WO2023037006A1 - Procédé et dispositif de détermination de potentiels d'excitation du coeur humain - Google Patents

Procédé et dispositif de détermination de potentiels d'excitation du coeur humain Download PDF

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Publication number
WO2023037006A1
WO2023037006A1 PCT/EP2022/075409 EP2022075409W WO2023037006A1 WO 2023037006 A1 WO2023037006 A1 WO 2023037006A1 EP 2022075409 W EP2022075409 W EP 2022075409W WO 2023037006 A1 WO2023037006 A1 WO 2023037006A1
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Prior art keywords
excitation
potential
space
determined
heart
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PCT/EP2022/075409
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German (de)
English (en)
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WO2023037006A9 (fr
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Tino KREUTZBERGER
Jan KNOBELOCH
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Mycor Gmbh
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Publication of WO2023037006A9 publication Critical patent/WO2023037006A9/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
    • A61B5/72—Signal processing specially adapted for physiological signals or for diagnostic purposes
    • A61B5/7235—Details of waveform analysis
    • A61B5/7253—Details of waveform analysis characterised by using transforms
    • A61B5/7257—Details of waveform analysis characterised by using transforms using Fourier transforms
    • 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 invention relates to a method for determining excitation potentials of the human heart using at least 4 electrodes, which are arranged on the body surface of a person and from which at least three derivatives, preferably bipolar derivatives, of the electrical potential of the excitation of the human heart are determined, wherein the connecting lines between the electrodes arranged on the body surface, which form the at least three leads, span a three-dimensional space.
  • the invention relates to a device for carrying out the method.
  • the human heart is made up of myocardial cells, which contract by passing electrical signals through the myocardial cells themselves.
  • the excitation potentials of ventricular excitation and regression of ventricular excitation can be measured on the body surface of a human being.
  • the course of cardiac muscle excitation and excitation recovery is also used to analyze abnormal changes in the heart. For example, the use of an electrocardiogram (ECG) to diagnose myocardial infarction is well known.
  • ECG electrocardiogram
  • Methods of cardiogoniometry are also used for the same purpose, with a cardiogoniogram being able to determine indications of an existing infarction or ischemia, i.e. an undersupply of the heart muscle tissue.
  • Amyloidosis refers to a group of diseases in which deposits of proteins occur in various human organs.
  • cardiac amyloidosis the heart muscle thickens and stiffens, preventing the heart from contracting and expanding evenly.
  • the abnormal proteins deposited in the intercellular spaces, which are called amyloid lead to cardiac insufficiency as the disease progresses, which manifests itself in shortness of breath and a reduction in exercise capacity.
  • heart diseases that lead to a structural change in the heart muscle tissue.
  • a method for determining excitation potentials of the human heart using at least 4 electrodes which is suitable for determining data for diagnosing structural diseases of the heart to be deployed.
  • a method for determining data for a diagnostic method for detecting cardiac amyloidosis is to be provided, so that a diagnosis no longer requires technically complex or invasive methods.
  • a device for carrying out the method should also be specified.
  • the stated object is achieved by a generic method mentioned at the outset for determining excitation potentials of the human heart using at least 4 electrodes in that
  • the measured values of the leads are fed to a signal processor in order to obtain a processed excitation potential signal, preferably in each lead,
  • the corrected excitation potential signal of the at least three leads the main orientation of the corrected excitation potential is determined, preferably in the form of an electric potential vector RDir with maximum length during the propagation of the ventricular excitation of the QRS excitation complex of the heart in the spanned space and
  • a measure for the spatial orientation of the ascertained corrected excitation potential of the ventricular excitation of the QRS excitation potential, preferably of the electric potential vector RDir is determined.
  • the method according to the invention can be carried out with at least four electrodes, which can in principle be arranged in any arrangement on the body surface of a person, as long as at least three Derivatives or the associated electrodes each have straight connecting lines that span a space.
  • the leads A, D, Ho, Ve and 1, as shown in FIG. 2 span such a space.
