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Background. The ECG is important for diagnosis and triage in the hyperacute phase of acute coronary syndrome (ACS), especially during the “golden hours”, when myocardial salvage possibilities are largest. An important triaging decision is whether or not a patient requires primary PCI, for which the guidelines mention ST elevation (STE) in the ECG as major criterion. This criterion has, however, a low sensitivity and specificity. [ABSTRACT FROM PUBLISHER]

Diagnosis/triage in the hyperacute phase of the acute coronary syndrome (ACS) is mainly based on the ECG. There are serious limitations in the interpretation of the ST segment in the ECG in the setting of ACS, so there is need for the investigation of alternative or additional ECG features. Therefore we studied the potential role of the Ventricular Gradient (VG) in acute ischemia. We computed, in ECGs of 84 patients (pts) recorded during elective PTCA, the maximal values of VG and ST, and the changes with respect to baseline, ΔST and ΔVG. In most pts, ΔST and ΔVG assumed the same direction and changed proportional in magnitude;55% of the pts responded to balloon inflations with ST elevation (STE) ECGs, 45% with non-STE (NSTE) ECGs. In a subset of 31pts with sestamibi area-at-risk (AAR) assessment, ROC analysis showed comparable performance of the maximal ST, ΔST, VG and ΔVG values to discriminate small and large AARs (areas under the curve >0.80, P<0.01). In conclusion, our study shows that: 1) the VG has, in addition to ST, a potential role in detecting ischemia and in relating this to the area at risk, and 2) the STE/NSTE classification of ischemic ECGs is not very meaningful to discriminate between complete and partial occlusions. [ABSTRACT FROM PUBLISHER]

Remote follow-up of implanted ICD's offers a solution to the problem of overcrowded clinics. All major device companies have developed a remote follow-up solution. Data from the remote follow-up are stored in a central database system, operated by the device company and accessible for the physician. However, the problem now arises that part of the patient's clinical information is stored in the local electronic health record (EHR) system in the hospital, while another part is only available in the remote monitoring database. In our hospital, we have implemented the IHE-IDCO profile to import data from the remote databases from two device vendors into our self-developed Cardiology Information System (EPD-Vision). Data is exchanged via a HL7/XML communication protocol, as defined in the IHE-IDCO profile. Remote follow-up data is visible in EPD-Vision™ in the same manner as the data from the in-house follow-up. [ABSTRACT FROM PUBLISHER]

Ejection fraction and microvolt T-wave alternans (mTWA) lack specificity to predict sudden cardiac death in heart failure (HF). We compared resting ECG variables (QRS duration, lead-dependent T-amplitudes) and exercise-ECG-derived TWA variables (amplitude in the 12 leads, in the orthogonal X, Y, Z leads and in the vector magnitude) of 56 HF patients with an implanted cardioverter-defibrillator: cases and matched controls with/without antiarrhythmic therapy for VT/VF during follow up. Linear discriminant models, using resting and exercise ECG variables, were built in half of the study group, and were tested on the other half. QRS duration and TWA in lead Z discriminated best in the resting and exercise ECG, respectively, and had comparable diagnostic accuracy for VT/VF prediction. [ABSTRACT FROM PUBLISHER]

In this study we present a vectorcardiographic method to identify the culprit artery in acute coronary syndrome (ACS) in a study population of 860 patients with single vessel disease who underwent percutaneous coronary intervention (PCI). This method takes, in addition to the classical STEMI definition of J point elevation > 100 μV, also features of the QRS complex and the T wave into account. Comparing this method with published algorithms we found, in our data set, an improvement in specificity and sensitivity using QRS axis elevation, QRS-T angle and T axis azimuth in the transverse plane. Extending this method to the ever increasing amount of patients with non-STEMI ACS who underwent PCI, we also found a beneficial effect of inclusion of QRS and T-wave feature on sensitivity and specificity. [ABSTRACT FROM PUBLISHER]

We estimate that as much as 5% of all recorded ECGs worldwide may, to some degree, suffer from poor signal quality or incorrect electrode positioning, which often interferes with correct interpretation of the ECG. Proper training of ECG technicians and regular inspection of signal quality is necessary to achieve a high standard. Due to the large amounts of ECGs recorded daily, we devised an automatic ECG quality inspection method based on the conversion of an ECG into a VCG and back again into a reconstructed ECG. Incorrectly placed electrodes as well as different types of noise can be detected with a high level of accuracy. We used this method to assess the quality of the ECGs in the learning set of the Physionet/Computing in Cardiology Challenge 2011, giving a correct interpretation of the quality of the ECGs of 92.2% which corresponded to a sensitivity of 97.0 and a specificity of 75.1% [ABSTRACT FROM PUBLISHER]