1
|
Senthilnathan S, Shenbaga Devi S, Sasikala M, Satheesh S, Selvaraj RJ. The role of beat-by-beat cardiac features in machine learning classification of ischemic heart disease (IHD) in magnetocardiogram (MCG). Biomed Phys Eng Express 2024; 10:045007. [PMID: 38640907 DOI: 10.1088/2057-1976/ad40b1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Accepted: 04/19/2024] [Indexed: 04/21/2024]
Abstract
Cardiac electrical changes associated with ischemic heart disease (IHD) are subtle and could be detected even in rest condition in magnetocardiography (MCG) which measures weak cardiac magnetic fields. Cardiac features that are derived from MCG recorded from multiple locations on the chest of subjects and some conventional time domain indices are widely used in Machine learning (ML) classifiers to objectively distinguish IHD and control subjects. Most of the earlier studies have employed features that are derived from signal-averaged cardiac beats and have ignored inter-beat information. The present study demonstrates the utility of beat-by-beat features to be useful in classifying IHD subjects (n = 23) and healthy controls (n = 75) in 37-channel MCG data taken under rest condition of subjects. The study reveals the importance of three features (out of eight measured features) namely, the field map angle (FMA) computed from magnetic field map, beat-by-beat variations of alpha angle in the ST-T region and T wave magnitude variations in yielding a better classification accuracy (92.7 %) against that achieved by conventional features (81 %). Further, beat-by-beat features are also found to augment the accuracy in classifying myocardial infarction (MI) Versus control subjects in two public ECG databases (92 % from 88 % and 94 % from 77 %). These demonstrations summarily suggest the importance of beat-by-beat features in clinical diagnosis of ischemia.
Collapse
Affiliation(s)
- S Senthilnathan
- SQUIDs Applications Section, SQUID and Detector Technology Division, Materials Science Group, Indira Gandhi Centre for Atomic Research, Kalpakkam-603 102, Tamil Nadu, India
| | - S Shenbaga Devi
- Centre for Medical Electronics, Department of Electronics and Communication Engineering, Anna University, Chennai-600 025, Tamil Nadu, India
| | - M Sasikala
- Centre for Medical Electronics, Department of Electronics and Communication Engineering, Anna University, Chennai-600 025, Tamil Nadu, India
| | - Santhosh Satheesh
- Department of Cardiology, Jawaharlal Institute of Postgraduate Medical Education and Research, Dhanvantri Nagar, Pondicherry-605 006, Puducherry, India
| | - Raja J Selvaraj
- Department of Cardiology, Jawaharlal Institute of Postgraduate Medical Education and Research, Dhanvantri Nagar, Pondicherry-605 006, Puducherry, India
| |
Collapse
|
2
|
Kesavaraja C, Sengottuvel S, Patel R, Selvaraj RJ, Satheesh S, Mani A. Enhancing the efficiency and cost-effectiveness of magnetocardiography by optimal channel selection for cardiac diagnosis. Biomed Phys Eng Express 2024; 10:025023. [PMID: 38277702 DOI: 10.1088/2057-1976/ad233e] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Accepted: 01/26/2024] [Indexed: 01/28/2024]
Abstract
Background. Magnetocardiography (MCG) is a non-invasive and non-contact technique that measures weak magnetic fields generated by the heart. It is highly effective in the diagnosis of heart abnormalities. Multichannel MCG provides detailed spatio-temporal information of the measured magnetic fields. While multichannel MCG systems are costly, usage of the optimal number of measurement channels to characterize cardiac magnetic fields without any appreciable loss of signal information would be economically beneficial and promote the widespread use of MCG technology.Methods. An optimization method based on the sequential selection approach is used to choose channels containing the maximum signal information while avoiding redundancy. The study comprised 40 healthy individuals, along with two subjects having ischemic heart disease and one subject with premature ventricular contraction. MCG measured using a 37 channel MCG system. After revisiting the existing methods of optimization, the mean error and correlation of the optimal set of measurement channels with those of all 37 channels are evaluated for different sets, and it has been found that 18 channels are adequate.Results. The chosen 18 optimal channels exhibited a strong correlation (0.99 ± 0.006) between the original and reconstructed magnetic field maps for a cardiac cycle in healthy subjects. The root mean square error is 0.295 pT, indicating minimal deviation.Conclusion. This selection method provides an efficient approach for choosing MCG, which could be used for minimizing the number of channels as well as in practical unforeseen measurement conditions where few channels are noisy during the measurement.
Collapse
Affiliation(s)
- C Kesavaraja
- Indira Gandhi Centre for Atomic Research, A CI of Homi Bhabha National Institute, Kalpakkam-603102, Tamil Nadu, India
| | - S Sengottuvel
- SQUIDs Applications section, SQUID & Detector Technology Division, Materials Science Group, Indira Gandhi Centre for Atomic Research (IGCAR), Kalpakkam-603102, Tamil Nadu, India
| | - Rajesh Patel
- SQUIDs Applications section, SQUID & Detector Technology Division, Materials Science Group, Indira Gandhi Centre for Atomic Research (IGCAR), Kalpakkam-603102, Tamil Nadu, India
| | - Raja J Selvaraj
- Department of Cardiology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry-605006, India
| | - Santhosh Satheesh
- Department of Cardiology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry-605006, India
| | - Awadhesh Mani
- Indira Gandhi Centre for Atomic Research, A CI of Homi Bhabha National Institute, Kalpakkam-603102, Tamil Nadu, India
- Condensed Matter Physics Division, Materials Science Group, Indira Gandhi Centre for Atomic Research (IGCAR), Kalpakkam-603102, Tamil Nadu, India
| |
Collapse
|
3
|
Wessel N, Kim JS, Joung BY, Ko YG, Dischl D, Gapelyuk A, Lee YH, Kim KW, Park JW, Landmesser U. Magnetocardiography at rest predicts cardiac death in patients with acute chest pain. Front Cardiovasc Med 2023; 10:1258890. [PMID: 38155993 PMCID: PMC10752986 DOI: 10.3389/fcvm.2023.1258890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 11/30/2023] [Indexed: 12/30/2023] Open
Abstract
Introduction Sudden cardiac arrest is a major cause of morbidity and mortality worldwide and remains a major public health problem for which better non-invasive prediction tools are needed. Primary preventive therapies, such as implantable cardioverter defibrillators, are not personalized and not predictive. Most of these devices do not deliver life-saving therapy during their lifetime. The individual relationship between fatal arrhythmias and cardiac function abnormalities in predicting cardiac death risk has rarely been explored. Methods We retrospectively analyzed the measurements at rest for 191 patients with acute chest pain (ACP) magnetocardiographically. Our recently introduced analyses are able to detect inhomogeneities of the depolarization and repolarization. Moreover, electrically silent phenomena-intracellular ionic currents as well as vortex currents-can be measured and quantified. All included ACP patients were recruited in 2009 at Yonsei University Hospital and were followed up until 2022. Results During half of the follow-up period (6.5 years), 11 patients died. Out of all the included nine clinical, eight magnetocardiographical, and nine newly introduced magnetoionographical parameters we tested in this study, three parameters revealed themselves to be outstanding at predicting death: heart rate-corrected QT (QTc) prolongation, depression of repolarization current IKr + IKs, and serum creatinine (all significant in Cox regression, p < 0.05). They clearly predicted cardiac death over the 6.5 years duration (sensitivity 90.9%, specificity 85.6%, negative predictive accuracy 99.4%). Cardiac death risk was more than ninefold higher in patients with low repolarization reserve and QTc prolongation in comparison with the remaining patients with ACP (p < 0.001). The non-parametric Kaplan-Meier statistics estimated significantly lower survival functions from their lifetime data (p < 0.001). Discussion To the best of our knowledge, these are the first data linking magnetocardiographical and magnetoionographical parameters and subsequent significant fatal events in people, suggesting structural and functional components to clinical life-threatening ventricular arrhythmogenesis. The findings support investigation of new prevention strategies and herald those new non-invasive techniques as complementary risk stratification tools.
Collapse
Affiliation(s)
- N. Wessel
- Department of Human Medicine, MSB Medical School Berlin GmbH, Humboldt-Universität zu Berlin, Berlin, Germany
- Department of Physics, Humboldt Universität zu Berlin, Berlin, Germany
| | - J. S. Kim
- Division of Cardiology, Department of Internal Medicine, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - B. Y. Joung
- Division of Cardiology, Department of Internal Medicine, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Y. G. Ko
- Division of Cardiology, Department of Internal Medicine, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - D. Dischl
- Deutsches Herzzentrum der Charité, Department of Cardiology, Angiology and Intensive Care Medicine, Berlin, Germany
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - A. Gapelyuk
- Department of Physics, Humboldt Universität zu Berlin, Berlin, Germany
| | - Y. H. Lee
- Center for Biosignals, KRISS Korea Research Institute of Standards and Science, Daejeon, Republic of Korea
| | - K. W. Kim
- Center for Biosignals, KRISS Korea Research Institute of Standards and Science, Daejeon, Republic of Korea
| | - J. W. Park
- Deutsches Herzzentrum der Charité, Department of Cardiology, Angiology and Intensive Care Medicine, Berlin, Germany
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - U. Landmesser
- Deutsches Herzzentrum der Charité, Department of Cardiology, Angiology and Intensive Care Medicine, Berlin, Germany
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| |
Collapse
|
4
|
Han X, Pang J, Xu D, Wang R, Xie F, Yang Y, Sun J, Li Y, Li R, Yin X, Xu Y, Fan J, Dong Y, Wu X, Yang X, Yu D, Wang D, Gao Y, Xiang M, Xu F, Sun J, Chen Y, Ning X. Magnetocardiography-based coronary artery disease severity assessment and localization using spatiotemporal features. Physiol Meas 2023; 44:125002. [PMID: 37995382 DOI: 10.1088/1361-6579/ad0f70] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Accepted: 11/23/2023] [Indexed: 11/25/2023]
Abstract
Objective.This study aimed to develop an automatic and accurate method for severity assessment and localization of coronary artery disease (CAD) based on an optically pumped magnetometer magnetocardiography (MCG) system.Approach.We proposed spatiotemporal features based on the MCG one-dimensional signals, including amplitude, correlation, local binary pattern, and shape features. To estimate the severity of CAD, we classified the stenosis as absence or mild, moderate, or severe cases and extracted a subset of features suitable for assessment. To localize CAD, we classified CAD groups according to the location of the stenosis, including the left anterior descending artery (LAD), left circumflex artery (LCX), and right coronary artery (RCA), and separately extracted a subset of features suitable for determining the three CAD locations.Main results.For CAD severity assessment, a support vector machine (SVM) achieved the best result, with an accuracy of 75.1%, precision of 73.9%, sensitivity of 67.0%, specificity of 88.8%, F1-score of 69.8%, and area under the curve of 0.876. The highest accuracy and corresponding model for determining locations LAD, LCX, and RCA were 94.3% for the SVM, 84.4% for a discriminant analysis model, and 84.9% for the discriminant analysis model.Significance. The developed method enables the implementation of an automated system for severity assessment and localization of CAD. The amplitude and correlation features were key factors for severity assessment and localization. The proposed machine learning method can provide clinicians with an automatic and accurate diagnostic tool for interpreting MCG data related to CAD, possibly promoting clinical acceptance.
