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Wessel N, Kim JS, Joung BY, Ko YG, Dischl D, Gapelyuk A, Lee YH, Kim KW, Park JW, Landmesser U. Magnetocardiography at rest predicts cardiac death in patients with acute chest pain. Front Cardiovasc Med 2023; 10:1258890. [PMID: 38155993 PMCID: PMC10752986 DOI: 10.3389/fcvm.2023.1258890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 11/30/2023] [Indexed: 12/30/2023] Open
Abstract
Introduction Sudden cardiac arrest is a major cause of morbidity and mortality worldwide and remains a major public health problem for which better non-invasive prediction tools are needed. Primary preventive therapies, such as implantable cardioverter defibrillators, are not personalized and not predictive. Most of these devices do not deliver life-saving therapy during their lifetime. The individual relationship between fatal arrhythmias and cardiac function abnormalities in predicting cardiac death risk has rarely been explored. Methods We retrospectively analyzed the measurements at rest for 191 patients with acute chest pain (ACP) magnetocardiographically. Our recently introduced analyses are able to detect inhomogeneities of the depolarization and repolarization. Moreover, electrically silent phenomena-intracellular ionic currents as well as vortex currents-can be measured and quantified. All included ACP patients were recruited in 2009 at Yonsei University Hospital and were followed up until 2022. Results During half of the follow-up period (6.5 years), 11 patients died. Out of all the included nine clinical, eight magnetocardiographical, and nine newly introduced magnetoionographical parameters we tested in this study, three parameters revealed themselves to be outstanding at predicting death: heart rate-corrected QT (QTc) prolongation, depression of repolarization current IKr + IKs, and serum creatinine (all significant in Cox regression, p < 0.05). They clearly predicted cardiac death over the 6.5 years duration (sensitivity 90.9%, specificity 85.6%, negative predictive accuracy 99.4%). Cardiac death risk was more than ninefold higher in patients with low repolarization reserve and QTc prolongation in comparison with the remaining patients with ACP (p < 0.001). The non-parametric Kaplan-Meier statistics estimated significantly lower survival functions from their lifetime data (p < 0.001). Discussion To the best of our knowledge, these are the first data linking magnetocardiographical and magnetoionographical parameters and subsequent significant fatal events in people, suggesting structural and functional components to clinical life-threatening ventricular arrhythmogenesis. The findings support investigation of new prevention strategies and herald those new non-invasive techniques as complementary risk stratification tools.
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Affiliation(s)
- N. Wessel
- Department of Human Medicine, MSB Medical School Berlin GmbH, Humboldt-Universität zu Berlin, Berlin, Germany
- Department of Physics, Humboldt Universität zu Berlin, Berlin, Germany
| | - J. S. Kim
- Division of Cardiology, Department of Internal Medicine, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - B. Y. Joung
- Division of Cardiology, Department of Internal Medicine, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Y. G. Ko
- Division of Cardiology, Department of Internal Medicine, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - D. Dischl
- Deutsches Herzzentrum der Charité, Department of Cardiology, Angiology and Intensive Care Medicine, Berlin, Germany
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - A. Gapelyuk
- Department of Physics, Humboldt Universität zu Berlin, Berlin, Germany
| | - Y. H. Lee
- Center for Biosignals, KRISS Korea Research Institute of Standards and Science, Daejeon, Republic of Korea
| | - K. W. Kim
- Center for Biosignals, KRISS Korea Research Institute of Standards and Science, Daejeon, Republic of Korea
| | - J. W. Park
- Deutsches Herzzentrum der Charité, Department of Cardiology, Angiology and Intensive Care Medicine, Berlin, Germany
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - U. Landmesser
- Deutsches Herzzentrum der Charité, Department of Cardiology, Angiology and Intensive Care Medicine, Berlin, Germany
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
