WO2010077305A1 - Mesure de l'étendue de lésions du muscle cardiaque - Google Patents

Mesure de l'étendue de lésions du muscle cardiaque Download PDF

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Publication number
WO2010077305A1
WO2010077305A1 PCT/US2009/006549 US2009006549W WO2010077305A1 WO 2010077305 A1 WO2010077305 A1 WO 2010077305A1 US 2009006549 W US2009006549 W US 2009006549W WO 2010077305 A1 WO2010077305 A1 WO 2010077305A1
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WIPO (PCT)
Prior art keywords
deviation
electrodes
magnitude
volume
electrode
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Application number
PCT/US2009/006549
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English (en)
Inventor
Paul David Phillips
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Heartscape Technologies, Inc.
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Application filed by Heartscape Technologies, Inc. filed Critical Heartscape Technologies, Inc.
Priority to CA2746992A priority Critical patent/CA2746992A1/fr
Priority to EP09836497A priority patent/EP2373215A1/fr
Priority to JP2011542126A priority patent/JP2012511998A/ja
Publication of WO2010077305A1 publication Critical patent/WO2010077305A1/fr

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    • G—PHYSICS
    • G16—INFORMATION AND COMMUNICATION TECHNOLOGY [ICT] SPECIALLY ADAPTED FOR SPECIFIC APPLICATION FIELDS
    • G16H—HEALTHCARE INFORMATICS, i.e. INFORMATION AND COMMUNICATION TECHNOLOGY [ICT] SPECIALLY ADAPTED FOR THE HANDLING OR PROCESSING OF MEDICAL OR HEALTHCARE DATA
    • G16H50/00—ICT specially adapted for medical diagnosis, medical simulation or medical data mining; ICT specially adapted for detecting, monitoring or modelling epidemics or pandemics
    • G16H50/50—ICT specially adapted for medical diagnosis, medical simulation or medical data mining; ICT specially adapted for detecting, monitoring or modelling epidemics or pandemics for simulation or modelling of medical disorders
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B5/00—Measuring for diagnostic purposes; Identification of persons
    • A61B5/24—Detecting, measuring or recording bioelectric or biomagnetic signals of the body or parts thereof
    • A61B5/316—Modalities, i.e. specific diagnostic methods
    • A61B5/318—Heart-related electrical modalities, e.g. electrocardiography [ECG]
    • A61B5/346—Analysis of electrocardiograms
    • A61B5/349—Detecting specific parameters of the electrocardiograph cycle
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B5/00—Measuring for diagnostic purposes; Identification of persons
    • A61B5/72—Signal processing specially adapted for physiological signals or for diagnostic purposes
    • A61B5/7235—Details of waveform analysis
    • A61B5/7264—Classification of physiological signals or data, e.g. using neural networks, statistical classifiers, expert systems or fuzzy systems
    • G—PHYSICS
    • G16—INFORMATION AND COMMUNICATION TECHNOLOGY [ICT] SPECIALLY ADAPTED FOR SPECIFIC APPLICATION FIELDS
    • G16H—HEALTHCARE INFORMATICS, i.e. INFORMATION AND COMMUNICATION TECHNOLOGY [ICT] SPECIALLY ADAPTED FOR THE HANDLING OR PROCESSING OF MEDICAL OR HEALTHCARE DATA
    • G16H20/00—ICT specially adapted for therapies or health-improving plans, e.g. for handling prescriptions, for steering therapy or for monitoring patient compliance
    • G16H20/30—ICT specially adapted for therapies or health-improving plans, e.g. for handling prescriptions, for steering therapy or for monitoring patient compliance relating to physical therapies or activities, e.g. physiotherapy, acupressure or exercising

