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Dahlberg P, Axelsson KJ, Rydberg A, Lundahl G, Gransberg L, Bergfeldt L. Spatiotemporal repolarization dispersion before and after exercise in patients with long QT syndrome type 1 versus controls: probing into the arrhythmia substrate. Am J Physiol Heart Circ Physiol 2023; 325:H1279-H1289. [PMID: 37773058 DOI: 10.1152/ajpheart.00335.2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 09/21/2023] [Accepted: 09/22/2023] [Indexed: 09/30/2023]
Abstract
Congenital long QT syndrome (LQTS) carries an increased risk for syncope and sudden death. QT prolongation promotes ventricular extrasystoles, which, in the presence of an arrhythmia substrate, might trigger ventricular tachycardia degenerating into fibrillation. Increased electrical heterogeneity (dispersion) is the suggested arrhythmia substrate in LQTS. In the most common subtype LQT1, physical exercise predisposes for arrhythmia and spatiotemporal dispersion was therefore studied in this context. Thirty-seven patients (57% on β-blockers) and 37 healthy controls (mean age, 31 vs. 35; range, 6-68 vs. 6-72 yr) performed an exercise test. Frank vectorcardiography was used to assess spatiotemporal dispersion as Tampl, Tarea, the ventricular gradient (VG), and the Tpeak-end interval from 10-s signal averages before and 7 ± 2 min after exercise; during exercise too much signal disturbance excluded analysis. Baseline and maximum heart rates as well as estimated exercise intensity were similar, but heart rate recovery was slower in patients. At baseline, QT and heart rate-corrected QT (QTcB) were significantly longer in patients (as expected), whereas dispersion parameters were numerically larger in controls. After exercise, QTpeakcB and Tpeak-endcB increased significantly more in patients (18 ± 23 vs. 7 ± 10 ms and 12 ± 17 vs. 2 ± 6 ms; P < 0.001 and P < 0.01). There was, however, no difference in the change in Tampl, Tarea, and VG between groups. In conclusion, although temporal dispersion of repolarization increased significantly more after exercise in patients with LQT1, there were no signs of exercise-induced increase in global dispersion of action potential duration and morphology. The arrhythmia substrate/mechanism in LQT1 warrants further study.NEW & NOTEWORTHY Physical activity increases the risk for life-threatening arrhythmias in LQTS type 1 (LQT1). The arrhythmia substrate is presumably altered electrical heterogeneity (a.k.a. dispersion). Spatiotemporal dispersion parameters were therefore compared before and after exercise in patients versus healthy controls using Frank vectorcardiography, a novelty. Physical exercise prolonged the time between the earliest and latest complete repolarization in patients versus controls, but did not increase parameters reflecting global dispersion of action potential duration and morphology, another novelty.
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Affiliation(s)
- Pia Dahlberg
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Region Vaestra Goetaland, Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Karl-Jonas Axelsson
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Region Vaestra Goetaland, Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Annika Rydberg
- Division of Pediatrics, Department of Clinical Sciences, Umeå University, Umeå, Sweden
| | - Gunilla Lundahl
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Lennart Gransberg
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Lennart Bergfeldt
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Region Vaestra Goetaland, Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden
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Pastore CA. The Conception of the Selvester Score: Interface with the Development of Electro- Vectorcardiography. Arq Bras Cardiol 2023; 120:e20230584. [PMID: 37878896 PMCID: PMC10547434 DOI: 10.36660/abc.20230584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Revised: 09/06/2023] [Accepted: 09/06/2023] [Indexed: 10/27/2023] Open
Affiliation(s)
- Carlos Alberto Pastore
- Hospital das ClínicasFaculdade de MedicinaUniversidade de São PauloSão PauloSPBrasilUnidade Clínica de Eletrocardiografia, Instituto do Coração (InCor), Hospital das Clínicas FMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP – Brasil
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3
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Aras KK. Sex differences in cardiac electrophysiology: does body size matter? Am J Physiol Heart Circ Physiol 2022; 323:H1055-H1056. [PMID: 36306214 PMCID: PMC9678427 DOI: 10.1152/ajpheart.00606.2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Accepted: 10/25/2022] [Indexed: 12/14/2022]
