Engineering topics

Schlegel, Todd T.

Publications and source records attributed to Schlegel, Todd T..

At least 19 records

NASA NTRS2018

Device and Method for Digital-To-Analog Transformations and Reconstructions of Multi-Channel Electrocardiograms

The present invention includes a method and apparatus for digital to analog conversion and reconstruction of multichannel electrocardiograms. The method may include receiving digital information representative of a plurality of independent signals, producing a plurality of analog outputs from said digital information wherein a first analog output is designated as a common reference, and imposing a predetermined voltage on a second analog output with respect to said common reference, which provides for a substantial recreation of the original independent signals. The apparatus may comprise a processor operable for receiving digital information representative of independent lead signals from a first ECG machine and digital to analog circuitry for substantially reproducing the original lead signals for analysis on a second ECG machine for convenient and efficient second opinions of cardiac data.

Schlegel, Todd T.↗

NASA NTRS2014

Reliability and Reproducibility of Advanced ECG Parameters in Month-to-Month and Year-to-Year Recordings in Healthy Subjects

Advanced resting ECG parameters such the spatial mean QRS-T angle and the QT variability index (QTVI) have important diagnostic and prognostic utility, but their reliability and reproducibility (R&R) are not well characterized. We hypothesized that the spatial QRS-T angle would have relatively higher R&R than parameters such as QTVI that are more responsive to transient changes in the autonomic nervous system. The R&R of several conventional and advanced ECG para-meters were studied via intraclass correlation coefficients (ICCs) and coefficients of variation (CVs) in: (1) 15 supine healthy subjects from month-to-month; (2) 27 supine healthy subjects from year-to-year; and (3) 25 subjects after transition from the supine to the seated posture. As hypothesized, for the spatial mean QRS-T angle and many conventional ECG parameters, ICCs we-re higher, and CVs lower than QTVI, suggesting that the former parameters are more reliable and reproducible.

Starc, Vito↗

NASA NTRS2012

Wireless Self-Acquistion of 12-Lead ECG via Android Smart Phone

Researchers at NASA s Johnson Space Center and at Orbital Research, Inc. (a NASA SBIR grant recipient) have recently developed a dry-electrode harness that allows for self-acquisition of resting 12-lead ECGs by minimally trained laypersons. When used in conjunction with commercial wireless (e.g., Bluetooth(TM) or 802.11-enabled) 12-lead ECG devices and custom smart phone-based software, the collected 12-lead ECG data can also immediately be forwarded from any geographic location within cellular range to the user s physician(s) of choice. The system can also be used to immediately forward to central receiving stations 12-lead ECG data collected during space flight or during activities in any remote terrestrial location supported by an internet or cellular phone infrastructure. The main novel aspects of the system are first, the dry-electrode 12-lead ECG harness itself, and second, an accompanying Android(TM) smart phone-based wireless 12-lead ECG capability. The ECG harness nominally employs dry electrodes manufactured by Orbital Research, Inc, recently cleared through the Food and Drug Administration (FDA). However, other dry electrodes that are not yet FDA cleared, for example those recently developed by Nanosonic, Inc as part of another NASA SBIR grant, can also be used. The various advantageous features of the harness include: 1) laypersons can be quickly instructed on its correct use, remotely if necessary; 2) all tangled "leadwire spaghetti" is eliminated, as is the common clinical problem of "leadwire reversal"; 3) all adhesives and disposables are also eliminated, the harness being fully reusable; if multiple individuals intend to use use the same harness, then standard antimicrobial wipes can be employed to sterilize the dry electrodes (and harness surface if needed) between users; 5) padded cushions at the lateral sides of the torso function to press the left arm (LA) and right arm (RA) dry electrodes mounted on the cushions against sideward or downward-rested arms of the subject; 6) sufficient distal placement of the arm electrodes achieves good electrode abutment to the arms without the need for adhesives, straps, bands, bracelets, or gloves; 7) padding over the sternum avoids "tenting" in the V1 through V3 (and, when present, the V3R) electrode positions; 8) easy-to-don, one-piece design with an adjustable, front-side single point of connection and an adjustable shoulder strap; and 9) Lund or "modified Lund" placement of the dry electrodes, the results of which more effectively reproduce results from "standard" 12-lead ECG placements than do results from Mason-Likar placements. The main limitation of the harness is that "one size does not fit all", meaning that an appropriately sized harness (small, medium, large, etc) must be chosen on the basis of an individual's size. To facilitate the use of the harness with inexpensive, commodity-grade cell phones and tablet devices, 12-lead ECG software is also being developed to accompany the harness for wireless use with Android. For this part of the project, NASA has teamed with TopCoder, Inc and the Harvard-affiliated NASA Tournament Lab in sponsoring java-based software programming contests through TopCoder. While ECG signals from the harness can already be wirelessly received and thoroughly processed (locally or remotely) by commercial-grade conventional (as well as advanced) 12-lead ECG software running on Microsoft Windows(TM), the Android-based software, once completed, will "cast a wider net" by allowing for a greater percentage of cell phone owners to participate in inexpensive, store-and-forward recordings of 12-lead ECGs worldwide, including for example Android cell phone users in many remote, third-world locations. At the time of writing, the Android 12-lead ECG software platform consists of a basic but expanding graphical user interface and accompanying software that: 1) wirelessly receives the 12-lead ECG data stream from a Bluetooth-based, FDA-cleared 12-leaCG device attached to the harness; 2) locally stores the same data in binary format to the SD card on the Android cell phone; and 3) makes the data stream in available in real time, for now to TopCoder's java programming contestants.

