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Naydenov S, Jekova I, Krasteva V. Recognition of Supraventricular Arrhythmias in Holter ECG Recordings by ECHOView Color Map: A Case Series Study. J Cardiovasc Dev Dis 2023; 10:360. [PMID: 37754789 PMCID: PMC10532174 DOI: 10.3390/jcdd10090360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 08/22/2023] [Accepted: 08/22/2023] [Indexed: 09/28/2023] Open
Abstract
Ambulatory 24-72 h Holter ECG monitoring is recommended for patients with suspected arrhythmias, which are often transitory and might remain unseen in resting standard 12-lead ECG. Holter manufacturers provide software diagnostic tools to assist clinicians in evaluating these large amounts of data. Nevertheless, the identification of short arrhythmia events and differentiation of the arrhythmia type might be a problem in limited Holter ECG leads. This observational clinical study aims to explore a novel and weakly investigated ECG modality integrated into a commercial diagnostic tool ECHOView (medilog DARWIN 2, Schiller AG, Switzerland), while used for the interpretation of long-term Holter-ECG records by a cardiologist. The ECHOView transformation maps the beat waveform amplitude to a color-coded bar. One ECHOView page integrates stacked color bars of about 1740 sequential beats aligned by R-peak in a window (R ± 750 ms). The collected 3-lead Holter ECG recordings from 86 patients had a valid duration of 21 h 20 min (19 h 30 min-22 h 45 min), median (quartile range). The ECG rhythm was reviewed with 3491 (3192-3723) standard-grid ECG pages and a substantially few number of 51 (44-59) ECHOView pages that validated the ECHOView compression ratio of 67 (59-74) times. Comments on the ECG rhythm and ECHOView characteristic patterns are provided for 14 examples representative of the most common rhythm disorders seen in our population, including supraventricular arrhythmias (supraventricular extrasystoles, paroxysmal supraventricular arrhythmia, sinus tachycardia, supraventricular tachycardia, atrial fibrillation, and flutter) and ventricular arrhythmias (ventricular extrasystoles, non-sustained ventricular tachycardia). In summary, the ECHOView color map transforms the ECG modality into a novel diagnostic image of the patient's rhythm that is comprehensively interpreted by a cardiologist. ECHOView has the potential to facilitate the manual overview of Holter ECG recordings, to visually identify short-term arrhythmia episodes, and to refine the diagnosis, especially in high-rate arrhythmias.
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Affiliation(s)
- Stefan Naydenov
- Department of Internal Diseases “Prof. St. Kirkovich”, Medical University of Sofia, 1431 Sofia, Bulgaria;
| | - Irena Jekova
- Institute of Biophysics and Biomedical Engineering, Bulgarian Academy of Sciences, Acad. G. Bonchev Str. Bl. 105, 1113 Sofia, Bulgaria;
| | - Vessela Krasteva
- Institute of Biophysics and Biomedical Engineering, Bulgarian Academy of Sciences, Acad. G. Bonchev Str. Bl. 105, 1113 Sofia, Bulgaria;
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Proniewska KK, Abächerli R, van Dam PM. The ΔWaveECG: The differences to the normal 12‑lead ECG amplitudes. J Electrocardiol 2023; 76:45-54. [PMID: 36436474 DOI: 10.1016/j.jelectrocard.2022.10.014] [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: 05/23/2022] [Revised: 10/17/2022] [Accepted: 10/22/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND The QRS, ST segment, and T-wave waveforms of electrocardiogram are difficult to interpret, especially for non-ECG experts readers, like general practitioners. As the ECG waveforms are influenced by many factors, like body build, age, sex, electrode placement, even for experience ECG readers the waveform is difficult to interpret. In this research we have created a novel method to distinguish normal from abnormal ECG waveforms for an individual ECG based on the ECG amplitude distribution derived from normal standard 12‑lead ECG recordings. AIM Creation of a normal ECG amplitude distribution to enable the distinction by non-ECG experts of normal from abnormal waveforms of the standard 12‑lead ECG. METHODS The ECGs of healthy normal controls in the PTB-XL database were used to construct a normal amplitude distribution of the 12 lead ECG for males and females. All ECGs were resampled to have the same number of samples to enable the classification of an individual ECG as either normal or abnormal, i.e. within the normal amplitude distribution or outside, the ΔWaveECG. RESULTS From the same PTB-XL database six ECG's were selected, normal, left and right bundle branch block, and three with a myocardial infarction. The normal ECG was obviously within the normal distribution, and all other five showed clear abnormal ECG amplitudes outside the normal distribution in any of the ECG segments (QRS, ST segment and remaining STT segment). CONCLUSION The ΔWaveECG can distinguish the abnormal from normal ECG waveform segments, making the ECG easier to classify as normal or abnormal. Conduction disorders and ST changes due to ischemia and abnormal T-waves are effortless to detect, also by non-ECG expert readers, thus improving the early detection of cardiac patients.
