Early detection of sudden cardiac death may be used for surviving the life of cardiac patients. In this paper we have investigated an algorithm to detect and predict sudden cardiac death, by processing of heart rate v...Early detection of sudden cardiac death may be used for surviving the life of cardiac patients. In this paper we have investigated an algorithm to detect and predict sudden cardiac death, by processing of heart rate variability signal through the classical and time-frequency methods. At first, one minute of ECG signals, just before the cardiac death event are extracted and used to compute heart rate variability (HRV) signal. Five features in time domain and four features in frequency domain are extracted from the HRV signal and used as classical linear features. Then the Wigner Ville transform is applied to the HRV signal, and 11 extra features in the time-frequency (TF) domain are obtained. In order to improve the performance of classification, the principal component analysis (PCA) is applied to the obtained features vector. Finally a neural network classifier is applied to the reduced features. The obtained results show that the TF method can classify normal and SCD subjects, more efficiently than the classical methods. A MIT-BIH ECG database was used to evaluate the proposed method. The proposed method was implemented using MLP classifier and had 74.36% and 99.16% correct detection rate (accuracy) for classical features and TF method, respectively. Also, the accuracy of the KNN classifier were 73.87% and 96.04%.展开更多
Objectives: To determine the predictive value of the ECG for sudden death in the general population. Design: In the Copenhagen City Heart Study, a randomly selected population sample in Copenhagen, Denmarkhas been fol...Objectives: To determine the predictive value of the ECG for sudden death in the general population. Design: In the Copenhagen City Heart Study, a randomly selected population sample in Copenhagen, Denmarkhas been followed prospectively since 1976. From this population sample, we analyzed ECGs of individuals who had suffered sudden cardiac death (SCD) before the age of 50 years and compared them with ECGs of a randomly selected control individuals from the same population sample. Specific ECG signs that could point toward a condition associated with a risk of SCD were noted. Results: From a total of 18,974 individuals in the cohort, 207 had died at an age younger than 50 years. Among these, 24 persons with SCD were identified. The most prevalent ECG abnormality was QRS fragmentation. We found no ECGs with long or short QTc, Brugada sign or WPW. The prevalence of signs of left ventricular hyper-trophy, early repolarization, or fragmentation was not different from the prevalence of these signs in the control group. Conclusion: In the Copenhagen City Heart Study, the ECG failed to predict SCD in persons who died before the age of 50 years.展开更多
Patients with a Brugada type 1 electrocardiogram(ECG) pattern may suffer sudden cardiac death(SCD). Recognized risk factors are spontaneous type 1 ECG and syncope of presumed arrhythmic origin. Familial sudden cardiac...Patients with a Brugada type 1 electrocardiogram(ECG) pattern may suffer sudden cardiac death(SCD). Recognized risk factors are spontaneous type 1 ECG and syncope of presumed arrhythmic origin. Familial sudden cardiac death(f-SCD) is not a recognized independent risk factor. Finally, positive electrophysiologic study(+EPS) has a controversial prognostic value. Current ESC guidelines recommend implantable cardioverter defibrillator(ICD) implantation in patients with a Brugada type 1 ECG pattern if they have suffered a previous resuscitated cardiac arrest(class Ⅰrecommendation) or if they have syncope of presumed cardiac origin(class Ⅱa recommendation). In clinical practice, however, many other patients undergo ICD implantation despite the suggestions of the guidelines. In a 2014 cumulative analysis of the largest available studies(including over 2000 patients), we found that 1/3 of patients received an ICD in primary prevention. Interestingly, 55% of these latter were asymptomatic, while 80% had a + EPS. This means that over 30% of subjects