AIM: To describe the electrocardiographic(ECG) phenomena characterized by T-wave inversion in the precordial leads in adults and to highlight its differential diagnosis. METHODS: A retrospective chart review of 8 adul...AIM: To describe the electrocardiographic(ECG) phenomena characterized by T-wave inversion in the precordial leads in adults and to highlight its differential diagnosis. METHODS: A retrospective chart review of 8 adult patients who were admitted with ECG T-wave inversion in the anterior chest leads with or without prolongation of corrected QT(QTc) interval. They had different clinical conditions. Each patient underwent appropriate clinical assessment including investigation for myocardial involvement. Single and multimodality noninvasive, semi-invasive and invasive diagnostic approach were used to ascertain the diagnosis. The diagnostic assessment included biochemical investigation, cardiac and abdominal ultrasound, cerebral and chest computed tomography, nuclear medicine and coronary angiography.RESULTS: Eight adult subjects(5 females) with a mean age of 66 years(range 51 to 82) are analyzed. The etiology of T-wave inversion in the precordial leads were diverse. On admission, all patients had normal blood pressure and the ECG showed sinus rhythm. Five patients showed marked prolongation of the QTc interval. The longest QTc interval(639 ms) was found in the patient with pheochromocytoma. Giant T-wave inversion(≥ 10 mm) was found in pheochromocytoma followed by electroconvulsive therapy and finally ischemic heart disease. The deepest T-wave was measured in lead V3(5 ×). In 3 patients presented with mild T-wave inversion(patients 1, 5 and 4 mm), the QTc interval was not prolonged(432, 409 and 424 msec), respectively.CONCLUSION: T-wave inversion associated with or without QTc prolongation requires meticulous history taking, physical examination and tailored diagnostic modalities to reach rapid and correct diagnosis to establish appropriate therapeutic intervention.展开更多
Background:T-wave alternans(TWA)is a risk factor of ventricular arrhythmias or sudden cardiac death(SCD)in patients with ischemic cardiomyopathy.Nevertheless,the relationship between TWA and adverse cardiac events(ACE...Background:T-wave alternans(TWA)is a risk factor of ventricular arrhythmias or sudden cardiac death(SCD)in patients with ischemic cardiomyopathy.Nevertheless,the relationship between TWA and adverse cardiac events(ACE)in patients with congenital long QT syndrome(LQT)remains controversial.Methods:A systematic electronic search of PubMed,Embase and the Cochrane Library was conducted from database inception dates to 28 April 2021 and assessed the relationship between TWA and ACE in patients with LQTS.Sub-group analysis evaluated the association between microvolt TWA(MTWA)and ACE in different monitoring models and ECGlead numbers.Results:A pooled analysis of seven studies of 625 patients with LQTS showed that TWA was significantly associated with ACE(OR 3.16,95%CI 1.86–5.37,P<0.001).Advanced analysis showed that macroscopic TWA was significantly related to ACE(OR 6.01,95%CI 2.96–12.21,P<0.001),while MTWA did not(OR 0.92,95%CI 0.37–2.30,P=0.85).Sub-group analysis showed that MTWA recorded in 24 h continuous ECG(OR 6.79,95%CI 0.80–57.75,P=0.08)might have a stronger association with ACE than recorded in stress ECG(OR 0.28,95%CI 0.07–1.10,P=0.07).No difference was observed between MTWA measured in multi-lead ECG and limited ECG leads(P=0.15).Conclusions:Macroscopic TWA was significantly related to ACE in patients with LQTS.In terms of MTWA,MTWA recorded in 24 h continuous ECG might have a stronger association with ACE than stress ECG,but still deserves further evaluation.展开更多
T-wave alternans(TWA)refers to the periodic beat-to-beat variation in the amplitude of T-wave in the electrocardiogram(ECG)signal in an ABAB-pattern.TWA has been proven to be a very important indicator of malignant ar...T-wave alternans(TWA)refers to the periodic beat-to-beat variation in the amplitude of T-wave in the electrocardiogram(ECG)signal in an ABAB-pattern.TWA has been proven to be a very important indicator of malignant arrhythmia risk stratification.A new method to detect TWA by combining fractional Fourier transform(FRFT)and tensor decomposition is proposed.First,the T-wave vector is extracted from the ECG of each heartbeat,and its FRFT amplitudes at multiple orders are arranged to form a T-wave matrix.Then,a third-order tensor is composed of T-wave matrices of several consecutive heart beats.After tensor decomposition,projection matrices are obtained in three dimensions.The complexity of the projection matrix is measured by Shannon entropy to obtain feature vector to detect the presence of TWA.Results show that the sensitivity,specificity,and accuracy of the algorithm on the MIT-BIH database are 91.16%,94.25%,and 92.68%,respectively.This method effectively utilizes the fractional domain information of ECG,and shows the promising potential of the FRFT in ECG signal processing.展开更多
