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Biomedical subjects

J Malmivuo

Publications and source records attributed to J Malmivuo.

13 recordsLinked to original sources
PubMed1997

Reproducibility of the ST-segment depression/heart rate analysis of the exercise electrocardiographic test in asymptomatic middle-aged population.

The reproducibility of the ST-segment depression against heart rate (ST/HR) hysteresis, ST/HR index, and end-exercise ST depression between the repeated exercise electrocardiographic tests were determined in 61 asymptomatic middle-aged subjects. The findings support the clinical utility of the ST/HR hysteresis, but it is noteworthy that the results also suggest that the magnitude of change in the exercise electrocardiographic variables, which has to be observed to make the clinician confident that a real diagnostic change has occurred, is surprisingly large.

Electrocardiography↗
PubMed1996

Accurate detection of coronary artery disease by integrated analysis of the ST-segment depression/heart rate patterns during the exercise and recovery phases of the exercise electrocardiography test.

In this comparative cross-sectional study, we evaluated whether a novel computerized diagnostic variable, ST-segment depression/heart rate ST/HR analysis during both the exercise and postexercise recovery phases of the exercise electrocardiography (ECG) test, can detect coronary artery disease more accurately than methods using either exercise or recovery phase alone. The study population comprised 347 clinical patients referred for a routine bicycle exercise ECG test at Tampere University Hospital, Finland. Of these, 127 had angiographically proven coronary artery disease, whereas 13 had no coronary artery disease according to angiography, 18 had no perfusion defect according to technetium-99m sestamibi single-photon emission computed tomography, and 189 were clinically normal with respect to cardiac diseases. For each patient, the maximum values of the ST/HR hysteresis, ST/HR index, end-exercise ST depression, and recovery ST depression were determined from the Mason-Likar modification of the standard 12-lead exercise electrocardiogram [aVL, aVR, and V1 excluded]. The diagnostic performance of these continuous diagnostic variables was compared by means of receiver-operating characteristic analysis. The area under the receiver-operating characteristic curve of the ST/HR hysteresis was 89%, which was significantly larger than that of the end-exercise ST depression (76%, p < or = 0.0001), recovery ST depression (84%, p = 0.0063), or ST/HR index (83%, p = 0.0023), indicating superior diagnostic performance of the ST/HR hysteresis independent of the partition value selection. In conclusion, computerized analysis of the HR-adjusted ST depression pattern during the exercise phase, integrated with the HR-adjusted ST depression pattern during the recovery phase after exercise, can significantly improve the diagnostic performance and clinical utility of the exercise ECG test for the detection of coronary artery disease.

Adult↗
PubMed1996

A computer program for comprehensive ST-segment depression/heart rate analysis of the exercise ECG test.

The ST-segment depression/heart rate (ST/HR) analysis has been found to improve the diagnostic accuracy of the exercise ECG test in detecting myocardial ischemia. Recently, three different continuous diagnostic variables based on the ST/HR analysis have been introduced; the ST/HR slope, the ST/HR index and the ST/HR hysteresis. The latter utilises both the exercise and recovery phases of the exercise ECG test, whereas the two former are based on the exercise phase only. This present article presents a computer program which not only calculates the above three diagnostic variables but also plots the full diagrams of ST-segment depression against heart rate during both exercise and recovery phases for each ECG lead from given ST/HR data. The program can be used in the exercise ECG diagnosis of daily clinical practice provided that the ST/HR data from the ECG measurement system can be linked to the program. At present, the main purpose of the program is to provide clinical and medical researchers with a practical tool for comprehensive clinical evaluation and development of the ST/HR analysis.

Exercise Test↗
PubMed1994

Compartmental multivariate analysis of exercise ECGs for accurate detection of myocardial ischaemia.

An accurate computer-assisted diagnostic method for detection of myocardial ischaemia, called MUSTA, is developed. MUSTA is based on compartmental multivariate analysis of variables available in the exercise ECGs, and is definitively implemented in Prolog. It is heuristically developed by determining diagnostic criteria, which interrelate a modified ST/HR-slope, ST-segment value and shape, and maximum heart rate, so that concordance with the TI-201 SPECT is maximised. In the learning group consisting of 47 patients, MUSTA provides a diagnostic accuracy of 98%, the detection of ischaemia being in absolute concordance with TI-201 SPECT. MUSTA is evaluated in a similar but independent group of 60 patients. Then, accuracy is 90%, and sensitivity is 94%. The performance characteristics are significantly better than those of the standard exercise ECG, whose diagnostic accuracy in these groups is 77% and 70%, respectively. This study suggests that MUSTA is a significant improvement for computerised assessment of myocardial ischaemia.

Adult↗
PubMed1994

Performance characteristics of various exercise ECG classifiers in different clinical populations.

To improve the diagnostic power of the exercise electrocardiographic test in detecting myocardial ischemia, the authors have recently developed a diagnostic method called multivariate ST-segment/heart rate (ST/HR) analysis (MUSTA). The goal of this study was to evaluate the validity of MUSTA in different clinical populations and to compare its performance characteristics with ST-segment depression, the ST/HR slope, and the delta ST/HR index in these populations. The computerized exercise electrocardiographic measurements were performed on 1,507 cases, and 382 patients were selected as the study population: 161 with significant coronary artery disease according to coronary angiography and 221 with a low likelihood of coronary artery disease. The diagnostic accuracy of MUSTA in the pooled population was 77.7% (297 out of 382 patients), which was clearly better than the accuracy of 69.6% (266 out of 382 patients) using the conventional ST-segment depression criterion of 0.10 mV in detecting coronary artery disease and exercise-induced myocardial ischemia. According to receiver operating characteristics analysis, MUSTA had significantly better diagnostic power than the other classifiers. These findings suggest that multivariate and compartmental analysis methods like MUSTA can further improve the clinical importance of the exercise electrocardiogram.

