Wearable technology for electrocardiogram and vectocardiogram using the Dower Transformation / Tecnologia vestível para exames de eletrocardiograma e vetocardiograma utilizando a transformada de Dower / Tecnología vestible para exámenes de electrocardiograma y vetocardiograma utilizando de la transformada de Dower

Objectives: Thousands of people suffer from cardiovascular diseases. Even though the electrocardiogram is an exam consolidated. The lack of methodological observation in the placement of sensors can compromise the results. This article proposes a wearable vest capable of conditioning cardiac signals from three simultaneous channels, reducing the chance of failures in the exam due to the smaller number of electrodes attached to the patient's body. Methods: It adds the vectorcardiogram technique to the electrocardiogram wearable, which consists of three orthonormal derivations Vx, Vy, and Vz, measuring dynamic components of the heart vector. Results: The display of the cardiac biopotential in the web-mobile application represents the visualization of the twelve derivations synthesized from the Dower transform and the spatial projections of the cardiac loop under a three-dimensional view. Conclusion: Feasibility of integrating the vectorcardiogram with the electrocardiogram exam.

Objetivos: Milhares de pessoas sofrem com doenças cardiovasculares, apesar do Eletrocardiograma ser um exame consolidado, a falta de observação metodológica na colocação dos sensores pode comprometer os resultados. O presente artigo propõe um colete vestível capaz de condicionar sinais cardíacos de três canais simultâneos, reduzindo a chance de falhas na execução do exame em função da menor quantidade de eletrodos fixados ao corpo do paciente. Métodos: Acrescenta a técnica do vetocardiograma ao vestível de eletrocardiograma, que consiste em três derivações ortonormais Vx, Vy e Vz, medindo componentes dinâmicos do vetor coração. Resultados: Exibição do biopotencial cardíaco na aplicação web-mobile representa de forma satisfatória a visualização das doze derivações sintetizadas a partir da transformada de Dower, bem como, as projeções espaciais do loop cardíaco sob uma visão tridimensional. Conclusão: Viabilidade de integração do vetocardiograma ao exame de eletrocardiograma.

Objetivos: Miles de personas padecen enfermedades cardiovasculares, a pesar de que el electrocardiograma es un examen consolidado, la falta de observación metodológica en la colocación de sensores puede comprometer los resultados. Este artículo propone una tecnología vestible capaz de acondicionar las señales cardíacas de tres canales simultáneos, reduciendo la posibilidad de fallas en el examen por la menor cantidad de electrodos adheridos al cuerpo del paciente. Métodos: Agrega la técnica del vetocardiograma al electrocardiograma vestible, que consta de tres derivaciones ortonormales Vx, Vy y Vz, midiendo los componentes dinámicos del vector cardíaco. Resultados: La visualización del biopotencial cardíaco en la aplicación web-móvil representa satisfactoriamente la visualización de las doce derivaciones sintetizadas a partir de la transformada de Dower, así como las proyecciones espaciales del bucle cardíaco bajo una vista tridimensional. Conclusión: Viabilidad de integrar el vetocardiograma con el examen electrocardiográfico.

Optimal configuration of adhesive ECG patches suitable for long-term monitoring of a vectorcardiogram.

The purpose of this study was to develop optimal configuration of adhesive ECG patches placement on the torso, which would provide the best agreement with the Frank orthogonal ECGs. Ten seconds of orthogonal ECG followed by 3-5min of ECGs using patches at 5 different locations simultaneously on the torso were recorded in 50 participants at rest in sitting position. Median beat was generated for each ECG and 3 patch ECGs that best correlate with orthogonal ECGs were selected for each participant. For agreement analysis, spatial QRS-T angle, spatial QRS and T vector characteristics, spatial ventricular gradient, roundness, thickness and planarity of vectorcardiographic (VCG) loops were measured. Key VCG parameters showed high agreement in Bland-Altman analysis (spatial QRS-T angle on 3-patch ECG vs. Frank ECG bias 0.3 (95% limits of agreement [-6.23;5.71 degrees]), Lin's concordance coefficient=0.996). In conclusion, newly developed orthogonal 3-patch ECG can be used for long-term VCG monitoring.

Construction of intracardiac vectorcardiogram from implantable cardioverter-defibrillator intracardiac electrograms.

