Starc Vito, Schlegel Todd T
University of Ljubljana, Faculty of Medicine, Ljubljana, Slovenia.
Karolinska Institutet, Stockholm, Sweden; Nicollier-Schlegel SARL, Trélex, Switzerland.
J Electrocardiol. 2016 May-Jun;49(3):337-44. doi: 10.1016/j.jelectrocard.2016.02.019. Epub 2016 Feb 27.
We developed an automated new method for determining QRS offset, based on angular velocity (AV) changes around the QRS loop, and compared the method's performance to that of manual and more established automated methods for determining QRS offset in both healthy subjects and patients with acute myocardial infarction (AMI). Specifically, using Frank leads reconstructed from standard 12-lead ECGs, we determined AV in the direction of change raised to the 4th power, d(t). We found that the d(t)-determined AV transition (ΔAV) nearly coincided with manually determined QRS offset in healthy subjects, and in 27 patients with anterior AMI. However, in 31 patients with inferior AMI, ΔAV typically preceded that of QRS offset determined by the established automated methods, and by more than 10ms in 32% of cases. While this "ΔAV precedence" coincided with diagnostic ST elevation in only a minority of patients with recent inferior AMI, the use of ΔAV precedence as a complement to traditional determination of ST elevation increased the sensitivity for detecting inferior AMIs from 23 to 42%.
我们开发了一种基于QRS环周围角速度（AV）变化来确定QRS偏移的自动化新方法，并将该方法的性能与用于确定健康受试者和急性心肌梗死（AMI）患者QRS偏移的手动及更为成熟的自动化方法进行了比较。具体而言，我们使用从标准12导联心电图重建的Frank导联，确定了变化方向提升到4次方的d(t)方向上的AV。我们发现，在健康受试者以及27例前壁AMI患者中，由d(t)确定的AV转变（ΔAV）与手动确定的QRS偏移几乎一致。然而，在31例下壁AMI患者中，ΔAV通常先于既定自动化方法确定的QRS偏移，在32%的病例中提前超过10毫秒。虽然这种“ΔAV优先”仅在少数近期下壁AMI患者中与诊断性ST段抬高相符，但使用ΔAV优先作为传统ST段抬高测定的补充，将检测下壁AMI的敏感性从23%提高到了42%。