  • At least four electrodes are preferably used, which are arranged on the body surface of the patient in such a way that they allow the formation of three leads, preferably bipolar leads, which are preferably perpendicular to one another and span a space.
  • bipolar leads which are preferably perpendicular to one another and span a space.
  • the bipolar leads A, D, Ho, Ve and 1 according to FIG. 2 are preferably used.
  • the term derivation is always also understood to mean a bipolar derivation.
  • the electrical potential of the ventricular excitation of the heart can be represented three-dimensionally as a loop via at least three leads.
  • the evaluation of the signal can be limited to the measurement data assigned to this excitation complex.
  • the planned signal processing of the measured values of the derivatives serves to eliminate all possible external interference, for example interference from high-frequency electromagnetic radiation from mobile phones, etc. in the signal as far as possible.
  • the excitation potential signal is corrected by an offset value so that constant contributions in the excitation potential signal are eliminated and the main orientation of the corrected excitation potential signal in space can be determined correctly and substantially comparably.
  • the principal orientation of the corrected capture potential signal is preferably determined in the form of an electrical potential vector RDir of maximum length during ventricular capture of the heart.
  • the orientation of the electric potential vector RDir describes the main orientation of the corrected excitation potential signal, ie the direction in which the corrected excitation potential signal has the greatest extent in space.
  • the main direction of the corrected excitation potential signal can be determined not only by a maximum length electric potential vector RDir but also in other ways. For example, by considering the obtained measured values of the corrected excitation potential signal as a cloud of points, the geometric extent of which, starting from the center of gravity of the cloud of points, which has the value zero, is described using eigenvectors. Eigenvectors are perpendicular to each other.
  • the eigenvector with the largest eigenvalue can also be used to determine the principal orientation of the corrected excitation potential signal.
  • the latter eigenvector and the electric potential vector RDir are not mathematically identical. However, both essentially indicate the main orientation of the corrected excitation potential signal during ventricular excitation in the space formed by the chosen leads.
  • a measure of its orientation or position in space can then be determined from the main orientation of the corrected excitation potential signal.
  • the measure of the spatial orientation can be, for example, an angle or another value, for example also a vector.
  • the method according to the invention can then be used in a diagnostic method by comparison with a reference angle or a reference vector.
  • cardiac amyloidosis has been shown to affect the principal orientation of the excitation potential of the spread of ventricular excitation of the heart, so a measure of the spatial orientation of the principal orientation of the corrected excitation potential signal, for example by comparison to a reference orientation, or reference angle, indicates cardiac amyloidosis declining, deviating ventricular excitation of the heart can be concluded in a diagnostic procedure.
  • the method according to the invention can also be used in diagnostic methods of other structural excitation disorders of the human heart.
  • diagnostic methods of other structural excitation disorders of the human heart due to the low cost of screening methods with the Methods according to the invention, for example for cardiac amyloidosis, can be carried out easily, since a large number of people can be examined at low cost.
  • the T-wave of the excitation regressions of the heart chambers is detected in the at least three leads,
  • the processed excitation potential signal is corrected by an offset value in order to obtain a corrected excitation potential signal
  • the main orientation of the corrected excitation potential of the excitation recovery of the heart chambers preferably in the form of an electric potential vector TDir with maximum length in the spanned space during the excitation recovery of the heart chambers is determined and
  • a measure of the alignment of the main alignment of the corrected excitation potential signal of the excitation recovery of the heart chambers can indicate a changed excitation recovery of the chambers of the heart.
  • the determination of the main orientation of QRS excitation complexes via eigenvectors can be used here analogously for the T waves.
  • the latter eigenvectors and the electric potential vector TDir are not mathematically identical. However, both essentially give the main orientation of the corrected excitation potential signal of the De-excitation of the heart in the space formed by the selected leads.
  • the respective electrical potential vectors RDir, TDir or both together can, for example, also be used in a comparison with one or more reference vectors.
  • the reference vectors are preferably determined by a multivariate discriminant analysis. Other analysis options using the electrical potential vectors RDir, TDir or both vectors are also conceivable.
