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Search Results (6)

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Keywords = aVL − S V1

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13 pages, 545 KiB  
Article
The Diagnostic Accuracy of an Electrocardiogram in Pulmonary Hypertension and the Role of “R V1, V2 + S I, aVL − S V1”
by Lukas Ley, Christoph B. Wiedenroth, Stefan Guth, Christian Gold, Athiththan Yogeswaran, Hossein Ardeschir Ghofrani and Dirk Bandorski
J. Clin. Med. 2024, 13(24), 7613; https://doi.org/10.3390/jcm13247613 - 13 Dec 2024
Viewed by 960
Abstract
Background: Pulmonary hypertension (PH) can cause characteristic electrocardiographic (ECG) changes due to right ventricular hypertrophy and/or strain. The aims of the present study were to explore the diagnostic accuracy of ECG parameters for the diagnosis of PH, applying the recently adjusted mean [...] Read more.
Background: Pulmonary hypertension (PH) can cause characteristic electrocardiographic (ECG) changes due to right ventricular hypertrophy and/or strain. The aims of the present study were to explore the diagnostic accuracy of ECG parameters for the diagnosis of PH, applying the recently adjusted mean pulmonary artery pressure (mPAP) threshold of >20 mmHg, and to determine the role of “R V1, V2 + S I, aVL − S V1”. Methods: Between July 2012 and November 2023, 100 patients without PH, with pulmonary arterial hypertension, or with chronic thromboembolic pulmonary hypertension were retrospectively enrolled. Results: The sensitivity and specificity of the ECG parameters for the diagnosis of PH varied from 3 to 98% and from 3 to 100% (means: 39% and 87%). After optimising the parameters’ cut-offs, the mean sensitivity (39% to 66%) increased significantly but the mean specificity (87% to 74%) slightly decreased. “R V1, V2 + S I, aVL − S V1” was able to predict an mPAP >20 mmHg (OR: 34.33; p < 0.001) and a pulmonary vascular resistance >5 WU (OR: 17.14, p < 0.001) but could not predict all-cause mortality. Conclusions: Even with improved cut-offs, ECG parameters alone are not able to reliably diagnose or exclude PH because of their low sensitivity. However, they still might be helpful to reveal a suspicion of PH, especially in early diagnostic stages, e.g., in primary care with general practitioners or non-specialised cardiologists and pulmonologists. “R V1, V2 + S I, aVL − S V1” was able to predict the diagnosis of (severe) PH but could not predict all-cause mortality. Nevertheless, it can still be useful in risk stratification. Full article
(This article belongs to the Special Issue Advances in the Diagnosis and Treatment of Pulmonary Hypertension)
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13 pages, 631 KiB  
Systematic Review
Community-Based Interventions in People with Palliative Care Needs: An Integrative Review of Studies from 2017 to 2022
by Antonia Vélez-López, Juan Manuel Carmona-Torres, Ángel López-González, José Alberto Laredo-Aguilera, David Callado-Pérez and Joseba Rabanales-Sotos
Healthcare 2024, 12(15), 1477; https://doi.org/10.3390/healthcare12151477 - 25 Jul 2024
Cited by 1 | Viewed by 2353
Abstract
Aim: To describe the latest scientific evidence regarding community-based interventions performed on patients in need of palliative care worldwide. Introduction and background: Given the rise of chronic diseases, their complexities and the fragility of patients, we are facing around 56.8 million people in [...] Read more.
