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Good WW, Zenger B, Bergquist JA, Rupp LC, Gillette KK, Gsell MAF, Plank G, MacLeod RS. Quantifying the spatiotemporal influence of acute myocardial ischemia on volumetric conduction velocity. J Electrocardiol 2021; 66:86-94. [PMID: 33836460 DOI: 10.1016/j.jelectrocard.2021.03.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 02/28/2021] [Accepted: 03/10/2021] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Acute myocardial ischemia occurs when coronary perfusion to the heart is inadequate, which can perturb the highly organized electrical activation of the heart and can result in adverse cardiac events including sudden cardiac death. Ischemia is known to influence the ST and repolarization phases of the ECG, but it also has a marked effect on propagation (QRS); however, studies investigating propagation during ischemia have been limited. METHODS We estimated conduction velocity (CV) and ischemic stress prior to and throughout 20 episodes of experimentally induced ischemia in order to quantify the progression and correlation of volumetric conduction changes during ischemia. To estimate volumetric CV, we 1) reconstructed the activation wavefront; 2) calculated the elementwise gradient to approximate propagation direction; and 3) estimated conduction speed (CS) with an inverse-gradient technique. RESULTS We found that acute ischemia induces significant conduction slowing, reducing the global median speed by 20 cm/s. We observed a biphasic response in CS (acceleration then deceleration) early in some ischemic episodes. Furthermore, we noted a high temporal correlation between ST-segment changes and CS slowing; however, when comparing these changes over space, we found only moderate correlation (corr. = 0.60). DISCUSSION This study is the first to report volumetric CS changes (acceleration and slowing) during episodes of acute ischemia in the whole heart. We showed that while CS changes progress in a similar time course to ischemic stress (measured by ST-segment shifts), the spatial overlap is complex and variable, showing extreme conduction slowing both in and around regions experiencing severe ischemia.
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Affiliation(s)
- Wilson W Good
- Scientific Computing and Imaging Institute, University of Utah, Salt Lake City, UT, USA; Department of Biomedical Engineering, University of Utah, Salt Lake City, UT, USA; Nora Eccles Cardiovascular Research and Training Institute, University of Utah, Salt Lake City, UT, USA.
| | - Brian Zenger
- Scientific Computing and Imaging Institute, University of Utah, Salt Lake City, UT, USA; Department of Biomedical Engineering, University of Utah, Salt Lake City, UT, USA; Nora Eccles Cardiovascular Research and Training Institute, University of Utah, Salt Lake City, UT, USA; School of Medicine, University of Utah, Salt Lake City, UT, USA
| | - Jake A Bergquist
- Scientific Computing and Imaging Institute, University of Utah, Salt Lake City, UT, USA; Department of Biomedical Engineering, University of Utah, Salt Lake City, UT, USA; Nora Eccles Cardiovascular Research and Training Institute, University of Utah, Salt Lake City, UT, USA
| | - Lindsay C Rupp
- Scientific Computing and Imaging Institute, University of Utah, Salt Lake City, UT, USA; Department of Biomedical Engineering, University of Utah, Salt Lake City, UT, USA
| | | | | | | | - Rob S MacLeod
- Scientific Computing and Imaging Institute, University of Utah, Salt Lake City, UT, USA; Department of Biomedical Engineering, University of Utah, Salt Lake City, UT, USA; Nora Eccles Cardiovascular Research and Training Institute, University of Utah, Salt Lake City, UT, USA
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Beadle R, McDonnell D, Ghasemi Roudsari S, Unitt L, Parker S, Varcoe BTH. Assessing heart disease using a novel magnetocardiography device. Biomed Phys Eng Express 2021; 7. [PMID: 33578399 DOI: 10.1088/2057-1976/abe5c5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Accepted: 02/12/2021] [Indexed: 11/12/2022]
Abstract
The aim of this paper is to present the use of a portable, unshielded magnetocardiograph (MCG) and identify key characteristics of MCG scans that could be used in future studies to identify parameters that are sensitive to cardiac pathology. We recruited 50 patients with confirmed myocardial infarction (MI) within the past 12 weeks and 46 volunteers with no history of cardiac disease. A set of 38 parameters were extracted from MCG features including both signals from the sensor array and from magnetic images obtained from the device and principal component analysis was used to concentrate the information contained in these parameters into uncorrelated predictors. Linear fits of these parameters were then used to examine the ability of MCG to distinguish between sub-groups of patients. In the fist instance, the primary aim of this study was to ensure that MCG has a basic ability to separate a highly polarised patient group (young controls from post infarction patients) and to identify parameters that could be used in future studies to build a formal diagnostic tool kit. Parameters that parameterised left ventricular ejection fraction (LVEF) were identified and an example is presented to show differential low and high ejection fractions.
