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Quintero JA, Medina CA, Penagos F, Montesdeoca JA, Orozco GA, Saavedra-Castrillón J, Diez-Sepulveda J. Electrocardiographic Abnormalities in Patients with Hyperkalemia: A Retrospective Study in an Emergency Department in Colombia. Open Access Emerg Med 2024; 16:133-144. [PMID: 38952854 PMCID: PMC11215665 DOI: 10.2147/oaem.s455159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Accepted: 04/17/2024] [Indexed: 07/03/2024] Open
Abstract
Introduction Hyperkalemia is a prevalent electrolyte disorder related to elevated serum potassium levels, resulting in diverse abnormal electrocardiographic findings and associated clinical signs and symptoms, often necessitating specific treatment. However, in some patients, these abnormal findings may not be present on the electrocardiogram even in elevated serum potassium levels. This study aims to identify electrocardiographic abnormalities related to the severity of hyperkalemia and the clinical outcomes in an emergency department in southwestern Colombia. Methodology This is a retrospective cross-sectional descriptive study. We described the electrocardiographic findings, clinical characteristics, treatment, and outcomes related to the degrees of hyperkalemia. The potential association between the severity of hyperkalemia and electrocardiographic findings was evaluated. Results A total of 494 patients were included. The median of the potassium level was 6.6 mEq/L. Abnormal electrocardiographic findings were reported in 61.5% of the cases. Mild and severe hyperkalemia groups reported abnormalities in 59.9% and 61.2%, respectively. The most common electrocardiography abnormalities were the peaked T wave 36.2%, followed by wide QRS 83 (16.8%). Only 1.4% of patients had adverse outcomes. The abnormal findings were registered in 61.5%. Mortality was 11.9%. The peaked T wave was the most common finding across different levels of hyperkalemia severity. Conclusion High serum potassium levels are related with abnormal ECG. However, patients with different degrees of hyperkalemia could not describe abnormal ECG findings. In a high proportion of patients with renal chronic disease and hyperkalemia, the abnormalities in the ECG could be minimal or absent.
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Affiliation(s)
- Jaime A Quintero
- Departamento de Medicina de Emergencias y Cuidado Crítico, Fundación Valle del Lili, Cali, Colombia
- Centro de Investigaciones Clínicas (CIC), Fundación Valle del Lili, Cali, Colombia
- Semillero de Investigación en Medicina de Emergencias y Reanimación (SIMER), Facultad de Ciencias de la Salud, Cali, Colombia
| | - Camilo A Medina
- Departamento de Medicina de Emergencias y Cuidado Crítico, Fundación Valle del Lili, Cali, Colombia
- Universidad Icesi, Facultad de Ciencia de la Salud, Cali, Colombia
- Departamento de Medicina Interna, Fundación Valle del Lili, Cali, Colombia
| | - Federico Penagos
- Semillero de Investigación en Medicina de Emergencias y Reanimación (SIMER), Facultad de Ciencias de la Salud, Cali, Colombia
- Universidad Icesi, Facultad de Ciencia de la Salud, Cali, Colombia
| | - Jaime Andres Montesdeoca
- Semillero de Investigación en Medicina de Emergencias y Reanimación (SIMER), Facultad de Ciencias de la Salud, Cali, Colombia
- Universidad Icesi, Facultad de Ciencia de la Salud, Cali, Colombia
| | - Gildardo Antonio Orozco
- Departamento de Medicina de Emergencias y Cuidado Crítico, Fundación Valle del Lili, Cali, Colombia
- Universidad Icesi, Facultad de Ciencia de la Salud, Cali, Colombia
| | - Juan Saavedra-Castrillón
- Semillero de Investigación en Medicina de Emergencias y Reanimación (SIMER), Facultad de Ciencias de la Salud, Cali, Colombia
- Universidad Icesi, Facultad de Ciencia de la Salud, Cali, Colombia
| | - Julio Diez-Sepulveda
- Departamento de Medicina de Emergencias y Cuidado Crítico, Fundación Valle del Lili, Cali, Colombia
- Semillero de Investigación en Medicina de Emergencias y Reanimación (SIMER), Facultad de Ciencias de la Salud, Cali, Colombia
- Universidad Icesi, Facultad de Ciencia de la Salud, Cali, Colombia
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Regolisti G, Rossi GM, Genovesi S. Can we trust ECG for diagnosing hyperkalemia? A challenging question for clinicians and bioengineers. Int J Cardiol 2023; 393:131380. [PMID: 37741347 DOI: 10.1016/j.ijcard.2023.131380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2023] [Accepted: 09/18/2023] [Indexed: 09/25/2023]
Affiliation(s)
- Giuseppe Regolisti
- UO Clinica e Immunologia Medica, Università di Parma e Azienda Ospedaliero-Universitaria di Parma, Parma, Italy.
| | - Giovanni Maria Rossi
- UO Nefrologia, Università di Parma e Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
| | - Simonetta Genovesi
- School of Medicine and Surgery, Nephrology Clinic, Milano-Bicocca University, Milan, Italy; Istituto Auxologico Italiano, IRCCS, Milan, Italy
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Kim D, Jeong J, Kim J, Cho Y, Park I, Lee SM, Oh YT, Baek S, Kang D, Lee E, Jeong B. Hyperkalemia Detection in Emergency Departments Using Initial ECGs: A Smartphone AI ECG Analyzer vs. Board-Certified Physicians. J Korean Med Sci 2023; 38:e322. [PMID: 37987103 PMCID: PMC10659922 DOI: 10.3346/jkms.2023.38.e322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 08/22/2023] [Indexed: 11/22/2023] Open
Abstract
BACKGROUND Hyperkalemia is a potentially fatal condition that mandates rapid identification in emergency departments (EDs). Although a 12-lead electrocardiogram (ECG) can indicate hyperkalemia, subtle changes in the ECG often pose detection challenges. An artificial intelligence application that accurately assesses hyperkalemia risk from ECGs could revolutionize patient screening and treatment. We aimed to evaluate the efficacy and reliability of a smartphone application, which utilizes camera-captured ECG images, in quantifying hyperkalemia risk compared to human experts. METHODS We performed a retrospective analysis of ED hyperkalemic patients (serum potassium ≥ 6 mmol/L) and their age- and sex-matched non-hyperkalemic controls. The application was tested by five users and its performance was compared to five board-certified emergency physicians (EPs). RESULTS Our study included 125 patients. The area under the curve (AUC)-receiver operating characteristic of the application's output was nearly identical among the users, ranging from 0.898 to 0.904 (median: 0.902), indicating almost perfect interrater agreement (Fleiss' kappa 0.948). The application demonstrated high sensitivity (0.797), specificity (0.934), negative predictive value (NPV) (0.815), and positive predictive value (PPV) (0.927). In contrast, the EPs showed moderate interrater agreement (Fleiss' kappa 0.551), and their consensus score had a significantly lower AUC of 0.662. The physicians' consensus demonstrated a sensitivity of 0.203, specificity of 0.934, NPV of 0.527, and PPV of 0.765. Notably, this performance difference remained significant regardless of patients' sex and age (P < 0.001 for both). CONCLUSION Our findings suggest that a smartphone application can accurately and reliably quantify hyperkalemia risk using initial ECGs in the ED.
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Affiliation(s)
- Donghoon Kim
- Department of Emergency Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Joo Jeong
- Department of Emergency Medicine, Seoul National University Bundang Hospital, Seongnam, Korea.
| | - Joonghee Kim
- Department of Emergency Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
- Division of Data Science, Department of Emergency Medicine, Seoul National University College of Medicine, Seoul, Korea
- ARPI Inc., Seongnam, Korea.
| | - Youngjin Cho
- Division of Cardiology, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
- ARPI Inc., Seongnam, Korea
| | - Inwon Park
- Department of Emergency Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Sang-Min Lee
- Department of Emergency Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Young Taeck Oh
- Department of Emergency Medicine, Hallym University Dongtan Sacred Heart Hospital, Hwaseong, Korea
| | - Sumin Baek
- Department of Emergency Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
- Division of Data Science, Department of Emergency Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Dongin Kang
- Department of Emergency Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
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Tsai C, Patel H, Horbal P, Dickey S, Peng Y, Nwankwo E, Hicks H, Chen G, Hussein A, Gopinathannair R, Mar PL. Comparison of quantifiable electrocardiographic changes associated with severe hyperkalemia. Int J Cardiol 2023; 391:131257. [PMID: 37574026 DOI: 10.1016/j.ijcard.2023.131257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 06/29/2023] [Accepted: 08/10/2023] [Indexed: 08/15/2023]
Abstract
BACKGROUND Hyperkalemia (HK) is a life-threatening condition that is frequently evaluated by electrocardiogram (ECG). ECG changes in severe HK (≥ 6.3 mEq/L) are not well-characterized. This study sought to compare and correlate ECG metrics in severe HK to baseline normokalemic ECGs and serum potassium. METHODS A retrospective analysis of 340 severe HK encounters with corresponding normokalemic ECGs was performed. RESULTS Various ECG metrics were analyzed. P wave amplitude in lead II, QRS duration, T wave slope, ratio of T wave amplitude: duration, and ratios of T wave: QRS amplitudes were significantly different between normokalemic and HK ECGs. P wave amplitude attenuation in lead II correlated better with serum potassium than in V1. T wave metrics that incorporated both T wave and QRS amplitudes correlated better than metrics utilizing T wave metrics alone. CONCLUSION Multiple statistically significant and quantifiable differences among ECG metrics were observed between normokalemic and HK ECGs and correlated with increasing degrees of serum potassium and along the continuum of serum potassium. When incorporated into a logistic regression model, the ability to distinguish HK versus normokalemia on ECG improved significantly. These findings could be integrated into an ECG acquisition system that can more accurately identify severe HK.
