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Iwakami N, Aiba T, Kamakura S, Takaki H, Furukawa TA, Sato T, Sun W, Shishido T, Nishimura K, Yamada-Inoue Y, Nagase S, Shimizu W, Yasuda S, Sugimachi M, Kusano K. Identification of malignant early repolarization pattern by late QRS activity in high-resolution magnetocardiography. Ann Noninvasive Electrocardiol 2020; 25:e12741. [PMID: 31955494 PMCID: PMC7358799 DOI: 10.1111/anec.12741] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Revised: 11/28/2019] [Accepted: 12/17/2019] [Indexed: 12/24/2022] Open
Abstract
Background The early repolarization pattern (ERP) in electrocardiography (ECG) has been considered as a risk for ventricular fibrillation (VF), but effective methods for identification of malignant ERP are still required. We investigated whether high spatiotemporal resolution 64‐channel magnetocardiography (MCG) would enable distinction between benign and malignant ERPs. Methods Among all 2,636 subjects who received MCG in our facility, we identified 116 subjects (43 ± 18 years old, 54% male) with inferior and/or lateral ERP in ECG and without structural heart disease, including 13 survivors of VF (ERP‐VF(+)) and 103 with no history of VF (ERP‐VF(−)). We measured the following MCG parameters in a time‐domain waveform of relative current magnitude: (a) QRS duration (MCG‐QRSD), (b) root‐mean‐square of the last 40 ms (MCG‐RMS40), and (c) low amplitude (<10% of maximal) signal duration (MCG‐LAS). Results Compared to ERP‐VF(−), ERP‐VF(+) subjects presented a significantly longer MCG‐QRS (108 ± 24 vs. 91 ± 23 ms, p = .02) and lower MCG‐RMS40 (0.10 ± 0.08 vs. 0.25 ± 0.20, p = .01) but no difference in MCG‐LAS (38 ± 22 vs. 29 ± 23 ms, p = .17). MCG‐QRSD and MCG‐RMS40 showed significantly larger area under the ROC curve compared to J‐peak amplitude in ECG (0.72 and 0.71 vs. 0.50; p = .04 and 0.03). The sensitivity, specificity, and odds ratio for identifying VF(+) based on MCG‐QRSD ≥ 100 ms and MCG‐RMS40 ≤ 0.24 were 69%, 74%, and 6.33 (95% CI, 1.80–22.3), and 92%, 48%, and 10.9 (95% CI, 1.37–86.8), respectively. Conclusion Magnetocardiography is an effective tool to distinguish malignant and benign ERPs.
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Affiliation(s)
- Naotsugu Iwakami
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan.,Department of Research Promotion and Management, National Cerebral and Cardiovascular Center, Osaka, Japan.,Department of Health Promotion and Human Behavior, Kyoto University School of Public Health, Kyoto, Japan
| | - Takeshi Aiba
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Shiro Kamakura
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Hiroshi Takaki
- Department of Cardiovascular Dynamics, Research Institute, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Toshiaki A Furukawa
- Department of Health Promotion and Human Behavior, Kyoto University School of Public Health, Kyoto, Japan
| | - Tosiya Sato
- Department of Biostatistics, Kyoto University School of Public Health, Kyoto, Japan
| | - Wenxu Sun
- Department of Research Promotion and Management, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Toshiaki Shishido
- Department of Research Promotion and Management, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Kunihiro Nishimura
- Department of Preventive Medicine and Epidemiology Informatics, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Yuko Yamada-Inoue
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Satoshi Nagase
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Wataru Shimizu
- Department of Cardiovascular Medicine, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan
| | - Satoshi Yasuda
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Masaru Sugimachi
- Department of Cardiovascular Dynamics, Research Institute, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Kengo Kusano
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan
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Kwong JSW, Leithäuser B, Park JW, Yu CM. Diagnostic value of magnetocardiography in coronary artery disease and cardiac arrhythmias: a review of clinical data. Int J Cardiol 2013; 167:1835-42. [PMID: 23336954 DOI: 10.1016/j.ijcard.2012.12.056] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2012] [Revised: 11/27/2012] [Accepted: 12/25/2012] [Indexed: 10/27/2022]
Abstract
Despite the availability of several advanced non-invasive diagnostic tests such as echocardiography and magnetic resonance imaging, electrocardiography (ECG) remains as the most widely used diagnostic technique in clinical cardiology. ECG detects electrical potentials that are generated by cardiac electrical activity. In addition to electrical potentials, the same electrical activity of the heart also induces magnetic fields. These extremely weak cardiac magnetic signals are detected by a non-invasive, contactless technique called magnetocardiography (MCG), which has been evaluated in a number of clinical studies for its usefulness in diagnosing heart diseases. We reviewed the basic principles, history and clinical data on the diagnostic role of MCG in coronary artery disease and cardiac arrhythmias.
