WO2023033654A1 - Détection d'anomalie d'activité cardiaque mise en oeuvre par ordinateur - Google Patents

Détection d'anomalie d'activité cardiaque mise en oeuvre par ordinateur Download PDF

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Publication number
WO2023033654A1
WO2023033654A1 PCT/NL2022/050622 NL2022050622W WO2023033654A1 WO 2023033654 A1 WO2023033654 A1 WO 2023033654A1 NL 2022050622 W NL2022050622 W NL 2022050622W WO 2023033654 A1 WO2023033654 A1 WO 2023033654A1
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ecg
heart
model
beat
torso
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PCT/NL2022/050622
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English (en)
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VAN Peter Michael DAM
VAN Eelco Mattias DAM
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Ecg Excellence B.V.
Peacs Investment B.V.
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Publication of WO2023033654A1 publication Critical patent/WO2023033654A1/fr

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    • 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
    • A61B5/36—Detecting PQ interval, PR interval or QT interval
    • 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]
    • A61B5/339—Displays specially adapted therefor
    • 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]
    • A61B5/339—Displays specially adapted therefor
    • A61B5/341—Vectorcardiography [VCG]

Definitions

  • the present invention relates to a method such as im- plemented on a computer, providing cardiac activity anomaly detection, relative to the heart in a torso while using ECG measurement data from an ECG recording device .
  • the present invention provides a method, such as implemented on a com- puter, providing cardiac activity anomaly detection, rela- tive to the heart in a torso while using ECG measurement data from an ECG recording device , the method comprising steps of :
  • beat selection such as selecting a beat or assembling a beat average based on several se- lected beats , for subsequent processing based on the beat selection,
  • Such directional pat- tern With the provided rendering of such directional pat- tern, it becomes possible to interpret such directional pattern . With the provided directional pattern, it becomes possible to relate a cardiac activation pathway to the car- diac anatomy, such as related to the model of the thorax and/or heart , the atria and/or ventricles . It also becomes possible to compare such rendering with the same person in a previous time , a standardi zed person or an average or disitribution over a statistical population . Also , the VCG may be use to compute the mTS I .
  • the method comprises steps of determining a respective timing of the at least one directional change relative to the selected beat .
  • the method comprises steps of determining the number of the at least one directional change present in the activation or recovery of the heart .
  • the method comprises steps of determining whether at least 1 of the at least one directional change occurs before a prede- termined timing of the beat , such as before 50- 90 ms , such as before 60- 80 ms , such as about before 70 ms , such as between 60-70 ms , such as between 50- 60 ms .
  • the method comprises steps of determining whether a directional change generally towards the right side of the heart occurs before a predetermined timing of the beat , such as before 30- 60 ms , such as before 40- 60 ms , such as before 40-50 ms , such as before 45-50 ms , such as before about 50 ms .
  • a predetermined timing of the beat such as before 30- 60 ms , such as before 40- 60 ms , such as before 40-50 ms , such as before 45-50 ms , such as before about 50 ms .
  • the method comprises steps of determining whether the at least one directional change occurs during the P wave .
  • assessments as to the cardiac activity anomaly may be made relative to the loca- tion thereof in the atria .
  • a further aspect according to the present invention relates to a method, such as implemented on a computer, providing cardiac activity anomaly detection, relative to the heart in a torso while using ECG measurement data from an ECG recording device , the method comprising steps of :
  • beat selection such as selecting a beat or assembling a beat average based on several se- lected beats , for subsequent processing based on the beat selection,
  • An advantage of such a method according to this aspect is that an assessment as to the cardiac activity anomaly may be made based on a comparison with such statistical information .
  • the method comprises steps of plotting the respective mTS I data relative to at least 1 of the 3 cardiac axes , such as RAO, LAO and/or for chamber .
  • An advantage of such preferred em- bodiment is that an assessment as to the cardiac activity anomaly may be made from such plot , such as displayed on a graphical user interface , such as on a display device .
  • the method comprises steps of rendering the respective mTS I data in a line plot or line graph .
  • An advantage of such preferred embodiment is that an assessment as to the car- diac activity anomaly may be made from such plots , such as displayed on a graphical user interface , such as on a dis- play device .
  • the method comprises steps of rendering the relative mTS I data in a graphical representation of the heart , preferably ac- cording to the model , preferably in 2D or 3D .
