Detection of myocardial ischemia due to clinically asymptomatic coronary artery stenosis at rest using supervised artificial intelligence-enabled vectorcardiography - A five-fold cross validation of accuracy.


BACKGROUND:Coronary artery disease (CAD) is a leading cause of death and disability. Conventional non-invasive diagnostic modalities for the detection of stable CAD at rest are subject to significant limitations: low sensitivity, and personal expertise. We aimed to develop a reliable and time-cost efficient screening tool for the detection of coronary ischemia using machine learning. METHODS:We developed a supervised artificial intelligence algorithm combined with a five lead vectorcardiography (VCG) approach (i.e. Cardisiography, CSG) for the diagnosis of CAD. Using vectorcardiography, the excitation process of the heart can be described as a three-dimensional signal. A diagnosis can be received, by first, calculating specific physical parameters from the signal, and subsequently, analyzing them with a machine learning algorithm containing neuronal networks. In this multi-center analysis, the primary evaluated outcome was the accuracy of the CSG Diagnosis System, validated by a five-fold nested cross-validation in comparison to angiographic findings as the gold standard. Individuals with 1, 2, or 3- vessel disease were defined as being affected. RESULTS:Of the 595 patients, 62·0% (n = 369) had 1, 2 or 3- vessel disease identified by coronary angiography. CSG identified a CAD at rest with a sensitivity of 90·2 ± 4·2% for female patients (male: 97·2 ± 3·1%), specificity of 74·4 ± 9·8% (male: 76·1 ± 8·5%), and overall accuracy of 82·5 ± 6·4% (male: 90·7 ± 3·3%). CONCLUSION:These findings demonstrate that supervised artificial intelligence-enabled vectorcardiography can overcome limitations of conventional non-invasive diagnostic modalities for the detection of coronary ischemia at rest and is capable as a highly valid screening tool.


J Electrocardiol


Braun T,Spiliopoulos S,Veltman C,Hergesell V,Passow A,Tenderich G,Borggrefe M,Koerner MM




Has Abstract


2020-01-01 00:00:00












  • Improved ECG models for left ventricular mass adjusted for body size, with specific algorithms for normal conduction, bundle branch blocks, and old myocardial infarction.

    abstract::Considerable efforts have been invested recently to improve electrocardiographic (ECG) classification accuracy for left ventricular hypertrophy (LVH). This study examines how LVH classification accuracy is influenced by (1) the selection of an echocardiographic standard for LVH, (2) LVH severity level in the test grou...

    journal_title:Journal of electrocardiology

    pub_type: 杂志文章


    authors: Rautaharju PM,Zhou SH,Park LP

    更新日期:1996-01-01 00:00:00

  • Good reproducibility of heart rate variability after orthostatic challenge in patients with a history of acute coronary syndrome.

    abstract:BACKGROUND:Several parameters of heart rate variability (HRV) have been shown to predict the risk of sudden cardiac death (SCD) in cardiac patients. There is consensus that risk prediction is increased when measuring HRV during specific provocations such as orthostatic challenge. For the first time, we provide data on ...

    journal_title:Journal of electrocardiology

    pub_type: 杂志文章


    authors: Schäfer D,Nil M,Herzig D,Eser P,Saner H,Wilhelm M

    更新日期:2015-07-01 00:00:00

  • A simulation study of Torsade de Pointes with M cells.

    abstract::Recent studies have reported the relation between Torsade de Pointes (TdP) and midmyocardial (M) cell function associated with long QT syndrome. To investigate this relation, we conducted a simulation study with a three-dimensional (3D) heart model incorporating M cells in the anterolateral areas of the model. Paramet...

    journal_title:Journal of electrocardiology

    pub_type: 杂志文章


    authors: Okazaki O,Wei D,Harumi K

    更新日期:1998-01-01 00:00:00

  • Isorhythmic Dissociation--a "physiological" arrhythmia.

