Buś Szymon, Jędrzejewski Konrad, Guzik Przemysław
Institute of Electronic Systems, Faculty of Electronics and Information Technology, Warsaw University of Technology, Nowowiejska 15/19, 00-665 Warsaw, Poland.
Department of Cardiology-Intensive Therapy and Internal Disease, Poznan University of Medical Sciences, 60-355 Poznan, Poland.
J Clin Med. 2023 Jan 15;12(2):687. doi: 10.3390/jcm12020687.
The ratio of the difference between neighboring RR intervals to the length of the preceding RR interval (x%) represents the relative change in the duration between two cardiac cycles. We investigated the diagnostic properties of the percentage of relative RR interval differences equal to or greater than x% (pRRx%) with x% in a range between 0.25% and 25% for the distinction of atrial fibrillation (AF) from sinus rhythm (SR).
We used 1-min ECG segments with RR intervals with either AF (32,141 segments) or SR (32,769 segments) from the publicly available Physionet Long-Term Atrial Fibrillation Database (LTAFDB). The properties of pRRx% for different x% were analyzed using the statistical procedures and metrics commonly used to characterize diagnostic methods.
The distributions of pRRx% for AF and SR differ significantly over the whole studied range of x% from 0.25% to 25%, with particularly outstanding diagnostic properties for the x% range of 1.5% to 6%. However, pRR3.25% outperformed other pRRx%. Firstly, it had one of the highest and closest to perfect areas under the curve (0.971). For pRR3.25%, the optimal threshold for distinction AF from SR was set at 75.32%. Then, the accuracy was 95.44%, sensitivity was 97.16%, specificity was 93.76%, the positive predictive value was 93.85%, the negative predictive value was 97.11%, and the diagnostic odds ratio was 514. The excellent diagnostic properties of pRR3.25% were confirmed in the publicly available MIT-BIH Atrial Fibrillation Database. In a direct comparison, pRR3.25% outperformed the diagnostic properties of pRR31 (the percentage of successive RR intervals differing by at least 31 ms), i.e., so far, the best single parameter differentiating AF from SR.
A family of pRRx% parameters has excellent diagnostic properties for AF detection in a range of x% between 1.5% and 6%. However, pRR3.25% outperforms other pRRx% parameters and pRR31 (until now, probably the most robust single heart rate variability parameter for AF diagnosis). The exquisite pRRx% diagnostic properties for AF and its simple computation make it well-suited for AF detection in modern ECG technologies (mobile/wearable devices, biopatches) in long-term monitoring. The diagnostic properties of pRRx% deserve further exploration in other databases with AF.
相邻RR间期差值与前一个RR间期长度的比值（x%）代表两个心动周期之间时长的相对变化。我们研究了相对RR间期差值百分比（pRRx%）在0.25%至25%范围内对区分心房颤动（AF）和窦性心律（SR）的诊断特性。
我们使用了公开可用的Physionet长期心房颤动数据库（LTAFDB）中1分钟的RR间期心电图片段，其中AF有32141段，SR有32769段。使用常用于表征诊断方法的统计程序和指标分析了不同x%时pRRx%的特性。
在整个研究的x%范围（从0.25%到25%）内，AF和SR的pRRx%分布有显著差异，在1.5%至6%的x%范围内具有特别突出的诊断特性。然而，pRR3.25%优于其他pRRx%。首先，它具有最高且最接近完美的曲线下面积之一（0.971）。对于pRR3.25%，区分AF和SR的最佳阈值设定为75.32%。然后，准确率为95.44%，灵敏度为97.16%，特异性为93.76%，阳性预测值为93.85%，阴性预测值为97.11%，诊断比值比为514。在公开可用的麻省理工学院 - 贝斯以色列女执事医疗中心（MIT - BIH）心房颤动数据库中证实了pRR3.25%的优异诊断特性。在直接比较中，pRR3.25%的诊断特性优于pRR31（连续RR间期相差至少31毫秒的百分比），即到目前为止区分AF和SR的最佳单一参数。
一系列pRRx%参数在1.5%至6%的x%范围内对AF检测具有优异的诊断特性。然而，pRR3.25%优于其他pRRx%参数和pRR31（直到现在，可能是用于AF诊断的最稳健的单一心率变异性参数）。pRRx%对AF的精确诊断特性及其简单的计算使其非常适合在现代心电图技术（移动/可穿戴设备、生物贴片）的长期监测中进行AF检测。pRRx%的诊断特性值得在其他有AF的数据库中进一步探索。