Definitions

  • the present disclosure relates generally to methods for quantifying the extent of cardiac muscle injury in various regions of a patient's heart based on data collected from an array of electrodes in an electrocardiograph (ECG).
  • ECG electrocardiograph
  • the disclosure also relates to methods for classifying the overall extent of cardiac muscle injury in a patient and for diagnosing myocardial infarction (Ml) based on the classification of the overall extent of cardiac muscle injury.
  • Ml myocardial infarction
  • An ECG is a device comprising a plurality of electrodes applied to the skin of a patient in the thoracic region. These electrodes measure electrical activities in different areas of the cardiac muscle.
  • An ECG is a useful tool for diagnosing various cardiac disorders, such as Ml and ischemia. In the case of acute Ml (also known as heart attack), an ECG may be useful for identifying the damage to the cardiac muscle.
  • the electrical signal recorded by an electrode may be traced on a standard grid, an example of which is shown in FIG. 1.
  • a standard grid On such a grid, time is represented horizontally, progressing from left to right, and voltage is represented vertically.
  • each square has a width of 0.04 sec and a height of 0.1 mV.
  • FIG. 1 illustrates an exemplary ECG waveform of a normal heartbeat (or cardiac cycle).
  • each beat comprises a P wave 110, a QRS complex 120 and a T wave 130.
  • a portion 140 of the trace between the P wave and the QRS complex is known as the PQ segment, and a portion 150 of the trace between the QRS complex and the T wave is known as the ST segment.
  • a small U wave 160 is also visible in this example, although in general U waves are not always visible in normal heartbeats.
  • the baseline voltage of the ECG waveform is known as the isoelectric line and is shown as line 170 in FIG. 1. Typically, the isoelectric line is determined according to the portion of the trace following the T wave and preceding the next P wave.
  • DOC Cardiac muscle injury may be indicated by an elevation or depression of the ST segment of an ECG waveform.
  • the ST segment is said to be elevated if it is at higher potential compared to the PQ segment of the waveform.
  • An exemplary waveform exhibiting ST elevation is shown in FIG. 2A, where the magnitude of elevation is represented by the distance d1 between the potential of the ST segment 210 and the potential of the PQ segment 220.
  • the ST segment is said to be depressed if it is at lower potential compared to the PQ segment.
  • An exemplary waveform exhibiting ST depression is shown in FIG. 2B, where the magnitude of depression is represented by the distance d2 between the potential of the ST segment 230 and the potential of the PQ segment 240.
  • ST deviation is often associated with cardiac injury.
  • elevation is often associated with ST elevation myocardial infarction (STEMI)
  • depression is often associated with ischemia, which may be a pre-cursor to evolving Ml.
  • STEMI ST elevation myocardial infarction
  • ischemia which may be a pre-cursor to evolving Ml.
  • a 12-lead ECG is used to detect such abnormalities.
  • a 12-lead ECG can only indicate the presence of STEMI and the general area that is affected (e.g., septal, anterior, lateral).
  • STEMI is detected on as few as 2 electrodes, making it difficult to obtain sufficient information regarding the location and extent of the injury.
  • a 12-lead ECG places most of the electrodes on the front of the chest, resulting in limited reliability in identifying STEMI occurring in other areas.
  • the 12-lead ECG has been known to miss STEMI occurring at the back surface of the heart.
  • FIGs. 3A and 3B An example of a BSM arrangement is illustrated in FIGs. 3A and 3B, with FIG. 3A showing electrodes 310 and 320 applied to the front of the thoracic region and FIG. 3B showing
  • a method for quantifying an extent of cardiac muscle injury comprises determining a magnitude of ST deviation based on electrocardiographic data obtained from at least one electrode in an electrocardiograph, the at least one electrode being associated with at least one region of a heart; determining an area factor for the at least one electrode, the area factor being associated with the at least one region; and computing an ST deviation volume for the at least one electrode, based, at least in part, on the magnitude of ST deviation and the area factor.
  • a computer- readable medium having computer-executable instructions for carrying out the above method is provided.
