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Reid BJ, Lindow T, Warren S, Persson E, Bhindi R, Ringborn M, Ugander M, Allahwala U. Immediate recruitment of dormant coronary collaterals can provide more than half of normal resting perfusion during coronary occlusion in patients with coronary artery disease. J Nucl Cardiol 2023; 30:2338-2345. [PMID: 37280387 PMCID: PMC10682227 DOI: 10.1007/s12350-023-03271-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Accepted: 03/24/2023] [Indexed: 06/08/2023]
Abstract
BACKGROUND Dormant coronary collaterals are highly prevalent and clinically beneficial in cases of coronary occlusion. However, the magnitude of myocardial perfusion provided by immediate coronary collateral recruitment during acute occlusion is unknown. We aimed to quantify collateral myocardial perfusion during balloon occlusion in patients with coronary artery disease (CAD). METHODS Patients without angiographically visible collaterals undergoing elective percutaneous transluminal coronary angioplasty (PTCA) to a single epicardial vessel underwent two scans with 99mTc-sestamibi myocardial perfusion single-photon emission computed tomography (SPECT). All subjects underwent at least three minutes of angiographically verified complete balloon occlusion, at which time an intravenous injection of the radiotracer was administered, followed by SPECT imaging. A second radiotracer injection followed by SPECT imaging was performed 24 h after PTCA. RESULTS The study included 22 patients (median [interquartile range] age 68 [54-72] years. The perfusion defect extent was 19 [11-38] % of the LV, and the collateral perfusion at rest was 64 [58-67]% of normal. CONCLUSION This is the first study to describe the magnitude of short-term changes in coronary microvascular collateral perfusion in patients with CAD. On average, despite coronary occlusion and an absence of angiographically visible collateral vessels, collaterals provided more than half of the normal perfusion.
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Affiliation(s)
- Brandon J Reid
- Kolling Institute, Royal North Shore Hospital, and University of Sydney, Sydney, Australia
| | - Thomas Lindow
- Kolling Institute, Royal North Shore Hospital, and University of Sydney, Sydney, Australia
- Clinical Sciences, Department of Clinical Physiology, Skane University Hospital, Lund University, Lund, Sweden
- Clinical Physiology, Department of Research and Development, Växjö Central Hospital, Kronoberg, Sweden
| | - Stafford Warren
- Department of Medicine, Cardiology Division, Anne Arundel Medical Center, Annapolis, MD, USA
| | - Eva Persson
- Clinical Sciences, Department of Clinical Physiology, Skane University Hospital, Lund University, Lund, Sweden
| | - Ravinay Bhindi
- Department of Cardiology, Royal North Shore Hospital, and University of Sydney, Sydney, Australia
| | | | - Martin Ugander
- Kolling Institute, Royal North Shore Hospital, and University of Sydney, Sydney, Australia.
- Department of Clinical Physiology, Karolinska University Hospital, and Karolinska Institute, Stockholm, Sweden.
| | - Usaid Allahwala
- Department of Cardiology, Royal North Shore Hospital, and University of Sydney, Sydney, Australia
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Vondrak J, Penhaker M. Review of Processing Pathological Vectorcardiographic Records for the Detection of Heart Disease. Front Physiol 2022; 13:856590. [PMID: 36213240 PMCID: PMC9536877 DOI: 10.3389/fphys.2022.856590] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Accepted: 03/04/2022] [Indexed: 11/23/2022] Open
Abstract
Vectorcardiography (VCG) is another useful method that provides us with useful spatial information about the electrical activity of the heart. The use of vectorcardiography in clinical practice is not common nowadays, mainly due to the well-established 12-lead ECG system. However, VCG leads can be derived from standard 12-lead ECG systems using mathematical transformations. These derived or directly measured VCG records have proven to be a useful tool for diagnosing various heart diseases such as myocardial infarction, ventricular hypertrophy, myocardial scars, long QT syndrome, etc., where standard ECG does not achieve reliable accuracy within automated detection. With the development of computer technology in recent years, vectorcardiography is beginning to come to the forefront again. In this review we highlight the analysis of VCG records within the extraction of functional parameters for the detection of heart disease. We focus on methods of processing VCG functionalities and their use in given pathologies. Improving or combining current or developing new advanced signal processing methods can contribute to better and earlier detection of heart disease. We also focus on the most commonly used methods to derive a VCG from 12-lead ECG.