Affiliation(s)
- Kedar K Aras
- Department of Physiology and Biophysics, Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, New York
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Kataoka Y, Tomoike H. Spatial Feature Extraction of Vectorcardiography via Minimum Volume Ellipsoid Enclosure in Classifying Left Ventricular Hypertrophy. Annu Int Conf IEEE Eng Med Biol Soc 2021; 2021:625-628. [PMID: 34891371 DOI: 10.1109/embc46164.2021.9630932] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
The voltage criteria used to diagnose left ventricular hypertrophy (LVH) in the chest and limb leads are by no means absolute. In addition to QRS voltages, QRS axis and duration, and P wave characteristics, repolarization (STT) changes have been focused attention due to their representing left ventricular overload. Vectorcardiography (VCG) has been studied specifically on its repolarization abnormality. The present study aims to devise spatial feature extraction of VCG and assess it in the LVH classification task. A minimum volume ellipsoid enclosure was applied to six segments obtained from upstroke and downstroke of each P, QRS, and T loops of a single-beat VCG. For the evaluation, VCG and 12 lead ECG dataset along with LVH labels of 61 subjects were derived from public open data, PTB-XL. These classification performances were compared with the LVH diagnosis criteria in the standard 12 lead ECG. As a result, the Random Forest classifier trained by the proposed spatial VCG feature resulted in accuracy of 0.904 (95% confidence interval: 0.861-0.947) when the classbalanced dataset was evaluated, which slightly exceeded the feature of 12 lead ECG. The feature importance analysis provided the quantitative ranking of the spatial feature of VCG, which were practically similar to those of ECG in the LVH classification task. Since the VCG are spatially comparable with three-dimensional data of CT, MRI, or Echocardiography, VCG will shed light on the spatial behavior of electrical depolarization and repolarization abnormalities in cardiac diseases.
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Braun T, Spiliopoulos S, Veltman C, Hergesell V, Passow A, Tenderich G, Borggrefe M, Koerner MM. Detection of myocardial ischemia due to clinically asymptomatic coronary artery stenosis at rest using supervised artificial intelligence-enabled vectorcardiography - A five-fold cross validation of accuracy. J Electrocardiol 2020; 59:100-105. [PMID: 32036110 DOI: 10.1016/j.jelectrocard.2019.12.018] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Revised: 12/16/2019] [Accepted: 12/31/2019] [Indexed: 11/16/2022]
Abstract
BACKGROUND Coronary artery disease (CAD) is a leading cause of death and disability. Conventional non-invasive diagnostic modalities for the detection of stable CAD at rest are subject to significant limitations: low sensitivity, and personal expertise. We aimed to develop a reliable and time-cost efficient screening tool for the detection of coronary ischemia using machine learning. METHODS We developed a supervised artificial intelligence algorithm combined with a five lead vectorcardiography (VCG) approach (i.e. Cardisiography, CSG) for the diagnosis of CAD. Using vectorcardiography, the excitation process of the heart can be described as a three-dimensional signal. A diagnosis can be received, by first, calculating specific physical parameters from the signal, and subsequently, analyzing them with a machine learning algorithm containing neuronal networks. In this multi-center analysis, the primary evaluated outcome was the accuracy of the CSG Diagnosis System, validated by a five-fold nested cross-validation in comparison to angiographic findings as the gold standard. Individuals with 1, 2, or 3- vessel disease were defined as being affected. RESULTS Of the 595 patients, 62·0% (n = 369) had 1, 2 or 3- vessel disease identified by coronary angiography. CSG identified a CAD at rest with a sensitivity of 90·2 ± 4·2% for female patients (male: 97·2 ± 3·1%), specificity of 74·4 ± 9·8% (male: 76·1 ± 8·5%), and overall accuracy of 82·5 ± 6·4% (male: 90·7 ± 3·3%). CONCLUSION These findings demonstrate that supervised artificial intelligence-enabled vectorcardiography can overcome limitations of conventional non-invasive diagnostic modalities for the detection of coronary ischemia at rest and is capable as a highly valid screening tool.