  • a method for diagnosing a patient based on aggregate ST deviation volume comprises: obtaining an aggregate ST deviation volume of the patient based on magnitude and area information collected from an array of electrodes applied to the patient; obtaining one or more diagnostic thresholds using aggregate ST deviation volume data from a plurality of patients with confirmed diagnoses; and comparing the aggregate ST deviation volume of the patient against the diagnostic thresholds.
  • a system for quantifying an extent of cardiac muscle injury based on electrographic data obtained from a patient comprises one or more processors programmed to: determine a magnitude of ST deviation based on electrocardiographic data obtained from at least one electrode applied to the patient, the at least one electrode being associated with at least one region of a heart; determine an area factor for the at least one electrode, the area factor being associated with the at least one region; and
  • FIG. 1 shows an ECG waveform of a normal heart beat traced on a standard grid
  • FIG. 2B shows an ECG waveform exhibiting ST depression
  • FIG. 3A shows an array of electrodes applied to the front of a human torso
  • FIG. 3B shows an array of electrodes applied to the back of a human torso
  • FIGs. 4A-B show examples of ST deviation volume (STDV) for a single electrode
  • FIGs. 5A-B show examples of aggregate ST deviation volume for a plurality of electrodes
  • FIGs. 6A and 6B show, respectively, an anterior portion and a posterior portion of an exemplary BSM device for obtaining ECG data
  • FIG. 6C shows an exemplary arrangement of electrodes into four regions
  • FIG. 7 is a flow chart illustrating a method for calculating aggregate STDV
  • FIG. 8 is a flow chart illustrating a method for diagnosing a patient
  • FIGs. 9-12 illustrate aggregate STDV values of patients with confirmed Ml or confirmed non-MI diagnoses
  • FIG. 13-20 are three-dimensional illustrations of example cases exhibiting ST elevation and/or depression.
  • FIG. 21 is a schematic illustration of an exemplary computer on which aspects of the invention may be implemented.
  • This may enable a physician to select an appropriate treatment for a patient diagnosed with Ml based on the severity of the Ml. It may also be used to assess a patient's condition before and after a percutaneous coronary intervention (PCI) procedure. Compared to other imaging modalities such as angiogram, MRI, and echocardiogram, a BSM-based method for quantifying the extent of cardiac injury may be less expensive and more convenient.
  • PCI percutaneous coronary intervention
  • data obtained from a BSM electrode array may have two aspects or dimensions: the areas affected, for example, as indicated by the distribution of electrodes detecting ST deviation, and the magnitudes of ST deviation detected by the individual electrodes.
  • a measurement comprising only one of these two dimensions may not provide sufficient information. For example, a simple area count may reveal how wide spread the injury is, but may fail to indicate the severity of injury in the affected areas.
  • a measurement based solely on the magnitudes of ST deviation (e.g., taking the most severe deviation observed by a single electrode) may miss a mild but wide-spread injury.
  • a new parameter called ST deviation volume (STDV) is used to assess the extent of cardiac muscle injury.
  • STDV ST deviation volume
  • the STDV parameter combines both area and magnitude information.
  • the STDV of an individual electrode may be determined based on an area of the heart associated with the electrode and the magnitude of ST deviation detected by
  • the STDV of an electrode may be calculated by multiplying the magnitude of ST deviation detected by the electrode with an area factor associated with the electrode.
  • the magnitude of ST deviation may be scaled, or otherwise adjusted, based on the location of the electrode on the patient's torso and therefore the distance between the electrode and the heart.
  • the area factor associated with the electrode may also be determined in a number of different ways, for example, by using the number of electrodes that are associated with the same region of the heart as the present electrode.
  • a first electrode that is associated with a densely populated region i.e., a region of the heart to which many electrodes are associated
  • a second electrode that is associated with a sparsely populated region i.e., a region of the heart to which few electrodes are associated