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Pille M, Gapelyuk A, Berg K, Bannasch S, Mockler J, Park LS, Park JW, Wessel N. Cardiac magnetic field map topology quantified by Kullback-Leibler entropy identifies patients with clinically suspected myocarditis. Front Cardiovasc Med 2023; 10:1276321. [PMID: 38028437 PMCID: PMC10663336 DOI: 10.3389/fcvm.2023.1276321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Accepted: 10/18/2023] [Indexed: 12/01/2023] Open
Abstract
Background Myocarditis is a condition that can have severe adverse outcomes and lead to sudden cardiac death if remaining undetected. This study tested the capability of cardiac magnetic field mapping to detect patients with clinically suspected myocarditis. This could open up the way for rapid, non-invasive, and cost-effective screening of suspected cases before a gold standard assessment via endomyocardial biopsy. Methods Historical cardiac magnetic field maps (n = 97) and data from a state-of-the-art magnetocardiography device (n = 30) were analyzed using the Kullback-Leibler entropy (KLE) for dimensionality reduction and topological quantification. Linear discriminant analysis was used to discern between patients with ongoing myocarditis and healthy controls. Results The STT segment of a magnetocardiogram, i.e., the section between the end of the S wave and the end of the T wave, was best suited to discern both groups. Using a 250-ms excerpt from the onset of the STT segment gave a reliable classification between the myocarditis and control group for both historic data (sensitivity: 0.83, specificity: 0.85, accuracy: 0.84) and recent data (sensitivity: 0.69, specificity: 0.88, accuracy: 0.80) using the KLE to quantify the topology of the cardiac magnetic field map. Conclusion The implementation based on KLE can reliably distinguish between clinically suspected myocarditis patients and healthy controls. We implemented an automatized feature selection based on LDA to replace the observer-dependent manual thresholding in previous studies.
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Affiliation(s)
- M. Pille
- Department of Physics, Humboldt-Universität zu Berlin, Berlin, Germany
- Berlin Institute of Health at Charité, Universitätsmedizin Berlin, Berlin, Germany
| | - A. Gapelyuk
- Department of Physics, Humboldt-Universität zu Berlin, Berlin, Germany
| | - K. Berg
- Department of Physics, Humboldt-Universität zu Berlin, Berlin, Germany
| | - S. Bannasch
- Biomagnetik Park Holding GmbH, Hamburg, Germany
| | - J. Mockler
- Biomagnetik Park Holding GmbH, Hamburg, Germany
| | - L.-S. Park
- Biomagnetik Park Holding GmbH, Hamburg, Germany
| | - J.-W. Park
- Biomagnetik Park Holding GmbH, Hamburg, Germany
- Deutsches Herzzentrum der Charité, Campus Benjamin Franklin, Berlin, Germany
| | - N. Wessel
- Department of Physics, Humboldt-Universität zu Berlin, Berlin, Germany
- Department of Human Medicine, MSB Medical School Berlin GmbH, Berlin, Germany
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Wang Y, Zhao ZG, Chai Z, Fang JC, Chen M. Electromagnetic field and cardiovascular diseases: A state-of-the-art review of diagnostic, therapeutic, and predictive values. FASEB J 2023; 37:e23142. [PMID: 37650634 DOI: 10.1096/fj.202300201rr] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Revised: 07/20/2023] [Accepted: 08/02/2023] [Indexed: 09/01/2023]
Abstract
Despite encouraging advances in early diagnosis and treatment, cardiovascular diseases (CVDs) remained a leading cause of morbidity and mortality worldwide. Increasing evidence has shown that the electromagnetic field (EMF) influences many biological processes, which has attracted much attention for its potential therapeutic and diagnostic modalities in multiple diseases, such as musculoskeletal disorders and neurodegenerative diseases. Nonionizing EMF has been studied as a therapeutic or diagnostic tool in CVDs. In this review, we summarize the current literature ranging from in vitro to clinical studies focusing on the therapeutic potential (external EMF) and diagnostic potential (internal EMF generated from the heart) of EMF in CVDs. First, we provided an overview of the therapeutic potential of EMF and associated mechanisms in the context of CVDs, including cardiac arrhythmia, myocardial ischemia, atherosclerosis, and hypertension. Furthermore, we investigated the diagnostic and predictive value of magnetocardiography in CVDs. Finally, we discussed the critical steps necessary to translate this promising approach into clinical practice.