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Affiliation(s)
- Till Braun
- Cardisio GmbH, The Squaire 12, D-60549 Frankfurt am Main, Germany
| | - Sotirios Spiliopoulos
- Department of Cardiac Surgery, University Heart Center Graz, Medical University Graz, Auenbruggerplatz 29, A-8036 Graz, Austria
| | | | - Vera Hergesell
- Department of Cardiac Surgery, University Heart Center Graz, Medical University Graz, Auenbruggerplatz 29, A-8036 Graz, Austria
| | - Alexander Passow
- Cardisio GmbH, The Squaire 12, D-60549 Frankfurt am Main, Germany; Faculty of Medicine, University Bochum, Universitaetsstrasse 150, D-44801 Bochum, Germany
| | - Gero Tenderich
- Cardisio GmbH, The Squaire 12, D-60549 Frankfurt am Main, Germany; Faculty of Medicine, University Bochum, Universitaetsstrasse 150, D-44801 Bochum, Germany
| | - Martin Borggrefe
- First Department of Medicine, University Medical Centre Mannheim (UMM), Faculty of Medicine Mannheim, University of Heidelberg, European Center for AngioScience (ECAS), and DZHK (German Center for Cardiovascular Research) partner site Heidelberg/Mannheim, Theodor-Kutzer-Ufer 1-3, D-68167 Mannheim, Germany
| | - Michael M Koerner
- Nazih Zuhdi Advanced Cardiac Care & Transplant Institute, Department of Medicine, Integris Baptist Medical Center, 3400 NW Expressway, Bldg C, Suite 300, Oklahoma City, OK 73162, USA; Department of Rural Health - Medicine/Cardiology, Oklahoma State University Center For Health Sciences, 1111 W 17(th) Street, Tulsa, OK 74107, USA.
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6
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Perez-Alday EA, Li-Pershing Y, Bender A, Hamilton C, Thomas JA, Johnson K, Lee TL, Gonzales R, Li A, Newton K, Tereshchenko LG. Importance of the heart vector origin point definition for an ECG analysis: The Atherosclerosis Risk in Communities (ARIC) study. Comput Biol Med 2019; 104:127-138. [PMID: 30472495 PMCID: PMC6400224 DOI: 10.1016/j.compbiomed.2018.11.013] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2018] [Revised: 11/15/2018] [Accepted: 11/15/2018] [Indexed: 01/14/2023]
Abstract
AIM Our goal was to investigate the effect of a global XYZ median beat construction and the heart vector origin point definition on predictive accuracy of ECG biomarkers of sudden cardiac death (SCD). METHODS Atherosclerosis Risk In Community study participants with analyzable digital ECGs were included (n = 15,768; 55% female, 73% white, mean age 54.2 ± 5.8 y). We developed an algorithm to automatically detect the heart vector origin point on a median beat. Three different approaches to construct a global XYZ beat and two methods to locate origin point were compared. Global electrical heterogeneity was measured by sum absolute QRST integral (SAI QRST), spatial QRS-T angle, and spatial ventricular gradient (SVG) magnitude, azimuth, and elevation. Adjudicated SCD served as the primary outcome. RESULTS There was high intra-observer (kappa 0.972) and inter-observer (kappa 0.984) agreement in a heart vector origin definition between an automated algorithm and a human. QRS was wider in a median beat that was constructed using R-peak alignment than in time-coherent beat (88.1 ± 16.7 vs. 83.7 ± 15.9 ms; P < 0.0001), and on a median beat constructed using QRS-onset as a zeroed baseline, vs. isoelectric origin point (86.7 ± 15.9 vs. 83.7 ± 15.9 ms; P < 0.0001). ROC AUC was significantly larger for QRS, QT, peak QRS-T angle, SVG elevation, and SAI QRST if measured on a time-coherent median beat, and for SAI QRST and SVG magnitude if measured on a median beat using isoelectric origin point. CONCLUSION Time-coherent global XYZ median beat with physiologically meaningful definition of the heart vector's origin point improved predictive accuracy of SCD biomarkers.
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Affiliation(s)
| | - Yin Li-Pershing
- Knight Cardiovascular Institute, Oregon Health & Science University, Portland, OR, USA
| | - Aron Bender
- Knight Cardiovascular Institute, Oregon Health & Science University, Portland, OR, USA
| | - Christopher Hamilton
- Knight Cardiovascular Institute, Oregon Health & Science University, Portland, OR, USA
| | - Jason A Thomas
- Knight Cardiovascular Institute, Oregon Health & Science University, Portland, OR, USA
| | - Kyle Johnson
- Knight Cardiovascular Institute, Oregon Health & Science University, Portland, OR, USA
| | - Tiffany L Lee
- Knight Cardiovascular Institute, Oregon Health & Science University, Portland, OR, USA
| | | | - Aaron Li
- Carleton College, Northfield, MN, USA
| | - Kelley Newton
- Knight Cardiovascular Institute, Oregon Health & Science University, Portland, OR, USA
| | - Larisa G Tereshchenko
- Knight Cardiovascular Institute, Oregon Health & Science University, Portland, OR, USA.