Aim: To describe the latest scientific evidence regarding community-based interventions performed on patients in need of palliative care worldwide. Introduction and background: Given the rise of chronic diseases, their complexities and the fragility of patients, we are facing around 56.8 million people in need of palliative care. Community-based healthcare, particularly palliative care, can address social inequalities and improve the biopsychosocial health of disadvantaged populations. Therefore, primary care, as the main health referent in the community, has a central role in the care of these patients. Methods: This is an integrative review from January 2017 to June 2022 that follows the PRISMA statement and has been registered in PROSPERO. PubMed, Cuiden, the Web of Science (WoS), Cochrane and LILACS were the five databases searched. The scientific quality assessment of the articles was carried out following the CASPe methodology. Study selection was carried out by two researchers, A.V.L. and J.M.C.T., using the inclusion and exclusion criteria mentioned below. In cases of doubt or discrepancy, a third author (J.R.S.) was consulted. Results: The interventions mentioned in the 16 articles analysed were classified under the following categories: music therapy, laughter therapy, spiritual and cognitive interventions, aromatherapy, interdisciplinary and community-based teams, advance care planning and community, volunteering, telemedicine and care mapping. Example: Educating people to talk about different ethical issues could improve their quality of life and help develop more compassionate cities. Conclusions: We have identified interventions that are easily accessible (laughter therapy, telemedicine or music therapy), simple enough to be carried out at the community level and do not incur high costs. This is why they are recommended for people with palliative care needs in order to improve their quality of life. Full article
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13 pages, 272 KiB  
Article
Electrocardiography versus Echocardiography in Severe Aortic Stenosis with the Consideration of Coexistent Coronary Artery Disease
by Michał Chyrchel, Wojciech Siłka, Mateusz Wylaź, Wiktor Wójcik and Andrzej Surdacki
J. Clin. Med. 2024, 13(4), 1013; https://doi.org/10.3390/jcm13041013 - 9 Feb 2024
Viewed by 1521
Abstract
(1) Background: Coexistent coronary artery disease (CAD) might influence the ability of electrocardiogram (ECG) to identify echocardiographic left ventricular hypertrophy (ECHO-LVH) in patients with aortic stenosis (AS). We aimed to assess the relation between ECG–LVH (by the Sokolov–Lyon or Cornell criteria) and ECHO-LVH [...] Read more.
(1) Background: Coexistent coronary artery disease (CAD) might influence the ability of electrocardiogram (ECG) to identify echocardiographic left ventricular hypertrophy (ECHO-LVH) in patients with aortic stenosis (AS). We aimed to assess the relation between ECG–LVH (by the Sokolov–Lyon or Cornell criteria) and ECHO-LVH considering coexistent CAD. (2) Methods: We retrospectively analyzed the medical records of 74 patients (36 males) with severe AS who were hospitalized in the University Hospital in Cracow from 2021 to 2022. (3) Results: ECHO-LVH was present in 49 (66%) patients, whereas 35 (47.3%) patients had ECG-LVH. There was no difference between the rate of ECG-LVH in patients with vs. without ECHO-LVH. Single-vessel and multi-vessel CAD were diagnosed by invasive coronary angiography in 18% and 11% of patients, respectively. The sensitivity of the classical ECG-LVH criteria with regard to ECHO-LVH was low, reaching at best 41% for the Sokolov–Lyon and Cornell criteria. The results were similar and lacked a pattern when considering patients without significant stenosis, with single- and multi-vessel disease separately. Correlations between the left ventricular mass index and ECG-derived parameters were weak and present solely for the Lewis index (r = 0.31), R wave’s amplitude >1.1 mV in aVL (r = 0.36), as well as the Cornell (r = 0.32) and Sokolov–Lyon (r = 0.31) voltage criteria (p < 0.01). The presence, location of stenoses, and CAD extent were not associated with the presence of either ECHO-LVH or ECG-LVH, irrespective of individual ECG-LVH criteria. (4) Conclusions: The sensitivity of classical ECG criteria for echocardiographic LVH in severe AS is low, regardless of coexistent CAD or its angiographic extent. Full article
(This article belongs to the Section Cardiology)
15 pages, 1604 KiB  
Article
Analysis of Electrocardiographic Criteria of Right Ventricular Hypertrophy in Patients with Chronic Thromboembolic Pulmonary Hypertension before and after Balloon Pulmonary Angioplasty
by Lukas Ley, Christoph B. Wiedenroth, Hossein Ardeschir Ghofrani, Reinhard Hoeltgen and Dirk Bandorski
J. Clin. Med. 2023, 12(13), 4196; https://doi.org/10.3390/jcm12134196 - 21 Jun 2023
Cited by 7 | Viewed by 1973
Abstract
Background: Chronic thromboembolic pulmonary hypertension (CTEPH) may lead to typical electrocardiographic changes that can be reversed by balloon pulmonary angioplasty (BPA). The aim of this study was to investigate the significance of rarely used electrocardiogram (ECG) parameters, possible electrocardiographic differences between residual and [...] Read more.