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Affiliation(s)
- Yan Wang
- Laboratory of Heart Valve Disease, West China Hospital, Sichuan University, Chengdu, Sichuan, China
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Zhen-Gang Zhao
- Laboratory of Heart Valve Disease, West China Hospital, Sichuan University, Chengdu, Sichuan, China
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Zheng Chai
- Laboratory of Heart Valve Disease, West China Hospital, Sichuan University, Chengdu, Sichuan, China
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Jian-Cheng Fang
- School of Instrumentation Science and Opto-Electronics Engineering, Beihang University, Beijing, China
| | - Mao Chen
- Laboratory of Heart Valve Disease, West China Hospital, Sichuan University, Chengdu, Sichuan, China
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
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Brisinda D, Fenici P, Fenici R. Clinical magnetocardiography: the unshielded bet-past, present, and future. Front Cardiovasc Med 2023; 10:1232882. [PMID: 37636301 PMCID: PMC10448194 DOI: 10.3389/fcvm.2023.1232882] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 06/23/2023] [Indexed: 08/29/2023] Open
Abstract
Magnetocardiography (MCG), which is nowadays 60 years old, has not yet been fully accepted as a clinical tool. Nevertheless, a large body of research and several clinical trials have demonstrated its reliability in providing additional diagnostic electrophysiological information if compared with conventional non-invasive electrocardiographic methods. Since the beginning, one major objective difficulty has been the need to clean the weak cardiac magnetic signals from the much higher environmental noise, especially that of urban and hospital environments. The obvious solution to record the magnetocardiogram in highly performant magnetically shielded rooms has provided the ideal setup for decades of research demonstrating the diagnostic potential of this technology. However, only a few clinical institutions have had the resources to install and run routinely such highly expensive and technically demanding systems. Therefore, increasing attempts have been made to develop cheaper alternatives to improve the magnetic signal-to-noise ratio allowing MCG in unshielded hospital environments. In this article, the most relevant milestones in the MCG's journey are reviewed, addressing the possible reasons beyond the currently long-lasting difficulty to reach a clinical breakthrough and leveraging the authors' personal experience since the early 1980s attempting to finally bring MCG to the patient's bedside for many years thus far. Their nearly four decades of foundational experimental and clinical research between shielded and unshielded solutions are summarized and referenced, following the original vision that MCG had to be intended as an unrivaled method for contactless assessment of the cardiac electrophysiology and as an advanced method for non-invasive electroanatomical imaging, through multimodal integration with other non-fluoroscopic imaging techniques. Whereas all the above accounts for the past, with the available innovative sensors and more affordable active shielding technologies, the present demonstrates that several novel systems have been developed and tested in multicenter clinical trials adopting both shielded and unshielded MCG built-in hospital environments. The future of MCG will mostly be dependent on the results from the ongoing progress in novel sensor technology, which is relatively soon foreseen to provide multiple alternatives for the construction of more compact, affordable, portable, and even wearable devices for unshielded MCG inside hospital environments and perhaps also for ambulatory patients.