We constructed an intracardiac vectorcardiogram from 3 configurations of intracardiac cardiovertor defibrilator (ICD) electrograms (EGMs). Six distinctive 3 lead combinations were selected out of five leads: can to right ventricular coil (RVC); RVC to superior vena cava coil (SVC); atrial lead tip (A-tip) to right ventricular (RV)-ring; can to RV-ring; RV-tip to RVC, in a patient with dual chamber ICD. Surface spatial QRS-T angle (119.8°) was similar to intracardiac spatial QRS-T angle derived from ICD EGMs combination A (101.3°), B (96.1°), C (92.8°), D (95.2), E (99.0), F (96.2) and median (101.5). Future validation of the novel method is needed.

Detection of myocardial scar from the VCG using a supervised learning approach.

This paper addresses the possibility of detecting presence of scar tissue in the myocardium through the investigation of vectorcardiogram (VCG) characteristics. Scarred myocardium is the result of myocardial infarction (MI) due to ischemia and creates a substrate for the manifestation of fatal arrhythmias. Our efforts are focused on the development of a classification scheme for the early screening of patients for the presence of scar. More specifically, a supervised learning model based on the extracted VCG features is proposed and validated through comprehensive testing analysis. The achieved accuracy of 82.36% (sensitivity 84.31%, specificity 77.36%) indicates the potential of the proposed screening mechanism for detecting the presence/absence of scar tissue.

Vectorcardiographic loop alignment for fetal movement detection using the expectation-maximization algorithm and support vector machines.

Reduced fetal movement is an important parameter to assess fetal distress. Currently, no suitable methods are available that can objectively assess fetal movement during pregnancy. Fetal vectorcardiographic (VCG) loop alignment could be such a method. In general, the goal of VCG loop alignment is to correct for motion-induced changes in the VCGs of (multiple) consecutive heartbeats. However, the parameters used for loop alignment also provide information to assess fetal movement. Unfortunately, current methods for VCG loop alignment are not robust against low-quality VCG signals. In this paper, a more robust method for VCG loop alignment is developed that includes a priori information on the loop alignment, yielding a maximum a posteriori loop alignment. Classification, based on movement parameters extracted from the alignment, is subsequently performed using support vector machines, resulting in correct classification of (absence of) fetal movement in about 75% of cases. After additional validation and optimization, this method can possibly be employed for continuous fetal movement monitoring.

Derivation of the 12-lead electrocardiogram and 3-lead vectorcardiogram.

OBJECTIVE: The cardiac dipolar field is represented by the measured 12-lead electrocardiogram (ECG) and 3-lead vectorcardiogram (VCG). The objective is to derive the 12-lead ECG and 3-lead VCG from 3 measured leads acquired from only 5 electrodes. METHODS: This is a retrospective blinded study comparing measured and derived ECG and VCG tracings. A nonlinear optimization model was used to synthesize the derived 12-lead ECG and 3-lead derived VCG from leads I, II, and V2. A total of 367 measured 12-lead electrocardiograms and 3-lead vectorcardiograms of varying morphologies were acquired from archived digital ECG databases. All tracings were interpreted by 2 blinded physician reference standards. The derived vs measured tracings were compared quantitatively using Pearson correlation and root mean square error. Qualitative comparisons were determined by physician percent agreement analysis and adjudication. RESULTS: The correlations between the measured and derived ECGs and VCGs were high (r=0.867). No clinically significant differences were noted in 98.1% of cases. Electrocardiographic rate, rhythm, segment, axis, and acute myocardial infarction interpretations showed 100% correlation. Root mean square error compared favorably against other synthesis techniques. Overall percent agreements for the various ECG morphologies were noted to be 98.4% to 100%. CONCLUSIONS: The 12-lead ECG and 3-lead VCG can be derived accurately from 3 measured leads with high quantitative and qualitative correlations. These derived tracings can be acquired instantaneously and displayed in real time from a cardiac rhythm monitor. This will allow for immediate, on-demand, convenient, and cost-effective acquisition and analysis of the 12-lead ECG and 3-lead VCG in areas of acute patient care.

A simple device to illustrate the Einthoven triangle.