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7
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Riera ARP, Barros RB, Sousa Neto AFSE, Raimundo RD, de Abreu LC, Nikus K. Extensive Anterior Myocardial Infarction ... and Something Else? Arq Bras Cardiol 2019; 112:803-806. [PMID: 31314834 PMCID: PMC6636365 DOI: 10.5935/abc.20190096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Accepted: 10/02/2018] [Indexed: 11/21/2022] Open
Affiliation(s)
- Andrés Ricardo Pérez Riera
- Faculdade de Medicina do ABC, Santo André, SP - Brazil
- Mailing Address: Andrés Ricardo Pérez
Riera, R. Nicolau Barreto, 258. Postal Code 04583-000, Vila Cordeiro,
São Paulo, SP - Brazil. E-mail: ,
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8
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Aranda Hernandez A, Bonizzi P, Karel J, Peeters R. Myocardial Ischemia Diagnosis Using a Reduced Lead System. Annu Int Conf IEEE Eng Med Biol Soc 2018; 2018:5302-5305. [PMID: 30441534 DOI: 10.1109/embc.2018.8513511] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
This research presents a novel statistical model for diagnosing acute myocardial infarction (AMI). The model is based on features extracted from a reduced lead system consisting of a subset of three leads from the standard 12-lead ECG. We selected a set of relevant parameters commonly used in the clinical practice for ECG-based AMI diagnosis, namely ST elevation and T-wave maximum. We also selectedfeatures, not used in clinical practice, that were derived from vectorcardiography and computed on the reduced three-lead system (pseudo-VCG parameters). To validate the model, we used 104 patients coming from the Physionet STAFF III database which contains 12-lead ECG recordings at baseline and in coronary artery occlusion condition during angioplasty (PTCA). Results show that pseudo-VCG features are able to diagnose AMI slightly better than ST elevation and T-wave maximum features together (area under the ROC curve (AUC) 0.87 vs AUC 0.85). When combining pseudo-VCG features together with ST elevation, and T-wave maximum, the performance improved significantly (AUC 0.95, sensitivity 89.6% and specificity 82.7%). Results indicate a potential for diagnosing AMI using the proposed reduced lead system and the selected set of features. We suggest its possible use for diagnosing AMI in long-term, ambulatory and home monitoring situations, allowing an earlier and faster diagnosis.
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9
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Maass AH, Vernooy K, Wijers SC, van 't Sant J, Cramer MJ, Meine M, Allaart CP, De Lange FJ, Prinzen FW, Gerritse B, Erdtsieck E, Scheerder COS, Hill MRS, Scholten M, Kloosterman M, Ter Horst IAH, Voors AA, Vos MA, Rienstra M, Van Gelder IC. Refining success of cardiac resynchronization therapy using a simple score predicting the amount of reverse ventricular remodelling: results from the Markers and Response to CRT (MARC) study. Europace 2018; 20:e1-e10. [PMID: 28339818 DOI: 10.1093/europace/euw445] [Citation(s) in RCA: 64] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2016] [Accepted: 12/31/2016] [Indexed: 02/15/2024] Open
Abstract
Aims Cardiac resynchronization therapy (CRT) reduces morbidity and mortality in systolic heart failure patients with ventricular conduction delay. Variability of individual response to CRT warrants improved patient selection. The Markers and Response to CRT (MARC) study was designed to investigate markers related to response to CRT. Methods and results We prospectively studied the ability of 11 clinical, 11 electrocardiographic, 4 echocardiographic, and 16 blood biomarkers to predict CRT response in 240 patients. Response was measured by the reduction of indexed left ventricular end-systolic volume (LVESVi) at 6 months follow-up. Biomarkers were related to LVESVi change using log-linear regression on continuous scale. Covariates that were significant univariately were included in a multivariable model. The final model was utilized to compose a response score. Age was 67 ± 10 years, 63% were male, 46% had ischaemic aetiology, LV ejection fraction was 26 ± 8%, LVESVi was 75 ± 31 mL/m2, and QRS was 178 ± 23 ms. At 6 months LVESVi was reduced to 58 ± 31 mL/m2 (relative reduction of 22 ± 24%), 130 patients (61%) showed ≥ 15% LVESVi reduction. In univariate analysis 17 parameters were significantly associated with LVESVi change. In the final model age, QRSAREA (using vectorcardiography) and two echocardiographic markers (interventricular mechanical delay and apical rocking) remained significantly associated with the amount of reverse ventricular remodelling. This CAVIAR (CRT-Age-Vectorcardiographic QRSAREA -Interventricular Mechanical delay-Apical Rocking) response score also predicted clinical outcome assessed by heart failure hospitalizations and all-cause mortality. Conclusions The CAVIAR response score predicts the amount of reverse remodelling after CRT and may be used to improve patient selection. Clinical Trials: NCT01519908.