Schlegel, Todd T.↗

NASA NTRS2010

When Deriving the Spatial QRS-T Angle from the 12-lead ECG, which Transform is More Frank: Regression or Inverse Dower?

Our primary objective was to ascertain which commonly used 12-to-Frank-lead transformation yields spatial QRS-T angle values closest to those obtained from simultaneously collected true Frank-lead recordings. Simultaneous 12-lead and Frank XYZ-lead recordings were analyzed for 100 post-myocardial infarction patients and 50 controls. Relative agreement, with true Frank-lead results, of 12-to-Frank-lead transformed results for the spatial QRS-T angle using Kors regression versus inverse Dower was assessed via ANOVA, Lin s concordance and Bland-Altman plots. Spatial QRS-T angles from the true Frank leads were not significantly different than those derived from the Kors regression-related transformation but were significantly smaller than those derived from the inverse Dower-related transformation (P less than 0.001). Independent of method, spatial mean QRS-T angles were also always significantly larger than spatial maximum (peaks) QRS-T angles. Spatial QRS-T angles are best approximated by regression-related transforms. Spatial mean and spatial peaks QRS-T angles should also not be used interchangeably.

Schlegel, Todd T.↗

NASA NTRS2010

High Resolution ECG for Evaluation of Heart Function During Exposure to Subacute Hypobaric Hypoxia

High altitude climbing presents a wide spectrum of health risks, including exposure to hypobaric hypoxia. Risks are also typically exacerbated by the difficulty in appropriately monitoring for early signs of organ dysfunction in remote areas. We investigated whether high resolution advanced ECG analysis might be helpful as a non-invasive and easy-to-use tool (e.g., instead of Doppler echocardiography) for evaluating early signs of heart overload in hypobaric hypoxia. Nine non-acclimatized healthy trained alpine rescuers (age 43.7 plus or minus 7.3 years) climbed in four days to the altitude of 4,200 m on Mount Ararat. Five-minute high-resolution 12-lead electrocardiograms (ECGs) were recorded (Cardiosoft) in each subject at rest in the supine position on different days but at the same time of day at four different altitudes: 400 m (reference altitude), 1,700 m, 3,200 m and 4,200 m. Changes in conventional and advanced resting ECG parameters, including in beat-to-beat QT and RR variability, waveform complexity, signal-averaged, high-frequency and spatial/spatiotemporal ECG was estimated by calculation of the regression coefficients in independent linear regression models. A p-value of less than 0.05 was adopted as statistically significant. As expected, the RR interval and its variability both decreased with increasing altitude, with trends k = -96 ms/1000 m with p = 0.000 and k = -9 ms/1000 m with p = 0.001, respectively. Significant changes were found in P-wave amplitude, which nearly doubled from the lowest to the highest altitude (k = 41.6 microvolt/1000 m with p = 0.000), and nearly significant changes in P-wave duration (k = 2.9 ms/1000 m with p = 0.059). Changes were less significant or non-significant in other studied parameters including those of waveform complexity, signal-averaged, high-frequency and spatial/spatiotemporal ECG. High resolution ECG analysis, particularly of the P wave, shows promise as a tool for monitoring early changes in heart function due to exposure to high altitude.