The Einthoven triangle is central to the field of electrocardiography, but the concept of cardiac vectors is often a difficult notion for students to grasp. To illustrate this principle, we constructed a device that recreates the conditions of an ECG reading using a battery to simulate the electrical vector of the heart and three voltmeters for the main electrocardiographic leads. Requiring minimal construction with low cost, this device provides hands-on practice that enables students to rediscover the principles of the Einthoven triangle, namely, that the direction of the cardiac dipole can be predicted from the deflections in any two leads and that lead I + lead III = lead II independent of the position of heart's electrical vector. We built a total of 6 devices for classes of 30 students and tested them in the first-year Human Physiology course at the University of California-Davis School of Medicine. Combined with traditional demonstrations with ECG machines, this equipment demonstrated its ability to help medical students obtain a solid foundation of the basic principles of electrocardiography.

Positioning of left ventricular pacing lead guided by intracardiac echocardiography with vector velocity imaging during cardiac resynchronization therapy procedure.

INTRODUCTION: Intraoperative modality for "real-time" left ventricular (LV) dyssynchrony quantification and optimal resynchronization is not established. This study determined the feasibility, safety, and efficacy of intracardiac echocardiography (ICE), coupled with vector velocity imaging (VVI), to evaluate LV dyssynchrony and to guide LV lead placement at the time of cardiac resynchronization therapy (CRT) implant. METHODS: One hundred and four consecutive heart failure patients undergoing ICE-guided (Group 1, N = 50) or conventional (Group 2, N = 54) CRT implant were included in the study. For Group 1 patients, LV dyssynchrony and resynchronization were evaluated by VVI including visual algorithms and the maximum differences in time-to-peak (MD-TTP) radial strain. Based on the findings, the final LV lead site was determined and optimal resynchronization was achieved. CRT responders were defined using standard criteria 6 months after implantation. RESULTS: Both groups underwent CRT implant with no complications. In Group 1, intraprocedural optimal resynchronization by VVI including visual algorithms and MD-TTP was a predictor discriminating CRT response with a sensitivity of 95% and specificity of 89%. Use of ICE/VVI increased number of and predicted CRT responders (82% in Group 1 vs 63% in Group 2; OR = 2.68, 95% CI 1.08-6.65, P = 0.03). CONCLUSION: ICE can be safely performed during CRT implantation. "Real-time" VVI appears to be helpful in determining the final LV lead position and pacing mode that allow better intraprocedural resynchronization. VVI-optimized acute resynchronization predicts CRT response and this approach is associated with higher number of CRT responders.

The spatial QRS-T angle in the Frank vectorcardiogram: accuracy of estimates derived from the 12-lead electrocardiogram.

BACKGROUND AND PURPOSE: The spatial QRS-T angle (SA), a predictor of sudden cardiac death, is a vectorcardiographic variable. Gold standard vertorcardiograms (VCGs) are recorded by using the Frank electrode positions. However, with the commonly available 12-lead ECG, VCGs must be synthesized by matrix multiplication (inverse Dower matrix/Kors matrix). Alternatively, Rautaharju proposed a method to calculate SA directly from the 12-lead ECG. Neither spatial angles computed by using the inverse Dower matrix (SA-D) nor by using the Kors matrix (SA-K) or by using Rautaharju's method (SA-R) have been validated with regard to the spatial angles as directly measured in the Frank VCG (SA-F). Our present study aimed to perform this essential validation. METHODS: We analyzed SAs in 1220 simultaneously recorded 12-lead ECGs and VCGs, in all data, in SA-F-based tertiles, and after stratification according to pathology or sex. RESULTS: Linear regression of SA-K, SA-D, and SA-R on SA-F yielded offsets of 0.01 degree, 20.3 degrees, and 28.3 degrees and slopes of 0.96, 0.86, and 0.79, respectively. The bias of SA-K with respect to SA-F (mean +/- SD, -3.2 degrees +/- 13.9 degrees) was significantly (P < .001) smaller than the bias of both SA-D and SA-R with respect to SA-F (8.0 degrees +/- 18.6 degrees and 9.8 degrees +/- 24.6 degrees, respectively); tertile analysis showed a much more homogeneous behavior of the bias in SA-K than of both the bias in SA-D and in SA-R. In pathologic ECGs, there was no significant bias in SA-K; bias in men and women did not differ. CONCLUSION: SA-K resembled SA-F best. In general, when there is no specific reason either to synthesize VCGs with the inverse Dower matrix or to calculate the spatial QRS-T angle with Rautaharju's method, it seems prudent to use the Kors matrix.