  • At least one angle of the electrical potential vectors RDir and/or TDir in the spanned space is determined, for example. Determining an angle in space is a particularly simple measure for determining the main orientation of the corrected excitation potential. At least one of these angles can be used to discriminate against or belong to a group affected by amyloidosis.
  • a simplified way of determining the orientation of the electrical potential vector RDir or TDir is achieved by determining the determined electrical potential vector RDir and/or TDir in spherical coordinates in the spanned space and using the elevation angle 0 for the orientation of the electrical potential vector RDir or TDir and/or the azimuth angle cp can be determined.
  • Other coordinate systems such as cylindrical coordinates, can also be used in analyzing the principal orientation of the corrected excitation potential signals.
  • the time of the start of the QRS excitation complex and/or the T-wave is determined in at least one derivation of the processed excitation potential signal and the measured electrical potential value is determined in at least one derivation at the time of the start of the QRS excitation complex or the T-wave used as an offset value for the correction of the excitation potential in the respective lead.
  • the beginning of the QRS excitation complex can be determined in the individual leads.
  • the determination of the beginning of the QRS excitation complexes can also be improved statistically, for example by averaging, in the respective leads or independently of the leads.
  • the determined candidates for the beginning of QRS excitation complexes can be combined statistically, for example by averaging, into a QRS excitation complex that is representative for the measurement, or this can be selected from the candidates.
  • electrical potentials are measured for a plurality of propagations and regressions of the ventricular excitation of the heart in each lead and the main orientation of the corrected excitation potential signal is determined using statistical measurement variables, for example medians or mean values, which are derived from the majority of the propagations and regressions measured the ventricular excitation of the heart were determined. This generally leads to higher measurement certainty with regard to determining the orientation of the corrected excitation potential signals.
  • the offset values used to determine the corrected excitation potential signals can be determined, for example, by detecting the QRS excitation complexes. They preferably correspond to the amplitude of the beginning of the respective QRS excitation complex in at least one derivation. In preparation for the detection of the QRS excitation complexes, a QRS detection signal is formed for at least one derivation, for example by selecting QRS-typical frequencies. In the formed QRS detection signals then an amplification of the relevant QRS areas. The precise start and end points of the QRS ranges are determined using adaptive threshold values, which can be calculated from statistical measurement variables in the QRS detection signal. The starting points of the QRS excitation complexes form the offset values. The same procedure can also be followed when determining the start of the T-wave, whose offset value can be used as an alternative.
  • a space curve of the electrical potential is determined during the propagation and regression of the ventricular excitation of the heart in the spanned space, the space curve of the electrical potential is subjected to a shape analysis, with a projection being used for the shape analysis of the space curve of the electric potential is carried out in the main plane of the space curve or in at least one plane in space and the projection of the space curve in the respective plane is subjected to a shape analysis.
  • the space curve has at least three dimensions due to the at least 3 derivatives used. When using 4 derivatives, the space curve can also have 4 dimensions, for example.
  • the principal plane is defined by N coordinate axes, where N is at least 2. A comparison with reference values or a reference space curve is preferably carried out.
  • the problem of analyzing the space curve can be reduced to a shape analysis in two-dimensional space.
  • a projection into the main plane is preferably carried out using principal component analysis.
  • the main plane is the plane which, after a main component analysis, preferably results from the first two main components of the three-dimensional space curve of the electric potential.
  • a three-dimensional statistical variable such as the space curve of the electric potential, is approximated and the principal components are calculated in this way.
  • the axes of the main plane can consist of a linear combination of the spatial axes defined by the at least three derivations.
  • the projection of the space curve of the electrical potential into the main plane leads to a plane in which the space curve of ventricular excitation essentially lies.
  • a projection can also be used, for example, in any plane in space, in order to only carry out an analysis in at least two dimensions in the shape analysis.
  • the shape analysis captures at least only part of the space curve of the electric potential, preferably only the part of the propagation of the chamber excitation of the space curve or only the part of the excitation recovery of the space curve or it captures the part of the propagation of the ventricular excitation and the part of the excitation recovery of the space curve, where both parts are analyzed separately.