  • the method comprises steps of rendering at least one warning signal relative to the directional change or a deviation of mTS I data relative to the heart in relation to the statis- tical information of a relevant group of the population .
  • the P wave is a segment of the activation of the heart related to the atria .
  • the P wave has a relatively low amplitude , at least in relation to the QRS segment . This makes it di f ficult to interpret any standard representation of the P wave in known ECG systems , although it has been possible to interpret a reference to atrial fibrillation due to a high degree of irregularity instead of a P wave . However, when such reference actually can be made based on such irregularity instead of a P wave , such atrial fibril- lation already developed into a substantial disease .
  • the activation of the heart is initiated in the sinus node, a structure with specialized pacemaker cells that au- tomatically depolarize.
  • This structure is located close to the Vena cava superior, in the roof of the right atrium (see below) .
  • the depolarizing sinus node initiates an acti- vation wave through the atrial myocardium activating both the left and right atrium near simultaneous from roof to the base of the atria, where in the atrial septal region the AV node is located.
  • This AV node in its turn conducts the electrical activity towards the ventricles.
  • the normal atrial depolarization starts in the sinus node, often located close to the vena cava superior, and proceeds sequentially from right to left, with the right atrial roof activated before the left atrium.
  • the P- wave of the ECG represents the electrical activation of the atria, where the right and left atrial activation waveforms summate to form the P-wave .
  • the amplitude of the normal P- wave on the standard surface 12-lead ECG is generally ra- ther small (maximum 0.2 mV) , making it difficult to quan- tify the P-wave morphology. It is even more difficult to visualize the atrial repolarization, which is generally as- sociated with the interval between the P-wave onset to Q wave onset.
  • the local electrical gradients during atrial repolarization are much less steep than the depolarization gradients, as the re- polarization is much slower than depolarization.
  • the atrial action potentials have a shorter plateau phase, which is implicated to be due to a smaller calcium influx.
  • Atrial repolarization starts ear- lier, and proceeds more gradually than ventricular repolar- ization. Consequently, depolarization forces appear noticeable in the P-wave , and the repolari zation is often not perceivable on the surface ECG with amplitudes less than 0 . 2 mV, which appears di f ferent from the ventricles where depolari zation and repolari zation are both of a larger scale or magnitude , respectively represented by QRS and T waves .
  • the P-wave during sinus rhythm may show subtle variations or patterns , di f ficult to quanti fy based on sig- nals from standard 12-lead ECG .
  • the inventor considers the possibility that alterations of P-wave morphology may cor- relate with atrial remodeling and/or with the presence of atrial conduction delays , possibly due to fibrosis , and may be predictive of atrial arrhythmias and atrial fibrilla- tion, or an early onset thereof .
  • P-wave dispersion defined as the di f ference between the longest and the shorter P- wave duration from the 12 ECG leads . Both increased P-wave duration and PWD reflect prolongation of intra- atrial and inter-atrial conduction .
  • Patients with enlarged P-wave and with increased PWD may have a higher risk of de- veloping atrial arrhythmias and atrial fibrillation, sup- porting that those ECG changes may reflect electrical and/or mechanical atrial remodeling ( 9 , 10 ) .
  • a CineECG derived from the standard 12-lead ECG by an inverse ECG method, can correlate the atrial waveforms to the cardiac anatomy, ob- taining a temporo-spatial correlation of the electrical ac- tivity with the anatomical location of the electrical source and the debtors to use a CineECG method in the field of atrial activity .
  • This optimi zes the ven- tricular filling and thus amount of blood pumped by the ventricles .
  • the atrial repolari zation al- most immediately contributes to the ECG signals measured on the body surface due to a lack of the plateau seen in the ventricular transmembrane potential ( TMP ) .
  • TMP ventricular transmembrane potential
  • the atrial tissue will be activated within about 100- 120 ms , i . e . ECG signals seen after this will most probably be caused by the repolari zation of the atrial tissue .
  • the direction of repolari zation 'wave ' through the atria tissue is preferably more or less opposite to the depolari zation wave direction, refer to Fig . 2 .
  • such inflection point may be determined as the moment the direc- tion derived from the P wave changes more than a predefined limit, for instance 30-60°, 35-55°, 40-50° or about 45 de- grees .
  • Fig. 3 is described relative to an example related to the ventricles of the heart.
  • Panel a) of Fig. 3 discloses a torso/heart model preferably used with the 8 of the 9 elec- trode positions (the VF electrode is not shown) .