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Affiliation(s)
- Jaroslav Vondrak
- Faculty of Electrical Engineering and Computer Science, VSB-Technical University of Ostrava, Ostrava, Czech Republic
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3
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Resolution of ST deviation after myocardial infarction in patients with and without sleep-disordered breathing. SOMNOLOGIE 2018. [DOI: 10.1007/s11818-018-0154-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Swenne CA, Pahlm O, Atwater BD, Bacharova L. Galen Wagner, M.D., Ph.D. (1939–2016) as international mentor of young investigators in electrocardiology. J Electrocardiol 2017; 50:21-46. [DOI: 10.1016/j.jelectrocard.2016.11.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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Dr. Galen Wagner (1939-2016) as an Academic Writer: An Overview of his Peer-reviewed Scientific Publications. J Electrocardiol 2017; 50:47-73. [DOI: 10.1016/j.jelectrocard.2016.11.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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6
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Zhang YJ, Zheng W, Sun J, Li GL, Chi BR. Electrocardiogram score for the selection of reperfusion strategy in early latecomers with ST-segment elevation myocardial infarction. J Electrocardiol 2015; 48:260-7. [DOI: 10.1016/j.jelectrocard.2015.01.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2014] [Indexed: 01/02/2023]
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Carlsen EA, Bang LE, Køber L, Strauss DG, Amaral M, Barbagelata A, Warren S, Wagner GS. Availability of a baseline Electrocardiogram changes the application of the Sclarovsky-Birnbaum Myocardial Ischemia Grade. J Electrocardiol 2014; 47:571-6. [DOI: 10.1016/j.jelectrocard.2014.02.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2013] [Indexed: 12/01/2022]
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Consideration of QRS complex in addition to ST-segment abnormalities in the estimation of the “risk region” during acute anterior or inferior myocardial infarction. J Electrocardiol 2014; 47:535-9. [DOI: 10.1016/j.jelectrocard.2014.04.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2014] [Indexed: 11/21/2022]
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Romero D, Ringborn M, Laguna P, Pueyo E. Detection and quantification of acute myocardial ischemia by morphologic evaluation of QRS changes by an angle-based method. J Electrocardiol 2013; 46:204-14. [DOI: 10.1016/j.jelectrocard.2013.02.014] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2012] [Indexed: 11/26/2022]
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Consideration of QRS complex in addition to ST segment abnormalities in the estimation of the ‘risk region’ during acute inferior myocardial infarction. J Electrocardiol 2013; 46:215-20. [DOI: 10.1016/j.jelectrocard.2013.02.004] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2012] [Indexed: 11/19/2022]
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Magrans R, Gomis P, Caminal P, Wagner GS. Complexity of the autonomic heart rate control in coronary artery occlusion in patients with and without prior myocardial infarction. Med Eng Phys 2012. [PMID: 23201277 DOI: 10.1016/j.medengphy.2012.11.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Autonomic nervous system (ANS) is governed by complex interactions arising from feedback loops of nonlinear systems that operate over a wide range of temporal and spatial scales, enabling the organism to adapt to stress, metabolic changes and diseases. This study is aimed to assess multifractal and nonlinear characteristics of the ANS during ischemic events provoked by a prolonged percutaneous coronary intervention (PCI) procedure. Eighty-seven patients from the STAFF III database were used. Patients were classified into 2 groups: (1) with prior myocardial infarction (MI) and (2) without MI (noMI). R-R signals during three 3-min stages of the procedures were analyzed using multifractal and surrogate data techniques. Multifractal indices increased significantly from the pre-inflation stage to the post-deflation stage. These variations were more marked for the noMI group. Multifractal changes significantly correlated with both the decreased parasympathetic and the increased sympathetic modulations accounted by classical linear indices. Multifractal measures resulted to be a more powerful indicator than linear HRV indices in quantifying the ischemia-induced changes. Right coronary artery (RCA) occlusions provoke greater multifractal reactions throughout the PCI procedure. Our findings suggest reduced complex multifractal and nonlinear reactions of ANS activity in patients with prior MI in comparison to the noMI group, possibly due to degradation in the complexity of control mechanism of heart rate generation.