  • mutual influences between the propagation of ventricular excitation and excitation recovery during the analysis in particular when projecting the measured space curve into the main plane or another plane in space, can be ruled out and the precision of the shape analysis can be improved.
  • a combined evaluation of the alignment of the corrected excitation potential signals of the QRS complex, the T wave and the shape analysis is carried out using a feature vector which parameters determined at least during the evaluation as vector components, in particular of the QRS complex that contains the T wave as well as the shape analysis as vector components. It is also conceivable that further parameters, for example parameters that have not been measured, are contained in the feature vector.
  • the feature vector thus enables a comparison with a reference vector in a simple manner by combining the parameters of the QRS complex, the T-wave and the shape analysis.
  • a simplified mathematical evaluation is preferably provided, preferably by using vector multiplication, for example by forming a dot or vector product. For example, it can be checked whether or not the scalar product of the feature vector and a reference vector that contains weighting factors exceeds a specific value.
  • Another option for evaluating the feature vector is to use multivariate statistics or machine learning algorithms, preferably a support vector machine (SVM) algorithm. They are used to classify objects, here the feature vector, into different groups, for example into a pathological and non-pathological group. Other evaluations of the feature vector are conceivable.
  • SVM support vector machine
  • the ratio of the enclosed area of the electrical space curve of the potential of the QRS complex to the enclosed area of the electrical space curve of the potential of the T-wave as a combined parameter from the QRS complex can also be determined from the determined space curve of the electrical potential of ventricular excitation and excitation recovery and determine T-wave. This parameter can, for example, also be taken into account in the feature vector for the evaluation. Analogously combined parameters can be formed from the ratio of the signal strengths of the QRS complex and the T wave.
  • the shape analysis is carried out on the basis of the aforementioned projection of the space curve.
  • This Analysis can be done by shape-defining parameters. These are, for example, roundness, compactness or the expansion of the space curve in at least one space dimension. These parameters can be determined, for example, directly from the entire space curve or from the determined QRS and T complexes.
  • the measured space curve of the electrical potential of the ventricular excitation and regression of the heart is transformed into the frequency space by a discrete Fourier transformation and the associated Fourier descriptors are thus determined.
  • An exact image of the measured space curve of the electrical potential can then be obtained by using all Fourier descriptors in the inverse transformation.
  • the number of Fourier descriptors for the inverse transformation is reduced, reduced basic forms of the measured space curves of the electrical potentials are obtained, which allow a simplified evaluation of the shape analysis of the space curves. Similar to a complex filter, a reduced number of Fourier descriptors can smooth the measured spatial curves in the respective plane and reduce them to pathological or healthy basic forms.
  • a particularly simple shape analysis of the two-dimensional projections of the space curve can be carried out by a further embodiment in that the roundness of the projection of the space curve is determined as a shape analysis in the respective plane, with the roundness being the ratio of the greatest width and the greatest height of the projection of the space curve is equivalent to. Roundness thus provides a particularly simple shape analysis parameter.
  • the compactness of the projection of the space curve in the respective plane from the ratio of the square of the circumference of the projection of the space curve and the area enclosed by the projection of the space curve can also be used as a shape analysis.
  • the compactness is at a minimum in the case of an approximately circular course of the projection of the space curve in the respective plane, since the enclosed area of the space curve is then at a maximum.
  • the compactness can also be used to infer a changed electrical excitation of the heart, for example caused by cardiac amyloidosis.
  • the shape analysis can also be carried out using determined Fourier descriptors, in that a feature vector is formed with the determined Fourier descriptors as components and a comparison is carried out with at least one reference feature vector. Since the determined Fourier descriptors are used here directly for the shape analysis, the step of generating a space curve using the Fourier descriptors and the subsequent shape analysis of the space curve generated from the Fourier descriptors is omitted.
  • the signal processing includes at least smoothing and/or filtering of the measured electrical potentials of the at least three leads, so that the main disturbances, such as movement artifacts, mains frequency disturbances or high-frequency disturbances, such as high-frequency interference from the patient, are present in the processed excitation potential signal, for example Muscle tremors should be reduced as much as possible in all three leads.