Zupet, Petra↗

NASA NTRS2010

Equivalent Dipole Vector Analysis for Detecting Pulmonary Hypertension

Various 12-lead ECG criteria have been established to detect right ventricular hypertrophy as a marker of pulmonary hypertension (PH). While some criteria offer good specificity they lack sensitivity because of a low prevalence of positive findings in the PH population. We hypothesized that three-dimensional equivalent dipole (ED) model could serve as a better detection tool of PH. We enrolled: 1) 17 patients (12 female, 5 male, mean age 57 years, range 19-79 years) with echocardiographically detected PH (systolic pulmonary arterial pressure greater than 35 mmHg) and no significant left ventricular disease; and 2) 19 healthy controls (7 female, 12 male, mean age 44, range 31-53 years) with no known heart disease. In each subject we recorded a 5-minute high-resolution 12-lead conventional ECG and constructed principal signals using singular value decomposition. Assuming a standard thorax dimension of an adult person with homogenous and isotropic distribution of thorax conductance, we determined moving equivalent dipoles (ED), characterized by the 3D location in the thorax, dipolar strength and the spatial orientation, in time intervals of 5 ms. We used the sum of all ED vectors in the second half of the QRS complex to derive the amplitude of the right-sided ED vector (RV), if the orientation of ED was to the right side of the thorax, and in the first half the QRS to derive the amplitude of the left-sided vector (LV), if the orientation was leftward. Finally, the parameter RV/LV ratio was determined over an average of 256 complexes. The groups differed in age and gender to some extent. There was a non-significant trend toward higher RV in patients with PH (438 units 284) than in controls (280 plus or minus 140) (p = 0.066) but the overlap was such that RV alone was not a good predictor of PH. On the other hand, the RV/LV ratio was a better predictor of PH, with 11/17 (64.7%) of PH patients but only in 1/19 (5.3%) control subjects having RV/LV ratio greater than or equal to 0.70 (p less than 0.001). The use of ED for evaluating PH shows good specificity at a reasonable sensitivity. The results are limited due to the small study groups and differences in age and gender, but further investigations are warranted, including of ED's diagnostic accuracy for PH versus that of other proposed ECG and VCG criteria.

Harlander, Matevz↗

NASA NTRS2010

High Resolution ECG for Evaluation of QT Interval Variability during Exposure to Acute Hypoxia

Ventricular repolarization instability as quantified by the index of QT interval variability (QTVI) is one of the best predictors for risk of malignant ventricular arrhythmias and sudden cardiac death. Because it is difficult to appropriately monitor early signs of organ dysfunction at high altitude, we investigated whether high resolution advanced ECG (HR-ECG) analysis might be helpful as a non-invasive and easy-to-use tool for evaluating the risk of cardiac arrhythmias during exposure to acute hypoxia. 19 non-acclimatized healthy trained alpinists (age 37, 8 plus or minus 4,7 years) participated in the study. Five-minute high-resolution 12-lead electrocardiograms (ECGs) were recorded (Cardiosoft) in each subject at rest in the supine position breathing room air and then after breathing 12.5% oxygen for 30 min. For beat-to-beat RR and QT variability, the program of Starc was utilized to derive standard time domain measures such as root mean square of the successive interval difference (rMSSD) of RRV and QTV, the corrected QT interval (QTc) and the QTVI in lead II. Changes were evaluated with paired-samples t-test with p-values less than 0.05 considered statistically significant. As expected, the RR interval and its variability both decreased with increasing altitude, with p = 0.000 and p = 0.005, respectively. Significant increases were found in both the rMSSDQT and the QTVI in lead II, with p = 0.002 and p = 0.003, respectively. There was no change in QTc interval length (p = non significant). QT variability parameters may be useful for evaluating changes in ventricular repolarization caused by hypoxia. These changes might be driven by increases in sympathetic nervous system activity at ventricular level.