[Application of coordinate parallel method in the research on standard lead vector by theoretical inference].

The coordinate parallel method was adopted in this study on the double pole lead vector by inference. The standard lead was used as an example, and the theoretical adjustment lead axis was compared with the Burger experiment adjustment lead axis, and with the Einthoven ideal symmetrical lead axis, too. The theoretical adjustment lead axis was noted to be very close to the Burger experiment adjustment lead axis.

On designing and testing transformations for derivation of standard 12-lead/18-lead electrocardiograms and vectorcardiograms from reduced sets of predictor leads.

The aim of this study was to develop and evaluate transformation coefficients for deriving the standard 12-lead electrocardiogram (ECG), 18-lead ECG (with additional leads V7, V8, V9, V3R, V4R, V5R), and Frank vectorcardiogram (VCG) from reduced lead sets using 3 "limb" electrodes at Mason-Likar torso sites combined with 2 chest electrodes at precordial sites V1 to V6; 15 such lead sets exist and each can be recorded with 6-wire cable. As a study population, we used Dalhousie Superset (n = 892) that includes healthy subjects, postinfarction patients, and patients with a history of ventricular tachycardia. For each subject, 120-lead ECG recordings of 15-second duration were averaged, and all samples of the QRST complex for leads of interest were extracted; these data were used to derive--by regression analysis--general and patient-specific coefficients for lead transformations. These coefficients were then used to predict 12-lead/18-lead ECG sets and 3-lead VCG from 15 reduced lead sets, and the success of these predictions was assessed by 3 goodness-of-fit measures applied to the entire QRST waveform and to the ST deviation at J point; these 3 measures were similarity coefficient (SC in percentage), relative error (in percentage), and RMS error (in microvolts). Our results show that the best pair for predicting the standard 12-lead ECG by either general coefficients (mean SC = 95.56) or patient-specific coefficients (mean SC = 99.11) is V2 and V4; the best pair for deriving the 18-lead set by general coefficients (mean SC = 93.74) or by patient-specific coefficients (mean SC = 98.71) is V1 and V4; the best pair for deriving the Frank X, Y, Z leads is V1 and V3 for general coefficients (mean SC = 95.76) and V3 and V6 for patient-specific coefficients (mean SC = 99.05). The differences in mean SC among the first 8 to 10 predictor sets in each ranking table are within 1% of the highest SC value. Thus, in conclusion, there are several near-equivalent choices of reduced lead set using 6-wire cable that offer a good prediction of 12-lead/18-lead ECG and VCG; a pair most appropriate for the clinical application can be selected.

[Localization of accessory atrioventricular pathways in patients with manifest premature ventricular excitation syndrome by three-dimensional vector electrocardiography].

Distribution of excitation via ventricular myocardium in patients with accessory atrioventricular pathways (AAVP) was studied using three-dimensional vector ECG. Analysis of the ECGs obtained during the study formed new views on the excitation process in the myocardium in the presence of AAVP, and made it possible to formulate vector ECG (VECG) criteria of AAVP localization. In 30 cases out of 33 it was possible to correctly localize AAVP. Information obtained as a result of VECG analysis made it possible to localize AAVP preoperatively within the limits of 1/14th atrioventricular sulcus with 97.1% accuracy, which is substantially higher than the accuracy of conventional electrocardiographic algorithms. Thus, the study found that in some cases three-dimensional vector ECG allows for substantial increase in the validity of AAVP localization, while in others it is the only sensitive non-invasive method of topical diagnostics of manifest premature ventricular excitation syndrome. Knowledge of the character of intervector interaction during ventricular electric systole makes it possible to predict the character of changes in the trajectory of QRS vector loop in any AAVP localization, i.e. to model the vector loop.

Superiority of the limb leads over the precordial leads on the 12-lead ECG in monitoring fluctuating fluid overload in a patient with congestive heart failure.