Coronary Angiography↗
PubMed1994

Normal vector magnetocardiogram. I. Correlation with the normal vector ECG.

The vector magnetocardiogram (VMCG) has been measured with the corrected unipositional VMCG lead system and analyzed statistically in 290 normal subjects. The morphologic study of the QRS waveforms showed that in the right-to-left (X) component, the triphasic qRs waveform appeared in 55% of the subjects. The superoinferior (Y) component was characterized by a prominent S wave in 96% of the subjects, and the anteroposterior (Z) component was also characterized by a prominent S wave in 95% . The VMGs were compared with the vector electrocardiograms (VECG) recorded in a subgroup of 200 subjects, in whom both the VMCG and VECG were available for computer analysis. The normal variability of the spatial vector magnitude measurements was significantly greater in the VMCG than in the VECG. Some similarities were observed in the waveforms of the time-averaged QRS complexes between the VMCG and VECG. Multiple linear regression analysis between the VMCG and VECG showed that maximally 27, 45, and 41% of the variation in the instantaneous QRS X, Y, and Z amplitudes of the VMCG, respectively, could be explained by the instantaneous X, Y, and Z amplitudes of the VECG.

Adolescent↗
PubMed1994

Normal vector magnetocardiogram. II. Effect of constitutional variables.

The effects of age, sex, height, weight, and dimensions of the thorax on the vector magnetocardiogram (VMCG) were studied in 290 normal subjects. The effect of sex on 141 VMCG parameters was tested with the Mann-Whitney U test, and the effects of age and body dimensions on the male and female subjects were tested with the Kruskal-Wallis H test. Similar analyses were applied for a comparison of the vector electrocardiogram (VECG) in a subgroup of 200 normal subjects. Sex had the most pronounced effect on the VMCG, a total of 58% of the instantaneous time-normalized QRS and T amplitude parameters were significantly (P < .01) different in men and women (47% for the VECG). In women, the absolute VMCG amplitudes were, on average, about 60% of those in men. In the VECG, the corresponding portion was about 85%. In men and women, 50 and 26% of the time-normalized amplitude parameters, respectively, were significantly (P < .01) affected by age; the main effect was a decrease in most VMCG amplitudes with increasing age. In the VECG, the corresponding effect was not as statistically significant. The effect of constitutional variables of the body on the VMCG and VECG was, in most cases, not statistically significant. Multiple correlation analysis showed that the five noncardiac factors together explained, at most, 16 and 28% of the variability in the instantaneous, time-normalized QRS amplitudes for men and women, respectively. In the VECG, these figures were 13 and 18%, respectively.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1991

Improved diagnostic performance of the exercise ECG test by computerized multivariate ST-segment/heart rate analysis.

The exercise ECG test is the most widely used noninvasive method of evaluating myocardial ischemia. To determine whether it is possible to enhance its diagnostic power, the authors carried out computerized ECG measurements on 118 nonischemic patients and 38 ischemic patients with or without myocardial infarctions (MIs). Forty-seven (all ischemic and nine normal cases) underwent T1-201 SPECT. The diagnostic variables include ST-segment deviation, modified ST/HR-slope, ST-segment shape, and maximum heart rate. These variables are interrelated by means of compartmental and specific decision rules by computer. The diagnostic method discussed in this article is called the multivariate ST/HR analysis (MUSTA). When compared with MUSTA, the T1-201 SPECT images detected myocardial ischemia with a sensitivity of 100% and a specificity of 89%. Its diagnostic performance was influenced by neither previous MIs nor cardiac medication of the 47 patients tested. MUSTA was also compared to the nonmodified ST/HR analyses (ST60/HR and ST80/HR) and the standard exercise ECG test. It performed significantly better than these methods. The authors conclude that the multivariate ST/HR analysis is comparable to T1-201 SPECT in diagnosing myocardial ischemia among the study subjects. Furthermore, MUSTA is executed during the noninvasive exercise ECG test and is easily applied using an IBM/AT-compatible microcomputer. However, further evaluation of MUSTA with a separate and unselected patient population is needed.

Adult↗
PubMed1976

Anaesthesia for cardioversion: immediate haemodynamics in patients anaesthetized with thiopental or althesin.

Immediate haemodynamic changes during electrical cardioversion were compared in 30 patients anaesthetized either with thiopental or with Althesin. The systolic arterial pressure, heart rate, stroke and cardiac indices were measured before atropine premedication, after atropine, during anaesthesia, and 3 and 10 minutes after defibrillation. The stroke index was estimated by transthoracic impedance method. Both anaesthetics caused a significant but similar decrease in systolic arterial pressure. The cardiac index remained relatively stable in both groups during all stages of the procedure. Atropine induced an expected increase in heart rate and a decrease in stroke index. while both variables tended to approach the baseline values after cardioversion with no difference between thiopental and althesin groups. No significant difference in the haemodynamic response to cardioversion was seen in patients with heart volumes exceeding 650 ml/m2 BSA as compared to those with smaller hearts. It is concluded that both thiopental and althesin can be considered as safe anaesthetics for cardioversion.

Adult↗
PubMedDate not supplied

Validation of a detailed computer model for the electric fields in the brain.

A computer model has been designed for the calculation of the electrical fields in the head, based on the finite difference method. This method has not previously been applied for head modelling. The model was validated by using three concentric spheres and comparing it with an analytic model. Three levels of accuracy were tested. The forward solutions show that the finite difference algorithm works correctly and, by selecting the size of the volume elements properly, accurate results are obtained. The model will be applied to accurate and realistic geometries of the human head obtained from magnetic resonance images.

Brain↗