Biomedical subjects

B Milan Horácek

Publications and source records attributed to B Milan Horácek.

10 recordsLinked to original sources

PubMed2006

Detection of acute ischemia from the EASI-derived 12-lead electrocardiogram and from the 12-lead electrocardiogram acquired in clinical practice.

ST-segment measurements in the standard 12-lead electrocardiogram (ECG) of patients with acute coronary syndromes are crucial for these patients' management. Our objective was to determine whether the 12-lead ECG derived from the 3-lead EASI system can attain a level of diagnostic performance similar to that of the Mason-Likar (ML) 12-lead ECG acquired in clinical practice (CP) by paramedics and emergency department technicians. Using 120-lead body surface potential maps recorded before and during balloon inflation angioplasty from 88 patients (divided into "responders" and "nonresponders"), and electrode placement data from 60 applications of precordial leads in CP, we generated for the "nonischemic" and "ischemic" states of each patient the following lead sets: the ML 12-lead ECG, the EASI-derived 12-lead ECG, and 60 sets of 12-lead CP ECGs. We extracted ST deviations at J + 60 milliseconds, summed them for all 12 leads of each lead set to obtain SigmaST, and, by using the bootstrap method, determined the mean sensitivity and specificity for recognizing the "ischemic" state at various thresholds of SigmaST. Results were displayed as receiver operating characteristics, and the area under these curves (AUC) +/- SE was used as the measure of diagnostic performance. AUC +/- SE for all patients were ML ECG, 0.66 +/- 0.03; EASI ECG, 0.64 +/- 0.03; and CP ECG, 0.67 +/- 0.03. Corresponding results for responders only were 0.81 +/- 0.04 for ML ECG, 0.78 +/- 0.04 for EASI ECG, and 0.81 +/- 0.04 for CP ECG. The differences between the AUCs for the different lead sets were not significant (P > .05). Thus, the EASI-derived 12-lead ECG is as good for detecting acute ischemia as is the 12-lead ECG acquired in CP.

Electrocardiography↗

PubMed2006

Body-surface potential mapping to aid ablation of scar-related ventricular tachycardia.

We investigated whether body-surface potential mapping (BSPM) during catheter ablation of scar-related ventricular tachycardia (VT) could assist with the identification of VT exit sites. The study population consisted of 9 patients who underwent catheter ablation for VT, among whom 12 induced VTs with known exit sites were identified by entrainment criteria, pace mapping, or site of successful ablation. Paced activation was initiated at various intracardiac sites (20 +/- 4 sites per patient, a total of 180) documented by nonfluoroscopic electroanatomic mapping. During all episodes of VT and pacing, patients had a 120-lead electrocardiogram recorded, and we analyzed these electrocardiographic data--by means of a similarity coefficient (SC) calculated over 100 milliseconds after the initiation of depolarization--to assess the similarity between the BSPM sequences occurring during VTs and those induced by pacing. Based on 245 observations, the relationship between the SC and the distance of the pacing site from the VT exit site was then obtained for each individual VT by linear regression analysis: the distance D (in millimeters) from the VT exit site was related to SC by the regression equation D = slope (1 - SC2) + intercept. The parameters in this equation varied widely for the 12 VTs, but, in general, the nearer the pacing site was to the exit site, the better the goodness of match. This suggests that, although there is no universally applicable relationship between D and SC, BSPM could provide a useful adjunct to standard pace mapping, although additional processing--namely, an inverse calculation of epicardial potentials/isochrones--may be needed to reliably identify VT exit sites from body-surface electrocardiograms.

Aged↗

PubMed2005

Development of an automated Selvester Scoring System for estimating the size of myocardial infarction from the electrocardiogram.

