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Biomedical subjects

J Malmivuo

Publications and source records attributed to J Malmivuo.

At least 19 recordsLinked to original sources
PubMed1998

Correct utilization of exercise electrocardiographic leads in differentiation of men with coronary artery disease from patients with a low likelihood of coronary artery disease using peak exercise ST-segment depression.

In this study we compared the diagnostic characteristics of the individual exercise electrocardiographic leads, 3 different lead sets comprising standard leads and the effect of the partition value in the detection of coronary artery disease (CAD). The diagnostic variable used was ST-segment depression at peak exercise, and the study population consisted of 101 patients with CAD and 100 patients with a low likelihood of the disease. The lead system used was the Mason-Likar modification of the standard 12-lead system and exercise tests were performed on a bicycle ergometer. The comparisons were performed by means of receiver-operating characteristic analysis and by determining sensitivities at a fixed 95% specificity. These properties, defined here as diagnostic capacity, were the most efficacious in leads I, -aVR, V4, V5, and V6. Diagnostic capacities in leads aVL, aVF, III, V1, and V2 were quite poor; statistical comparisons indicated significant differences between these leads and lead V5 (p < or = 0.0001 in each case). Use of the maximum value of ST-segment depression at peak exercise derived from all 12 leads produced a considerable decrease in the diagnostic capacity of the exercise electrocardiogram compared with lead V5. The exclusion of leads aVL, V1, and III improved the diagnostic capacity compared with the 12-lead set, but it was still smaller than that of lead V5. With use of a lead set with the 5 best leads increased the diagnostic capacity over other lead sets and over any individual lead. Further improvement was noted when a 50% smaller partition value was applied to leads I and -aVR than for the other leads (p = 0.041). In conclusion, this study suggests that use of leads I, -aVR, V4, V5, and V6 is the most influential when differentiating between patients with CAD and patients with a low likelihood of disease using peak exercise ST-segment depression. The effective use of leads I and -aVR requires the partition value applied for these leads to be 50% smaller than that used for the lateral precordial leads.

Coronary Disease↗
PubMed1998

Semi-automatic tool for segmentation and volumetric analysis of medical images.

Segmentation software is described, developed for medical image processing and run on Windows. The software applies basic image processing techniques through a graphical user interface. For particular applications, such as brain lesion segmentation, the software enables the combination of different segmentation techniques to improve its efficiency. The program is applied for magnetic resonance imaging, computed tomography and optical images of cryosections. The software can be utilised in numerous applications, including pre-processing for three-dimensional presentations, volumetric analysis and construction of volume conductor models.

Brain Ischemia↗
PubMed1997

Effect of ST segment measurement point on performance of exercise ECG analysis.

To evaluate the effect of ST-segment measurement point on diagnostic performance of the ST-segment/heart rate (ST/HR) hysteresis, the ST/HR index, and the end-exercise ST-segment depression in the detection of coronary artery disease, we analysed the exercise electrocardiograms of 347 patients using ST-segment depression measured at 0, 20, 40, 60 and 80 ms after the J-point. Of these patients, 127 had and 13 had no significant coronary artery disease according to angiography, 18 had no myocardial perfusion defect according to technetium-99m sestamibi single-photon emission computed tomography, and 189 were clinically 'normal' having low likelihood of coronary artery disease. Comparison of areas under the receiver operating characteristic curves showed that the discriminative capacity of the above diagnostic variables improved systematically up to the ST-segment measurement point of 60 ms after the J-point. As compared to analysis at the J-point (0 ms), the areas based on the 60-ms point were 89 vs. 84% (p=0.0001) for the ST/HR hysteresis, 83 vs. 76% (p<0.0001) for the ST/HR index, and 76 vs. 61% (p<0.0001) for the end-exercise ST depression. These findings suggest that the ST-segment measurement at 60 ms after the J-point is the most reasonable point of choice in terms of discriminative capacity of both the simple and the heart rate-adjusted indices of ST depression. Moreover, the ST/HR hysteresis had the best discriminative capacity independently of the ST-segment measurement point, the observation thus giving further support to clinical utility of this new method in the detection of coronary artery disease.

Coronary Disease↗
PubMed1997

Reproducibility of the ST-segment depression/heart rate analysis of the exercise electrocardiographic test in asymptomatic middle-aged population.

The reproducibility of the ST-segment depression against heart rate (ST/HR) hysteresis, ST/HR index, and end-exercise ST depression between the repeated exercise electrocardiographic tests were determined in 61 asymptomatic middle-aged subjects. The findings support the clinical utility of the ST/HR hysteresis, but it is noteworthy that the results also suggest that the magnitude of change in the exercise electrocardiographic variables, which has to be observed to make the clinician confident that a real diagnostic change has occurred, is surprisingly large.