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Affiliation(s)
- R Magrans
- Departament d'Enginyeria de Sistemas, Automàtica i Informàtica Industrial, Universitat Politècnica de Catalunya, Barcelona, Spain.
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Correa R, Arini PD, Valentinuzzi ME, Laciar E. Novel set of vectorcardiographic parameters for the identification of ischemic patients. Med Eng Phys 2012; 35:16-22. [PMID: 22516167 DOI: 10.1016/j.medengphy.2012.03.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2011] [Revised: 01/24/2012] [Accepted: 03/12/2012] [Indexed: 10/28/2022]
Abstract
New signal processing techniques have enabled the use of the vectorcardiogram (VCG) for the detection of cardiac ischemia. Thus, we studied this signal during ventricular depolarization in 80 ischemic patients, before undergoing angioplasty, and 52 healthy subjects with the objective of evaluating the vectorcardiographic difference between both groups so leading to their subsequent classification. For that matter, seven QRS-loop parameters were analyzed, i.e.: (a) Maximum Vector Magnitude; (b) Volume; (c) Planar Area; (d) Maximum Distance between Centroid and Loop; (e) Angle between XY and Optimum Plane; (f) Perimeter and, (g) Area-Perimeter Ratio. For comparison, the conventional ST-Vector Magnitude (ST(VM)) was also calculated. Results indicate that several vectorcardiographic parameters show significant differences between healthy and ischemic subjects. The identification of ischemic patients via discriminant analysis using ST(VM) produced 73.2% Sensitivity (Sens) and 73.9% Specificity (Spec). In our study, the QRS-loop parameter with the best global performance was Volume, which achieved Sens=64.5% and Spec=74.6%. However, when all QRS-loop parameters and ST(VM) were combined, we obtained Sens=88.5% and Spec=92.1%. In conclusion, QRS loop parameters can be accepted as a complement to conventional ST(VM) analysis in the identification of ischemic patients.
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Affiliation(s)
- Raúl Correa
- Gabinete de Tecnología Médica, Facultad de Ingeniería, Universidad Nacional de San Juan-UNSJ, San Juan, Argentina.
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Evaluation of depolarization changes during acute myocardial ischemia by analysis of QRS slopes. J Electrocardiol 2011; 44:416-24. [DOI: 10.1016/j.jelectrocard.2011.03.005] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2010] [Indexed: 11/23/2022]
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van Hellemond IE, Bouwmeester S, Olson CW, Bøtker HE, Kaltoft AK, Nielsen SS, Terkelsen CJ, Maynard C, Andersen MP, Gorgels AP, Wagner GS. Consideration of QRS complex in addition to ST-segment abnormalities in the estimated “risk region” during acute anterior myocardial infarction. J Electrocardiol 2011; 44:370-6. [DOI: 10.1016/j.jelectrocard.2011.01.004] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2010] [Indexed: 12/17/2022]
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Rubulis A, Jensen SM, Näslund U, Lundahl G, Jensen J, Bergfeldt L. Ischemia-induced repolarization response in relation to the size and location of the ischemic myocardium during short-lasting coronary occlusion in humans. J Electrocardiol 2010; 43:104-12. [DOI: 10.1016/j.jelectrocard.2009.10.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2009] [Indexed: 10/20/2022]
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Ringborn M, Pettersson J, Persson E, Warren SG, Platonov P, Pahlm O, Wagner GS. Comparison of high-frequency QRS components and ST-segment elevation to detect and quantify acute myocardial ischemia. J Electrocardiol 2010; 43:113-20. [DOI: 10.1016/j.jelectrocard.2009.11.009] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2009] [Indexed: 11/28/2022]
