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Martínez-Suárez F, García-Limón JA, Baños-Bautista JE, Alvarado-Serrano C, Casas O. Low-Power Long-Term Ambulatory Electrocardiography Monitor of Three Leads with Beat-to-Beat Heart Rate Measurement in Real Time. SENSORS (BASEL, SWITZERLAND) 2023; 23:8303. [PMID: 37837133 PMCID: PMC10574881 DOI: 10.3390/s23198303] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 09/20/2023] [Accepted: 10/03/2023] [Indexed: 10/15/2023]
Abstract
A low-power long-term ambulatory ECG monitor was developed for the acquisition, storage and processing of three simultaneous leads DI, aVF and V2 with a beat-to-beat heart rate measurement in real time. It provides long-term continuous ECG recordings until 84 h. The monitor uses a QRS complex detection algorithm based on the continuous wavelet transform with splines, which automatically selects the scale for the analysis of ECG records with different sampling frequencies. It includes a lead-off detection to continuously monitor the electrode connections and a real-time system of visual and acoustic alarms to alert users of abnormal conditions in its operation. The monitor presented is based in an ADS1294 analogue front end with four channels, 24-bit analog-to-digital converters and programmable gain amplifiers, a low-power dual-core ESP32 microcontroller, a microSD memory for data storage in a range of 4 GB to 32 GB and a 1.4 in thin-film transistor liquid crystal display (LCD) variant with a resolution of 128 × 128 pixels. It has programmable sampling rates of 250, 500 and 1000 Hz; a bandwidth of 0 Hz to 50% of the selected sampling rate; a CMRR of -105 dB; an input margin of ±2.4 V; a resolution of 286 nV; and a current consumption of 50 mA for an average battery life of 84 h. The ambulatory ECG monitor was evaluated with the commercial data-acquisition system BIOPAC MP36 and its module for ECG LABEL SS2LB, simultaneously comparing the morphologies of two ECG records and obtaining a correlation of 91.78%. For the QRS detection in real time, the implemented algorithm had an error less than 5%. The developed ambulatory ECG monitor can be used for the analysis of the dynamics of the heart rate variability in long-term ECG records and for the development of one's own databases of ECG recordings of normal subjects and patients with cardiovascular and noncardiovascular diseases.
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Affiliation(s)
- Frank Martínez-Suárez
- Bioelectronics Section, Department of Electrical Engineering, Centro de Investigación y de Estudios Avanzados del Instituto Politécnico Nacional (Cinvestav), Mexico City 07360, Mexico; (J.A.G.-L.); (J.E.B.-B.)
- Instrumentation, Sensors and Interfaces Group, Universitat Politècnica de Catalunya (Barcelona Tech), 08860 Barcelona, Spain;
| | - José Alberto García-Limón
- Bioelectronics Section, Department of Electrical Engineering, Centro de Investigación y de Estudios Avanzados del Instituto Politécnico Nacional (Cinvestav), Mexico City 07360, Mexico; (J.A.G.-L.); (J.E.B.-B.)
- Instrumentation, Sensors and Interfaces Group, Universitat Politècnica de Catalunya (Barcelona Tech), 08860 Barcelona, Spain;
| | - Jorge Enrique Baños-Bautista
- Bioelectronics Section, Department of Electrical Engineering, Centro de Investigación y de Estudios Avanzados del Instituto Politécnico Nacional (Cinvestav), Mexico City 07360, Mexico; (J.A.G.-L.); (J.E.B.-B.)
| | - Carlos Alvarado-Serrano
- Bioelectronics Section, Department of Electrical Engineering, Centro de Investigación y de Estudios Avanzados del Instituto Politécnico Nacional (Cinvestav), Mexico City 07360, Mexico; (J.A.G.-L.); (J.E.B.-B.)
