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Detecting hemodynamic abnormalities using electrocardiographic and cardiac acoustic data
144
Poster Session III / Journal of Electrocardiology 38 (2005) 140 – 144
2 precordial leads (eg, III, V3, V6, or III, V1, V4) attained AUC values that were not significantly different from those of the full 12-lead ML ECG, provided the appropriate threshold values are used. Conclusion: Our results based on the AUC are consistent with the current guidelines and recommendations. For our population of pts, several 3-lead systems, based on a 6-electrode lead set, could recognize controlled ischemic state with as good diagnostic performance as 12-lead ML ECG. doi:10.1016/j.jelectrocard.2005.06.087
Using simultaneous electrocardiographic and acoustic data to evaluate and monitor patients with cardiac disease Robert A. Warner, Eunyoung Lee, Patricia Arand, Andrew D. Michaels, Barbara J. Drew (University of California, San Francisco, San Francisco, CA, USA; Inovise Medical, Inc, Portland OR, USA)
Background: Acute myocardial ischemia is associated with hemodynamic as well as electrocardiographic (ECG) abnormalities. For example, impaired left ventricular (LV) systolic function can produce a third heart sound (S3) that previous research, as reflected in the American College of Cardiology/ American Heart Association Practice Guidelines, has shown is associated with increased clinical risk. Methods: We obtained ECG and acoustic data from 89 patients before cardiac catheterization using Audicor, a device that records and algorithmically interprets simultaneous 12-lead ECG and electronic cardiac sound recordings. In an additional patient, we recorded continuous Audicor data immediately before and during the early phase of an acute ST-elevation anterior myocardial infarction (MI). We displayed these continuous data using a method that reveals statistically significant changes in diagnostic parameters from their respective baseline values. Results: In the 89 precatheterization patients, the recorded S3 had a sensitivity/specificity for detecting an LV ejection fraction of less than 50% and LV end-diastolic pressure of more than 15 mm Hg of 13 (sensitivity, 62%) of 21 and 60 (specificity, 88%) of 68. In the patient with acute MI, acoustic changes preceded ECG changes, and a new S3 appeared shortly after the onset of the acute MI. Conclusions: Electronically recorded S3 identifies patients with impaired LV systolic function, and recorded heart sounds can be added to multiparameter monitoring of patients with suspected acute MI. doi:10.1016/j.jelectrocard.2005.06.088
Detecting hemodynamic abnormalities using electrocardiographic and cardiac acoustic data Michel Zuber, MD, Peter Kipfer, MD, Patti Arand, PhD, Peter Bauer, PhD, Robert Warner, MD (Facharzt, Othmarsingen, Switzerland; Facharzt, Frauenfeld, Switzerland; Inovise Medical, Inc, Portland, OR, USA)
Background: Hemodynamic abnormalities can be associated with electrocardiographic (ECG) changes. For example, the ECG evidence of left ventricular hypertrophy (LVH) is a consequence of the hemodynamic abnormalities that produced the LVH. However, we hypothesized that abnormal hemodynamics are more likely to be associated with the presence of a third heart sound (S3) than with ECG findings. Methods: We obtained recordings from 50 ambulatory subjects (39 men; age, 36-84 years; mean, 65 years) using Audicor, a device that records and algorithmically interprets simultaneous 12-lead ECG and acoustic data. We used unpaired t tests to determined if there are significant differences in the values of BNP and of 4 echocardiographic parameters of cardiac function in subjects with vs without an S3 and with vs without ECG evidence of LVH, prior myocardial infarction (MI), and ST-T abnormalities. Results: Table 1 shows all P values less than .05. Table 1 Parameter
S3
LVH Abn
ST-T
Prior MI
BNP EA ratio T decal EE’ ratio Hi diast pressure
b .001 b .01 b .05 b .05 b .001
– – – b .001 –
– – b .05 – –
– – – – –
Conclusions: The electronically recorded S3 is associated with a wider range of evidence for hemodynamic abnormalities than is ECG evidence of LVH, ST-T, or prior MI. The electronically recorded S3 can therefore augment the diagnostic capabilities of the ECG. doi:10.1016/j.jelectrocard.2005.06.089