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Affiliation(s)
| | - Roger Abächerli
- Lucerne University of Applied Sciences and Arts, HSLU, Lucerne, Switzerland
| | - Peter M van Dam
- Department of Cardiology, University Medical Center Utrecht, Utrecht, the Netherlands; Department of Automation and Robotics, AGH University of science and technology, Kraków, Poland.
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Han Y, Yang J, Fang J, Zhou Y, Candi E, Wang J, Hua D, Shao C, Shi Y. The secretion profile of mesenchymal stem cells and potential applications in treating human diseases. Signal Transduct Target Ther 2022; 7:92. [PMID: 35314676 PMCID: PMC8935608 DOI: 10.1038/s41392-022-00932-0] [Citation(s) in RCA: 205] [Impact Index Per Article: 102.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 11/18/2021] [Accepted: 02/20/2022] [Indexed: 02/06/2023] Open
Abstract
AbstractMesenchymal stromal/stem cells (MSCs) possess multi-lineage differentiation and self-renewal potentials. MSCs-based therapies have been widely utilized for the treatment of diverse inflammatory diseases, due to the potent immunoregulatory functions of MSCs. An increasing body of evidence indicates that MSCs exert their therapeutic effects largely through their paracrine actions. Growth factors, cytokines, chemokines, extracellular matrix components, and metabolic products were all found to be functional molecules of MSCs in various therapeutic paradigms. These secretory factors contribute to immune modulation, tissue remodeling, and cellular homeostasis during regeneration. In this review, we summarize and discuss recent advances in our understanding of the secretory behavior of MSCs and the intracellular communication that accounts for their potential in treating human diseases.
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van Dam PM, Boonstra M, Locati ET, Loh P. The relation of 12 lead ECG to the cardiac anatomy: The normal CineECG. J Electrocardiol 2021; 69S:67-74. [PMID: 34325899 DOI: 10.1016/j.jelectrocard.2021.07.014] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 07/02/2021] [Accepted: 07/17/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND The interpretation of the 12‑lead ECG is notoriously difficult and requires experts to distinguish normal from abnormal ECG waveforms. ECG waveforms depend on body build and electrode positions, both often different in males and females. To relate the ECG waveforms to cardiac anatomical structures is even more difficult. The novel CineECG algorithm enables a direct projection of the 12‑lead ECG to the cardiac anatomy by computing the mean location of cardiac activity over time. The aim of this study is to investigate the cardiac locations of the CineECG derived from standard 12‑lead ECGs of normal subjects. METHODS In this study we used 6525 12‑lead ECG tracings labelled as normal obtained from the certified Physionet PTB XL Diagnostic ECG Database to construct the CineECG. All 12 lead ECGs were analyzed, and then divided by age groups (18-29,30-39,40-49,50-59,60-69,70-100 years) and by gender (male/female). For each ECG, we computed the CineECG within a generic 3D heart/torso model. Based on these CineECG's, the average normal cardiac location and direction for QRS, STpeak, and TpeakTend segments were determined. RESULTS The CineECG direction for the QRS segment showed large variation towards the left free wall, whereas the STT segments were homogeneously directed towards the septal/apical region. The differences in the CineECG location for the QRS, STpeak, and TpeakTend between the age and gender groups were relatively small (maximally 10 mm at end T-wave), although between the gender groups minor differences were found in the 4 chamber direction angles (QRS 4°, STpeak 5°, and TpeakTend 8°) and LAO (QRS 1°, STpeak 13°, and TpeakTend 30°). CONCLUSION CineECG demonstrated to be a feasible and pragmatic solution for ECG waveform interpretation, relating the ECG directly to the cardiac anatomy. The variations in depolarization and repolarization CineECG were small within this group of normal healthy controls, both in cardiac location as well as in direction. CineECG may enable an easier discrimination between normal and abnormal QRS and T-wave morphologies, reducing the amount of expert training. Further studies are needed to prove whether novel CineECG can significantly contribute to the discrimination of normal versus abnormal ECG tracings.