Collapse
Affiliation(s)
- Xiaole Han
- Key Laboratory of Ultra-Weak Magnetic Field Measurement Technology, Ministry of Education, School of Instrumentation and Optoelectronic Engineering, Beihang University, People's Republic of China
- Zhejiang Provincial Key Laboratory of Ultra-Weak Magnetic-Field Space and Applied Technology, Hangzhou Innovation Institute, Beihang University, Hangzhou 310051, People's Republic of China
| | - Jiaojiao Pang
- Shandong Key Laboratory for Magnetic Field-free Medicine & Functional Imaging, Institute of Magnetic Field-free Medicine & Functional Imaging, Shandong University, People's Republic of China
- Department of Emergency Medicine, Qilu Hospital of Shandong University, Shandong Provincial Clinical Research Center for Emergency and Critical Care Medicine, People's Republic of China
- National Innovation Platform for Industry-Education Intearation in Medicine-Engineering Interdisciplinary, Shandong University, People's Republic of China
| | - Dong Xu
- National Institute of Extremely-Weak Magnetic Field Infrastructure, Hangzhou, People's Republic of China
| | - Ruizhe Wang
- Key Laboratory of Ultra-Weak Magnetic Field Measurement Technology, Ministry of Education, School of Instrumentation and Optoelectronic Engineering, Beihang University, People's Republic of China
- Zhejiang Provincial Key Laboratory of Ultra-Weak Magnetic-Field Space and Applied Technology, Hangzhou Innovation Institute, Beihang University, Hangzhou 310051, People's Republic of China
| | - Fei Xie
- Shandong Key Laboratory for Magnetic Field-free Medicine & Functional Imaging, Institute of Magnetic Field-free Medicine & Functional Imaging, Shandong University, People's Republic of China
- Department of Emergency Medicine, Qilu Hospital of Shandong University, Shandong Provincial Clinical Research Center for Emergency and Critical Care Medicine, People's Republic of China
- National Innovation Platform for Industry-Education Intearation in Medicine-Engineering Interdisciplinary, Shandong University, People's Republic of China
| | - Yanfei Yang
- Key Laboratory of Ultra-Weak Magnetic Field Measurement Technology, Ministry of Education, School of Instrumentation and Optoelectronic Engineering, Beihang University, People's Republic of China
- Zhejiang Provincial Key Laboratory of Ultra-Weak Magnetic-Field Space and Applied Technology, Hangzhou Innovation Institute, Beihang University, Hangzhou 310051, People's Republic of China
| | - Jiguang Sun
- Hangzhou Nuochi Life Science Co., Ltd, People's Republic of China
| | - Yu Li
- Shandong Key Laboratory for Magnetic Field-free Medicine & Functional Imaging, Institute of Magnetic Field-free Medicine & Functional Imaging, Shandong University, People's Republic of China
- Department of Emergency Medicine, Qilu Hospital of Shandong University, Shandong Provincial Clinical Research Center for Emergency and Critical Care Medicine, People's Republic of China
- National Innovation Platform for Industry-Education Intearation in Medicine-Engineering Interdisciplinary, Shandong University, People's Republic of China
| | - Ruochuan Li
- Shandong Key Laboratory for Magnetic Field-free Medicine & Functional Imaging, Institute of Magnetic Field-free Medicine & Functional Imaging, Shandong University, People's Republic of China
- Department of Emergency Medicine, Qilu Hospital of Shandong University, Shandong Provincial Clinical Research Center for Emergency and Critical Care Medicine, People's Republic of China
- National Innovation Platform for Industry-Education Intearation in Medicine-Engineering Interdisciplinary, Shandong University, People's Republic of China
| | - Xiaofei Yin
- Shandong Key Laboratory for Magnetic Field-free Medicine & Functional Imaging, Institute of Magnetic Field-free Medicine & Functional Imaging, Shandong University, People's Republic of China
- Department of Emergency Medicine, Qilu Hospital of Shandong University, Shandong Provincial Clinical Research Center for Emergency and Critical Care Medicine, People's Republic of China
- National Innovation Platform for Industry-Education Intearation in Medicine-Engineering Interdisciplinary, Shandong University, People's Republic of China
| | - Yansong Xu
- Shandong Key Laboratory for Magnetic Field-free Medicine & Functional Imaging, Institute of Magnetic Field-free Medicine & Functional Imaging, Shandong University, People's Republic of China
- Department of Emergency Medicine, Qilu Hospital of Shandong University, Shandong Provincial Clinical Research Center for Emergency and Critical Care Medicine, People's Republic of China
- National Innovation Platform for Industry-Education Intearation in Medicine-Engineering Interdisciplinary, Shandong University, People's Republic of China
| | - Jiaxin Fan
- Shandong Key Laboratory for Magnetic Field-free Medicine & Functional Imaging, Institute of Magnetic Field-free Medicine & Functional Imaging, Shandong University, People's Republic of China
- Department of Emergency Medicine, Qilu Hospital of Shandong University, Shandong Provincial Clinical Research Center for Emergency and Critical Care Medicine, People's Republic of China
- National Innovation Platform for Industry-Education Intearation in Medicine-Engineering Interdisciplinary, Shandong University, People's Republic of China
| | - Yiming Dong
- Shandong Key Laboratory for Magnetic Field-free Medicine & Functional Imaging, Institute of Magnetic Field-free Medicine & Functional Imaging, Shandong University, People's Republic of China
- Department of Emergency Medicine, Qilu Hospital of Shandong University, Shandong Provincial Clinical Research Center for Emergency and Critical Care Medicine, People's Republic of China
- National Innovation Platform for Industry-Education Intearation in Medicine-Engineering Interdisciplinary, Shandong University, People's Republic of China
| | - Xiaohui Wu
- Shandong Key Laboratory for Magnetic Field-free Medicine & Functional Imaging, Institute of Magnetic Field-free Medicine & Functional Imaging, Shandong University, People's Republic of China
- Department of Emergency Medicine, Qilu Hospital of Shandong University, Shandong Provincial Clinical Research Center for Emergency and Critical Care Medicine, People's Republic of China
- National Innovation Platform for Industry-Education Intearation in Medicine-Engineering Interdisciplinary, Shandong University, People's Republic of China
| | - Xiaoyun Yang
- Shandong Key Laboratory for Magnetic Field-free Medicine & Functional Imaging, Institute of Magnetic Field-free Medicine & Functional Imaging, Shandong University, People's Republic of China
- National Innovation Platform for Industry-Education Intearation in Medicine-Engineering Interdisciplinary, Shandong University, People's Republic of China
- Department of Gastroenterology, Qilu Hospital of Shandong University, Shandong Provincial Clinical Research Center for Digestive Disease, People's Republic of China
| | - Dexin Yu
- Shandong Key Laboratory for Magnetic Field-free Medicine & Functional Imaging, Institute of Magnetic Field-free Medicine & Functional Imaging, Shandong University, People's Republic of China
- National Innovation Platform for Industry-Education Intearation in Medicine-Engineering Interdisciplinary, Shandong University, People's Republic of China
- Department of Radiology, Qilu Hospital of Shandong University, People's Republic of China
| | - Dawei Wang
- Shandong Key Laboratory for Magnetic Field-free Medicine & Functional Imaging, Institute of Magnetic Field-free Medicine & Functional Imaging, Shandong University, People's Republic of China
- National Innovation Platform for Industry-Education Intearation in Medicine-Engineering Interdisciplinary, Shandong University, People's Republic of China
- Department of Radiology, Qilu Hospital of Shandong University, People's Republic of China
| | - Yang Gao
- Key Laboratory of Ultra-Weak Magnetic Field Measurement Technology, Ministry of Education, School of Instrumentation and Optoelectronic Engineering, Beihang University, People's Republic of China
- Zhejiang Provincial Key Laboratory of Ultra-Weak Magnetic-Field Space and Applied Technology, Hangzhou Innovation Institute, Beihang University, Hangzhou 310051, People's Republic of China
- National Institute of Extremely-Weak Magnetic Field Infrastructure, Hangzhou, People's Republic of China
- Institute of Large-Scale Scientific Facility and Centre for Zero Magnetic Field Science, Beihang University, People's Republic of China
| | - Min Xiang
- Key Laboratory of Ultra-Weak Magnetic Field Measurement Technology, Ministry of Education, School of Instrumentation and Optoelectronic Engineering, Beihang University, People's Republic of China
- Zhejiang Provincial Key Laboratory of Ultra-Weak Magnetic-Field Space and Applied Technology, Hangzhou Innovation Institute, Beihang University, Hangzhou 310051, People's Republic of China
- National Institute of Extremely-Weak Magnetic Field Infrastructure, Hangzhou, People's Republic of China
- Institute of Large-Scale Scientific Facility and Centre for Zero Magnetic Field Science, Beihang University, People's Republic of China
- Hefei National Laboratory, People's Republic of China
| | - Feng Xu
- Shandong Key Laboratory for Magnetic Field-free Medicine & Functional Imaging, Institute of Magnetic Field-free Medicine & Functional Imaging, Shandong University, People's Republic of China
- Department of Emergency Medicine, Qilu Hospital of Shandong University, Shandong Provincial Clinical Research Center for Emergency and Critical Care Medicine, People's Republic of China
- National Innovation Platform for Industry-Education Intearation in Medicine-Engineering Interdisciplinary, Shandong University, People's Republic of China
| | - Jinji Sun
- Key Laboratory of Ultra-Weak Magnetic Field Measurement Technology, Ministry of Education, School of Instrumentation and Optoelectronic Engineering, Beihang University, People's Republic of China
- Zhejiang Provincial Key Laboratory of Ultra-Weak Magnetic-Field Space and Applied Technology, Hangzhou Innovation Institute, Beihang University, Hangzhou 310051, People's Republic of China
- National Institute of Extremely-Weak Magnetic Field Infrastructure, Hangzhou, People's Republic of China
- Institute of Large-Scale Scientific Facility and Centre for Zero Magnetic Field Science, Beihang University, People's Republic of China
- Hefei National Laboratory, People's Republic of China
| | - Yuguo Chen
- Shandong Key Laboratory for Magnetic Field-free Medicine & Functional Imaging, Institute of Magnetic Field-free Medicine & Functional Imaging, Shandong University, People's Republic of China
- Department of Emergency Medicine, Qilu Hospital of Shandong University, Shandong Provincial Clinical Research Center for Emergency and Critical Care Medicine, People's Republic of China
- National Innovation Platform for Industry-Education Intearation in Medicine-Engineering Interdisciplinary, Shandong University, People's Republic of China
| | - Xiaolin Ning
- Key Laboratory of Ultra-Weak Magnetic Field Measurement Technology, Ministry of Education, School of Instrumentation and Optoelectronic Engineering, Beihang University, People's Republic of China
- Zhejiang Provincial Key Laboratory of Ultra-Weak Magnetic-Field Space and Applied Technology, Hangzhou Innovation Institute, Beihang University, Hangzhou 310051, People's Republic of China
- National Institute of Extremely-Weak Magnetic Field Infrastructure, Hangzhou, People's Republic of China
- Institute of Large-Scale Scientific Facility and Centre for Zero Magnetic Field Science, Beihang University, People's Republic of China
- Hefei National Laboratory, People's Republic of China
| |
Collapse
|
5
|
Wang Y, Zhao ZG, Chai Z, Fang JC, Chen M. Electromagnetic field and cardiovascular diseases: A state-of-the-art review of diagnostic, therapeutic, and predictive values. FASEB J 2023; 37:e23142. [PMID: 37650634 DOI: 10.1096/fj.202300201rr] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Revised: 07/20/2023] [Accepted: 08/02/2023] [Indexed: 09/01/2023]
Abstract
Despite encouraging advances in early diagnosis and treatment, cardiovascular diseases (CVDs) remained a leading cause of morbidity and mortality worldwide. Increasing evidence has shown that the electromagnetic field (EMF) influences many biological processes, which has attracted much attention for its potential therapeutic and diagnostic modalities in multiple diseases, such as musculoskeletal disorders and neurodegenerative diseases. Nonionizing EMF has been studied as a therapeutic or diagnostic tool in CVDs. In this review, we summarize the current literature ranging from in vitro to clinical studies focusing on the therapeutic potential (external EMF) and diagnostic potential (internal EMF generated from the heart) of EMF in CVDs. First, we provided an overview of the therapeutic potential of EMF and associated mechanisms in the context of CVDs, including cardiac arrhythmia, myocardial ischemia, atherosclerosis, and hypertension. Furthermore, we investigated the diagnostic and predictive value of magnetocardiography in CVDs. Finally, we discussed the critical steps necessary to translate this promising approach into clinical practice.
Collapse
Affiliation(s)
- Yan Wang
- Laboratory of Heart Valve Disease, West China Hospital, Sichuan University, Chengdu, Sichuan, China
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Zhen-Gang Zhao
- Laboratory of Heart Valve Disease, West China Hospital, Sichuan University, Chengdu, Sichuan, China
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Zheng Chai
- Laboratory of Heart Valve Disease, West China Hospital, Sichuan University, Chengdu, Sichuan, China
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Jian-Cheng Fang
- School of Instrumentation Science and Opto-Electronics Engineering, Beihang University, Beijing, China
| | - Mao Chen
- Laboratory of Heart Valve Disease, West China Hospital, Sichuan University, Chengdu, Sichuan, China
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| |
Collapse
|
6
|
Suwalski P, Golpour A, Musigk N, Wilke F, Landmesser U, Heidecker B. Case report: Recurrence of inflammatory cardiomyopathy detected by magnetocardiography. Front Cardiovasc Med 2023; 10:1225057. [PMID: 37808876 PMCID: PMC10556648 DOI: 10.3389/fcvm.2023.1225057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Accepted: 09/01/2023] [Indexed: 10/10/2023] Open
Abstract
Background The diagnosis of inflammatory cardiomyopathies remains challenging. Life-threatening conditions such as acute coronary syndrome (ACS) always have to be considered as differential diagnoses due to similarities in presentation. Diagnostic methods for inflammatory cardiomyopathy include endomyocardial biopsy (EMB), cardiac magnetic resonance imaging (CMR), and positron emission tomography-computed tomography (PET-CT). We report a case in whom magnetocardiography (MCG) led to an initial diagnosis of inflammatory cardiomyopathy and in whom MCG was used for subsequent monitoring of treatment response under immunosuppression. Case presentation A 53-year-old man presented with two recurrent episodes of inflammatory cardiomyopathy within a 2-year period. The patient initially presented with reduced exercise capacity. Echocardiography revealed a moderately reduced left ventricular ejection fraction (LVEF 40%). Coronary angiography ruled out obstructive coronary artery disease (CAD) and an EMB was performed. The EMB revealed inflammatory cardiomyopathy without viral pathogens or replication. Moreover, we performed MCG, which confirmed a pathological Tbeg-Tmax vector of 0.108. We recently established a cutoff value of Tbeg-Tmax of 0.051 or greater for the diagnosis of inflammatory cardiomyopathy. Immunosuppressive therapy with prednisolone was initiated, resulting in clinical improvement and an LVEF increase from 40% to 45% within 1 month. Furthermore, the MCG vector improved to 0.036, which is considered normal based on our previous findings. The patient remained clinically stable for 23 months. During a routine follow-up, MCG revealed an abnormal Tbeg-Tmax vector of 0.069. The patient underwent additional testing including routine laboratory values, echocardiography (LVEF 35%), and PET-CT. PET-CT revealed increased metabolism in the myocardium-primarily in the lateral wall. Therapy with prednisolone and azathioprine was initiated and MCG was used to monitor the effect of immunosuppressive therapy. Conclusion In addition to diagnostic screening, MCG has the potential to become a valuable method for surveillance monitoring of patients who have completed treatment for inflammatory cardiomyopathy. Furthermore, it could be used for treatment monitoring. While changes in the magnetic vector of the heart are not specific to inflammatory cardiomyopathy, as they may also occur in other types of cardiomyopathies, MCG offers a tool of broad and efficient diagnostic screening for cardiac pathologies without side effects.
Collapse
Affiliation(s)
| | | | | | | | | | - Bettina Heidecker
- Department of Cardiology, Angiology and Intensive Care Medicine CBF, Deutsches Herzzentrum der Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt – Universität zu Berlin, Berlin, Germany
| |
Collapse
|
7
|
Sengottuvel S, Shenbaga Devi S, Sasikala M, Satheesh S, Selvaraj RJ. A method for noninvasive beat-by-beat visualization of His bundle signals. Ann Noninvasive Electrocardiol 2023; 28:e13076. [PMID: 37496182 PMCID: PMC10475892 DOI: 10.1111/anec.13076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 06/13/2023] [Accepted: 07/11/2023] [Indexed: 07/28/2023] Open
Abstract
BACKGROUND Invasive recording of His bundle signals (HBS) in electrophysiological study (EPS) is important in determining HV interval, the time taken to activate the ventricles from the His bundle. Noninvasive surface measurements of HBS are attempted by averaging typically 100-200 cardiac cycles of ECG time series in body surface potential mapping (BSPM) and in magnetocardiography (MCG) which records weak cardiac magnetic fields by highly sensitive detectors. However, noninvasive beat-by-beat extraction of HBS is challenged by ramp-like atrial signals and noise in PR segment of the cardiac cycle. METHODS By making use of a signal-averaged trace showing prominent HBS as a guide trace, we developed a method combining interval-dependent wavelet thresholding (IDWT) and signal space projection (SSP) technique to eliminate artifacts from single beats. The method was applied on MCG recorded on 21 subjects with known HV intervals based on EPS and noninvasive signal-averaging, including five subjects with BSPM recorded subsequently. The method was also applied on stress-MCG of a subject featuring autonomic dynamics. RESULTS HBS could be extracted from 19 out of 21 subjects by signal-averaging whose timing differed from EPS between -8 and 11 ms as tested by 2 observers. HBS in single beats were seen as aligned patterns in inter-beat contours and were appreciable in stress-MCG and conspicuous than BSPM. The performance of the method was evaluated on simulated and measured MCG to be adequate if the signal-to-noise ratio was at least 20 dB. CONCLUSIONS These results suggest the use of this method for noninvasive assessments on HBS.
Collapse
Affiliation(s)
- S. Sengottuvel
- SQUIDs Applications Section, SQUID and Detector Technology DivisionMaterials Science Group, Indira Gandhi Centre for Atomic ResearchKalpakkamIndia
| | - S. Shenbaga Devi
- Department of Electronics and Communication Engineering, Centre for Medical ElectronicsAnna UniversityChennaiIndia
| | - M. Sasikala
- Department of Electronics and Communication Engineering, Centre for Medical ElectronicsAnna UniversityChennaiIndia
| | - S. Satheesh
- Department of CardiologyJawaharlal Institute of Postgraduate Medical Education and ResearchPuducherryIndia
| | - R. J. Selvaraj
- Department of CardiologyJawaharlal Institute of Postgraduate Medical Education and ResearchPuducherryIndia
| |
Collapse
|
8
|
Golpour A, Suwalski P, Landmesser U, Heidecker B. Case report: Magnetocardiography as a potential method of therapy monitoring in amyloidosis. Front Cardiovasc Med 2023; 10:1224578. [PMID: 37663414 PMCID: PMC10469684 DOI: 10.3389/fcvm.2023.1224578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Accepted: 08/01/2023] [Indexed: 09/05/2023] Open
Abstract
Amyloidosis is characterized by a disorder of protein conformation and metabolism, resulting in deposits of insoluble fibrils in various organs causing functional disturbances. Amyloidosis can also affect the heart. Cardiac amyloidosis tends to have a poor prognostic outcome if diagnosed at a late stage. Therefore, early diagnosis and initiation of therapy as well as monitoring of treatment response are crucial to improve outcomes and to learn more about its pathophysiology and clinical course. We present an 83-year-old woman with cardiac transthyretin amyloidosis (ATTR) who was treated with tafamidis. The patient significantly improved 18 months after initiation of therapy with regards to exercise capacity and quality of life. In addition to standard diagnostic methods, we used magnetocardiography (MCG) to monitor potential treatment response by detecting changes in the magnetic field of the heart. MCG is a non-invasive method that detects the cardiac magnetic field generated by electrical currents in the heart with high sensitivity. We have recently shown that this magnetic field changes in various types of cardiomyopathies may be used as a non-invasive screening tool. We determined previously that an MCG vector ≥0.052 was the optimal threshold to detect cardiac amyloidosis. The patient's MCG was measured at various time points during therapy. At the time of diagnosis, the patient's MCG vector was 0.052. After starting therapy, the MCG vector increased to 0.090, but improved to 0.037 after 4 months of therapy. The MCG vector reached a value of 0.017 after 5 months of therapy with tafamidis, and then increased slightly after 27 months to a value of 0.027 (<0.052). Data from this case support our previous findings that MCG may be used to monitor treatment response non-invasively. Further research is needed to understand the unexpected changes in the MCG vector that were observed at the beginning of therapy and later in the course. Larger studies will be necessary to determine how these changes in the electromagnetic field of the heart are related to structural changes and how they affect clinical outcomes.