Electrocardiography↗
PubMed1997

The effect of lead selection on traditional and heart rate-adjusted ST segment analysis in the detection of coronary artery disease during exercise testing.

Several methods of heart rate-adjusted ST segment (ST/HR) analysis have been suggested to improve the diagnostic accuracy of exercise electrocardiography in the identification of coronary artery disease compared with traditional ST segment analysis. However, no comprehensive comparison of these methods on a lead-by-lead basis in all 12 electrocardiographic leads has been reported. This article compares the diagnostic performances of ST/HR hysteresis, ST/HR index, ST segment depression 3 minutes after recovery from exercise, and ST segment depression at peak exercise in a study population of 128 patients with angiographically proved coronary artery disease and 189 patients with a low likelihood of the disease. The methods were determined in each lead of the Mason-Likar modification of the standard 12-lead exercise electrocardiogram for each patient. The ST/HR hysteresis, ST/HR index, ST segment depression 3 minutes after recovery from exercise, and ST segment depression at peak exercise achieved more than 85% area under the receiver-operating characteristic curve in nine, none, three, and one of the 12 standard leads, respectively. The diagnostic performance of ST/HR hysteresis was significantly superior in each lead, with the exception of leads a VL and V1. Examination of individual leads in each study method revealed the high diagnostic performance of leads I and -aVR, indicating that the importance of these leads has been undervalued. In conclusion, the results indicate that when traditional ST segment analysis is used for the detection of coronary artery disease, more attention should be paid to the leads chosen for analysis, and lead-specific cut points should be applied. On the other hand, ST/HR hysteresis, which integrates the ST/HR depression of the exercise and recovery phases, seems to be relatively insensitive to the lead selection and significantly increases the diagnostic performance of exercise electrocardiography in the detection of coronary artery disease.

Coronary Disease↗
PubMed1997

Computer model analysis of the relationship of ST-segment and ST-segment/heart rate slope response to the constituents of the ischemic injury source.

The objective of the study was to investigate a proposed linear relationship between the extent of myocardial ischemic injury and the ST-segment/heart rate (ST/HR) slope by computer simulation of the injury sources arising in exercise electrocardiographic (ECG) tests. The extent and location of the ischemic injury were simulated for both single- and multivessel coronary artery disease by use of an accurate source-volume conductor model which assumes a linear relationship between heart rate and extent of ischemia. The results indicated that in some cases the ST/HR slope in leads II, aVF, and especially V5 may be related to the extent of ischemia. However, the simulations demonstrated that neither the ST-segment deviation nor the ST/HR slope was directly proportional to either the area of the ischemic boundary or the number of vessels occluded. Furthermore, in multivessel coronary artery disease, the temporal and spatial diversity of the generated multiple injury sources distorted the presumed linearity between ST-segment deviation and heart rate. It was concluded that the ST/HR slope and ST-segment deviation of the 12-lead ECG are not able to indicate extent of ischemic injury or number of vessels occluded.

Adult↗
PubMed1997

Segmentation of T1 MR scans for reconstruction of resistive head models.

This paper describes a segmentation method primarily developed for reconstructing resistive head models for electroencephalographic modelling purposes. The method was implemented by combining several image processing techniques, such as amplitude segmentation, region growing, and image fusion. Also a graphical user interface was developed to enable semiautomatic approach to the segmentation process. This method was developed especially for segmentation of the brain and skull from T1-weighted magnetic resonance images, but can also be applied in any segmentation procedure. The entire project was implemented successfully in a PC-based computer running the Unix/NeXTstep operating system.

Algorithms↗
PubMed1997

Sensitivity distributions of EEG and MEG measurements.

It is generally believed that because the skull has low conductivity to electric current but is transparent to magnetic fields, the measurement sensitivity of the magnetoencephalography (MEG) in the brain region should be more concentrated than that of the electroencephalography (EEG). It is also believed that the information recorded by these techniques is very different. If this were indeed the case, it might be possible to justify the cost of MEG instrumentation which is at least 25 times higher than that of EEG instrumentation. The localization of measurement sensitivity using these techniques was evaluated quantitatively in an inhomogeneous spherical head model using a new concept called half-sensitivity volume (HSV). It is shown that the planar gradiometer has a far smaller HSV than the axial gradiometer. However, using the EEG it is possible to achieve even smaller HSV's than with whole-head planar gradiometer MEG devices. The micro-superconducting quantum interference device (SQUID) MEG device does have HSV's comparable to those of the EEG. The sensitivity distribution of planar gradiometers, however, closely resembles that of dipolar EEG leads and, therefore, the MEG and EEG record the electric activity of the brain in a very similar way.

