 100% (normal) to 60% (Osteoporosis). Negligible BMD relative error was obtained with SNR>60 [dB]. Position changes errors indicate that for long term monitoring, measurement should be taken at the same geometrical configuration with great accuracy. The numerical simulations were compared to actual measurements that were acquired from a healthy male subject using a five electrodes belt bioimpedance device. The results suggest that pEIT may provide an inexpensive easy to use tool for frequent monitoring BMD in small clinics during pharmacological treatment, as a complementary method to DEXA test.

Monitoring lung resistivity changes in congestive heart failure patients using the bioimpedance technique.

The feasibility of a novel, dedicated system for monitoring lung resistivity in congestive heart failure patients, implementing a hybrid approach of the bioimpedance technique, was assessed in this preliminary study. Thirty-three healthy volunteers and 34 congestive heart failure patients were measured with the PulmoTrace system (CardioInspect, Tel Aviv University, Tel Aviv, Israel) during tidal respiration, and the ability to monitor the respective lung resistivity values was assessed. Mean left and right lung resistivity values of 1205+/-163 and 1200+/-165 ohm.cm for the control group and 888+/-193 and 943+/-187 ohm.cm for the congestive heart failure group were found, indicating a significant (p<2.10(-7)) difference between the two groups. The results of long-term monitoring of two patients during medical treatment are also shown. This hybrid approach system is believed to improve diagnostic capabilities and help physicians to better adjust medication dosage on a frequent basis.

Induced current bio-impedance technique for monitoring cryosurgery procedure in a two-dimensional head model using generalized coordinate systems.

In the noninvasive bio-impedance technique, small amplitude currents are applied to the body and the developing potentials on its surface are measured. This noninvasive technique is used to monitor physiological and pathological processes, which alter the values or the spatial distribution of the electrical impedance inside the human body. A possible application of the bio-impedance technique is monitoring brain cryosurgery procedure--a surgical technique that employs freezing to destroy undesirable tissues. A numerical solver was developed to evaluate the ability of an induced-current bio-impedance system to monitor the growth of the frozen tissue inside the head in simulation. The forward-problem bio-impedance solver, which is based on the finite volume method in generalized two-dimensional (2-D) coordinate systems, was validated by a comparison to a known analytical solution for body-fitted and Cartesian meshing grids. The sensitivity of the developed surface potential to the ice-ball area was examined using a 2-D head model geometry, and was found to range between 0.8 x 10(-2) and 1.68 x 10(-2) (relative potential difference/mm2), depending on the relative positioning of the excitation coil and the head. The maximal sensitivity was achieved when the coil was located at the geometrical center of the model.

Monitoring brain damage using bioimpedance technique in a 3D numerical model of the head.

Disturbance in the blood supply to the brain causes a stroke or cerebrovascular accident. This can be due to ischemia caused by blockage (thrombosis, arterial embolism) or a hemorrhage. In this study, the feasibility of basic electrical impedance technique for monitoring such damage was analyzed using a computerized model. Simulations were conducted on a realistic 3D numerical model of the head. Tissues were assumed to act as linear isotropic volume conductors, and the quasi-static approximation was applied. Electrical potentials were calculated by solving Poisson's equation, using the finite volume method and the successive over relaxation method. Left-right asymmetry was calculated for several conductivities and volumes of the damaged region. The results were compared with the left-right asymmetry in a head model with normal brain. A negative asymmetry was revealed for blockage (i.e. the potential amplitude over the ischemic hemisphere was greater than that over the intact hemisphere). In case of hemorrhage, a positive asymmetry was found. Furthermore, correlation was found between the location of the damaged region and the electrodes with significant asymmetry. The 3D numerical simulations revealed that the electrical conductivity and the size of the damaged tissue have an effect on the left-right asymmetry of the surface potential.

Induced-current electrical impedance tomography: a 2-D theoretical simulation.

A reconstruction algorithm, based on the modified Newton-Raphson algorithm, was developed for induced-current electrical impedance tomography and studied in theoretical two-dimensional geometry representing a human thorax. The finite-volume method was applied for the discretization of the physical domain, resulting in a symbolic representation of the Jacobian matrix, which is accurate and fast to construct. Several system configurations, differing in the number of excitation coils and electrodes, were simulated, and the performance in thoracic imaging was studied. It was found that a six-coil system shows a significant 40% improvement of conductivity values reconstruction over the three-coil system (an error of 2.06 omega(-1) compared with 3.44 omega(-1)). A number of 32 electrodes was found to be sufficient, being the smallest number of electrodes to still provide a reasonable performance (only 4.2% degradation in average conductivity error compared with the maximum possible 106-electrode system).