  • the signal processing of a further embodiment of the method includes a classification of the measured electrical potentials of the at least three leads, so that ventricular excitations of the heart, in particular ventricular extrasystoles, which deviate from the normal excitation complex, in particular QRS complex, are not used for further excitation complex analysis.
  • a corresponding classification can be carried out, for example, by analyzing the electrical potentials in relation to the characteristic morphology of the excitation complex, in particular the QRS complex, and in the event of a deviation this can result in this measurement of electrical potentials not being permitted for further analysis.
  • the classification can also exclude supraventricular extrasystoles or other forms of extrasystoles that lead to a change in the excitation complex from further analysis.
  • the above-mentioned object is achieved by a device for carrying out a method according to the invention with - means for measuring electrical potentials of at least 4 electrodes arranged on the body surface of a person for determining at least three leads, preferably at least three bipolar leads, where the connecting lines between those on the body surface arranged electrodes, which form the at least three derivatives, span a three-dimensional space,
  • Means for analyzing the shape of the projection of the space curve of the electrical potential in a main plane or in at least one plane in space the means for analyzing the shape preferably carrying out a comparison with a reference space curve and means for outputting the determined extent of the alignment of the electrical potential vectors or the results of the shape analysis, solved.
  • the method according to the invention can be carried out with the device.
  • the device is characterized by a low expenditure on equipment and can therefore be used particularly well in a diagnostic method.
  • the device can be further developed, for example, in that it analyzes the measurement data online, ie during the measurement of the derivations, and can also carry out a more extensive offline analysis of the data determined.
  • the same also applies to the method according to the invention, which can optionally be divided into an online measurement method and an analysis method carried out offline.
  • FIG. 2 shows a preferred arrangement of at least four electrodes on the surface of the upper body of a patient
  • 6a, 6b a representation of the projection of the space curves into the main plane after a discrete Fourier transformation and inverse transformation using the first three Fourier descriptors without findings
  • the P wave is an expression of the
  • the first part of the P wave represents the electrical excitation of the right atrium, the second part the electrical excitation of the left atrium.
  • the PQ interval comprises the time from the onset of the P wave to the beginning of ventricular excitation. It reflects the time it takes for electrical impulses generated by the sinus node to travel through the atrium, AV node, and bundle of His to the ventricles.
  • the QRS excitation complex then corresponds to the spread of excitation in the two heart chambers.
  • the ventricles are fully excited at the beginning of the ST segment.
  • the ST segment then transitions into the T wave of ventricular resuscitation.
  • the maximum value of the T-wave represents the maximum repolarization of the regression of ventricular excitation. This is followed by the U-wave and then the propagation of excitation at the sinus node of the heart begins again.
  • At least 4 electrodes are used to determine excitation potentials of the human heart in order to determine at least three leads, preferably bipolar leads.
  • the electrodes are preferably arranged on the surface of the upper body of a person, as shown in FIG.
  • the lines connecting the electrodes of leads Ho, Ve and 1 span a space.
  • This electrode arrangement is also characterized by mutually perpendicular connection lines between the electrodes of leads Ho, Ve and I.
  • a fifth electrode can also be used, which can serve as a neutral electrode.
  • more electrodes can also be used, in which case several triple derivations that span a space can be formed from the electrodes and evaluated.
  • FIGS. 4a and 4b show the spatial curves of the electrical potential for two different pathological changes in the cardiac amyloidosis electrical excitation of the heart shown.
  • determined electric potential vectors RDir and TDir are plotted as the main orientation of the corrected excitation potential.
  • a comparison of the three-dimensional representations of the pathological space curves in FIGS. 4a and 4b with the non-pathological space curves in FIGS diagnostic methods can be used.
  • a measure of the alignment can be specified on the basis of the alignment of the electrical potential vectors RDir and TDir and also the alignment of the vectors RDir and TDir to one another, so that it is possible to conclude that electrical excitation of the heart has been altered by cardiac amyloidosis.