Although the Selvester Scoring System for estimating the size of myocardial infarction from the standard 12-lead electrocardiogram (ECG) has potential clinical value, it has found limited application because of the difficulties in making precise and reproducible measurements. The objective of this study was to develop software to automate the Selvester Scoring System, thus allowing wider application of the technique. The study was carried out using a training set consisting of ECG data recorded from 705 individuals with and without previous myocardial infarction. Algorithms for the 50 criteria in the Selvester Scoring System were iteratively improved by comparison of scores obtained by 2 experienced cardiologist investigators with those generated by the program. The final version was evaluated in a test set consisting of 60 ECGs by comparing scores derived by cardiologist investigator with those obtained by the program. The disagreements occurred only in 1.1% of the score comparisons and in 1.6% of the specific measurements. In all cases in which a disagreement occurred, it resulted from very small differences in measurements. These results indicate that the algorithm for automated application of the Selvester Scoring System is adequate for both clinical and research applications.

Algorithms↗

PubMed2005

Analytic solution of the anisotropic bidomain equations for myocardial tissue: the effect of adjoining conductive regions.

The anisotropic bidomain model for the propagation of electrical activation in the human myocardium H consists of coupled elliptic-parabolic partial differential equations for the transmembrane potential Vm, intracellular potential phi(i), and extracellular potential phi(e) in H, together with quasi-static equations for the potential distribution phiB in the surrounding (passive) isotropic extracardiac regions B. Four local parameters sigma((i,e) (l,t)) specify the conductivities in the longitudinal (l) and transverse (t) directions with respect to cardiac muscle fibers. Continuous current flow is required at the interface S(H) between H and B. We derive analytic formulas for Vm, phi(e), phi(i), and phiB for plane wave propagation in a uniformly anisotropic slab surmounted by a homogeneous region of conductivity sigmaB. No assumptions are required regarding the anisotropy ratios of the conductivity coefficients. The properties of these solutions are examined with a view to providing insight into the effect of the passive region B on the propagation of Vm and phi(e) in H. We show that for a suitably chosen boundary condition, the problem can be reduced to solving the bidomain equations in H alone.

Action Potentials↗

PubMed2004

Activation dynamics in anisotropic cardiac tissue via decoupling.

Bidomain theory for cardiac tissue assumes two interpenetrating anisotropic media--intracellular (i) and extracellular (e)--connected everywhere via a cell membrane; four local parameters sigma(i,e)(l,t) specify conductivities in the longitudinal (l) and transverse (t) directions with respect to cardiac muscle fibers. The full bidomain model for the propagation of electrical activation consists of coupled elliptic-parabolic partial differential equations for the transmembrane potential upsilon(m) and extracellular potential phi(e), together with quasistatic equations for the flow of current in the extracardiac regions. In this work we develop a preliminary assessment of the consequences of neglecting the effect of the passive extracardiac tissue and intracardiac blood masses on wave propagation in isolated whole heart models and describe a decoupling procedure, which requires no assumptions on the anisotropic conductivities and which yields a single reaction-diffusion equation for simulating the propagation of activation. This reduction to a decoupled model is justified in terms of the dimensionless parameter epsilon = (sigma(i)(l)sigma(e)(t) - sigma(i)(t)sigma(e)(l))/(sigma(i)(l) + sigma(e)(l))(sigma(i)(t) + sigma(e)(t)). Numerical simulations are generated which compare propagation in a sheet H of cardiac tissue using the full bidomain model, an isolated bidomain model, and the decoupled model. Preliminary results suggest that the decoupled model may be adequate for studying general properties of cardiac dynamics in isolated whole heart models.

Action Potentials↗

PubMed2003

Quantitative assessment of myocardial ischemia by electrocardiographic and scintigraphic imaging.