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Affiliation(s)
- Christina Tsai
- Department of Medicine, Saint Louis University, Saint Louis, MO, 1008 S. Spring Avenue, Suite 2113, Saint Louis, MO 63110, USA
| | - Hiren Patel
- Division of Cardiovascular Medicine, Saint Louis University, 1008 S. Spring Avenue, Suite 2113, Saint Louis, MO 63110, USA
| | - Piotr Horbal
- Department of Medicine, Saint Louis University, Saint Louis, MO, 1008 S. Spring Avenue, Suite 2113, Saint Louis, MO 63110, USA
| | - Sierra Dickey
- Department of Medicine, Saint Louis University, Saint Louis, MO, 1008 S. Spring Avenue, Suite 2113, Saint Louis, MO 63110, USA
| | - Yuanzun Peng
- Saint Louis University School of Medicine, 1008 S. Spring Avenue, Suite 2113, Saint Louis, MO 63110, USA
| | - Eugene Nwankwo
- Department of Medicine, Saint Louis University, Saint Louis, MO, 1008 S. Spring Avenue, Suite 2113, Saint Louis, MO 63110, USA
| | - Hunter Hicks
- Saint Louis University School of Medicine, 1008 S. Spring Avenue, Suite 2113, Saint Louis, MO 63110, USA
| | - Guanhua Chen
- Department of Biostatistics and Medical Informatics, University of Wisconsin, 610 Walnut Street, Room 207D, Madison, WI 53726, USA
| | - Ahmed Hussein
- Division of Cardiovascular Medicine, Saint Louis University, 1008 S. Spring Avenue, Suite 2113, Saint Louis, MO 63110, USA
| | - Rakesh Gopinathannair
- Kansas City Heart Rhythm Institute, Missouri, 2330 East Meyer Blvd, Suite 509, Kansas City, MO 64132, USA
| | - Philip L Mar
- Division of Cardiovascular Medicine, Saint Louis University, 1008 S. Spring Avenue, Suite 2113, Saint Louis, MO 63110, USA.
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Bukhari HA, Sánchez C, Laguna P, Potse M, Pueyo E. Differences in ventricular wall composition may explain inter-patient variability in the ECG response to variations in serum potassium and calcium. Front Physiol 2023; 14:1060919. [PMID: 37885805 PMCID: PMC10598848 DOI: 10.3389/fphys.2023.1060919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Accepted: 09/18/2023] [Indexed: 10/28/2023] Open
Abstract
Objective: Chronic kidney disease patients have a decreased ability to maintain normal electrolyte concentrations in their blood, which increases the risk for ventricular arrhythmias and sudden cardiac death. Non-invasive monitoring of serum potassium and calcium concentration, [K+] and [Ca2+], can help to prevent arrhythmias in these patients. Electrocardiogram (ECG) markers that significantly correlate with [K+] and [Ca2+] have been proposed, but these relations are highly variable between patients. We hypothesized that inter-individual differences in cell type distribution across the ventricular wall can help to explain this variability. Methods: A population of human heart-torso models were built with different proportions of endocardial, midmyocardial and epicardial cells. Propagation of ventricular electrical activity was described by a reaction-diffusion model, with modified Ten Tusscher-Panfilov dynamics. [K+] and [Ca2+] were varied individually and in combination. Twelve-lead ECGs were simulated and the width, amplitude and morphological variability of T waves and QRS complexes were quantified. Results were compared to measurements from 29 end-stage renal disease (ESRD) patients undergoing hemodialysis (HD). Results: Both simulations and patients data showed that most of the analyzed T wave and QRS complex markers correlated strongly with [K+] (absolute median Pearson correlation coefficients, r, ranging from 0.68 to 0.98) and [Ca2+] (ranging from 0.70 to 0.98). The same sign and similar magnitude of median r was observed in the simulations and the patients. Different cell type distributions in the ventricular wall led to variability in ECG markers that was accentuated at high [K+] and low [Ca2+], in agreement with the larger variability between patients measured at the onset of HD. The simulated ECG variability explained part of the measured inter-patient variability. Conclusion: Changes in ECG markers were similarly related to [K+] and [Ca2+] variations in our models and in the ESRD patients. The high inter-patient ECG variability may be explained by variations in cell type distribution across the ventricular wall, with high sensitivity to variations in the proportion of epicardial cells. Significance: Differences in ventricular wall composition help to explain inter-patient variability in ECG response to [K+] and [Ca2+]. This finding can be used to improve serum electrolyte monitoring in ESRD patients.
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Affiliation(s)
- Hassaan A. Bukhari
- BSICoS Group, I3A Institute, University of Zaragoza, IIS Aragón, Zaragoza, Spain
- CIBER en Bioingeniería, Biomateriales y Nanomedicina (CIBER-BBN), Zaragoza, Spain
- Carmen Team, Inria Bordeaux—Sud-Ouest, Talence, France
- University of Bordeaux, IMB, UMR 5251, Talence, France
| | - Carlos Sánchez
- BSICoS Group, I3A Institute, University of Zaragoza, IIS Aragón, Zaragoza, Spain
- CIBER en Bioingeniería, Biomateriales y Nanomedicina (CIBER-BBN), Zaragoza, Spain
| | - Pablo Laguna
- BSICoS Group, I3A Institute, University of Zaragoza, IIS Aragón, Zaragoza, Spain
- CIBER en Bioingeniería, Biomateriales y Nanomedicina (CIBER-BBN), Zaragoza, Spain
| | - Mark Potse
- Carmen Team, Inria Bordeaux—Sud-Ouest, Talence, France
- University of Bordeaux, IMB, UMR 5251, Talence, France
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Bordeaux, France
| | - Esther Pueyo
- BSICoS Group, I3A Institute, University of Zaragoza, IIS Aragón, Zaragoza, Spain
- CIBER en Bioingeniería, Biomateriales y Nanomedicina (CIBER-BBN), Zaragoza, Spain
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Miller F, Murray J, Budhota A, Harake T, Steig A, Whittaker D, Gupta S, Sivaprakasam R, Kuraguntla D. Evaluation of a wearable biosensor to monitor potassium imbalance in patients receiving hemodialysis. SENSING AND BIO-SENSING RESEARCH 2023. [DOI: 10.1016/j.sbsr.2023.100561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/08/2023] Open
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Bukhari HA, Sánchez C, Ruiz JE, Potse M, Laguna P, Pueyo E. Monitoring of Serum Potassium and Calcium Levels in End-Stage Renal Disease Patients by ECG Depolarization Morphology Analysis. SENSORS 2022; 22:s22082951. [PMID: 35458934 PMCID: PMC9027214 DOI: 10.3390/s22082951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 04/05/2022] [Accepted: 04/07/2022] [Indexed: 11/16/2022]
Abstract
Objective: Non-invasive estimation of serum potassium, [K+], and calcium, [Ca2+], can help to prevent life-threatening ventricular arrhythmias in patients with advanced renal disease, but current methods for estimation of electrolyte levels have limitations. We aimed to develop new markers based on the morphology of the QRS complex of the electrocardiogram (ECG). Methods: ECG recordings from 29 patients undergoing hemodialysis (HD) were processed. Mean warped QRS complexes were computed in two-minute windows at the start of an HD session, at the end of each HD hour and 48 h after it. We quantified QRS width, amplitude and the proposed QRS morphology-based markers that were computed by warping techniques. Reference [K+] and [Ca2+] were determined from blood samples acquired at the time points where the markers were estimated. Linear regression models were used to estimate electrolyte levels from the QRS markers individually and in combination with T wave morphology markers. Leave-one-out cross-validation was used to assess the performance of the estimators. Results: All markers, except for QRS width, strongly correlated with [K+] (median Pearson correlation coefficients, r, ranging from 0.81 to 0.87) and with [Ca2+] (r ranging from 0.61 to 0.76). QRS morphology markers showed very low sensitivity to heart rate (HR). Actual and estimated serum electrolyte levels differed, on average, by less than 0.035 mM (relative error of 0.018) for [K+] and 0.010 mM (relative error of 0.004) for [Ca2+] when patient-specific multivariable estimators combining QRS and T wave markers were used. Conclusion: QRS morphological markers allow non-invasive estimation of [K+] and [Ca2+] with low sensitivity to HR. The estimation performance is improved when multivariable models, including T wave markers, are considered. Significance: Markers based on the QRS complex of the ECG could contribute to non-invasive monitoring of serum electrolyte levels and arrhythmia risk prediction in patients with renal disease.
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Affiliation(s)
- Hassaan A. Bukhari
- BSICoS Group, I3A Institute, IIS Aragón, University of Zaragoza, 50018 Zaragoza, Spain; (C.S.); (P.L.); (E.P.)
- CIBER en Bioingeniería, Biomateriales y Nanomedicina (CIBER-BBN), 50018 Zaragoza, Spain
- Carmen Team, Inria Bordeaux—Sud-Ouest, 33405 Talence, France;
- Université de Bordeaux, IMB, UMR 5251, 33400 Talence, France
- Correspondence:
| | - Carlos Sánchez
- BSICoS Group, I3A Institute, IIS Aragón, University of Zaragoza, 50018 Zaragoza, Spain; (C.S.); (P.L.); (E.P.)
- CIBER en Bioingeniería, Biomateriales y Nanomedicina (CIBER-BBN), 50018 Zaragoza, Spain
| | - José Esteban Ruiz
- Nephrology Department, Hospital Clínico Universitario Lozano Blesa, 50009 Zaragoza, Spain;
| | - Mark Potse
- Carmen Team, Inria Bordeaux—Sud-Ouest, 33405 Talence, France;
- Université de Bordeaux, IMB, UMR 5251, 33400 Talence, France
| | - Pablo Laguna
- BSICoS Group, I3A Institute, IIS Aragón, University of Zaragoza, 50018 Zaragoza, Spain; (C.S.); (P.L.); (E.P.)
- CIBER en Bioingeniería, Biomateriales y Nanomedicina (CIBER-BBN), 50018 Zaragoza, Spain
| | - Esther Pueyo
- BSICoS Group, I3A Institute, IIS Aragón, University of Zaragoza, 50018 Zaragoza, Spain; (C.S.); (P.L.); (E.P.)