Anisotropy↗
PubMed1996

Accurate detection of coronary artery disease by integrated analysis of the ST-segment depression/heart rate patterns during the exercise and recovery phases of the exercise electrocardiography test.

In this comparative cross-sectional study, we evaluated whether a novel computerized diagnostic variable, ST-segment depression/heart rate ST/HR analysis during both the exercise and postexercise recovery phases of the exercise electrocardiography (ECG) test, can detect coronary artery disease more accurately than methods using either exercise or recovery phase alone. The study population comprised 347 clinical patients referred for a routine bicycle exercise ECG test at Tampere University Hospital, Finland. Of these, 127 had angiographically proven coronary artery disease, whereas 13 had no coronary artery disease according to angiography, 18 had no perfusion defect according to technetium-99m sestamibi single-photon emission computed tomography, and 189 were clinically normal with respect to cardiac diseases. For each patient, the maximum values of the ST/HR hysteresis, ST/HR index, end-exercise ST depression, and recovery ST depression were determined from the Mason-Likar modification of the standard 12-lead exercise electrocardiogram [aVL, aVR, and V1 excluded]. The diagnostic performance of these continuous diagnostic variables was compared by means of receiver-operating characteristic analysis. The area under the receiver-operating characteristic curve of the ST/HR hysteresis was 89%, which was significantly larger than that of the end-exercise ST depression (76%, p < or = 0.0001), recovery ST depression (84%, p = 0.0063), or ST/HR index (83%, p = 0.0023), indicating superior diagnostic performance of the ST/HR hysteresis independent of the partition value selection. In conclusion, computerized analysis of the HR-adjusted ST depression pattern during the exercise phase, integrated with the HR-adjusted ST depression pattern during the recovery phase after exercise, can significantly improve the diagnostic performance and clinical utility of the exercise ECG test for the detection of coronary artery disease.

Adult↗
PubMed1996

A computer program for comprehensive ST-segment depression/heart rate analysis of the exercise ECG test.

The ST-segment depression/heart rate (ST/HR) analysis has been found to improve the diagnostic accuracy of the exercise ECG test in detecting myocardial ischemia. Recently, three different continuous diagnostic variables based on the ST/HR analysis have been introduced; the ST/HR slope, the ST/HR index and the ST/HR hysteresis. The latter utilises both the exercise and recovery phases of the exercise ECG test, whereas the two former are based on the exercise phase only. This present article presents a computer program which not only calculates the above three diagnostic variables but also plots the full diagrams of ST-segment depression against heart rate during both exercise and recovery phases for each ECG lead from given ST/HR data. The program can be used in the exercise ECG diagnosis of daily clinical practice provided that the ST/HR data from the ECG measurement system can be linked to the program. At present, the main purpose of the program is to provide clinical and medical researchers with a practical tool for comprehensive clinical evaluation and development of the ST/HR analysis.

Exercise Test↗
PubMed1994

Compartmental multivariate analysis of exercise ECGs for accurate detection of myocardial ischaemia.

An accurate computer-assisted diagnostic method for detection of myocardial ischaemia, called MUSTA, is developed. MUSTA is based on compartmental multivariate analysis of variables available in the exercise ECGs, and is definitively implemented in Prolog. It is heuristically developed by determining diagnostic criteria, which interrelate a modified ST/HR-slope, ST-segment value and shape, and maximum heart rate, so that concordance with the TI-201 SPECT is maximised. In the learning group consisting of 47 patients, MUSTA provides a diagnostic accuracy of 98%, the detection of ischaemia being in absolute concordance with TI-201 SPECT. MUSTA is evaluated in a similar but independent group of 60 patients. Then, accuracy is 90%, and sensitivity is 94%. The performance characteristics are significantly better than those of the standard exercise ECG, whose diagnostic accuracy in these groups is 77% and 70%, respectively. This study suggests that MUSTA is a significant improvement for computerised assessment of myocardial ischaemia.

Adult↗
PubMed1994

Performance characteristics of various exercise ECG classifiers in different clinical populations.