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Affiliation(s)
- Roger Beadle
- Department of Cardiology, South Warwickshire NHS Foundation Trust, Lakin Road Warwick CV34 5BW, Warwick, Warwickshire, CV34 5BW, UNITED KINGDOM OF GREAT BRITAIN AND NORTHERN IRELAND
| | - Donna McDonnell
- Department of Cardiology, South Warwickshire NHS Foundation Trust, Lakin Road Warwick CV34 5BW, Warwick, Warwickshire, CV34 5BW, UNITED KINGDOM OF GREAT BRITAIN AND NORTHERN IRELAND
| | - Shima Ghasemi Roudsari
- Creavo Medical Technologies, Westwood Way Westwood Business Park, Coventry, CV4 8HS, Coventry, CV4 8HS, UNITED KINGDOM OF GREAT BRITAIN AND NORTHERN IRELAND
| | - Lynda Unitt
- Creavo Medical Technologies, Westwood Way Westwood Business Park, Coventry, CV4 8HS, Coventry, CV4 8HS, UNITED KINGDOM OF GREAT BRITAIN AND NORTHERN IRELAND
| | - Steve Parker
- Creavo Medical Technologies, Westwood Way Westwood Business Park, Coventry, CV4 8HS, Coventry, CV4 8HS, UNITED KINGDOM OF GREAT BRITAIN AND NORTHERN IRELAND
| | - Benjamin T H Varcoe
- School of Physics and Astronomy, University of Leeds, Woodhouse Lane, Leeds, West Yorkshire, LS2 9JT, UNITED KINGDOM OF GREAT BRITAIN AND NORTHERN IRELAND
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Liu L, Wang D. A rare transitory change of the De Winter ST/T-wave complex in a patient with cardiac arrest: A case report. Medicine (Baltimore) 2020; 99:e20133. [PMID: 32384494 PMCID: PMC7220489 DOI: 10.1097/md.0000000000020133] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
RATIONALE The De Winter ST/T-wave complex is a rare and special electrocardiogram (ECG) manifestation in some patients with a total or subtotal occlusion in the proximal left anterior descending (LAD) coronary artery. It mainly appears as an ST-segment superior oblique depression instead of an ST elevation. However, a transitory change of the De Winter ST/T-wave complex has not been reported previously. PATIENT CONCERNS A 40-year-old man developed sudden precordial dull and unrelieved pain. One hour later, he suddenly lost consciousness when he arrived at the emergency department. After successful cardiopulmonary resuscitation (CPR), 2 ECGs were taken at 22-minute interval, which showed completely different manifestations. The first ECG showed acute inferior-wall ST elevation myocardial infarction (STEMI), while the second ECG showed a De Winter ST/T-wave complex, which indicated acute anterior-wall myocardial infarction. DIAGNOSIS The patient was diagnosed with acute myocardial infarction. INTERVENTIONS The patient responded to urgent treatment by percutaneous coronary intervention (PCI). OUTCOMES It was confirmed that the case was consistent with the main characteristics of a De Winter ST/T-wave complex after PCI. The first ECG was a rare transitory change of the De Winter ST/T-wave complex. The patient was well recovered and discharged. LESSONS The De Winter ST/T-wave complex is an extremely dangerous and rare ECG manifestation that is not widely recognized at present. Although the mechanism is not very clear, it should be considered as indicating an equivalent risk of STEMI because it may suggest total or subtotal occlusion in the proximal LAD coronary artery. It is believed that in the near future, the mechanism of ECG including its transitory changes, will be fully revealed.
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Affiliation(s)
- Li Liu
- Department of Cardiology of Hankou District of the General Hospital of Central Theatre Command of PLA
| | - Dan Wang
- Department of Ophthalmology of the General Hospital of Central Theatre Command of PLA, China
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