Browsing by Subject "Electrocardiography"

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  • Lahdenoja, Olli; Hurnanen, Tero; Kaisti, Matti; Koskinen, Juho; Tuominen, Jarno; Vähä-Heikkilä, Matti; Parikka, Laura; Wiberg, Maria; Koivisto, Tero; Pänkäälä, Mikko (BioMed Central, 2019)
    Abstract Background In the context of monitoring dogs, usually, accelerometers have been used to measure the dog’s movement activity. Here, we study another application of the accelerometers (and gyroscopes)—seismocardiography (SCG) and gyrocardiography (GCG)—to monitor the dog’s heart. Together, 3-axis SCG and 3-axis GCG constitute of 6-axis mechanocardiography (MCG), which is inbuilt to most modern smartphones. Thus, the objective of this study is to assess the feasibility of using a smartphone-only solution to studying dog’s heart. Methods A clinical trial (CT) was conducted at the University Small Animal Hospital, University of Helsinki, Finland. 14 dogs (3 breeds) including 18 measurements (about one half of all) where the dog’s status was such that it was still and not panting were further selected for the heart rate (HR) analysis (each signal with a duration of 1 min). The measurement device in the CT was a custom Holter monitor including synchronized 6-axis MCG and ECG. In addition, 16 dogs (9 breeds, one mixed-breed) were measured at home settings by the dog owners themselves using Sony Xperia Android smartphone sensor to further validate the applicability of the method. Results The developed algorithm was able to select 10 good-quality signals from the 18 CT measurements, and for 7 of these, the automated algorithm was able to detect HR with deviation below or equal to 5 bpm (compared to ECG). Further visual analysis verified that, for approximately half of the dogs, the signal quality at home environment was sufficient for HR extraction at least in some signal locations, while the motion artifacts due to dog’s movements are the main challenges of the method. Conclusion With improved data analysis techniques for managing noisy measurements, the proposed approach could be useful in home use. The advantage of the method is that it can operate as a stand-alone application without requiring any extra equipment (such as smart collar or ECG patch).
  • Aro, Aapo Lauri Aleksi; Phan, Derek; Teodorescu, Carmen; Uy-Evanado, Audrey; Reinier, Kyndaron; Gunson, Karen; Jui, Jonathan; Huikuri, Heikki V.; Chugh, Sumeet S. (2017)
    Delayed QRS transition zone in the precordial leads of the 12-lead electrocardiogram (ECG) has been recently associated with increased risk of sudden cardiac death (SCD), but the underlying mechanisms are unknown. We correlated echocardiographic findings with ECG and clinical characteristics to investigate how alterations in cardiac structure and function contribute to this risk marker. From the ongoing population-based Oregon Sudden Unexpected Death Study (catchment population similar to 1 million), SCD cases with prior ECG available (n = 627) were compared with controls (n = 801). Subjects with delayed transition at V-5 or later were identified, and clinical and echocardiographic patterns associated with delayed transition were analysed. Delayed transition was present in 31% of the SCD cases and 17% of the controls. These subjects were older and more likely to have cardiovascular risk factors and history of myocardial infarction. Delayed transition was associated with increased left ventricular (LV) mass (122.7 +/- 40.2 vs. 102.9 +/- 33.7 g/m(2); P <0.001), larger LV diameter (53.3 +/- 10.4 vs. 49.2 +/- 8.0 mm; P <0.001), and lower LV ejection fraction (LVEF) (46.4 +/- 15.7 vs. 55.6 +/- 12.5%; P <0.001). In multivariate analysis, delayed transition was independently associated with myocardial infarction, reduced LVEF, and LV hypertrophy. The association between delayed transition and SCD was independent of the LVEF (OR 1.57; 95% CI 1.04-2.38; P = 0.032). The underpinnings of delayed QRS transition zone extend beyond previous myocardial infarction and reduced LVEF. Since the association with sudden death is independent of these factors, this novel marker of myocardial electrical remodelling should be explored as a potential risk predictor of SCD.