Collapse
Affiliation(s)
| | | | | | - Bettina Heidecker
- Deutsches Herzzentrum der Charité, Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt – Universität zu Berlin, Berlin, Germany
| |
Collapse
|
9
|
Her AY, Dischl D, Kim YH, Kim SW, Shin ES. Magnetocardiography for the detection of myocardial ischemia. Front Cardiovasc Med 2023; 10:1242215. [PMID: 37485271 PMCID: PMC10361573 DOI: 10.3389/fcvm.2023.1242215] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Accepted: 06/28/2023] [Indexed: 07/25/2023] Open
Abstract
Ischemic heart disease (IHD) continues to be a significant global public health concern and ranks among the leading causes of mortality worldwide. However, the identification of myocardial ischemia in patients suspected of having coronary artery disease (CAD) remains a challenging issue. Functional or stress testing is widely recognized as the gold standard method for diagnosing myocardial ischemia, but it is hindered by low diagnostic accuracy and limitations such as radiation exposure. Magnetocardiography (MCG) is a non-contact, non-invasive method that records magnetic fields produced by the electrical activity of the heart. Unlike electrocardiography (EKG) and other functional or stress testing, MCG offers numerous advantages. It is highly sensitive and can detect early signs of myocardial ischemia that may be missed by other diagnostic tools. This review aims to provide an extensive overview of the available evidence that establishes the utility of MCG as a valuable diagnostic tool for identifying myocardial ischemia, accompanied by a discussion of potential future research directions in this domain.
Collapse
Affiliation(s)
- Ae-Young Her
- Department of Internal Medicine, Division of Cardiology, Kangwon National University College of Medicine, Kangwon National University School of Medicine, Chuncheon, Republic of Korea
| | - Dominic Dischl
- Department of Cardiology, Deutsches Herzzentrum der Charité (DHZC), Angiology and Intensive Care Medicine, Berlin, Germany
| | - Yong Hoon Kim
- Department of Internal Medicine, Division of Cardiology, Kangwon National University College of Medicine, Kangwon National University School of Medicine, Chuncheon, Republic of Korea
| | - Sang-Wook Kim
- Heart Research Institute, Cardiovascular-Arrhythmia Center, College of Medicine, Chung-Ang University Hospital, Seoul, Republic of Korea
| | - Eun-Seok Shin
- Department of Cardiology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Republic of Korea
| |
Collapse
|
10
|
Han X, Xue X, Yang Y, Liang X, Gao Y, Xiang M, Sun J, Ning X. Magnetocardiography using optically pumped magnetometers array to detect acute myocardial infarction and premature ventricular contractions in dogs. Phys Med Biol 2023. [PMID: 37406640 DOI: 10.1088/1361-6560/ace497] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/07/2023]
Abstract
OBJECTIVE Optically pumped magnetometers (OPMs) are recently developed magnetocardiography (MCG) sensors that can detect cardiac diseases. This is of great clinical significance for detecting acute myocardial infarction (AMI) and premature ventricular contractions (PVC). This study investigates the use of an array of OPMs to detect heart disease in animals. APPROACH An array of OPMs was used to detect the MCG of AMI and PVC in dogs. We used four dogs in this study, and models of AMI with different degrees of severity were established by ligating the middle and proximal segments of the left anterior descending coronary artery. The dogs had PVC at the time of AMI. Continuous MCG time series with corresponding electrocardiograms (ECGs) and average MCG for each dog in different states are presented. The MCG features were extracted from the MCG butterfly diagram, magnetic field map, and pseudo current density map. The MCG features were used to quantify and compare with the gold-standard ECG measures. MAIN RESULTS The results show that MCG features can accurately distinguish different states of dogs. That is, an array of OPMs can effectively detect AMI and PVC in dogs. SIGNIFICANCE We conclude that the array of OPMs can detect heart diseases in animals. Moreover, OPMs can complement or even replace superconducting quantum interference devices for MCG measurement in animals and diagnosis of human heart diseases in the future.
Collapse
Affiliation(s)
- Xiaole Han
- Beihang University, XueYuan Road No.37,HaiDian District,BeiJing,China, Beijing, 100083, CHINA
| | - Xiaoyan Xue
- Beihang University, XueYuan Road No.37,HaiDian District,BeiJing,China, Beijing, Beijing, 100191, CHINA
| | - Yanfei Yang
- Beihang University, XueYuan Road No.37,HaiDian District,BeiJing,China, Beijing, Beijing, 100191, CHINA
| | - Xiaoyu Liang
- Beihang University, XueYuan Road No.37,HaiDian District,BeiJing,China, Beijing, 100191, CHINA
| | - Yang Gao
- Beihang University, XueYuan Road No.37,HaiDian District,BeiJing,China, Beijing, 100191, CHINA
| | - Min Xiang
- Beihang University, XueYuan Road No.37,HaiDian District,BeiJing,China, Beijing, 100191, CHINA
| | - Jinji Sun
- Beihang University, XueYuan Road No.37,HaiDian District,BeiJing,China, Beijing, Beijing, 100091, CHINA
| | - Xiaolin Ning
- Beihang University, XueYuan Road No.37,HaiDian District,BeiJing,China, Beijing, Beijing, 100191, CHINA
| |
Collapse
|
11
|
Zhu K, Kiourti A. Real-Time Magnetocardiography with Passive Miniaturized Coil Array in Earth Ambient Field. Sensors (Basel) 2023; 23:5567. [PMID: 37420733 DOI: 10.3390/s23125567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 06/08/2023] [Accepted: 06/12/2023] [Indexed: 07/09/2023]
Abstract
We demonstrate a magnetocardiography (MCG) sensor that operates in non-shielded environments, in real-time, and without the need for an accompanying device to identify the cardiac cycles for averaging. We further validate the sensor's performance on human subjects. Our approach integrates seven (7) coils, previously optimized for maximum sensitivity, into a coil array. Based on Faraday's law, magnetic flux from the heart is translated into voltage across the coils. By leveraging digital signal processing (DSP), namely, bandpass filtering and averaging across coils, MCG can be retrieved in real-time. Our coil array can monitor real-time human MCG with clear QRS complexes in non-shielded environments. Intra- and inter-subject variability tests confirm repeatability and accuracy comparable to gold-standard electrocardiography (ECG), viz., a cardiac cycle detection accuracy of >99.13% and averaged R-R interval accuracy of <5.8 ms. Our results confirm the feasibility of real-time R-peak detection using the MCG sensor, as well as the ability to retrieve the full MCG spectrum as based upon the averaging of cycles identified via the MCG sensor itself. This work provides new insights into the development of accessible, miniaturized, safe, and low-cost MCG tools.
Collapse
Affiliation(s)
- Keren Zhu
- Department of Electrical and Computer Engineering, The Ohio State University, Columbus, OH 43210, USA
| | - Asimina Kiourti
- Department of Electrical and Computer Engineering, The Ohio State University, Columbus, OH 43210, USA
| |
Collapse
|
12
|
Mercado L, Escalona-Vargas D, Blossom S, Siegel ER, Whittington JR, Preissl H, Walden K, Eswaran H. The effect of maternal pregestational diabetes on fetal autonomic nervous system. Physiol Rep 2023; 11:e15680. [PMID: 37144450 PMCID: PMC10161040 DOI: 10.14814/phy2.15680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 03/29/2023] [Accepted: 04/12/2023] [Indexed: 05/06/2023] Open
Abstract
Heart rate variability assessment of neonates of pregestational diabetic mothers have shown alterations in the autonomic nervous system (ANS). The objective was to study the effect of maternal pregestational diabetes on ANS at the fetal stage by combining cardiac and movement parameters using a non-invasive fetal magnetocardiography (fMCG) technique. This is an observational study with 40 participants where fetuses from a group of 9 Type 1, 19 Type 2 diabetic, and 12 non-diabetic pregnant women were included. Time and frequency domain fetal heart rate variability (fHRV) and coupling of movement and heart rate acceleration parameters related to fetal ANS were analyzed. Group differences were investigated using analysis of covariance to adjust for gestational age (GA). When compared to non-diabetics, the Type 1 diabetics had a 65% increase in average ratio of very low-frequency (VLF) to low-frequency (LF) bands and 63% average decrease in coupling index after adjusting for GA. Comparing Type 2 diabetics to non-diabetics, there was an average decrease in the VLF (50%) and LF bands (63%). Diabetics with poor glycemic control had a higher average VLF/LF (49%) than diabetics with good glycemic control. No significant changes at p < 0.05 were observed in high-frequency (HF) frequency domain parameters or their ratios, or in the time domain. Fetuses of pregestational diabetic mothers exhibited some differences in fHRV frequency domain and heart rate-movement coupling when compared to non-diabetics but the effect of fHRV related to fetal ANS and sympathovagal balance were not as conclusive as observed in the neonates of pregestational diabetic mothers.
Collapse
Affiliation(s)
- Luis Mercado
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Diana Escalona-Vargas
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
- Department of Pediatrics, University of Arkansas for Medical Sciences, Arkansas Children's Research Institute, Little Rock, Arkansas, USA
| | - Sarah Blossom
- Department of Pediatrics, University of Arkansas for Medical Sciences, Arkansas Children's Research Institute, Little Rock, Arkansas, USA
| | - Eric R Siegel
- Department of Biostatistics, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Julie R Whittington
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Hubert Preissl
- Institute for Diabetes Research and Metabolic Diseases of the Helmholtz Center Munich at the University of Tübingen, German Center for Diabetes Research (DZD), Tübingen, Germany
| | - Kaitlyn Walden
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Hari Eswaran
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| |
Collapse
|
13
|
Brala D, Thevathasan T, Grahl S, Barrow S, Violano M, Bergs H, Golpour A, Suwalski P, Poller W, Skurk C, Landmesser U, Heidecker B. Application of Magnetocardiography to Screen for Inflammatory Cardiomyopathy and Monitor Treatment Response. J Am Heart Assoc 2023; 12:e027619. [PMID: 36744683 PMCID: PMC10111485 DOI: 10.1161/jaha.122.027619] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Background Inflammatory cardiomyopathy is one of the most common causes of sudden cardiac death in young adults. Diagnosis of inflammatory cardiomyopathy remains challenging, and better monitoring tools are needed. We present magnetocardiography as a method to diagnose myocardial inflammation and monitor treatment response. Methods and Results A total of 233 patients were enrolled, with a mean age of 45 (±18) years, and 105 (45%) were women. The primary analysis included 209 adult subjects, of whom 66 (32%) were diagnosed with inflammatory cardiomyopathy, 17 (8%) were diagnosed with cardiac amyloidosis, and 35 (17%) were diagnosed with other types of nonischemic cardiomyopathy; 91 (44%) did not have cardiomyopathy. The second analysis included 13 patients with inflammatory cardiomyopathy who underwent immunosuppressive therapy after baseline magnetocardiography measurement. Finally, diagnostic accuracy of magnetocardiography was tested in 3 independent cohorts (total n=23) and 1 patient, who developed vaccine-related myocarditis. First, we identified a magnetocardiography vector to differentiate between patients with cardiomyopathy versus patients without cardiomyopathy (vector of ≥0.051; sensitivity, 0.59; specificity, 0.95; positive predictive value, 93%; and negative predictive value, 64%). All patients with inflammatory cardiomyopathy, including a patient with mRNA vaccine-related myocarditis, had a magnetocardiography vector ≥0.051. Second, we evaluated the ability of the magnetocardiography vector to reflect treatment response. We observed a decrease of the pathologic magnetocardiography vector toward normal in all 13 patients who were clinically improving under immunosuppressive therapy. Magnetocardiography detected treatment response as early as day 7, whereas echocardiographic detection of treatment response occurred after 1 month. The magnetocardiography vector decreased from 0.10 at baseline to 0.07 within 7 days (P=0.010) and to 0.03 within 30 days (P<0.001). After 30 days, left ventricular ejection fraction improved from 42.2% at baseline to 53.8% (P<0.001). Conclusions Magnetocardiography has the potential to be used for diagnostic screening and to monitor early treatment response. The method is valuable in inflammatory cardiomyopathy, where there is a major unmet need for early diagnosis and monitoring response to immunosuppressive therapy.
Collapse
Affiliation(s)
- Debora Brala
- Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin Berlin Germany
| | - Tharusan Thevathasan
- Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin Berlin Germany
| | - Simon Grahl
- Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin Berlin Germany
| | - Steve Barrow
- Division of Instrumentation at Space Telescope Science Institute Baltimore MD
| | - Michele Violano
- Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin Berlin Germany
| | - Hendrikje Bergs
- Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin Berlin Germany
| | - Ainoosh Golpour
- Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin Berlin Germany
| | - Phillip Suwalski
- Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin Berlin Germany
| | - Wolfgang Poller
- Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin Berlin Germany
| | - Carsten Skurk
- Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin Berlin Germany
| | - Ulf Landmesser
- Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin Berlin Germany.,Berlin Institute of Health at Charité Berlin Germany
| | - Bettina Heidecker
- Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin Berlin Germany
| |
Collapse
|
14
|
Kurashima K, Kataoka M, Nakano T, Fujiwara K, Kato S, Nakamura T, Yuzawa M, Masuda M, Ichimura K, Okatake S, Moriyasu Y, Sugiyama K, Oogane M, Ando Y, Kumagai S, Matsuzaki H, Mochizuki H. Development of Magnetocardiograph without Magnetically Shielded Room Using High-Detectivity TMR Sensors. Sensors (Basel) 2023; 23:646. [PMID: 36679442 PMCID: PMC9866167 DOI: 10.3390/s23020646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 12/23/2022] [Accepted: 12/29/2022] [Indexed: 06/17/2023]
Abstract
A magnetocardiograph that enables the clear observation of heart magnetic field mappings without magnetically shielded rooms at room temperatures has been successfully manufactured. Compared to widespread electrocardiographs, magnetocardiographs commonly have a higher spatial resolution, which is expected to lead to early diagnoses of ischemic heart disease and high diagnostic accuracy of ventricular arrhythmia, which involves the risk of sudden death. However, as the conventional superconducting quantum interference device (SQUID) magnetocardiographs require large magnetically shielded rooms and huge running costs to cool the SQUID sensors, magnetocardiography is still unfamiliar technology. Here, in order to achieve the heart field detectivity of 1.0 pT without magnetically shielded rooms and enough magnetocardiography accuracy, we aimed to improve the detectivity of tunneling magnetoresistance (TMR) sensors and to decrease the environmental and sensor noises with a mathematical algorithm. The magnetic detectivity of the TMR sensors was confirmed to be 14.1 pTrms on average in the frequency band between 0.2 and 100 Hz in uncooled states, thanks to the original multilayer structure and the innovative pattern of free layers. By constructing a sensor array using 288 TMR sensors and applying the mathematical magnetic shield technology of signal space separation (SSS), we confirmed that SSS reduces the environmental magnetic noise by -73 dB, which overtakes the general triple magnetically shielded rooms. Moreover, applying digital processing that combined the signal average of heart magnetic fields for one minute and the projection operation, we succeeded in reducing the sensor noise by about -23 dB. The heart magnetic field resolution measured on a subject in a laboratory in an office building was 0.99 pTrms and obtained magnetocardiograms and current arrow maps as clear as the SQUID magnetocardiograph does in the QRS and ST segments. Upon utilizing its superior spatial resolution, this magnetocardiograph has the potential to be an important tool for the early diagnosis of ischemic heart disease and the risk management of sudden death triggered by ventricular arrhythmia.
