ECG scar quantification correlates with cardiac magnetic resonance scar size and prognostic factors in Chagas' disease

Objective To test the hypothesis that 12-lead ECG QRS scoring quantifies myocardial scar and correlates with disease severity in Chagas' heart disease. Design Patients underwent 12-lead ECG for QRS scoring and cardiac magnetic resonance with late gadolinium enhancement (CMR-LGE) to assess myocardial scar. Setting University of Sao Paulo Medical School, Sao Paulo, Brazil. Patients 44 Seropositive patients with Chagas' disease without a history of myocardial infarction and at low risk for coronary artery disease. Main outcome measures Correlation between QRS score, CMR-LGE scar size and left ventricular ejection fraction. Relation between QRS score, heart failure (HF) class and history of ventricular tachycardia (VT). Results QRS score correlated directly with CMR-LGE scar size (R=0.69, p<0.0001) and inversely with left ventricular ejection fraction (R=-0.54, p=0.0002), which remained significant in the subgroup with conduction defects. Patients with class II or III HF had significantly higher QRS scores than those with class I HF (5.1 +/- 3.4 vs 2.1 +/- 3.1 QRS points (p=0.002)) and patients with a history of VT had significantly higher QRS scores than those without a history of VT (5.3 +/- 3.2% vs 2.6 +/- 3.4 QRS points (p=0.02)). A QRS score >= 2 points had particularly good sensitivity and specificity (95% and 83%, respectively) for prediction of large CMR-LGE, and a QRS score >= 7 points had particularly high specificity (92% and 89%, respectively) for predicting significant left ventricular dysfunction and history of VT. Conclusions The wide availability of 12-lead ECG makes it an attractive screening tool and may enhance clinical risk stratification of patients at risk for more severe, symptomatic Chagas' heart disease.

Characterization of the electrocardiographic pattern of individuals with cerebral palsy

Background: Dentists of Lar Sao Francisco observed during dental treatment that children with cerebral palsy (CP) had increased heart rate (HR) and lower production of saliva. Despite the high prevalence of CP found in the literature (2.08-3.6/1000 individuals), little is known about the electrocardiographic (ECG) characteristics, especially HR, of individuals with CP. Objective: This study aimed to investigate the hypothesis that individuals with CP have a higher HR and to define other ECG characteristics of this population. Methods: Ninety children with CP underwent clinical examination and 12-lead rest ECG. Electrocardiographic data on rhythm, HR, PR interval, QRS duration, P/QRS/T axis, and QT, QTc and T(peak-end) intervals (minimum, mean, maximum, and dispersion) were measured and analyzed then compared with data from a control group with 35 normal children. Fisher and Mann-Whitney U tests were used, respectively, to compare categorical and continuous data. Results: Groups cerebral palsy and control did not significantly differ in age (9 +/- 3 x 9 +/- 4 years) and male gender (65% x 49%). Children with CP had a higher HR (104.0 +/- 20.6 x 84.2 +/- 13.3 beats per minute; P < .0001), shorter PR interval (128.8 +/- 15.0 x 138.1 +/- 15.1 milliseconds; P = .0018), shorter QRS duration (77.4 +/- 8.6 x 82.0 +/- 8.7 milliseconds; P = .0180), QRS axis (46.0 degrees +/- 26.3 degrees x 59.7 degrees +/- 24.8 degrees; P = .0024) and T-wave axis (34.3 degrees +/- 28.9 degrees x 42.9 degrees +/- 17.1 degrees; P = .034) more horizontally positioned, and greater mean QTc (418.1 +/- 18.4 x 408.5 +/- 19.4 milliseconds; P = .0110). All the electrocardiogram variables were within the reference range for the age group including those with significant differences. Conclusion: Children with CP showed increased HR and other abnormal ECG findings in the setting of this investigation. Further studies are needed to explain our findings and to correlate the increased HR with situations such as dehydration, stress, and autonomic nervous disorders. (C) 2011 Elsevier Inc. All rights reserved.