| | - Oscar Casas
- Instrumentation, Sensors and Interfaces Group, Universitat Politècnica de Catalunya (Barcelona Tech), 08860 Barcelona, Spain;
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Svennberg E, Caiani EG, Bruining N, Desteghe L, Han JK, Narayan SM, Rademakers FE, Sanders P, Duncker D. The digital journey: 25 years of digital development in electrophysiology from an Europace perspective. Europace 2023; 25:euad176. [PMID: 37622574 PMCID: PMC10450797 DOI: 10.1093/europace/euad176] [Citation(s) in RCA: 17] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 06/03/2023] [Indexed: 08/26/2023] Open
Abstract
AIMS Over the past 25 years there has been a substantial development in the field of digital electrophysiology (EP) and in parallel a substantial increase in publications on digital cardiology.In this celebratory paper, we provide an overview of the digital field by highlighting publications from the field focusing on the EP Europace journal. RESULTS In this journey across the past quarter of a century we follow the development of digital tools commonly used in the clinic spanning from the initiation of digital clinics through the early days of telemonitoring, to wearables, mobile applications, and the use of fully virtual clinics. We then provide a chronicle of the field of artificial intelligence, a regulatory perspective, and at the end of our journey provide a future outlook for digital EP. CONCLUSION Over the past 25 years Europace has published a substantial number of papers on digital EP, with a marked expansion in digital publications in recent years.
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Affiliation(s)
- Emma Svennberg
- Department of Medicine Huddinge, Karolinska Institutet, Karolinska University Hospital Huddinge, SE-141 86 Stockholm, Sweden
| | - Enrico G Caiani
- Politecnico di Milano, Electronic, Information and Biomedical Engineering Department, Milan, Italy
- Istituto Auxologico Italiano IRCCS, Milan, Italy
| | - Nico Bruining
- Department of Clinical and Experimental Information processing (Digital Cardiology), Erasmus Medical Center, Thoraxcenter, Rotterdam, The Netherlands
| | - Lien Desteghe
- Research Group Cardiovascular Diseases, University of Antwerp, 2000 Antwerp, Belgium
- Department of Cardiology, Antwerp University Hospital, 2056 Edegem, Belgium
- Faculty of Medicine and Life Sciences, Hasselt University, 3500 Hasselt, Belgium
- Department of Cardiology, Heart Centre Hasselt, Jessa Hospital, 3500 Hasselt, Belgium
| | - Janet K Han
- Division of Cardiology, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA 90073, USA
- Cardiac Arrhythmia Center, University of California Los Angeles, Los Angeles, CA, USA
| | - Sanjiv M Narayan
- Cardiology Division, Cardiovascular Institute and Institute for Computational and Mathematical Engineering, Stanford University, Stanford, CA, USA
| | | | - Prashanthan Sanders
- Centre for Heart Rhythm Disorders, University of Adelaide and Royal Adelaide Hospital, 5005 Adelaide, Australia
| | - David Duncker
- Hannover Heart Rhythm Center, Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany
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Kareem M, Lei N, Ali A, Ciaccio EJ, Acharya UR, Faust O. A review of patient-led data acquisition for atrial fibrillation detection to prevent stroke. Biomed Signal Process Control 2021. [DOI: 10.1016/j.bspc.2021.102818] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Rajanna RREDDY, Natarajan S, Prakash V, Vittala PR, Arun U, Sahoo S. External Cardiac Loop Recorders: Functionalities, Diagnostic Efficacy, Challenges and Opportunities. IEEE Rev Biomed Eng 2021; 15:273-292. [DOI: 10.1109/rbme.2021.3055219] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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Vijayarangan S, Murugesan B, Vignesh R, Preejith SP, Joseph J, Sivaprakasam M. Interpreting Deep Neural Networks for Single-Lead ECG Arrhythmia Classification. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2020; 2020:300-303. [PMID: 33017988 DOI: 10.1109/embc44109.2020.9176396] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Cardiac arrhythmia is a prevalent and significant cause of morbidity and mortality among cardiac ailments. Early diagnosis is crucial in providing intervention for patients suffering from cardiac arrhythmia. Traditionally, diagnosis is performed by examination of the Electrocardiogram (ECG) by a cardiologist. This method of diagnosis is hampered by the lack of accessibility to expert cardiologists. For quite some time, signal processing methods had been used to automate arrhythmia diagnosis. However, these traditional methods require expert knowledge and are unable to model a wide range of arrhythmia. Recently, Deep Learning methods have provided solutions to performing arrhythmia diagnosis at scale. However, the black-box nature of these models prohibit clinical interpretation of cardiac arrhythmia. There is a dire need to correlate the obtained model outputs to the corresponding segments of the ECG. To this end, two methods are proposed to provide interpretability to the models. The first method is a novel application of Gradient-weighted Class Activation Map (Grad-CAM) for visualizing the saliency of the CNN model. In the second approach, saliency is derived by learning the input deletion mask for the LSTM model. The visualizations are provided on a model whose competence is established by comparisons against baselines. The results of model saliency not only provide insight into the prediction capability of the model but also aligns with the medical literature for the classification of cardiac arrhythmia.Clinical relevance- Adapts interpretability modules for deep learning networks in ECG arrhythmia classfication, allowing for better clinical interpretation.