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Affiliation(s)
- Joey S W Kwong
- Division of Cardiology, Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong SAR
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Vesterinen P, Väänänen H, Stenroos M, Hänninen H, Korhonen P, Tierala I, Husa T, Mäkijärvi M, Toivonen L. Localization of prior myocardial infarction by repolarization variables. Int J Cardiol 2008; 124:100-6. [PMID: 17383749 DOI: 10.1016/j.ijcard.2006.12.029] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2006] [Revised: 12/13/2006] [Accepted: 12/30/2006] [Indexed: 10/23/2022]
Abstract
BACKGROUND To find quantitative, automatically applicable electrocardiographic (ECG) variables for detecting prior myocardial infarction (MI) in different myocardial regions. METHODS Observational study. Body surface potential mapping (BSPM) was recorded at rest, and automatically analyzed with regard to ECG parameters, blinded to the clinical characteristics of the study subjects, 144 patients with prior MI and 75 healthy controls. MI location was determined by cine angiography or echocardiography as anterior (66 patients), inferoposterior (89 patients), and lateral (15 patients). Patients' 12-lead ECG was interpreted according to Minnesota code (Q-wave MI in 97 patients). The QRSSTT, QRS, and STT integrals, and the T-apex amplitude in detecting prior anterior and inferoposterior MI were analyzed. RESULTS The T-apex amplitude, QRSSTT integral, and STT integral were functional in detecting MI in all tested locations on a single-lead basis, with areas under receiver operating characteristic curves (AUC) of over 90% (p<0.001) in optimal sites. In the best leads AUC for the QRSSTT integral in anterior MI was 93% (CI 87-99%) and for the inferoposterior MI 92% (CI 88-97%). These repolarization variables outperformed the Minnesota code in all tested MI locations. They were also able to distinguish between anterior and inferoposterior MI with an AUC of >85% (p<0.001). CONCLUSIONS Quantitative, automatically applicable single-lead repolarization variables detect prior MI irrespective of its location. They may simplify the screening for and localization of old infarctions as compared to the conventional ECG methods.
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Affiliation(s)
- Paula Vesterinen
- Division of Cardiology, Helsinki University Central Hospital, Helsinki, Finland.
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Vesterinen P, Väänänen H, Hänninen H, Korhonen P, Tierala I, Husa T, Mäkijärvi M, Toivonen L. Single-lead electrocardiographic variables in the detection of prior myocardial infarction with respect to Q-wave status and infarct age. Cardiology 2007; 109:222-9. [PMID: 17873485 DOI: 10.1159/000107784] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2006] [Accepted: 02/09/2007] [Indexed: 11/19/2022]
Abstract
OBJECTIVES Conventionally, the detection of prior myocardial infarction (MI) is based on QRS abnormalities, which may ignore non-Q-wave MI (NQMI). We aimed at finding automatically applicable quantitative ECG variables for diagnosing prior MI. METHODS Body surface potential mapping (BSPM) was registered and automatically analyzed in 144 patients with prior MI and in 75 healthy controls. The MI was defined according to its age as recent or old, and Q-wave status as Q-wave MI (QMI) or NQMI. RESULTS The QRSSTT integral, the STT integral and the T-wave apex amplitude applied in single, selected leads were found to be the optimal parameters in the detection of prior MI. The areas under the receiver-operating characteristic curves (AUC) were 89% for each, and detection was equal in old and recent MI (AUCs from 87 to 90%), and in QMI and NQMI (AUCs from 88 to 90%). CONCLUSIONS The quantitative, automatically applicable single-lead variables comprising ventricular repolarization was effective in detecting prior MI, irrespective of the time elapsed from MI or the Q-wave status. These variables could be suitable for population studies and health screening purposes and are applicable to automatic ECG diagnostics of prior MI.
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Affiliation(s)
- Paula Vesterinen
- Division of Cardiology, Helsinki University Central Hospital, Helsinki, Finland.
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Koskinen R, Lehto M, Väänänen H, Rantonen J, Voipio-Pulkki LM, Mäkijärvi M, Lehtonen L, Montonen J, Toivonen L. Measurement and reproducibility of magnetocardiographic filtered atrial signal in patients with paroxysmal lone atrial fibrillation and in healthy subjects. J Electrocardiol 2005; 38:330-6. [PMID: 16216607 DOI: 10.1016/j.jelectrocard.2005.03.012] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2004] [Accepted: 03/30/2005] [Indexed: 11/20/2022]
Abstract
Magnetocardiography (MCG) is a method complementary to electrocardiography (ECG). We examined recording and reproducibility of atrial depolarization signal by MCG. Multichannel MCG over anterior chest and orthogonal 3-lead ECG were recorded in 9 patients who had paroxysmal lone atrial fibrillation and in 10 healthy subjects in duplicate at least 1 week apart. Data were averaged using atrial wave template and high-pass filtered at 25, 40, and 60 Hz. Atrial signal duration with automatic detection of onset and offset and root mean square amplitudes of the last portion of atrial signal were determined. Coefficient of variation of atrial signal duration by MCG at 40 Hz was 3.3% and difference between the measurements was 3.5 milliseconds on average. The corresponding figures obtained by signal-averaged ECG (SAECG) were 6.1% and 6.9 milliseconds. Coefficient of variation for root mean square of the last 40 milliseconds of atrial signal were 16% in MCG and 17% in SAECG. Reproducibility was best at 40-Hz filter and similar in patients and healthy subjects. In conclusion, the reproducibility of atrial signal variables in MCG is adequate and somewhat better than in SAECG and equal in patients with lone atrial fibrillation and healthy subjects. Magnetocardiography seems to be a potentially valuable method to evaluate features of atrial depolarization in patient studies.
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Affiliation(s)
- Raija Koskinen
- Division of Cardiology, Helsinki University Central Hospital, P.O. Box 340, 0029 HUS, Helsinki, Finland.
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