  • the torso/heart model on the left represents the standard 12 lead ECG configuration, preferably used to analyze PTB and clinical database ECGs.
  • the torso/heart model on the right shows an example of the model, with an adapted Brugada lead system.
  • Panel b) shows fiducials of a single ECG beat from the 12 lead ECG such as preferably automatically, derived from the root mean square (RMS) of all ECG signals meas- ured.
  • the QRS onset (31) is defined as the time when subse- quent ECG samples have an increasing value for at least 10 ms.
  • the QRS offset (33) is defined as the time when the RMS amplitude is lowest between 80 and 200 ms after the de- tected QRS onset.
  • QRS 90 (32) is defined as the time 90 ms after QRS onset.
  • J-Point 30 is defined as the time 30 ms after the QRS offset
  • the Q-point 35 is defined by an intersection point at the time axis and the upslope tan- gent between the T-peak (37) and the mid- amplitude T-wave 36 (orange lines)
  • the T-wave end 39 is defined by the intersection point at the time axis and the downslope tangent 38 between the T wave peak and the mid T wave amplitude (blue lines) .
  • Mean temporo-spatial isochrone (CineECG) .
  • a CineECG method quantifies a mean temporo-spatial localization of the normal cardiac electrical activity, including both de- polarization and repolarization.
  • Such CineECG relates the cardiac activation and recovery pathway to the cardiac anatomy, using the torso/heart model of a 57-year male , with average body build relative to the example population ( example Figure 7 ) .
  • the torso/heart model is used to derive the vectorcardiogram (VCG) from the recorded 12 lead ECG .
  • the VCG is used to compute the CineECG, estimating the mean temporo-spatial isochrone .
  • a CineECG which represents the mean traj ectory of the cardiac activation pathway, was de- fined to move through a heart with a constant velocity of 0 . 7 meter per second (m/ s ) in a 3D direction indicated by the VCG .
  • the velocity of 0 . 7 m/ s is in the physiolog- ical range of the myocardial propagation velocity 1 ' 2 .
  • The the direction of activation, is prefera- bly computed based on signals from the 9 electrodes , build- ing the 12-lead ECG by the following equation :
  • v(t) can be adapted to obtain this behavior .
  • the cardiac activation starts in the left sep- tum, close to the center of mass of the ventricles 3 ' 4 .
  • the center of mass of the ventricular model is used as the of starting point of the mTSI(0).
  • Fig. 4 provides an example of an iECG work-flow in a normal subject.
  • a first step is to convert the 12-lead ECG into the VCG, that is preferably positioned at the center of ventricular mass.
  • the panel on the right shows the ana- tomical view on the VCG.
  • the VCG may be converted into the atrial CineECG .
  • Signal descriptions Both from the tempo-spatial localization of the electrical ac- tivity pathway (CineECG) within the cardiac anatomic struc- tures as well as the VCG, newly derived signals are prefer- ably determined by computation.
  • CineECG electrical ac- tivity pathway
  • a direction change re- lates to an anatomical VCG and/or CineECG to determine a direction change or a change in the mean direction of the VCG for the different segments of the ECG beat, i.e. P- wave, PQ interval, QRS complex, ST segment (e.g. initial, S-omega point) and the T-Wave.
  • the VCG direction is preferably determined for the first 30 ms.
  • the direction of VCG is preferably un- related to the amplitude of the ECG signals, and preferably the direction of the VCG (the normalized VCG, similarly used in the CineECG computation) .
  • an inf lection/de- flection point is determined ( see Fig . 5 ) .
  • the inflection point sepa- rates depolari zation from repolari zation .
  • gener- ally the inflection point is intended to show an at least one change of direction of relevance to the present inven- tion or an embodiment thereof .
  • the inflection point is found at an earlier time point then average , when for example initially the activation travels solely through the right atrium and then after for instance 50 ms the left atrium get activated, which changes the direction of the VCG/CineECG ( see below) such activation anomaly is prefera- bly indicated when using a preferred embodiment according to the present invention .
  • Another example is of a patient with intra atrial conduction delay with an inflection point much earlier at 58 ms .
  • Such inflection point directs at a directional change in the activation of the heart , in this case the atria .
  • an anomaly is highly likely to be present .
  • a normal P-wave po- sition in the heart may be readily discerned along at least one of the 3 cardiac axes , such as a long one , along two and/or along 3 of the cardiac axes .
  • a CineECG pathway describes an average of all cardiac activity during the activation and recovery of the heart , such as atria as part of the heart .