Zupet, P.↗

NASA NTRS2009

Real-time, high frequency QRS electrocardiograph with reduced amplitude zone detection

Real time cardiac electrical data are received from a patient, manipulated to determine various useful aspects of the ECG signal, and displayed in real time in a useful form on a computer screen or monitor. The monitor displays the high frequency data from the QRS complex in units of microvolts, juxtaposed with a display of conventional ECG data in units of millivolts or microvolts. The high frequency data are analyzed for their root mean square (RMS) voltage values and the discrete RMS values and related parameters are displayed in real time. The high frequency data from the QRS complex are analyzed with imbedded algorithms to determine the presence or absence of reduced amplitude zones, referred to herein as ''RAZs''. RAZs are displayed as ''go, no-go'' signals on the computer monitor. The RMS and related values of the high frequency components are displayed as time varying signals, and the presence or absence of RAZs may be similarly displayed over time.

Schlegel, Todd T.↗

NASA NTRS2008

System for the diagnosis and monitoring of coronary artery disease, acute coronary syndromes, cardiomyopathy and other cardiac conditions

Cardiac electrical data are received from a patient, manipulated to determine various useful aspects of the ECG signal, and displayed and stored in a useful form using a computer. The computer monitor displays various useful information, and in particular graphically displays various permutations of reduced amplitude zones and kurtosis that increase the rapidity and accuracy of cardiac diagnoses. New criteria for reduced amplitude zones are defined that enhance the sensitivity and specificity for detecting cardiac abnormalities.

Schlegel, Todd T.↗

NASA NTRS2007

High-frequency Electrocardiogram Analysis in the Ability to Predict Reversible Perfusion Defects during Adenosine Myocardial Perfusion Imaging

Background: A previous study has shown that analysis of high-frequency QRS components (HF-QRS) is highly sensitive and reasonably specific for detecting reversible perfusion defects on myocardial perfusion imaging (MPI) scans during adenosine. The purpose of the present study was to try to reproduce those findings. Methods: 12-lead high-resolution electrocardiogram recordings were obtained from 100 patients before (baseline) and during adenosine Tc-99m-tetrofosmin MPI tests. HF-QRS were analyzed regarding morphology and changes in root mean square (RMS) voltages from before the adenosine infusion to peak infusion. Results: The best area under the curve (AUC) was found in supine patients (AUC=0.736) in a combination of morphology and RMS changes. None of the measurements, however, were statistically better than tossing a coin (AUC=0.5). Conclusion: Analysis of HF-QRS was not significantly better than tossing a coin for determining reversible perfusion defects on MPI scans.

Tragardh, Elin↗

NASA NTRS2006

Real-time, high frequency QRS electrocardiograph

Real time cardiac electrical data are received from a patient, manipulated to determine various useful aspects of the ECG signal, and displayed in real time in a useful form on a computer screen or monitor. The monitor displays the high frequency data from the QRS complex in units of microvolts, juxtaposed with a display of conventional ECG data in units of millivolts or microvolts. The high frequency data are analyzed for their root mean square (RMS) voltage values and the discrete RMS values and related parameters are displayed in real time. The high frequency data from the QRS complex are analyzed with imbedded algorithms to determine the presence or absence of reduced amplitude zones, referred to herein as RAZs. RAZs are displayed as go, no-go signals on the computer monitor. The RMS and related values of the high frequency components are displayed as time varying signals, and the presence or absence of RAZs may be similarly displayed over time.