  • Porthan, Kimmo; Kentta, Tuomas; Niiranen, Teemu J.; Nieminen, Markku S.; Oikarinen, Lasse; Viitasalo, Matti; Hernesniemi, Jussi; Jula, Antti M.; Salomaa, Veikko; Huikuri, Heikki; Albert, Christine M.; Tikkanen, Jani T. (2019)
    Background: Electrocardiographic (ECG) left ventricular hypertrophy (LVH) is an established risk factor for cardiovascular events. However, limited data is available on the prognostic values of different ECG LVH criteria specifically to sudden cardiac death (SCD). Our goal was to assess relationships of different ECG LVH criteria to SCD. Methods: Three traditional and clinically useful (Sokolow-Lyon, Cornell, RaVL) and a recently proposed (Peguero-Lo Presti) ECG LVH voltage criteria were measured in 5730 subjects in the Health 2000 Survey, a national general population cohort study. Relationships between LVH criteria, aswell as their selected composites, to SCD were analyzed with Cox regression models. In addition, population-attributable fractions for LVH criteria were calculated. Results: After a mean follow-up of 12.5 +/- 2.2 years, 134 SCDs had occurred. When used as continuous variables, all LVH criteria except for RaVL were associated with SCD in multivariable analyses. When single LVH criteria were used as dichotomous variables, only Cornell was significant after adjustments. The dichotomous composite of Sokolow-Lyon and Cornell was also significant after adjustments (hazard ratio for SCD 1.82, 95% confidence interval 1.20-2.70, P = 0.006) and was the only LVH measure that showed statistically significant population attributable fraction (11.0%, 95% confidence interval 1.9-19.2%, P=0.019). Conclusions: Sokolow-Lyon, Cornell, and Peguero-Lo Presti ECG, but not RaVL voltage, are associated with SCD risk as continuous ECG voltage LVH variables. When SCD risk assessment/adjustment is performed using a dichotomous ECG LVH measure, composite of Sokolow-Lyon and Cornell voltages is the preferred option. (c) 2018 The Authors. Published by Elsevier B.V.
  • Korhonen, Petri; Raatikainen, Pekka; Viitasalo, Matti (2021)
    EKG:n pitkäaikaisrekisteröinnillä tarkoitetaan menetelmiä, joiden avulla sydämen sähköistä toimintaa seurataan mukana kuljetettavan rekisteröintilaitteen avulla. Alkuperäisen, Sir Norman Holterin kehittämän, EKG:tä jatkuvasti rekisteröivän laitteiston rinnalle on sittemmin kehitetty menetelmiä, joissa talteen kerätään ainoastaan tietyt kriteerit täyttävät löydökset sekä löydökset tutkittavan potilaan oireiden ajalta. Tavallisimmat EKG:n pitkäaikaisrekisteröinnin aiheet ovat olleet rytmihäiriötuntemusten selvittely ja etiologialtaan epäselvä synkopee. Rekisteröintilaitteiden sekä muun kardiologisen diagnostiikan ja hoidon kehitys on merkittävästi laajentanut ja muovannut tutkimusaiheita.
  • Holkeri, Arttu; Eranti, Antti; Kenttä, Tuomas V.; Noponen, Kai; Haukilahti, M. Anette E.; Seppänen, Tapio; Junttila, M. Juhani; Kerola, Tuomas; Rissanen, Harri; Heliövaara, Markku; Knekt, Paul; Aro, Aapo L.; Huikuri, Heikki V. (2018)
    Background: No established method for digitizing and digital measuring of paper electrocardiograms (ECG) exists. We describe a paper ECG digitizing and digital measuring process, and report comparability to manual measurements. Methods: A paper ECG was recorded from 7203 health survey participants in 1978-1980. With specific software, the ECGs were digitized (ECG Trace Tool), and measured digitally (EASE). A sub-sample of 100 ECGs was selected for manual measurements. Results: The measurement methods showed good agreement. The mean global (EASE)-(manual) differences were 1.4 ms (95% CI 0.5-2.2) for PR interval, 1.0 ms (95% CI 1.5 [-0.5]) for QRS duration, and 11.6 ms (95% CI 10.5-12.7) for QT interval. The mean inter-method amplitude differences of RampV5, RampV6, SampV1, TampII and TampV5 ranged from 0.03 mV to 0.01 mV. Conclusions: The presented paper-to-digital conversion and digital measurement process is an accurate and reliable method, enabling efficient storing and analysis of paper ECGs. (C) 2017 Elsevier Inc. All rights reserved.