Automatic identification of bacterial types using statistical imaging methods.

The objective of the current study is to develop an automatic tool to identify microbiological data types using computer-vision and statistical modeling techniques. Bacteriophage (phage) typing methods are used to identify and extract representative profiles of bacterial types out of species such as the Staphylococcus aureus. Current systems rely on the subjective reading of profiles by a human expert. This process is time-consuming and prone to errors, especially as technology is enabling the increase in the number of phages used for typing. The statistical methodology presented in this work, provides for an automated, objective and robust analysis of visual data, along with the ability to cope with increasing data volumes.

Induced current electrical impedance tomography system: experimental results and numerical simulations.

In electrical impedance tomography (EIT), measurements of developed surface potentials due to applied currents are used for the reconstruction of the conductivity distribution. Practical implementation of EIT systems is known to be problematic due to the high sensitivity to noise of such systems, leading to a poor imaging quality. In the present study, the performance of an induced current EIT (ICEIT) system, where eddy current is applied using magnetic induction, was studied by comparing the voltage measurements to simulated data, and examining the imaging quality with respect to simulated reconstructions for several phantom configurations. A 3-coil, 32-electrode ICEIT system was built, and an iterative modified Newton-Raphson algorithm was developed for the solution of the inverse problem. The RMS norm between the simulated and the experimental voltages was found to be 0.08 +/- 0.05 mV (<3%). Two regularization methods were implemented and compared: the Marquardt regularization and the Laplacian regularization (a bounded second-derivative regularization). While the Laplacian regularization method was found to be preferred for simulated data, it resulted in distinctive spatial artifacts for measured data. The experimental reconstructed images were found to be indicative of the angular positioning of the conductivity perturbations, though the radial sensitivity was low, especially when using the Marquardt regularization method.

Validation of vital signs recorded via a new telecare system.

A telecare system (Medic4All) has been developed that relies on a wireless wristwatch-like sensor to measure the pulse wave from the radial artery. From this, the heart rate and respiration rate are derived. The system's performance was examined by comparing the results obtained from the pulse wave signal with those obtained from conventional electrocardiographic and spirometer devices. A total of 144 patients participated in the study; their mean (SD) age was 43 (18) years. There were 44 cardiac patients in group 1 and 100 healthy patients, who were studied in their homes, in group 2. There was a significant correlation between the heart rates measured by the two monitoring methods. A 'difference versus average' analysis showed that the error distribution had a mean (SD) value of -0.1 (3.3) beats/min. Similarly, the respiration rates measured by the two techniques were significantly correlated. The error distribution had a mean (SD) value of 0.1 (1.9) respirations/min. The present study suggests that the wrist-worn sensor represents a promising tool for online detection and monitoring of vital signs in the home.

Assessment of cardiac stroke volume in patients with implanted cardiac pacemaker using parametric electrical impedance tomography: a theoretical 2D study.

The present theoretical study examines the ability to estimate cardiac stroke volume (CSV) in patients with implanted cardiac pacemaker using parametric electrical impedance tomography (pEIT) in a 2D computerized model of the thorax. CSV is a direct indicator of the cardiac pumping efficiency. The commonly used methods for measuring CSV require the invasive procedure of right heart catheterization or use expensive imaging techniques (i.e., MRI). Hence, experience with these techniques for diagnosis and monitoring has been limited to hospitalized patients. In the present study, pEIT scheme was applied in a computerized 2D model of the human thorax with implanted cardiac device to determine the left ventricular (LV) volume at different cardiac cycle phases. The LV was simulated as a prolate ellipse with its axes' lengths as the reconstruction parameters while all other geometries and conductivity values remained constant. An optimization was carried out in order to ensure that the ellipse is the appropriate model for the LV at each cardiac cycle phase. LV volumes calculated by both the pEIT algorithm and the ellipsoid model are consistent. A high correlation (ρ = 0.99) between the true and reconstructed volumes was found. The SV calculation error was ∼1%. The results suggest that the LV volume can be estimated using the pEIT method in a 2D computerized model, and that the method has the potential to be used for monitoring patients with implanted cardiac pacemaker.