Poster Session III / Journal of Electrocardiology 38 (2005) 140 – 144
2 precordial leads (eg, III, V3, V6, or III, V1, V4) attained AUC values that were not significantly different from those of the full 12-lead ML ECG, provided the appropriate threshold values are used. Conclusion: Our results based on the AUC are consistent with the current guidelines and recommendations. For our population of pts, several 3-lead systems, based on a 6-electrode lead set, could recognize controlled ischemic state with as good diagnostic performance as 12-lead ML ECG. doi:10.1016/j.jelectrocard.2005.06.087
Using simultaneous electrocardiographic and acoustic data to evaluate and monitor patients with cardiac disease Robert A. Warner, Eunyoung Lee, Patricia Arand, Andrew D. Michaels, Barbara J. Drew (University of California, San Francisco, San Francisco, CA, USA; Inovise Medical, Inc, Portland OR, USA)
Background: Acute myocardial ischemia is associated with hemodynamic as well as electrocardiographic (ECG) abnormalities. For example, impaired left ventricular (LV) systolic function can produce a third heart sound (S3) that previous research, as reflected in the American College of Cardiology/ American Heart Association Practice Guidelines, has shown is associated with increased clinical risk. Methods: We obtained ECG and acoustic data from 89 patients before cardiac catheterization using Audicor, a device that records and algorithmically interprets simultaneous 12-lead ECG and electronic cardiac sound recordings. In an additional patient, we recorded continuous Audicor data immediately before and during the early phase of an acute ST-elevation anterior myocardial infarction (MI). We displayed these continuous data using a method that reveals statistically significant changes in diagnostic parameters from their respective baseline values. Results: In the 89 precatheterization patients, the recorded S3 had a sensitivity/specificity for detecting an LV ejection fraction of less than 50% and LV end-diastolic pressure of more than 15 mm Hg of 13 (sensitivity, 62%) of 21 and 60 (specificity, 88%) of 68. In the patient with acute MI, acoustic changes preceded ECG changes, and a new S3 appeared shortly after the onset of the acute MI. Conclusions: Electronically recorded S3 identifies patients with impaired LV systolic function, and recorded heart sounds can be added to multiparameter monitoring of patients with suspected acute MI. doi:10.1016/j.jelectrocard.2005.06.088
Detecting hemodynamic abnormalities using electrocardiographic and cardiac acoustic data Michel Zuber, MD, Peter Kipfer, MD, Patti Arand, PhD, Peter Bauer, PhD, Robert Warner, MD (Facharzt, Othmarsingen, Switzerland; Facharzt, Frauenfeld, Switzerland; Inovise Medical, Inc, Portland, OR, USA)
Background: Hemodynamic abnormalities can be associated with electrocardiographic (ECG) changes. For example, the ECG evidence of left ventricular hypertrophy (LVH) is a consequence of the hemodynamic abnormalities that produced the LVH. However, we hypothesized that abnormal hemodynamics are more likely to be associated with the presence of a third heart sound (S3) than with ECG findings. Methods: We obtained recordings from 50 ambulatory subjects (39 men; age, 36-84 years; mean, 65 years) using Audicor, a device that records and algorithmically interprets simultaneous 12-lead ECG and acoustic data. We used unpaired t tests to determined if there are significant differences in the values of BNP and of 4 echocardiographic parameters of cardiac function in subjects with vs without an S3 and with vs without ECG evidence of LVH, prior myocardial infarction (MI), and ST-T abnormalities. Results: Table 1 shows all P values less than .05. Table 1 Parameter
S3
LVH Abn
ST-T
Prior MI
BNP EA ratio T decal EE’ ratio Hi diast pressure
b .001 b .01 b .05 b .05 b .001
– – – b .001 –
– – b .05 – –
– – – – –
Conclusions: The electronically recorded S3 is associated with a wider range of evidence for hemodynamic abnormalities than is ECG evidence of LVH, ST-T, or prior MI. The electronically recorded S3 can therefore augment the diagnostic capabilities of the ECG. doi:10.1016/j.jelectrocard.2005.06.089