  • Koskela, Jenni (2021)
  • Lyyra, Markus (2018)
    Seitsemissäkymmenissä olevalla miehellä oli toistuvia poissaolokohtauksia. Huolestunut vaimo soitti hätäkeskukseen.
  • Holkeri, Arttu; Eranti, Antti; Haukilahti, M. Anette E.; Kerola, Tuomas; Kenttä, Tuomas V.; Tikkanen, Jani T.; Rissanen, Harri; Heliövaara, Markku; Knekt, Paul; Junttila, M. Juhani; Aro, Aapo L.; Huikuri, Heikki V. (2020)
    BACKGROUND Early repolarization (ER) has been linked to the risk of sudden cardiac death (SCD) in the general population, although controversy remains regarding risks across various subgroups. OBJECTIVE The purpose of this study was to investigate whether age and sex influence the prognostic significance of ER. METHODS We evaluated the 12-lead electrocardiograms of 6631 Finnish general population subjects age >= 30 years (mean age 50.1 +/- 13.9 years; 44.5% men) for the presence of ER (J-point elevation >= 0.1 mV in >= 2 inferior/lateral leads) and followed them for 24.4 +/- 10.3 years. We analyzed the association between ER and the risk of SCD, cardiac death, and ad-cause mortality in subgroups according to age (= 50 years) and sex. RESULTS ER was present in 367 of the 3305 subjects age = 50 years. ER was not associated with any of the endpoints in the entire study population. After adjusting for clinical factors, ER was associated with SCD (hazard ratio [HR] 1.88; 95% confidence interval [CI] 1.16-3.07) in subjects CONCLUSION ER is associated with SCD in subjects younger than 50 years, particularly in women, but not in subjects 50 years and older.
  • Lehtonen, Arttu O.; Langen, Ville L.; Puukka, Pauli J.; Kahonen, Mika; Nieminen, Markku S.; Jula, Antti M.; Niiranen, Teemu J. (2017)
    Background: Scant data exist on incidence rates, correlates, and prognosis of electrocardiographic P-wave abnormalities in the general population. Methods: We recorded ECG and measured conventional cardiovascular risk factors in 5667 Finns who were followed up for incident atrial fibrillation (AF). We obtained repeat ECGs from 3089 individuals I I years later. Results: The incidence rates of prolonged P-wave duration, abnormal P terminal force (PTF), left P-wave axis deviation, and right P-wave axis deviation were 16.0%, 7.4%, 3.4%, and 2.2%, respectively. Older age and higher BMI were associated with incident prolonged P-wave duration and abnormal PTF (P Conclusions: Modifiable risk factors associate with P-wave abnormalities that are common and may represent intermediate steps of atrial cardiomyopathy on a pathway leading to AF. (C) 2017 Elsevier Inc. All rights reserved.
  • Meinander, Tuula; Lassila, Riitta (2017)
    •Keuhkoemboliapotilaan diagnostiikka etenee eri tavoin siitä riippuen, onko potilas sokissa vai ei. •Sokissa olevan potilaan kuolemanriski on suuri, joten on toimittava nopeasti ja suunnitelmallisesti. •Kuolemanriski on pienempi, jos potilas ei ole sokissa. Diagnostiikka perustuu todennäköisyyteen ja muiden diagnoosien sulkemiseen pois. •Keuhkoembolian sulkeminen pois todennäköisyysarvion ja D-dimeeritutkimuksen avulla vähentää säde¬rasitusta, varjoainekuormitusta ja kustannuksia.