    abstract::The behavior of the sino-atrial mechanism in isorhythmic dissociation (IRD) was studied in 21 patients, nine with spontaneous IRD and 12 with artificially pacemaker-induced IRD following electrode placement for heart block. Successive P-P, R-R and P-R intervals and blood pressure (BP) fluctuations were determined and ...

    journal_title:Journal of electrocardiology

    pub_type: 杂志文章


    authors: Kaplinsky E,Aronson R,Neufeld HN

    更新日期:1977-04-01 00:00:00

  • Alternating Wolff-Parkinson-White (preexcitation) pattern.

    abstract::An electrocardiogram is presented which shows sinus rhythm with alternating Wolff-Parkinson-White (preexcitation) pattern. The frequency of intermittent preexcitation and mechanisms for its production are discussed. ...

    journal_title:Journal of electrocardiology

    pub_type: 杂志文章


    authors: Lichstein E,Goyal S,Chadda K,Gupta PK

    更新日期:1978-01-01 00:00:00

  • Complexity of the dynamic QT variability and RR variability in patients with acute anterior wall myocardial infarction: a novel technique using a non-linear method.

    abstract::QT and RR intervals' fluctuations are implicated in the development of malignant arrhythmias. Recent research has quantified repolarization lability using stochastic and linear methods. However, QT-RR intervals are nonlinearly coupled. To this end, QT and RR intervals were extracted from twenty four patients with acut...

    journal_title:Journal of electrocardiology

    pub_type: 杂志文章


    authors: Nahshoni E,Strasberg B,Adler E,Imbar S,Sulkes J,Weizman A

    更新日期:2004-07-01 00:00:00

  • Distorted T-vector loop and increased heart rate are associated with ventricular fibrillation in a porcine ischemia-reperfusion model.

    abstract:BACKGROUND:The ventricular repolarization (VR) response to short-lasting coronary occlusion has been characterized by 3-dimensional vectorcardiography during angioplasty in humans; the T-vector loop becomes distorted (increased T(avplan)) and more circular (decreased T(eigenvalue)), but these changes have not been rela...

    journal_title:Journal of electrocardiology

    pub_type: 杂志文章


    authors: Odenstedt J,Rubulis A,Grip L,Bergfeldt L

    更新日期:2009-05-01 00:00:00

  • Prognostic value of ambulatory electrocardiography monitoring in patients with dilated cardiomyopathy.

    abstract:BACKGROUND:Performance of ambulatory electrocardiography (AECG) may provide data useful for counseling patients regarding prognosis and for selecting potential patients for defibrillator implantation, but this practice remains controversial. METHODS:We reviewed clinical and AECG data on 355 patients diagnosed with dil...

    journal_title:Journal of electrocardiology

    pub_type: 杂志文章


    authors: Baker RL,Koelling TM

    更新日期:2005-01-01 00:00:00

  • Elevated Hemi-diaphragms as a Cause of ST-segment Elevation: A case report and review of literature.

    abstract::While ST-segment elevation (STE) on ECG is widely recognized as representing myocardial infarction or injury such as coronary occlusion or pericarditis, STE may occasionally ensue from non-cardiac etiologies. Indeed, gastrointestinal disorders causing STE are not well documented in the literature. We present a case wh...

    journal_title:Journal of electrocardiology

    pub_type: 杂志文章,评审


    authors: Singh M,Sood A,Rehman MU,Othman M,Afonso L

    更新日期:2017-01-01 00:00:00

  • Importance of standardized assessment of late gadolinium enhancement for quantification of infarct size by cardiac magnetic resonance: implications for comparison with electrocardiogram.

    abstract:BACKGROUND:Cardiac magnetic resonance (CMR) is currently considered the reference standard for in vivo assessment of myocardial infarction (MI). There is, however, no international consensus on how MI quantification from CMR should be performed. The aim of this study was to test how previously published manual quantifi...