Cardiac resynchronization therapy evaluated by myocardial scintigraphy with (99m)Tc-MIBI: changes in left ventricular uptake, dyssynchrony, and function

(99m)Tc-MIBI gated myocardial scintigraphy (GMS) evaluates myocyte integrity and perfusion, left ventricular (LV) dyssynchrony and function. Cardiac resynchronization therapy (CRT) may improve the clinical symptoms of heart failure (HF), but its benefits for LV function are less pronounced. We assessed whether changes in myocardial (99m)Tc-MIBI uptake after CRT are related to improvement in clinical symptoms, LV synchrony and performance, and whether GMS adds information for patient selection for CRT. A group of 30 patients with severe HF were prospectively studied before and 3 months after CRT. Variables analysed were HF functional class, QRS duration, LV ejection fraction (LVEF) by echocardiography, myocardial (99m)Tc-MIBI uptake, LV end-diastolic volume (EDV) and end-systolic volume (ESV), phase analysis LV dyssynchrony indices, and regional motion by GMS. After CRT, patients were divided into two groups according to improvement in LVEF: group 1 (12 patients) with increase in LVEF of 5 or more points, and group 2 (18 patients) without a significant increase. After CRT, both groups showed a significant improvement in HF functional class, reduced QRS width and increased septal wall (99m)Tc-MIBI uptake. Only group 1 showed favourable changes in EDV, ESV, LV dyssynchrony indices, and regional motion. Before CRT, EDV, and ESV were lower in group 1 than in group 2. Anterior and inferior wall (99m)Tc-MIBI uptakes were higher in group 1 than in group 2 (p < 0.05). EDV was the only independent predictor of an increase in LVEF (p=0.01). The optimal EDV cut-off point was 315 ml (sensitivity 89%, specificity 94%). The evaluation of EDV by GMS added information on patient selection for CRT. After CRT, LVEF increase occurred in hearts less dilated and with more normal (99m)Tc-MIBI uptake.

Effects of progressive exercise during phase I cardiac rehabilitation on the heart rate variability of patients with acute myocardial infarction

Purpose. aEuro integral Heart rate variability (HRV) decreases after an acute myocardial infarction (AMI) due to changes in cardiac autonomic balance. The purpose of the present study, therefore, was to evaluate the effects of a progressive exercise protocol used in phase I cardiac rehabilitation on the HRV of patients with post-AMI. Material and methods. aEuro integral Thirty-seven patients who had been admitted to hospital with their first non-complicated AMI were studied. The treated group (TG, n == 21, age == 52 +/-+/- 12 years) performed a 5-day programme of progressive exercise during phase I cardiac rehabilitation, while the control group (CG, n == 16, age == 54 +/-+/- 11 years) performed only respiratory exercises. Instantaneous heart rate (HR) and RR interval were acquired by a HR monitor (Polar (R) A (R) S810i). HRV was analysed by frequency domain methods. Power spectral density was expressed as normalised units (nu) at low (LF) and high (HF) frequencies, and as LF/HF. Results. aEuro integral After 5 days of progressive exercise, the TG showed an increase in HFnu (35.9 +/-+/- 19.5 to 65.19 +/-+/- 25.4) and a decrease in LFnu and LF/HF (58.9 +/-+/- 21.4 to 32.5 +/-+/- 24.1; 3.12 +/-+/- 4.0 to 1.0 +/-+/- 1.5, respectively) in the resting position (p < 0.05). No changes were observed in the CG. Conclusions. aEuro integral A progressive physiotherapeutic exercise programme carried out during phase I cardiac rehabilitation, as supplement to clinical treatment increased vagal and decreased sympathetic cardiac modulation in patients with post-AMI.