  • FIGS. 5a, 5b the projection of the space curve into the main plane is shown in a diagram in which the X and Y axes represent the first and second main components of the space curve. It can be seen that this projection of the space curve of the electrical potential onto the level of the main components clearly shows a unification of the two non-pathological space curves.
  • FIG. 5 further shows a standardization of the values compared to a shape analysis of the projections in FIGS. 5a and 5b.
  • the Fourier descriptors FD2 and FD3 of the projections into the main plane are plotted against one another for a plurality of space curves.
  • Pathological excitation potentials are marked with an x and non-pathological ones with an o. It is shown that pathological and non-pathological measurements can be separated with a high degree of certainty using the linear separation function shown.
  • the separation function used is not limited to a linear form; higher-order functions are also possible.
  • This separation function can also be expressed in terms of reference vectors. A comparison with these reference vectors can result in a diagnosis of cardiac amyloidosis, for example.
  • the separation of the pathological and non-pathological space curves of the electrical potential can therefore be carried out with a very high level of quality.
  • the pathological measurements can be separated from non-pathological measurements using a plurality of Fourier descriptors or also other features, such as angles or extensions of the space curves. Depending on the number of features (dimensions), a corresponding hyperplane is then necessary for this.
  • the selected features are combined in feature vectors, which are also used to evaluate pathological or non-pathological changes in the excitation of the heart.
  • FIG. 10 shows a schematic view of an embodiment according to the first aspect of the invention for the evaluation of the angle of the main orientation of the electrical excitation potential signal in the form of the electrical potential vector RDir of the QRS excitation complexes.
  • the recorded measured values of the at least three leads (b1, b2, b3) are fed to a signal processing unit in block 1.
  • the QRS excitation complexes for the propagation of the ventricular excitation of the heart in the at least three leads are detected in the exemplary embodiment.
  • These detected QRS excitation complexes are fed to the optional classification unit in block 3 and divided into different classes. This classification also includes the division of excitation potential signals into the class of extrasystoles.
  • a normal class is preferably defined, which corresponds to the normal physiological course of the heartbeats, which is preferably evaluated, for example.
  • the processed excitation potential signal is subjected to an offset correction and an offset-corrected angle determination is carried out for all detected QRS excitation complexes and their main alignment in the leads.
  • the angles determined for example the elevation angle and the azimuth angle in spherical coordinates as a measure of the main alignment of the QRS excitation complexes, are compared in block 5 with reference values or reference vectors, ie reference features. The result of this comparison is forwarded or output to block D, an optional diagnostics block.
  • the diagnosis block D either outputs the measured degree of alignment as a value or already outputs it a diagnosis of, for example, structural heart disease, preferably cardiac amyloidosis.
  • FIG. 11 shows an embodiment according to the second aspect of the invention, in which the steps of the embodiment according to the first aspect are carried out analogously for the T-wave of the heart's resuscitation.
  • the recorded measured values of the at least three leads (b1, b2, b3j) are fed to a signal processing unit in block 1.
  • the T waves of the propagation of the excitation regression of the heart are detected in the at least three leads in block 6.
  • These detected T - Waves are fed to the optional classification unit in block 7 and divided into different classes analogous to block 3.
  • an offset correction of the processed excitation potential signals and an alignment of the electrical potential vector TDir analogous to the ORS excitation complex in the corrected excitation potential signal is determined over all detected T-waves.
  • the orientation of the electric potential vector TDir indicates the main orientation of the corrected capture potential signal of decapitation of the ventricles in the leads.
  • the angles determined as a measure of the main orientation are compared in block 5 with reference values or reference vectors, ie reference features.
  • the result of the comparison is forwarded or output to block D, an optional diagnostics block.
  • the diagnosis block D either outputs the determined degree of alignment as a value or already indicates a diagnosis, for example of a structural heart disease, preferably of cardiac amyloidosis.
  • a combination of the alignment measures of the electrical potential vectors RDir and TDir of FIGS. 10 and 11 can preferably also be used to provide a combined evaluation measure of an alignment of the corrected excitation potential signals in block 5 for a diagnostic method.