  • Perttunen, Heli; Vessari, Hannu; Sumanen, Markku; Koskinen, Outi; Varinen, Aleksi; Joutsiniemi, Liisa; Raivio, Risto; Palvanen, Mika; Kosunen, Elise; Koskela, Tuomas (2019)
    LÄHTÖKOHDAT EKG:n käytöstä perusterveydenhuollon kiireettömillä vastaanotoilla ei ole selkeää valtakunnallista suositusta, vaikka kustannukset ovat suuret. MENETELMÄT Kyselylomakkeella kerättiin tiedot EKG-tutkimusten määrästä ja niitä koskevista ohjeista 20:stä Sisä-Suomen terveyskeskuksesta marraskuulta 2016. TULOKSET Kiireettömien EKG-tutkimusten määrä suhteessa lääkärilläkäynteihin vaihteli yksiköittäin välillä 6–60 %. Suhteessa kaikkiin käynteihin vaihtelu oli pienempää, 3−20 %. Tutkimuksia tehtiin enemmän terveyskeskuksissa, joissa kävi paljon iäkkäitä potilaita, hoitajilla oli oikeus määrätä EKG ja hoitajan vastaanotolla käyntien osuus oli suurempi. PÄÄTELMÄT EKG:n kiireettömässä käytössä on jopa kymmenkertaista vaihtelua terveyskeskusten välillä. Eroihin voivat vaikuttaa potilaskunnan ikärakenne ja terveyskeskusten sisäinen työjako.
  • Hiippala, Anita; Happonen, Juha-Matti (2021)
    • EKG:n tutkiminen ei ole tarpeen aloitettaessa psyykenlääkitystä lapselle tai nuorelle, jos sairaushistoria, statuslöydökset ja sukuanamneesi ovat normaalit. • Tarpeettomista EKG-tutkimuksista voi aiheutua potilaille ja perheille turhaa huolta, ja tarpeellisen hoidon aloitus saattaa viivästyä. • Jos käytetään samanaikaisesti useita psyykenlääkkeitä tai muita QT-aikaa pidentäviä lääkkeitä, EKG on hyvä tarkistaa. • Leikattu sydänvika tai perinnöllinen sydänlihas- tai rytmihäiriösairaus ei välttämättä ole esteenä ¬lääkityksille, mutta hoitavan kardiologin konsultaatio on aiheellinen.
  • Mustonen, Jukka; Strandin, Tomas; Mäkelä, Satu; Vaheri, Antti (2020)
    Myyräkuume on Puumala-viruksen (PUUV) aiheuttama zoonoosi. Tärkeitä tekijöitä ihmisen immuuni-vasteessa virukselle ovat ainakin neutrofiiliset granulosyytit ja sytotoksiset tappaja-T-solut, joiden suhteettoman voimakas aktivaatio saattaa johtaa endoteelivaurioon. Lisääntynyt kapillaarivuoto, fibrinolyysi ja komplementin aktivaatio kuuluvat taudin patogeneesiin. Akuutin munuaisvaurion vaikeutta ennustaa hyvin taudin alkuvaiheessa otetun virtsan seulontatestin tulos. Trombosytopenian synnyssä keskeistä ovat trombosyyttien ja endoteelisolujen interaktio. Ohimenevät EKG-muutokset sekä bradykardia ovat tavallisia löydöksiä. Kroonisten hormonivajausten kehittyminen on mahdollista. Spesifistä hoitoa ei ole olemassa, mutta bradykiniinireseptorin estäjä ikatibantti saattaa olla tehokas lääke hyvin vaikeasti sairaiden potilaiden hoitona.
