Screening for RV Dysfunction Using Smartphone ECG Analysis App: Validation Study with Acute Pulmonary Embolism Patients
Abstract
:1. Introduction
2. Methods
2.1. Study Design and Data Collection
2.2. Assessment of RV Function
2.3. ECG Analysis by AI Application
2.4. Expert Analysis of ECGs
2.5. Statistical Analysis
3. Results
4. Discussion
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Presence of RV Dysfunction | ||||
---|---|---|---|---|
No (N = 81) | Yes (N = 35) | |||
Demographics | Age, years, median (IQR) | 72.0 (50.0–81.0) | 67.0 (45.5–77.0) | 0.388 |
Sex, male, N (%) | 35 (43.2%) | 14 (40.0%) | 0.907 | |
Weight, kilograms, median (IQR) | 61.3 (50.2–73.8) | 55.8 (53.0–74.0) | 0.946 | |
Height, centimeters, median (IQR) | 160.0 (155.0–170.0) | 162.0 (157.0–168.0) | 0.781 | |
Risk Factors of PTE | Diabetes Mellitus, N (%) | 18 (22.2%) | 5 (14.3%) | 0.465 |
Hypertension, N (%) | 37 (45.7%) | 12 (34.3%) | 0.350 | |
Coronary artery occlusive disease, N (%) | 7 (8.6%) | 3 (8.6%) | 1.000 | |
Cerebrovascular disease, N (%) | 10 (12.3%) | 1 (2.9%) | 0.209 | |
Current smoker, N (%) | 5 (6.2%) | 3 (8.6%) | 0.945 | |
Prolonged immobility (>1 week), N (%) | 18 (22.2%) | 8 (22.9%) | 1.000 | |
Recent trauma or surgery (within 3 months), N (%) | 16 (19.8%) | 13 (37.1%) | 0.080 | |
Active malignancy, N (%) | 18 (22.2%) | 3 (8.6%) | 0.136 | |
Infectious disease (within 3 months), N (%) | 19 (23.5%) | 3 (8.6%) | 0.105 | |
Hormone treatment, N (%) | 2 (2.5%) | 1 (2.9%) | 1.000 | |
History of pulmonary thromboembolism, N (%) | 10 (12.3%) | 4 (11.4%) | 1.000 | |
History of deep vein thrombosis, N (%) | 0 (0.0%) | 3 (8.6%) | 0.042 | |
Vital Signs | Systolic blood pressure, mean (SD) | 130.0 (26.1) | 129.4 (26.6) | 0.915 |
Diastolic blood pressure, mean (SD) | 82.2 (17.7) | 81.0 (15.1) | 0.734 | |
Pulse rate, median (IQR) | 99.0 (81.5–115.5) | 101.0 (90.0–117.0) | 0.150 | |
Respiratory rate, median (IQR) | 20.0 (18.0–22.0) | 21.0 (20.0–24.0) | 0.092 | |
Laboratory Measurements | White blood cell, 109/L, median (IQR) | 9.2 (7.4–13.1) | 10.0 (7.3–13.5) | 0.740 |
Hemoglobin, g/dL, mean (SD) | 12.1 (2.4) | 12.4 (2.3) | 0.486 | |
Aspartate transaminase, U/L, median (IQR) | 22.5 (16.0–35.0) | 32.0 (25.0–56.0) | 0.003 | |
Alanine transaminase, U/L, median (IQR) | 19.0 (12.0–34.0) | 30.0 (18.0–60.5) | 0.017 | |
Blood urea nitrogen, mg/dL, median (IQR) | 14.9 (11.0–22.4) | 14.3 (11.5–19.6) | 0.551 | |
Creatinine, mg/dL, median (IQR) | 0.9 (0.7–1.1) | 0.8 (0.7–1.1) | 0.440 | |
Troponin I, μg/mL, median (IQR) | 0.052 (0.019–0.266) | 0.176 (0.075–0.723) | 0.034 | |
ProBNP, pg/mL, median (IQR) | 482.0 (140.0–2400.0) | 1366.0 (576.0–4733.0) | 0.024 | |
D-dimer, mg/L, median (IQR) | 3.6 (2.1–12.3) | 4.6 (2.8–10.7) | 0.599 | |
Lactate, mg/dL, median (IQR) | 1.0 (0.8–2.3) | 2.0 (1.1–2.3) | 0.097 | |
Heart rhythm (on ECG) | 0.117 | |||