  • the main alignments RDir and TDir themselves can be combined in that the alignment with one another is evaluated and a comparison with reference values is also carried out in block 5, for example.
  • FIG. 12 shows a schematic view of an exemplary embodiment according to the third aspect of the invention, which includes a shape analysis of the space curve of the electrical potentials.
  • the recorded measured values of the at least three derivatives (b1, b2, b3j) are fed to a signal processing unit in block 1.
  • the QRS excitation complexes for the propagation of the ventricular excitation of the heart in the at least three derivatives are detected in block 2.
  • These are detected QRS excitation complexes are fed to the optional classification unit in block 3 and divided into different classes. This classification also includes marking as extrasystole.A normal class is preferably also defined, which corresponds to the normal physiological course of the heartbeats, which is preferably evaluated, for example.
  • the space curves of the measured electrical potential are projected into the main plane of the space curve or into a plane in space, which can be formed by at least two derivatives, for example.
  • a space curve based on a corrected excitation potential signal can also be used in the projection.
  • the determined projection of the space curve is subjected to a shape analysis in block 10 .
  • the shape analysis values determined as a measure of the shape are then fed to block 5 and compared by it with reference values or reference vectors, ie reference features. The result of the comparison is forwarded to block D, an optional diagnostics block, or output.
  • the diagnosis block D either outputs the determined measure of the shape as a value or already indicates a diagnosis, for example of a structural heart disease, preferably of cardiac amyloidosis.
  • the shape analysis can be done directly using the projection of the space curve or using an approximated projection obtained by a discrete Fourier transformation of the projection of the space curve into Fourier space and the inverse transformation using, for example, only the first three Fourier descriptors. As already explained, these only have typical basic forms, which can be classified with greater certainty into at least two groups to be discriminated; these are preferably defined as non-pathological or pathological.
  • the shape analysis of the projections of the space curve using Fourier descriptors can also take place in block 10 .
  • the shape analysis can be carried out in different ways. For example, as will be shown below, by determining the compactness of the projection of the space curve, which results from the ratio of the square of the circumference of the projection of the space curve to the area enclosed by the projection of the space curve, a distinction can be made between pathological and non-pathological space curves of the electrical excitation potential signal can be reached and a cardiac amyloidosis can thus be concluded. This also applies, for example, to the roundness of the projection of the space curve.
  • FIG. 13 also shows an embodiment of the device V according to the fourth aspect of the invention, which can execute each individual method according to the first to third aspects of the invention, but also any combination thereof.
  • the angles between RDir and TDir in block 11 can also be used as a measure of alignment with one another be determined.
  • this measure of alignment is compared with reference values or reference vectors, ie reference features. Again, the result of the comparison is forwarded or output to block D, an optional diagnostics block.
  • the diagnosis block D either outputs the determined degree of alignment as a value or already indicates a diagnosis, for example of a structural heart disease, preferably of cardiac amyloidosis.
  • signal processing is carried out as for all exemplary embodiments, for example via smoothing and/or filtering of the measured electrical potentials of the at least three leads.
  • the optional classification of the electrical excitation potential signals occurs in Block 3.
  • block 5 in Fig. 13 The purpose of block 5 in Fig. 13 is to perform a combination of the results of blocks 4, 8, 10 and 11 described above.
  • the features detected in blocks 4, 8, 10 and 11 are output to block 5.
  • Block 5 in FIG. 13 can then combine the features, for example using a feature vector, and carry out a clear separation between at least two groups, preferably defined as non-pathological and pathological groups, with a high hit probability via an evaluation.
  • the features can preferably be combined in a feature vector which at least contains parameters determined during the evaluation as vector components.
  • the feature vector can be evaluated, for example, via vector multiplication, for example by forming a scalar product or vector product, using multivariate statistics or a machine learning algorithm, preferably a support vector machine (SVM) algorithm.
  • SVM support vector machine
  • a separation function can be defined, which divides the feature vectors into at least two groups, of which at least one can be defined as pathological and at least one as non-pathological.
  • the features can be linked in any combination to derive group information.
  • the combinations include the calculated values or ratios between these calculated values.