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Affiliation(s)
- Alexander H Maass
- Department of Cardiology, Thoraxcenter, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9700RB Groningen, The Netherlands
| | - Kevin Vernooy
- Department of Cardiology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Sofieke C Wijers
- Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Jetske van 't Sant
- Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Maarten J Cramer
- Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Mathias Meine
- Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Cornelis P Allaart
- Department of Cardiology, VU University Medical Center, Amsterdam, The Netherlands
| | - Frederik J De Lange
- Department of Cardiology, Academic Medical Center, Amsterdam, The Netherlands
| | - Frits W Prinzen
- Department of Physiology, University of Maastricht, Maastricht, The Netherlands
| | - Bart Gerritse
- Medtronic Bakken Research Center, Maastricht, The Netherlands
| | - Erna Erdtsieck
- Center for Translational Molecular Medicine, Utrecht, The Netherlands
| | - Coert O S Scheerder
- Medtronic Bakken Research Center, Maastricht, The Netherlands
- Currently Employed by Medtronic Trading NL, Eindhoven, The Netherlands
| | | | - Marcoen Scholten
- Thoraxcenter Twente, Medisch Spectrum Twente, Enschede, The Netherlands
| | - Mariëlle Kloosterman
- Department of Cardiology, Thoraxcenter, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9700RB Groningen, The Netherlands
| | - Iris A H Ter Horst
- Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Adriaan A Voors
- Department of Cardiology, Thoraxcenter, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9700RB Groningen, The Netherlands
| | - Marc A Vos
- Department of Medical Physiology, University of Utrecht, Hanzeplein 1, 9700RB Groningen, Utrecht, The Netherlands
| | - Michiel Rienstra
- Department of Cardiology, Thoraxcenter, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9700RB Groningen, The Netherlands
| | - Isabelle C Van Gelder
- Department of Cardiology, Thoraxcenter, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9700RB Groningen, The Netherlands
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Petersson R, Smith JG, Larsson DA, Reitan Ö, Carlson J, Platonov P, Holmqvist F. Orthogonal P-wave morphology is affected by intra-atrial pressures. BMC Cardiovasc Disord 2017; 17:288. [PMID: 29212469 PMCID: PMC5719760 DOI: 10.1186/s12872-017-0724-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Accepted: 11/28/2017] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND It has previously been shown that the morphology of the P-wave neither depends on atrial size in healthy subjects with physiologically enlarged atria nor on the physiological anatomical variation in transverse orientation of the left atrium. The present study aimed to investigate if different pressures in the left and right atrium are associated with different P-wave morphologies. METHODS 38 patients with isolated, increased left atrial pressure, 51 patients with isolated, increased right atrial pressure and 76 patients with biatrially increased pressure were studied. All had undergone right heart catheterization and had 12-lead electrocardiographic recordings, which were transformed into vectorcardiograms for detailed P-wave morphology analysis. RESULTS Normal P-wave morphology (type 1) was more common in patients with isolated increased pressure in the right atrium while abnormal P-wave morphology (type 2) was more common in the groups with increased left atrial pressure (P = 0.032). Moreover, patients with increased left atrial pressure, either isolated or in conjunction with increased right atrial pressure, had significantly more often a P-wave morphology with a positive deflection in the sagittal plane (P = 0.004). CONCLUSION Isolated elevated right atrial pressure was associated with normal P-wave morphology while left-sided atrial pressure elevation, either isolated or in combination with right atrial pressure elevation, was associated with abnormal P-wave morphology.