To improve the diagnostic power of the exercise electrocardiographic test in detecting myocardial ischemia, the authors have recently developed a diagnostic method called multivariate ST-segment/heart rate (ST/HR) analysis (MUSTA). The goal of this study was to evaluate the validity of MUSTA in different clinical populations and to compare its performance characteristics with ST-segment depression, the ST/HR slope, and the delta ST/HR index in these populations. The computerized exercise electrocardiographic measurements were performed on 1,507 cases, and 382 patients were selected as the study population: 161 with significant coronary artery disease according to coronary angiography and 221 with a low likelihood of coronary artery disease. The diagnostic accuracy of MUSTA in the pooled population was 77.7% (297 out of 382 patients), which was clearly better than the accuracy of 69.6% (266 out of 382 patients) using the conventional ST-segment depression criterion of 0.10 mV in detecting coronary artery disease and exercise-induced myocardial ischemia. According to receiver operating characteristics analysis, MUSTA had significantly better diagnostic power than the other classifiers. These findings suggest that multivariate and compartmental analysis methods like MUSTA can further improve the clinical importance of the exercise electrocardiogram.

Coronary Angiography↗
PubMed1994

Normal vector magnetocardiogram. I. Correlation with the normal vector ECG.

The vector magnetocardiogram (VMCG) has been measured with the corrected unipositional VMCG lead system and analyzed statistically in 290 normal subjects. The morphologic study of the QRS waveforms showed that in the right-to-left (X) component, the triphasic qRs waveform appeared in 55% of the subjects. The superoinferior (Y) component was characterized by a prominent S wave in 96% of the subjects, and the anteroposterior (Z) component was also characterized by a prominent S wave in 95% . The VMGs were compared with the vector electrocardiograms (VECG) recorded in a subgroup of 200 subjects, in whom both the VMCG and VECG were available for computer analysis. The normal variability of the spatial vector magnitude measurements was significantly greater in the VMCG than in the VECG. Some similarities were observed in the waveforms of the time-averaged QRS complexes between the VMCG and VECG. Multiple linear regression analysis between the VMCG and VECG showed that maximally 27, 45, and 41% of the variation in the instantaneous QRS X, Y, and Z amplitudes of the VMCG, respectively, could be explained by the instantaneous X, Y, and Z amplitudes of the VECG.

Adolescent↗
PubMed1994

Normal vector magnetocardiogram. II. Effect of constitutional variables.

The effects of age, sex, height, weight, and dimensions of the thorax on the vector magnetocardiogram (VMCG) were studied in 290 normal subjects. The effect of sex on 141 VMCG parameters was tested with the Mann-Whitney U test, and the effects of age and body dimensions on the male and female subjects were tested with the Kruskal-Wallis H test. Similar analyses were applied for a comparison of the vector electrocardiogram (VECG) in a subgroup of 200 normal subjects. Sex had the most pronounced effect on the VMCG, a total of 58% of the instantaneous time-normalized QRS and T amplitude parameters were significantly (P < .01) different in men and women (47% for the VECG). In women, the absolute VMCG amplitudes were, on average, about 60% of those in men. In the VECG, the corresponding portion was about 85%. In men and women, 50 and 26% of the time-normalized amplitude parameters, respectively, were significantly (P < .01) affected by age; the main effect was a decrease in most VMCG amplitudes with increasing age. In the VECG, the corresponding effect was not as statistically significant. The effect of constitutional variables of the body on the VMCG and VECG was, in most cases, not statistically significant. Multiple correlation analysis showed that the five noncardiac factors together explained, at most, 16 and 28% of the variability in the instantaneous, time-normalized QRS amplitudes for men and women, respectively. In the VECG, these figures were 13 and 18%, respectively.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1991

Improved diagnostic performance of the exercise ECG test by computerized multivariate ST-segment/heart rate analysis.

The exercise ECG test is the most widely used noninvasive method of evaluating myocardial ischemia. To determine whether it is possible to enhance its diagnostic power, the authors carried out computerized ECG measurements on 118 nonischemic patients and 38 ischemic patients with or without myocardial infarctions (MIs). Forty-seven (all ischemic and nine normal cases) underwent T1-201 SPECT. The diagnostic variables include ST-segment deviation, modified ST/HR-slope, ST-segment shape, and maximum heart rate. These variables are interrelated by means of compartmental and specific decision rules by computer. The diagnostic method discussed in this article is called the multivariate ST/HR analysis (MUSTA). When compared with MUSTA, the T1-201 SPECT images detected myocardial ischemia with a sensitivity of 100% and a specificity of 89%. Its diagnostic performance was influenced by neither previous MIs nor cardiac medication of the 47 patients tested. MUSTA was also compared to the nonmodified ST/HR analyses (ST60/HR and ST80/HR) and the standard exercise ECG test. It performed significantly better than these methods. The authors conclude that the multivariate ST/HR analysis is comparable to T1-201 SPECT in diagnosing myocardial ischemia among the study subjects. Furthermore, MUSTA is executed during the noninvasive exercise ECG test and is easily applied using an IBM/AT-compatible microcomputer. However, further evaluation of MUSTA with a separate and unselected patient population is needed.

Adult↗