- CIBER en Bioingeniería, Biomateriales y Nanomedicina (CIBER-BBN), 50018 Zaragoza, Spain
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Bukhari HA, Sánchez C, Srinivasan S, Palmieri F, Potse M, Laguna P, Pueyo E. Estimation of potassium levels in hemodialysis patients by T wave nonlinear dynamics and morphology markers. Comput Biol Med 2022; 143:105304. [PMID: 35168084 DOI: 10.1016/j.compbiomed.2022.105304] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 02/01/2022] [Accepted: 02/05/2022] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Noninvasive screening of hypo- and hyperkalemia can prevent fatal arrhythmia in end-stage renal disease (ESRD) patients, but current methods for monitoring of serum potassium (K+) have important limitations. We investigated changes in nonlinear dynamics and morphology of the T wave in the electrocardiogram (ECG) of ESRD patients during hemodialysis (HD), assessing their relationship with K+ and designing a K+ estimator. METHODS ECG recordings from twenty-nine ESRD patients undergoing HD were processed. T waves in 2-min windows were extracted at each hour during an HD session as well as at 48 h after HD start. T wave nonlinear dynamics were characterized by two indices related to the maximum Lyapunov exponent (λt, λwt) and a divergence-related index (η). Morphological variability in the T wave was evaluated by three time warping-based indices (dw, reflecting morphological variability in the time domain, and da and daNL, in the amplitude domain). K+was measured from blood samples extracted during and after HD. Stage-specific and patient-specific K+ estimators were built based on the quantified indices and leave-one-out cross-validation was performed separately for each of the estimators. RESULTS The analyzed indices showed high inter-individual variability in their relationship with K+. Nevertheless, all of them had higher values at the HD start and 48 h after it, corresponding to the highest K+. The indices η and dw were the most strongly correlated with K+ (median Pearson correlation coefficient of 0.78 and 0.83, respectively) and were used in univariable and multivariable linear K+ estimators. Agreement between actual and estimated K+ was confirmed, with averaged errors over patients and time points being 0.000 ± 0.875 mM and 0.046 ± 0.690 mM for stage-specific and patient-specific multivariable K+ estimators, respectively. CONCLUSION ECG descriptors of T wave nonlinear dynamics and morphological variability allow noninvasive monitoring of K+ in ESRD patients. SIGNIFICANCE ECG markers have the potential to be used for hypo- and hyperkalemia screening in ESRD patients.
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Affiliation(s)
- Hassaan A Bukhari
- BSICoS group, I3A Institute, University of Zaragoza, IIS Aragón, Zaragoza, Spain; CIBER en Bioingeniería, Biomateriales y Nanomedicina (CIBER-BBN), Zaragoza, Spain; Carmen team, Inria Bordeaux - Sud-Ouest, Talence, France; University of Bordeaux, IMB, UMR 5251, Talence, France.
| | - Carlos Sánchez
- BSICoS group, I3A Institute, University of Zaragoza, IIS Aragón, Zaragoza, Spain; CIBER en Bioingeniería, Biomateriales y Nanomedicina (CIBER-BBN), Zaragoza, Spain
| | - Sabarathinam Srinivasan
- BSICoS group, I3A Institute, University of Zaragoza, IIS Aragón, Zaragoza, Spain; CIBER en Bioingeniería, Biomateriales y Nanomedicina (CIBER-BBN), Zaragoza, Spain
| | - Flavio Palmieri
- CIBER en Bioingeniería, Biomateriales y Nanomedicina (CIBER-BBN), Zaragoza, Spain; Centre de Recerca en Enginyeria Biomèdica, Universitat Politècnica de Catalunya, Barcelona, Spain
| | - Mark Potse
- Carmen team, Inria Bordeaux - Sud-Ouest, Talence, France; University of Bordeaux, IMB, UMR 5251, Talence, France
| | - Pablo Laguna
- BSICoS group, I3A Institute, University of Zaragoza, IIS Aragón, Zaragoza, Spain; CIBER en Bioingeniería, Biomateriales y Nanomedicina (CIBER-BBN), Zaragoza, Spain
| | - Esther Pueyo
- BSICoS group, I3A Institute, University of Zaragoza, IIS Aragón, Zaragoza, Spain; CIBER en Bioingeniería, Biomateriales y Nanomedicina (CIBER-BBN), Zaragoza, Spain
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Electrocardiogram-based index for the assessment of drug-induced hERG potassium channel block. J Electrocardiol 2021; 69S:55-60. [PMID: 34736759 DOI: 10.1016/j.jelectrocard.2021.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Revised: 10/15/2021] [Accepted: 10/16/2021] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Drug-induced block of the hERG potassium channel could predispose to torsade de pointes, depending on occurrence of concomitant blocks of the calcium and/or sodium channels. Since the hERG potassium channel block affects cardiac repolarization, the aim of this study was to propose a new reliable index for non-invasive assessment of drug-induced hERG potassium channel block based on electrocardiographic T-wave features. METHODS ERD30% (early repolarization duration) and TS/A (down-going T-wave slope to T-wave amplitude ratio) features were measured in 22 healthy subjects who received, in different days, doses of dofetilide, ranolazine, verapamil and quinidine (all being hERG potassium channel blockers and the latter three being also blockers of calcium and/or sodium channels) while undergoing continuous electrocardiographic acquisition from which ERD30% and TS/A were evaluated in fifteen time points during the 24 h following drug administration ("ECG Effects of Ranolazine, Dofetilide, Verapamil, and Quinidine in Healthy Subjects" database by Physionet). A total of 1320 pairs of ERD30% and TS/A measurements, divided in training (50%) and testing (50%) datasets, were obtained. Drug-induced hERG potassium channel block was modelled by the regression equation BECG(%) = a·ERD30% + b·TS/A+ c·ERD30%·TS/A + d; BECG(%) values were compared to plasma-based measurements, BREF(%). RESULTS Regression coefficients values, obtained on the training dataset, were: a = -561.0 s-1, b = -9.7 s, c = 77.2 and d = 138.9. In the testing dataset, correlation coefficient between BECG(%) and BREF(%) was 0.67 (p < 10-81); estimation error was -11.5 ± 16.7%. CONCLUSION BECG(%) is a reliable non-invasive index for the assessment of drug-induced hERG potassium channel block, independently from concomitant blocks of other ions.
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Cadamuro J. Rise of the Machines: The Inevitable Evolution of Medicine and Medical Laboratories Intertwining with Artificial Intelligence-A Narrative Review. Diagnostics (Basel) 2021; 11:1399. [PMID: 34441333 PMCID: PMC8392825 DOI: 10.3390/diagnostics11081399] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 07/05/2021] [Accepted: 07/21/2021] [Indexed: 01/04/2023] Open
Abstract
Laboratory medicine has evolved from a mainly manual profession, providing few selected test results to a highly automated and standardized medical discipline, generating millions of test results per year. As the next inevitable evolutional step, artificial intelligence (AI) algorithms will need to assist us in structuring and making sense of the masses of diagnostic data collected today. Such systems will be able to connect clinical and diagnostic data and to provide valuable suggestions in diagnosis, prognosis or therapeutic options. They will merge the often so separated worlds of the laboratory and the clinics. When used correctly, it will be a tool, capable of freeing the physicians time so that he/she can refocus on the patient. In this narrative review I therefore aim to provide an overview of what AI is, what applications currently are available in healthcare and in laboratory medicine in particular. I will discuss the challenges and pitfalls of applying AI algorithms and I will elaborate on the question if healthcare workers will be replaced by such systems in the near future.