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Affiliation(s)
- D. Brisinda
- Dipartimento Scienze dell'invecchiamento, ortopediche e reumatologiche, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome, Italy
- School of Medicine and Surgery, Catholic University of the Sacred Heart, Rome, Italy
- Biomagnetism and Clinical Physiology International Center (BACPIC), Rome, Italy
| | - P. Fenici
- School of Medicine and Surgery, Catholic University of the Sacred Heart, Rome, Italy
- Biomagnetism and Clinical Physiology International Center (BACPIC), Rome, Italy
| | - R. Fenici
- Biomagnetism and Clinical Physiology International Center (BACPIC), Rome, Italy
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Her AY, Dischl D, Kim YH, Kim SW, Shin ES. Magnetocardiography for the detection of myocardial ischemia. Front Cardiovasc Med 2023; 10:1242215. [PMID: 37485271 PMCID: PMC10361573 DOI: 10.3389/fcvm.2023.1242215] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Accepted: 06/28/2023] [Indexed: 07/25/2023] Open
Abstract
Ischemic heart disease (IHD) continues to be a significant global public health concern and ranks among the leading causes of mortality worldwide. However, the identification of myocardial ischemia in patients suspected of having coronary artery disease (CAD) remains a challenging issue. Functional or stress testing is widely recognized as the gold standard method for diagnosing myocardial ischemia, but it is hindered by low diagnostic accuracy and limitations such as radiation exposure. Magnetocardiography (MCG) is a non-contact, non-invasive method that records magnetic fields produced by the electrical activity of the heart. Unlike electrocardiography (EKG) and other functional or stress testing, MCG offers numerous advantages. It is highly sensitive and can detect early signs of myocardial ischemia that may be missed by other diagnostic tools. This review aims to provide an extensive overview of the available evidence that establishes the utility of MCG as a valuable diagnostic tool for identifying myocardial ischemia, accompanied by a discussion of potential future research directions in this domain.
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Affiliation(s)
- Ae-Young Her
- Department of Internal Medicine, Division of Cardiology, Kangwon National University College of Medicine, Kangwon National University School of Medicine, Chuncheon, Republic of Korea
| | - Dominic Dischl
- Department of Cardiology, Deutsches Herzzentrum der Charité (DHZC), Angiology and Intensive Care Medicine, Berlin, Germany
| | - Yong Hoon Kim
- Department of Internal Medicine, Division of Cardiology, Kangwon National University College of Medicine, Kangwon National University School of Medicine, Chuncheon, Republic of Korea
| | - Sang-Wook Kim
- Heart Research Institute, Cardiovascular-Arrhythmia Center, College of Medicine, Chung-Ang University Hospital, Seoul, Republic of Korea
| | - Eun-Seok Shin
- Department of Cardiology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Republic of Korea
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Chen C, Jin Y, Lo IL, Zhao H, Sun B, Zhao Q, Zheng J, Zhang XD. Complexity Change in Cardiovascular Disease. Int J Biol Sci 2017; 13:1320-1328. [PMID: 29104498 PMCID: PMC5666530 DOI: 10.7150/ijbs.19462] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Accepted: 04/21/2017] [Indexed: 12/02/2022] Open
Abstract
With the fast development of wearable medical device in recent years, it becomes critical to conduct research on continuously measured physiological signals. Entropy is a key metric for quantifying the irregularity and/or complexity contained in human physiological signals. In this review, we focus on exploring how entropy changes in various physiological signals in cardiovascular diseases. Our review concludes that the direction of entropy change relies on the physiological signals under investigation. For heart rate variability and pulse index, the entropy of a healthy person is higher than that of a patient with cardiovascular diseases. For diastolic period variability and diastolic heart sound, the direction of entropy change is reversed. Our conclusion should not only give valuable guidance for further research on the application of entropy in cardiovascular diseases but also provide a foundation for using entropy to analyze the irregularity and/or complexity of physiological signals measured by wearable medical device.
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Affiliation(s)
- Chang Chen
- Faculty of Health Sciences, University of Macau, Taipa, Macau
| | - Yu Jin
- Faculty of Health Sciences, University of Macau, Taipa, Macau
| | - Iek Long Lo
- Department of Geriatrics, Centro Hospital Conde de Sao Januario, Macau
| | - Hansen Zhao
- Department of Cardiovascular Diseases, Beijing Hospital of Chinese Medicine, Capital Medical University, Beijing, China
| | - Baoqing Sun
- State Key Laboratory of Respiratory Disease, The 1st Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Qi Zhao
- Faculty of Health Sciences, University of Macau, Taipa, Macau
| | - Jun Zheng
- Faculty of Health Sciences, University of Macau, Taipa, Macau
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Noninvasively diagnosing coronary artery disease with 61-channel MCG data. CHINESE SCIENCE BULLETIN-CHINESE 2014. [DOI: 10.1007/s11434-014-0177-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Wu Y, Gu J, Chen T, Wang W, Jiang S, Quan W. Noninvasive diagnosis of coronary artery disease using two parameters extracted in an extrema circle of magnetocardiogram. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2013; 2013:1843-1846. [PMID: 24110069 DOI: 10.1109/embc.2013.6609882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Magnetocardiography (MCG) is a complementary or alternative tool for noninvasive detection of coronary artery disease (CAD). The effectiveness of the tool for CAD diagnosis is generally evaluated by statistical analysis. In this study, we present a new method for screening CAD, in which two parameters including the curvature of magnetic field zero line and the area ratio of the extrema circle are extracted in magnetic field maps. 50 normal and 28 CAD subjects, whose signals were recorded by a 4-channel superconducting quantum interference device system, are analyzed with this method. The statistical results show a sensitivity and specificity of 71.4% and 72.0% respectively.