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DeCamilla J, Xia X, Wang M, Wade J, Mykins B, Zareba W, Couderc JP. The multiple arrhythmia dataset evaluation database (M.A.D.A.E.). J Electrocardiol 2018; 51:S106-S112. [PMID: 30115367 DOI: 10.1016/j.jelectrocard.2018.08.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Revised: 07/31/2018] [Accepted: 08/07/2018] [Indexed: 10/28/2022]
Abstract
The convergence between wearable and medical device technologies is a natural progression. Miniaturization has allowed the design of small, compact monitoring systems that can record physiological signals over longer periods of time. Thus, the potential for these devices to expand the understanding of disease progression and patients' clinical status is very high. The accuracy of these devices, however, is dependent upon the computer algorithms utilized in the analysis of the large volume of physiological data monitored and/or recorded by the devices. Automated interpretation of the data by these new technologies, therefore, necessitates closer examination by regulatory organizations. The current requirements for the validation of novel Ambulatory ECG (A-ECG) annotation algorithms are based on the AAMI/ANSI-EC57 and IEC60601-2-47 Standard. These standards are being updated, but they rely on a very limited set of digitized ECG recordings from a couple of ECG databases built in the first half of the 70's. These reference signals are obsolete. We are developing a validation tool for computerized methods designed to detect and monitor cardiac activities based on body-surface ECGs. We will rely on a set of existing digital high-resolution 12‑lead A-ECG recordings acquired in cardiac patients and healthy individuals. These ECG signals include a large and unique set of electrocardiographic events. This tool is being qualified by the Center for Devices and Radiological Health of the United States Food and Drug Administration (FDA) as a Medical Device Development Tool (MDDT). This document provides insights into the design of the M.A.D.A.E. database, its functionalities, and its ultimate role in enabling the next generations of automatic interpretation of ECG signals.
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Affiliation(s)
- J DeCamilla
- Telemetric and Holter ECG warehouse Initiative, University of Rochester Medical Center, Rochester, NY, United States of America
| | - X Xia
- Telemetric and Holter ECG warehouse Initiative, University of Rochester Medical Center, Rochester, NY, United States of America
| | - M Wang
- Telemetric and Holter ECG warehouse Initiative, University of Rochester Medical Center, Rochester, NY, United States of America
| | - J Wade
- Telemetric and Holter ECG warehouse Initiative, University of Rochester Medical Center, Rochester, NY, United States of America
| | - B Mykins
- Telemetric and Holter ECG warehouse Initiative, University of Rochester Medical Center, Rochester, NY, United States of America
| | - W Zareba
- Telemetric and Holter ECG warehouse Initiative, University of Rochester Medical Center, Rochester, NY, United States of America
| | - J P Couderc
- Telemetric and Holter ECG warehouse Initiative, University of Rochester Medical Center, Rochester, NY, United States of America.