  • Jalanko, Mikko; Heliö, Tiina; Mustonen, Pirjo; Kokkonen, Jorma; Huhtala, Heini; Laine, Mika; Jääskeläinen, Pertti; Tarkiainen, Mika; Lauerma, Kirsi; Sipola, Petri; Laakso, Markku; Kuusisto, Johanna; Nikus, Kjell (2018)
    Objectives: The sensitivity and specificity of the conventional 12-lead ECG to identify carriers of hypertrophic cardiomyopathy (HCM) - causing mutations without left ventricular hypertrophy (LVH) has been limited. We assessed the ability of novel electrocardiographic parameters to improve the detection of HCM mutation carriers. Methods: We studied 140 carriers (G+) of the TPM7-Asp175Asn or MYBPC3-Glnl 061X pathogenic variants for HCM: The G+/LVH+ group (n = 98) consisted of mutation carriers with LVH and the G+/LVH- group (n = 42) without LVH. The control group consisted of 30 subjects. The standard 12-lead ECG was comprehensively analyzed and two novel ECG variables were introduced: RVlRV3 and septal remodeling. A subset of 65 individuals underwent cardiac magnetic resonance imaging and 2D strain echocardiography. Results: Conventional major ECG criteria were sensitive (90%) and specific (97%) in identifying G+/LVH+ subjects. RV1RV3 and septal remodeling were more prevalent in the G+/LVH- subjects compared to the control group (33% vs 3%, p = 0.005 and 45% vs 3%, p <0.001, respectively). The combination of RVlRV3 and Q waves and repolarization abnormalities (QR) differentiated between the G+/LVH- subjects and the control group with a sensitivity of 52% and specificity of 97%. The combination of septa] remodeling and QR differentiated between G+/LVH- subjects and the control group with a sensitivity of 64% and specificity of 97%. Conclusions: The novel ECG-parameters RVlRV3 and septal remodeling were effective in identifying G+/LVH-subjects and could be useful in the diagnostics of new suspected HCM patients and in the screening and follow-up of HCM families. (C) 2018 Elsevier Inc. All rights reserved.
  • Koivula, Kimmo; Eskola, Markku; Viikilä, Juho; Lilleberg, Jyrki; Huhtala, Heini; Birnbaum, Yochai; Nikus, Kjell (2018)
    Background: Grade 3 ischemia (G3I) in the 12 lead electrocardiogram (ECG) predicts poor outcome in patients with ST-elevation myocardial infarction (STEMI). The outcome of G3I in "real-life" patient cohorts is unclear. Methods: The aim of the study was to establish the prognostic significance of grade 2 ischemia (G2I), G3I and the STEMI patients excluded from ischemia grading (No grade of ischemia, NG) in a real-life patient population. We assessed in-hospital, 30-day and 1-year mortality as well as other endpoints. Results: The NG patients had more comorbidities and longer treatment delays than the two other groups. Shortterm and 1-year mortality were highest in patients with NG and lowest in patients with G2I. Maximum troponin level was highest in G3I, followed by NG and G2I. In logistic regression multivariable analysis, NG was independently associated with 1-year mortality. Conclusions: NG predicted poor outcome in STEMI patients. G2I predicted relatively favorable outcome. (C) 2018 Elsevier Inc. All rights reserved.
  • Schröder, Linda C.; Holkeri, Arttu; Eranti, Antti; Haukilahti, M. Anette E.; Kerola, Tuomas; Kenttä, Tuomas V.; Noponen, Kai; Seppänen, Tapio; Rissanen, Harri; Heliövaara, Markku; Knekt, Paul; Junttila, M. Juhani; Huikuri, Heikki V.; Aro, Aapo L. (2022)
    Background: Poor R-wave progression (PRWP) is a common clinical finding on the standard 12-lead electrocardiogram (ECG), but its prognostic significance is unclear. Objective: The purpose of this study was to examine the prognosis associated with PRWP in terms of sudden cardiac death (SCD), cardiac death, and all-cause mortality in general population subjects with and without coronary artery disease (CAD). Methods: Data and 12-lead ECGs were collected from a Finnish general population health examination survey conducted during 1978–1980 with follow-up until 2011. The study population consisted of 6854 subjects. Main end points were SCD, cardiac death, and all-cause mortality. PRWP was defined as R-wave amplitude ≤ 0.3 mV in lead V3 and R-wave amplitude in lead V2 ≤ R-wave amplitude in lead V3. Results: PRWP occurred in 213 subjects (3.1%). During the follow-up period of 24.3 ± 10.4 years, 3723 subjects (54.3%) died. PRWP was associated with older age, higher prevalence of heart failure and CAD, and β-blocker medication. In multivariate analyses, PRWP was associated with SCD (hazard ratio [HR] 2.13; 95% confidence interval [CI] 1.34–3.39), cardiac death (HR 1.75; 95% CI 1.35–2.15), and all-cause mortality (HR 1.29; 95% CI 1.08–1.54). In the subgroup with CAD, PRWP had a stronger association with cardiac mortality (HR 1.71; 95% CI 1.19–2.46) than in the subgroup without CAD, while the association with SCD was significant only in the subgroup with CAD (HR 2.62; 95% CI 1.38–4.98). Conclusion: PRWP was associated with adverse prognosis in the general population and with SCD in subjects with CAD.
