From the Departments of Neurology (D.L.B., N.B., M.M.W., J.B.), University of Michigan Medical School, Ann Arbor.
Cardiovascular Center (D.L.B., M.M.W., J.B.), University of Michigan Medical School, Ann Arbor.
Stroke. 2019 Jul;50(7):1676-1681. doi: 10.1161/STROKEAHA.119.025361. Epub 2019 Jun 10.
Background and Purpose- Cardiac telemetry is a routine part of inpatient ischemic stroke/transient ischemic attack evaluation to assess for atrial fibrillation (AF). Yet, tools to assist stroke clinicians in the evaluation of the large quantities of telemetry data are limited. The investigators developed a new method to evaluate electrocardiographic signals, electrocardiomatrix, that was applied to stroke unit telemetry data to determine its feasibility, validity, and usefulness. Electrocardiomatrix displays telemetry data in a 3-dimensional matrix that allows for more accurate and less time consuming P-wave analysis. Methods- In this single-center, prospective, observational study conducted in a stroke unit, all telemetry data from ischemic stroke and transient ischemic attack patients were collected (April 2017-January 2018) for examination facilitated by electrocardiomatrix. AF>30 seconds was identified through review of electrocardiomatrix-generated matrices by a nonphysician researcher. Electrocardiomatrix results were compared with the clinical team's medical record documentation of AF identified through telemetry. A study cardiologist reviewed the standard telemetry associated with all AF episodes identified by electrocardiomatrix and each case of disagreement. Results- Telemetry data (median 46 hours [interquartile range: 22-90]) were analyzed among 265 unique subjects (88% ischemic stroke). Electrocardiomatrix was successfully applied in 260 (98%) of cases. The positive predictive value of electrocardiomatrix compared with the clinical documentation was 86% overall and 100% among the subset with no prior history of AF. For the 5 false-positive and 5 false-negative cases, expert overview disagreed with the clinical documentation and confirmed the electrocardiomatrix-based diagnosis. Conclusions- The application of electrocardiomatrix to stroke unit-acquired telemetry data is feasible and appears to have superior accuracy compared with traditional monitor analysis by noncardiologists.
背景与目的- 心脏遥测是住院缺血性卒中和短暂性脑缺血发作评估的常规部分，用于评估心房颤动（AF）。然而，帮助中风临床医生评估大量遥测数据的工具是有限的。研究人员开发了一种新的方法来评估心电图信号，即心电图矩阵，该方法应用于中风病房的遥测数据，以确定其可行性、有效性和实用性。心电图矩阵以三维矩阵的形式显示遥测数据，从而可以更准确和更省时地进行 P 波分析。
方法- 在这项在中风病房进行的单中心、前瞻性、观察性研究中，收集了所有缺血性卒中和短暂性脑缺血发作患者的遥测数据（2017 年 4 月至 2018 年 1 月），通过心电图矩阵进行检查。非医师研究人员通过审查心电图矩阵生成的矩阵来识别>30 秒的 AF。将心电图矩阵的结果与临床团队通过遥测记录的 AF 病历进行比较。研究心脏病专家审查了与心电图矩阵识别的所有 AF 事件相关的标准遥测以及每个有争议的病例。
结果- 在 265 名独特的患者（88%为缺血性卒中和 12%为短暂性脑缺血发作）中分析了遥测数据（中位数 46 小时[四分位距：22-90]）。在 260 例（98%）患者中成功应用了心电图矩阵。与临床文档相比，心电图矩阵的阳性预测值总体为 86%，在无既往 AF 病史的亚组中为 100%。对于 5 例假阳性和 5 例假阴性病例，专家综述与临床文档不一致，并确认了基于心电图矩阵的诊断。
结论- 将心电图矩阵应用于中风病房获得的遥测数据是可行的，并且似乎比非心脏病专家传统的监测分析具有更高的准确性。