  • the group information can be forwarded to the optional block D.
  • This provides a simple way of screening for structural heart diseases, for example cardiac amyloidosis, in order to detect them as early as possible.

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  • Signal Processing (AREA)
  • Psychiatry (AREA)
  • Physiology (AREA)
  • Measurement And Recording Of Electrical Phenomena And Electrical Characteristics Of The Living Body (AREA)

Abstract

L'invention concerne un procédé de détermination de potentiels d'excitation du coeur humain. L'invention concerne également un dispositif de mise en œuvre de ce procédé. L'objectif de la présente invention est de proposer un procédé de détermination de potentiels d'excitation du coeur humain à l'aide d'au moins 4 électrodes, qui est approprié pour être utilisé pour la détermination de données pour le diagnostic de maladies structurales du coeur. A cet effet, l'invention fait intervenir un procédé selon la revendication 1 et un dispositif selon la revendication 18.
PCT/EP2022/075409 2021-09-13 2022-09-13 Procédé et dispositif de détermination de potentiels d'excitation du coeur humain WO2023037006A1 (fr)

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EPPCT/EP2021/075107 2021-09-13

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EP0086429B1 (fr) 1982-02-12 1989-08-09 Sanz, Ernst, Dr. med. Procédé de cardiogoniométrie et cardiogoniomètre correspondant
EP1038498A2 (fr) * 1999-03-25 2000-09-27 St. George's Enterprises Limited Procédés de caractérisation d'une operation ventriculaire et leurs applications
US20040111021A1 (en) * 2002-12-09 2004-06-10 Olson Charles W. Three dimensional vector cardiograph and method for detecting and monitoring ischemic events
US20110137191A1 (en) * 2008-06-02 2011-06-09 Polar Electro Oy Method and Apparatus in Connection with Exercise
WO2011075429A1 (fr) * 2009-12-14 2011-06-23 Newcardio, Inc. Marqueurs alternatifs utilisés pour l'évaluation quantitative d'événements électriques cardiaques
US20180000374A1 (en) * 2013-06-04 2018-01-04 Analytics For Life Noninvasive method and system for estimating mammalian cardiac chamber size and mechanical function
EP3417295B1 (fr) 2016-02-18 2020-01-01 Universita' Degli Studi Di Padova Procédé de diagnostic et de typage de l'amyloïdose
US20210128046A1 (en) * 2014-02-27 2021-05-06 Zoll Medical Corporation Vcg vector loop bifurcation

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* Cited by examiner, † Cited by third party
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EP0086429B1 (fr) 1982-02-12 1989-08-09 Sanz, Ernst, Dr. med. Procédé de cardiogoniométrie et cardiogoniomètre correspondant
EP1038498A2 (fr) * 1999-03-25 2000-09-27 St. George's Enterprises Limited Procédés de caractérisation d'une operation ventriculaire et leurs applications
US20040111021A1 (en) * 2002-12-09 2004-06-10 Olson Charles W. Three dimensional vector cardiograph and method for detecting and monitoring ischemic events
US20110137191A1 (en) * 2008-06-02 2011-06-09 Polar Electro Oy Method and Apparatus in Connection with Exercise
WO2011075429A1 (fr) * 2009-12-14 2011-06-23 Newcardio, Inc. Marqueurs alternatifs utilisés pour l'évaluation quantitative d'événements électriques cardiaques
US20180000374A1 (en) * 2013-06-04 2018-01-04 Analytics For Life Noninvasive method and system for estimating mammalian cardiac chamber size and mechanical function
US20210128046A1 (en) * 2014-02-27 2021-05-06 Zoll Medical Corporation Vcg vector loop bifurcation
EP3417295B1 (fr) 2016-02-18 2020-01-01 Universita' Degli Studi Di Padova Procédé de diagnostic et de typage de l'amyloïdose

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W. M. MICHAEL SCHÜHBACH: "Non-invasive diagnosis of coronary artery disease using cardiogoniometry performed at rest", SWISS MED WKLY, vol. 138, no. 15-16, 2008, pages 230 - 238

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