    journal_title:Journal of electrocardiology

    pub_type: 杂志文章


    authors: Welinder A,Hakacova N,Martin T,Engblom H

    更新日期:2011-09-01 00:00:00

  • Reevaluation of the VCG and ECG criteria for left ventricular enlargement.

    abstract::Traditional electrocardiographic (ECG) and vectorcardiographic (VCG) criteria for left ventricular enlargement (LVE) understandably emphasize the increased tendency of the maximal electrical forces of ventricular depolarization to be directed toward the left. This tendency is manifested on the ECG by increased amplitu...

    journal_title:Journal of electrocardiology

    pub_type: 杂志文章


    authors: Warner RA,Hill NE

    更新日期:1987-10-01 00:00:00

  • Prime number variant of concealed trigeminy.

    abstract::A 53-year-old man with myocardial infarction was found to have frequent premature ventricular beats. The predominant pattern was classical concealed trigeminy; i.e., the number of conducted sinus beats, S, between extrasystoles satisfied the equation S = 3n + 2, where "n" is zero or any positive integer. Two other tra...

    journal_title:Journal of electrocardiology

    pub_type: 杂志文章


    authors: Medeiros CM,Medeiros NP,de Nonohay NC,Rodrigues R

    更新日期:1985-10-01 00:00:00

  • Apparent electrocardiogram left ventricular hypertrophy during tachycardia.

    abstract::The electrocardiographic transient display of left ventricular hypertrophy (LVH), during rapid heart rates, in the setting of sinus/supraventricular tachycardias and atrial fibrillation, is illustrated via 3 case reports. This common occurrence is expressed by an increase in the S-waves in leads V2-V5, during tachycar...

    journal_title:Journal of electrocardiology

    pub_type: 杂志文章


    authors: Madias JE

    更新日期:2021-01-09 00:00:00

  • Altered mental status in the emergency department - Can an electrocardiogram show the right way to go?

    abstract::A 38-year-old African American male patient with a past medical history of human immunodeficiency virus and schizophrenia who was noncompliant with medications presented to the emergency department (ED) after activation of the local crisis response center for altered mental status. Upon arrival he was lethargic and un...

    journal_title:Journal of electrocardiology

    pub_type: 杂志文章


    authors: Dias A,Franco E,Martinez J,Figueredo VM

    更新日期:2017-01-01 00:00:00

  • Correlation between ECG presentation and cardiovascular magnetic resonance imaging in Takotsubo cardiomyopathy.

    abstract::Takotsubo cardiomyopathy (TTC) is characterized by acute and reversible ventricular dysfunction in the absence of significant coronary artery disease, typically triggered by acute emotional or physical stress. In the acute phase of TTC, the electrocardiogram (ECG) shows ST-segment elevation, which rapidly evolves into...

    journal_title:Journal of electrocardiology

    pub_type: 杂志文章


    authors: Zhong-qun Z,Chong-quan W,Nikus KC,Sclarovsky S

    更新日期:2013-07-01 00:00:00

  • Extraction of respiratory myogram interference from the ECG and its application to characterize sleep-related breathing disorders in atrial fibrillation.

    abstract:BACKGROUND AND PURPOSE:Present methods to extract respiratory myogram interference (RMI) from the Holter-ECG and assess effect of supraventricular arrhythmias (SVAs) onto ECG-based detection of sleep-related breathing disorders (SRBDs) and AHI estimation. METHODS:RMI was quantified as residual energy after ECG cancell...

    journal_title:Journal of electrocardiology

    pub_type: 杂志文章


    authors: Maier C,Dickhaus H

    更新日期:2014-11-01 00:00:00

  • Thrombolytic therapy in a patient with chest pain with de Winter ECG pattern occurred after ST-segment elevation: A case report.

    abstract::The de Winter electrocardiogram (ECG) pattern may signify proximal left anterior descending artery (LAD) occlusion and was suggested to be managed as ST-segment elevation myocardial infarction (STEMI) equivalent for urgent angiography and reperfusion therapy. However, cardiac catheter laboratory is not readily or time...