T-wave alternans (TWA), consisting in an alternation of the electrocardiographic (ECG) repolarization segment (T-wave), is a promising index of the risk of sudden cardiac death. By definition, it is characterized by a...T-wave alternans (TWA), consisting in an alternation of the electrocardiographic (ECG) repolarization segment (T-wave), is a promising index of the risk of sudden cardiac death. By definition, it is characterized by a frequency component, termed fTWA, that matches half heart rate. The heart-rate adaptive match filter (AMF) based method is a technique for automatic TWA identification from the digital ECG. Aim of the present study was to provide a complete technical description of the filter able to explain its methodological principles. The AMF is usually realized as a 6th order Butterworth filter with a narrow (0.12 Hz) passing band centered in fTWA. It is applied in a bidirectional fashion, so that final filtering order is 12. While extracting the TWA component, the AMF simultaneously filters out every ECG component including noise and artefacts, and thus results are very robust. Goodness of the technique was tested using 8 synthetic ECG tracings corrupted by typical noisy factors, such as white random noise, baseline wanderings, heart-rate variability, and others. Six ECG tracings were affected by 100 μV TWA, whereas two were not. Results indicate that the AMF-based method is able to prevent false-positive and false-negative detections and, thus, represents a useful tool for a reliable TWA identification.展开更多
Presently T-wave alternans (TWA) has become a clinical index of non-invasive diagnosis for heart sudden death prediction, and detecting T-wave alternate accurately is particularly important. This paper introduces an a...Presently T-wave alternans (TWA) has become a clinical index of non-invasive diagnosis for heart sudden death prediction, and detecting T-wave alternate accurately is particularly important. This paper introduces an algorithm for detecting TWA using Poincare mapping method which is a technique for nonlinear dynamic systems to display periodic behavior. Sample series of beat to beat cycles were selected to prepare Poincare mapping method. Vector Angle Index (VAI), which is the mean of the difference between θi (the angle between the line connecting the i point to the origin and the X axis) and 45 degrees was used to present the presence or absence of TWA. The value of 0.9 rad ≤ VAI ≤ 1.03 rad is accepted as a level determinative for presence of TWA. VAI via Poincare mapping method (PM) is used for correlation analysis with T-wave alternans voltage (Vtwa) by way of the spectral method (SM). The cross-correlation coefficient between Vtwa and VAI is γ = 0.8601. The algorithm can identify the absence and presence of TWA accurately and provide idea for further study of TWA-PM.展开更多
Objective: To explore the application value of electrocardiograph (ECG) T-wave Alternans (TWA) anomaly in acute stage of intracerebral hemorrhage patients. Methods: We choose 1175 intracerebral hemorrhage patients who...Objective: To explore the application value of electrocardiograph (ECG) T-wave Alternans (TWA) anomaly in acute stage of intracerebral hemorrhage patients. Methods: We choose 1175 intracerebral hemorrhage patients whose conventional 12-lead ECG has TWA in our hospital from January 2011 to December 2015, 751 patients without TWA in the same period as the control group, compared the volume of intracerebral hemorrhage, bleeding site and mortality between the 2 groups. Results: In TWA group, 247 cases died, 361 cases with massive intracerebral hemorrhage, 298 cases with brain stem hemorrhage;in TWA negative group (control group), 41 cases died, 93 cases with massive brain hemorrhage, 64 cases with brain stem hemorrhage. There are statistical differences between two groups (P Conclusion: The occurrence of TWA is significantly related to the volume of bleeding, the bleeding site and mortality, and can be used as an important parameter in the prognosis of intracerebral hemorrhage.展开更多