  • a model of the thorax and heart both atria and ven- tricles , is preferably used ( see Figure 7 ) .
  • atria/torso model of a 57-year male was used, with an average body build relative to an example population .
  • This torso/heart model is used to de- rive the vectorcardiogram (VCG) from the recorded twelve lead ECG and assumed electrode positions .
  • VCG was sub- sequently used to compute the mean temporal spatial iso- chrone (mTS I or CineECG) .
  • a first step is to convert the ECG into a VCG, preferably posi- tioned relative to the center of ventricular mass , from which the mean temporal spatial isochrone ( CineECG) traj ec- tory may be constructed ( lower panel on the right ) .
  • the colors of the VCG and CineECG indicate the time from P-wave onset to the QRS onset .
  • the upper left panel represents the standard 12-lead ECG configuration, applied to analyze the PTB database ECGs .
  • the torso/heart model shows the 9 elec- trode positions .
  • the right panel shows the transition from VCG to CineECG, according to the three standard x-ray views ( 4-chamber, right and left anterior oblique , RAO and LAO) .
  • the bottom panel shows the traj ectory of the CineECG local- i zation, defined as the mean temporo-spatial isochrone (mTS I ) of the atrial activation, indicating activation of the atrium moving from right to left atrium .
  • mTS I mean temporo-spatial isochrone
  • the circle 71 marks the end of the P-wave on the 12-lead ECG, which in this case coincides with the deflection point .
  • a computed VCG direction is used to compute a CineECG traj ectory, depicting the locali zation of the average elec- trical activity of the ventricles at each given time inter- val .
  • the VCG direction is a unit vector of the normali zed
  • VCG signal Normal atrial activation starts in the sinus node located close to the Vena Cava superior and from there through the atrial tissue ( see Figure 8 ) .
  • P-wave location is set to the center of mass of the atrial model .
  • This site represents the center of electrical ven- tricular activation, when approximately hal f of the atrial mass is activated, or ventricle mass in case of a ventricu- lar example .
  • the subsequent CineECG cardiac locations are computed according to the following equa- tions : in which v is the speed with which the CineECG travels through the myocardial anatomy, and dt is the time step, in this case 1 ms .
  • the used speed of 0 . 7 m/ s is an example in the physiological range of the myocardial propagation ve- locity a directional change .
  • the VCG is rotated towards the three heart axes , x ) poste- rior to anterior axis , y) the right to left axis from the ventricles , and z ) the long axis of the ventricles .
  • three standard X-ray views along each of the cardiac axes of the heart model are determined : a standard 4 chamber view, and the right and left anterior oblique views , see figure 7 .
  • the direction and position of the CineECG is subsequently related to structures of the atria .
  • a first step is to convert the ECG into the VCG, positioned at the center of ventricular mass , from which the mean temporal spatial isochrone ( CineECG) traj ectory is preferably con- structed, the lower panel on the right .
  • the colors of the VCG and CineECG indicate the time from onset QRS till end QRS ( green and red line in the ECG panel ) .
  • the VF electrode is not shown .
  • the left representation rep- resents the standard 12 lead ECG configuration, used to an- alyze the PTB database ECGs .
  • the CineECG is intended to estimate the average position of the atrial activation .
  • a model of the thorax and atria is pref- erably used, as well as the isochrones of the atrial myo- cardium .
  • the open source simulation tool ECGsim www.ecgsim.org
  • ECGsim was used with data relating to a nor- mal young male ( 20 year ) of which both an ventricular as well as an atrial model was available .
  • the young male was a slender person with a verti- cal heart orientation .
  • the atrial activation sequence was estimated using an inverse procedure using a body surface map (BSM) of 67 ECG signals , showing an activation that starts in a region associated with the sinus node ( Fig . 8 shows ) .
  • BSM body surface map
  • the atrial model , torso model and measured BSM data were used to determine the CineECG, i . e . the 12-lead ECG was obtained using BSM, and the atrial , torso and elec- trode positions were exported using ECGsim .
  • the atrial model is shown in Fig . 8 shows in standard X-ray view orientations .
  • the activation isochrones initially show an spread in all directions from the anticipated sinus node (right from the vena cava superior) . After about 50-60 ms the right atrial appendage is activated, which results in progressing isochrones towards the vena cava inferior and to the left appendage.