A 78-year old woman with congestive heart failure had fluctuating peripheral edema and weights while hospitalized and was subsequently followed in the cardiac clinic. Sums of the amplitudes of the QRS complexes for the leads I + II (SigmaQRS(I + II)), the 6 limb leads (SigmaQRS(6L)), the 6 precordial leads (SigmaQRS(V1-V6)), and all 12 leads (SigmaQRS(12L)) were calculated. Analysis showed that SigmaQRS(I + II) and SigmaQRS(6L) correlated very well with corresponding weights (r = 0.78, P .01 and r = 0.75, P = .02, respectively), whereas SigmaQRS(V1-V6) and SigmaQRS(12L) did not (r = 0.20, P = .60 and r = 0.47, P = .20, respectively). The reason for the poor correlation of the latter two was the erratic values of SigmaQRS(V1-V6) in serial electrocardiogram recordings. SigmaQRS(I + II) and SigmaQRS(6L) are useful for serially following patients with congestive heart failure and peripheral edema.

Vectorcardiographic lead systems for the characterization of atrial fibrillation.

OBJECTIVE: The aim of the study was to design a vectorcardiographic lead system dedicated to the analysis of atrial fibrillation (AF). METHODS: Body surface potentials during AF were simulated by using a biophysical model of the human atria and thorax. The XYZ components of the equivalent dipole were derived from the Gabor-Nelson equations. These served as the gold standard while searching for an optimal orthogonal lead system for the estimation of the heart vector while using a limited number of electrode positions. Six electrode configurations and their dedicated transfer matrices were tested by using 10 different episodes of simulated AF and 25 different thorax geometries. RESULTS: Root-mean-square-based relative estimation error of the vectorcardiogram using the Frank electrodes was 0.39. An adaptation of 4 of the 9 electrode locations of the standard electrocardiogram, with 1 electrode moved to the back, reduced the error to 0.24. CONCLUSION: The Frank lead system is suboptimal for estimating the equivalent dipole components (VCG) during AF. Alternative electrode configurations should include at least 1 electrode on the back.

Derived 12-lead electrocardiogram in the assessment of ST-segment deviation and cardiac rhythm.

BACKGROUND: There are little data on the validation of 12-lead electrocardiogram (ECG) derived by the EASI lead system used for continuous monitoring in critical care settings. OBJECTIVE: The objectives of this study were to determine the accuracy of 12-lead ECG derived by the EASI lead system in the detection of ST-segment deviation and cardiac rhythm compared with the standard 12-lead ECG. METHODS: All patients admitted to the coronary care unit were studied. Kappa statistics was used to calculate the agreement between both ECG systems in the determination of cardiac rhythm and premature ventricular complex morphology. ST-segment analysis was performed in patients with acute coronary syndromes. Pearson correlation was used to correlate the ST-segment deviation between both techniques. The sensitivity and specificity of the determination of significant ST-segment deviation by the EASI lead system were calculated. RESULTS: There were a total of 282 patients enrolled in this study. There was a complete agreement in the interpretation of cardiac rhythm between the 2 methods (kappa = 1). Analysis of ST-segment deviation of 12-lead ECG also showed a significant correlation (correlation coefficient varied from 0.62 in lead I to 0.823 in lead aVF with a P value of <.001 in all leads) between the 2 methods with very high sensitivity and specificity in the detection of significant ST-segment elevation and depression. CONCLUSION: The 12-lead ECG derived by the EASI lead system is an accurate and reliable information for the assessment of ST-segment deviation and cardiac rhythm in critically ill patients.

[Development and applications of an auto-analyzing system for Model TJ-IV vector-cardiogram].

A new computer-assisted vector-cardiogram analyzing system Model TJ-IV developed based on Model TJ-III, has been using in the routine clinical work in order to evaluate its features and performances. The system employs a 586 computer with a CPU of 120 MHz, a special low-noise amplifier, a 12 bit A/D tranducer and the C language for programming. The examinations of 206 cases were performed and all the vector-cardiograms were analyzed by the computer system and by manipulative methods respectively. In comparison with the manipulative methods the system has a very high accuracy of picture-recognition. The accuracy for distinguishing the onsets and terminals of orthogonal ECG waves is 98% while that for distinguishing the peaks and troughs of the waves is 100%. These waves include P, Q, R, S, R' and S' waves. The new system is capable to provide the parameters of more than 591 items, including 46 newly-developed diagnostic parameters. The testing and analyzing of 12 parameters of orthogonal ECG and plane VCG have proved that the results of the aboved two methods have no difference. The new system has a very high accuracy of picture-recognition and index calculation with many technical problems existing in the old versions, solved--a great improvement of safety and anti-interference and an increase of the detecting & diagnostic speed.