Several cardiac outcomes have been reported with West Nile-encephalitis;however, the underlying pathophysiology remains complex. We present a 42-year-old female, with multiple sclerosis, whose neurological symptoms an...Several cardiac outcomes have been reported with West Nile-encephalitis;however, the underlying pathophysiology remains complex. We present a 42-year-old female, with multiple sclerosis, whose neurological symptoms and respiratory decline were finally explained by the diagnosis of West Nile-encephalitis. During her admission, the isolated peaked T-waves indicated the underlying stress-induced cardiomyopathy. The absence of all other causes of hyperacute T-waves, their subsequent resolution with the resolution of infection and improvement in wall motion abnormalities, further supported the association. This case highlights the importance of considering hyperacute T-waves in an approach towards the diagnosis of WNV-encephalitis related atypical variant of stress-induced cardiomyopathy.展开更多
Background: Atrial fibrillation (AF) and T wave inversion (TWI) are occasionally found on pre-operative electrocardiograms (EKG) of patients with long standing hy-pertension (HTN) associated with left ventricular hype...Background: Atrial fibrillation (AF) and T wave inversion (TWI) are occasionally found on pre-operative electrocardiograms (EKG) of patients with long standing hy-pertension (HTN) associated with left ventricular hypertrophy (LVH). Each of these two pathologies, AF and LVH, can impose negative hemodynamic effects on the car-diac function. Case: We present a case of a patient with AF, TWI and long standing HTN that went into post-operative pulmonary edema. Conclusion: Even returning to base line poorly controlled hypertension, and even more so during a hypertensive cri-sis, their concurrent presence may inflict even more detrimental effect manifested by elevation of pulmonary venous pressure and pulmonary edema.展开更多
Background: The long-term predicted value of microvolt T-wave alternans (MTWA) for ventricular tachyarrhythmia in patients with arrhythmogenic right ventricular cardiomyopathy (ARVC) remains unclear. Our study explore...Background: The long-term predicted value of microvolt T-wave alternans (MTWA) for ventricular tachyarrhythmia in patients with arrhythmogenic right ventricular cardiomyopathy (ARVC) remains unclear. Our study explored the characteristics of MTWA and its prognostic value when combined with an electrophysiologic study (EPS) in patients with ARVC. Methods: All patients underwent non-invasive MTWA examination with modified moving average (MMA) analysis and an EPS. A positive event was defined as the first occurrence of sudden cardiac death, documented sustained ventricular tachycardia (VT), ventricular fibrillation, or the administration of appropriate implantable cardioverter defibrillator therapy including shock or antitachycardia pacing. Results: Thirty-five patients with ARVC (age 38.6 ± 11.0 years;28 males) with preserved left ventricular (LV) function were recruited. The maximal TWA value (MaxValt) was 17.0 (11.0–27.0)μV. Sustained VT was induced in 22 patients by the EPS. During a median follow-up of 99.9 ± 7.7 months, 15 patients had positive clinical events. When inducible VT was combined with the MaxValt, the area under the curve improved from 0.739 to 0.797. The receiver operating characteristic curve showed that a MaxValt of 23.5 μV was the optimal cutoff value to identify positive events. The multivariate Cox regression model for survival showed that MTWA (MaxValt, hazard ratio [HR], 1.06;95% confidence interval [CI], 1.01–1.11;P = 0.01) and inducible VT (HR, 5.98;95% CI, 1.33–26.8;P = 0.01) independently predicted positive events in patients with ARVC. Conclusions: MTWA assessment with MMA analysis complemented by an EPS might provide improved prognostic ability in patients with ARVC with preserved LV function during long-term follow-up.展开更多
T-wave alternans （TWA） in surface electrocardiograph （ECG） signal is considered a marker of abnormal ventricular function which may be associated with ventricular tachy- cardia. Several methods have been developed...T-wave alternans （TWA） in surface electrocardiograph （ECG） signal is considered a marker of abnormal ventricular function which may be associated with ventricular tachy- cardia. Several methods have been developed in recent years to evaluate the important feature. One such method is known as modified moving average （MMA） analysis, which performs well for different levels of TWA, but it is sensitive to the noise in T-waves. In this paper we propose an improved MMA algorithm, which adds a stage of T-wave curve fitting for the MMA method before intermediate averaging. The curve fitting is performed by means of least square method technique. Our assessment study demon- strates the improved performance.展开更多