  • the CineECG coincides well with this activation pattern: firstly, the CineECG moves from roof of the atria towards the base for the first 56 ms, where the CineECG bends towards the left inferior region. After 101 ms the CineECG start to move in the opposite direction, represent- ing the atrial repolarization direction.
  • Fig. 8 shows The atrial CineECG compared to activa- tion isochrones using ECGsim (www.wcgsim.org) data. 12 lead ECG data is shown on the left. The P-wave is amplified in the adjacent panel in order to provide better visibility of features or fiducials thereof.
  • the activation sequence as stored the ECGsim (normal young male) is shown in the 3 standard X-ray views (4 chamber, Right- and Left anterior oblique RAO/LAO) in the panels below the CineECG as prefer- ably computed from the 12-lead ECG using the patient spe- cific model and electrode positions.
  • the CineECG is shown as computed from the 12-lead ECG using the torso/heart model with the standard electrode posi- tions, moving from right-to-lef t and from roof-to-base .
  • the deflection point 81 is shown as a circle 81 the CineECG, the end of the P-wave 82 as a circle 82.
  • PQ-interval parameters We determine the duration of the PQ-interval , from the onset of the P-wave to the onset of the Q wave, from the 12-lead automatically detected fi- ducial points. We then divided the PQ-interval into the following two sections:
  • the P-wave duration is a significant discriminator between pathological activation sequences and normal activations.
  • an inflection point is de- fined as a moment in time where the CineECG direction devi- ates more than for example in a range of 30-90°, such as between 40-80°, such as between 50-70°, such as 60° from the average direction of the initial preferred 30 ms of the CineECG or from an average direction leading up to the in- flection point.
  • ECGs were applied labelled as healthy control in the certi fied Physionet PTB Diagnostic ECG Database https://www.physionet.org/con- tent/ptbdb/1.0.0/) . From every 10 second ECG a median beat was for example constructed . The P-wave fiducials were manually determined . A total of 426 ECGs were removed from the anal- ysis , either because the atrial ECG contained too much noise to reliably detect a P-wave onset and end, or the P- wave duration was longer than 125 ms .
  • Each of the 6382 analyzed ECG were assigned to an age and a gender group ( Fig . 12 ) .
  • the direction of the P-waves were corrected for comparisons between patients .
  • all P-waves were resampled to obtain a P-wave with the same number of samples ( 110 ms ) .
  • the P-wave duration is largely caused by the si ze of the atria, such as for preferred normali zation, therein preferably the resampled CineECG provides an ana- tomical location within the atria .
  • the average CineECG location is plotted along one of the three cardiac axes (Error ! Reference source not found . 9 ) .
  • the variation among the age groups is limited, as referenced by the mean of each gender/age group in the top panels of Error! Refer- ence source not found.9.
  • the difference between the genders (blue and red lines) is also limited at the end of the P- wave .
  • the angle distribution (histograms) in each of these three heart views and its spatial distribution for the 5- 95% angle range is shown in Error! Reference source not found. .
  • the variation for the P-wave direction is prefera- bly limited from the roof of the atrium (sinus node area) towards the left atrial base Error! Reference source not found.10 (top panels) .
  • the atrial CineECG average directions were similar for male and female, with a small standard deviation.
  • the average direction found in the 4-chamber view was 56°, in the ROA view 96° and 8° in the LAO view, see Error! Refer- ence source not found. .
  • the largest standard deviation found in the LAO view of 20° was as represented.
  • the distribution of all 6382 CineECG waveforms from the normal atrial ECG tracings are plotted as a background for a specific CineECG in Error! Reference source not found. a.
  • the orange lines represent the 90% range (5-95%) of the atrial CineECG as derived from all normal ECG trac- ings, providing a normal range for CineECG location on one of the cardiac axes.
  • Ila shows a normal atrial CineECG with a P-wave duration of 95 ms, the first inflection point was found at 105 ms. In about 6 patients out of the 6382 normal ECGs an inverted CineECG was found (Error! Reference source not found.
  • the atrial CineECG shows a normal initial 56 ms , at which the first inflection point is found and the activations starts to move to the left atrium . This may be explained by a missing connection or functional ac- tivation block between left and right atrium, such as may be present with an atrial block, and thus the activation to the left occurs later in time which than also is dominantly represented in the CineECG traj ectory .
  • the CineECG matches well with the atrial acti- vation isochrones .
  • Figure 14 shows normal atrial CineECG temporo-spatial locations for age and gender groups by the 3 cardiac axes .