with a Brugada type 1 ECG pattern were considered at high risk of SCD mainly on the basis of EPS, to which a class Ⅱb indication for ICD is assigned by the current ESC guidelines. Follow-up data confirm that in clinical practice single, and often frail, risk factors overestimate the real risk in subjects with the Brugada type 1 ECG pattern. We can argue that, in clinical practice, many cardiology centers adopt an aggressive treatment in subjects with a Brugada type 1 ECG pattern who are not at high risk. As a result, many healthy persons may be treated in order to save a few patients with a true Brugada Syndrome. Better risk stratification is needed. A multi-parametric approach that considers the contemporary presence of multiple risk factors is a promising one.展开更多
Sudden cardiac death(SCD)is a common cause of death due to the high prevalence and mortality of cardiovascular disease(CVD).Currently,the forensic identification of SCD relies on traditional histomorphological examina...Sudden cardiac death(SCD)is a common cause of death due to the high prevalence and mortality of cardiovascular disease(CVD).Currently,the forensic identification of SCD relies on traditional histomorphological examination,lacking stable biomarkers with high specificity and sensitivity.Previous studies have shown that exosomes(Exos)are ideal vectors and the application of Exos provides novel insight as the diagnostic biomarkers and treatment of CVD,and is hot research filed in biomedicine.This review briefly describes the biology of Exos,including the biogenesis of Exos and the mechanisms of action.The research progresses on Exos multi‑omics,i.e.,genomics,proteomics and metabolomics,and their roles in the diagnosis of different types of CVD,especially coronary heart disease and cardiomyopathy,are summarized.In addition,the current difficulties of applications of Exos in forensic identification of SCD and the prospective forensic applications in the future are highlighted.The aim of this review is to summarize the current advances of Exos in CVD in a disease‑oriented manner,and to provide a reference for future forensic pathological identification of SCD,as well as the early diagnosis of SCD in clinic.展开更多
目的 分析血清果蝇母性DPP同源物(serum small mother against decapentaplegic,Smad)2、Smad3与冠状动脉粥样硬化性心脏病(冠心病)患者心脏猝死的相关性。方法 选取2018年3月至2020年6月无锡市人民医院收治的住院接受治疗的冠心病患者...目的 分析血清果蝇母性DPP同源物(serum small mother against decapentaplegic,Smad)2、Smad3与冠状动脉粥样硬化性心脏病(冠心病)患者心脏猝死的相关性。方法 选取2018年3月至2020年6月无锡市人民医院收治的住院接受治疗的冠心病患者134例为研究对象,随访1年,根据冠心病患者有无发生心脏猝死分为猝死组(21例)和未猝死组(113例)。采用酶联免疫吸附试验(ELISA)法检测患者血清中Smad2、Smad3浓度。采用动态心电图仪详细记录患者QT间期、PR间期、QRS波持续时间。采用受试者工作特征曲线(receiver operating characteristic curve,ROC)评价QRS波持续时间联合Smad2、Smad3对冠心病患者心脏猝死的诊断价值。应用二元Logistic回归分析对影响冠心病患者心脏猝死的危险因素进行分析。结果 与未猝死组相比,猝死组患者QRS波持续时间[(116.74±14.58)ms vs.(88.42±10.67)ms]、血清Smad2[(286.42±38.71)μg/L vs.(164.93±22.28)μg/L]、Smad3[(335.18±50.06)μg/L vs.(190.25±29.72)μg/L]浓度较高,差异有统计学意义(P<0.05)。ROC分析显示,QRS波持续时间、血清Smad2和Smad3浓度诊断冠心病患者心脏猝死的曲线下面积(area under the curve,AUC)分别为0.742、0.825、0.842;QRS波持续时间联合Smad2、Smad3诊断冠心病患者心脏猝死的AUC为0.893,其敏感度、特异度分别为81.00%、93.80%。QRS波持续时间、Smad2、Smad3是冠心病患者心脏猝死危险因素(P<0.05)。结论 动态心电图联合血清Smad2、Smad3浓度检测对预测冠心病患者心脏猝死有一定价值。展开更多
目的探究24 h动态心电图微伏级T波电交替(AECGs-MTWA)技术对慢性心力衰竭(CHF)患者心源性猝死(SCD)的预测价值。方法选取2019年4月至2021年7月期间成都市第六人民医院收治的96例CHF患者为研究对象,所有患者均行动态心电图(AECGs)检查,...目的探究24 h动态心电图微伏级T波电交替(AECGs-MTWA)技术对慢性心力衰竭(CHF)患者心源性猝死(SCD)的预测价值。方法选取2019年4月至2021年7月期间成都市第六人民医院收治的96例CHF患者为研究对象,所有患者均行动态心电图(AECGs)检查,并借助时域分析法移动平均修正技术分析24 h AECGs-MTWA,测量V1导联及V5导联中的MTWAmax及8∶00amMTWA;随访1年,主要终点为SCD,次要终点为CHF死亡,根据患者结局将其分为存活组、SCD组、非SCD组,比较3组基线资料、V1导联及V5导联MTWA最大值及8∶00amMTWA,采用受试者工作特征(ROC)曲线分析对CHF患者SCD的预测效能。结果3组基线资料比较,差异均无统计学意义;3组V1导联及V5导联中的MTWAmax及8∶00amMTWA比较,差异均有统计学意义(P<0.05);SCD组V1导联及V5导联中的MTWAmax及8∶00amMTWA均低于存活组,差异均有统计学意义(P<0.05),但存活组、非SCD组上述指标比较,差异均无统计学意义(P>0.05)。ROC曲线结果分析,V1导联MTWAmax预测SCD的曲线下面积、敏感度、特异度分别为0.865、76.00%、88.50%;V5导联MTWAmax预测SCD的曲线下面积、敏感度、特异度分别为0.851、72.00%、92.30%;V1导联8∶00amMTWA预测SCD的曲线下面积、敏感度、特异度分别为0.846、80.00%、88.50%;V5导联8∶00amMTWA预测SCD的曲线下面积、敏感度、特异度分别为0.861、80.00%、90.04%。结论AECGs-MTWA技术对CHF患者发生SCD具有一定的预测价值,可为临床诊疗提供科学依据。展开更多