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Affiliation(s)
- Richard Petersson
- Department of Cardiology, Clinical Sciences, Lund University, Lund, Sweden
- Center for Integrative Electrocardiology, Lund University, Lund, Sweden
| | - J. Gustav Smith
- Department of Cardiology, Clinical Sciences, Lund University, Lund, Sweden
- Heart Failure and Valvular Disease Clinic, Skåne University Hospital, Lund, Sweden
| | - David A. Larsson
- Department of Internal and Emergency Medicine, Skåne University Hospital, Lund, Sweden
| | - Öyvind Reitan
- Department of Cardiology, Clinical Sciences, Lund University, Lund, Sweden
- Heart Failure and Valvular Disease Clinic, Skåne University Hospital, Lund, Sweden
| | - Jonas Carlson
- Department of Cardiology, Clinical Sciences, Lund University, Lund, Sweden
- Center for Integrative Electrocardiology, Lund University, Lund, Sweden
| | - Pyotr Platonov
- Department of Cardiology, Clinical Sciences, Lund University, Lund, Sweden
- Center for Integrative Electrocardiology, Lund University, Lund, Sweden
- Arrhythmia Clinic, Skåne University Hospital, Lund, Sweden
| | - Fredrik Holmqvist
- Department of Cardiology, Clinical Sciences, Lund University, Lund, Sweden
- Center for Integrative Electrocardiology, Lund University, Lund, Sweden
- Arrhythmia Clinic, Skåne University Hospital, Lund, Sweden
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11
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Filos D, Chouvarda I, Tachmatzidis D, Vassilikos V, Maglaveras N. Beat-to-beat P-wave morphology as a predictor of paroxysmal atrial fibrillation. Comput Methods Programs Biomed 2017; 151:111-121. [PMID: 28946993 DOI: 10.1016/j.cmpb.2017.08.016] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/14/2016] [Revised: 08/11/2017] [Accepted: 08/21/2017] [Indexed: 06/07/2023]
Abstract
BACKGROUND AND OBJECTIVES Atrial Fibrillation (AF) is the most common cardiac arrhythmia. The initiation and the perpetuation of AF is linked with phenomena of atrial remodeling, referring to the modification of the electrical and structural characteristics of the atrium. P-wave morphology analysis can reveal information regarding the propagation of the electrical activity on the atrial substrate. The purpose of this study is to investigate patterns on the P-wave morphology that may occur in patients with Paroxysmal AF (PAF) and which can be the basis for distinguishing between PAF and healthy subjects. METHODS Vectorcardiographic signals in the three orthogonal axes (X, Y and Z), of 3-5 min duration, were analyzed during SR. In total 29 PAF patients and 34 healthy volunteers were included in the analysis. These data were divided into two distinct datasets, one for the training and one for the testing of the proposed approach. The method is based on the identification of the dominant and the secondary P-wave morphology by combining adaptive k-means clustering of morphologies and a beat-to-beat cross correlation technique. The P-waves of the dominant morphology were further analyzed using wavelet transform whereas time domain characteristics were also extracted. Following a feature selection step, a SVM classifier was trained, for the discrimination of the PAF patients from the healthy subjects, while its accuracy was tested using the independent testing dataset. RESULTS In the cohort study, in both groups, the majority of the P-waves matched a main and a secondary morphology, while other morphologies were also present. The percentage of P-waves which simultaneously matched the main morphology in all three leads was lower in PAF patients (90.4 ± 7.8%) than in healthy subjects (95.5 ± 3.4%, p= 0.019). Three optimal scale bands were found and wavelet parameters were extracted which presented statistically significant differences between the two groups. Classification between the two groups was based on a feature selection process which highlighted 7 features, while an SVM classifier resulted a balanced accuracy equal to 93.75%. The results show the virtue of beat-to-beat analysis for PAF prediction. CONCLUSION The difference in the percentage of the main P-wave-morphology and in the P-wave time-frequency characteristics suggests a higher electrical instability of the atrial substrate in patients with PAF and different conduction patterns in the atria.
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Affiliation(s)
- Dimitrios Filos
- Laboratory of Computing and Medical Informatics, Aristotle University of Thessaloniki, Box 323, 54124, Thessaloniki, Greece.
| | - Ioanna Chouvarda
- Laboratory of Computing and Medical Informatics, Aristotle University of Thessaloniki, Box 323, 54124, Thessaloniki, Greece.
| | | | | | - Nicos Maglaveras
- Laboratory of Computing and Medical Informatics, Aristotle University of Thessaloniki, Box 323, 54124, Thessaloniki, Greece.