Schlegel, Todd T.↗

NASA NTRS2006

Construction of a Resting High Fidelity ECG "SuperScore" for Management and Screening of Heart Disease

Resting conventional ECG is notoriously insensitive for detecting coronary artery disease (CAD) and only nominally useful in screening for cardiomyopathy (CM). Similarly, conventional exercise stress test ECG is both time- and labor-consuming and its accuracy in identifying CAD is suboptimal for use in population screening. We retrospectively investigated the accuracy of several advanced resting electrocardiographic (ECG) parameters, both alone and in combination, for detecting CAD and cardiomyopathy (CM).

Schlegel, Todd T.↗

NASA NTRS2006

Effect of DC Offset on the T-Wave Residuum Parameter

The T-wave residuum (TWR) is a relatively new 12-lead ECG parameter that may reflect cardiac repolarization heterogeneity. TWR shows clinical promise and may become an important diagnostic tool if accurate, consistent, and convenient methods for its calculation can be developed. However, there are discrepancies between the methods that various investigators have used to calculate TWR, as well as some questions about basic methodology and assumptions that require resolution. The presence of a DC offset or very low frequency AC component to the ECG is often observed. Many researchers have attempted to compensate for these by high pass filters and by median beat techniques. These techniques may help minimize the contribution of a low frequency AC component to the TWR, but they will not eliminate a DC offset inherent within the instrumentation. The present study examined the presence of DC offsets in the ECG record, and their effect on TWR. Specifically, in healthy individuals, a DC offset was added to all 8 channels collectively or to each channel selectively. Even with offsets that were relatively small compared to T-wave amplitude, the addition of either collectively or individually applied offsets was observed to produce very significant changes in the TWR, affecting its value by as much as an order of magnitude. These DC offsets may arise from at least two possible sources: a transient artifact from EMG or electrode movement resulting in a transient baseline offset in one or more channels. Since highpass filters have a settling time of several seconds, these artifacts will contribute to a transitory baseline offset lasting 1020 cycles. The machine hardware may also introduce an offset. Regardless of the cause or source of a DC offset, this study demonstrates that offsets have a very significant impact on TWR, and that future studies must not ignore their presence, but rather more appropriately compensate for them.

Scott, N.↗

NASA NTRS2006

Month-to-Month and Year-to-Year Reproducibility of High Frequency QRS ECG signals

High frequency (HF) electrocardiography analyzing the entire QRS complex in the frequency range of 150 to 250 Hz may prove useful in the detection of coronary artery disease, yet the long-term stability of these waveforms has not been fully characterized. We therefore prospectively investigated the reproducibility of the root mean squared (RMS) voltage, kurtosis, and the presence versus absence of reduced amplitude zones (RAzs) in signal averaged 12-lead HF QRS recordings acquired in the supine position one month apart in 16 subjects and one year apart in 27 subjects. Reproducibility of RMS voltage and kurtosis was excellent over these time intervals in the limb leads, and acceptable in the precordial leads using both the V-lead and CR-lead derivations. The relative error of RMS voltage was 12% month-to-month and 16% year-to-year in the serial recordings when averaged over all 12 leads. RAzs were also reproducible at a rate of up to 87% and 8 1 %, respectively, for the month-to-month and year-to-year recordings. We conclude that 12-lead HF QRS electrocardiograms are sufficiently reproducible for clinical use.