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Affiliation(s)
- Janne Cadamuro
- Department of Laboratory Medicine, Paracelsus Medical University, A-5020 Salzburg, Austria
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11
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Palmieri F, Gomis P, Ferreira D, Ruiz JE, Bergasa B, Martín-Yebra A, Bukhari HA, Pueyo E, Martínez JP, Ramírez J, Laguna P. Monitoring blood potassium concentration in hemodialysis patients by quantifying T-wave morphology dynamics. Sci Rep 2021; 11:3883. [PMID: 33594135 PMCID: PMC7887245 DOI: 10.1038/s41598-021-82935-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Accepted: 01/27/2021] [Indexed: 12/29/2022] Open
Abstract
We investigated the ability of time-warping-based ECG-derived markers of T-wave morphology changes in time (\documentclass[12pt]{minimal}
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\begin{document}$$d_{w}$$\end{document}dw) and amplitude (\documentclass[12pt]{minimal}
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\begin{document}$$d_a$$\end{document}da), as well as their non-linear components (\documentclass[12pt]{minimal}
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\begin{document}$${d_w^{{\mathrm{NL}}}}$$\end{document}dwNL and \documentclass[12pt]{minimal}
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\begin{document}$${d_a^{\mathrm{NL}}}$$\end{document}daNL), and the heart rate corrected counterpart (\documentclass[12pt]{minimal}
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\begin{document}$$d_{w,c}$$\end{document}dw,c), to monitor potassium concentration (\documentclass[12pt]{minimal}
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\begin{document}$$[K^{+}]$$\end{document}[K+]) changes (\documentclass[12pt]{minimal}
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\begin{document}$$\Delta [K^+]$$\end{document}Δ[K+]) in end-stage renal disease (ESRD) patients undergoing hemodialysis (HD). We compared the performance of the proposed time-warping markers, together with other previously proposed \documentclass[12pt]{minimal}
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\begin{document}$$[K^{+}]$$\end{document}[K+] markers, such as T-wave width (\documentclass[12pt]{minimal}
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\begin{document}$$T_w$$\end{document}Tw) and T-wave slope-to-amplitude ratio (\documentclass[12pt]{minimal}
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\begin{document}$$T_{S/A}$$\end{document}TS/A), when computed from standard ECG leads as well as from principal component analysis (PCA)-based leads. 48-hour ECG recordings and a set of hourly-collected blood samples from 29 ESRD-HD patients were acquired. Values of \documentclass[12pt]{minimal}
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\begin{document}$$d_w$$\end{document}dw, \documentclass[12pt]{minimal}
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\begin{document}$$d_a$$\end{document}da, \documentclass[12pt]{minimal}
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\begin{document}$${d_w^{\mathrm{NL}}}$$\end{document}dwNL, \documentclass[12pt]{minimal}
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\begin{document}$${d_a^{\mathrm{NL}}}$$\end{document}daNL and \documentclass[12pt]{minimal}
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\begin{document}$$d_{w,c}$$\end{document}dw,c were calculated by comparing the morphology of the mean warped T-waves (MWTWs) derived at each hour along the HD with that from a reference MWTW, measured at the end of the HD. From the same MWTWs \documentclass[12pt]{minimal}
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\begin{document}$$T_w$$\end{document}Tw and \documentclass[12pt]{minimal}
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\begin{document}$$T_{S/A}$$\end{document}TS/A were also extracted. Similarly, \documentclass[12pt]{minimal}
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\begin{document}$$\Delta [K^+]$$\end{document}Δ[K+] was calculated as the difference between the \documentclass[12pt]{minimal}
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\begin{document}$$[K^{+}]$$\end{document}[K+] values at each hour and the \documentclass[12pt]{minimal}
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\begin{document}$$[K^{+}]$$\end{document}[K+] reference level at the end of the HD session. We found that \documentclass[12pt]{minimal}
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\begin{document}$$d_{w}$$\end{document}dw and \documentclass[12pt]{minimal}
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\begin{document}$$d_{w,c}$$\end{document}dw,c showed higher correlation coefficients with \documentclass[12pt]{minimal}
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\begin{document}$$\Delta [K^+]$$\end{document}Δ[K+] than \documentclass[12pt]{minimal}
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\begin{document}$$T_{S/A}$$\end{document}TS/A—Spearman’s (\documentclass[12pt]{minimal}
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\begin{document}$$\rho$$\end{document}ρ) and Pearson’s (r)—and \documentclass[12pt]{minimal}
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\begin{document}$$T_w$$\end{document}Tw—Spearman’s (\documentclass[12pt]{minimal}
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\begin{document}$$\rho$$\end{document}ρ)—in both SL and PCA approaches being the intra-patient median \documentclass[12pt]{minimal}
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\begin{document}$$\rho \ge 0.82$$\end{document}ρ≥0.82 and \documentclass[12pt]{minimal}
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\begin{document}$$r \ge 0.87$$\end{document}r≥0.87 in SL and \documentclass[12pt]{minimal}
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\begin{document}$$\rho \ge 0.82$$\end{document}ρ≥0.82 and \documentclass[12pt]{minimal}
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\begin{document}$$r \ge 0.89$$\end{document}r≥0.89 in PCA respectively. Our findings would point at \documentclass[12pt]{minimal}
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\begin{document}$$d_{w}$$\end{document}dw and \documentclass[12pt]{minimal}
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\begin{document}$$d_{w,c}$$\end{document}dw,c as the most suitable surrogate of \documentclass[12pt]{minimal}
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\begin{document}$$\Delta [K^+]$$\end{document}Δ[K+], suggesting that they could be potentially useful for non-invasive monitoring of ESRD-HD patients in hospital, as well as in ambulatory settings. Therefore, the tracking of T-wave morphology variations by means of time-warping analysis could improve continuous and remote \documentclass[12pt]{minimal}
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\begin{document}$$[K^{+}]$$\end{document}[K+] monitoring of ESRD-HD patients and flagging risk of \documentclass[12pt]{minimal}
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\begin{document}$$[K^{+}]$$\end{document}[K+]-related cardiovascular events.
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Affiliation(s)
- Flavio Palmieri
- Centre de Recerca en Enginyeria Biomèdica, Universitat Politècnica de Catalunya, Barcelona, Spain. .,CIBER en Bioingeniería, Biomateriales y Nanomedicina (CIBER-BBN), Zaragoza, Spain. .,Laboratorios Rubió, Castellbisbal, Barcelona, Spain.
| | - Pedro Gomis
- Centre de Recerca en Enginyeria Biomèdica, Universitat Politècnica de Catalunya, Barcelona, Spain.,Valencian International University, Valencia, Spain
| | | | - José Esteban Ruiz
- Nephrology Department, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
| | - Beatriz Bergasa
- Nephrology Department, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
| | - Alba Martín-Yebra
- CIBER en Bioingeniería, Biomateriales y Nanomedicina (CIBER-BBN), Zaragoza, Spain.,BSICoS Group, I3A, IIS Aragón, Universidad de Zaragoza, Zaragoza, Spain
| | - Hassaan A Bukhari
- CIBER en Bioingeniería, Biomateriales y Nanomedicina (CIBER-BBN), Zaragoza, Spain.,BSICoS Group, I3A, IIS Aragón, Universidad de Zaragoza, Zaragoza, Spain
| | - Esther Pueyo
- CIBER en Bioingeniería, Biomateriales y Nanomedicina (CIBER-BBN), Zaragoza, Spain.,BSICoS Group, I3A, IIS Aragón, Universidad de Zaragoza, Zaragoza, Spain
| | - Juan Pablo Martínez
- CIBER en Bioingeniería, Biomateriales y Nanomedicina (CIBER-BBN), Zaragoza, Spain.,BSICoS Group, I3A, IIS Aragón, Universidad de Zaragoza, Zaragoza, Spain
| | - Julia Ramírez
- William Harvey Research Institute, Queen Mary University of London, London, UK
| | - Pablo Laguna
- CIBER en Bioingeniería, Biomateriales y Nanomedicina (CIBER-BBN), Zaragoza, Spain.,BSICoS Group, I3A, IIS Aragón, Universidad de Zaragoza, Zaragoza, Spain
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12
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Bukhari HA, Palmieri F, Ramirez J, Laguna P, Ruiz JE, Ferreira D, Potse M, Sanchez C, Pueyo E. Characterization of T Wave Amplitude, Duration and Morphology Changes During Hemodialysis: Relationship With Serum Electrolyte Levels and Heart Rate. IEEE Trans Biomed Eng 2020; 68:2467-2478. [PMID: 33301399 DOI: 10.1109/tbme.2020.3043844] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Chronic kidney disease affects more than 10% of the world population. Changes in serum ion concentrations increase the risk for ventricular arrhythmias and sudden cardiac death, particularly in end-stage renal disease (ESRD) patients. We characterized how T wave amplitude, duration and morphology descriptors change with variations in serum levels of potassium and calcium and in heart rate, both in ESRD patients and in simulated ventricular fibers. METHODS Electrocardiogram (ECG) recordings from twenty ESRD patients undergoing hemodialysis (HD) and pseudo-ECGs (pECGs) calculated from twenty-two simulated ventricular fibers at varying transmural heterogeneity levels were processed to quantify T wave width ( Tw), T wave slope-to-amplitude ratio ([Formula: see text]) and four indices of T wave morphological variability based on time warping ( dw, [Formula: see text], da and [Formula: see text]). Serum potassium and calcium levels and heart rate were measured along HD. RESULTS [Formula: see text] was the marker most strongly correlated with serum potassium, dw with calcium and da with heart rate, after correction for covariates. Median values of partial correlation coefficients were 0.75, -0.74 and -0.90, respectively. For all analyzed T wave descriptors, high inter-patient variability was observed in the pattern of such relationships. This variability, accentuated during the first HD time points, was reproduced in the simulations and shown to be influenced by differences in transmural heterogeneity. CONCLUSION Changes in serum potassium and calcium levels and in heart rate strongly affect T wave descriptors, particularly those quantifying morphological variability. SIGNIFICANCE ECG markers have the potential to be used for monitoring serum ion concentrations in ESRD patients.
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13
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Pilia N, Severi S, Raimann JG, Genovesi S, Dössel O, Kotanko P, Corsi C, Loewe A. Quantification and classification of potassium and calcium disorders with the electrocardiogram: What do clinical studies, modeling, and reconstruction tell us? APL Bioeng 2020; 4:041501. [PMID: 33062908 PMCID: PMC7532940 DOI: 10.1063/5.0018504] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Accepted: 09/13/2020] [Indexed: 11/14/2022] Open
Abstract
Diseases caused by alterations of ionic concentrations are frequently observed challenges and play an important role in clinical practice. The clinically established method for the diagnosis of electrolyte concentration imbalance is blood tests. A rapid and non-invasive point-of-care method is yet needed. The electrocardiogram (ECG) could meet this need and becomes an established diagnostic tool allowing home monitoring of the electrolyte concentration also by wearable devices. In this review, we present the current state of potassium and calcium concentration monitoring using the ECG and summarize results from previous work. Selected clinical studies are presented, supporting or questioning the use of the ECG for the monitoring of electrolyte concentration imbalances. Differences in the findings from automatic monitoring studies are discussed, and current studies utilizing machine learning are presented demonstrating the potential of the deep learning approach. Furthermore, we demonstrate the potential of computational modeling approaches to gain insight into the mechanisms of relevant clinical findings and as a tool to obtain synthetic data for methodical improvements in monitoring approaches.