Collapse
Affiliation(s)
- Koshi Kurashima
- Device & Process Application Development Unit, Research & Development Center, Asahi Kasei Microdevices Corporation, Atsugi AXT Maintower 20F, 3050 Okata, Atsugi 243-0021, Kanagawa, Japan
| | - Makoto Kataoka
- Device & Process Application Development Unit, Research & Development Center, Asahi Kasei Microdevices Corporation, Atsugi AXT Maintower 20F, 3050 Okata, Atsugi 243-0021, Kanagawa, Japan
| | - Takafumi Nakano
- Department of Applied Physics, Graduate School of Engineering, Tohoku University, 6-6-05 Aoba-yama, Aoba-ku, Sendai 980-8579, Miyagi, Japan
| | - Kosuke Fujiwara
- Spin Sensing Factory Corporation, Research Center for Rare Metal and Green Innovation, 403 468-1 Aramaki Aza-Aoba, Aoba-ku, Sendai 980-0845, Miyagi, Japan
| | - Seiichi Kato
- Device & Process Application Development Unit, Research & Development Center, Asahi Kasei Microdevices Corporation, Atsugi AXT Maintower 20F, 3050 Okata, Atsugi 243-0021, Kanagawa, Japan
| | - Takenobu Nakamura
- Device & Process Application Development Unit, Research & Development Center, Asahi Kasei Microdevices Corporation, Atsugi AXT Maintower 20F, 3050 Okata, Atsugi 243-0021, Kanagawa, Japan
| | - Masaki Yuzawa
- Device & Process Application Development Unit, Research & Development Center, Asahi Kasei Microdevices Corporation, Atsugi AXT Maintower 20F, 3050 Okata, Atsugi 243-0021, Kanagawa, Japan
| | - Masanori Masuda
- Device & Process Application Development Unit, Research & Development Center, Asahi Kasei Microdevices Corporation, Atsugi AXT Maintower 20F, 3050 Okata, Atsugi 243-0021, Kanagawa, Japan
| | - Kakeru Ichimura
- Device & Process Application Development Unit, Research & Development Center, Asahi Kasei Microdevices Corporation, Atsugi AXT Maintower 20F, 3050 Okata, Atsugi 243-0021, Kanagawa, Japan
| | - Shigeki Okatake
- Device & Process Application Development Unit, Research & Development Center, Asahi Kasei Microdevices Corporation, Atsugi AXT Maintower 20F, 3050 Okata, Atsugi 243-0021, Kanagawa, Japan
| | - Yoshitaka Moriyasu
- Device & Process Application Development Unit, Research & Development Center, Asahi Kasei Microdevices Corporation, Atsugi AXT Maintower 20F, 3050 Okata, Atsugi 243-0021, Kanagawa, Japan
| | - Kazuhiro Sugiyama
- Department of Applied Physics, Graduate School of Engineering, Tohoku University, 6-6-05 Aoba-yama, Aoba-ku, Sendai 980-8579, Miyagi, Japan
| | - Mikihiko Oogane
- Department of Applied Physics, Graduate School of Engineering, Tohoku University, 6-6-05 Aoba-yama, Aoba-ku, Sendai 980-8579, Miyagi, Japan
| | - Yasuo Ando
- Department of Applied Physics, Graduate School of Engineering, Tohoku University, 6-6-05 Aoba-yama, Aoba-ku, Sendai 980-8579, Miyagi, Japan
| | - Seiji Kumagai
- Department of Applied Physics, Graduate School of Engineering, Tohoku University, 6-6-05 Aoba-yama, Aoba-ku, Sendai 980-8579, Miyagi, Japan
- Spin Sensing Factory Corporation, Research Center for Rare Metal and Green Innovation, 403 468-1 Aramaki Aza-Aoba, Aoba-ku, Sendai 980-0845, Miyagi, Japan
| | - Hitoshi Matsuzaki
- Department of Applied Physics, Graduate School of Engineering, Tohoku University, 6-6-05 Aoba-yama, Aoba-ku, Sendai 980-8579, Miyagi, Japan
- Spin Sensing Factory Corporation, Research Center for Rare Metal and Green Innovation, 403 468-1 Aramaki Aza-Aoba, Aoba-ku, Sendai 980-0845, Miyagi, Japan
| | - Hidenori Mochizuki
- Device & Process Application Development Unit, Research & Development Center, Asahi Kasei Microdevices Corporation, Atsugi AXT Maintower 20F, 3050 Okata, Atsugi 243-0021, Kanagawa, Japan
| |
Collapse
|
15
|
Zhou P, Quan W, Wei K, Liang Z, Hu J, Liu L, Hu G, Wang A, Ye M. Application of VCSEL in Bio-Sensing Atomic Magnetometers. Biosensors (Basel) 2022; 12:1098. [PMID: 36551063 PMCID: PMC9775631 DOI: 10.3390/bios12121098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 11/27/2022] [Accepted: 11/28/2022] [Indexed: 06/17/2023]
Abstract
Recent years have seen rapid development of chip-scale atomic devices due to their great potential in the field of biomedical imaging, namely chip-scale atomic magnetometers that enable high resolution magnetocardiography (MCG) and magnetoencephalography (MEG). For atomic devices of this kind, vertical cavity surface emitting lasers (VCSELs) have become the most crucial components as integrated pumping sources, which are attracting growing interest. In this paper, the application of VCSELs in chip-scale atomic devices are reviewed, where VCSELs are integrated in various atomic bio-sensing devices with different operating environments. Secondly, the mode and polarization control of VCSELs in the specific applications are reviewed with their pros and cons discussed. In addition, various packaging of VCSEL based on different atomic devices in pursuit of miniaturization and precision measurement are reviewed and discussed. Finally, the VCSEL-based chip-scale atomic magnetometers utilized for cardiac and brain magnetometry are reviewed in detail. Nowadays, biosensors with chip integration, low power consumption, and high sensitivity are undergoing rapid industrialization, due to the growing market of medical instrumentation and portable health monitoring. It is promising that VCSEL-integrated chip-scale atomic biosensors as featured applications of this kind may experience extensive development in the near future.
Collapse
Affiliation(s)
- Peng Zhou
- School of Instrumentation and Optoelectronic Engineering, Beihang University, Beijing 100191, China
- Beihang Hangzhou Innovation Institute Yuhang, Xixi Octagon City, Yuhang District, Hangzhou 310023, China
| | - Wei Quan
- School of Instrumentation and Optoelectronic Engineering, Beihang University, Beijing 100191, China
- Beihang Hangzhou Innovation Institute Yuhang, Xixi Octagon City, Yuhang District, Hangzhou 310023, China
| | - Kai Wei
- School of Instrumentation and Optoelectronic Engineering, Beihang University, Beijing 100191, China
- Beihang Hangzhou Innovation Institute Yuhang, Xixi Octagon City, Yuhang District, Hangzhou 310023, China
| | - Zihua Liang
- School of Instrumentation and Optoelectronic Engineering, Beihang University, Beijing 100191, China
- Beihang Hangzhou Innovation Institute Yuhang, Xixi Octagon City, Yuhang District, Hangzhou 310023, China
| | - Jinsheng Hu
- School of Instrumentation and Optoelectronic Engineering, Beihang University, Beijing 100191, China
- Beihang Hangzhou Innovation Institute Yuhang, Xixi Octagon City, Yuhang District, Hangzhou 310023, China
| | - Lu Liu
- School of Instrumentation and Optoelectronic Engineering, Beihang University, Beijing 100191, China
- Beihang Hangzhou Innovation Institute Yuhang, Xixi Octagon City, Yuhang District, Hangzhou 310023, China
| | - Gen Hu
- School of Instrumentation and Optoelectronic Engineering, Beihang University, Beijing 100191, China
- Beihang Hangzhou Innovation Institute Yuhang, Xixi Octagon City, Yuhang District, Hangzhou 310023, China
| | - Ankang Wang
- School of Instrumentation and Optoelectronic Engineering, Beihang University, Beijing 100191, China
- Beihang Hangzhou Innovation Institute Yuhang, Xixi Octagon City, Yuhang District, Hangzhou 310023, China
| | - Mao Ye
- School of Instrumentation and Optoelectronic Engineering, Beihang University, Beijing 100191, China
- Beihang Hangzhou Innovation Institute Yuhang, Xixi Octagon City, Yuhang District, Hangzhou 310023, China
| |
Collapse
|
16
|
Wang Z, Zhu K, Kaur A, Recker R, Yang J, Kiourti A. Quantifying Cognitive Workload Using a Non-Contact Magnetocardiography (MCG) Wearable Sensor. Sensors (Basel) 2022; 22:9115. [PMID: 36501816 PMCID: PMC9735863 DOI: 10.3390/s22239115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 11/17/2022] [Accepted: 11/22/2022] [Indexed: 06/17/2023]
Abstract
Quantifying cognitive workload, i.e., the level of mental effort put forth by an individual in response to a cognitive task, is relevant for healthcare, training and gaming applications. However, there is currently no technology available that can readily and reliably quantify the cognitive workload of an individual in a real-world environment at a seamless way and affordable price. In this work, we overcome these limitations and demonstrate the feasibility of a magnetocardiography (MCG) sensor to reliably classify high vs. low cognitive workload while being non-contact, fully passive and low-cost, with the potential to have a wearable form factor. The operating principle relies on measuring the naturally emanated magnetic fields from the heart and subsequently analyzing the heart rate variability (HRV) matrix in three time-domain parameters: standard deviation of RR intervals (SDRR); root mean square of successive differences between heartbeats (RMSSD); and mean values of adjacent R-peaks in the cardiac signals (MeanRR). A total of 13 participants were recruited, two of whom were excluded due to low signal quality. The results show that SDRR and RMSSD achieve a 100% success rate in classifying high vs. low cognitive workload, while MeanRR achieves a 91% success rate. Tests for the same individual yield an intra-subject classification accuracy of 100% for all three HRV parameters. Future studies should leverage machine learning and advanced digital signal processing to achieve automated classification of cognitive workload and reliable operation in a natural environment.
Collapse
Affiliation(s)
- Zitong Wang
- ElectroScience Laboratory, Department of Electrical and Computer Engineering, The Ohio State University, Columbus, OH 43210, USA
| | - Keren Zhu
- ElectroScience Laboratory, Department of Electrical and Computer Engineering, The Ohio State University, Columbus, OH 43210, USA
| | - Archana Kaur
- Center for Injury Research and Policy, Abigail Wexner Research Institute at Nationwide Children’s Hospital, Columbus, OH 43215, USA
| | - Robyn Recker
- Center for Injury Research and Policy, Abigail Wexner Research Institute at Nationwide Children’s Hospital, Columbus, OH 43215, USA
| | - Jingzhen Yang
- Center for Injury Research and Policy, Abigail Wexner Research Institute at Nationwide Children’s Hospital, Columbus, OH 43215, USA
| | - Asimina Kiourti
- ElectroScience Laboratory, Department of Electrical and Computer Engineering, The Ohio State University, Columbus, OH 43210, USA
| |
Collapse
|
17
|
Abstract
Background Fetal echocardiography has been the mainstay of fetal arrhythmia diagnosis; however, fetal magnetocardiography (fMCG) has recently become clinically available. We sought to determine to what extent fMCG contributed to the precision and accuracy of fetal arrhythmia diagnosis and risk assessment, and in turn, how this altered pregnancy management. Methods and Results We reviewed fMCG tracings and medical records of 215 pregnancies referred to the Biomagnetism Laboratory, UW‐Madison, over the last 10 years, because of fetal arrhythmia or risk of arrhythmia. We compared referral diagnosis and treatment with fMCG diagnosis using a rating scale and restricted our review to the 144 subjects from the tachycardia, bradycardia/AV block, and familial long QT syndrome categories. Additional fMCG findings beyond those of the referring echocardiogram, or an alternative diagnosis were seen in 117/144 (81%), and 81 (56%) were critical changes. Eight (5.5%) had resolution of arrhythmia before fMCG. At least moderate changes in management were seen in 109/144 (76%) fetuses, of which 35/144 (24%) were major. The most diverse fMCG presentation was long QT syndrome, present in all 3 referral categories. Four of 5 stillbirths were seen with long QT syndrome. Nine fetuses showed torsades de pointes ventricular tachycardia, of which only 2 were recognized before fMCG. Conclusions FMCG has a significant impact on prenatal diagnosis and management of arrhythmias or familial arrhythmia risk, which cannot be fully met by existing technology. The combination of fMCG and fetal echocardiography in fetal care centers will be needed in the future to optimize care.
Collapse
Affiliation(s)
- Annette Wacker-Gussmann
- Department of Congential Heart Disease and Pediatric Cardiology German Heart Center Munich Germany
| | - Janette F Strasburger
- Departments of Pediatrics and Biomedical Engineering Children's Wisconsin and Herma Heart Institute Milwaukee WI
| | - Ronald T Wakai
- Department of Medical Physics University of Wisconsin-Madison Madison WI
| |
Collapse
|
18
|
Udovychenko Y, Popov A, Chaikovsky I. Multistage Classification of Current Density Distribution Maps of Various Heart States Based on Correlation Analysis and k-NN Algorithm. Front Med Technol 2022; 3:779800. [PMID: 35047968 PMCID: PMC8757770 DOI: 10.3389/fmedt.2021.779800] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Accepted: 11/08/2021] [Indexed: 11/24/2022] Open
Abstract
Magnetocardiography is a modern method of registration of the magnetic component of electromagnetic field, generated by heart activity. Magnetocardiography results are a useful source for the diagnosis of various heart diseases and states, but their usage is still undervalued in the cardiology community. In this study, a two-stage classification by correlation analysis using a k-Nearest Neighbor (k-NN) algorithm is applied for the binary classification of myocardium current density distribution maps (CDDMs). Fourteen groups of CDDMs from patients with different heart states, healthy volunteers, sportsmen, patients with negative T-peak, patients with myocardial damage, male and female patients with microvascular disease, patients with ischemic heart disease, and patients with left ventricular hypertrophy, divided into five and three different groups depending on the degree of pathology, were compared. Selection of best metric, used in classifier and number of neighbors, was performed to define the classifier with best performance for each pair of heart states. Accuracy, specificity, sensitivity, and precision values dependent on the number of neighbors are obtained for each class. The proposed method allows to obtain a value of average accuracy equal to 96%, 70% sensitivity, 98% specificity, and 70% precision.