Bioimpedance technique for monitoring cerebral artery stenosis in a 3D numerical model of the head.

Insufficient blood supply to the brain causes a transient ischemic attack (TIA) or a stroke. One of the causes to insufficient blood supply is cerebral artery stenosis. In this study, the feasibility of bioimpedance for monitoring such stenosis was analyzed. Simulations were conducted on a realistic numerical model of the head, focusing on the left middle cerebral artery (LMCA). Tissues were assumed to act as linear isotropic volume conductors, and the quasi-static approximation was applied. Electrical potentials were calculated by solving Poisson's equation, using the finite volume method (FVM) and the successive over relaxation (SOR) method. The best sensitivity found was 0.471 µV/% stenosis, using this electrode configuration: one injector near the left eye and the other injector near the right ear, one measurement position near the left eye and the other one in the right ear, keeping a distance of at least 2.5 cm between measurement and injection positions. The maximal sensitivity achieved in the numerical model under the applied assumptions supports the feasibility of bioimpedance technique for monitoring cerebral artery stenosis. However, according to sensitivity [1/m(4)] maps, calculated for the preferable electrode configurations, the measurements' specificity to the stenosis degree might be inadequate and should be further studied.

Estimating pulmonary congestion in elderly patients using bio-impedance technique: correlation with clinical examination and X-ray results.

The bio-impedance technique provides a safe, low-cost and non-invasive alternative for lung fluid level monitoring. Here we have investigated the feasibility of a novel bio-impedance system in measuring pulmonary congestion in elderly patients suffering from congestive heart failure (CHF). The system employed a parametric reconstruction algorithm to assess mean lung resistivity. Fourteen patients were studied before and following treatment to reduce lung congestion. Significant correlation was found between the changes of radiographic scores and resistivity values following treatment (R=0.57, p<0.04). A significant difference in resistivity values between patients having low and high congestion degrees was also demonstrated (p<0.01). Moreover, the bio-impedance technique successfully diagnosed an improvement of congestion level in 10 out of 14 patients, while the radiographic score indicated such an improvement in only 5 out of the 14 patients. These results, along with our previous validation studies, suggest that the bio-impedance technique is a feasible bedside system for monitoring of pulmonary congested patients, thus facilitating effective treatment strategies.

High-frequency QRS electrocardiogram analysis during exercise stress testing for detecting ischemia.

INTRODUCTION: ECG stress testing is an inexpensive and non-invasive detector of myocardial ischemia; addition of high-frequency QRS analysis (HFQRS) may improve accuracy. This study compared HFQRS during exercise in patients with and without ischemia as defined by multiple criteria. MATERIAL AND METHODS: High-resolution ECGs were recorded for 139 patients undergoing T99-sestamibi/T201-thallium stress testing. Twenty-three were positive by at least two and 37 were negative for ischemia by all three of the following criteria: nuclear scan, ST-segment analysis and typical angina. Sixty-four not meeting criteria for positive or negative, six with adenosine test and nine patients with ECG recording artifacts were excluded. Mean age of the study group was 62+/-10 years, 83% were male. Ischemic patients had a higher incidence of previous myocardial infarction and coronary intervention than non-ischemic patients (74% vs. 46%; P=0.03 and 70% vs. 43%; P=0.05, respectively), but had a lower body mass index (28.7+/-5 vs. 33.0+/-8; P=0.015). HFQRS analysis consisting of signal averaging (150-250 Hz) and calculation of root mean squared values for each lead at different time points was performed and was similar between the groups. The relative change in HFQRS (RCQ) was calculated for each lead: {(maxHFQRS-minHFQRS)/maxHFQRS}. For each patient an RCQ index was calculated by averaging the two leads with the greatest RCQ value. The RCQ index was greater in ischemic vs. non-ischemic patients (45% vs. 34%; P=0.0069). CONCLUSION: Maximum decrease in HFQRS, as quantified by RCQ index, was greater in ischemic vs. non-ischemic patients. Use of the RCQ index may improve the diagnosis of ischemia during exercise stress testing.