New ECG criteria for acute myocardial infarction in patients with left bundle branch block

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An evaluation of planarity of the spatial QRS loop by three dimensional vectorcardiography: its emergence and loss

Aims: To objectively characterize and mathematically justify the observation that vectorcardiographic QRS loops in normal individuals are more planar than those from patients with ST elevation myocardial infarction (STEMI). Methods: Vectorcardiograms (VCGs) were constructed from three simultaneously recorded quasi-orthogonal leads, I, aVF and V2 (sampled at 1000 samples/s). The planarity of these QRS loops was determined by fitting a surface to each loop. Goodness of fit was expressed in numerical terms. Results: 15 healthy individuals aged 35–65 years (73% male) and 15 patients aged 45–70 years (80% male) with diagnosed acute STEMI were recruited. The spatial-QRS loop was found to lie in a plane in normal controls. In STEMI patients, this planarity was lost. Calculation of goodness of fit supported these visual observations. Conclusions: The degree of planarity of the VCG loop can differentiate healthy individuals from patients with STEMI. This observation is compatible with our basic understanding of the electrophysiology of the human heart

Automatic detection of end QRS notching or slurring

The purpose of this study was to define criteria suited to automated detection of end QRS notching and slurring and to evaluate their accuracy. One hundred resting 12 lead ECGs from young adult men, split randomly into equal training and test sets, were examined independently by two reviewers for the presence of such notching or slurring. Consensus was reached by re-examination. Logic was added to the Glasgow resting ECG program to automate the detection of the phenomenon. After training, the automated detection had a sensitivity (SE) of 92.1% and a specificity (SP) of 96.6%. For the test set, SE was 90.5%, SP 96.5%. Two populations of healthy subjects – one Caucasian, one Nigerian – were analysed using the automated method. The prevalence of notching/slurring with peak/onset amplitude respectively ≥ 0.1 mV in two contiguous inferolateral leads was 23% and 29% respectively. In conclusion, the detection of end QRS notching or slurring can be automated with a high degree of accuracy

Comparison of the spatial QRS-T angle derived from digital ECGs recorded using conventional electrode placement with that derived from Mason-Likar electrode position

Background: The spatial QRS-T angle is ideally derived from orthogonal leads. We compared the spatial QRS-T angle derived from orthogonal leads reconstructed from digital 12-lead ECGs and from digital Holter ECGs recorded with the Mason-Likar (M-L) electrode positions. Methods and results: Orthogonal leads were constructed by the inverse Dower method and used to calculate spatial QRS-T angle by (1) a vector method and (2) a net amplitude method, in 100 volunteers. Spatial QRS-T angles from standard and M-L ECGs differed significantly (57° ± 18° vs 48° ± 20° respectively using net amplitude method and 53° ± 28° vs 48° ± 23° respectively by vector method; p < 0.001). Difference in amplitudes in leads V4–V6 was also observed between Holter and standard ECGs, probably due to a difference in electrical potential at the central terminal. Conclusion: Mean spatial QRS-T angles derived from standard and M-L lead systems differed by 5°–9°. Though statistically significant, these differences may not be clinically significant

Debatable issues in automated ECG reporting

Although automated ECG analysis has been available for many years, there are some aspects which require to be re-assessed with respect to their value while newer techniques which are worthy of review are beginning to find their way into routine use. At the annual International Society of Computerized Electrocardiology conference held in April 2017, four areas in particular were debated. These were a) automated 12 lead resting ECG analysis; b) real time out of hospital ECG monitoring; c) ECG imaging; and d) single channel ECG rhythm interpretation. One speaker presented the positive aspects of each technique and another outlined the more negative aspects. Debate ensued. There were many positives set out for each technique but equally, more negative features were not in short supply, particularly for out of hospital ECG monitoring

Novel electrocardiographic criteria for the diagnosis of arrhythmogenic right ventricular cardiomyopathy

Aims: In order to improve the electrocardiographic (ECG) diagnosis of arrhythmogenic right ventricular cardiomyopathy (ARVC), we evaluated novel quantitative parameters of the QRS complex and the value of bipolar chest leads (CF leads) computed from the standard 12 leads. Methods and results: We analysed digital 12-lead ECGs in 44 patients with ARVC, 276 healthy subjects including 44 age and sex-matched with the patients and 36 genotyped members of ARVC families. The length and area of the terminal S wave in V1 to V3 were measured automatically using a common for all 12 leads QRS end. T wave negativity was assessed in V1 to V6 and in the bipolar CF leads computed from the standard 12 leads. The length and area of the terminal S wave were significantly shorter, whereas the S wave duration was significantly longer in ARVC patients compared with matched controls. Among members of ARVC families, those with mutations (n = 15) had shorter QRS length in V2 and V3 and smaller QRS area in lead V2 compared with those without mutations (n = 20). In ARVC patients, the CF leads were diagnostically superior to the standard unipolar precordial leads. Terminal S wave duration in V1 >48 ms or major T wave negativity in CF leads separated ARVC patients from matched controls with 90% sensitivity and 86% specificity. Conclusion: The terminal S wave length and area in the right precordial leads are diagnostically useful and suitable for automatic analysis in ARVC. The CF leads are diagnostically superior to the unipolar precordial leads

Two French threats to North America, 1760-1783, as seen by British Colonial officials