    journal_title:Journal of electrocardiology

    pub_type: 杂志文章


    authors: Xu W,Xu L,Peng J,Huang S

    更新日期:2019-01-01 00:00:00

  • Evaluation of ECG algorithms designed to improve detect of transient myocardial ischemia to minimize false alarms in patients with suspected acute coronary syndrome.

    abstract:BACKGROUND:Patients hospitalized for suspected acute coronary syndrome (ACS) are at risk for transient myocardial ischemia. During the "rule-out" phase, continuous ECG ST-segment monitoring can identify transient myocardial ischemia, even when asymptomatic. However, current ST-segment monitoring software is vastly unde...

    journal_title:Journal of electrocardiology

    pub_type: 杂志文章


    authors: Pelter MM,Xu Y,Fidler R,Xiao R,Mortara DW,Xiao H

    更新日期:2018-01-01 00:00:00

  • Studies of acute myocardial infarction with intermittent bundle branch and hemiblock.

    abstract::Two cases of transient hemiblock occurring during the course of acute myocardial infarction are reported. The transient manifestation permits the accurate evaluation of the diagnostic features of the hemiblocks as modified by acute infarction. One case reflects the development of left bundle branch block due to bilate...

    journal_title:Journal of electrocardiology

    pub_type: 杂志文章


    authors: Schamroth L,Friedberg HD,de Kock J

    更新日期:1978-04-01 00:00:00

  • Development of linear and non-linear properties of heart rate control during quiet and active sleep in healthy infants.

    abstract::In this study it is analyzed by linear and non-linear methods, how the control of instantaneous heart rate (IHR) develops in infants in quiet and active sleep. Ten healthy and term newborns were studied during their first half year of life. Low (LF) and high frequency power (HF) of the spectrum, and the largest Lyapun...

    journal_title:Journal of electrocardiology

    pub_type: 杂志文章


    authors: Patzak A

    更新日期:1995-10-01 00:00:00

  • Assessment of QT-measurement accuracy using the 12-lead electrocardiogram derived from EASI leads.

    abstract::The purpose of the present study is to assess QT-interval measurements from the EASI 12-lead electrocardiogram (ECG) as compared with the standard 12-lead ECG. The QT interval was automatically determined in simultaneously recorded standard and EASI 12-lead ECGs, using a validated wavelet-based delineator. The agreeme...

    journal_title:Journal of electrocardiology

    pub_type: 杂志文章


    authors: Martínez JP,Laguna P,Olmos S,Pahlm O,Pettersson J,Sörnmo L

    更新日期:2007-04-01 00:00:00

  • Epicardial ablation of right pulmonary artery ganglionated plexi for the prevention of atrial fibrillation originating in the pulmonary veins.

    abstract:UNLABELLED:PROBLEM PRESENTED: A novel study of catheter ablation of the right pulmonary artery ganglionated plexi (RPA GP) to reduce atrial fibrillation (AF) originating in the pulmonary veins (PVs) is presented. STUDIES UNDERTAKEN:In 20 dogs, atrial effective refractory periods (AERPs), PVERP, and the dispersion of A...

    journal_title:Journal of electrocardiology

    pub_type: 杂志文章


    authors: Wang H,Li J,Hong C,Liu X,Shang F,He Y,Wang Z,Zheng Q

    更新日期:2010-07-01 00:00:00

  • The spectrum of right bundle branch block as manifested in electrocardiographic body surface potential maps.

    abstract::A wide spectrum of types of right bundle branch block (RBBB) were studied utilizing the body surface potential maps (BSPMs) of 37 children. Although the spectrum varied from very advanced RBBB to minimal partial RBBB, a common diagnostic feature was the absence of evidence for right ventricular breakthrough in the map...

    journal_title:Journal of electrocardiology

    pub_type: 杂志文章


    authors: Liebman J,Rudy Y,Diaz P,Thomas CW,Plonsey R

    更新日期:1984-10-01 00:00:00

  • Evaluation of exercise-induced Q-wave amplitude changes and their clinical value.