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Interrelation of ST-segment depression during bicycle ergometry and extent of myocardial ischaemia by myocardial perfusion SPECT. Eur J Nucl Med Mol Imaging 2009; 36:1842-50. [PMID: 19471924 DOI: 10.1007/s00259-009-1167-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2009] [Accepted: 05/01/2009] [Indexed: 01/10/2023]
Abstract
PURPOSE The aim of this study was to compare ST-segment depression (STD) during bicycle ergometry and extent of myocardial ischaemia assessed by myocardial perfusion SPECT (MPS) in a large patient cohort. METHODS Consecutive patients (n = 955) referred for MPS with bicycle ergometry and interpretable stress ECG were evaluated with respect to ECG and MPS findings of ischaemia. The maximal STD was recorded and exercise ECG was considered ischaemic if STD was horizontal or downsloping (>or=1 mm). MPS was interpreted using a 20-segment model with a scale of 0 to 4. A summed stress (SSS), summed rest (SRS) and summed difference score (SDS = SSS-SRS, e.g. extent of ischaemia) were derived. Ischaemia was defined as an SDS >or= 2. RESULTS An exercise-induced STD was present in 215 patients (22%) and myocardial ischaemia on MPS was present in 366 patients (38%). The extent of ST-segment depression and the number of ECG leads with significant STD were each strongly and significantly associated with increasing severity of ischaemia and the number of coronary territories involved (p < 0.01 for all correlations). CONCLUSION These data demonstrate a strong correlation between the extent of STD, number of ischaemic leads and severity of myocardial ischaemia as assessed by MPS during bicycle ergometry.
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Vectorcardiogram synthesized from the 12-lead electrocardiogram to image ischemia. J Electrocardiol 2009; 42:190-7. [DOI: 10.1016/j.jelectrocard.2008.12.018] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2008] [Indexed: 11/19/2022]
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Galeotti L, Strauss DG, Ubachs JF, Pahlm O, Heiberg E. Development of an automated method for display of ischemic myocardium from simulated electrocardiograms. J Electrocardiol 2009; 42:204-12. [DOI: 10.1016/j.jelectrocard.2008.12.007] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2008] [Indexed: 11/24/2022]
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Green M, Ohlsson M, Forberg JL, Björk J, Edenbrandt L, Ekelund U. Best leads in the standard electrocardiogram for the emergency detection of acute coronary syndrome. J Electrocardiol 2007; 40:251-6. [PMID: 17292385 DOI: 10.1016/j.jelectrocard.2006.12.011] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2006] [Accepted: 12/15/2006] [Indexed: 11/17/2022]
Abstract
BACKGROUND AND PURPOSE The purpose of this study was to determine which leads in the standard 12-lead electrocardiogram (ECG) are the best for detecting acute coronary syndrome (ACS) among chest pain patients in the emergency department. METHODS Neural network classifiers were used to determine the predictive capability of individual leads and combinations of leads from 862 ECGs from chest pain patients in the emergency department at Lund University Hospital. RESULTS The best individual lead was aVL, with an area under the receiver operating characteristic curve of 75.5%. The best 3-lead combination was III, aVL, and V2, with a receiver operating characteristic area of 82.0%, compared with the 12-lead ECG performance of 80.5%. CONCLUSIONS Our results indicate that leads III, aVL, and V2 are sufficient for computerized prediction of ACS. The present results are likely important in situations where the 12-lead ECG is impractical and for the creation of clinical decision support systems for ECG prediction of ACS.
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Affiliation(s)
- Michael Green
- Department of Theoretical Physics, Lund University, Lund, Sweden.
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