  • the mean CineECG traj ectories are su- perimposed for gender and age classes by decades , according to the 3 cardiac axes ( right-left view on the right , roof- to-base view in the middle , posterior-anterior view on the left .
  • the deflection point is especially visible in the roof-to-base view, as a generally bottom part of the line .
  • the mean CineECG traj ectories contin- uous red lines for females , blue dashed lines for males ) with 5% to 95% range by age classes by decades .
  • Figure 15 shows normal distribution of the CineECG atrial traj ectories derived from the 6409 ECG analysed tracings , according to the three cardiac axes .
  • the distribution of the CineECG temporo-spatial lo- cations during PQ-interval derived from all 6409 normal atrial ECG tracings were used to create a normal distribu- tion of the CineECG during the entire atrial activity .
  • the normal PQ-interval position distribution is plotted as or- ange lines representing the 90% range (with 5- 95% confi- dence intervals ) of the normal , in the lower panel , the be- haviour of a single normal CineECG atrial traj ectory, mov- ing from right-to-left , and from roof-to-base .
  • the time scale ranges from dark red 150 to yellow 153 .
  • the green circles 151 indicate the deflection point , and the blue circle 152 the end of the P-wave .
  • the atrial activa- tion was mainly located in the right atrium, and the main direction of atrial activation moves from left to right , from base to roof , and from posterior to anterior .
  • Figure 16 shows an angle distribution of the CineECG P-wave direction by the three cardiac views for included ECGs .
  • the angle distribution indicates the main direction of the atrial activation, pointing towards a given atrial region relative to the positive x-axis ( 0 ° line ) ; the P- wave duration ( P-wave onset to P-wave end) .
  • the angle dis- tribution is shown in red 161
  • the terminal PQ-interval P-wave end to Q wave onset
  • the targeted anatomical regions are shown for the 5- 95% range in each of the three cardiac views ( 4-chamber, right and left anterior oblique (RAO/LAO) views ) .
  • the angle distribu- tion is used to determine the main direction of atrial CineECG .
  • the yellow dots 163 indicate the sinus node loca- tions
  • the pink dots 164 indicate the centre of atrial mass location .
  • the direction of the terminal PQ-in- terval is at a sharp angle compared to the direction of the P-wave in 4-chamber and RAO views , while coincident in LAO view .
  • Figure 17 shows examples of CineECG atrial traj ecto- ries of one normal beat and one premature atrial beat in the same subj ect compared to the mean distribution of atrial traj ectories of the CineECG of the 6409 ECG normal tracings .
  • Both the normal P-wave (upper views ) and the PAC ( lower views ) CineECG traj ectories are shown, derived from an ECG ( left panel ) selected from the PTB-XL database as having at least one single premature (black arrow) and one atrial contraction (PAC, right arrow) . While the normal beat follows the normal traj ectory, moving from right to left , from roof to base , and from posterior to anterior (upper right panel ) , the PAC still moves from roof to top, but from left to right , and from to anterior to posterior ( lower right panels ) . In the CineECG traj ectory there was no deflection point present .
  • An embodiment of a system according to the invention comprises a system for performing a computer implemented method .
  • a computer comprises a processing unit , a with the processing unit functionally coupled memory, a 3D or ana- tomic model receiver, the model preferably being a torso model and/or a heart model , a location information receiver of at least one heart conduction feature , such as the His Purkinj e system or parts , or a model thereof , the base of the papillary muscles , the right free wall moderator band connection, the right apical septal position, the mute apical left septal position and/or the basal left septal position .
  • the computer is preferably coupled with an ECG receiver for receiving ( 600 ) ECG recording data, preferably with corresponding 3D torso information, of a currently performed ECG . It is however also envisaged to perform the method at a later time based on previously acquired data, including the 3D model , ECG measurements , for creating an activation map and thereto related renderings or data crea- tions as indicated in this document .
  • the computer comprises a heart activation map determining module relative to the model , such as comprising steps of updating of electrophys- iological properties of the model .
  • the system may comprise a three-dimensional camera, for detecting ECG electrodes arranged at a torso T , is arranged above the torso T ( sche- matically shown) of a person .
  • the camera is suitable for moving thereof relative to the torso such that from several sides the torso can be recorded for detecting of the ECG electrodes in place .
  • Data from the camera are trans ferred to the computer .
  • the computer is connected to a monitor, keyboard and mouse for receiving input data from these pe- ripherals from a user and for outputting of image data to the user .
