Gruwez Henri, Evens Stijn, Proesmans Tine, Duncker David, Linz Dominik, Heidbuchel Hein, Manninger Martin, Vandervoort Pieter, Haemers Peter, Pison Laurent
Department of Cardiology, Hospital East-Limburg, Genk, Belgium.
Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium.
Front Cardiovasc Med. 2021 Sep 20;8:734737. doi: 10.3389/fcvm.2021.734737. eCollection 2021.
This study aims to compare the performance of physicians to detect atrial fibrillation (AF) based on photoplethysmography (PPG), single-lead ECG and 12-lead ECG, and to explore the incremental value of PPG presentation as a tachogram and Poincaré plot, and of algorithm classification for interpretation by physicians. Email invitations to participate in an online survey were distributed among physicians to analyse almost simultaneously recorded PPG, single-lead ECG and 12-lead ECG traces from 30 patients (10 in sinus rhythm (SR), 10 in SR with ectopic beats and 10 in AF). The task was to classify the readings as 'SR', 'ectopic/missed beats', 'AF', 'flutter' or 'unreadable'. Sixty-five physicians detected or excluded AF based on the raw PPG waveforms with 88.8% sensitivity and 86.3% specificity. Additional presentation of the tachogram plus Poincaré plot significantly increased sensitivity and specificity to 95.5% ( < 0.001) and 92.5% ( < 0.001), respectively. The algorithm information did not further increase the accuracy to detect AF (sensitivity 97.5%, = 0.556; specificity 95.0%, = 0.182). Physicians detected AF on single-lead ECG tracings with 91.2% sensitivity and 93.9% specificity. Diagnostic accuracy was also not optimal on full 12-lead ECGs (93.9 and 98.6%, respectively). Notably, there was no significant difference between the performance of PPG waveform plus tachogram and Poincaré, compared to a single-lead ECG to detect or exclude AF (sensitivity = 0.672; specificity = 0.536). Physicians can detect AF on a PPG output with equivalent accuracy compared to single-lead ECG, if the PPG waveforms are presented together with a tachogram and Poincaré plot and the quality of the recordings is high.
本研究旨在比较医生基于光电容积脉搏波描记法（PPG）、单导联心电图和12导联心电图检测心房颤动（AF）的性能，并探讨PPG呈现为心动图和庞加莱图的增量价值，以及算法分类对医生解读的价值。向医生发送了参与在线调查的电子邮件邀请，以分析来自30名患者（10名处于窦性心律（SR）、10名处于伴有异位搏动的SR和10名处于AF）几乎同时记录的PPG、单导联心电图和12导联心电图轨迹。任务是将读数分类为“SR”、“异位/漏搏”、“AF”、“扑动”或“无法读取”。65名医生根据原始PPG波形检测或排除AF，灵敏度为88.8%，特异性为86.3%。心动图加庞加莱图的额外呈现显著提高了灵敏度和特异性，分别达到95.5%（P<0.001）和92.5%（P<0.001）。算法信息并未进一步提高检测AF的准确性（灵敏度97.5%，P = 0.556；特异性95.0%，P = 0.182）。医生在单导联心电图轨迹上检测AF的灵敏度为91.2%，特异性为93.9%。全12导联心电图的诊断准确性也不理想（分别为93.9%和98.6%）。值得注意的是，与单导联心电图检测或排除AF相比，PPG波形加心动图和庞加莱图的性能之间没有显著差异（灵敏度P = 0.672；特异性P = 0.536）。如果PPG波形与心动图和庞加莱图一起呈现且记录质量较高，医生在PPG输出上检测AF的准确性与单导联心电图相当。