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Steinisch M, Torke PR, Haueisen J, Hailer B, Grönemeyer D, Van Leeuwen P, Comani S. Early detection of coronary artery disease in patients studied with magnetocardiography: an automatic classification system based on signal entropy. Comput Biol Med 2012; 43:144-53. [PMID: 23260570 DOI: 10.1016/j.compbiomed.2012.11.014] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2012] [Revised: 11/20/2012] [Accepted: 11/22/2012] [Indexed: 01/18/2023]
Abstract
We propose an automatic system for the classification of coronary artery disease (CAD) based on entropy measures of MCG recordings. Ten patients with coronary artery narrowing ≥ or ≤ 50% were categorized by a multilayer perceptron (MLP) neural network based on Linear Discriminant Analysis (LDA). Best results were obtained with MCG at rest: 99% sensitivity, 97% specificity, 98% accuracy, 96% and 99% positive and negative predictive values for single heartbeats. At patient level, these results correspond to a correct classification of all patients. The classifier's suitability to detect CAD-induced changes on the MCG at rest was validated with surrogate data.
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Affiliation(s)
- Martin Steinisch
- Behavioral Imaging and Neural Dynamics Center, G. d'Annunzio University, Via dei Vestini 33, 66013 Chieti, Italy
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Agarwal R, Saini A, Alyousef T, Umscheid CA. Magnetocardiography for the diagnosis of coronary artery disease: a systematic review and meta-analysis. Ann Noninvasive Electrocardiol 2012; 17:291-8. [PMID: 23094875 DOI: 10.1111/j.1542-474x.2012.00538.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Coronary artery disease (CAD) has a significant disease burden making early diagnosis and management imperative. Magnetocardiography (MCG) is a relatively new noninvasive technique that allows diagnosis of CAD by recording the magnetic fields generated by the electrical activity of the heart. METHODS We searched MEDLINE and the Cochrane Central Register of Controlled Trials for prospective studies that evaluated the test characteristics (e.g., sensitivity, specificity, likelihood ratios) of MCG for detection of CAD. Studies were included if they evaluated either patients with stable CAD documented by angiogram or patients presenting initially with acute coronary syndrome and subsequently diagnosed with CAD. The quality of included studies was assessed using an adaptation of the Quality Assessment of Diagnostic Accuracy Studies (QUADAS) tool. We performed meta-analyses of sensitivity, specificity and positive and negative likelihood ratios using Meta-DiSc software. RESULTS Screening of titles and abstracts followed by full-text review yielded seven studies that met our inclusion criteria. Meta-analyses yielded a pooled sensitivity of 83% (95% confidence interval [CI] 80% to 86%) and a specificity of 77% (95% CI 73% to 81%). The pooled positive likelihood ratio was 3.92 (95% CI 2.30 to 6.66) and negative likelihood ratio was 0.20 (95% CI 0.12 to 0.35). Significant heterogeneity was present in all meta-analyses. CONCLUSIONS The pooled test characteristics for MCG are similar to those of existing noninvasive modalities for diagnosing CAD. Our results suggest that MCG is a potential complementary or alternative tool for noninvasive detection of CAD.
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Affiliation(s)
- Rajender Agarwal
- Department of Medicine, University of Pennsylvania, Philadelphia, PA, USA
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