STANDARDIZATION OF SOME ELECTROCARDIOGRAPHIC PARAMETERS OF CAPTIVE LEOPARD CATS (LEOPARDUS TIGRINUS)

Thirty-three captive leopard cats, Leopardus tigrinus, were anesthetized with xylazine (1-2 mg/kg) and ketamine (10 mg/kg), and electrocardiograph (ECG) tests were recorded in all leads with 1 cm = 1 mV sensibility and 25 mm/sec speed repeating DII lead at 50 mm/sec speed with the same sensibility. Results expressed by mean and standard deviation were: heart rate (HR) = 107 +/- 17 (bpm); P-wave = 0.048 +/- 0.072 (s) x 0.128 +/- 0.048 (mV); PR interval = 0.101 +/- 0.081 (s); QRS compound = 0.053 +/- 0.012 (s) x 1.446 +/- 0.602 (mV); QT interval = 0.231 +/- 0.028 (s); R-wave (CV(6)LL) = 1.574 +/- 0.527 (mV); R-wave (CV(6)LU) = 1.583 +/- 0.818 (mV); heart rhythm: normal sinus rhythm (15.2%), sinus rhythm with wandering pacemaker (WPM) (60.6%), sinus arrhythmia with WPM (24.2%); electric axis: between +30 degrees and +60 degrees (6.1%), +60 (6.1%), between +60 degrees and +90 degrees (57.6%), +90 degrees (9%), between +90 degrees and +120 degrees (21.2%); ST segment: normal (75.7%), elevation (18.2%), depression (6.1%); T-wave polarity (DII): positive (100%); T-wave (V(10)): absent (6.1%), negative (63.6%), positive (18.2%), and with interference (12.1%). Through ECG data comparison with other species, unique features of Leopardus tigrinus` (leopard cat) ECG parameters were detected. Some of the study animals presented with an R-Wave amplitude that was indicative of left ventricle overload according to patterns for normal domestic cats (Felis cati). Echocardiographic exams revealed normal heart cavities` function and morphology. The aim of this study was to establish some electrocardiographic parameters of captive L. tigrinus.

Electrocardiographic parameters of captive lions (Panthera leo) and tigers (Panthera tigris) immobilized with ketamine plus xylazine

Twenty-seven healthy captive lions (Panthera leo) and 13 healthy captive tigers (Panthera tigris) from S to Paulo Zoo (Fundacao Parque Zoologico de Rio Paulo, Sao Paulo, Brazil) collection were selected for this study. They were anesthetized with ketamine (10 mg/kg) combined with xylazine (1-2 mg/kg) for physical examinations. hematologic and serum chemical analysis and electrocardiogram recording. The main aim of this research was to gather initial information about normal electrocardiographic parameters of large felids. Standard P-QRS-T deflections on leads described for domestic carnivores were analyzed, and they did not greatly differ from those of large felids. taking into account the greater weight and corporal mass of large felids. Heart rate of lions ranged frorn 42 to 76 beats per minute (bpm). Heart rate of tigers ranged from 56 to 97 bpm. In both species, the most common rhythm detected was normal sinus rhythm followed by sinus arrhythmia: wandering, pacemaker was also observed with normal sinus rhythm or sinus arrhythmia. Mean electrical axis lay between +60 degrees and +120 degrees. QRS complexes were predominantly positive in leads DI, DII, DIII, and AVF and negative in AVR and AVL. This Study provides insights into normal electrocardiograms of large felids. Wider investigations on the same subject arc necessary to establish criteria for the recognition of abnormalities in these species and should include other anesthetic drug(s) combinations and reports of electrocardiographic features of animals with cardiac disease and electrolytes disturbances.