Background: Chronic thromboembolic pulmonary hypertension (CTEPH) may lead to typical electrocardiographic changes that can be reversed by balloon pulmonary angioplasty (BPA). The aim of this study was to investigate the significance of rarely used electrocardiogram (ECG) parameters, possible electrocardiographic differences between residual and significantly improved CTEPH and the role of electrocardiographic parameters in low mPAP (mean pulmonary arterial pressure) ranges since the mPAP threshold for the definition of pulmonary hypertension has recently been adjusted (≥25 mmHg to >20 mmHg). Material and Methods: Between March 2014 and October 2020, 140 patients with CTEPH and 10 with CTEPD (chronic thromboembolic pulmonary disease) without pulmonary hypertension (PH) were retrospectively enrolled (12-lead ECG and right heart catheterization before and 6 months after BPA). The ECG parameters of right heart strain validated by studies and clinical experience were evaluated. Special attention was paid to six specific ECG parameters. After BPA, the cohort was divided into subgroups to investigate possible electrocardiographic differences with regard to the haemodynamic result. Results: The present study confirmed that the typical electrocardiographic signs of CTEPH can be found on an ECG, can regress after BPA and partially correlate well with haemodynamic parameters. “R V1, V2 + S I, aVL − S V1” was a parameter of particular note. BPA reduced its frequency (47% vs. 29%) statistically significantly after Bonferroni correction (p < 0.001). Moreover, it showed a good correlation with mPAP and PVR (r-values: 0.372–0.519, p-values: < 0.001). Exceeding its cut-off value before therapy was associated with more severe CTEPH before therapy (higher mPAP, PVR, NT-pro-BNP and troponin and lower TAPSE) and an increased risk of death. Exceeding its cut-off value before and after therapy was associated with more severe CTEPH after therapy (higher RAP, mPAP, PVR, NT-pro-BNP and NYHA class) and an increased risk of death. Men tend to be affected more frequently. After subgrouping, it was observed that a higher median mPAP was associated with a higher right atrial pressure (RAP), a higher pulmonary vascular resistance (PVR) and a lower cardiac output (CO) before and after BPA. In addition, under these conditions, more and more severe electrocardiographic pathologies were detected before and after BPA. Some patients with low mPAP also continued to show mild ECG changes after BPA. In some cases, very few to no pathological ECG changes were detected, and the ECG could present as mostly normal in some patients (5% before BPA and 13% after BPA). Conclusion: “R V1, V2 + S I, aVL − S V1” seems to be able to support the diagnosis of CTEPH, indicate therapeutic improvement and estimate haemodynamics. It also seems capable of predicting a (persistent) severe disease with probably increased need for therapy and increased mortality. Mild PH has been observed to have either no or few mild ECG changes. This might complicate the (early) detection of PH. Full article
(This article belongs to the Special Issue New Insights in Critical Care Cardiology)
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30 pages, 9022 KiB  
Article
Atrioventricular Synchronization for Detection of Atrial Fibrillation and Flutter in One to Twelve ECG Leads Using a Dense Neural Network Classifier
by Irena Jekova, Ivaylo Christov and Vessela Krasteva
Sensors 2022, 22(16), 6071; https://doi.org/10.3390/s22166071 - 14 Aug 2022
Cited by 19 | Viewed by 3376
Abstract
This study investigates the use of atrioventricular (AV) synchronization as an important diagnostic criterion for atrial fibrillation and flutter (AF) using one to twelve ECG leads. Heart rate, lead-specific AV conduction time, and P-/f-wave amplitude were evaluated by three representative ECG metrics (mean [...] Read more.