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Affiliation(s)
- N Pilia
- Institute of Biomedical Engineering, Karlsruhe Institute of Technology (KIT), 76131 Karlsruhe, Germany
| | - S Severi
- Department of Electrical, Electronic, and Information Engineering "Guglielmo Marconi," University of Bologna, 47522 Cesena, Italy
| | - J G Raimann
- Renal Research Institute, New York, New York 10065, USA
| | - S Genovesi
- Department of Medicine and Surgery, University of Milan-Bicocca, 20100 Milan, Italy
| | - O Dössel
- Institute of Biomedical Engineering, Karlsruhe Institute of Technology (KIT), 76131 Karlsruhe, Germany
| | | | - C Corsi
- Department of Electrical, Electronic, and Information Engineering "Guglielmo Marconi," University of Bologna, 47522 Cesena, Italy
| | - A Loewe
- Institute of Biomedical Engineering, Karlsruhe Institute of Technology (KIT), 76131 Karlsruhe, Germany
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14
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Lindner G, Burdmann EA, Clase CM, Hemmelgarn BR, Herzog CA, Małyszko J, Nagahama M, Pecoits-Filho R, Rafique Z, Rossignol P, Singer AJ. Acute hyperkalemia in the emergency department: a summary from a Kidney Disease: Improving Global Outcomes conference. Eur J Emerg Med 2020; 27:329-337. [PMID: 32852924 PMCID: PMC7448835 DOI: 10.1097/mej.0000000000000691] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Accepted: 02/17/2020] [Indexed: 11/30/2022]
Abstract
Hyperkalemia is a common electrolyte disorder observed in the emergency department. It is often associated with underlying predisposing conditions, such as moderate or severe kidney disease, heart failure, diabetes mellitus, or significant tissue trauma. Additionally, medications, such as inhibitors of the renin-angiotensin-aldosterone system, potassium-sparing diuretics, nonsteroidal anti-inflammatory drugs, succinylcholine, and digitalis, are associated with hyperkalemia. To this end, Kidney Disease: Improving Global Outcomes (KDIGO) convened a conference in 2018 to identify evidence and address controversies on potassium management in kidney disease. This review summarizes the deliberations and clinical guidance for the evaluation and management of acute hyperkalemia in this setting. The toxic effects of hyperkalemia on the cardiac conduction system are potentially lethal. The ECG is a mainstay in managing hyperkalemia. Membrane stabilization by calcium salts and potassium-shifting agents, such as insulin and salbutamol, is the cornerstone in the acute management of hyperkalemia. However, only dialysis, potassium-binding agents, and loop diuretics remove potassium from the body. Frequent reevaluation of potassium concentrations is recommended to assess treatment success and to monitor for recurrence of hyperkalemia.
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Affiliation(s)
- Gregor Lindner
- Department of Internal and Emergency Medicine, Bürgerspital Solothurn, Solothurn, Switzerland
| | - Emmanuel A. Burdmann
- LIM 12, Division of Nephrology, University of Sao Paulo Medical School, Sao Paulo, SP, Brazil
| | | | - Brenda R. Hemmelgarn
- Departments of Community Health Sciences and Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Charles A. Herzog
- Division of Cardiology, Department of Medicine, Hennepin Healthcare/University of Minnesota, Minneapolis, Minnesota, USA
| | - Jolanta Małyszko
- Department of Nephrology, Dialysis and Internal Medicine, Warsaw Medical University, Poland
| | - Masahiko Nagahama
- Division of Nephrology, Department of Internal Medicine, St. Luke’s International Hospital, Tokyo, Japan
| | - Roberto Pecoits-Filho
- Pontificia Universidade Catolica do Paraná, Curitiba, Brazil and Arbor Research Collaborative for Health, Ann Arbor, Michigan
| | - Zubaid Rafique
- Department of Emergency Medicine, Baylor College of Medicine, Houston, Texas, USA
| | - Patrick Rossignol
- Université de Lorraine, Inserm, Centre d’Investigations Cliniques-Plurithématique 14-33 and Inserm U1116, CHRU, F-CRIN INI-CRCT (Cardiovascular and Renal Clinical Trialists), Nancy, France
| | - Adam J. Singer
- Department of Emergency Medicine, Stony Brook University, Stony Brook, New York, USA
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15
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Implantable cardioverter defibrillators - the past, present and future. ACTA ACUST UNITED AC 2020; 5:e163-e170. [PMID: 32832716 PMCID: PMC7433784 DOI: 10.5114/amsad.2020.97103] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 05/31/2020] [Indexed: 11/17/2022]
Abstract
Since their formal introduction in 1980, implantable cardioverter defibrillators (ICDs) have undergone innumerable design modifications through several generations. They are indispensable today in successfully managing fatal ventricular arrhythmias. Their role in averting sudden cardiac death is recognized beyond doubt. Their applications and indications have continuously expanded over the last two decades. This article reviews the salient features in the evolution of ICDs, their current indications, recent advances and future directions. With more advanced detection algorithms, the potential integration with leadless pacing, and the possibility to serve as a remote monitoring device to recognize atrial fibrillation, acute ischemia, or electrolyte imbalance, the application of ICDs is rapidly evolving.
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16
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Abstract
PURPOSE OF REVIEW To (i) review the concept of artificial intelligence (AI); (ii) summarize recent developments in artificial intelligence-enabled electrocardiogram (AI-ECG); (iii) address notable inherent limitations and challenges of AI-ECG; and (iv) discuss the future direction of the field. RECENT FINDINGS Advancements in machine learning and computing methods have led to application of AI-ECG and potential new applications to patient care. Further study is needed to verify previous findings in diverse populations as well as begin to confront the limitations needed for clinical implementation. Nearly one century after the Nobel Prize was awarded to Willem Einthoven for demonstrating that an electrocardiogram (ECG) could record the electrical signature of the heart, the ECG remains one of the most important diagnostic tests in modern medicine. We now stand at the edge of true ECG innovation. Simultaneous advancements in computing power, wireless technology, digitized data availability, and machine learning have led to the birth of AI-ECG algorithms with novel capabilities and real potential for clinical application. AI has the potential to improve diagnostic accuracy and efficiency by providing fully automated, unbiased, and unambiguous ECG analysis along with promising new findings that may unlock new value in the ECG. These breakthroughs may cause a paradigm shift in clinical workflow as well as patient monitoring and management.
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17
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Bachtiger P, Plymen CM, Pabari PA, Howard JP, Whinnett ZI, Opoku F, Janering S, Faisal AA, Francis DP, Peters NS. Artificial Intelligence, Data Sensors and Interconnectivity: Future Opportunities for Heart Failure. Card Fail Rev 2020; 6:e11. [PMID: 32514380 PMCID: PMC7265101 DOI: 10.15420/cfr.2019.14] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Accepted: 01/23/2020] [Indexed: 11/08/2022] Open
Abstract
A higher proportion of patients with heart failure have benefitted from a wide and expanding variety of sensor-enabled implantable devices than any other patient group. These patients can now also take advantage of the ever-increasing availability and affordability of consumer electronics. Wearable, on- and near-body sensor technologies, much like implantable devices, generate massive amounts of data. The connectivity of all these devices has created opportunities for pooling data from multiple sensors – so-called interconnectivity – and for artificial intelligence to provide new diagnostic, triage, risk-stratification and disease management insights for the delivery of better, more personalised and cost-effective healthcare. Artificial intelligence is also bringing important and previously inaccessible insights from our conventional cardiac investigations. The aim of this article is to review the convergence of artificial intelligence, sensor technologies and interconnectivity and the way in which this combination is set to change the care of patients with heart failure.
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Affiliation(s)
- Patrik Bachtiger
- Imperial Centre for Cardiac Engineering, National Heart and Lung Institute, Imperial College London, UK
| | - Carla M Plymen
- Department of Cardiology, Imperial College Healthcare NHS Trust, Hammersmith Hospital London, UK
| | - Punam A Pabari
- Department of Cardiology, Imperial College Healthcare NHS Trust, Hammersmith Hospital London, UK
| | - James P Howard
- Imperial Centre for Cardiac Engineering, National Heart and Lung Institute, Imperial College London, UK.,Department of Cardiology, Imperial College Healthcare NHS Trust, Hammersmith Hospital London, UK
| | - Zachary I Whinnett
- Department of Cardiology, Imperial College Healthcare NHS Trust, Hammersmith Hospital London, UK
| | - Felicia Opoku
- IT Department, Imperial College Healthcare NHS London, UK
| | | | - Aldo A Faisal
- Departments of Bioengineering and Computing, Data Science Institute, Imperial College London, UK
| | - Darrel P Francis
- Imperial Centre for Cardiac Engineering, National Heart and Lung Institute, Imperial College London, UK.,Department of Cardiology, Imperial College Healthcare NHS Trust, Hammersmith Hospital London, UK
| | - Nicholas S Peters
- Imperial Centre for Cardiac Engineering, National Heart and Lung Institute, Imperial College London, UK.,Department of Cardiology, Imperial College Healthcare NHS Trust, Hammersmith Hospital London, UK
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18
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Regolisti G, Maggiore U, Greco P, Maccari C, Parenti E, Di Mario F, Pistolesi V, Morabito S, Fiaccadori E. Electrocardiographic T wave alterations and prediction of hyperkalemia in patients with acute kidney injury. Intern Emerg Med 2020; 15:463-472. [PMID: 31686358 DOI: 10.1007/s11739-019-02217-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Accepted: 10/12/2019] [Indexed: 11/25/2022]
Abstract
Electrocardiographic (ECG) alterations are common in hyperkalemic patients. While the presence of peaked T waves is the most frequent ECG alteration, reported findings on ECG sensitivity in detecting hyperkalemia are conflicting. Moreover, no studies have been conducted specifically in patients with acute kidney injury (AKI). We used the best subset selection and cross-validation methods [via linear and logistic regression and leave-one-out cross-validation (LOOCV)] to assess the ability of T waves to predict serum potassium levels or hyperkalemia (defined as serum potassium ≥ 5.5 mEq/L). We included the following clinical variables as a candidate for the predictive models: peaked T waves, T wave maximum amplitude, T wave/R wave maximum amplitude ratio, age, and indicator variates for oliguria, use of ACE-inhibitors, sartans, mineralocorticoid receptor antagonists, and loop diuretics. Peaked T waves poorly predicted the serum potassium levels in both full and test sample (R2 = 0.03 and R2 = 0.01, respectively), and also poorly predicted hyperkalemia. The selection algorithm based on Bayesian information criterion identified T wave amplitude and use of loop diuretics as the best subset of variables predicting serum potassium. Nonetheless, the model accuracy was poor in both full and test sample [root mean square error (RMSE) = 0.96 mEq/L and adjR2 = 0.08 and RMSE = 0.97 mEq/L, adjR2 = 0.06, respectively]. T wave amplitude and the use of loop diuretics had also poor accuracy in predicting hyperkalemia in both full and test sample [area-under-curve (AUC) at receiver-operator curve (ROC) analysis 0.74 and AUC 0.72, respectively]. Our findings show that, in patients with AKI, electrocardiographic changes in T waves are poor predictors of serum potassium levels and of the presence of hyperkalemia.