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Solomon MD, Yang J, Sung SH, Livingston ML, Sarlas G, Lenane JC, Go AS. Incidence and timing of potentially high-risk arrhythmias detected through long term continuous ambulatory electrocardiographic monitoring. BMC Cardiovasc Disord 2016; 16:35. [PMID: 26883019 PMCID: PMC4756401 DOI: 10.1186/s12872-016-0210-x] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2015] [Accepted: 02/02/2016] [Indexed: 11/18/2022] Open
Abstract
Background Ambulatory electrocardiographic (ECG) monitoring is the standard to screen for high-risk arrhythmias. We evaluated the clinical utility of a novel, leadless electrode, single-patient-use ECG monitor that stores up to 14 days of a continuous recording to measure the burden and timing of potentially high-risk arrhythmias. Methods We examined data from 122,815 long term continuous ambulatory monitors (iRhythm ZIO® Service, San Francisco) prescribed from 2011 to 2013 and categorized potentially high-risk arrhythmias into two types: (1) ventricular arrhythmias including non-sustained and sustained ventricular tachycardia and (2) bradyarrhythmias including sinus pauses >3 s, atrial fibrillation pauses >5 s, and high-grade heart block (Mobitz Type II or third-degree heart block). Results Of 122,815 ZIO® recordings, median wear time was 9.9 (IQR 6.8–13.8) days and median analyzable time was 9.1 (IQR 6.4–13.1) days. There were 22,443 (18.3 %) with at least one episode of non-sustained ventricular tachycardia (NSVT), 238 (0.2 %) with sustained VT, 1766 (1.4 %) with a sinus pause >3 s (SP), 520 (0.4 %) with a pause during atrial fibrillation >5 s (AFP), and 1486 (1.2 %) with high-grade heart block (HGHB). Median time to first arrhythmia was 74 h (IQR 26–149 h) for NSVT, 22 h (IQR 5–73 h) for sustained VT, 22 h (IQR 7–64 h) for SP, 31 h (IQR 11–82 h) for AFP, and 40 h (SD 10–118 h) for HGHB. Conclusions A significant percentage of potentially high-risk arrhythmias are not identified within 48-h of ambulatory ECG monitoring. Longer-term continuous ambulatory ECG monitoring provides incremental detection of these potentially clinically relevant arrhythmic events.
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Affiliation(s)
- Matthew D Solomon
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA. .,Stanford University School of Medicine, Stanford, CA, USA. .,Department of Cardiology, Kaiser Permanente Oakland Medical Center, 3600 Broadway, Oakland, CA, 94611, USA.
| | - Jingrong Yang
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
| | - Sue Hee Sung
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
| | | | | | | | - Alan S Go
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA.,Stanford University School of Medicine, Stanford, CA, USA.,Departments of Epidemiology, Biostatistics and Medicine, University of California, San Francisco, CA, USA
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Abstract
Recent studies designed to assess the relationship between aortic compliance and heterogeneity of heart electrical activity has shown that hypertrophy aggravates repolarization disturbances in the myocardium. Numerous mechanisms of electrical instability and inhomogeneity associated with left ventricular hypertrophy are now under investigation. Most of the studies have been found to be focused on ventricular Gradient, QT dispersion, amplitudes of isointegral maps during ventricular repolarization, abnormally low-QRST areas, dispersion of the QT interval, and spatial QRS-T(angle). These studies point to marked repolarization abnormalities in left ventricular hypertrophy and the dispersion of the QT interval as a valuable index for inhomogeneity of repolarization and the subsequent heart rate variability. The heart rate-corrected QT dispersion and QT apex dispersion seem to be significantly longer in the patients with left ventricular hypertrophy than in normal individuals. The review study has also identified QRST isointegral map as a valuable technique in assessment of the electro-cardiac events in LVH.
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Affiliation(s)
- Changzhao Gao
- Department of Clinical Medicine, School of Clinical Medicine, Jilin University, Changchun, Jilin, People's Republic of China
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Abstract
Ambulatory Holter electrocardiographic (ECG) monitoring has undergone continuous technological evolution since its invention and development in the 1950s era. With commercial introduction in 1963, there has been an evolution of Holter recorders from 1 channel to 12 channel recorders with increasingly smaller storage media, and there has evolved Holter analysis systems employing increasingly technologically advanced electronics providing a myriad of data displays. This evolution of smaller physical instruments with increasing technological capacity has characterized the development of electronics over the past 50 years. Currently the technology has been focused upon the conventional continuous 24 to 48 hour ambulatory ECG examination, and conventional extended ambulatory monitoring strategies for infrequent to rare arrhythmic events. However, the emergence of the Internet, Wi-Fi, cellular networks, and broad-band transmission has positioned these modalities at the doorway of the digital world. This has led to an adoption of more cost-effective strategies to these conventional methods of performing the examination. As a result, the emergence of the mobile smartphone coupled with this digital capacity is leading to the recent development of Holter smartphone applications. The potential of point-of-care applications utilizing the Holter smartphone and a vast array of new non-invasive sensors is evident in the not too distant future. The Holter smartphone is anticipated to contribute significantly in the future to the field of global health.