  • each region of the heart may be projected to a region of the patient's torso, so that an area factor for a particular electrode may be determined using the density of electrodes in the region of the torso in which the particular electrode resides.
  • an aggregate STDV may be determined by considering STDV values obtained from a plurality of electrodes. For example, an aggregate STDV may be computed as the sum of all STDV values, both elevation and depression, obtained from all electrodes in an electrode array. In this case, the aggregate STDV may be referred to as a total STDV. Alternatively, an aggregate STDV may be computed as the sum of all STDV values obtained from electrodes detecting STDV elevation. In this case, the aggregate STDV may be referred to as a total ST elevation volume (total STEV). Similarly, an aggregate STDV may be computed as the sum of all STDV values obtained from electrodes detecting STDV depression. In this case, the aggregate STDV may be referred to as a total ST depression volume (total STDpV).
  • total STEV and total STDpV may be more useful than total STDV.
  • the Applicant has recognized that an area of ST elevation is often accompanied by a reciprocal area of ST depression on the opposite side of the torso. If a patient is diagnosed with STEMI 1 it may be more informative to compare the patient's total STEV against a database of total STEV values. Likewise, if
  • the aggregate STDV value of the new patient may be compared against the diagnostic threshold to determine whether the new patient suffers from Ml, and if so, to classify the new patient's condition as severe, medium, or mild, based on the top/middle/bottom bands.
  • An appropriate treatment e.g., aggressive vs. moderate
  • the area factor used to compute STDV for an individual electrode may be obtained using another suitable method, without relying on the density of electrodes.
  • the classification bands are non-limiting.
  • STDV for a single electrode may be determined based on an ST deviation magnitude detected by the electrode and an area factor associated with the electrode.
  • the ST deviation magnitude may be determined using any suitable technique, as the invention is not limited in this respect.
  • the ST deviation may be measured at any of the standard points such as the J point (also known as STO, the point at which the QRS complex meets the ST segment), ST60 (60 msec after STO), or ST80 (80 msec after STO).
  • the area factor associated with the electrode may depend on the location of the electrode on the patient's torso.
  • the area factor may depend on the density of electrodes in the region of the torso in which the electrode is located.
  • the area factor of a first electrode in a densely populated region may be smaller than that of a second electrode in a sparsely populated region, because the first electrode monitors a smaller area of the heart compared to the second electrode.
  • FIG. 4A represents the STDV of a first electrode that is detecting an ST elevation of 3 mm and is associated with an area factor of 1.
  • the STDV for the first electrode is 3 mm.
  • the area factor is obtained by taking a ratio of the electrode density in the most dense region (denoted EDh) and the electrode density in the region of the electrode (denoted EDr). More particularly, the first electrode may be located in the most dense region, or in a region with the same density as the most dense region. Therefore, the area factor A is simply 1.
  • FIG. 4B represents the STDV of a second electrode that is detecting an ST elevation of 0.75 mm and is associated with an area factor of 4.
  • the second electrode may be located in a region with lower density (e.g., 4 electrodes per dm 2 ), compared to
  • the STDV of an electrode may also have any suitable unit.
  • STDV has the same unit as ST deviation, because the former is a product of the latter with a unitless area factor.
  • STDV may have other units, or may be treated as a unitless quantity.
  • FIGs. 5A-B illustrate examples of total STDV for a plurality of electrodes.
  • each column represents STDV for one electrode.
  • the height of each column represents the magnitude of ST elevation detected by the corresponding electrode.
  • column 510 has a height of 1.25, indicating that the electrode corresponding to column 510 detects an ST elevation of 1.25 mm. As shown in FIG.
  • the eight corresponding electrodes detect various levels of ST elevation, ranging from 0 mm to 1.25 mm. Moreover, the eight electrodes may be located in the same region of the patient's torso, for example, in the most densely populated region, so that the area factor for each electrode is 1. Summing all of the STDV values, the total STDV for the eight electrodes in FIG. 5A is computed to be 3.75 mm.