We calculated distributions of epicardial potentials from body-surface electrocardiograms (ECGs) recorded during controlled myocardial ischemia and compared them with scintigraphic estimates of ischemia's extent/severity. The study population consisted of patients suffering from single-vessel coronary artery disease, referred for elective percutaneous transluminal coronary angioplasty of either the left anterior descending (n=7), the right coronary (n=9), or the left circumflex (n=2) artery. After the target vessel had been dilated, a 1960s "study" inflation was performed with a non-perfusion-type balloon catheter; at its commencement, technetium-99m sestamibi was injected via a femoral-vein catheter, and ECGs were recorded throughout the inflation from 120 leads. Single photon emission computed tomographic imaging was performed one hour after the injection of radionuclide to obtain an "occlusion image", and again one hour after a repeat injection 24 hours later to obtain a "control image"; the latter image was subtracted from the former, to derive a scintigraphic difference map (Delta map). The ECGs were signal-averaged over a 10-s window at preinflation and peak-inflation states, the preinflation averaged complexes were subtracted from the peak-inflation ones to produce body-surface Delta maps, and the corresponding Delta maps of epicardial potentials were calculated by applying the electrocardiographic inverse solution; this procedure is referred to as electrocardiographic imaging. The ECG-derived epicardial Delta maps related spatially to the scintigraphic Delta maps in all patients. The percent areas and surface integrals of positive values in ECG-derived Delta maps were found to be very good single-variable predictors of the extent (r=0.73; p=0.0006) and severity (r=0.72; p=0.0008) of the scintigraphically-estimated perfusion defect; a regression equation using two ECG-derived predictors further improved the agreement with scintigraphic estimates (r=0.81; p=0.0004 for estimates of severity). These findings suggest that noninvasive electrocardiographic imaging might provide quantitative estimates of the extent/severity of myocardial ischemia that agree closely with those provided by scintigraphic techniques.

Adult↗

PubMed2002

Electrocardiographic ST-segment changes during acute myocardial ischemia.

The recognition and management of patients with acute coronary syndromes has relied to a large extent on the standard 12-lead electrocardiogram (ECG) for assessing ST-segment changes associated with ischemia. The purpose of this review is to show both the capabilities and the limitations of the 12-lead ECG in recognizing ischemia, and to seek alternative electrocardiographic leads, optimized for detection of ischemia originating in different regions of the ventricular myocardium. Three such leads are proposed-based on the results obtained by electrocardiographic body-surface mapping performed during ischemia induced by balloon-inflation coronary angioplasty. A survey of recent clinical studies shows that the electrocardiographic manifestations of acute myocardial ischemia observed during coronary angioplasty are in agreement with the ST-segment measurements in admission ECGs of patients with acute myocardial infarction.

Body Surface Potential Mapping↗

PubMed2002

Improved EASI coefficients: their derivation, values, and performance.

The EASI lead system, which is based on the dipole hypothesis of vectorcardiography, offers the possibility of deriving the standard 12-lead electrocardiogram (ECG) and other desired leads from ECGs recorded at only 4 sites; it uses the Frank E, A, and I electrode locations, a fourth electrode location (S) at the manubrium, and a reference electrode. Accordingly, the electrodes of this system can be applied rapidly on easy-to-locate, stable anatomical sites that leave the precordium free for other diagnostic procedures. In early EASI implementations, the derived leads differed from actual leads by more than some clinicians found acceptable. As these differences were thought to be caused by the fact that the coefficients that were used had been derived from a limited data set, we have calculated a new set of EASI coefficients for the standard 12 leads, and several other leads, by using a data set of 983 adult subjects with 120-lead ECGs and well-documented diagnoses. This database is a concatenation of 2 previously described ones: one consisting of 892 persons (normal subjects, postmyocardial-infarction patients with and without arrhythmias, and patients with ventricular arrhythmias but no history of myocardial infarction) and the other consisting of 91 patients with single-vessel coronary artery disease who underwent coronary balloon-inflation angioplasty. In addition to the coefficients for the standard 12 leads (derived for standard limb leads as well as for Mason-Likar leads), we derived coefficients for six additional unipolar leads (posterior V(7)-V(9), and right-sided V(3)R-V(5)R), the Frank orthogonal leads, and three bipolar, vessel-specific leads that have been previously shown to exhibit optimal sensitivity for acute myocardial ischemia. We also derived coefficients for the modified electrode locations of the EASI system that must be used with patients who have undergone a midline sternotomy. Optimal coefficients for lead transformations were determined by maximizing the ensemble average (over the entire data set) of the correlation between the derived and the true lead for the chosen interval of the averaged complex. For derived standard limb leads, the amplitude was adjusted to give the best root-mean-square fit over the entire PQRST interval, whereas for derived Mason-Likar leads it was adjusted to give the best ST-segment fit. The entire set of coefficients and their corresponding goodness-of-fit measures are presented.