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Affiliation(s)
- Giuseppe Regolisti
- UO Nefrologia, Azienda Ospedaliero-Universitaria Di Parma, Via Gramsci 14, 43100, Parma, Italy.
- Dipartimento Di Medicina E Chirurgia, Università Di Parma, Parma, Italy.
| | - Umberto Maggiore
- UO Nefrologia, Azienda Ospedaliero-Universitaria Di Parma, Via Gramsci 14, 43100, Parma, Italy
- Dipartimento Di Medicina E Chirurgia, Università Di Parma, Parma, Italy
| | - Paolo Greco
- UO Nefrologia, Azienda Ospedaliero-Universitaria Di Parma, Via Gramsci 14, 43100, Parma, Italy
| | - Caterina Maccari
- UO Nefrologia, Azienda Ospedaliero-Universitaria Di Parma, Via Gramsci 14, 43100, Parma, Italy
| | - Elisabetta Parenti
- UO Nefrologia, Azienda Ospedaliero-Universitaria Di Parma, Via Gramsci 14, 43100, Parma, Italy
| | - Francesca Di Mario
- UO Nefrologia, Azienda Ospedaliero-Universitaria Di Parma, Via Gramsci 14, 43100, Parma, Italy
| | | | - Santo Morabito
- UOD Dialisi, Policlinico Università Di Roma "La Sapienza", Roma, Italy
| | - Enrico Fiaccadori
- UO Nefrologia, Azienda Ospedaliero-Universitaria Di Parma, Via Gramsci 14, 43100, Parma, Italy
- Dipartimento Di Medicina E Chirurgia, Università Di Parma, Parma, Italy
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19
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Lin CS, Lin C, Fang WH, Hsu CJ, Chen SJ, Huang KH, Lin WS, Tsai CS, Kuo CC, Chau T, Yang SJ, Lin SH. A Deep-Learning Algorithm (ECG12Net) for Detecting Hypokalemia and Hyperkalemia by Electrocardiography: Algorithm Development. JMIR Med Inform 2020; 8:e15931. [PMID: 32134388 PMCID: PMC7082733 DOI: 10.2196/15931] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Revised: 11/28/2019] [Accepted: 12/15/2019] [Indexed: 01/17/2023] Open
Abstract
Background The detection of dyskalemias—hypokalemia and hyperkalemia—currently depends on laboratory tests. Since cardiac tissue is very sensitive to dyskalemia, electrocardiography (ECG) may be able to uncover clinically important dyskalemias before laboratory results. Objective Our study aimed to develop a deep-learning model, ECG12Net, to detect dyskalemias based on ECG presentations and to evaluate the logic and performance of this model. Methods Spanning from May 2011 to December 2016, 66,321 ECG records with corresponding serum potassium (K+) concentrations were obtained from 40,180 patients admitted to the emergency department. ECG12Net is an 82-layer convolutional neural network that estimates serum K+ concentration. Six clinicians—three emergency physicians and three cardiologists—participated in human-machine competition. Sensitivity, specificity, and balance accuracy were used to evaluate the performance of ECG12Net with that of these physicians. Results In a human-machine competition including 300 ECGs of different serum K+ concentrations, the area under the curve for detecting hypokalemia and hyperkalemia with ECG12Net was 0.926 and 0.958, respectively, which was significantly better than that of our best clinicians. Moreover, in detecting hypokalemia and hyperkalemia, the sensitivities were 96.7% and 83.3%, respectively, and the specificities were 93.3% and 97.8%, respectively. In a test set including 13,222 ECGs, ECG12Net had a similar performance in terms of sensitivity for severe hypokalemia (95.6%) and severe hyperkalemia (84.5%), with a mean absolute error of 0.531. The specificities for detecting hypokalemia and hyperkalemia were 81.6% and 96.0%, respectively. Conclusions A deep-learning model based on a 12-lead ECG may help physicians promptly recognize severe dyskalemias and thereby potentially reduce cardiac events.
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Affiliation(s)
- Chin-Sheng Lin
- Division of Cardiology, Department of Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Chin Lin
- Graduate Institute of Life Sciences, National Defense Medical Center, Taipei, Taiwan.,School of Public Health, National Defense Medical Center, Taipei, Taiwan.,Department of Research and Development, National Defense Medical Center, Taipei, Taiwan
| | - Wen-Hui Fang
- Department of Family and Community Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Chia-Jung Hsu
- Planning and Management Office, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Sy-Jou Chen
- Department of Emergency Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.,Graduate Institute of Injury Prevention and Control, College of Public Health and Nutrition, Taipei Medical University, Taipei, Taiwan
| | - Kuo-Hua Huang
- Planning and Management Office, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Wei-Shiang Lin
- Division of Cardiology, Department of Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Chien-Sung Tsai
- Division of Cardiovascular Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Chih-Chun Kuo
- Department of Electrical Engineering, National Taiwan University, Taipei, Taiwan
| | - Tom Chau
- Department of Medicine, Providence St Vincent Medical Center, Portland, OR, United States
| | - Stephen Jh Yang
- Department of Computer Science and Information Engineering, National Central University, Taoyuan, Taiwan
| | - Shih-Hua Lin
- Graduate Institute of Life Sciences, National Defense Medical Center, Taipei, Taiwan.,Division of Nephrology, Department of Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
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20
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The relationship between serum potassium concentrations and electrocardiographic characteristics in 163,547 individuals from primary care. J Electrocardiol 2019; 57:104-111. [DOI: 10.1016/j.jelectrocard.2019.09.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Revised: 08/08/2019] [Accepted: 09/04/2019] [Indexed: 12/17/2022]
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21
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Morettini M, Peroni C, Sbrollini A, Marcantoni I, Burattini L. Classification of drug-induced hERG potassium-channel block from electrocardiographic T-wave features using artificial neural networks. Ann Noninvasive Electrocardiol 2019; 24:e12679. [PMID: 31347753 DOI: 10.1111/anec.12679] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Revised: 05/09/2019] [Accepted: 06/03/2019] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Human ether-à-go-go-related gene (hERG) potassium-channel block represents a harmful side effect of drug therapy that may cause torsade de pointes (TdP). Analysis of ventricular repolarization through electrocardiographic T-wave features represents a noninvasive way to accurately evaluate the TdP risk in drug-safety studies. This study proposes an artificial neural network (ANN) for noninvasive electrocardiography-based classification of the hERG potassium-channel block. METHODS The data were taken from the "ECG Effects of Ranolazine, Dofetilide, Verapamil, and Quinidine in Healthy Subjects" Physionet database; they consisted of median vector magnitude (VM) beats of 22 healthy subjects receiving a single 500 μg dose of dofetilide. Fourteen VM beats were considered for each subject, relative to time-points ranging from 0.5 hr before to 14.0 hr after dofetilide administration. For each VM, changes in two indexes accounting for the early and the late phases of repolarization, ΔERD30% and ΔTS /A , respectively, were computed as difference between values at each postdose time-point and the predose time-point. Thus, the dataset contained 286 ΔERD30% -ΔTS /A pairs, partitioned into training, validation, and test sets (114, 29, and 143 pairs, respectively) and used as inputs of a two-layer feedforward ANN with two target classes: high block (HB) and low block (LB). Optimal ANN (OANN) was identified using the training and validation sets and tested on the test set. RESULTS Test set area under the receiver operating characteristic was 0.91; sensitivity, specificity, accuracy, and precision were 0.93, 0.83, 0.92, and 0.96, respectively. CONCLUSION OANN represents a reliable tool for noninvasive assessment of the hERG potassium-channel block.
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Affiliation(s)
- Micaela Morettini
- Department of Information Engineering, Università Politecnica delle Marche, Ancona, Italy
| | - Chiara Peroni
- Department of Information Engineering, Università Politecnica delle Marche, Ancona, Italy
| | - Agnese Sbrollini
- Department of Information Engineering, Università Politecnica delle Marche, Ancona, Italy
| | - Ilaria Marcantoni
- Department of Information Engineering, Università Politecnica delle Marche, Ancona, Italy
| | - Laura Burattini
- Department of Information Engineering, Università Politecnica delle Marche, Ancona, Italy
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22
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Dzobo K, Adotey S, Thomford NE, Dzobo W. Integrating Artificial and Human Intelligence: A Partnership for Responsible Innovation in Biomedical Engineering and Medicine. OMICS-A JOURNAL OF INTEGRATIVE BIOLOGY 2019; 24:247-263. [PMID: 31313972 DOI: 10.1089/omi.2019.0038] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Historically, the term "artificial intelligence" dates to 1956 when it was first used in a conference at Dartmouth College in the US. Since then, the development of artificial intelligence has in part been shaped by the field of neuroscience. By understanding the human brain, scientists have attempted to build new intelligent machines capable of performing complex tasks akin to humans. Indeed, future research into artificial intelligence will continue to benefit from the study of the human brain. While the development of artificial intelligence algorithms has been fast paced, the actual use of most artificial intelligence (AI) algorithms in biomedical engineering and clinical practice is still markedly below its conceivably broader potentials. This is partly because for any algorithm to be incorporated into existing workflows it has to stand the test of scientific validation, clinical and personal utility, application context, and is equitable as well. In this context, there is much to be gained by combining AI and human intelligence (HI). Harnessing Big Data, computing power and storage capacities, and addressing societal issues emergent from algorithm applications, demand deploying HI in tandem with AI. Very few countries, even economically developed states, lack adequate and critical governance frames to best understand and steer the AI innovation trajectories in health care. Drug discovery and translational pharmaceutical research stand to gain from AI technology provided they are also informed by HI. In this expert review, we analyze the ways in which AI applications are likely to traverse the continuum of life from birth to death, and encompassing not only humans but also all animal, plant, and other living organisms that are increasingly touched by AI. Examples of AI applications include digital health, diagnosis of diseases in newborns, remote monitoring of health by smart devices, real-time Big Data analytics for prompt diagnosis of heart attacks, and facial analysis software with consequences on civil liberties. While we underscore the need for integration of AI and HI, we note that AI technology does not have to replace medical specialists or scientists and rather, is in need of such expert HI. Altogether, AI and HI offer synergy for responsible innovation and veritable prospects for improving health care from prevention to diagnosis to therapeutics while unintended consequences of automation emergent from AI and algorithms should be borne in mind on scientific cultures, work force, and society at large.