The implantable cardioverter defibrillator （ICD） represents today the treatment and prophylaxis of choice for patients at risk for sustained ventricular tachyarrhythmias.1-6 Accurate sensing of ventricular tachyarr...The implantable cardioverter defibrillator （ICD） represents today the treatment and prophylaxis of choice for patients at risk for sustained ventricular tachyarrhythmias.1-6 Accurate sensing of ventricular tachyarrhythmias is a critical aspect of the function of ICD. All currently available models include algorithms with variable sensitivity, allowing adjustments which optimize the detection of low amplitude signals during ventricular tachyarrhythmia. However,展开更多
目的分析轮班工作对医务人员发生心电图非特异性ST-T改变(nospecific ST-segment and T-ware abnormalities in electrocardiogram,NSSTTAs)的影响。方法选取杭州市某公立医院432名在职医务人员作为研究对象,其中参与轮班的207名医务人...目的分析轮班工作对医务人员发生心电图非特异性ST-T改变(nospecific ST-segment and T-ware abnormalities in electrocardiogram,NSSTTAs)的影响。方法选取杭州市某公立医院432名在职医务人员作为研究对象,其中参与轮班的207名医务人员为轮班组,不参与轮班的225名医务人员为非轮班组,分析轮班工作与医务人员发生NSSTTAs的关系。结果结果显示,共检出NSSTTAs阳性72例(16.67%),其中轮班组NSSTTAs阳性率要明显高于非轮班组(24.64%vs.9.33%,P<0.01)。多因素logistic回归分析结果显示,在排除年龄、体质量指数(body mass index,BMI)、血压、饮酒史、空腹血糖(fasting blood glucose,FBG)、血清总胆固醇(serum total cholesterol,TC)等混杂因素后,轮班工作是医务人员发生NSSTTAs的独立危险因素(OR=7.559,P<0.01)。且不同轮班制度,不同夜班频率及不同轮班年限的轮班医务人员NSSTTAs阳性率较非轮班者有不同程度的升高(P均<0.05)。结论提示,轮班工作与医务人员发生NSSTTAs有关,应重视轮班医务人员的心血管健康问题。展开更多
This study investigated the relationship between electrocardiography(ECG)and serum potassium levels in 100 children aged 6–18 years with chronic kidney disease admitted to the Department of Nephrology,Beijing Childre...This study investigated the relationship between electrocardiography(ECG)and serum potassium levels in 100 children aged 6–18 years with chronic kidney disease admitted to the Department of Nephrology,Beijing Children's Hospital Affiliated,Capital Medical University,China.The research data were obtained from children in their growth and development stages with significant differences in their physical characteristics.We established a promising indicator,Ts/a,calculated Ts/a for V2–V6 in 100 children,and correlated it with their serum potassium levels.Despite significant differences in age and body shape between developing children and adults,the results showed that the Ts/a values of V5 and V6 were more strongly correlated with blood potassium values.T wave at the V5 and V6 leads in children can reflect the direction of the primary amplitude of the T-wave and Twave downward slope,and the heart space position in the chest characteristics during childhood lead to these results.This study provides an essential foundation for the future mobile monitoring of serum potassium levels.展开更多
文摘AIM: To describe the electrocardiographic(ECG) phenomena characterized by T-wave inversion in the precordial leads in adults and to highlight its differential diagnosis. METHODS: A retrospective chart review of 8 adult patients who were admitted with ECG T-wave inversion in the anterior chest leads with or without prolongation of corrected QT(QTc) interval. They had different clinical conditions. Each patient underwent appropriate clinical assessment including investigation for myocardial involvement. Single and multimodality noninvasive, semi-invasive and invasive diagnostic approach were used to ascertain the diagnosis. The diagnostic assessment included biochemical investigation, cardiac and abdominal ultrasound, cerebral and chest computed tomography, nuclear medicine and coronary angiography.RESULTS: Eight adult subjects(5 females) with a mean age of 66 years(range 51 to 82) are analyzed. The etiology of T-wave inversion in the precordial leads were diverse. On admission, all patients had normal blood pressure and the ECG showed sinus rhythm. Five patients showed marked prolongation of the QTc interval. The longest QTc interval(639 ms) was found in the patient with pheochromocytoma. Giant T-wave inversion(≥ 10 mm) was found in pheochromocytoma followed by electroconvulsive therapy and finally ischemic heart disease. The deepest T-wave was measured in lead V3(5 ×). In 3 patients presented with mild T-wave inversion(patients 1, 5 and 4 mm), the QTc interval was not prolonged(432, 409 and 424 msec), respectively.CONCLUSION: T-wave inversion associated with or without QTc prolongation requires meticulous history taking, physical examination and tailored diagnostic modalities to reach rapid and correct diagnosis to establish appropriate therapeutic intervention.