Collapse
Affiliation(s)
- Yevhenii Udovychenko
- Electronic Engineering Department, Faculty of Electronics, Kyiv Polytechnic Institute, Kyiv, Ukraine
| | - Anton Popov
- Electronic Engineering Department, Faculty of Electronics, Kyiv Polytechnic Institute, Kyiv, Ukraine
| | - Illya Chaikovsky
- Institute of Cybernetics, National Academy of Sciences of Ukraine, Kyiv, Ukraine
| |
Collapse
|
19
|
Moore JP, Gallotti RG, Shannon KM, Bos JM, Sadeghi E, Strasburger JF, Wakai RT, Horigome H, Clur SA, Hill AC, Shah MJ, Behere S, Sarquella-Brugada G, Czosek R, Etheridge SP, Fischbach P, Kannankeril PJ, Motonaga K, Landstrom AP, Williams M, Patel A, Dagradi F, Tan RB, Stephenson E, Krishna MR, Miyake CY, Lee ME, Sanatani S, Balaji S, Young ML, Siddiqui S, Schwartz PJ, Shivkumar K, Ackerman MJ. Genotype Predicts Outcomes in Fetuses and Neonates With Severe Congenital Long QT Syndrome. JACC Clin Electrophysiol 2020; 6:1561-1570. [PMID: 33213816 DOI: 10.1016/j.jacep.2020.06.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 05/26/2020] [Accepted: 06/02/2020] [Indexed: 11/16/2022]
Abstract
OBJECTIVES This study sought to determine the relationship between long QT syndrome (LQTS) subtype (LTQ1, LTQ2, LTQ3) and postnatal cardiac events (CEs). BACKGROUND LQTS presenting with 2:1 atrioventricular block or torsades de pointes in the fetus and/or neonate has been associated with risk for major CEs, but overall outcomes and predictors remain unknown. METHODS A retrospective study involving 25 international centers evaluated the course of fetuses/newborns diagnosed with congenital LQTS and either 2:1 atrioventricular block or torsades de pointes. The primary outcomes were age at first CE after dismissal from the newborn hospitalization and death and/or cardiac transplantation during follow-up. CE was defined as aborted cardiac arrest, appropriate shock from implantable cardioverter-defibrillator, or sudden cardiac death. RESULTS A total of 84 fetuses and/or neonates were identified with LQTS (12 as LQT1, 35 as LQT2, 37 as LQT3). Median gestational age at delivery was 37 weeks (interquartile range: 35 to 39 weeks) and age at hospital discharge was 3 weeks (interquartile range: 2 to 5 weeks). Fetal demise occurred in 2 and pre-discharge death in 1. Over a median of 5.2 years, there were 1 LQT1, 3 LQT2, and 23 LQT3 CEs (13 aborted cardiac arrests, 5 sudden cardiac deaths, and 9 appropriate shocks). One patient with LQT1 and 11 patients with LQT3 died or received cardiac transplant during follow-up. The only multivariate predictor of post-discharge CEs was LQT3 status (LQT3 vs. LQT2: hazard ratio: 8.4; 95% confidence interval: 2.6 to 38.9; p < 0.001), and LQT3, relative to LQT2, genotype predicted death and/or cardiac transplant (p < 0.001). CONCLUSIONS In this large multicenter study, fetuses and/or neonates with LQT3 but not those with LQT1 or LQT2 presenting with severe arrhythmias were at high risk of not only frequent, but lethal CEs.
Collapse
Affiliation(s)
- Jeremy P Moore
- Division of Pediatric Cardiology, University of California Los Angeles (UCLA) Medical Center, Los Angeles, California, USA; UCLA Cardiac Arrhythmia Center and Ahmanson Adult Congenital Heart Disease Center, UCLA Health System, Los Angeles, California, USA.
| | - Roberto G Gallotti
- Division of Pediatric Cardiology, University of California Los Angeles (UCLA) Medical Center, Los Angeles, California, USA; UCLA Cardiac Arrhythmia Center and Ahmanson Adult Congenital Heart Disease Center, UCLA Health System, Los Angeles, California, USA
| | - Kevin M Shannon
- Division of Pediatric Cardiology, University of California Los Angeles (UCLA) Medical Center, Los Angeles, California, USA; UCLA Cardiac Arrhythmia Center and Ahmanson Adult Congenital Heart Disease Center, UCLA Health System, Los Angeles, California, USA
| | - J Martijn Bos
- Department of Cardiovascular Medicine (Division of Heart Rhythm Services), Mayo Clinic, Rochester, Minnesota, USA; Division of Pediatric Cardiology, Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, Minnesota, USA; Department of Molecular Pharmacology and Experimental Therapeutics, Windland Smith Rice Sudden Death Genomics Laboratory, Mayo Clinic, Rochester, Minnesota, USA
| | - Elham Sadeghi
- Department of Pediatrics, Medical College of Wisconsin, Herma Heart Institute, Milwaukee, Wisconsin, USA
| | - Janette F Strasburger
- Department of Pediatrics, Medical College of Wisconsin, Herma Heart Institute, Milwaukee, Wisconsin, USA
| | - Ronald T Wakai
- Biomagnetism Laboratory, Department of Medical Physics, University of Wisconsin, Madison, Wisconsin, USA
| | | | - Sally-Ann Clur
- Department of Pediatric Cardiology, Emma Children's Hospital, Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - Allison C Hill
- Division of Cardiology, Children's Hospital Los Angeles, Los Angeles, California, USA
| | - Maully J Shah
- Division of Cardiology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Shashank Behere
- Division of Cardiology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Georgia Sarquella-Brugada
- Arrhythmia, Inherited Cardiac Diseases Unit, Hospital Sant Joan de Déu, Barcelona, Spain; Medical Sciences Department, School of Medicine, University of Girona, Girona, Spain
| | - Richard Czosek
- The Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Susan P Etheridge
- Primary Children's Hospital, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Peter Fischbach
- Division of Pediatric Cardiology, Children's Healthcare of Atlanta, Emory University, Atlanta, Georgia, USA
| | - Prince J Kannankeril
- Monroe Carrell Children's Hospital, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | - Kara Motonaga
- Division of Pediatric Cardiology, Stanford University, Palo Alto, California, USA
| | - Andrew P Landstrom
- Department of Pediatrics, Division of Cardiology, Duke University School of Medicine, Durham, North Carolina, USA; Department of Cell Biology, Duke University School of Medicine, Durham, North Carolina, USA
| | - Matthew Williams
- Division of Cardiology, Rady Children's Hospital, University of California San Diego, San Diego, California, USA
| | - Akash Patel
- Division of Pediatric Cardiology, University of California San Francisco Benioff Children's Hospital, University of California, San Francisco, California, USA
| | - Federica Dagradi
- Center for Cardiac Arrhythmias of Genetic Origin, Istituto di Ricovero e Cura a Carattere Scientifico, Istituto Auxologico Italiano, Milan, Italy
| | - Reina B Tan
- Division of Pediatric Cardiology, New York University Langone School of Medicine, New York, New York, USA
| | - Elizabeth Stephenson
- Labbatt Family Heart Centre, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | | | - Christina Y Miyake
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA; Department of Molecular Physiology and Biophysics, Baylor College of Medicine, Houston, Texas, USA
| | - Michelle E Lee
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA; Department of Molecular Physiology and Biophysics, Baylor College of Medicine, Houston, Texas, USA
| | - Shubhayan Sanatani
- Division of Cardiology, British Columbia Children's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Seshadri Balaji
- Division of Pediatric Cardiology, Oregon Health and Science University, Portland, Oregon, USA
| | - Ming-Lon Young
- Joe DiMaggio Children's Hospital Heart Institute, Memorial Healthcare System, Hollywood, Florida, USA
| | - Saad Siddiqui
- The Heart Institute for Children, Advocate Children's Hospital, Oak Lawn, Illinois, USA
| | - Peter J Schwartz
- Center for Cardiac Arrhythmias of Genetic Origin, Istituto di Ricovero e Cura a Carattere Scientifico, Istituto Auxologico Italiano, Milan, Italy; Department of Cardiology, Fondazione IRCCS Policlinico S. Matteo, Pavia, Italy; Molecular Cardiology Laboratory, Fondazione IRCCS Policlinico S. Matteo, Pavia, Italy
| | - Kalyanam Shivkumar
- Division of Pediatric Cardiology, University of California Los Angeles (UCLA) Medical Center, Los Angeles, California, USA; UCLA Cardiac Arrhythmia Center and Ahmanson Adult Congenital Heart Disease Center, UCLA Health System, Los Angeles, California, USA
| | - Michael J Ackerman
- Department of Cardiovascular Medicine (Division of Heart Rhythm Services), Mayo Clinic, Rochester, Minnesota, USA; Division of Pediatric Cardiology, Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, Minnesota, USA; Department of Molecular Pharmacology and Experimental Therapeutics, Windland Smith Rice Sudden Death Genomics Laboratory, Mayo Clinic, Rochester, Minnesota, USA
| |
Collapse
|
20
|
Strasburger JF, Wacker-Gussmann A. Congenital Heart Block in Subsequent Pregnancies of SSA/Ro-Positive Mothers: Cutting Recurrence in Half. J Am Coll Cardiol 2020; 76:303-305. [PMID: 32674793 PMCID: PMC7357977 DOI: 10.1016/j.jacc.2020.05.052] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Accepted: 05/27/2020] [Indexed: 11/04/2022]
Affiliation(s)
- Janette F Strasburger
- Department of Pediatrics, Division of Cardiology, Children's Wisconsin, Milwaukee, Wisconsin.
| | - Annette Wacker-Gussmann
- Department of Pediatric Cardiology and Congenital Heart Disease, German Heart Center, Munich, Germany
| |
Collapse
|
21
|
Abstract
BACKGROUND Long QT syndrome (LQTS) is a leading cause of sudden cardiac death in early life and has been implicated in ≈10% of sudden infant deaths and unexplained stillbirths. The purpose of our study was to use fetal magnetocardiography to characterize the electrophysiology and rhythm phenotypes of fetuses with de novo and inherited LQTS variants and identify risk factors for sudden death before birth. METHODS We reviewed the fetal magnetocardiography database from the University of Wisconsin Biomagnetism Laboratory for fetuses with confirmed LQTS. We assessed waveform intervals, heart rate, and rhythm, including the signature LQTS rhythms: functional 2° atrioventricular block, T-wave alternans, and torsade de pointes (TdP). RESULTS Thirty-nine fetuses had pathogenic variants in LQTS genes: 27 carried the family variant, 11 had de novo variants, and 1 was indeterminate. De novo variants, especially de novo SCN5A variants, were strongly associated with a severe rhythm phenotype and perinatal death: 9 (82%) showed signature LQTS rhythms, 6 (55%) showed TdP, 5 (45%) were stillborn, and 1 (9%) died in infancy. Those that died exhibited novel fetal rhythms, including atrioventricular block with 3:1 conduction ratio, QRS alternans in 2:1 atrioventricular block, long-cycle length TdP, and slow monomorphic ventricular tachycardia. Premature ventricular contractions were also strongly associated with TdP and perinatal death. Fetuses with familial variants showed a lower incidence of signature LQTS rhythm (6/27=22%), including TdP (3/27=11%). All were live born. CONCLUSIONS The malignancy of de novo LQTS variants was remarkably high and demonstrate that these mutations are a significant cause of stillbirth. Their ability to manifest rhythms not known to be associated with LQTS increases the difficulty of echocardiographic diagnosis and decreases the likelihood that a resultant fetal loss is attributed to LQTS. Registration: URL: http://www.clinicaltrials.gov. Unique identifier: NCT03047161.
Collapse
Affiliation(s)
- Sarah Strand
- Department of Medical Physics, University of Wisconsin-Madison (S.S. R.T.W.)
| | - Janette F Strasburger
- Division of Cardiology, Department of Pediatrics, Children's Hospital of Wisconsin, Medical College of Wisconsin, Milwaukee (J.F.S.)
| | - Bettina F Cuneo
- Division of Cardiology, Department of Pediatrics (B.F.C.), Children's Hospital Colorado & University of Colorado School of Medicine, Aurora.,The Colorado Fetal Care Center (B.F.C), Children's Hospital Colorado & University of Colorado School of Medicine, Aurora
| | - Ronald T Wakai
- Department of Medical Physics, University of Wisconsin-Madison (S.S. R.T.W.)
| |
Collapse
|
22
|
Llinás RR, Ustinin M, Rykunov S, Walton KD, Rabello GM, Garcia J, Boyko A, Sychev V. Noninvasive muscle activity imaging using magnetography. Proc Natl Acad Sci U S A 2020; 117:4942-7. [PMID: 32071237 DOI: 10.1073/pnas.1913135117] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Historically, the activity of muscle groups has been evaluated indirectly, through strength and range of movement measurements. While direct evaluation of muscle activity has been achieved using surface or invasive electrodes, the latter methodologies are limited to individual muscles. By contrast, magnetic recording of muscle activity, as illustrated here, offers a noninvasive approach to evaluate the activity of large muscle groups. This includes deep structures such as the heart and intraabdominal musculature such as the iliacus muscle. An unexpected finding was the ability to image activity associated with muscle pain. Thus, this method offers a noninvasive biomarker for muscular pain and, significantly, of neck and back pain, which now relies mainly on the patient’s report of signs and symptoms. A spectroscopic paradigm has been developed that allows the magnetic field emissions generated by the electrical activity in the human body to be imaged in real time. The growing significance of imaging modalities in biology is evident by the almost exponential increase of their use in research, from the molecular to the ecological level. The method of analysis described here allows totally noninvasive imaging of muscular activity (heart, somatic musculature). Such imaging can be obtained without additional methodological steps such as the use of contrast media.
Collapse
|
23
|
Iwakami N, Aiba T, Kamakura S, Takaki H, Furukawa TA, Sato T, Sun W, Shishido T, Nishimura K, Yamada-Inoue Y, Nagase S, Shimizu W, Yasuda S, Sugimachi M, Kusano K. Identification of malignant early repolarization pattern by late QRS activity in high-resolution magnetocardiography. Ann Noninvasive Electrocardiol 2020; 25:e12741. [PMID: 31955494 PMCID: PMC7358799 DOI: 10.1111/anec.12741] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Revised: 11/28/2019] [Accepted: 12/17/2019] [Indexed: 12/24/2022] Open
Abstract
Background The early repolarization pattern (ERP) in electrocardiography (ECG) has been considered as a risk for ventricular fibrillation (VF), but effective methods for identification of malignant ERP are still required. We investigated whether high spatiotemporal resolution 64‐channel magnetocardiography (MCG) would enable distinction between benign and malignant ERPs. Methods Among all 2,636 subjects who received MCG in our facility, we identified 116 subjects (43 ± 18 years old, 54% male) with inferior and/or lateral ERP in ECG and without structural heart disease, including 13 survivors of VF (ERP‐VF(+)) and 103 with no history of VF (ERP‐VF(−)). We measured the following MCG parameters in a time‐domain waveform of relative current magnitude: (a) QRS duration (MCG‐QRSD), (b) root‐mean‐square of the last 40 ms (MCG‐RMS40), and (c) low amplitude (<10% of maximal) signal duration (MCG‐LAS). Results Compared to ERP‐VF(−), ERP‐VF(+) subjects presented a significantly longer MCG‐QRS (108 ± 24 vs. 91 ± 23 ms, p = .02) and lower MCG‐RMS40 (0.10 ± 0.08 vs. 0.25 ± 0.20, p = .01) but no difference in MCG‐LAS (38 ± 22 vs. 29 ± 23 ms, p = .17). MCG‐QRSD and MCG‐RMS40 showed significantly larger area under the ROC curve compared to J‐peak amplitude in ECG (0.72 and 0.71 vs. 0.50; p = .04 and 0.03). The sensitivity, specificity, and odds ratio for identifying VF(+) based on MCG‐QRSD ≥ 100 ms and MCG‐RMS40 ≤ 0.24 were 69%, 74%, and 6.33 (95% CI, 1.80–22.3), and 92%, 48%, and 10.9 (95% CI, 1.37–86.8), respectively. Conclusion Magnetocardiography is an effective tool to distinguish malignant and benign ERPs.