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Affiliation(s)
- Peter M van Dam
- Department of Cardiology, University Medical Center Utrecht, the Netherlands; ECG Excellence BV, Nieuwerbrug aan den Rijn, Netherlands.
| | - Machteld Boonstra
- Department of Cardiology, University Medical Center Utrecht, the Netherlands
| | - Emanuela T Locati
- Department of Arrhythmology and Electrophysiology, IRCCS Policlinico San Donato, Milano, Italy
| | - Peter Loh
- Department of Cardiology, University Medical Center Utrecht, the Netherlands
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Zhang Y, Hui J, Chen X. Preprocedural Ticagrelor Treatment was Associated with Improved Early Reperfusion and Reduced Short-term Heart Failure in East-Asian ST-segment Elevation Myocardial Infarction Patients Undergoing Primary Percutaneous Coronary Intervention. Int J Gen Med 2021; 14:1927-1938. [PMID: 34040425 PMCID: PMC8140910 DOI: 10.2147/ijgm.s307404] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 04/27/2021] [Indexed: 12/12/2022] Open
Abstract
Purpose The purpose of this monocentric retrospective observational study is to investigate whether a loading dose of ticagrelor treatment before percutaneous coronary intervention (PCI) procedure improves the early reperfusion and short-term heart function in East-Asian ST segment elevation myocardial infarction (STEMI) patients. Patients and Methods The study included 326 STEMI patients undergoing primary PCI in Jiading Central Hospital. One hundred and forty patients received a loading dose of ticagrelor before entering the catheter laboratory. One hundred and eighty-six patients received a loading dose of ticagrelor in the catheter laboratory before the initiation of PCI. Reperfusion endpoints included the presence of self-patency in the culprit artery, the ST-segment elevation resolution over 50% within 24 h after PCI, and the presence of no-reflow in the culprit artery. Clinical endpoints included all-cause mortality, new-onset heart failure, reinfarction and stent thrombosis within 28 days after PCI. Secondary clinical endpoints included mechanical complications and bleeding events. Results In comparison with the in-lab treatment group, the preprocedural treatment group had a significant higher proportion of self-patency in the culprit artery (25.71% vs 16.67%, P=0.045) and early ST-segment elevation resolution (48.57% vs 27.96%, P<0.001). Preprocedural ticagrelor treatment was associated with a significant reduction of new-onset heart failure (9.29% vs 18.82%, p=0.016). Stent thrombosis risks were numerically reduced in the preprocedural treatment group (0.71% vs 1.61%, P=0.466). The rates of major cardiovascular adverse events, reinfarctions and mortality did not differ between the two groups. Bleeding events in the preprocedural treatment group was notn significantly higher than the in-lab treatment group (4.39% vs 1.39%, P=0.142). Conclusion Preprocedural administration of a loading dose of ticagrelor was associated with improved early reperfusion and reduced short-term heart failure in East-Asian STEMI patients undergoing primary PCI, but care should be taken for excess bleeding events.