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12
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Pérez-Riera AR, Baranchuk A, Zhang L, Barbosa-Barros R, de Abreu LC, Brugada P. Myotonic dystrophy and Brugada syndrome: A common pathophysiologic pathway? J Electrocardiol 2017; 50:513-517. [PMID: 28389016 DOI: 10.1016/j.jelectrocard.2017.03.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2016] [Indexed: 11/18/2022]
Abstract
Type 1 myotonic dystrophy (DM1) is a hereditary neuromuscular disease affecting multiple organs in human adults. Here we report a 42-year-old man diagnosed with DM1. Having a history of progressive muscular weakness and gradual loss of visual acuity, he was referred to us by his ophthalmologist for risk assessment of undergoing cataract surgery. Cardiology workup revealed type 1 Brugada ECG pattern, positive late potentials and inducible ventricular fibrillation in an electrophysiology study. Literature review revealed that those ECG changes may be observed in DM1, suggesting that DM1 and Brugada syndrome may share a common pathophysiologic pathway.
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Affiliation(s)
- Andrés Ricardo Pérez-Riera
- Design of Studies and Scientific Writing Laboratory at the ABC School of Medicine, Santo André, São Paulo, Brazil.
| | - Adrian Baranchuk
- Division of Cardiology, Queen's University, Kingston, Ontario, Canada
| | - Li Zhang
- Lankenau Medical Center and Lankenau Institute for Medical Research, Wynnewood, PA, USA
| | - Raimundo Barbosa-Barros
- Coronary Center of the Hospital de Messejana Dr. Carlos Alberto Studart Gomes, Fortaleza, CE, Brazil
| | - Luiz Carlos de Abreu
- Design of Studies and Scientific Writing Laboratory at the ABC School of Medicine, Santo André, São Paulo, Brazil
| | - Pedro Brugada
- Department of Cardiology, Heart Rhythm Management Center, UZ Brussel, Vrije Universiteit Brussel (VUB), Brussels, Belgium
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Aranda A, Bonizzi P, Karel J, Peeters R. Performance of Dower's inverse transform and Frank lead system for Identification of Myocardial Infarction. Annu Int Conf IEEE Eng Med Biol Soc 2016; 2015:4495-8. [PMID: 26737293 DOI: 10.1109/embc.2015.7319393] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
This study performs a comparison between Dower's inverse transform and Frank lead system for Myocardial Infarction (MI) identification. We have selected a set of relevant features for MI detection from the vectorcardiogram and used the lasso method after that to build a model for the Dower's inverse transform and one for the Frank leads system. Then we analyzed the performance between both models on MI detection. The proposed methods have been tested using PhysioNet PTB database that contains 550 records from which 368 are MIs. Two main conclusions are coming from this study. The first one is that Dower's inverse transform performs equally well than Frank leads in identification of MI patients. The second one is that lead positions have a large influence on the accuracy of MI patient identification.
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Gomes MC, Lima CA, Goncalves FR, Ramalhão C, Maia J. Correlations between radiological heart size and the vectocardiogram in patients with left anterior hemiblock. Adv Cardiol 2015; 14:136-47. [PMID: 124529 DOI: 10.1159/000397646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Benchimol A, Desser KB. Combined his bundle electrography and timed vectorcardiography. Left bundle branch conduction abnormalities. Adv Cardiol 2015; 14:204-7. [PMID: 1136883 DOI: 10.1159/000397651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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Král V, Novák V, Jezek V. The relation of repolarisation potentials to the localisation of transmural infarctions. Adv Cardiol 2015; 16:445-9. [PMID: 1274754 DOI: 10.1159/000398440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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von der Groeben J, Toole JG. Correlation of serial microscopic studies of the ventricles in coronary artery disease with electrocardiographic and vectorcardiographic findings. Adv Cardiol 2015; 16:403-6. [PMID: 1274749 DOI: 10.1159/000398432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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Recke SH, Knebel R, Recke AS. Vectorcardiographic diagnosis of inferior myocardial infarction in the presence of rS complex in the orthogonal lead Y. Adv Cardiol 2015; 16:439-44. [PMID: 1274753 DOI: 10.1159/000398439] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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So CS, Kolb P, Blömer H. Vectorcardiographic findings in Friedreich's ataxia. Adv Cardiol 2015; 16:545-8. [PMID: 132108 DOI: 10.1159/000398458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Shakin VV, Csapodi C, Préda I, Kenedi P, Breuer P. Adaptive data reduction in body surface mapping. Adv Cardiol 2015; 21:40-3. [PMID: 619565 DOI: 10.1159/000400418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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Ribeiro C, Bordalo AD, Lacximy I. Unstable axis deviations during the acute phase of myocardial