Collapse
Affiliation(s)
- Naotsugu Iwakami
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan.,Department of Research Promotion and Management, National Cerebral and Cardiovascular Center, Osaka, Japan.,Department of Health Promotion and Human Behavior, Kyoto University School of Public Health, Kyoto, Japan
| | - Takeshi Aiba
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Shiro Kamakura
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Hiroshi Takaki
- Department of Cardiovascular Dynamics, Research Institute, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Toshiaki A Furukawa
- Department of Health Promotion and Human Behavior, Kyoto University School of Public Health, Kyoto, Japan
| | - Tosiya Sato
- Department of Biostatistics, Kyoto University School of Public Health, Kyoto, Japan
| | - Wenxu Sun
- Department of Research Promotion and Management, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Toshiaki Shishido
- Department of Research Promotion and Management, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Kunihiro Nishimura
- Department of Preventive Medicine and Epidemiology Informatics, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Yuko Yamada-Inoue
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Satoshi Nagase
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Wataru Shimizu
- Department of Cardiovascular Medicine, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan
| | - Satoshi Yasuda
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Masaru Sugimachi
- Department of Cardiovascular Dynamics, Research Institute, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Kengo Kusano
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan
| |
Collapse
|
24
|
Bhat VR, Anitha H. Computational imaging of the cardiac activities using magnetocardiography. J Med Eng Technol 2019; 43:401-410. [PMID: 31738627 DOI: 10.1080/03091902.2019.1687770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
The electrical impulses of the heart will generate a tiny magnetic field outside the thorax that is measured as Magnetocardiographic signals. The challenging study is to estimate the cardiac activities in terms of depolarisation and repolarization maps from the measured signals called as inverse problem. This is computed only if one has solved generic or subject- specific prior models using the anatomical structures of the myocardium, the torso and the detectors called as forward problem. In this study, the Discretised heart is priorily assumed as the dipolar sources forming a double layer. The thorax structure modelled with finite element meshes is considered in the forward study. The magnetocardiographic data are simulated using uniform double layer model representing transmembrane distribution on the epicardium and endocardium. Using this data, the activation maps are non-invasively imaged on the heart surface using Tikhonov's regularisation technique. The inverse study is extended to reconstruct the depolarisation sequences of the abnormal cases.
Collapse
Affiliation(s)
- Vikas R Bhat
- Department of Electronics and Communication, Manipal Institute of Technology, Manipal, India
| | - H Anitha
- Department of Electronics and Communication, Manipal Institute of Technology, Manipal, India
| |
Collapse
|
25
|
Strand S, Lutter W, Strasburger JF, Shah V, Baffa O, Wakai RT. Low-Cost Fetal Magnetocardiography: A Comparison of Superconducting Quantum Interference Device and Optically Pumped Magnetometers. J Am Heart Assoc 2019; 8:e013436. [PMID: 31394997 PMCID: PMC6759914 DOI: 10.1161/jaha.119.013436] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Fetal magnetocardiography (fMCG) is a highly effective technique for evaluation of fetuses with life-threatening arrhythmia, but its dissemination has been constrained by the high cost and complexity of Superconducting Quantum Interference Device (SQUID) instrumentation. Optically pumped magnetometers (OPMs) are a promising new technology that can replace SQUIDs for many applications. This study compares the performance of an fMCG system, utilizing OPMs operating in a person-sized magnetic shield, to that of a conventional fMCG system, utilizing SQUID magnetometers operating in a magnetically shielded room. Methods and Results fMCG recordings were made in 24 subjects using the SQUID system with the mother lying supine in a magnetically shielded room and the OPM system with the mother lying prone in a person-sized, cylindrical shield. Signal-to-noise ratios of the OPM and SQUID recordings were not statistically different and were adequate for diagnostic purposes with both technologies. Although the environmental noise was higher using the small open-ended shield, this was offset by the higher signal amplitude achieved with prone positioning, which reduced the distance between the fetus and sensors and improved patient comfort. In several subjects, fMCG provided a differential diagnosis that was more precise and/or definitive than was possible with echocardiography alone. Conclusions The OPM-based system was portable, improved patient comfort, and performed as well as the SQUID-based system at a small fraction of the cost. Electrophysiological assessment of fetal rhythm is now practical and will have a major impact on management of fetuses with long QT syndrome and other life-threatening arrhythmias.
Collapse
Affiliation(s)
- Sarah Strand
- Department of Medical Physics University of Wisconsin Madison WI
| | - William Lutter
- Department of Medical Physics University of Wisconsin Madison WI
| | - Janette F Strasburger
- Division of Cardiology Department of Pediatrics Children's Hospital of Wisconsin- Milwaukee Milwaukee WI
| | | | - Oswaldo Baffa
- Department of Physics FFCLRP Ribeirao Preto, University of Sao Paulo Brazil
| | - Ronald T Wakai
- Department of Medical Physics University of Wisconsin Madison WI
| |
Collapse
|
26
|
Bolin EH, Escalona-Vargas D, Daily JA, Siegel ER, Lowery CL, Coker J, Stowe ZN, Eswaran H. Magnetocardiographic identification of prolonged fetal corrected QT interval in women receiving treatment for opioid use disorder. J Obstet Gynaecol Res 2019; 45:1989-1996. [PMID: 31297963 DOI: 10.1111/jog.14055] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Accepted: 06/23/2019] [Indexed: 01/04/2023]
Abstract
AIM Pregnant women undergoing treatment for opioid use disorder (OUD) may be exposed to multiple QT prolonging agents. We used magnetocardiography to measure fetal QT intervals in mothers with OUD on buprenorphine therapy. METHODS Fetal and maternal magnetocardiography was performed in pregnant women receiving buprenorphine-assisted treatment (Disorder group); these were matched by gestational age to pregnant women who were opiate naïve (Reference group). Corrected QT intervals were determined using Bazett's formula and compared between groups. RESULTS A total of eight women in the Disorder group matched to eight in the Reference group. Seven of the mothers (88%) in the Disorder group were smokers; there were no smokers in the Reference group. The average fetal corrected QT was significantly longer (P = 0.022) in the Disorder group than that in the Reference group (505 milliseconds [ms] ± 68.6 [standard deviation] vs 383 ms ± 70.3 [standard deviation]). CONCLUSION Novel data from this small sample demonstrate prolongation of fetal corrected QT in women with OUD participating in buprenorphine assisted therapy. Additional investigation from a larger sample is needed to clarify if fetal buprenorphine and/or tobacco exposure is associated with changes in fetal QT which would warrant further prenatal and postnatal testing.
Collapse
Affiliation(s)
- Elijah H Bolin
- Department of Pediatrics, Division of Cardiology, University of Arkansas for Medical Sciences, Arkansas Children's Hospital, Little Rock, Arkansas, USA
| | - Diana Escalona-Vargas
- Department of Obstetrics and Gynecology, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Joshua A Daily
- Department of Pediatrics, Division of Cardiology, University of Arkansas for Medical Sciences, Arkansas Children's Hospital, Little Rock, Arkansas, USA
| | - Eric R Siegel
- Department of Biostatistics, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Curtis L Lowery
- Department of Obstetrics and Gynecology, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Jessica Coker
- Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Zachary N Stowe
- Department of Psychiatry, University of Wisconsin at Madison, Madison, Wisconsin, USA
| | - Hari Eswaran
- Department of Obstetrics and Gynecology, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| |
Collapse
|
27
|
Her AY, Shin ES, Zhou Q, Wierzbinski J, Vidal-Lopez S, Saleh A, Kim YH, Garg S, Jung F, Brachmann J. Magnetocardiography detects left atrial dysfunction in paroxysmal atrial fibrillation. Clin Hemorheol Microcirc 2019; 72:353-363. [PMID: 30958336 DOI: 10.3233/ch-180528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Magnetocardiography (MCG) is a non-invasive technique and to characterize the magnetic field, a pseudo-current conversion was used. The role of MCG in detecting left atrial (LA) dysfunction in patients with paroxysmal atrial fibrillation (PAF) is unknown. OBJECTIVE The aim of this study was to evaluate LA function using MCG in patients with PAF and healthy subjects, to identify possible indices to diagnose PAF. METHODS We enrolled a total of 70 subjects including 26 healthy volunteers (group 1) and 22 marathon runners (group 2) who did not exhibit any cardiac abnormalities, and 22 patients with PAF (group 3) which was documented by electrocardiography (ECG). Spatiotemporal activation graph (STAG) in base-apex and left-right direction was reconstructed. The maximum value of LA pseudo-current under rest and peak exercise were measured between the end of the P wave and beginning of the Q wave. RESULTS LA pseudo-current increase at peak exercise in PAF patients was significantly lower than in healthy volunteers and marathon runners (0.4±0.3 pT in group 3 vs. 0.8±0.3 pT in group 1 vs. 1.1±0.5 pT in group 2, p < 0.001). PAF patients had less pseudo-current increase in STAG at peak exercise than healthy volunteers and marathon runners (46% of 26 PAF patients, 81% of 22 healthy subjects vs. 81% of 22 marathon runners, p = 0.002). Sensitivity, specificity, and the area under the receiver-operator characteristics curve of LA pseudo-current increase at peak exercise for differentiating PAF patients from healthy subjects were 77%, 92%, and 0.896. CONCLUSIONS MCG can provide important non-invasive information for detecting LA dysfunction in PAF patients. Therefore, MCG may help in differentiating PAF patients from healthy subjects.
Collapse
Affiliation(s)
- Ae-Young Her
- Department of Internal Medicine, Division of Cardiology, Kangwon National University School of Medicine, Chuncheon, South Korea
| | - Eun-Seok Shin
- Division of Cardiology, Ulsan Medical Center, Ulsan Hospital, Ulsan, South Korea
| | - Qing Zhou
- Department of Medical II., Coburg Hospital, Coburg, Germany
| | - Jan Wierzbinski
- Department of Cardiology, Asklepios Hospital Harburg, Hamburg, Germany
| | | | - Ahmed Saleh
- Department of Medical II., Coburg Hospital, Coburg, Germany
| | - Yong Hoon Kim
- Department of Internal Medicine, Division of Cardiology, Kangwon National University School of Medicine, Chuncheon, South Korea
| | - Scot Garg
- East Lancashire Hospitals NHS Trust, Blackburn, Lancashire, UK
| | - Friedrich Jung
- Institute for Clinical Hemostasiology and Transfusion Medicine, University of Saarland, Saarbrücken, Germany
| | | |
Collapse
|
28
|
Guida G, Sorbo AR, Fenici R, Brisinda D. Predictive value of unshielded magnetocardiographic mapping to differentiate atrial fibrillation patients from healthy subjects. Ann Noninvasive Electrocardiol 2018; 23:e12569. [PMID: 29947446 DOI: 10.1111/anec.12569] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Revised: 05/07/2018] [Accepted: 05/23/2018] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND P-wave duration, its dispersion and signal-averaged ECG, are currently used markers of vulnerability to atrial fibrillation (AF). However, since tangential atrial currents are better detectable at the body surface as magnetic than electric signals, we investigated the accuracy of magnetocardiographic mapping (MCG), recorded in unshielded clinical environments, as predictor of AF occurrence. METHODS MCG recordings, in sinus rhythm (SR), of 71 AF patients and 75 controls were retrospectively analyzed. Beside electric and magnetic P-wave and PR interval duration, two MCG P-wave subintervals, defined P-dep and P-rep, were measured, basing on the point of inversion of atrial magnetic field (MF). Eight parameters were calculated from inverse solution with "Effective Magnetic Dipole (EMD) model" and 5 from "MF Extrema" analysis. Discriminant analysis (DA) was used to assess MCG predictive accuracy to differentiate AF patients from controls. RESULTS All but one (P-rep) intervals were significantly longer in AF patients. At univariate analysis, three EMD parameters differed significantly: in AF patients, the dipole-angle-elevation angular speed was lower during P-dep (p < 0.05) and higher during P-rep (p < 0.001) intervals. The space-trajectory during P-rep and the angle-dynamics during P-dep were higher (p < 0.05), whereas ratio-dynamics P-dep was lower (p < 0.01), in AF. At DA, with a combination of MCG and clinical parameters, 81.5% accuracy in differentiating AF patients from controls was achieved. At Cox-regression, the angle-dynamics P-dep was an independent predictor of AF recurrences (p = 0.037). CONCLUSIONS Quantitative analysis of atrial MF dynamics in SR and the solution of the inverse problem provide new sensitive markers of vulnerability to AF.
Collapse
Affiliation(s)
- Gianluigi Guida
- Biomagnetism and Clinical Physiology International Center, Catholic University of Sacred Heart, Rome, Italy
| | - Anna Rita Sorbo
- Biomagnetism and Clinical Physiology International Center, Catholic University of Sacred Heart, Rome, Italy
| | - Riccardo Fenici
- Biomagnetism and Clinical Physiology International Center, Catholic University of Sacred Heart, Rome, Italy
| | - Donatella Brisinda
- Biomagnetism and Clinical Physiology International Center, Catholic University of Sacred Heart, Rome, Italy
| |
Collapse
|
29
|
Patel R, Sengottuvel S, Gireesan K, Janawadkar MP, Radhakrishnan TS. Designing a Low-Cost, Single-Supply ECG System for Suppression of Movement Artifact from Contaminated Magnetocardiogram. SLAS Technol 2018; 23:463-469. [PMID: 29447023 DOI: 10.1177/2472630318759063] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Measurement of the late potentials and His-bundle activity is crucial for many clinical studies using the noncontact and noninvasive magnetocardiography (MCG) technique; these weak signals are extracted by averaging many cardiac cycles aligned using the R-peak of the cardiac cycle identified using an electrocardiography (ECG) lead. ECG is measured simultaneously with MCG using a conventional dual-supply ECG amplifier, which requires either two separate batteries or a single battery with a switching voltage inverter circuit for its proper operation. The ECG circuitry based on two separate batteries requires a relatively large voltage supply (-18 to +18 V). The single-supply (low voltage: 0-9 V) ECG circuitry may be implemented using a switching voltage inverter; however, this mode of operation introduces switching noise in the system. The objective of the present work is to overcome these problems by carefully designing a low-voltage, single-supply ECG system, which can be used simultaneously with the MCG setup without introducing a significant level of additional noise in the MCG measurement system.
Collapse
Affiliation(s)
- Rajesh Patel
- 1 SQUIDs and Applications Section, Condensed Matter Physics Division, Materials Science Group, Indira Gandhi Centre for Atomic Research, HBNI, Kalpakkam, India
| | - S Sengottuvel
- 1 SQUIDs and Applications Section, Condensed Matter Physics Division, Materials Science Group, Indira Gandhi Centre for Atomic Research, HBNI, Kalpakkam, India
| | - K Gireesan
- 1 SQUIDs and Applications Section, Condensed Matter Physics Division, Materials Science Group, Indira Gandhi Centre for Atomic Research, HBNI, Kalpakkam, India
| | - M P Janawadkar
- 1 SQUIDs and Applications Section, Condensed Matter Physics Division, Materials Science Group, Indira Gandhi Centre for Atomic Research, HBNI, Kalpakkam, India
| | - T S Radhakrishnan
- 1 SQUIDs and Applications Section, Condensed Matter Physics Division, Materials Science Group, Indira Gandhi Centre for Atomic Research, HBNI, Kalpakkam, India
| |
Collapse
|
30
|
Fehlert E, Willmann K, Fritsche L, Linder K, Mat-Husin H, Schleger F, Weiss M, Kiefer-Schmidt I, Brucker S, Häring HU, Preissl H, Fritsche A. Gestational diabetes alters the fetal heart rate variability during an oral glucose tolerance test: a fetal magnetocardiography study. BJOG 2016; 124:1891-1898. [PMID: 28029217 DOI: 10.1111/1471-0528.14474] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/03/2016] [Indexed: 12/20/2022]
Abstract
OBJECTIVE Gestational diabetes mellitus (GDM) potentially harms the child before birth. We previously found GDM to be associated with developmental changes in the central nervous system. We now hypothesise that GDM may also impact on the fetal autonomic nervous system under metabolic stress like an oral glucose tolerance test (OGTT). DESIGN We measured heart rate variability (HRV) of mothers and fetuses during a three-point OGTT using fetal magnetocardiography (fMCG). SETTING Measurements were performed in the fMEG Centre in Tübingen. POPULATION After exclusion of 23 participants, 13 pregnant women with GDM and 36 pregnant women with normal glucose tolerance were examined. METHODS All women underwent the same examination setting with OGTT during which fMCG was recorded three times. MAIN OUTCOME MEASURE(S) Parameters of heart rate variability were measured. RESULTS Compared with mothers with normal glucose regulation, mothers with GDM showed increased heart rate but no significant differences of maternal HRV. In contrast, HRV in fetuses of mothers with GDM differed from those in the metabolically healthy group regarding standard deviation normal to normal beat (SDNN) (P = 0.012), low-frequency band (P = 0.008) and high-frequency band (P = 0.031). These HRV parameters exhibit a decrease only in GDM fetuses during the second hour of the OGTT. CONCLUSIONS These results show an altered response of the fetal autonomic nervous system to metabolic stress in GDM-complicated pregnancies. Hence, disturbances in maternal glucose metabolism might not only impact on the central nervous system of the fetus but may also affect the fetal autonomic nervous system. TWEETABLE ABSTRACT Metabolic stress reveals a different response of fetal autonomic nervous system in GDM-complicated pregnancies.