  • each electrode is associated with an area factor of 1.
  • the total STDV for the eight electrodes in FIG. 5B is also 3.75mm.
  • total STDV may provide a meaningful way of comparing a patient with a larger ST deviation that is only exhibited in a small area against another patient with a widespread but small ST deviation.
  • the data shown in FIG. 5A indicates a relatively severe ST deviation at one electrode, namely, the electrode corresponding to column 510.
  • the data shown in FIG. 5B indicates a relatively mild ST deviation of at most 0.5 mm across all eight electrodes.
  • the maximum deviation in FIG. 5A (1.25 mm) is much high than that in FIG. 5B (0.5 mm)
  • the cardiac muscle injury is more widespread in FIG. 5B than it is in FIG. 5A.
  • an aggregate STDV parameter may allow a physician to assess more accurately the condition of a patient suffering from Ml, by comparing an aggregate STDV value from the patient against aggregate STDV values of patients with confirmed diagnoses.
  • an anterior portion 600a of an exemplary BSM device comprising an array of 65 electrodes.
  • different electrode columns in the array may be located in different anatomical regions.
  • electrodes 1-7 may be located on the right hand side on the front of the patient's chest, whereas electrodes 56-58, V6, and 60-61 may be located under the patient's left arm.
  • FIG. 6B shows a posterior portion 600b of the exemplary BSM device, comprising 16 electrodes.
  • electrodes 62-71 When applied to the patient, electrodes 62-71 may be located on the patient's back, with electrodes 62-65 to the left of the patient's spine and electrodes 68-71 to the right of the patient's spine. Electrodes 72-77 may be located under the patient's right arm.
  • electrodes may be organized into different groups based on their respective locations on the patient's torso. This grouping may in turn determine whether and how the ST deviation data collected from each of the electrodes is processed and incorporated into an aggregate STDV value.
  • at least some electrodes of a BSM device may be divided into four regions: anterior, inferior, posterior, and right ventricle (RV). For example, in
  • electrodes 8, 18-21.V2, 23, 24, 28-32, V3, 34, 38- 43, V4, 48-52, V5, 56-58, and V6 may belong to the anterior region (shown as 610 and 612 in FIG. 6A); electrodes 7, 15-17, 25-27, 35-37, 45-47, 54, 55, 60, and 61 may belong to the inferior region 620; electrodes 1-6, 9-11, V1 , 13, 14, and 72-77 may belong to the RV region (shown as 630a in FIG. 6A and 630b in FIG. 6B); and electrodes 62-71 may belong to the posterior region 640.
  • Electrodes in each of these regions may monitor a corresponding region of the heart as indicated by the name of the group. This arrangement is further illustrated in FIG. 6C, showing all electrodes from FIGs 6A and 6B grouped into four regions: ANT, INF, RV, and POST. As shown in FIGs. 6A-C, electrodes are more densely distributed in the anterior region compared to the posterior region. As discussed above, these densities of electrodes may be taken into account when computing aggregate STDV.
  • an ST deviation threshold may be chosen for each of the regions, with a highest threshold being associated with the anterior region.
  • the anterior threshold may be 1.5 mm
  • the posterior threshold may be 0.5 mm
  • the inferior threshold may be 1.0 mm
  • the RV threshold may be 0.9 mm.
  • an ST elevation below the corresponding threshold may be considered normal. If an ST elevation above the corresponding threshold is observed, an adjusted (or exceedance) magnitude may be computed by subtracting the corresponding threshold from the raw magnitude. For example, if an anterior electrode detects an ST elevation of raw magnitude 2 mm, an adjusted magnitude of 0.5 mm (obtained by subtracting the anterior threshold of 1.5 mm) may be reported and used in the calculation of STDV. On the other hand, if a posterior electrode detects an ST elevation of raw magnitude 1.5 mm, an adjusted magnitude of 1.0 mm (obtained by
  • STDV for a single electrode is calculated by first adjusting a raw ST deviation magnitude using a threshold and thereafter scaling the adjusted ST deviation magnitude using a scaling factor.
  • FIG. 7 illustrates a method for computing total STEV.
  • the process begins at step 700 by setting a variable TSTEV to zero. This variable will be used as an accumulator for computing the total STEV.