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Affiliation(s)
- Kevin Dzobo
- International Centre for Genetic Engineering and Biotechnology (ICGEB), Cape Town Component, Wernher and Beit Building (South), UCT Medical Campus, Anzio Road, Observatory 7925, Cape Town, South Africa.,Division of Medical Biochemistry and Institute of Infectious Disease and Molecular Medicine, Department of Integrative Biomedical Sciences, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Sampson Adotey
- International Development Innovation Network, D-Lab, Massachusetts Institute of Technology, Cambridge, Massachusetts, USA
| | - Nicholas E Thomford
- Pharmacogenetics Research Group, Division of Human Genetics, Department of Pathology and Institute of Infectious Diseases and Molecular Medicine, Faculty of Health Sciences, University of Cape Town, Observatory 7925, Cape Town, South Africa
| | - Witness Dzobo
- Pathology and Immunology Department, University Hospital Southampton, Mail Point B, Tremona Road, Southampton, UK.,University of Portsmouth, Faculty of Science, St Michael's Building, White Swan Road, Portsmouth, UK
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23
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Yoon D, Lim HS, Jeong JC, Kim TY, Choi JG, Jang JH, Jeong E, Park CM. Quantitative Evaluation of the Relationship between T-Wave-Based Features and Serum Potassium Level in Real-World Clinical Practice. BIOMED RESEARCH INTERNATIONAL 2018; 2018:3054316. [PMID: 30662906 PMCID: PMC6312577 DOI: 10.1155/2018/3054316] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/02/2018] [Accepted: 11/25/2018] [Indexed: 11/17/2022]
Abstract
BACKGROUND Proper management of hyperkalemia that leads to fatal cardiac arrhythmia has become more important because of the increased prevalence of hyperkalemia-prone diseases. Although T-wave changes in hyperkalemia are well known, their usefulness is debatable. We evaluated how well T-wave-based features of electrocardiograms (ECGs) are correlated with estimated serum potassium levels using ECG data from real-world clinical practice. METHODS We collected ECGs from a local ECG repository (MUSE™) from 1994 to 2017 and extracted the ECG waveforms. Of about 1 million reports, 124,238 were conducted within 5 minutes before or after blood collection for serum potassium estimation. We randomly selected 500 ECGs and two evaluators measured the amplitude (T-amp) and right slope of the T-wave (T-right slope) on five lead waveforms (V3, V4, V5, V6, and II). Linear correlations of T-amp, T-right slope, and their normalized feature (T-norm) with serum potassium levels were evaluated using Pearson correlation coefficient analysis. RESULTS Pearson correlation coefficients for T-wave-based features with serum potassium between the two evaluators were 0.99 for T-amp and 0.97 for T-right slope. The coefficient for the association between T-amp, T-right slope, and T-norm, and serum potassium ranged from -0.22 to 0.02. In the normal ECG subgroup (normal ECG or otherwise normal ECG), there was no correlation between T-wave-based features and serum potassium level. CONCLUSIONS T-wave-based features were not correlated with serum potassium level, and their use in real clinical practice is currently limited.
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Affiliation(s)
- Dukyong Yoon
- Department of Biomedical Informatics, Ajou University School of Medicine, Suwon, Gyeonggi-do, Republic of Korea
- Department of Biomedical Sciences, Ajou University Graduate School of Medicine, Suwon, Gyeonggi-do, Republic of Korea
| | - Hong Seok Lim
- Department of Cardiology, Ajou University School of Medicine, Suwon, Gyeonggi-do, Republic of Korea
| | - Jong Cheol Jeong
- Department of Nephrology, Ajou University School of Medicine, Suwon, Gyeonggi-do, Republic of Korea
| | - Tae Young Kim
- Department of Biomedical Informatics, Ajou University School of Medicine, Suwon, Gyeonggi-do, Republic of Korea
| | - Jung-gu Choi
- Department of Biomedical Informatics, Ajou University School of Medicine, Suwon, Gyeonggi-do, Republic of Korea
| | - Jong-Hwan Jang
- Department of Biomedical Informatics, Ajou University School of Medicine, Suwon, Gyeonggi-do, Republic of Korea
| | - Eugene Jeong
- Department of Biomedical Informatics, Ajou University School of Medicine, Suwon, Gyeonggi-do, Republic of Korea
| | - Chan Min Park
- Department of Biomedical Informatics, Ajou University School of Medicine, Suwon, Gyeonggi-do, Republic of Korea
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24
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Friedman PA, Scott CG, Bailey K, Baumann NA, Albert D, Attia ZI, Ladewig DJ, Yasin O, Dillon JJ, Singh B. Errors of Classification With Potassium Blood Testing: The Variability and Repeatability of Critical Clinical Tests. Mayo Clin Proc 2018; 93:566-572. [PMID: 29728199 DOI: 10.1016/j.mayocp.2018.03.013] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2017] [Revised: 03/08/2018] [Accepted: 03/16/2018] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To understand the performance of a currently used clinical blood test with regard to the frequency and size of variation of the results. PATIENTS AND METHODS From November 29, 2012, through November 29, 2013, patients were recruited at 65 sites as part of a previously reported clinical trial (ClinicalTrials.gov Identifier: NCT01737697). Eligible outpatients who had been fasting for at least 8 hours underwent venous phlebotomy at baseline, 30 minutes, and 60 minutes to measure plasma potassium levels in whole blood using a point-of-care device (i-STAT, Abbott Laboratories). We analyzed the results to assess their variability and frequency of pseudohyperkalemia and pseudonormokalemia. RESULTS A total of 1170 patients were included in this study. Absolute differences between pairs of measurements from different time points ranged from 0 to 2.5 mmol/L, with a mean difference of 0.26 mmol/L. The mean percentage differences were approximately 5% with an SD of 5%. Approximately 12% of differences between repeated fasting potassium blood test results were above 0.5 mmol/L (33% of the normal range), and 20% of patients (234) had at least one difference greater than 0.5 mmol/L. In 44.0% of the patients with a hyperkalemic average value (true hyperkalemia) (302 of 686), at least one blood test result was in the normal range (pseudonormokalemia), and in 30.2% of the patients with a normal average value (146 of 484), at least one blood test result was elevated (pseudohyperkalemia). CONCLUSION Expected variability and errors exist with potassium blood tests, even when conditions are optimized. Pseudohyperkalemia and pseudonormokalemia are common, indicating a need for thoughtful clinical interpretation of unexpected test results.
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Affiliation(s)
- Paul A Friedman
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN.
| | - Christopher G Scott
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN
| | - Kent Bailey
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN
| | - Nikola A Baumann
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN
| | | | - Zachi I Attia
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
| | | | - Omar Yasin
- Department of Internal Medicine, Mayo Clinic, Rochester, MN
| | - John J Dillon
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN
| | - Bhupinder Singh
- ZS Pharma, Inc, San Mateo, CA; University of California, Irvine, School of Medicine, Irvine, CA
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25
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Dialytic interval and the timing of electrocardiographic screening for subcutaneous cardioverter-defibrillator placement in chronic hemodialysis patients. J Interv Card Electrophysiol 2018. [DOI: 10.1007/s10840-018-0343-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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26
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Yasin OZ, Attia Z, Dillon JJ, DeSimone CV, Sapir Y, Dugan J, Somers VK, Ackerman MJ, Asirvatham SJ, Scott CG, Bennet KE, Ladewig DJ, Sadot D, Geva AB, Friedman PA. Noninvasive blood potassium measurement using signal-processed, single-lead ecg acquired from a handheld smartphone. J Electrocardiol 2017. [PMID: 28641860 DOI: 10.1016/j.jelectrocard.2017.06.008] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVE We have previously used a 12-lead, signal-processed ECG to calculate blood potassium levels. We now assess the feasibility of doing so with a smartphone-enabled single lead, to permit remote monitoring. PATIENTS AND METHODS Twenty-one hemodialysis patients held a smartphone equipped with inexpensive FDA-approved electrodes for three 2min intervals during hemodialysis. Individualized potassium estimation models were generated for each patient. ECG-calculated potassium values were compared to blood potassium results at subsequent visits to evaluate the accuracy of the potassium estimation models. RESULTS The mean absolute error between the estimated potassium and blood potassium 0.38±0.32 mEq/L (9% of average potassium level) decreasing to 0.6 mEq/L using predictors of poor signal. CONCLUSIONS A single-lead ECG acquired using electrodes attached to a smartphone device can be processed to calculate the serum potassium with an error of 9% in patients undergoing hemodialysis. SUMMARY A single-lead ECG acquired using electrodes attached to a smartphone can be processed to calculate the serum potassium in patients undergoing hemodialysis remotely.
