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Biomedical subjects

J E Pope

Publications and source records attributed to J E Pope.

13 recordsLinked to original sources
PubMed1992

Evolution of an automated ST-segment analysis program for dynamic real-time, noninvasive detection of coronary occlusion and reperfusion.

Patients in whom early and stable reperfusion through the infarct artery fails after thrombolytic treatment might benefit from further revascularization therapy. A reliable noninvasive technique able to detect both reperfusion and reocclusion would be useful to test this hypothesis. However, no such technique presently exists. ST-segment recovery analysis using continuous digital 12-lead ST monitoring has been shown to be an accurate predictor of infarct artery patency in real time. This method was dependent on a trained clinician's analysis of the recordings on a personal computer. For optimal bedside application, salient principles of this ST-segment recovery analysis were converted into algorithms and built into the ST monitor software. The essentials of these algorithms are described in this report.

Electrocardiography↗
PubMed1992

Performance of the automated complete Selvester QRS scoring system in normal subjects and patients with single and multiple myocardial infarctions.

The automated version of the complete Selvester QRS scoring system for estimation of myocardial infarct size was evaluated in 1,344 normal subjects, 706 patients with a single myocardial infarction (366 with inferior infarction, 277 with anterior infarction and 63 with posterolateral infarction) and 131 patients with combined inferior and anterior infarction. The presence and location were determined by angiographic and ventriculographic criteria. The performance of the overall 32-point system, each of the 19 criteria and the 13 criteria sets and each of the 35 criteria within the 13 sets was examined. The mean point scores were 1.7 for normal subjects, 3.7 for posterolateral infarction, 4.1 for inferior infarction, 6.3 for anterior infarction and 6.9 for multiple infarcts. A score greater than 4 yielded a sensitivity of 67% for anterior infarction, 41% for inferior infarction, 32% for posterolateral infarction and 72% for multiple infarcts. However, 7 of 32 criteria failed to achieve 95% specificity and 10 of 35 criteria in criteria sets had a sensitivity that was even lower than their false positive rate. The automated Selvester QRS scoring system currently has limitations that are attributable to development of the original system, which used manual scoring techniques and established criteria limits from middle-aged men. Future automated analysis should use gender- and age-dependent criteria limits.

Computer Simulation↗
PubMed1991

Specificity and sensitivity of QRS criteria for diagnosis of single and multiple myocardial infarcts.

A subset of 3 criteria from the complete Selvester scoring system has been proposed earlier for electrocardiographic screening of healed myocardial infarcts. This subset yielded 95% specificity and high sensitivity for single anterior and inferior infarcts. In the present study, an automated version of these criteria was applied to 1,344 electrocardiograms from normal subjects (473 normal subjects as determined by cardiac catheterization and 871 apparently normal subjects by history and physical examination), to 706 from subjects with single myocardial infarction, and to 131 from subjects with combined anterior and inferior myocardial infarcts. Of the single infarcts, 366 had inferior, 277 anterior and 63 posterolateral locations. Presence and location of infarcts were judged from left ventriculograms and coronary angiograms. Overall specificity was only 86%, whereas overall sensitivity for the infarct population was 77%. Specificity was lower in men than in women; it was also lower in older than in younger subjects. One of the screening criteria (R greater than or equal to 40 ms in V1) may possibly be eliminated to augment specificity; this can be done with only minor loss of sensitivity. Differences in wave form measurements between the manual and computer methods account for a large part of the deterioration of specificity in this study compared with previously published results. Computer application of the screening criteria requires altered criteria limits in comparison with those used in manual application. Probably sex- and age-dependent criteria limits should be used.

Age Factors↗
PubMed1990

The portable programmable microprocessor-driven real-time 12-lead electrocardiographic monitor: a preliminary report of a new device for the noninvasive detection of successful reperfusion or silent coronary reocclusion.

Successful intravenous thrombolytic therapy early in myocardial infraction has the potential to reduce patient mortality without the additional risk and cost of aggressive invasive therapy. Noninvasive detection of successful reperfusion using resolution of chest pain, ST-segment changes assessed on static electrocardiograms, arrhythmia evolution, early isoenzyme peaking or changes in ventricular perfusion or function has been hampered by poor sensitivity or specificity, or inability to provide timely information. A newly available portable programmable microprocessor-driven real-time 12-lead electrocardiographic monitor has been introduced that may address these limitations. A continuously updated precise digital record of ST-segment activity at the bedside provides valuable information both in monitoring patients during reperfusion therapy to determine the efficacy of such treatment and in the subsequent hours to signal threatened reocclusion. This report describes the salient features of the monitor and presents 4 distinct situations in which the monitor detected timely information regarding coronary patency after reperfusion.