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Fensli R, Gundersen T, Snaprud T, Hejlesen O. Clinical evaluation of a wireless ECG sensor system for arrhythmia diagnostic purposes. Med Eng Phys 2013; 35:697-703. [DOI: 10.1016/j.medengphy.2013.03.002] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Puurtinen M, Väisänen J, Viik J, Hyttinen J. New precordial bipolar electrocardiographic leads for detecting left ventricular hypertrophy. J Electrocardiol 2011; 43:654-9. [PMID: 20435318 DOI: 10.1016/j.jelectrocard.2010.04.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2009] [Indexed: 10/19/2022]
Abstract
BACKGROUND Novel small and wearable electrocardiogram (ECG) devices offer new means of recording cardiac activity in different applications. Our objective was to evaluate the performance of closely separated (6 cm) bipolar leads in differentiating subjects with left ventricular hypertrophy (LVH) from healthy subjects. METHODS The material contained body surface ECG of 236 healthy and 116 LVH subjects. A total of 36 vertical, 30 horizontal, and 66 diagonal bipolar leads located on the anterior thorax were analyzed. The QRS amplitudes were calculated, and the leads' overall diagnostic performance was assessed by receiver operating characteristic (ROC) analysis. RESULTS The best overall diagnostic performances were obtained from 2 areas: one near the precordial electrodes of standard leads V(1) to V(3) and the other on lower anterior thorax. Vertical and diagonal bipolar leads located at lower anterior thorax provided the highest ROC areas (≥0.79). These bipolar leads also provided similar sensitivities than the traditional Sokolow-Lyon method. CONCLUSION The new short distance vertical and diagonal bipolar leads are efficient in discriminating subjects with LVH from healthy subjects based on QRS amplitude.
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Affiliation(s)
- Merja Puurtinen
- Department of Biomedical Engineering, Tampere University of Technology, Tampere, Finland.
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Lemmert ME, Janata A, Erkens P, Russell JK, Gehman S, Nammi K, Crijns HJ, Sterz F, Gorgels AP. Detection of ventricular ectopy by a novel miniature electrocardiogram recorder. J Electrocardiol 2011; 44:222-8. [DOI: 10.1016/j.jelectrocard.2010.10.028] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2010] [Indexed: 11/25/2022]
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Abstract
Measuring heart rate variability (HRV) is widely used to assess autonomic nervous system function. It requires accurate measurement of the interval between successive heartbeats. This can be achieved from recording the electrocardiogram (ECG), which is non-invasive and widely available. However, methodological problems inherent in recording and analyzing ECG traces have motivated a search for alternative means of measuring the interval between successive heartbeats. Recording blood oxygenation pulsations (photoplethysmography-PPG) is also convenient, non-invasive and widely available, and has been suggested as an effective alternative to ECG to derive HRV. Moreover, it has been claimed that the pulse waveforms produced by oximetry may be more practicable than R-R intervals measured from the by ECG, especially for ambulatory recordings. We have therefore compared PPG with ECG recordings to measure HRV applying the same signal analysis techniques to PPG and ECG recordings made simultaneously. Comparison of 5 min recording epochs demonstrated a very high degree of correlation, in temporal, frequency domains and non-linear analysis, between HRV measures derived from the PPG and ECG. However, we found that the PPG signal is especially vulnerable to motion artifacts when compared to the ECG, preventing any HRV analysis at all in a significant minority of PPG recordings. Our results demonstrate that even though PPG provides accurate interpulse intervals to measure heart rate variability under ideal conditions, it is less reliable due to its vulnerability to motion artifacts. Therefore it is unlikely to prove a practical alternative to the ECG in ambulatory recordings or recordings made during other activities.
