The impact of noise on the reliability of heart-rate variability and complexity analysis in trauma patients

This study focused on the impact of noise on the reliability of heart-rate variability and complexity (HRV, HRC) to discriminate between different trauma patients and to monitor individual patients. Life-saving interventions (LSIs) were chosen as an endpoint because performance of LSIs is a critical aspect of trauma patient care. Noise was modeled and simulated by modifying original R–R interval (RRI) sequences via decimation, concatenation, and division of RRIs, as well as R-wave detection using the electrocardiogram. Results showed that under increasing simulated noise, entropy and autocorrelation measures can still effectively discriminate between LSI and non-LSI patients and monitor individuals over time.     

Frequency-plane analysis of normal and pathological ECG signals for disease identification

In this paper a frequency plane analysis of both normal and diseased ECG signals is performed specifically for disease identification. Image processing techniques are used to develop an automated data acquisition package of 12 lead ECG signals from paper records. A regeneration domain is also developed to check the captured pattern with the original wave shape. A QRS complex detector with an accuracy level ～98.4% in up to 30% signal to noise level is developed. Discrete Fourier transform (DFT) is performed to obtain the frequency spectrum of every ECG signal. Some interesting amplitude and phase response properties of chest lead V2, V3, V4, V6 and limb lead I, II, III, AVL, AVF are seen. Both amplitude and phase properties are different for normal and diseased subjects and can serve an important role in disease identification. A statistical analysis of amplitude property is carried out to show that this property is significantly different for normal and diseased subjects.     

起源点邻近二尖瓣环的频发室性早搏体表心电图特征及射频消融治疗

目的评估起源点邻近二尖瓣环的频发室性早搏(简称室早)体表心电图特点及射频消融治疗效果。方法10例频发室早患者接受常规电生理检查及射频消融治疗,对所有病例12导联体表心电图进行分析。结果10例室早均消融成功,并证实起源点邻近二尖瓣环的不同部位,根据成功消融靶点将本组病例分为3组,二尖瓣环前侧壁组(4例)、二尖瓣环后侧壁组(3例)、二尖瓣环后间隔组(3例)。所有病例胸前导联R波移行区位于V1～V2导联,绝大部分病例V6导联可见s波。对各组二尖瓣环室早心电图做进一步比较,可概括出系列心电图判断指标用以估计消融靶点的部位。结论射频消融治疗起源点邻近二尖瓣环的频发室早可取得良好效果,掌握其体表心电图特点有助于判定室早的起源部位。     

Prognostic value of frontal QRS-T angle in predicting survival after primary percutaneous coronary revascularization/coronary artery bypass grafting for ST-elevation myocardial infarction

BackgroundFrontal QRS-T angle (FQRST) has previously been correlated with mortality in patients with stable coronary artery disease, but its role as survival predictor after ST-elevation myocardial infarction (STEMI) remains unknown.MethodsWe evaluated 267 consecutive patients with STEMI undergoing reperfusion or coronary artery bypass grafting. Data assessed included demographics, clinical presentation, electrocardiograms, medical therapy, and one-year mortality.ResultsOf 267 patients, 187 (70%) were males and most (49.4%) patients were Caucasian. All-cause mortality was significantly higher among patients with the highest (101–180°) FQRST [28% vs. 15%, p = 0.02]. Patients with FQRST 1–50° had higher survival (85.6%) compared with FQRST = 51–100° (72.3%) and FQRST = 101–180° (67.9%), [log rank, p = 0.01]. Adjusting for significant variables identified during univariate analysis, FQRST (OR = 2.04 [95% CI: 1.31–13.50]) remained an independent predictor of one-year mortality. FQRST-based risk score (1–50° = 0 points, 51–100° = 2 points, 101–180° = 5 points) had excellent discriminatory ability for one-year mortality when combined with Mayo Clinic Risk Score (C statistic = 0.875 [95%CI: 0.813–0.937]. A high (>4 points) FQRST risk score was associated with greater mortality (32% vs. 19%, p = 0.02) and longer length of stay (6 vs. 2 days, p < 0.001).ConclusionFQRST represents a novel independent predictor of one-year mortality in patients with STEMI undergoing reperfusion. A high FQRST-based risk score was associated with greater mortality and longer length of stay and, after combining with Mayo Clinic Risk Score, improved discriminatory ability for one-year mortality.     