Angioplasty, Balloon, Coronary↗
PubMed1988

Development and validation of an automated method of the Selvester QRS scoring system for myocardial infarct size.

The Selvester QRS score for estimation of myocardial infarct (MI) size from the standard 12-lead electrocardiogram (ECG) has not yet achieved wide recognition as a valuable tool in the routine assessment of the MI patient, primarily because of the practical limitations inherent to manual application. This study examined the ECGs of 438 patients (105 normal subjects, 161 with "possible" MI and 172 with "definite" MI based on data from cardiac catheterization) to develop software for an automated method of the Selvester system in attempts to overcome the manual constraints. After a comprehensive validation process involving extensive interactions between the manual scorer and the software developer, an automated method of the Selvester system was generated that had a high correlation with manual application (r = 0.94) and was superior regarding time, training, reader bias, reproducibility and precision of measurement. These results indicate that an automated version of the Selvester QRS scoring system would resolve many of the limitations of manual application and would provide a reliable, technically accurate estimate of MI size that could be incorporated into ECG diagnostic programs and used in standard digital ECG machines.

Cardiac Catheterization↗
PubMed1988

An ischemic index from the electrocardiogram to select patients with low left ventricular ejection fraction for coronary artery bypass grafting.

Patients who have a decreased left ventricular (LV) ejection fraction (EF) may be denied coronary by-pass grafting (CABG) because it is assumed that improvement in function is unlikely. If the low LVEF were due to myocardial necrosis, this assumption would be valid. If the dysfunction were due to both necrosis and ischemia, however, then improvement may be possible with CABG. A method capable of identifying such patients would be useful. In this study, an "ischemic index" was determined for 37 patients based on the difference between the presurgical LVEF estimated from the standard 12-lead electrocardiogram by the Selvester QRS score (indicating the extent of dysfunction due to necrosis) and the presurgical LVEF measured from resting multigated radionuclide angiography (indicating dysfunction due to both necrosis and ischemia). It was hypothesized that a high ischemia index, that is, a large discrepancy between estimated and measured LVEF, would be associated with an improved post-surgical measured LVEF. The results showed that patients with an ischemic index of less than or equal to 0 had a mean decrease in LVEF of 8% (p = 0.02) and those with an index between 0 and 10 had no mean change. Patients with an index greater than or equal to 11, however, had a mean increase of 5% (p = 0.02), suggesting that depressed LVEF may improve following CABG among patients whose low function is due primarily to reversible ischemia as indicated by a high ischemic index.

Adult↗
PubMed1987

Computer-assisted ST-segment monitoring: experience during and after brief coronary occlusion.

As the technology of computer-assisted ECG analysis continues to advance the frontier of multi-lead acquisition and real time analysis, conceptual approaches to the research applications as well as to the electrical and clinical validity of changes in the ECG signal amongst heterogeneous patient groups need to be continually reassessed. Comparisons between different devices, lead configurations, rates of acquisition, approaches to analysis, and patient populations may have large gaps that will require cautious extrapolation and careful investigation.

Coronary Disease↗
PubMedDate not supplied

The dental status of cerebral palsied children.

The prevalence of dental disease, the types and quality of dental care, and the provision of services were assessed for 150 cerebral palsied children (mean age 10.25 years) attending special schools in Leeds and compared with a matched control group of 191 children (mean age 10.39 years). Similar dental caries experience existed in the two groups, but study children had more extracted and unrestored teeth, and fewer and poorer quality restorations than control children. Oral hygiene and gingival health were worse in the study group, which also exhibited delayed eruption and higher levels of tooth wear. Significantly greater overjet (5.1 mm compared with 2.5 mm) and less crowding occurred in the study group than in the control group. All parents had favorable attitudes toward dentistry and were satisfied with their children's dental care. More study children received treatment from the community dental service, while the general dental services were used more commonly by the control group.

Adolescent↗