Sinus Rhythm, N (%) | 52 (64.2%) | 14 (41.2%) | ||
Sinus Tachycardia, N (%) | 22 (27.2%) | 16 (47.1%) | ||
Atrial Fibrillation, N (%) | 3 (3.7%) | 1 (2.9%) | ||
Multifocal Atrial Tachycardia, N (%) | 2 (2.5%) | 0 (0.0%) | ||
Sinus Arrhythmia, N (%) | 1 (1.2%) | 0 (0.0%) | ||
Atrial Rhythm, N (%) | 0 (0.0%) | 1 (2.9%) | ||
Wandering Atrial Rhythm, N (%) | 0 (0.0%) | 1 (2.9%) | ||
Undetermined Rhythm, N (%) | 1 (1.2%) | 1 (2.9%) | ||
Right Ventricular Systolic Pressure (RVSP) | <0.001 | |||
RVSP I (<35 mmHg), N (%) | 61 (75.3%) | 4 (11.4%) | ||
RVSP II (35–49 mmHg), N (%) | 15 (18.5%) | 12 (34.3%) | ||
RVSP III (50–64 mmHg), N (%) | 5 (6.2%) | 10 (28.6%) | ||
RVSP IV (>64 mmHg), N (%) | 0 (0.0%) | 9 (25.7%) | ||
Time of the test | ED arrival to ECG, hours, median (IQR) | 1.0 (0.6–1.6) | 0.8 (0.6–1.3) | 0.388 |
ED arrival to echocardiography, hours, median (IQR) | 22.1 (16.0–35.6) | 16.1 (4.8–27.5) | 0.036 | |
ECG to echocardiography, hours, median (IQR) | 20.4 (14.9–34.0) | 13.8 (4.3–26.1) | 0.045 |
QCG Biomarker | Group | Biomarker Measurements, Median (IQR) | p |
---|---|---|---|
QCG-RVDys | RVD | 6.8 (2.5–22.5) | <0.001 (for difference) |
No RVD | 78.7 (35.7–94.9) | ||
QCG-PHTN | RVSP I (<35 mmHg) | 8.1 (2.1–22.9) | <0.001 (for both difference and trend) |
RVSP II (35–49 mmHg) | 21.7 (13.4–38.3) | ||
RVSP III (50–64 mmHg) | 41.6 (31.2–65.1) | ||
RVSP IV (>64 mmHg) | 49.2 (19.9–85.4) |
Biomarker | AUC | p for Difference | Sensitivity (95% CI) | Specificity (95% CI) | PPV (95% CI) | NPV (95% CI) | Threshold |
---|---|---|---|---|---|---|---|
QCG-RVDys (continuous scale) | 0.895 (0.829–0.960) | - | 91.2 (82.4–100) | 77.8 (69.1–86.4) | 63.3 (54.4–73.9) | 95.5 (90.8–100) | 24.65 |
Troponin I | 0.692 (0.536–0.847) | 0.046 | 81.2 (62.5–100) | 54.8 (38.7–71) | 48.1 (37.5–61.1) | 85 (70.6–100) | 0.0685 μg/mL |
ProBNP | 0.655 (0.532–0.778) | 0.001 | 80.8 (65.4–96.2) | 53.4 (39.7–65.5) | 43.8 (35.6–52.5) | 86.4 (75.8–96.3) | 534.5 pg/mL |
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Choi, Y.J.; Park, M.J.; Cho, Y.; Kim, J.; Lee, E.; Son, D.; Kim, S.-Y.; Soh, M.S. Screening for RV Dysfunction Using Smartphone ECG Analysis App: Validation Study with Acute Pulmonary Embolism Patients. J. Clin. Med. 2024, 13, 4792. https://doi.org/10.3390/jcm13164792
Choi YJ, Park MJ, Cho Y, Kim J, Lee E, Son D, Kim S-Y, Soh MS. Screening for RV Dysfunction Using Smartphone ECG Analysis App: Validation Study with Acute Pulmonary Embolism Patients. Journal of Clinical Medicine. 2024; 13(16):4792. https://doi.org/10.3390/jcm13164792
Chicago/Turabian StyleChoi, Yoo Jin, Min Ji Park, Youngjin Cho, Joonghee Kim, Eunkyoung Lee, Dahyeon Son, Seo-Yoon Kim, and Moon Seung Soh. 2024. "Screening for RV Dysfunction Using Smartphone ECG Analysis App: Validation Study with Acute Pulmonary Embolism Patients" Journal of Clinical Medicine 13, no. 16: 4792. https://doi.org/10.3390/jcm13164792