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Affiliation(s)
- Yunke Zhang
- Department of Cardiology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, People's Republic of China.,Department of Cardiology, Shanghai University of Medicine and Health Sciences Affiliated Jiading Central Hospital, Shanghai, 201800, People's Republic of China
| | - Jie Hui
- Department of Cardiology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, People's Republic of China
| | - Xia Chen
- Department of Cardiology, Shanghai University of Medicine and Health Sciences Affiliated Jiading Central Hospital, Shanghai, 201800, People's Republic of China
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Costa OS, Thompson S, Ashton V, Palladino M, Bunz TJ, Coleman CI. Rivaroxaban versus warfarin for treatment and prevention of recurrence of venous thromboembolism in African American patients: a retrospective cohort analysis. Thromb J 2020; 18:6. [PMID: 32292291 PMCID: PMC7140368 DOI: 10.1186/s12959-020-00219-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Accepted: 03/18/2020] [Indexed: 11/12/2022] Open
Abstract
Background African Americans are under-represented in trials evaluating oral anticoagulants for the treatment of acute venous thromboembolism (VTE). The aim of this study was to evaluate the effectiveness and safety of rivaroxaban versus warfarin for the treatment of VTE in African Americans. Methods We utilized Optum® De-Identified Electronic Health Record data from 11/1/2012–9/30/2018. We included African Americans experiencing an acute VTE during a hospital or emergency department visit, who received rivaroxaban or warfarin as their first oral anticoagulant within 7-days of the acute VTE event and had ≥1 provider visit in the prior 12-months. Differences in baseline characteristics between cohorts were adjusted using inverse probability-of-treatment weighting based on propensity scores (standard differences < 0.10 were achieved for all covariates). Our primary endpoint was the composite of recurrent VTE or major bleeding at 6-months. Three- and 12-month timepoints were also assessed. Secondary endpoints included recurrent VTE and major bleeding as individual endpoints. Cohort risk was compared using Cox regression and reported as hazard ratios (HRs) with 95% confidence intervals (CIs). Results We identified 2097 rivaroxaban and 2842 warfarin users with incident VTE. At 6-months, no significant differences in the composite endpoint (HR = 0.96, 95%CI = 0.75–1.24), recurrent VTE (HR = 1.02, 95%CI = 0.76–1.36) or major bleeding alone (HR = 0.93, 95%CI = 0.59–1.47) were observed between cohorts. Analysis at 3- and 12-months provided consistent findings for these endpoints. Conclusions In African Americans experiencing an acute VTE, no significant difference in the incidence of recurrent VTE or major bleeding was observed between patients receiving rivaroxaban or warfarin.
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Affiliation(s)
- Olivia S Costa
- 1Department of Pharmacy Practice, University of Connecticut School of Pharmacy, 69 North Eagleville Road, Unit 3092, Storrs, CT 06269 USA.,2Evidence-Based Practice Center, Hartford Hospital, Hartford, CT USA
| | | | - Veronica Ashton
- 4Real World Value and Evidence, Janssen Scientific Affairs LLC, Titusville, NJ USA
| | | | - Thomas J Bunz
- Department of Pharmacoepidemiology, New England Health Analytics LLC, Granby, CT USA
| | - Craig I Coleman
- 1Department of Pharmacy Practice, University of Connecticut School of Pharmacy, 69 North Eagleville Road, Unit 3092, Storrs, CT 06269 USA.,2Evidence-Based Practice Center, Hartford Hospital, Hartford, CT USA
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Dr. Galen Wagner (1939-2016) as an Academic Writer: An Overview of his Peer-reviewed Scientific Publications. J Electrocardiol 2017; 50:47-73. [DOI: 10.1016/j.jelectrocard.2016.11.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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Abstract
Hydrogel delivery systems can leverage therapeutically beneficial outcomes of drug delivery and have found clinical use. Hydrogels can provide spatial and temporal control over the release of various therapeutic agents, including small-molecule drugs, macromolecular drugs and cells. Owing to their tunable physical properties, controllable degradability and capability to protect labile drugs from degradation, hydrogels serve as a platform in which various physiochemical interactions with the encapsulated drugs control their release. In this Review, we cover multiscale mechanisms underlying the design of hydrogel drug delivery systems, focusing on physical and chemical properties of the hydrogel network and the hydrogel-drug interactions across the network, mesh, and molecular (or atomistic) scales. We discuss how different mechanisms interact and can be integrated to exert fine control in time and space over the drug presentation. We also collect experimental release data from the literature, review clinical translation to date of these systems, and present quantitative comparisons between different systems to provide guidelines for the rational design of hydrogel delivery systems.