This thesis considers two aspects of colonial history which never seem to have been given the appropriate amount of attention in overall histories of the time period involved, 1763-1783. The first subject deals with the failure of British policy for the territories west of the 1763 Proclamation Line. The events which led up to Pontiac's 1763 rebellion are covered, beginning with the surrender of New France by the Marquis de Vaudreuil to General Amherst on September 8th, 1760. Attention is given to the rebellion itself, followed by an account of the difficulties experienced by the British in their efforts to occupy the Illinois Country. The efforts of Major-General Gage, the Commander in Chief, to obtain firm policy directives are also covered. The second subject is General Haldimand's defence of Canada, 1778-1783. In addition to the perceived French threat to Canada, the multitude of problems Haldimand also had to deal with are presented, not the least of which were his communications with England, together with the unreliability of his overland contacts with General Clinton, which took his agents through hostile territory. Particular attention has been given to the successful deception of Haldimand by Washington as to the objective of his 1779 campaign. Finally, the last two chapters of the thesis are devoted to the Haldimand Negotiations with Vermont which took place between 1780 and 1782. Their purpose was to try to entice that (at the time) independent republic to rejoin the British empire

A 3D stereo camera system for precisely positioning animals in space and time

PLT was supported by the Scottish Funding Council (grant HR09011) through the Marine Alliance for Science and Technology for Scotland.Here, we describe a portable stereo camera system that integrates a GPS receiver, an attitude sensor and 3D stereo photogrammetry to rapidly estimate the position of multiple animals in space and time. We demonstrate the performance of the system during a field test by simultaneously tracking the individual positions of six long-finned pilot whales, Globicephala melas. In shore-based accuracy trials, a system with a 50-cm stereo baseline had an average range estimation error of 0.09 m at a 5-m distance increasing up to 3.2 at 50 m. The system is especially useful in field situations where it is necessary to follow groups of animals travelling over relatively long distances and time periods whilst obtaining individual positions with high spatial and temporal resolution (up to 8 Hz). These positions provide quantitative estimates of a variety of key parameters and indicators for behavioural studies such as inter-animal distances, group dispersion, speed and heading. This system can additionally be integrated with other techniques such as archival tags, photo-identification methods or acoustic playback experiments to facilitate fieldwork investigating topics ranging from natural social behaviour to how animals respond to anthropogenic disturbance. By grounding observations in quantitative metrics, the system can characterize fine-scale behaviour or detect changes as a result of disturbance that might otherwise be difficult to observe.PostprintPeer reviewe

Relationship between R-R interval variation and left ventricular function in sinus rhythm and atrial fibrillation as estimated by means of heart rate variability fraction

Background: Reduced heart rate variability (HRV) is associated with a poor outcome in patients with sinus rhythm (SR) or atrial fibrillation (AF). However, cut-off points for HRV measures differ between SR and AF. We hypothesized that a global index of 24-hour HRV based on evaluation of scatterplot would describe HRV irrespective of cardiac rhythm. Methods: 407 patients with ischemic heart disease (317 male, 90 female, mean age 57 ± 9 years) were studied. 331 patients had SR and 76 patients had AF. 24-hour ECGs were recorded, and standard HRV indices were calculated. Scatterplots was used to determine the HRV fraction (HRVF, %). HRV measures were compared in respect to left ventricular ejection fraction (LVEF £ 35% or > 35%). Results: Standard HRV measures were higher in AF-patients despite the mean RR interval was lower. In patients with LVEF £ 35%, standard HRV indices were lower in SR group, in AF group only SDNN and RMSSD were reduced. The HRVF was comparably reduced (SR 39.3 ± 15.3%, AF 37.3 ± 17.9%). In patients with LVEF > 35%, HRVF did not differ between SR (47.2 ± ± 10.5%) and AF (46.1 ± 12.1%). The HRVF correlated with SDNN and SDANN (~0.85) in SR. Correlations were weaker in AF (~0.6). Standard HRV indices and HRVF showed similar relations with LVEF, but only in AF at the same range. Conclusions: The HRV fraction allows for HRV evaluation irrespective of cardiac rhythm. The index elicited a similar dependence of HRV on left ventricular function in SR and AF. (Cardiol J 2011; 18, 5: 538–545

Factors determining the progression of nonalcoholic fatty liver disease; the role of abnormal fatty acid and glucocorticoid metabolism

Obesity and insulin resistance are associated with a constellation of features including hypertension, dyslipidaemia, type 2 diabetes, and premature cardiovascular disease, collectively termed the metabolic syndrome. Non-alcoholic fatty liver disease (NAFLD) represents the hepatic component of this syndrome, incorporating a spectrum of liver disease with increasing morbidity and mortality, from simple steatosis, to non-alcoholic steatohepatitis (or NASH), fibrosis, cirrhosis and ultimately hepatocellular carcinoma. However, factors influencing this progression are incompletely understood. In this thesis I sought to investigate pathways which promote hepatic inflammation and fibrosis by studying two contrasting dietary models of NAFLD in mice in which the risk of hepatic inflammation, insulin resistance and fibrosis differ; namely the methionine and choline deficient diet (MCDD) which induces steatohepatitis, hepatic insulin resistance, and weight loss, and the choline deficient diet (CDD) which may be protected from insulin resistance, and leads to steatosis without inflammation or weight loss. I investigated the possible molecular mechanisms underlying these differences, and whether they influenced progression to hepatic fibrosis induced by carbon tetrachloride (CCl4)