Batdorf, Niles↗

NASA NTRS2006

High-frequency ECG

The standard ECG is by convention limited to 0.05-150 Hz, but higher frequencies are also present in the ECG signal. With high-resolution technology, it is possible to record and analyze these higher frequencies. The highest amplitudes of the high-frequency components are found within the QRS complex. In past years, the term "high frequency", "high fidelity", and "wideband electrocardiography" have been used by several investigators to refer to the process of recording ECGs with an extended bandwidth of up to 1000 Hz. Several investigators have tried to analyze HF-QRS with the hope that additional features seen in the QRS complex would provide information enhancing the diagnostic value of the ECG. The development of computerized ECG-recording devices that made it possible to record ECG signals with high resolution in both time and amplitude, as well as better possibilities to store and process the signals digitally, offered new methods for analysis. Different techniques to extract the HF-QRS have been described. Several bandwidths and filter types have been applied for the extraction as well as different signal-averaging techniques for noise reduction. There is no standard method for acquiring and quantifying HF-QRS. The physiological mechanisms underlying HF-QRS are still not fully understood. One theory is that HF-QRS are related to the conduction velocity and the fragmentation of the depolarization wave in the myocardium. In a three-dimensional model of the ventricles with a fractal conduction system it was shown that high numbers of splitting branches are associated with HF-QRS. In this experiment, it was also shown that the changes seen in HF-QRS in patients with myocardial ischemia might be due to the slowing of the conduction velocity in the region of ischemia. This mechanism has been tested by Watanabe et al by infusing sodium channel blockers into the left anterior descending artery in dogs. In their study, 60 unipolar ECGs were recorded from the entire ventricular surface and were signal-averaged and filtered in the 30-250 Hz frequency range. The results showed that the decrease noted in the HF-QRS correlated linearly with the local conduction delay. The results suggest that HF-QRS is a potent indicator of disturbed local conduction. An alternative theory is that HF-QRS reflect the shape of the original electrocardiographic signal. Bennhagen et al showed that root mean square (RMS) voltage values of the depolarization signal correlate poorly with the signal amplitude but highly with the first and second derivatives, i.e. the velocity and the acceleration of the signal. It has also been suggested that the autonomic nervous system affects HF-QRS. For example, sitting up causes significant changes in HF-QRS in some leads compared to the supine position [Douglas et al., 2006]. Unpublished results indicate that familial dysautonomic patients (both vagal and sympathetic degeneration) have very little Reduced Amplitude Zones (RAZ) formation . Athletic individuals, especially elite athletes, who have vagally-mediated changes on the conventional ECG (i.e. early repolarization, bradycardia) have increased RAZ formation. Further electrophysiological studies are needed, however, to better understand the underlying mechanisms of HF-QRS. Several investigators have studied HF-QRS in different cardiac conditions, including acute myocardial ischemia and myocardial infarction (MI). However, in order for clinicians to confidently use HF-QRS as an adjunct to standard ECG, more knowledge about the characteristics of HF-QRS is needed.

Tragardh, Elin↗

NASA NTRS2006

Realtime Multichannel System for Beat to Beat QT Interval Variability

The measurement of beat-to-beat QT interval variability (QTV) shows clinical promise for identifying several types of cardiac pathology. However, until now, there has been no device capable of displaying, in real time on a beattobeat basis, changes in QTV in all 12 conventional leads in a continuously monitored patient. While several software programs have been designed to analyze QTV, heretofore, such programs have all involved only a few channels (at most) and/or have required laborious user interaction or offline calculations and postprocessing, limiting their clinical utility. This paper describes a PC-based ECG software program that in real time, acquires, analyzes and displays QTV and also PQ interval variability (PQV) in each of the eight independent channels that constitute the 12lead conventional ECG. The system also processes certain related signals that are derived from singular value decomposition and that help to reduce the overall effects of noise on the realtime QTV and PQV results.

Starc, Vito↗

NASA NTRS2006

Noninvasive Diagnosis of Coronary Artery Disease Using 12-Lead High-Frequency Electrocardiograms