  • the computer is furthermore coupled with an ECG ampli bomb that in its turn is coupled to ECG electrodes on the torso T .
  • a practical number of electrodes that is sup- plied is between 4 and 16 , preferably substantially .
  • a larger number for achieving a higher resolution is envis- aged and use thereof dependent on the surroundings in which the installation is applied also usable .
  • the skilled person would be able to determine the number of electrodes as a correct choice based on available equipment .
  • the computer is equipped with modules , in hardware or software , for per- forming steps as indicated in this document and/or for providing renderings of data and/or results on a display .
  • Such a method preferably comprises detection of any cardiac disease from the ECG can optimi ze patient treatment to a personali zed level .
  • Espe- cially changes in the genetical disease patients like Brugada syndrome , ARVC, ACM, HCM, etc, but also acquired cardiac diseases , for instance ischemia or Atrial fibrilla- tion, Arterial Coronary Syndrome (ACS ) , can be monitored reliably with the ECG .
  • the relevant changes can, with the methodology described here , be related to the cardiac anat- omy and thus be of diagnostic use .
  • Steps preferably, but not limitedly defined comprise individual steps or parts thereof as follows .
  • the recorded ECG can be converted into and vector cardiogram (VCG) from the selected ECG beats ( atrial or ventricular ) .
  • VCG vector cardiogram
  • Both 3D signals can be related to the heart model from 100 .
  • the initial position of the CineECG is set to the center of mass of either the atria or ventricles , depending on which waveform is analyzed .
  • the velocity used depends on the part of the waveform analyzed .
  • ECG i.e. connect the wires of the ECG re- corder to the electrodes on the chest of the patient.
  • ECG this the left and right arms, the left foot and the precordial leads V1-V6 over the heart as shown below.
  • the ECG cables and electrodes are specific per manu- facturer. Shape and colors are different. To be able to lo- calize the electrodes automatically these electrode/cable connector features need to be retrieved from a database.
  • thorax size sensor based on the ECG electrodes attached.
  • One implementation of such a sen- sor is a special (multi-electrode) ECG electrode patch, with stretch and/or bend sensors to measure the thorax size and the chest circumference available.
  • Another implementation could use the impedance measured between di f ferent electrodes of the ECG system .
  • the thorax si ze will be estimated from clinical pa- tients characteristics , such as height , weight , gender, ... When also no clinical patients characteristics are available a standard model will be used .
  • this can also a signal averaged beat , i . e . the average of multiple beats with similar wave- form .
  • the fiducials of a single ECG beat from the 12 lead CEG are automatically derived from the root mean square (RMS ) of all ECG signals meas- ured .
  • the QRS onset is defined as the time when subsequent ECG samples have an increasing value for at least 10 ms .
  • the QRS of fset is defined as the time when the RMS ampli- tude is lowest between 80 and 200 ms after the detected QRS onset .
  • QRS 90 is defined as the time 90 ms after QRS onset .
  • J-Point 30 is defined as the time 30 ms after the QRS of f- set
  • the Q-point is defined by the intersection point at the time axis and the upslope tangent between the T-peak and the mid- amplitude T-wave ( oranges lines )
  • the T-wave end is defined by the inter section point at the time axis and the downslope tangent between the T wave peak and the mid T wave amplitude (blue lines ) .
  • Fiducial of the P wave are determined based on the low RMS amplitudes
  • Devia- tions larger than a certain threshold e.g. 10%, will be visualized and used for differential diagnosis.
  • Method according to claim 1 or 7, wherein the steps of performing a beat selection comprises steps of de- ter-mining at least one fiducial of the selected beat or assembled beat average.
  • Method according to clause 3 further comprising steps of determining whether the properties of the VCG and/or mTSI features are within predetermined thresholds or ranges .
  • Method according to clause 3 or 4 comprising steps of determining a projection or displayable result of the properties of the VCG and/or mTSI features. 6 .
  • Method according to one or more of the preceding clauses comprising steps of performing a di f ferential di- agnostic operation ( 600 ) between results of at least two ECG recordings that are recorded at di f ferent times , such as a most recent ECG recordal and a previous ECG recordal .
  • Method according to one or more of the preceding clauses comprising steps of relating a location of ECG leads relative to the model , preferably by means of meas- urement data from a 3D imaging device , such as a camera .
  • Method according to one or more of the preceding claims comprising steps of determining at least one pa- tient characteristic, such as torso si ze and or heart si ze based on a torso si ze sensor, such as stretch sen-sor, in- put .