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Shkolnikova M, Shalnova S, Shkolnikov VM, Metelskaya V, Deev A, Andreev E, Jdanov D, Vaupel JW. Biological mechanisms of disease and death in Moscow: rationale and design of the survey on Stress Aging and Health in Russia (SAHR). BMC Public Health 2009; 9:293. [PMID: 19678931 PMCID: PMC2745385 DOI: 10.1186/1471-2458-9-293] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2009] [Accepted: 08/13/2009] [Indexed: 11/02/2022] Open
Abstract
BACKGROUND Prior research has revealed large differences in health and mortality across countries, socioeconomic groups, and individuals. Russia experiences one of the world's highest levels of all-cause and cardiovascular mortality, great mortality differences within the population, and a heavy burden of ill health. Psychological stress has been suggested as a likely explanation of health loss and premature death in Russia and Eastern Europe. However, physiological mechanisms connecting stress with health in Russia remain unclear since existing epidemiological data are scarce and limited to conventional risk factors. METHOD AND DESIGN The survey on Stress Aging and Health in Russia (SAHR) is addressing this knowledge gap by collecting an unusually rich database that includes a wide range of reported information, physical and cognitive health outcomes, and biomarkers in a sample of Muscovite men and women aged 55 and older. The total planned sample size is 2,000 individuals. The sample was randomly selected from epidemiological cohorts formed in Moscow between the mid-1970s and the 1990s and from medical population registers. The baseline data collection was carried out from December 2006 to June 2009. Interviews and medical tests were administered at hospital or at home according to standardized protocol. Questionnaire information includes health, socio-demographic characteristics, economic well-being, cognitive functioning, and batteries on stress and depression. Biomarkers include anthropometry, grip strength, resting ECG, conventional cardiovascular factors of risk such as lipid profile and blood pressure, and other biochemical parameters such as those related to inflammation, glucose and insulin resistance, coagulation, fibrinolysis, and stress hormones. In addition to these measurements, SAHR includes dynamic biomarkers provided by 24-hour ECG (Holter) monitoring. This method continuously registers the beat-to-beat heart rate in naturalistic conditions without restrictions on normal daily activities. It provides information about heart functioning, including heart rate variability and ischemic and arrhythmic events.Re-examination of the study subjects will be conducted in 2009-2011 and will focus on health, functional status, economic conditions, behaviors, and attitudes towards aging. The subjects are also followed up for mortality and non-fatal health events. DISCUSSION The SAHR will produce a valuable set of established and novel biomarkers combined with self-reported data for the international research community and will provide important insights into factors and biological mechanisms of mortality and health losses in Russia.
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Affiliation(s)
- Maria Shkolnikova
- Federal Arrhythmia Centre, Moscow Institute of Pediatry and Surgery, Moscow, Russia
- Laboratory of Survival and Longevity, Max Planck Institute for Demographic Research, Rostock, Germany
| | - Svetlana Shalnova
- Department of Epidemiology of Non-Communicable Diseases, State Research Centre for Preventive Medicine, Moscow, Russia
| | - Vladimir M Shkolnikov
- Laboratory of Demographic Data, Max Planck Institute for Demographic Research, Rostock, Germany
| | - Victoria Metelskaya
- Laboratory of Biochemistry, State Research Centre for Preventive Medicine, Moscow, Russia
| | - Alexander Deev
- Laboratory of Biostatistics, State Research Centre for Preventive Medicine, Moscow, Russia
| | - Evgueni Andreev
- Laboratory of Demographic Data, Max Planck Institute for Demographic Research, Rostock, Germany
| | - Dmitri Jdanov
- Laboratory of Demographic Data, Max Planck Institute for Demographic Research, Rostock, Germany
| | - James W Vaupel
- Laboratory of Survival and Longevity, Max Planck Institute for Demographic Research, Rostock, Germany
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Morris JG, Duffis EJ, Fisher M. Cardiac workup of ischemic stroke: can we improve our diagnostic yield? Stroke 2009; 40:2893-8. [PMID: 19478214 DOI: 10.1161/strokeaha.109.551226] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
BACKGROUND AND PURPOSE Discovering potential cardiac sources of stroke is an important part of the urgent evaluation of the ischemic stroke patient as it often impacts treatment decisions that are essential for determining secondary stroke prevention strategies, yet the optimal approach to the cardiac workup of an ischemic stroke patient is not known. METHODS A review of the literature concerning the utility of cardiac rhythm monitoring (ECG, telemetry, Holter monitors, and event recorders) and structural imaging (transthoracic and transesophageal echocardiography) was performed. RESULTS Data supporting a definitive, optimal, and cost-effective approach are lacking, though some data suggest that appropriate patient selection can improve the diagnostic and therapeutic yield of rhythm monitoring and echocardiography in the evaluation of stroke etiology. CONCLUSIONS Based on available data, an algorithmic approach for the evaluation of patients with acute ischemic cerebrovascular events that takes into account therapeutic and diagnostic yield as well as cost-efficiency is proposed.