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Affiliation(s)
- Jianyu Li
- John A. Paulson School of Engineering and Applied Sciences, and the Wyss Institute for biologically Inspired Engineering, Harvard University, Cambridge, Massachusetts 02138, USA
| | - David J Mooney
- John A. Paulson School of Engineering and Applied Sciences, and the Wyss Institute for biologically Inspired Engineering, Harvard University, Cambridge, Massachusetts 02138, USA
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Soofi M, Yong C, Froelicher V. Justification of an introductory electrocardiogram teaching mnemonic by demonstration of its prognostic value. Am J Med 2014; 127:1202-7. [PMID: 25065339 DOI: 10.1016/j.amjmed.2014.07.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2014] [Revised: 07/12/2014] [Accepted: 07/14/2014] [Indexed: 10/25/2022]
Abstract
OBJECTIVES With diminishing time afforded to electrocardiography in the medical curriculum, we have found Sibbitt's simple mnemonic, the Diagonal Line Lead Rule, for a pattern recognition approach to 12-lead electrocardiogram (ECG) interpretation to be appreciated by students. However, it still lacks universal acceptance because its clinical utility has not been documented. The study objective was to demonstrate the clinical utility of the Diagonal Line Lead ECG Teaching Rule. METHODS After excluding ECGs of high-risk patients with Wolff-Parkinson-White syndrome and QRS durations greater than 120 ms, the initial ECGs of the remaining 43,798 patients were scored according to the Diagonal Line Lead Rule. A total of 45,497 patients from the Veterans Affairs Palo Alto Healthcare System were referred for a routine initial resting ECG from 1987 to 1999. We determined cardiovascular mortality with 8 years of follow-up. RESULTS In patients with normal QRS duration, diagnostic Q-wave or T-wave inversions isolated to the diagonal line leads showed no increased risk of cardiovascular death. Q-wave or T-wave inversion in any other lead was significantly associated with cardiovascular death with an age-adjusted Cox hazard of 2.6 (confidence interval, 2.4-2.8; P < .0001) and an annual cardiovascular mortality rate of 3.0%. Leads V4-V6, I, and aVL were especially significant predictors of cardiovascular death, with a Cox hazard greater than 3. CONCLUSIONS Our analysis demonstrates the prognostic power and clinical utility of a simple mnemonic for 12-lead ECG interpretation that can facilitate ECG teaching and interpretation.
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Affiliation(s)
| | - Celina Yong
- Stanford Cardiovascular Institute/The Division of Cardiovascular Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, Calif
| | - Victor Froelicher
- Stanford Cardiovascular Institute/The Division of Cardiovascular Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, Calif; Veterans Affairs Palo Alto Health Care System, Palo Alto, Calif.
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Hampton DR. Steps required to inclusion in commercial ECG analysis systems — the new ECG indices for quantitating extent, acuteness and severity of acute myocardial ischemia for facilitating emergency triage decisions. J Electrocardiol 2014; 47:577-82. [DOI: 10.1016/j.jelectrocard.2014.04.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2014] [Indexed: 11/16/2022]
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