  • the process enters into a loop to process ECG data obtained from a plurality of electrodes.
  • an electrode that has not yet been processed is selected, and ECG data from that electrode is obtained from a suitable source.
  • DOC established method such as testing for Troponin levels in the blood.
  • the total STEV values of confirmed Ml patients may be sorted, and various band thresholds may be identified. For example, a threshold for diagnosing whether a patient is suffering from Ml may be determined. In addition, thresholds representing the top/middle/bottom thirds of Ml may also be determined. An exemplary method for diagnosing a new patient using these thresholds will now be discussed in connection with FIG. 8.
  • step 820 it is determined whether the patient's total STEV exceeds the Ml threshold. If the conclusion is yes, then the patient is determined to be suffering from Ml and the process proceeds to step 830. Otherwise, the patient is determined not to be suffering from Ml and the process ends.
  • step 830 it is determined whether the patient's total STEV exceeds the top third threshold. If the conclusion is yes, then the patient is determined to be suffering from severe Ml, and aggressive treatment is recommended at step 835 and the process ends thereafter. Otherwise, it is determined at step 840 whether the patient's total STEV exceeds the middle third threshold. If the conclusion is yes, then the patient is determined to be suffering from medium Ml. In that case, moderate treatment is recommended at step 845, and thereafter the process ends. Otherwise, the patient is determined to be suffering from mild Ml, and the process continues to step 850, where it is recommended that the patient continue to be monitored.
  • FIGs. 9-12 methods for building a database comprising aggregate STDV values from patients with confirmed diagnoses (Ml or non-MI) and for determining various diagnostic thresholds are described in greater detail.
  • the database is not limited to the number and composition of cases described in this example.
  • the database is not limited to any particular proportions of patients from different demographic groups and/or with different medical conditions.
  • STDV is treated as a unitless quantity in this example, a comparison between STDV values of different patients is still meaningful, because the STDV values are obtained in a consistent manner across all patients.
  • Each of the cases in the database has an Ml or a non-MI diagnosis that is confirmed by Troponin testing.
  • two versions of total STEV were calculated for each of four regions, anterior, posterior, inferior, and RV. In the first version, ST elevation was measured with respect to the isoelectric line (or baseline).
  • STO Filter thresholds 1.5 for anterior, 0.5 for posterior, 1 for inferior, and 0.9 for RV.
  • two versions of total STDpV were calculated, one with respect to the isoelectric line and another with respect to the STO Filter thresholds.
  • both area factors and scaling factors are used.
  • the area factors are: 1 for anterior, inferior and RV, and 4 for posterior.
  • the scaling factors are: 1 for anterior, 1.5 for inferior, 1.67 for RV, and 3 for posterior.
  • FIG. 9 the number of cases is plotted against total STEV, where total STEV is computed from ST elevation measured with respect to baseline.
  • the two curves represent, respectively, data from confirmed Ml patients and data from confirmed non- MI patients. As shown, there are roughly the same number of Ml and non-MI patients
  • FIG. 10 shows the number of cases being plotted against total STEV with respect to STO Filter thresholds. As shown, very few non-MI patients exhibit a total STEV value of 25 or higher with respect to STO Filter thresholds. This, therefore, demonstrates that the chosen STO Filter thresholds have been correctly chosen as they open up clear separation between the Ml and non-MI cases.
  • Computer 2100 may have one or more input and output devices, such as devices 2106 and 2107 illustrated in FIG. 21. These devices can be used, among other things, to present a user interface. Examples of output devices that can be used to provide a user interface include printers or display screens for visual presentation of output and speakers or other sound generating devices for audible presentation of output. Examples of input devices that can be used for a user interface include
  • DOC keyboards, and pointing devices such as mice, touch pads, and digitizing tablets.
  • a computer may receive input information through speech recognition or in other audible format.