  • Tikkanen, Jani T.; Kentta, Tuomas; Porthan, Kimmo; Anttonen, Olli; Eranti, Antti; Aro, Aapo L.; Kerola, Tuomas; Rissanen, Harri A.; Knekt, Paul; Heliövaara, Markku; Holkeri, Arttu; Haukilahti, Anette; Niiranen, Teemu; Hernesniemi, Jussi; Jula, Antti; Nieminen, Markku S.; Myerburg, Robert J.; Albert, Christine M.; Salomaa, Veikko; Huikuri, Heikki V.; Junttila, M. Juhani (2022)
    BACKGROUND QRS duration and corrected QT (QTc) interval have been associated with sudden cardiac death (SCD), but no data are available on the significance of repolarization component (JTc interval) of the QTc interval as an independent risk marker in the general population. OBJECTIVE In this study, we sought to quantify the risk of SCD associated with QRS, QTc, and JTc intervals. METHODS This study was conducted using data from 3 population cohorts from different eras, comprising a total of 20,058 individuals. The follow-up period was limited to 10 years and age at baseline to 30-61 years. QRS duration and QT interval (Bazett's) were measured from standard 12-lead electrocardiograms at baseline. JTc interval was defined as QTc interval - QRS duration. Cox proportional hazards models that controlled for confounding clinical factors identified at baseline were used to estimate the relative risk of SCD. RESULTS During a mean period of 9.7 years, 207 SCDs occurred (1.1 per 1000 person-years). QRS duration was associated with a significantly increased risk of SCD in each cohort (pooled hazard ratio [HR] 1.030 per 1-ms increase; 95% confidence interval [CI] 1.017-1.043). The QTc interval had borderline to significant associations with SCD and varied among cohorts (pooled HR 1.007; 95% CI 1.001-1.012). JTc interval as a continuous variable was not associated with SCD (pooled HR 1.001; 95% CI 0.996-1.007). CONCLUSION Prolonged QRS durations and QTc intervals are associated with an increased risk of SCD. However, when the QTc interval is deconstructed into QRS and JTc intervals, the repolarization component (JTc) appears to have no independent prognostic value.
  • Marjamaa, Annukka; Parikka, Hannu (2021)
    Tarkka ja oikea-aikainen rytmihäiriön EKG-rekisteröinti on rytmihäiriösairauden diagnosoinnin kulmakivi. Tavanomainen EKG ei rytmihäiriöiden kohtauksellisuuden vuoksi johda läheskään aina diagnoosiin, vaan tarvitaan pitkäkestoista EKG:n rekisteröintiä. Tapahtuma-EKG-pitkäaikaisrekisteröinti on järkevä ratkaisu oireisille rytmihäiriöpotilaille, jotka oireen tunnistaessaan aktivoivat laitteen EKG-tallennuksen. Potilaille, joilla on toistuvia, etiologialtaan epäselviä tajunnanmenetyskohtauksia, on perusteltua asentaa ihonalainen rytmivalvuri toteamaan tai sulkemaan pois synkopeen rytmihäiriöperäinen syy. Rytmivalvuria käytetään yhä enemmän myös oireettoman eteisvärinän diagnosoimiseen, kun potilas on sairastanut salasyntyisen aivoinfarktin. Rytmivalvurin kuten muidenkin sydämen rytmiä rekisteröivien laitteiden tallenteiden tulkintaan liittyy kuitenkin rajoituksia. Laitteiden rytmihäiriölähetykset vaativat koulutetun ihmisen tulkitsemaan rytmin, eikä väärien positiivisten hälytysten määrä ole mitätön. Tuotekehityksessä pyritäänkin edelleen parantamaan signaalin tulkittavuutta ja rytmihäiriöalgoritmien osuvuutta.
  • Sarvilinna, Nanna; Isaksson, Camilla; Kokljuschkin, Henrica; Timonen, Susanna; Halmesmäki, Erja (2016)