Electrocardiographic Alterations During Endosseous Implant Placement Performed with Local Anesthetic Agents

Purpose: The purpose of this study was to analyze electrocardiographic alterations during dental implant surgeries when local anesthetic agents were used. Materials and Methods: Twenty implants were placed in 18 healthy patients. An electrocardiogram and Wincardio software were used to gather recordings from 12 static leads every 2 minutes, continuously record coronary artery (D2) derivations, and automatically measure the following electrocardiographic parameters: heart rate, duration and amplitude of the P wave, PR segment duration, ST segment deviation, QRS complex duration, and duration of the RR, QT, and corrected QT (QTc) intervals. Results: Analysis of variance of the values obtained at the different stages showed significant differences (P < .05) for the heart rate and for the duration of the RR and QT intervals. The heart rate increased during the anesthesia, incision, and bone drilling stages, reaching a peak during drilling. Duration of the RR and QT intervals decreased during the incision and drilling stages. Among the electrocardiographic parameters individually assessed, several altered values were found for the duration of the P wave, the QRS complex, and the QT and QTc intervals. Sinusal tachycardia and bradycardia, sinusal arrhythmia, supraventricular extrasystole, ventricular extrasystole, and T-wave inversion were detected. Conclusion: Dental implant placement surgery may induce electrocardiographic alterations. The most frequently found arrhythmias were extrasystole and sinusal tachycardia. The anesthesia, incision, and bone drilling stages exhibited the highest heart rate values and the shortest durations of the RR and QT intervals. INT J ORAL MAXILLOFAC IMPLANTS 2009;24:412-418

Avaliação ecocardiográfica de doentes propostos para terapêutica de ressincronização: impacto dos índices de dissincronia

Mestrado em Tecnologia de Diagnóstico e Intervenção Cardiovascular - Área de especialização: Ultrassonografia Cardiovascular.

Embedded platform for ECG biometric recognition

Trabalho Final de Mestrado para obtenção do grau de Mestre em Engenharia de Electrónica e Telecomunicações

Sistema para monitorização cardiovascular

Esta dissertação propõe o desenvolvimento de um sistema capaz de adquirir e monitorizar num computador o sinal do electrocardiograma (ECG) e de detectar o pico R do complexo QRS do referido sinal. Numa primeira fase foi efectuado um estudo do sistema cardiovascular, de forma a compreender a actividade eléctrica do coração e dos diversos sinais que constituem o ECG. Foi efectuado um estudo sobre o sinal ECG, tendo sido estudadas as suas características, bem como técnicas e componentes básicos de aquisição e condicionamento do sinal, sendo também analisados diversos sistemas que efectuam a aquisição de ECG. Numa segunda fase foram estudadas as Field Programmable Analog Array (FPAA), analisando o estado da arte desta tecnologia, bem como os dispositivos disponíveis comercialmente. Após esta análise foram seleccionados os dispositivos FPAA, bem como o restante hardware e software necessários para a realização desta Tese. Foi desenvolvido um sistema de condicionamento de sinal ECG, e de detecção de pico R do complexo QRS, apenas com componentes analógicos discretos tendo sido analisados os resultados obtidos antes de se avançar para a fase seguinte. Após a realização do sistema com componentes discretos, foi implementado um sistema em que grande parte do condicionamento do sinal ECG é efectuado por duas placas de desenvolvimento FPAA, de forma a diminuir a quantidade de componentes e a obter um sinal com melhor resolução. Os resultados obtidos foram analisados e comparados com o sistema desenvolvido. Para monitorizar o sinal ECG e o pico R num computador, foi desenvolvido um sistema em que os sinais são convertidos pelo conversor A/D de um microcontrolador, e enviados por comunicação série para um computador, sendo os valores obtidos visualizados numa aplicação em ambiente MATLAB.

Aurícula direita: mecânica e sobrecarga de volume

Mestrado em Tecnologia de Diagnóstico e Intervenção Cardiovascular - Ramo de especialização: Ultrassonografia Cardiovascular

The resting electrocardiogram of t. cruzi-infected rats

A total of 125 rats were infected with the Colômbia strain of T. cruzi (2000 parasites/g) shortly after weaning. Of these, 58 survived the acute phase and were used in the present experiment. Twenty eight similar but not infected rats served as controls. All rats were submitted to the resting ECG When they were 6 months old. Classic and 3 precordial leads were employed in order to record the ECG as completely as possible. Electrocardiographic changes similar to those found in human chronic Chagas' heart disease and not previously described in this model were found in 44% of the T. cruzi-infected rats: left axis deviation (22%), right axis deviation (7%), lengthened and bizarre QRS complex (14%) and abnormal J point elevation (3%). On the basis of these results, we believe that the resting ECG constitutes a valuable tool for studying experimental chronic Chagas' heart disease in rats.