文摘Early detection of sudden cardiac death may be used for surviving the life of cardiac patients. In this paper we have investigated an algorithm to detect and predict sudden cardiac death, by processing of heart rate variability signal through the classical and time-frequency methods. At first, one minute of ECG signals, just before the cardiac death event are extracted and used to compute heart rate variability (HRV) signal. Five features in time domain and four features in frequency domain are extracted from the HRV signal and used as classical linear features. Then the Wigner Ville transform is applied to the HRV signal, and 11 extra features in the time-frequency (TF) domain are obtained. In order to improve the performance of classification, the principal component analysis (PCA) is applied to the obtained features vector. Finally a neural network classifier is applied to the reduced features. The obtained results show that the TF method can classify normal and SCD subjects, more efficiently than the classical methods. A MIT-BIH ECG database was used to evaluate the proposed method. The proposed method was implemented using MLP classifier and had 74.36% and 99.16% correct detection rate (accuracy) for classical features and TF method, respectively. Also, the accuracy of the KNN classifier were 73.87% and 96.04%.
文摘Objectives: To determine the predictive value of the ECG for sudden death in the general population. Design: In the Copenhagen City Heart Study, a randomly selected population sample in Copenhagen, Denmarkhas been followed prospectively since 1976. From this population sample, we analyzed ECGs of individuals who had suffered sudden cardiac death (SCD) before the age of 50 years and compared them with ECGs of a randomly selected control individuals from the same population sample. Specific ECG signs that could point toward a condition associated with a risk of SCD were noted. Results: From a total of 18,974 individuals in the cohort, 207 had died at an age younger than 50 years. Among these, 24 persons with SCD were identified. The most prevalent ECG abnormality was QRS fragmentation. We found no ECGs with long or short QTc, Brugada sign or WPW. The prevalence of signs of left ventricular hyper-trophy, early repolarization, or fragmentation was not different from the prevalence of these signs in the control group. Conclusion: In the Copenhagen City Heart Study, the ECG failed to predict SCD in persons who died before the age of 50 years.
文摘Patients with a Brugada type 1 electrocardiogram(ECG) pattern may suffer sudden cardiac death(SCD). Recognized risk factors are spontaneous type 1 ECG and syncope of presumed arrhythmic origin. Familial sudden cardiac death(f-SCD) is not a recognized independent risk factor. Finally, positive electrophysiologic study(+EPS) has a controversial prognostic value. Current ESC guidelines recommend implantable cardioverter defibrillator(ICD) implantation in patients with a Brugada type 1 ECG pattern if they have suffered a previous resuscitated cardiac arrest(class Ⅰrecommendation) or if they have syncope of presumed cardiac origin(class Ⅱa recommendation). In clinical practice, however, many other patients undergo ICD implantation despite the suggestions of the guidelines. In a 2014 cumulative analysis of the largest available studies(including over 2000 patients), we found that 1/3 of patients received an ICD in primary prevention. Interestingly, 55% of these latter were asymptomatic, while 80% had a + EPS. This means that over 30% of subjects with a Brugada type 1 ECG pattern were considered at high risk of SCD mainly on the basis of EPS, to which a class Ⅱb indication for ICD is assigned by the current ESC guidelines. Follow-up data confirm that in clinical practice single, and often frail, risk factors overestimate the real risk in subjects with the Brugada type 1 ECG pattern. We can argue that, in clinical practice, many cardiology centers adopt an aggressive treatment in subjects with a Brugada type 1 ECG pattern who are not at high risk. As a result, many healthy persons may be treated in order to save a few patients with a true Brugada Syndrome. Better risk stratification is needed. A multi-parametric approach that considers the contemporary presence of multiple risk factors is a promising one.