注射用华蟾素对大鼠心率及心电图的影响

目的观察注射用华蟾素对大鼠心率及心电图的影响,为该药在临床应用时监控心脏的不良反应提供实验依据。 方法大鼠经颈外静脉插管后恒速蠕动泵给药,标准肢体Ⅱ导联监测大鼠的心率及心电图;比较给药前后心率及心电图的变化。 结果静脉注射华蟾素注射液与注射用华蟾素中、大剂量30 min后均可使大鼠心率加快,分别为:(469±40),(466±29) 和(484±40)次·min-1,与空白对照组[(411±17)次·min-1]比较,差异有统计学意义(P＜0.05),但随后恢复正常。少数大鼠可偶致心律失常(期前收缩、传导阻滞等),且相比于空白对照组[P-R间期:(46.90±3.90) ms,Q-T间期:(61.29±9.46) ms],给药后能明显缩短心电图的P-R间期[华蟾素注射液组(39.70±2.54) ms,注射用华蟾素中剂量组(37.70±3.77) ms,注射用华蟾素大剂量组(39.30±7.12) ms]和Q-T间期[注射用华蟾素中剂量组(55.13±4.67) ms,注射用华蟾素大剂量组(51.75±11.53) ms](P＜0.05),而对QRS与S-T段无明显改变。 结论注射用华蟾素对大鼠心脏有一定的毒副作用,可引起心率加快,偶发心律失常。     

家庭作坊式人工宝石加工噪声对作业工人心电图的影响

目的探讨家庭作坊式人工宝石加工噪声对作业工人心电图的影响。方法对家庭作坊作业环境进行噪声水平测量;对388名接触噪声工人(暴露组)和177名非接噪者(对照组)的心电图检查结果进行比较分析。结果检测的69个作业点噪声强度为62.4~95.4 d B(A),超标53个(23.19%);暴露组心电图异常率为32.73%(127/388),明显高于对照组的21.47%(38/177)(P<0.01),其中暴露组心律失常率为15.21%(59/388),明显高于对照组的9.04%(16/177)(P<0.05);暴露组18~30岁年龄段心电图异常率为36.67%(22/60),明显高于对照组的11.36%(5/44)(P<0.01)。结论家庭作坊式人工宝石加工产生的噪声对作业工人心电图改变有影响,应加强家庭作坊式作业的职业健康监护,佩戴个人防护耳塞。     

Prognosis and first diagnostic ECG in STEMI patients referred to the emergency medical system for primary PCI

Background

Pathological Q waves (QWs) in the first ECG recorded at hospital admission has been found to correlate with myocardial damage and mortality in STEMI patients. We investigated the association between new QWs recorded in the pre-hospital setting and adverse outcome during the hospital stay.

单纯性心肌桥-壁冠状动脉的双源CT表现与心肌缺血的相关性研究

目的：探讨双源CT在检查单纯性心肌桥-壁冠状动脉(MB-MCA)的临床价值,并讨论单纯性MB-MCA与心肌缺血之间的关系。方法回顾双源CT冠脉成像检出的239例单纯性MB-MCA的临床资料。结果双源CT冠脉成像发现239例单纯性MB-MCA患者中90.16%位于左前降支。其中静息心电图提示心肌缺血者的有50例,24 h动态心电图检查有心肌缺血者19例,其余170例无心电图变化。分析两组检测指标发现, MB厚度、MCA横断面面积及狭窄程度比较差异具有统计学意义(P<0.05),而MCA长度比较则差异无统计学意义(P>0.05)。结论双源CT冠脉成像可用于单纯性MB-MCA的诊断,结合心电图及临床相关资料,有助于单纯性心肌桥引起心肌缺血的诊断。     

B 超联合心电图诊断高血压性心脏病的临床研究

目的:探讨B超联合心电图诊断高血压性心脏病的临床效果及其应用价值. 方法:选取2014年6月至2014年11月我院收治的90例高血压性心脏病患者,对其临床资料进行回顾性分析,对比分析B超联合心电图及单独采用B超及心电图的诊断效果. 结果:以B超联合心电图诊断组患者的左室肥厚诊断准确率(66.67%)明显高于单独采用B超诊断组患者准确率(60.00%)及单独采用心电图诊断组患者准确率(40.00%) ,且差异具有统计学意义( P<0.05). 结论:以B超联合心电图的方式作为诊断高血压性心脏病的诊断方法较单独采用B超或心电图的诊断方式,其效果更为显著,准确性更高,具有广泛的临床使用价值.