This study investigates the use of atrioventricular (AV) synchronization as an important diagnostic criterion for atrial fibrillation and flutter (AF) using one to twelve ECG leads. Heart rate, lead-specific AV conduction time, and P-/f-wave amplitude were evaluated by three representative ECG metrics (mean value, standard deviation), namely RR-interval (RRi-mean, RRi-std), PQ-interval (PQi-mean, PQI-std), and PQ-amplitude (PQa-mean, PQa-std), in 71,545 standard 12-lead ECG records from the six largest PhysioNet CinC Challenge 2021 databases. Two rhythm classes were considered (AF, non-AF), randomly assigning records into training (70%), validation (20%), and test (10%) datasets. In a grid search of 19, 55, and 83 dense neural network (DenseNet) architectures and five independent training runs, we optimized models for one-lead, six-lead (chest or limb), and twelve-lead input features. Lead-set performance and SHapley Additive exPlanations (SHAP) input feature importance were evaluated on the test set. Optimal DenseNet architectures with the number of neurons in sequential [1st, 2nd, 3rd] hidden layers were assessed for sensitivity and specificity: DenseNet [16,16,0] with primary leads (I or II) had 87.9–88.3 and 90.5–91.5%; DenseNet [32,32,32] with six limb leads had 90.7 and 94.2%; DenseNet [32,32,4] with six chest leads had 92.1 and 93.2%; and DenseNet [128,8,8] with all 12 leads had 91.8 and 95.8%, indicating sensitivity and specificity values, respectively. Mean SHAP values on the entire test set highlighted the importance of RRi-mean (100%), RR-std (84%), and atrial synchronization (40–60%) for the PQa-mean (aVR, I), PQi-std (V2, aVF, II), and PQi-mean (aVL, aVR). Our focus on finding the strongest AV synchronization predictors of AF in 12-lead ECGs would lead to a comprehensive understanding of the decision-making process in advanced neural network classifiers. DenseNet self-learned to rely on a few ECG behavioral characteristics: first, characteristics usually associated with AF conduction such as rapid heart rate, enhanced heart rate variability, and large PQ-interval deviation in V2 and inferior leads (aVF, II); second, characteristics related to a typical P-wave pattern in sinus rhythm, which is best distinguished from AF by the earliest negative P-peak deflection of the right atrium in the lead (aVR) and late positive left atrial deflection in lateral leads (I, aVL). Our results on lead-selection and feature-selection practices for AF detection should be considered for one- to twelve-lead ECG signal processing settings, particularly those measuring heart rate, AV conduction times, and P-/f-wave amplitudes. Performances are limited to the AF diagnostic potential of these three metrics. SHAP value importance can be used in combination with a human expert’s ECG interpretation to change the focus from a broad observation of 12-lead ECG morphology to focusing on the few AV synchronization findings strongly predictive of AF or non-AF arrhythmias. Our results are representative of AV synchronization findings across a broad taxonomy of cardiac arrhythmias in large 12-lead ECG databases. Full article
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9 pages, 1467 KiB  
Article
The Effect of Common Viral Inactivation Techniques on 16S rRNA Amplicon-Based Analysis of the Gut Microbiota
by Zachary McAdams, Kevin Gustafson and Aaron Ericsson
Microorganisms 2021, 9(8), 1755; https://doi.org/10.3390/microorganisms9081755 - 17 Aug 2021
Cited by 2 | Viewed by 2774
Abstract
Research investigating the gut microbiome (GM) during a viral infection may necessitate inactivation of the fecal viral load. Here, we assess how common viral inactivation techniques affect 16S rRNA-based analysis of the gut microbiome. Five common viral inactivation methods were applied to cross-matched [...] Read more.
Research investigating the gut microbiome (GM) during a viral infection may necessitate inactivation of the fecal viral load. Here, we assess how common viral inactivation techniques affect 16S rRNA-based analysis of the gut microbiome. Five common viral inactivation methods were applied to cross-matched fecal samples from sixteen female CD-1 mice of the same GM background prior to fecal DNA extraction. The V4 region of the 16S rRNA gene was amplified and sequenced from extracted DNA. Treatment-dependent effects on DNA yield, genus-level taxonomic abundance, and alpha and beta diversity metrics were assessed. A sodium dodecyl sulfate (SDS)-based inactivation method and Holder pasteurization had no effect on measures of microbial richness, while two Buffer AVL-based inactivation methods resulted in a decrease in detected richness. SDS inactivation, Holder pasteurization, and the AVL-based inactivation methods had no effect on measures of alpha diversity within samples or beta diversity between samples. Fecal DNA extracted with TRIzol-treated samples failed to amplify and sequence, making it unsuitable for microbiome analysis. These results provide guidance in the 16S rRNA microbiome analysis of fecal samples requiring viral inactivation. Full article
(This article belongs to the Section Gut Microbiota)
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