Collapse
Affiliation(s)
- E Fehlert
- Division of Endocrinology, Diabetology, Angiology, Nephrology and Clinical Chemistry, Department of Internal Medicine, University Hospital, Eberhard Karls University, Tübingen, Germany.,Institute for Diabetes Research and Metabolic Diseases, Helmholtz Centre Munich, University of Tübingen, Tübingen, Germany.,German Centre for Diabetes Research (DZD), Tübingen, Germany
| | - K Willmann
- Division of Endocrinology, Diabetology, Angiology, Nephrology and Clinical Chemistry, Department of Internal Medicine, University Hospital, Eberhard Karls University, Tübingen, Germany
| | - L Fritsche
- Division of Endocrinology, Diabetology, Angiology, Nephrology and Clinical Chemistry, Department of Internal Medicine, University Hospital, Eberhard Karls University, Tübingen, Germany.,Institute for Diabetes Research and Metabolic Diseases, Helmholtz Centre Munich, University of Tübingen, Tübingen, Germany.,German Centre for Diabetes Research (DZD), Tübingen, Germany
| | - K Linder
- Division of Endocrinology, Diabetology, Angiology, Nephrology and Clinical Chemistry, Department of Internal Medicine, University Hospital, Eberhard Karls University, Tübingen, Germany.,Institute for Diabetes Research and Metabolic Diseases, Helmholtz Centre Munich, University of Tübingen, Tübingen, Germany.,German Centre for Diabetes Research (DZD), Tübingen, Germany
| | - H Mat-Husin
- Division of Endocrinology, Diabetology, Angiology, Nephrology and Clinical Chemistry, Department of Internal Medicine, University Hospital, Eberhard Karls University, Tübingen, Germany
| | - F Schleger
- Institute for Diabetes Research and Metabolic Diseases, Helmholtz Centre Munich, University of Tübingen, Tübingen, Germany.,German Centre for Diabetes Research (DZD), Tübingen, Germany
| | - M Weiss
- Department of Obstetrics and Gynaecology, University Hospital, Eberhard Karls University, Tübingen, Germany
| | - I Kiefer-Schmidt
- Department of Obstetrics and Gynaecology, University Hospital, Eberhard Karls University, Tübingen, Germany
| | - S Brucker
- Department of Obstetrics and Gynaecology, University Hospital, Eberhard Karls University, Tübingen, Germany
| | - H-U Häring
- Division of Endocrinology, Diabetology, Angiology, Nephrology and Clinical Chemistry, Department of Internal Medicine, University Hospital, Eberhard Karls University, Tübingen, Germany.,Institute for Diabetes Research and Metabolic Diseases, Helmholtz Centre Munich, University of Tübingen, Tübingen, Germany.,German Centre for Diabetes Research (DZD), Tübingen, Germany
| | - H Preissl
- Division of Endocrinology, Diabetology, Angiology, Nephrology and Clinical Chemistry, Department of Internal Medicine, University Hospital, Eberhard Karls University, Tübingen, Germany.,Institute for Diabetes Research and Metabolic Diseases, Helmholtz Centre Munich, University of Tübingen, Tübingen, Germany.,German Centre for Diabetes Research (DZD), Tübingen, Germany.,Department of Pharmacy and Biochemistry, Institute of Pharmaceutical Sciences, Tübingen, Germany.,Interfaculty Centre for Pharmacogenomics and Pharma Research, Eberhard Karls Universität Tübingen, Tübingen, Germany.,Institute for Diabetes and Obesity, Helmholtz Diabetes Centre, Helmholtz Zentrum München, German Research Centre for Environmental Health (GmbH), Neuherberg, Germany
| | - A Fritsche
- Division of Endocrinology, Diabetology, Angiology, Nephrology and Clinical Chemistry, Department of Internal Medicine, University Hospital, Eberhard Karls University, Tübingen, Germany.,Institute for Diabetes Research and Metabolic Diseases, Helmholtz Centre Munich, University of Tübingen, Tübingen, Germany.,German Centre for Diabetes Research (DZD), Tübingen, Germany
| |
Collapse
|
31
|
Bang WD, Kim K, Lee YH, Kwon H, Park Y, Pak HN, Ko YG, Lee M, Joung B. Repolarization Heterogeneity of Magnetocardiography Predicts Long-Term Prognosis in Patients with Acute Myocardial Infarction. Yonsei Med J 2016; 57:1339-46. [PMID: 27593860 PMCID: PMC5011264 DOI: 10.3349/ymj.2016.57.6.1339] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Revised: 04/25/2016] [Accepted: 04/25/2016] [Indexed: 11/27/2022] Open
Abstract
PURPOSE Magnetocardiography (MCG) has been proposed as a noninvasive, diagnostic tool for risk-stratifying patients with acute myocardial infarction (AMI). This study evaluated whether MCG predicts long-term prognosis in AMI. MATERIALS AND METHODS In 124 AMI patients (95 males, mean age 60±11 years), including 39 with ST-elevation myocardial infarction, a 64-channel MCG was performed within 2 days after AMI. During a mean follow-up period of 6.1 years, major adverse cardiac events (MACE) were evaluated. RESULTS MACE occurred in 31 (25%) patients, including 20 revascularizations, 8 deaths, and 3 re-infarctions. Non-dipole patterns were observed at the end of the T wave in every patients. However, they were observed at T-peak in 77% (24/31) and 54% (50/93) of patients with and without MACE, respectively (p=0.03). Maximum current, field map angles, and distance dynamics were not different between groups. In the multivariate analysis, patients with non-dipole patterns at T-peak had increased age- and gender-adjusted hazard ratios for MACE (hazard ratio 2.89, 95% confidence interval 1.20-6.97, p=0.02) and lower cumulative MACE-free survival than those with dipole patterns (p=0.02). CONCLUSION Non-dipole patterns at T-peak were more frequently observed in patients with MACE and were related to poor long-term prognosis. Thus, repolarization heterogeneity measured by MCG may be a useful predictor for AMI prognosis.
Collapse
Affiliation(s)
- Woo Dae Bang
- Cardiology Division, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
- Department of Cardiology, University of Ulsan College of Medicine, Gangneung Asan Hospital, Gangneung, Korea
| | - Kiwoong Kim
- Bio-Signal Research Center, Korea Research Institute of Standards and Science, Daejeon, Korea
| | - Yong Ho Lee
- Bio-Signal Research Center, Korea Research Institute of Standards and Science, Daejeon, Korea
| | - Hyukchan Kwon
- Bio-Signal Research Center, Korea Research Institute of Standards and Science, Daejeon, Korea
| | - Yongki Park
- Bio-Signal Research Center, Korea Research Institute of Standards and Science, Daejeon, Korea
| | - Hui Nam Pak
- Cardiology Division, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Young Guk Ko
- Cardiology Division, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Moonhyoung Lee
- Cardiology Division, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Boyoung Joung
- Cardiology Division, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.
| |
Collapse
|
32
|
Wacker-Gussmann A, Strasburger JF, Srinivasan S, Cuneo BF, Lutter W, Wakai RT. Fetal Atrial Flutter: Electrophysiology and Associations With Rhythms Involving an Accessory Pathway. J Am Heart Assoc 2016; 5:JAHA.116.003673. [PMID: 27302699 PMCID: PMC4937288 DOI: 10.1161/jaha.116.003673] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Background Atrial flutter (AFl) accounts for up to one third of all fetal tachyarrhythmias and can result in premature delivery, hydrops, and fetal death in 10% of cases; however, the electrophysiology of AFl in utero is virtually unstudied. Methods and Results In this observational study, we reviewed 19 fetal magnetocardiography studies from 16 fetuses: 15 fetuses (21–38 weeks’ gestation) referred with an echocardiographic diagnosis of AFl and 1 fetus (20 weeks’ gestation) referred with a diagnosis of tachycardia that was shown by fetal magnetocardiography to have transient AFl in addition to atrioventricular reciprocating tachycardia. Thirteen fetuses showed AFl during the fetal magnetocardiography session, including 4 that presented prior to the third trimester. Five fetuses had incessant AFl; all but 1 of the others with AFl showed additional significant rhythms. Specifically, AFl showed a strong association with rhythms involving an accessory pathway: atrioventricular reciprocating tachycardia, blocked reentrant premature atrial contractions, and ventricular preexcitation. The observed initiations and terminations of AFl most often involved reentrant premature atrial contractions. Spontaneous termination of AFl showed AFl cycle length oscillations. Nine fetuses with 2:1 AFl also showed periods of 4:1 conduction or variable conduction that oscillated between 2:1 and 4:1; however, 3:1 AFl was relatively rare. Conclusions Fetal AFl can occur as early as midgestation and is often accompanied by atrioventricular reciprocating tachycardia and other rhythms associated with an accessory pathway. The findings depict critical differences in the electrophysiology of AFl in the fetus versus the neonate.
Collapse
Affiliation(s)
- Annette Wacker-Gussmann
- Faculty of Sport and Health Sciences, Institute of Preventive Pediatrics, Munich, Germany Department of Pediatric Cardiology and Congenital Heart Defects, German Heart Center, Munich, Germany
| | - Janette F Strasburger
- Division of Cardiology, Department of Pediatrics, Children's Hospital of Wisconsin, Milwaukee, WI
| | - Sharda Srinivasan
- Division of Cardiology, Department of Pediatrics, University of Wisconsin-Madison, Madison, WI
| | - Bettina F Cuneo
- Department of Pediatrics, The Heart Institute, Children's Hospital Colorado, Aurora, CO
| | - William Lutter
- Department of Medical Physics, University of Wisconsin-Madison, Madison, WI
| | - Ronald T Wakai
- Department of Medical Physics, University of Wisconsin-Madison, Madison, WI
| |
Collapse
|
33
|
Conde D, Seoane L, Gysel M, Mitrione S, Bayés de Luna A, Baranchuk A. Bayés' syndrome: the association between interatrial block and supraventricular arrhythmias. Expert Rev Cardiovasc Ther 2015; 13:541-50. [PMID: 25907617 DOI: 10.1586/14779072.2015.1037283] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
The past few years have given rise to extensive research on atrial conduction disorders and their clinical relevance. Most notably, an association between interatrial block and supraventricular arrhythmias has been discovered. This disorder, recently termed 'Bayés' syndrome', has important clinical implications. In this article, the authors review normal atrial conduction and associated disorders. A particular focus is placed on Bayés' syndrome and the relationship between interatrial block and supraventricular arrhythmias in different clinical scenarios. The report also outlines the current progress in the study of this syndrome and highlights areas requiring further investigation.
Collapse
Affiliation(s)
- Diego Conde
- Instituto Cardiovascular de Buenos Aires, Buenos Aires, Argentina
| | | | | | | | | | | |
Collapse
|
34
|
Hoyer D, Kowalski EM, Schmidt A, Tetschke F, Nowack S, Rudolph A, Wallwitz U, Kynass I, Bode F, Tegtmeyer J, Kumm K, Moraru L, Götz T, Haueisen J, Witte OW, Schleußner E, Schneider U. Fetal autonomic brain age scores, segmented heart rate variability analysis, and traditional short term variability. Front Hum Neurosci 2014; 8:948. [PMID: 25505399 PMCID: PMC4243554 DOI: 10.3389/fnhum.2014.00948] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2014] [Accepted: 11/07/2014] [Indexed: 11/13/2022] Open
Abstract
Disturbances of fetal autonomic brain development can be evaluated from fetal heart rate patterns (HRP) reflecting the activity of the autonomic nervous system. Although HRP analysis from cardiotocographic (CTG) recordings is established for fetal surveillance, temporal resolution is low. Fetal magnetocardiography (MCG), however, provides stable continuous recordings at a higher temporal resolution combined with a more precise heart rate variability (HRV) analysis. A direct comparison of CTG and MCG based HRV analysis is pending. The aims of the present study are: (i) to compare the fetal maturation age predicting value of the MCG based fetal Autonomic Brain Age Score (fABAS) approach with that of CTG based Dawes-Redman methodology; and (ii) to elaborate fABAS methodology by segmentation according to fetal behavioral states and HRP. We investigated MCG recordings from 418 normal fetuses, aged between 21 and 40 weeks of gestation. In linear regression models we obtained an age predicting value of CTG compatible short term variability (STV) of R (2) = 0.200 (coefficient of determination) in contrast to MCG/fABAS related multivariate models with R (2) = 0.648 in 30 min recordings, R (2) = 0.610 in active sleep segments of 10 min, and R (2) = 0.626 in quiet sleep segments of 10 min. Additionally segmented analysis under particular exclusion of accelerations (AC) and decelerations (DC) in quiet sleep resulted in a novel multivariate model with R (2) = 0.706. According to our results, fMCG based fABAS may provide a promising tool for the estimation of fetal autonomic brain age. Beside other traditional and novel HRV indices as possible indicators of developmental disturbances, the establishment of a fABAS score normogram may represent a specific reference. The present results are intended to contribute to further exploration and validation using independent data sets and multicenter research structures.