Recent advances in magnetocardiography.

New developments in instrumentation, in clinical application, as well as in data analysis and visualization have provided new momentum to magnetocardiography (MCG). On one hand robust, easy to use and budget-priced MCG-systems entered the market and are applied to a multi-centred clinical study. On the other hand highly sophisticated vectormagnetometer systems with >300 SQUID sensors are opening new perspectives in electrocardiology research. Several parameters have recently been introduced to evaluate MCG-signals in order to support diagnosis, therapy follow-up and risk stratification. Particularly interesting is the renaissance of the Hosaka-Cohen-transformation which allows to visualize so-called pseudo current density (PCD) maps. A few examples are given to emphasise the value of these maps.

Simplified [correction of Simlified] calculation of mean QRS vector (mean electrical axis of heart) of electrocardiogram.

In clinical practice assessment of the mean QRS axis (MQRSA) provides information related either with hypertrophy of the ventricles or conduction blocks. The method adopted by clinicians i.e. the inspection of the QRS voltage in six of the limb leads has inherent element of subjectivity of approximately 10degrees. Moreover, in certain condition, when there is ambiguity about differentiation of left axis deviation assessed by inspection method in to either hypertrophy of left ventricles or complete/hemi block of the left bundle branches, accurate measurement of the axis becomes necessary to arrive at the correct diagnosis. Though a formula based on area under R wave and S-wave of the same QRS complex has been derived for accurate measurement of axis, considering its use in the computer software, working with ordinary electrocardiograph the only method for accurate measurement of the QRS axis is plotting method i. e. the net voltages in Lead-I, and III on their respective axes which is not practicable in clinical settings. Although, calculation of MQRSA by area method gives an accurate assessment of MQRSA, some authors prefer measurement of axis by voltage method, as in cases of the right ventricular hypertrophy with a broad S-wave calculation of axis by area method may give erroneous results. Hence, to obtain correct measurement of MQRSA, we have derived a simplified formula based on the net voltage of QRS complexes in Lead-I and Lead-III. The formula derived is as follows, Tan(theta) =(I + 2III) divided by sqrt [3I], where I and III represent net voltage in Lead-I and III, theta = angle subtended with the axis Lead-I. The value of theta can be found by using scientific calculator or the table. In case net voltage of QRS complex in Lead-I being negative, the value of the theta should be subtracted from 180degrees to find the angle of mean QRS vector.

Computerized vectorcardiography telemetry: a new device for continuous multilead ST-segment monitoring of ambulatory patients. A preliminary report.

BACKGROUND: Continuous vectorcardiography ST-segment monitoring has become a well-established method in the surveillance of patients with acute myocardial ischemia. However, immobility of the vectorcardiography technique prevents monitoring of patients during ambulatory activities. Computerized vectorcardiography telemetry (CVT) with the capacity of real-time ST-segment analysis has been developed in an attempt to overcome this shortcoming. Recent data, however, indicate that changes in body position occasionally lead to pseudo-ischemic ST-segment changes during continuous ST-segment monitoring. AIMS: This report describes the technical features of the CVT system, presents clinical examples using CVT, and assesses the influence of changes in body position on ST-vector magnitude (ST-VM) during CVT, respectively. METHODS: Clinical cases involving CVT are presented. The influence of changing body position during CVT monitoring was evaluated on 24 patients with suspected acute coronary syndromes, i.e., unstable angina or acute myocardial infarction. Each patient performed a specific body positional schedule. RESULTS: We present three discrete clinical cases where CVT provided early and valuable evidence of ongoing myocardial ischemia. The consequences of different recumbent and ambulatory body positions on ST-VM during CVT monitoring appear to be limited. CONCLUSION: Computerized vectorcardiography telemetry is a promising new tool for disclosing residual myocardial ischemic activity during the mobilization phase of patients with acute coronary syndromes. The clinical value of CVT needs further investigation in future trials.