infarction. Serial vectorcardiographic study of 200 cases. Adv Cardiol 2015; 21:253-8. [PMID: 619549 DOI: 10.1159/000400461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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Vassilev J. On the vectorcardiographic changes in adults. Adv Cardiol 2015; 19:61-4. [PMID: 835440 DOI: 10.1159/000399625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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Belov J, Urumov G, Torbova S. Analysis of the corrected and uncorrected leads in patients with arterial hypertension. Adv Cardiol 2015; 19:263-5. [PMID: 138348 DOI: 10.1159/000399682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Pavlov Z. VCG estimation of haemodynamic changes in right ventricle loading. Adv Cardiol 2015; 16:339-42. [PMID: 1274738 DOI: 10.1159/000398420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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Sano T, Sakamoto Y, Suzuki F. The U vector loop and the genesis of the U wave. Adv Cardiol 2015; 21:202-5. [PMID: 619540 DOI: 10.1159/000400449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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Tuna N, Liedtke C. Influence of age and somatic variables height, weight and chest circumference on electrocardiogram-vectorcardiogram. Adv Cardiol 2015; 21:286-95. [PMID: 619554 DOI: 10.1159/000400466] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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Vitanova M. On the specific features of the vectorcardiogram in children. Adv Cardiol 2015; 19:58-60. [PMID: 835439 DOI: 10.1159/000399624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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Makolkin VI. Specific features of the heart electric field in varying hemodynamic disturbances. Adv Cardiol 2015; 19:234-5. [PMID: 835419 DOI: 10.1159/000399674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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Schönberger W, Michaelis J, Scheidt E, Schmidt M, Stopfkuchen H. Correlations of vectorcardiographic parameters with constitutional variables in early childhood. Adv Cardiol 2015; 16:102-7. [PMID: 1274724 DOI: 10.1159/000398377] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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Kowarzyk H. Hemodynamics and vectorcardiogram. Adv Cardiol 2015; 16:322-7. [PMID: 1274737 DOI: 10.1159/000398417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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Borzycka B, Lorkiewicz Z. Vectorcardiographic evaluation of patients after operation of mitral stenosis. Adv Cardiol 2015; 16:350-3. [PMID: 1274739 DOI: 10.1159/000398422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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Meyer V, Hüttemann U, Schüren KP. The value of the electro- and vectorcardiogram in chronic cor pulmonale. Adv Cardiol 2015; 16:360-5. [PMID: 1274742 DOI: 10.1159/000398424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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Miguel JP, Dantas dos Reis D, Lopes VM, Pereira CM, de Pádua F. Vectorcardiographic study of right bundle branch block and its associations with the left hemiblocks. Adv Cardiol 2015; 16:451-64. [PMID: 1274756 DOI: 10.1159/000398442] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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Abel H, Zywietz C, Klusmeier S. Clinical experience upon an ECG program with multivariate diagnostic classification. Adv Cardiol 2015; 21:168-72. [PMID: 145789 DOI: 10.1159/000400442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Schwartze H. Effect of different perfusion pressures on the excitation spreading pattern of isolated guinea pig hearts from transitional and adult type circulations. Adv Cardiol 2015; 19:29-32. [PMID: 835432 DOI: 10.1159/000399616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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Smets P, Kornreich F. New parametrisation of the VCG for diagnostic purpose. Adv Cardiol 2015; 16:139-42. [PMID: 775902 DOI: 10.1159/000398386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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Popov AA, Maslova EM, Shestak EM, Yanenko VM. Towards the identification of vectorcardiograms plotted in two orthogonal systems of registration points. Adv Cardiol 2015; 16:237-9. [PMID: 775919 DOI: 10.1159/000398404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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Ruttkay-Nedecký I. Information content of instantaneous QRS vectors. Adv Cardiol 2015; 16:52-4. [PMID: 132107 DOI: 10.1159/000398367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Hiroki T, Kanaya H, Doi Y, Arakawa K. U vectorcardiograms in left ventricular overloading. Adv Cardiol 2015; 21:214-9. [PMID: 145792 DOI: 10.1159/000400452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Szabados T, Kenedi P, Frey T, Schwarczmann P. Study of the ventricular spread of activation by computer model. Adv Cardiol 2015; 19:165-6. [PMID: 319632 DOI: 10.1159/000399651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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