文摘Sudden cardiac death(SCD)is a common cause of death due to the high prevalence and mortality of cardiovascular disease(CVD).Currently,the forensic identification of SCD relies on traditional histomorphological examination,lacking stable biomarkers with high specificity and sensitivity.Previous studies have shown that exosomes(Exos)are ideal vectors and the application of Exos provides novel insight as the diagnostic biomarkers and treatment of CVD,and is hot research filed in biomedicine.This review briefly describes the biology of Exos,including the biogenesis of Exos and the mechanisms of action.The research progresses on Exos multi‑omics,i.e.,genomics,proteomics and metabolomics,and their roles in the diagnosis of different types of CVD,especially coronary heart disease and cardiomyopathy,are summarized.In addition,the current difficulties of applications of Exos in forensic identification of SCD and the prospective forensic applications in the future are highlighted.The aim of this review is to summarize the current advances of Exos in CVD in a disease‑oriented manner,and to provide a reference for future forensic pathological identification of SCD,as well as the early diagnosis of SCD in clinic.
文摘目的 分析血清果蝇母性DPP同源物(serum small mother against decapentaplegic,Smad)2、Smad3与冠状动脉粥样硬化性心脏病(冠心病)患者心脏猝死的相关性。方法 选取2018年3月至2020年6月无锡市人民医院收治的住院接受治疗的冠心病患者134例为研究对象,随访1年,根据冠心病患者有无发生心脏猝死分为猝死组(21例)和未猝死组(113例)。采用酶联免疫吸附试验(ELISA)法检测患者血清中Smad2、Smad3浓度。采用动态心电图仪详细记录患者QT间期、PR间期、QRS波持续时间。采用受试者工作特征曲线(receiver operating characteristic curve,ROC)评价QRS波持续时间联合Smad2、Smad3对冠心病患者心脏猝死的诊断价值。应用二元Logistic回归分析对影响冠心病患者心脏猝死的危险因素进行分析。结果 与未猝死组相比,猝死组患者QRS波持续时间[(116.74±14.58)ms vs.(88.42±10.67)ms]、血清Smad2[(286.42±38.71)μg/L vs.(164.93±22.28)μg/L]、Smad3[(335.18±50.06)μg/L vs.(190.25±29.72)μg/L]浓度较高,差异有统计学意义(P<0.05)。ROC分析显示,QRS波持续时间、血清Smad2和Smad3浓度诊断冠心病患者心脏猝死的曲线下面积(area under the curve,AUC)分别为0.742、0.825、0.842;QRS波持续时间联合Smad2、Smad3诊断冠心病患者心脏猝死的AUC为0.893,其敏感度、特异度分别为81.00%、93.80%。QRS波持续时间、Smad2、Smad3是冠心病患者心脏猝死危险因素(P<0.05)。结论 动态心电图联合血清Smad2、Smad3浓度检测对预测冠心病患者心脏猝死有一定价值。
文摘目的探究24 h动态心电图微伏级T波电交替(AECGs-MTWA)技术对慢性心力衰竭(CHF)患者心源性猝死(SCD)的预测价值。方法选取2019年4月至2021年7月期间成都市第六人民医院收治的96例CHF患者为研究对象,所有患者均行动态心电图(AECGs)检查,并借助时域分析法移动平均修正技术分析24 h AECGs-MTWA,测量V1导联及V5导联中的MTWAmax及8∶00amMTWA;随访1年,主要终点为SCD,次要终点为CHF死亡,根据患者结局将其分为存活组、SCD组、非SCD组,比较3组基线资料、V1导联及V5导联MTWA最大值及8∶00amMTWA,采用受试者工作特征(ROC)曲线分析对CHF患者SCD的预测效能。结果3组基线资料比较,差异均无统计学意义;3组V1导联及V5导联中的MTWAmax及8∶00amMTWA比较,差异均有统计学意义(P<0.05);SCD组V1导联及V5导联中的MTWAmax及8∶00amMTWA均低于存活组,差异均有统计学意义(P<0.05),但存活组、非SCD组上述指标比较,差异均无统计学意义(P>0.05)。ROC曲线结果分析,V1导联MTWAmax预测SCD的曲线下面积、敏感度、特异度分别为0.865、76.00%、88.50%;V5导联MTWAmax预测SCD的曲线下面积、敏感度、特异度分别为0.851、72.00%、92.30%;V1导联8∶00amMTWA预测SCD的曲线下面积、敏感度、特异度分别为0.846、80.00%、88.50%;V5导联8∶00amMTWA预测SCD的曲线下面积、敏感度、特异度分别为0.861、80.00%、90.04%。结论AECGs-MTWA技术对CHF患者发生SCD具有一定的预测价值,可为临床诊疗提供科学依据。