基金This work was supported by Beijing Municipal Science&Technology Commission(No.Z191100006619007)Beijing Municipal Administration of Hospitals’Ascent Plan(DFL20190902)of Professor Ping Zhang.
文摘Background:T-wave alternans(TWA)is a risk factor of ventricular arrhythmias or sudden cardiac death(SCD)in patients with ischemic cardiomyopathy.Nevertheless,the relationship between TWA and adverse cardiac events(ACE)in patients with congenital long QT syndrome(LQT)remains controversial.Methods:A systematic electronic search of PubMed,Embase and the Cochrane Library was conducted from database inception dates to 28 April 2021 and assessed the relationship between TWA and ACE in patients with LQTS.Sub-group analysis evaluated the association between microvolt TWA(MTWA)and ACE in different monitoring models and ECGlead numbers.Results:A pooled analysis of seven studies of 625 patients with LQTS showed that TWA was significantly associated with ACE(OR 3.16,95%CI 1.86–5.37,P<0.001).Advanced analysis showed that macroscopic TWA was significantly related to ACE(OR 6.01,95%CI 2.96–12.21,P<0.001),while MTWA did not(OR 0.92,95%CI 0.37–2.30,P=0.85).Sub-group analysis showed that MTWA recorded in 24 h continuous ECG(OR 6.79,95%CI 0.80–57.75,P=0.08)might have a stronger association with ACE than recorded in stress ECG(OR 0.28,95%CI 0.07–1.10,P=0.07).No difference was observed between MTWA measured in multi-lead ECG and limited ECG leads(P=0.15).Conclusions:Macroscopic TWA was significantly related to ACE in patients with LQTS.In terms of MTWA,MTWA recorded in 24 h continuous ECG might have a stronger association with ACE than stress ECG,but still deserves further evaluation.
基金supported by the National Natural Science Found-ation of China(No.61701028).
文摘T-wave alternans(TWA)refers to the periodic beat-to-beat variation in the amplitude of T-wave in the electrocardiogram(ECG)signal in an ABAB-pattern.TWA has been proven to be a very important indicator of malignant arrhythmia risk stratification.A new method to detect TWA by combining fractional Fourier transform(FRFT)and tensor decomposition is proposed.First,the T-wave vector is extracted from the ECG of each heartbeat,and its FRFT amplitudes at multiple orders are arranged to form a T-wave matrix.Then,a third-order tensor is composed of T-wave matrices of several consecutive heart beats.After tensor decomposition,projection matrices are obtained in three dimensions.The complexity of the projection matrix is measured by Shannon entropy to obtain feature vector to detect the presence of TWA.Results show that the sensitivity,specificity,and accuracy of the algorithm on the MIT-BIH database are 91.16%,94.25%,and 92.68%,respectively.This method effectively utilizes the fractional domain information of ECG,and shows the promising potential of the FRFT in ECG signal processing.
文摘T-wave alternans (TWA), consisting in an alternation of the electrocardiographic (ECG) repolarization segment (T-wave), is a promising index of the risk of sudden cardiac death. By definition, it is characterized by a frequency component, termed fTWA, that matches half heart rate. The heart-rate adaptive match filter (AMF) based method is a technique for automatic TWA identification from the digital ECG. Aim of the present study was to provide a complete technical description of the filter able to explain its methodological principles. The AMF is usually realized as a 6th order Butterworth filter with a narrow (0.12 Hz) passing band centered in fTWA. It is applied in a bidirectional fashion, so that final filtering order is 12. While extracting the TWA component, the AMF simultaneously filters out every ECG component including noise and artefacts, and thus results are very robust. Goodness of the technique was tested using 8 synthetic ECG tracings corrupted by typical noisy factors, such as white random noise, baseline wanderings, heart-rate variability, and others. Six ECG tracings were affected by 100 μV TWA, whereas two were not. Results indicate that the AMF-based method is able to prevent false-positive and false-negative detections and, thus, represents a useful tool for a reliable TWA identification.