Collapse
Affiliation(s)
- Dirk Hoyer
- Biomagnetic Center, Hans Berger Department of Neurology, Jena University Hospital, Friedrich Schiller University Jena, Germany
| | - Eva-Maria Kowalski
- Biomagnetic Center, Hans Berger Department of Neurology, Jena University Hospital, Friedrich Schiller University Jena, Germany ; Institute of Biomedical Engineering and Informatics, Ilmenau University of Technology Ilmenau, Germany
| | - Alexander Schmidt
- Biomagnetic Center, Hans Berger Department of Neurology, Jena University Hospital, Friedrich Schiller University Jena, Germany
| | - Florian Tetschke
- Biomagnetic Center, Hans Berger Department of Neurology, Jena University Hospital, Friedrich Schiller University Jena, Germany
| | - Samuel Nowack
- Biomagnetic Center, Hans Berger Department of Neurology, Jena University Hospital, Friedrich Schiller University Jena, Germany
| | - Anja Rudolph
- Biomagnetic Center, Hans Berger Department of Neurology, Jena University Hospital, Friedrich Schiller University Jena, Germany ; Department of Obstetrics, Jena University Hospital, Friedrich Schiller University Jena, Germany
| | - Ulrike Wallwitz
- Biomagnetic Center, Hans Berger Department of Neurology, Jena University Hospital, Friedrich Schiller University Jena, Germany ; Department of Obstetrics, Jena University Hospital, Friedrich Schiller University Jena, Germany
| | - Isabelle Kynass
- Biomagnetic Center, Hans Berger Department of Neurology, Jena University Hospital, Friedrich Schiller University Jena, Germany ; Department of Obstetrics, Jena University Hospital, Friedrich Schiller University Jena, Germany
| | - Franziska Bode
- Biomagnetic Center, Hans Berger Department of Neurology, Jena University Hospital, Friedrich Schiller University Jena, Germany ; Department of Obstetrics, Jena University Hospital, Friedrich Schiller University Jena, Germany
| | - Janine Tegtmeyer
- Biomagnetic Center, Hans Berger Department of Neurology, Jena University Hospital, Friedrich Schiller University Jena, Germany ; Department of Obstetrics, Jena University Hospital, Friedrich Schiller University Jena, Germany
| | - Kathrin Kumm
- Biomagnetic Center, Hans Berger Department of Neurology, Jena University Hospital, Friedrich Schiller University Jena, Germany ; Department of Obstetrics, Jena University Hospital, Friedrich Schiller University Jena, Germany
| | - Liviu Moraru
- Biomagnetic Center, Hans Berger Department of Neurology, Jena University Hospital, Friedrich Schiller University Jena, Germany
| | - Theresa Götz
- Biomagnetic Center, Hans Berger Department of Neurology, Jena University Hospital, Friedrich Schiller University Jena, Germany
| | - Jens Haueisen
- Institute of Biomedical Engineering and Informatics, Ilmenau University of Technology Ilmenau, Germany
| | - Otto W Witte
- Biomagnetic Center, Hans Berger Department of Neurology, Jena University Hospital, Friedrich Schiller University Jena, Germany
| | - Ekkehard Schleußner
- Department of Obstetrics, Jena University Hospital, Friedrich Schiller University Jena, Germany
| | - Uwe Schneider
- Department of Obstetrics, Jena University Hospital, Friedrich Schiller University Jena, Germany
| |
Collapse
|
35
|
Abstract
AIMS Detection and careful stratification of fetal heart rate (FHR) is extremely important in all pregnancies. The most lethal cardiac rhythm disturbances occur during apparently normal pregnancies where FHR and rhythm are regular and within normal or low-normal ranges. These hidden depolarization and repolarization abnormalities, associated with genetic ion channelopathies cannot be detected by echocardiography, and may be responsible for up to 10% of unexplained fetal demise, prompting a need for newer and better fetal diagnostic techniques. Other manifest fetal arrhythmias such as premature beats, tachycardia, and bradycardia are commonly recognized. METHODS Heart rhythm diagnosis in obstetrical practice is usually made by M-mode and pulsed Doppler fetal echocardiography, but not all fetal cardiac time intervals are captured by echocardiographic methods. RESULTS AND CONCLUSIONS This article reviews different types of fetal arrhythmias, their presentation and treatment strategies, and gives an overview of the present and future diagnostic techniques.
Collapse
Affiliation(s)
| | - Janette F. Strasburger
- Division of Cardiology, Department of Pediatrics, Children’s Hospital of Wisconsin-Milwaukee and Fox Valley, Milwaukee, Wisconsin
| | - Bettina F. Cuneo
- Department of Pediatrics, Children’s Hospital Colorado, The Heart Institute, The University of Colorado School of Medicine, Denver, Colorado
| | - Ronald T. Wakai
- Department of Medical Physics, University of Wisconsin, Madison, Wisconsin
| |
Collapse
|
36
|
Abstract
BACKGROUND The electrophysiology of long QT syndrome (LQTS) in utero is virtually unstudied. Our goal here was to evaluate the efficacy of fetal magnetocardiography (fMCG) for diagnosis and prognosis of fetuses at risk of LQTS. METHODS AND RESULTS We reviewed the pre/postnatal medical records of 30 fetuses referred for fMCG because of a family history of LQTS (n=17); neonatal/childhood sudden cardiac death (n=3), or presentation of prenatal LQTS rhythms (n=12): 2° atrioventricular block, ventricular tachycardia, heart rate < 3(rd) percentile. We evaluated heart rate and reactivity, cardiac time intervals, T-wave characteristics, and initiation/termination of Torsade de Pointes, and compared these with neonatal ECG findings. After birth, subjects were tested for LQTS mutations. Based on accepted clinical criteria, 21 subjects (70%; 9 KCNQ1, 5 KCNH2, 2 SCN5A, 2 other, 3 untested) had LQTS. Using a threshold of corrected QT= 490 ms, fMCG accurately identified LQTS fetuses with 89% (24/27) sensitivity and 89% (8/9) specificity in 36 sessions. Four fetuses (2 KCNH2 and 2 SCN5A), all with corrected QT ≥ 620 ms, had frequent episodes of Torsade de Pointes, which were present 22-79% of the time. Although some episodes initiated with a long-short sequence, most initiations showed QRS aberrancy and a notable lack of pause dependency. T-wave alternans was strongly associated with severe LQTS phenotype. CONCLUSIONS Corrected QT prolongation (≥490 ms) assessed by fMCG accurately identified LQTS in utero; extreme corrected QT prolongation (≥620 ms) predicted Torsade de Pointes. FMCG can play a critical role in the diagnosis and management of fetuses at risk of LQTS.
Collapse
Affiliation(s)
- Bettina F Cuneo
- Department of Pediatrics, Children's Hospital of Colorado, University of Colorado School of Medicine, Denver (B.F.C.); Division of Cardiology, Department of Pediatrics, Children's Hospital of Wisconsin and Medical College of Wisconsin, Milwaukee (J.F.S.); Department of Medical Physics, University of Wisconsin-Madison, (S.Y., R.T.W.); Department of Child Health, Graduate School of Comprehensive Human Sciences, University of Tsukuba, Tsukuba, Japan (H.H.); Department of Biomedical Engineering, Osaka Electro-Communication University, Osaka, Japan (T.H.); and Central Research Laboratory, Hitachi, Ltd, Tokyo, Japan (A.K.)
| | | | | | | | | | | | | |
Collapse
|
37
|
Kangwanariyakul Y, Nantasenamat C, Tantimongcolwat T, Naenna T. Data mining of magnetocardiograms for prediction of ischemic heart disease. EXCLI J 2010; 9:82-95. [PMID: 29255391 PMCID: PMC5698888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/07/2010] [Accepted: 07/29/2010] [Indexed: 11/26/2022]
Abstract
Ischemic Heart Disease (IHD) is a major cause of death. Early and accurate detection of IHD along with rapid diagnosis are important for reducing the mortality rate. Magnetocardiogram (MCG) is a tool for detecting electro-physiological activity of the myocardium. MCG is a fully non-contact method, which avoids the problems of skin-electrode contact in the Electrocardiogram (ECG) method. However, the interpretation of MCG recordings is time-consuming and requires analysis by an expert. Therefore, we propose the use of machine learning for identification of IHD patients. Back-propagation neural network (BPNN), the Bayesian neural network (BNN), the probabilistic neural network (PNN) and the support vector machine (SVM) were applied to develop classification models for identifying IHD patients. MCG data was acquired by sequential measurement, above the torso, of the magnetic field emitted by the myocardium using a J-T interval of 125 cases. The training and validation data of 74 cases employed 10-fold cross-validation methods to optimize support vector machine and neural network parameters. The predictive performance was assessed on the testing data of 51 cases using the following metrics: accuracy, sensitivity, and specificity and area under the receiver operating characteristic (ROC) curve. The results demonstrated that both BPNN and BNN displayed the highest and the same level of accuracy at 78.43 %. Furthermore, the decision threshold and the area under the ROC curve was -0.2774 and 0.9059, respectively, for BPNN and 0.0470 and 0.8495, respectively, for BNN. This indicated that BPNN was the best classification model, BNN was the best performing model with sensitivity of 96.65 %, and SVM employing the radial basis function kernel displayed the highest specificity of 86.36 %.
Collapse
Affiliation(s)
- Yosawin Kangwanariyakul
- Master of Science Program in Technology of Information System Management, Faculty of Engineering, Mahidol University, Nakhon Pathom 73170, Thailand
| | - Chanin Nantasenamat
- Department of Clinical Microbiology, Faculty of Medical Technology, Mahidol University, Bangkok 10700, Thailand
| | - Tanawut Tantimongcolwat
- Department of Clinical Microbiology, Faculty of Medical Technology, Mahidol University, Bangkok 10700, Thailand
| | - Thanakorn Naenna
- Department of Industrial Engineering, Faculty of Engineering, Mahidol University, Nakhon Pathom 73170, Thailand
| |
Collapse
|
38
|
Abstract
OBJECTIVES Conventional manifestations of fetal Sjogren's antibodies (SSA/SSB) associated cardiac disease include atrioventricular block (AVB), transient sinus bradycardia, endocardial fibroelastosis (EFE) and dilated cardiomyopathy. We describe other manifestations of cardiac disease. METHODS We describe three fetuses with unique myocardial and conduction system disease. RESULTS One had isolated EFE with subsequent mitral and tricuspid valve chordal avulsion, the second had sinoatrial and infrahissian conduction system disease, and in both, neonatal progression to life threatening disease occurred. The third had sinus node dysfunction and atrial flutter. CONCLUSION These findings expand the clinical phenotype of maternal SSA/SSB antibody associated fetal cardiac disease.
Collapse
Affiliation(s)
- Bettina F Cuneo
- The Heart Institute for Children, Hope Children's Hospital, Oak Lawn, IL 60453, USA.
| | | | | | | | | |
Collapse
|
39
|
Gödde P, Agrawal R, Müller HP, Czerski K, Endt P, Steinhoff U, Oeff M, Schultheiss HP, Behrens S. Magnetocardiographic mapping of QRS fragmentation in patients with a history of malignant tachyarrhythmias. Clin Cardiol 2009; 24:682-8. [PMID: 11594414 PMCID: PMC6654772 DOI: 10.1002/clc.4960241009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND The identification of patients at increased risk for ventricular tachycardia or ventricular fibrillation (VT/VF) and sudden cardiac death has consequences for therapeutic options and thus may reduce mortality in patients with coronary artery disease (CAD). HYPOTHESIS We hypothesized that the intra-QRS fragmentation in magnetocardiographic recordings is increased in patients with CAD and with a history of VT/VF. METHODS Multichannel magnetocardiography (MCG) was carried out in 34 healthy controls, 42 patients with CAD without a history of VT/VF, and 43 patients with CAD and with a history of VT/VF. The intra-QRS fragmentation was quantified by a new fragmentation score. Its spatial distribution was investigated using two-dimensional (2-D) contour maps according to the sensor position of the 49-channel magnetogradiometer. RESULTS Patients with CAD and with a history of VT/VF had significantly increased QRS fragmentation compared with patients with CAD without VT/VF or controls (72.9+/-37.5, 48.5+/-14.3, and 42.5+/-7.8, respectively: p <0.05). The area of high fragmentation in 2-D contour maps was twice as large in patients with than in those without a history of VT/VF (represented by the number of MCG channels with high fragmentation: 26.3+/-15.5 vs. 12.4+/-9.9, p<0.0001). Patients prone to VT/VF could be identified with a sensitivity of 64% and a specificity of 90%. CONCLUSION In patients with CAD and with a history of VT/VF, intra-QRS fragmentation is increased and the area of high fragmentation in 2-D contour maps is enlarged. These findings may be helpful in identifying patients with CAD at risk for malignant tachyarrhythmias.
Collapse
Affiliation(s)
- P Gödde
- University Clinic Benjamin Franklin, Free Berlin University, 2nd Medical Clinic, Department of Cardiology and Pulmonary Disease, Berlin, Germany
| | | | | | | | | | | | | | | | | |
Collapse
|
40
|
Cuneo BF, Strasburger JF, Wakai RT. Magnetocardiography in the evaluation of fetuses at risk for sudden cardiac death before birth. J Electrocardiol 2008; 41:116.e1-6. [PMID: 18328335 PMCID: PMC3464492 DOI: 10.1016/j.jelectrocard.2007.12.010] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2007] [Accepted: 12/21/2007] [Indexed: 11/26/2022]
Abstract
BACKGROUND We hypothesized that fetuses at risk for sudden death may have abnormal conduction or depolarization, ischemia, or abnormal heart rate variability (HRV) detectable by magnetocardiography. METHODS Using a 37-channel biomagnetometer, we evaluated 3 groups of fetuses at risk for sudden death: group 1, critical aortic stenosis (AS); group 2, arrhythmias; and group 3, heart failure and in utero demise. Five to 10 recordings of 10-minute duration were recorded, and signal was averaged to determine rhythm, conduction intervals, HRV, and T-wave morphology. RESULTS In group 1, 2 of 3 had atrial and ventricular strain patterns. In (n = 53) group 2, 15% had prolonged QTc and 17% had T-wave alternans (TWA). Of 23 group 2 fetuses with atrioventricular block, 74% had ventricular ectopy, 21% had junctional ectopic tachycardia, and 29% had ventricular tachycardia. Group 3 (n = 2) had abnormal HRV and TWA. CONCLUSION Repolarization abnormalities, unexpected arrhythmias, and abnormal HRV suggest an arrhythmogenic mechanism for "sudden cardiac death before birth."
Collapse
Affiliation(s)
- Bettina F Cuneo
- The Heart Institute for Children, Hope Children's Hospital, Rush Medical College, Chicago, IL, USA.
| | | | | |
Collapse
|
41
|
Zhou XJ. Magnetism in Medicine: A handbook, Second Completely Revised and Enlarged Edition. Med Phys 2007; 34:4978. [PMID: 28523814 DOI: 10.1118/1.2806958] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2007] [Accepted: 10/09/2007] [Indexed: 11/07/2022] Open
Abstract
Magnetism in Medicine: A handbook, Second Completely Revised and Enlarged Edition Andrä Wilfried Nowak Hannes Wiley-VCH, Berlin, 2006. 629 pp. $210.00 ISBN 9783527405589.
Collapse
|
42
|
Korhonen P, Tierala I, Simelius K, Väänänen H, Mäkijärvi M, Nenonen J, Katila T, Toivonen L. Late QRS activity in signal-averaged magnetocardiography, body surface potential mapping, and orthogonal ECG in postinfarction ventricular tachycardia patients. Ann Noninvasive Electrocardiol 2006; 7:389-98. [PMID: 12431319 PMCID: PMC7027709 DOI: 10.1111/j.1542-474x.2002.tb00190.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Delayed electrical activity necessary for re-entrant ventricular tachycardia (VT) is detectable noninvasively with high resolution techniques. We compared high resolution signal-averaged analysis of magnetocardiography (MCG), body surface potential mapping (BSPM), and orthogonal three-lead ECG (SA-ECG) in the identification of patients prone to VT after myocardial infarction (MI). METHODS Patients with remote myocardial infarction and cardiac dysfunction were studied, 22 with (VT group) and 22 without VT (control group). MCG with seven channels and BSPM with 63 and SA-ECG with three orthogonal leads were registered. After signal-averaging and highpass filtering, three time domain analysis (TDA) parameters describing late electrical activity were computed: QRS duration (QRSd), root mean square amplitude (RMS) of the last 40 ms of QRS, and the duration of the low-amplitude QRS end (LAS). RESULTS All parameters by each method were significantly different between the patients' groups. For example, LAS parameter in MCG was 59 (SD 22) ms in the VT group vs. 37 (SD 13) ms in controls (P < 0.001), 77 (SD 22) ms vs. 56 (SD 19) ms in BSPM (P = 0.002), and 60 (SD 24) ms vs. 39 (SD 22) ms in SA-ECG (P = 0.005). The combination of LAS parameter in MCG and SA-ECG resulted in improved performance in comparison to any single parameter with 95% sensitivity and 68% specificity. CONCLUSIONS All three high resolution methods identified VT propensity among post-MI patients with cardiac dysfunction and between-method differences were small. Information in MCG and SA-ECG may be complementary and their combination could be of value in postinfarction arrhythmia risk assessment.
Collapse
Affiliation(s)
- Petri Korhonen
- Division of Cardiology, Helsinki University Central Hospital, PL 340, 00029 HUS, Finland.
| | | | | | | | | | | | | | | |
Collapse
|