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Affiliation(s)
- Jane G Morris
- Department of Neurology, University of Massachusetts Medical Center, 55 Lake Ave North, Worcester, MA 01655, USA.
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Amit G, Gavriely N, Intrator N. Cluster analysis and classification of heart sounds. Biomed Signal Process Control 2009. [DOI: 10.1016/j.bspc.2008.07.003] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Brandes A, Bethge KP. [Long term electrocardiography (Holter monitoring)]. Herzschrittmacherther Elektrophysiol 2008; 19:107-129. [PMID: 18956158 DOI: 10.1007/s00399-008-0010-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2008] [Accepted: 07/14/2008] [Indexed: 05/27/2023]
Abstract
During the past almost 50 years Holter monitoring has become an established non-invasive diagnostic tool in clinical electrophysiology. It allows ECG recording independent of stationary monitoring facilities during daily life and, therefore, contains much information. In the beginning the main interest was directed towards quantitative and qualitative assessment of arrhythmias, their circadian behaviour, and the circadian behaviour of the heart rate. With advances in technology the analysis spectrum of Holter monitoring expanded, and it was used also for detection of silent myocardial ischaemia. New digital recorders and computers with large capacities made it possible to measure every single heart beat very accurately, which was a prerequisite for heart rate variability and QT-interval analysis, which provided new knowledge about the autonomic modulation of the heart rate and the circadian dynamicity of the QT interval, respectively. Beyond arrhythmia analysis Holter monitoring was increasingly used to assess prognosis in different cardiac conditions. It can also be valuable in assessing transient symptoms possibly related to arrhythmias or device dysfunction, which will not necessarily be revealed by simple device control.
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Affiliation(s)
- Axel Brandes
- Dept of Cardiology B, Odense University Hospital, Sdr. Boulevard 29, 5000 Odense C, Denmark.
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JANATA ANDREAS, LEMMERT MIGUELE, RUSSELL JAMESK, GEHMAN STACY, FLEISCHHACKL ROMAN, ROBAK OLIVER, PERNICKA ELISABETH, STERZ FRITZ, GORGELS ANTONP. Quality of ECG Monitoring with a Miniature ECG Recorder. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2008; 31:676-84. [DOI: 10.1111/j.1540-8159.2008.01070.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Sulfi S, Balami D, Sekhri N, Suliman A, Kapur A, Archbold RA, Ranjadayalan K, Timmis AD. Limited clinical utility of Holter monitoring in patients with palpitations or altered consciousness: analysis of 8973 recordings in 7394 patients. Ann Noninvasive Electrocardiol 2008; 13:39-43. [PMID: 18234005 DOI: 10.1111/j.1542-474x.2007.00199.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
AIMS To determine the clinical utility of 24 hour Holter monitoring by measuring the frequency of candidate arrhythmias recorded during the investigation of palpitations and altered consciousness. METHODS Of 9,729 Holter recordings, reports were available in 8,973 (92.2%) performed in the 7394 patients who comprise the study group. The mean age of the study group was 66 +/- 19 years and 56.4% were women. RESULTS The most common indications were altered consciousness (41.7%) and palpitations (36.2%). Among patients with palpitations and sinus rhythm (n=2688), recordings were normal in 2247 (83.6%). Abnormalities included paroxysmal atrial fibrillation (PAF, 6.6%), narrow complex tachycardia (NCT, 2.8%) nonsustained or sustained ventricular tachycardia (NSVT/VT, 2.6%). Among patients with altered consciousness (n=3075), recordings were normal in 2589 (84.2%). Abnormalities included PAF (9.5%), NCT (2.6%), NSV/VT (0.2%), pause >2.8s (2.2%) and high degree AV block (1.3%). The diagnostic yield of Holter monitoring was particularly low in patients aged < or =50 years, of whom 93.1% had palpitations and 95.3% had altered consciousness had normal recordings. CONCLUSIONS The diagnostic utility of Holter monitoring in patients being investigated for palpitations and altered consciousness is very limited, particularly in young patients for whom alternative diagnostic methods should be considered.
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Early experience with a novel ambulatory monitor. J Electrocardiol 2007; 40:S160-4. [DOI: 10.1016/j.jelectrocard.2007.06.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2007] [Accepted: 06/06/2007] [Indexed: 11/20/2022]
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