  • Method according to one or more of the preceding clauses comprising steps of determining torso si ze and/or heart si ze based on patient information input or from a da- tabase .
  • Method according to one or more of the preceding clauses comprising steps of using a standard model , such as obtainable from a database .
  • Method according to one or more of the preceding clauses comprising steps of creating at least one altered model , preferably the heart model based on at least one disease based di f ferential , such as changes or defects .
  • Method according to claim 11 comprising steps of determining a VCG and/or mTS I for at least one of the at least one altered model .
  • Method according to clause 11 or 12 comprising steps of determining activation and/or recovery derived pa- rameters for at least one of the at least one altered model .
  • Method according to one or more of the clauses 11- 13 comprising steps of determining at least one of car- diac anatomical VCG and/or mTS I features , such as po-sition or direction, preferably at speci fic times , time segments or positions relative to the ECG recordal data .
  • Method according to one or more of the clauses 11- 14 comprising steps of selecting a best match of the at least one model for matching boundary conditions of the re- spective mTS I and/or mTS I feature and the respec-tive dis- ease .
  • Method according to one or more of the previous losses comprising steps of estimating the mean path of car- diac activation and recovery using the VCG direction .
  • Method according to one or more of the previous clauses comprising steps of plotting the mTS I position per X, Y and/or the Z axis relative to the start of the mTS I .
  • Method according to one or more of the previous clauses comprising steps of plotting the movement of the mTS I relative to the same of a population of subj ects .
  • Method such as implemented on a computer, providing cardiac activity anomaly detection, relative to the heart in a torso while using ECG measurement data from an ECG recording device , the method comprising steps of :
  • beat selection such as selecting a beat or assembling a beat average based on several se- lected beats , for subsequent processing based on the beat selection,
  • both inflection point and deflection point may not fully or to the fullest accuracy the mathematical sense describe the pattern and/or changes of the direction that is represented within the meaning of the present invention or embodiments thereof .
  • both inflection point for a deflection point is construed as representing a change of direction of the activation or recovery of the heart in any rendering, change of direction, curvature or bend therein .
  • di f ferent aspects of di f ferent embodiments are expressly considered disclosed in combination with each other and in all combinations that on the basis of this document , when read by a skilled person of the area of skill , fall within the scope of the inven- tion or are deemed to be read with the disclosure of this document .
  • These preferred embodiments are not limitative for the scope of protection of this document .
  • the rights sought are defined in the appended claims .

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  • Heart & Thoracic Surgery (AREA)
  • Molecular Biology (AREA)
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  • Measurement And Recording Of Electrical Phenomena And Electrical Characteristics Of The Living Body (AREA)

Abstract

La présente invention concerne un procédé, mis en œuvre par ordinateur, assurant une détection d'anomalie d'activité cardiaque, par rapport au cœur dans un torse tout en utilisant des données de mesure d'ECG provenant d'un dispositif d'enregistrement d'ECG, le procédé comprenant les étapes consistant à : recevoir (100) un modèle 3D ou anatomique et/ou le traiter, tel qu'un modèle cardiaque et/ou un modèle de torse comprenant le modèle cardiaque, recevoir (200a) des données d'enregistrement d'ECG et/ou les traiter, de préférence avec des informations de torse 3D correspondantes, d'un ECG, effectué sur le torse, réaliser (200) une sélection de battement, par ex. sélectionner un battement ou déterminer une moyenne de battements sur la base de plusieurs battements sélectionnés, pour un traitement ultérieur sur la base de la sélection de battement, déterminer (300) un VCG et/ou mTSI sur la base des données d'enregistrement d'ECG par rapport au modèle, déterminer au moins un changement directionnel dans l'activation ou la récupération du coeur, par rapport aux oreillettes et/ou par rapport aux ventricules, de préférence sur la base d'au moins une caractéristique anatomique cardiaque de VCG et/ou de mTSI, ou comprenant celle-ci, telle que la position ou la direction, de préférence à des moments, des segments de temps ou des positions spécifiques par rapport aux données d'enregistrement d'ECG, et afficher un rendu d'un tel changement directionnel par rapport au modèle.
PCT/NL2022/050622 2021-09-02 2022-11-02 Détection d'anomalie d'activité cardiaque mise en oeuvre par ordinateur WO2023033654A1 (fr)

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Citations (2)

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