    abstract::We studied the influence of exercise level, severity of coronary artery disease (CAD), presence of previous myocardial infarction (MI), anterior or diaphragmatic, on the clinical value of exertional Q wave changes (Delta-Q). We retrospectively evaluated the exercise electrocardiograms of 62 patients without angiograph...

    journal_title:Journal of electrocardiology

    pub_type: 杂志文章


    authors: DeCaprio L,Ascione L,Cuomo S,Vigorito C,Brienza A,Acanfora D,Papa M,Donatiello A,Chieffo C,Rengo F

    更新日期:1988-01-01 00:00:00

  • ST analysis of Holter tapes.

    abstract::In recent years, it has become increasingly clear that for an important subset of patients with coronary artery disease, many or all of their ischemic episodes are not accompanied by anginal pain. For these patients, it is desirable to detect these ischemic episodes as periods of ST-segment depression on Holter tapes....

    journal_title:Journal of electrocardiology

    pub_type: 杂志文章


    authors: Hubelbank M

    更新日期:1992-01-01 00:00:00

  • Electrocardiogram training for residents: A curriculum based on Facebook and Twitter.

    abstract:BACKGROUND:We studied whether social media applications can serve as effective educational tools for teaching electrocardiogram (ECG) interpretation to medical residents. METHODS:39 emergency, family, and internal medicine residents participated in the 33-week "ECG of the Week" curriculum via Facebook and Twitter. ECG...

    journal_title:Journal of electrocardiology

    pub_type: 杂志文章


    authors: Liu SS,Zakaria S,Vaidya D,Srivastava MC

    更新日期:2017-01-01 00:00:00

  • Is it time to include ion channel diseases among cardiomyopathies?

    abstract::Heart muscle diseases are traditionally classified according to their peculiar pathophysiologic features such as "dilated," "hypertrophic," "restrictive," and "arrhythmogenic right ventricular" cardiomyopathy. The extraordinary advances accomplished in the last two decades in molecular genetics have allowed the identi...

    journal_title:Journal of electrocardiology

    pub_type: 杂志文章,评审


    authors: Corrado D,Basso C,Thiene G

    更新日期:2005-10-01 00:00:00

  • Evaluation of index of cardiac-electrophysiological balance before and after hemodialysis in patients with end-stage renal disease.

    abstract:BACKGROUND:Ventricular arrhythmias and sudden cardiac deaths are the most common cause of mortality in patients with end-stage renal disease (ESRD). Index of cardiac-electrophysiological balance (iCEB) (QT/QRS) may predict malignant ventricular arrhythmias. In this study, we investigated whether iCEB value is increased...

    journal_title:Journal of electrocardiology

    pub_type: 杂志文章


    authors: Sivri S,Çelik M

    更新日期:2019-01-01 00:00:00

  • Computer analysis of the spatial angular parameters of the canine QRSsE loop from necropsy-verified normal dogs.

    abstract::Vectorcardiograms were recorded by the canine modification of the axial lead system of McFee and Parungao from 38 necropsy-verified normal dogs placed in the recommended position of right lateral recumbency. A digital computer program was used to identify and analyze the spatial characteristics of the QRSsE loop. In o...

    journal_title:Journal of electrocardiology

    pub_type: 杂志文章


    authors: Musselman EE

    更新日期:1983-07-01 00:00:00

  • The reliability of pacemaker electrode-leads.

    abstract::Extensive experience has been obtained with Medtronic pacemakers, in Glasgow where over 400 patients have received their primary implant. In this review, which covers a period of seven and a half years ending December 31, 1973, the technical reliability of electrode-leads is considered in terms of failed implant lifet...

    journal_title:Journal of electrocardiology

    pub_type: 杂志文章


    authors: Green GD

    更新日期:1975-01-01 00:00:00