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Affiliation(s)
- Omar Z Yasin
- Department of Internal Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, USA; Department of Cardiovascular Diseases, Mayo Clinic, 200 First Street SW, Rochester, MN, USA
| | - Zachi Attia
- Department of Internal Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, USA; Department of Cardiovascular Diseases, Mayo Clinic, 200 First Street SW, Rochester, MN, USA; Electrical and Computer Engineering, Ben-Gurion University of the Negev, P.O. Box 653, Beer Sheva, Israel
| | - John J Dillon
- Nephrology and Hypertension, Mayo Clinic, 200 First Street SW, Rochester, MN, USA
| | - Christopher V DeSimone
- Department of Cardiovascular Diseases, Mayo Clinic, 200 First Street SW, Rochester, MN, USA
| | - Yehu Sapir
- Electrical and Computer Engineering, Ben-Gurion University of the Negev, P.O. Box 653, Beer Sheva, Israel
| | - Jennifer Dugan
- Department of Internal Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, USA; Department of Cardiovascular Diseases, Mayo Clinic, 200 First Street SW, Rochester, MN, USA
| | - Virend K Somers
- Department of Internal Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, USA; Department of Cardiovascular Diseases, Mayo Clinic, 200 First Street SW, Rochester, MN, USA
| | - Michael J Ackerman
- Department of Internal Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, USA; Department of Cardiovascular Diseases, Mayo Clinic, 200 First Street SW, Rochester, MN, USA
| | - Samuel J Asirvatham
- Department of Internal Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, USA; Department of Cardiovascular Diseases, Mayo Clinic, 200 First Street SW, Rochester, MN, USA
| | - Christopher G Scott
- Biomedical Statistics and Informatics, Mayo Clinic, 200 First Street SW, Rochester, MN, USA
| | - Kevin E Bennet
- Division of Engineering, Mayo Clinic, 200 First Street SW, Rochester, MN, USA
| | | | - Dan Sadot
- Electrical and Computer Engineering, Ben-Gurion University of the Negev, P.O. Box 653, Beer Sheva, Israel
| | - Amir B Geva
- Electrical and Computer Engineering, Ben-Gurion University of the Negev, P.O. Box 653, Beer Sheva, Israel
| | - Paul A Friedman
- Department of Internal Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, USA; Department of Cardiovascular Diseases, Mayo Clinic, 200 First Street SW, Rochester, MN, USA.
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27
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Heine T, Lenis G, Reichensperger P, Beran T, Doessel O, Deml B. Electrocardiographic features for the measurement of drivers' mental workload. APPLIED ERGONOMICS 2017; 61:31-43. [PMID: 28237018 DOI: 10.1016/j.apergo.2016.12.015] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/12/2016] [Revised: 11/26/2016] [Accepted: 12/21/2016] [Indexed: 06/06/2023]
Abstract
This study examines the effect of mental workload on the electrocardiogram (ECG) of participants driving the Lane Change Task (LCT). Different levels of mental workload were induced by a secondary task (n-back task) with three levels of difficulty. Subjective data showed a significant increase of the experienced workload over all three levels. An exploratory approach was chosen to extract a large number of rhythmical and morphological features from the ECG signal thereby identifying those which differentiated best between the levels of mental workload. No single rhythmical or morphological feature was able to differentiate between all three levels. A group of parameters were extracted which were at least able to discriminate between two levels. For future research, a combination of features is recommended to achieve best diagnosticity for different levels of mental workload.
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Affiliation(s)
- Tobias Heine
- Institute of Human and Industrial Engineering (ifab), Karlsruhe Institute of Technology (KIT), Kaiserstrasse 12, 76131 Karlsruhe, Germany.
| | - Gustavo Lenis
- Institute of Biomedical Engineering (IBT), Karlsruhe Institute of Technology (KIT), Fritz-Haber-Weg 1, 76131 Karlsruhe, Germany
| | - Patrick Reichensperger
- Institute of Biomedical Engineering (IBT), Karlsruhe Institute of Technology (KIT), Fritz-Haber-Weg 1, 76131 Karlsruhe, Germany
| | - Tobias Beran
- Institute of Human and Industrial Engineering (ifab), Karlsruhe Institute of Technology (KIT), Kaiserstrasse 12, 76131 Karlsruhe, Germany
| | - Olaf Doessel
- Institute of Biomedical Engineering (IBT), Karlsruhe Institute of Technology (KIT), Fritz-Haber-Weg 1, 76131 Karlsruhe, Germany
| | - Barbara Deml
- Institute of Human and Industrial Engineering (ifab), Karlsruhe Institute of Technology (KIT), Kaiserstrasse 12, 76131 Karlsruhe, Germany
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Electrocardiographic Predictors of Torsadogenic Risk During Dofetilide or Sotalol Initiation: Utility of a Novel T Wave Analysis Program. Cardiovasc Drugs Ther 2016; 29:433-41. [PMID: 26411977 DOI: 10.1007/s10557-015-6619-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
INTRODUCTION Initiation of class III anti-arrhythmic medications requires telemetric monitoring for ventricular arrhythmias and QT prolongation to reduce the risk of torsades de pointes (TdP). Heart rate-corrected QT interval (QTc) is an indicator of risk, however it is imperfect, and subtle abnormalities of repolarization have been linked with arrhythmogenesis. PURPOSE Identification of electrocardiographic predictors of torsadogenic risk through the application of a novel T wave analysis tool. METHODS Among all patients admitted to Mayo Clinic for initiation of dofetilide or sotalol, we identified 13 cases who developed drug-induced TdP and 26 age and sex matched controls that did not develop TdP. The immediate pre-TdP ECG of those with TdP was compared to the last ECG performed prior to hospital discharge in controls using a novel T wave program that quantified subtle changes in T wave morphology. RESULTS The QTc and 12 T wave parameters successfully distinguished TdP cases from controls. The top performing parameters were the QTc in lead V3 (mean case vs control 480 vs 420 msec, p < 0.001, r = 0.72) and T wave right slope in lead I (mean case vs control -840.29 vs -1668.71 mV/s, p = 0.002, r = 0.45). The addition of T wave right slope to QTc improved prediction accuracy from 79 to 88 %. CONCLUSION Our data demonstrate that, in addition to QTc, the T wave right slope is correlated strongly with TdP risk. This suggests that a computer-based repolarization measurement tool that integrates additional data beyond the QTc may identify patients with the greatest torsadogenic potential.
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Attia ZI, DeSimone CV, Dillon JJ, Sapir Y, Somers VK, Dugan JL, Bruce CJ, Ackerman MJ, Asirvatham SJ, Striemer BL, Bukartyk J, Scott CG, Bennet KE, Ladewig DJ, Gilles EJ, Sadot D, Geva AB, Friedman PA. Novel Bloodless Potassium Determination Using a Signal-Processed Single-Lead ECG. J Am Heart Assoc 2016; 5:e002746. [PMID: 26811164 PMCID: PMC4859394 DOI: 10.1161/jaha.115.002746] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2015] [Accepted: 12/21/2015] [Indexed: 01/01/2023]
Abstract
BACKGROUND Hyper- and hypokalemia are clinically silent, common in patients with renal or cardiac disease, and are life threatening. A noninvasive, unobtrusive, blood-free method for tracking potassium would be an important clinical advance. METHODS AND RESULTS Two groups of hemodialysis patients (development group, n=26; validation group, n=19) underwent high-resolution digital ECG recordings and had 2 to 3 blood tests during dialysis. Using advanced signal processing, we developed a personalized regression model for each patient to noninvasively calculate potassium values during the second and third dialysis sessions using only the processed single-channel ECG. In addition, by analyzing the entire development group's first-visit data, we created a global model for all patients that was validated against subsequent sessions in the development group and in a separate validation group. This global model sought to predict potassium, based on the T wave characteristics, with no blood tests required. For the personalized model, we successfully calculated potassium values with an absolute error of 0.36±0.34 mmol/L (or 10% of the measured blood potassium). For the global model, potassium prediction was also accurate, with an absolute error of 0.44±0.47 mmol/L for the training group (or 11% of the measured blood potassium) and 0.5±0.42 for the validation set (or 12% of the measured blood potassium). CONCLUSIONS The signal-processed ECG derived from a single lead can be used to calculate potassium values with clinically meaningful resolution using a strategy that requires no blood tests. This enables a cost-effective, noninvasive, unobtrusive strategy for potassium assessment that can be used during remote monitoring.
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Affiliation(s)
- Zachi I. Attia
- Division of Cardiovascular DiseasesMayo ClinicRochesterMN
- Electrical and Computer EngineeringBen‐Gurion University of the NegevBeer ShevaIsrael
| | | | | | - Yehu Sapir
- Electrical and Computer EngineeringBen‐Gurion University of the NegevBeer ShevaIsrael
| | | | | | | | | | | | | | - Jan Bukartyk
- Division of Cardiovascular DiseasesMayo ClinicRochesterMN
| | | | | | | | | | - Dan Sadot
- Electrical and Computer EngineeringBen‐Gurion University of the NegevBeer ShevaIsrael
| | - Amir B. Geva
- Electrical and Computer EngineeringBen‐Gurion University of the NegevBeer ShevaIsrael
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Tenjimbayashi M, Komatsu H, Akamatsu M, Nakanishi W, Suzuki K, Hill JP, Shiratori S, Ariga K. Determination of blood potassium using a fouling-resistant PVDF–HFP-based optode. RSC Adv 2016. [DOI: 10.1039/c5ra26514b] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
Monitoring potassium levels in blood is a significant aspect of clinical analysis. Here, we report a system for determination of potassium in blood which has the additional advantage of being blood-fouling resistant for safe and easy in situ sensing.
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Affiliation(s)
- Mizuki Tenjimbayashi
- Department of Integrated Design Engineering
- Faculty of Science and Technology
- Keio University
- Yokohama
- Japan
| | - Hirokazu Komatsu
- WPI-MANA
- National Institute for Materials Science (NIMS)
- Tsukuba
- Japan
| | | | - Waka Nakanishi
- WPI-MANA
- National Institute for Materials Science (NIMS)
- Tsukuba
- Japan
| | - Koji Suzuki
- Department of Integrated Design Engineering
- Faculty of Science and Technology
- Keio University
- Yokohama
- Japan
| | - Jonathan P. Hill
- WPI-MANA
- National Institute for Materials Science (NIMS)
- Tsukuba
- Japan
| | - Seimei Shiratori
- Department of Integrated Design Engineering
- Faculty of Science and Technology
- Keio University
- Yokohama
- Japan
| | - Katsuhiko Ariga
- WPI-MANA
- National Institute for Materials Science (NIMS)
- Tsukuba
- Japan
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The subcutaneous implantable cardioverter defibrillator: state-of-the-art review. Eur Heart J 2015; 38:247-257. [DOI: 10.1093/eurheartj/ehv507] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2015] [Revised: 08/14/2015] [Accepted: 09/07/2015] [Indexed: 01/20/2023] Open
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Extramiana F. A step toward “electrocardiobiology”? J Electrocardiol 2015; 48:19-20. [DOI: 10.1016/j.jelectrocard.2014.10.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2014] [Indexed: 11/15/2022]
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