文摘Presently T-wave alternans (TWA) has become a clinical index of non-invasive diagnosis for heart sudden death prediction, and detecting T-wave alternate accurately is particularly important. This paper introduces an algorithm for detecting TWA using Poincare mapping method which is a technique for nonlinear dynamic systems to display periodic behavior. Sample series of beat to beat cycles were selected to prepare Poincare mapping method. Vector Angle Index (VAI), which is the mean of the difference between θi (the angle between the line connecting the i point to the origin and the X axis) and 45 degrees was used to present the presence or absence of TWA. The value of 0.9 rad ≤ VAI ≤ 1.03 rad is accepted as a level determinative for presence of TWA. VAI via Poincare mapping method (PM) is used for correlation analysis with T-wave alternans voltage (Vtwa) by way of the spectral method (SM). The cross-correlation coefficient between Vtwa and VAI is γ = 0.8601. The algorithm can identify the absence and presence of TWA accurately and provide idea for further study of TWA-PM.
文摘Objective: To explore the application value of electrocardiograph (ECG) T-wave Alternans (TWA) anomaly in acute stage of intracerebral hemorrhage patients. Methods: We choose 1175 intracerebral hemorrhage patients whose conventional 12-lead ECG has TWA in our hospital from January 2011 to December 2015, 751 patients without TWA in the same period as the control group, compared the volume of intracerebral hemorrhage, bleeding site and mortality between the 2 groups. Results: In TWA group, 247 cases died, 361 cases with massive intracerebral hemorrhage, 298 cases with brain stem hemorrhage;in TWA negative group (control group), 41 cases died, 93 cases with massive brain hemorrhage, 64 cases with brain stem hemorrhage. There are statistical differences between two groups (P Conclusion: The occurrence of TWA is significantly related to the volume of bleeding, the bleeding site and mortality, and can be used as an important parameter in the prognosis of intracerebral hemorrhage.
文摘Several cardiac outcomes have been reported with West Nile-encephalitis;however, the underlying pathophysiology remains complex. We present a 42-year-old female, with multiple sclerosis, whose neurological symptoms and respiratory decline were finally explained by the diagnosis of West Nile-encephalitis. During her admission, the isolated peaked T-waves indicated the underlying stress-induced cardiomyopathy. The absence of all other causes of hyperacute T-waves, their subsequent resolution with the resolution of infection and improvement in wall motion abnormalities, further supported the association. This case highlights the importance of considering hyperacute T-waves in an approach towards the diagnosis of WNV-encephalitis related atypical variant of stress-induced cardiomyopathy.
文摘Background: Atrial fibrillation (AF) and T wave inversion (TWI) are occasionally found on pre-operative electrocardiograms (EKG) of patients with long standing hy-pertension (HTN) associated with left ventricular hypertrophy (LVH). Each of these two pathologies, AF and LVH, can impose negative hemodynamic effects on the car-diac function. Case: We present a case of a patient with AF, TWI and long standing HTN that went into post-operative pulmonary edema. Conclusion: Even returning to base line poorly controlled hypertension, and even more so during a hypertensive cri-sis, their concurrent presence may inflict even more detrimental effect manifested by elevation of pulmonary venous pressure and pulmonary edema.
基金This research was supported by grants from the National Natural Science Foundation of China (No. 81470457)the Frontier Technology of Jiangsu Provincial Science and Technology Department (No. BE2016764).