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Abstract

L'invention concerne un procédé où un paramètre d'écart de volume de ST (ST deviation volume, STDV) est déterminé sur la base d'une amplitude d'écart de ST observée par une électrode dans un dispositif d'ECG et d'une aire associée à l'électrode. Par exemple, le STDV peut être calculé en multipliant l'amplitude de l'écart de ST par un facteur d'aire obtenu en utilisant une densité régionale d'électrode. Un STDV agrégé est déterminé à l'aide de valeurs de STDV obtenu à partir d'une pluralité d'électrodes. L'invention concerne également un procédé au moyen duquel un médecin peut interpréter une valeur de STDV agrégé. Dans certains modes de réalisation, un seuil de diagnostic et des bandes de classification peuvent être obtenus à partir d'une base de données de valeurs de STDV agrégé issus d'une pluralité de patients ayant fait l'objet de diagnostics confirmés. Une valeur de STDV agrégé du nouveau patient peut être comparée au seuil de diagnostic et aux bandes de classification pour déterminer si le nouveau patient souffre d'un infarctus du myocarde (Ml) et, si c'est le cas, pour classifier l'état du nouveau patient.
PCT/US2009/006549 2008-12-15 2009-12-15 Mesure de l'étendue de lésions du muscle cardiaque WO2010077305A1 (fr)

Priority Applications (3)

Application Number Priority Date Filing Date Title
CA2746992A CA2746992A1 (fr) 2008-12-15 2009-12-15 Mesure de l'etendue de lesions du muscle cardiaque
EP09836497A EP2373215A1 (fr) 2008-12-15 2009-12-15 Mesure de l'étendue de lésions du muscle cardiaque
JP2011542126A JP2012511998A (ja) 2008-12-15 2009-12-15 心筋障害の程度の測定

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US12250208P 2008-12-15 2008-12-15
US61/122,502 2008-12-15

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JP2014529308A (ja) * 2011-06-30 2014-11-06 ユニヴァーシティ オヴ ピッツバーグ オヴ ザ コモンウェルス システム オヴ ハイアー エデュケーション 心肺機能不全に対する易罹患性（ｓｕｓｃｅｐｔｉｂｉｌｉｔｙ）を判断するシステム及び方法
JP2018075310A (ja) * 2016-11-11 2018-05-17 学校法人自治医科大学 心電図解析装置、心電図解析方法、および生体情報計測装置

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US5419337A (en) * 1992-02-14 1995-05-30 Dempsey; George J. Non-invasive multi-electrocardiographic apparatus and method of assessing acute ischaemic damage
US20050197586A1 (en) * 2000-01-31 2005-09-08 Pearlman Justin D. Method of and system for signal separation during multivariate physiological monitoring
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JP2014529308A (ja) * 2011-06-30 2014-11-06 ユニヴァーシティ オヴ ピッツバーグ オヴ ザ コモンウェルス システム オヴ ハイアー エデュケーション 心肺機能不全に対する易罹患性（ｓｕｓｃｅｐｔｉｂｉｌｉｔｙ）を判断するシステム及び方法
JP2017029750A (ja) * 2011-06-30 2017-02-09 ユニヴァーシティ オヴ ピッツバーグ オヴ ザ コモンウェルス システム オヴ ハイアー エデュケーション 心肺機能不全に対する易罹患性（ｓｕｓｃｅｐｔｉｂｉｌｉｔｙ）を判断するシステム及び方法
US10631792B2 (en) 2011-06-30 2020-04-28 University Of Pittsburgh—Of The Commonwealth System Of Hgiher Education System and method of determining a susceptibility to cardiorespiratory insufficiency
JP2018075310A (ja) * 2016-11-11 2018-05-17 学校法人自治医科大学 心電図解析装置、心電図解析方法、および生体情報計測装置

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