ECG wave detector and delineation with wavelets

Proceedings of the International Conference on Computational Intelligence in Medicine Healthcare, CIMED 2005, Costa da Caparica, June 29 - July 1, 2005

Efecto de la reinfección sobre la evolución de ratas infectadas con Trypanosoma cruzi

El objetivo de este trabajo fue comprobar si una de las variables medio-ambientales, la reinfección, puede modificar el comportamiento observado en un modelo de rata a nivel de parasitemia, anticuerpos séricos, manifestaciones electrocardiográficas y/o lesión miocárdica. Los grupos experimentales fueron: GI: ratas infectadas al destete con 1 x 10(6) T. cruzi; GR: igual a GI más reinfecciones cada 30 días hasta los 150 días post-infección inicial (p.i.i.); GI1 ratas de 51 días infectadas; GT: testigos. Se detectó parasitemia alta en GI y GR hasta los 20 días p.i.i. tendiendo a negativizarse al día 30. En GR no se observaron parásitos despúes del primer reinóculo, resistencia que no es debida sólo a la mayor edad del huésped pués hubo parasitemia en GI1. Los xenodiagnósticos fueron negativos en los tres grupos. Los anticuerpos séricos no se modificaron significativamente en GR respecto de GI, salvo en los anticuerpos 7S, pues los del GR presentaron títulos superiores en algunos de los días estudiados. Los ECG basales no mostraron cambios distintivos en las ratas infectadas. La prueba de ajmalina mostró una disminución de la FC independiente del tratamiento; el PR, QaT y QRS se prolongaron significativamente en todos los grupos respecto del basal (p < 0.05), salvo el QaT en el GT; además, el cambio de PR y QaT fue mayor en los infectados (p < 0.05). En los grupos infectados hubo también una amplia variación en la orientación del eje eléctrico respecto del valor basal, acompañado de cambios morfológicos más manifiestos en GR. La proporción de lesión cardíaca detectada histológicamente en los grupos infectados, fue significativamente superior a la del GT (p < 0.01). Se concluye que la reinfección no reproduce el cuadro agudo inicial y no modifica el tipo y grado de lesión cardíaca observada histológicamete. La prueba de ajmalina muestra cambios electrocardiográficos compatibles con daño miocárdico incipiente en las ratas infectadas y sugieren mayor compromiso en el grupo reinfectado.

Análise do sinal cardíaco ECG através da técnica SVD

Este trabalho surge no âmbito da área Electromedicina, uma componente da Engenharia Electrotécnica cada vez mais influente e em permanente desenvolvimento, existindo nela uma constante inovação e tentativa de desenvolvimento e aplicação de novas tecnologias. Este projecto possui como principal objectivo o estudo aprofundado das aplicações da técnica SVD (Singular Value Decomposition), uma poderosa ferramenta matemática que permite a manipulação de sinais através da decomposição de matrizes, ao caso específico do sinal eléctrico obtido através de um electrocardiograma (ECG). Serão discriminados os princípios da operação do sistema eléctrico cardíaco, as principais componentes do sinal ECG (a onda P, o complexo QRS e a onda T) e os fundamentos da técnica SVD. A última fase deste trabalho consistirá na aplicação, em ambiente Matlab, da técnica SVD a sinais ECG concretos, com enfase na sua filtragem, para efeitos de remoção de ruído. De modo verificar as suas vantagens e desvantagens face a outras técnicas, os resultados da filtragem por SVD serão comparados com aqueles obtidos, em condições similares, através da aplicação de um filtro FIR de coeficientes estáticos e de um filtro adaptativo iterativo.