A noninvasive, sensitive method of diagnosing certain pathological conditions of the human heart involves computational processing of digitized electrocardiographic (ECG) signals acquired from a patient at all 12 conventional ECG electrode positions. In the processing, attention is focused on low-amplitude, high-frequency components of those portions of the ECG signals known in the art as QRS complexes. The unique contribution of this method lies in the utilization of signal features and combinations of signal features from various combinations of electrode positions, not reported previously, that have been found to be helpful in diagnosing coronary artery disease and such related pathological conditions as myocardial ischemia, myocardial infarction, and congestive heart failure. The electronic hardware and software used to acquire the QRS complexes and perform some preliminary analyses of their high-frequency components were summarized in Real-Time, High-Frequency QRS Electrocardiograph (MSC- 23154), NASA Tech Briefs, Vol. 27, No. 7 (July 2003), pp. 26-28. To recapitulate, signals from standard electrocardiograph electrodes are preamplified, then digitized at a sampling rate of 1,000 Hz, then analyzed by the software that detects R waves and QRS complexes and analyzes them from several perspectives. The software includes provisions for averaging signals over multiple beats and for special-purpose nonrecursive digital filters with specific low- and high-frequency cutoffs. These filters, applied to the averaged signal, effect a band-pass operation in the frequency range from 150 to 250 Hz. The output of the bandpass filter is the desired high-frequency QRS signal. Further processing is then performed in real time to obtain the beat-to-beat root mean square (RMS) voltage amplitude of the filtered signal, certain variations of the RMS voltage, and such standard measures as the heart rate and R-R interval at any given time. A key signal feature analyzed in the present method is the presence versus the absence of reduced-amplitude zones (RAZs). In terms that must be simplified for the sake of brevity, an RAZ comprises several cycles of a high-frequency QRS signal during which the amplitude of the high-frequency oscillation in a portion of the signal is abnormally low (see figure). A given signal sample exhibiting an interval of reduced amplitude may or may not be classified as an RAZ, depending on quantitative criteria regarding peaks and troughs within the reduced-amplitude portion of the high-frequency QRS signal. This analysis is performed in all 12 leads in real time.

Schlegel, Todd T.↗

NASA NTRS2005

High Frequency QRS ECG Accurately Detects Cardiomyopathy

High frequency (HF, 150-250 Hz) analysis over the entire QRS interval of the ECG is more sensitive than conventional ECG for detecting myocardial ischemia. However, the accuracy of HF QRS ECG for detecting cardiomyopathy is unknown. We obtained simultaneous resting conventional and HF QRS 12-lead ECGs in 66 patients with cardiomyopathy (EF = 23.2 plus or minus 6.l%, mean plus or minus SD) and in 66 age- and gender-matched healthy controls using PC-based ECG software recently developed at NASA. The single most accurate ECG parameter for detecting cardiomyopathy was an HF QRS morphological score that takes into consideration the total number and severity of reduced amplitude zones (RAZs) present plus the clustering of RAZs together in contiguous leads. This RAZ score had an area under the receiver operator curve (ROC) of 0.91, and was 88% sensitive, 82% specific and 85% accurate for identifying cardiomyopathy at optimum score cut-off of 140 points. Although conventional ECG parameters such as the QRS and QTc intervals were also significantly longer in patients than controls (P less than 0.001, BBBs excluded), these conventional parameters were less accurate (area under the ROC = 0.77 and 0.77, respectively) than HF QRS morphological parameters for identifying underlying cardiomyopathy. The total amplitude of the HF QRS complexes, as measured by summed root mean square voltages (RMSVs), also differed between patients and controls (33.8 plus or minus 11.5 vs. 41.5 plus or minus 13.6 mV, respectively, P less than 0.003), but this parameter was even less accurate in distinguishing the two groups (area under ROC = 0.67) than the HF QRS morphologic and conventional ECG parameters. Diagnostic accuracy was optimal (86%) when the RAZ score from the HF QRS ECG and the QTc interval from the conventional ECG were used simultaneously with cut-offs of greater than or equal to 40 points and greater than or equal to 445 ms, respectively. In conclusion 12-lead HF QRS ECG employing RAZ scoring is a simple, accurate and inexpensive screening technique for cardiomyopathy. Although HF QRS ECG is highly sensitive for cardiomyopathy, its specificity may be compromised in patients with cardiac pathologies other than cardiomyopathy, such as uncomplicated coronary artery disease or multiple coronary disease risk factors. Further studies are required to determine whether HF QRS might be useful for monitoring cardiomyopathy severity or the efficacy of therapy in a longitudinal fashion.

Schlegel, Todd T.↗