Adult↗

PubMed2002

Comparability of 12-lead ECGs derived from EASI leads with standard 12-lead ECGS in the classification of acute myocardial ischemia and old myocardial infarction.

We compared 12-lead electrocardiograms (ECGs) derived with an improved transformation matrix from EASI leads and standard 12-lead ECGs in the detection of acute myocardial ischemia and old infarction (MI). For the ischemia test, we used ECGs of 40 patients recorded prior to and at peak inflation during percutaneous transluminal coronary angioplasty, and for old MI we used test ECGs of 382 non-MI subjects and of 472 patients with prior MI documented by enzyme findings. Two experienced ECG readers served as separate, independent standards for lead-set comparisons, and the Philips ECG analysis program also classified the ECGs. The results showed no significant differences between the two lead sets in the detection of acute inflation-induced ischemia or of old MI according to coding by the electrocardiographers or the computer program. No significant differences were found between the electrocardiographers and the lead sets for acute ischemia. Classification differences between the electrocardiographers were larger than those between the lead sets for acute and old MI and were significant for the latter (P <.001). A more detailed comparison of the lead sets suggested a possible need for modified old-MI criteria and optimization of ST classification thresholds for acute ischemic injury, specific for the EASI 12-lead ECG. We conclude that the EASI-derived 12-lead ECG deserves serious consideration as an alternative to the standard 12-lead ECG in emergency situations and for monitoring in acute-care setting.

Electrocardiography↗

PubMed2002

Statistical and deterministic approaches to designing transformations of electrocardiographic leads.

Two different approaches can be used to investigate the relationships among electrocardiographic leads: a statistical one, based on the analysis of recorded electrocardiograms (ECGs), and a deterministic one, based on physical principles that govern the current flow in irregularly shaped volume conductors such as the human body. The purpose of this study was to compare these two approaches. For the statistical investigation, the data set consisted of 120-lead ECGs recorded in a population including normal subjects (n = 290), post-myocardial-infarction patients (n = 497), patients with a history of ventricular tachycardia but no evidence of a previous myocardial infarction (n = 105), and patients with a single-vessel coronary artery disease who underwent coronary angioplasty (n = 91). Lead transformations of interest were obtained by fitting the multiple-regression model to this data set by the least-squares method. For the deterministic investigation, we used a boundary-element model of the human torso to simulate body-surface potentials in response to three orthogonal unit dipoles placed consecutively at 1,239 ventricular source locations, and the resulting body-surface potential distributions (instead of the recorded ECGs) were then fitted by the multiple-regression model. The results suggest that the lead transformations should be preferably designed by statistical analysis of recorded ECGs. Regression models with a small number of predictors (eg, those based on three ECG leads) are the most reliable; those using more predictors are fraught with the danger of collinearity when predictors are highly correlated (as occurs in the standard 12-lead ECG). Model-derived deterministic transformations are compatible with statistically derived ones, provided that the distributed character of the cardiac sources is taken into account. We conclude that statistical associations among electrocardiographic leads can be reliably quantified in sufficiently large and diverse databases of recorded data; the causality of these associations can be supported by appropriate deterministic models based on the laws of physics.

Angioplasty, Balloon, Coronary↗