文摘Background: The long-term predicted value of microvolt T-wave alternans (MTWA) for ventricular tachyarrhythmia in patients with arrhythmogenic right ventricular cardiomyopathy (ARVC) remains unclear. Our study explored the characteristics of MTWA and its prognostic value when combined with an electrophysiologic study (EPS) in patients with ARVC. Methods: All patients underwent non-invasive MTWA examination with modified moving average (MMA) analysis and an EPS. A positive event was defined as the first occurrence of sudden cardiac death, documented sustained ventricular tachycardia (VT), ventricular fibrillation, or the administration of appropriate implantable cardioverter defibrillator therapy including shock or antitachycardia pacing. Results: Thirty-five patients with ARVC (age 38.6 ± 11.0 years;28 males) with preserved left ventricular (LV) function were recruited. The maximal TWA value (MaxValt) was 17.0 (11.0–27.0)μV. Sustained VT was induced in 22 patients by the EPS. During a median follow-up of 99.9 ± 7.7 months, 15 patients had positive clinical events. When inducible VT was combined with the MaxValt, the area under the curve improved from 0.739 to 0.797. The receiver operating characteristic curve showed that a MaxValt of 23.5 μV was the optimal cutoff value to identify positive events. The multivariate Cox regression model for survival showed that MTWA (MaxValt, hazard ratio [HR], 1.06;95% confidence interval [CI], 1.01–1.11;P = 0.01) and inducible VT (HR, 5.98;95% CI, 1.33–26.8;P = 0.01) independently predicted positive events in patients with ARVC. Conclusions: MTWA assessment with MMA analysis complemented by an EPS might provide improved prognostic ability in patients with ARVC with preserved LV function during long-term follow-up.
文摘T-wave alternans （TWA） in surface electrocardiograph （ECG） signal is considered a marker of abnormal ventricular function which may be associated with ventricular tachy- cardia. Several methods have been developed in recent years to evaluate the important feature. One such method is known as modified moving average （MMA） analysis, which performs well for different levels of TWA, but it is sensitive to the noise in T-waves. In this paper we propose an improved MMA algorithm, which adds a stage of T-wave curve fitting for the MMA method before intermediate averaging. The curve fitting is performed by means of least square method technique. Our assessment study demon- strates the improved performance.
文摘The implantable cardioverter defibrillator （ICD） represents today the treatment and prophylaxis of choice for patients at risk for sustained ventricular tachyarrhythmias.1-6 Accurate sensing of ventricular tachyarrhythmias is a critical aspect of the function of ICD. All currently available models include algorithms with variable sensitivity, allowing adjustments which optimize the detection of low amplitude signals during ventricular tachyarrhythmia. However,
文摘目的分析轮班工作对医务人员发生心电图非特异性ST-T改变(nospecific ST-segment and T-ware abnormalities in electrocardiogram,NSSTTAs)的影响。方法选取杭州市某公立医院432名在职医务人员作为研究对象,其中参与轮班的207名医务人员为轮班组,不参与轮班的225名医务人员为非轮班组,分析轮班工作与医务人员发生NSSTTAs的关系。结果结果显示,共检出NSSTTAs阳性72例(16.67%),其中轮班组NSSTTAs阳性率要明显高于非轮班组(24.64%vs.9.33%,P<0.01)。多因素logistic回归分析结果显示,在排除年龄、体质量指数(body mass index,BMI)、血压、饮酒史、空腹血糖(fasting blood glucose,FBG)、血清总胆固醇(serum total cholesterol,TC)等混杂因素后,轮班工作是医务人员发生NSSTTAs的独立危险因素(OR=7.559,P<0.01)。且不同轮班制度,不同夜班频率及不同轮班年限的轮班医务人员NSSTTAs阳性率较非轮班者有不同程度的升高(P均<0.05)。结论提示,轮班工作与医务人员发生NSSTTAs有关,应重视轮班医务人员的心血管健康问题。
基金Transformation Incubation Fund for Scientific and Technological Achievements of Beijing Children's Hospital,Capital Medical University.
文摘This study investigated the relationship between electrocardiography(ECG)and serum potassium levels in 100 children aged 6–18 years with chronic kidney disease admitted to the Department of Nephrology,Beijing Children's Hospital Affiliated,Capital Medical University,China.The research data were obtained from children in their growth and development stages with significant differences in their physical characteristics.We established a promising indicator,Ts/a,calculated Ts/a for V2–V6 in 100 children,and correlated it with their serum potassium levels.Despite significant differences in age and body shape between developing children and adults,the results showed that the Ts/a values of V5 and V6 were more strongly correlated with blood potassium values.T wave at the V5 and V6 leads in children can reflect the direction of the primary amplitude of the T-wave and Twave downward slope,and the heart space position in the chest characteristics during childhood lead to these results.This study provides an essential foundation for the future mobile monitoring of serum potassium levels.
