Effect of the recording condition on the quality of a single-lead electrocardiogram.
Effect of the recording condition on the quality of a single-lead electrocardiogram.
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记录条件对单导联心电图质量的影响。
DOI：
10.1007/s00380-021-01991-z
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发表时间：
2022
期刊：
影响因子：
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通讯作者：
Sasano T.
中科院分区：
文献类型：
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作者：
Hamada S;Sasaki K;Kito H;Tooyama Y;Ihara K;Aoyagi E;Ichimura N;Tohda S;Sasano T.
尽管已经开发了许多可穿戴单导联心电图（ECG）监测设备，但是关于其ECG质量的信息是有限的。本研究旨在评估健康受试者在各种条件下（体位和运动）和心律失常患者的单导联ECG质量，估计自动分析的要求，并确定通过改变电极类型和位置来提高ECG质量的方法。将单导联心电图发射器与一对电极置于胸骨上，对12例不同情况下的健康人和35例心律失常患者同时进行常规霍尔特心电图记录。将心律失常患者分为窦性心律（SR）组和心房颤动（AF）组。通过计算QRS波群视觉检测（vQRS）、QRS波群自动检测（aQRS）和P波视觉检测（vP）的灵敏度和阳性预测值（PPV）评估ECG质量。准确度定义为100%灵敏度和PPV。我们还测量了基线、P波和QRS波群的振幅，并计算了信噪比（SNR）。然后，我们专注于aQRS和估计阈值，以获得95%以上数据的准确aQRS。最后，我们试图改善心电图质量，通过改变电极放置在10名健康受试者使用偏置型电极。在各种条件下，单导联ECG在健康受试者中提供了100%的vQRS准确度、87%的aQRS准确度和74%的vP准确度。在基线振幅增加或QRS或P振幅较低的受试者中，发生了几次无法准确检测的运动，导致SNR较低。单导联ECG对心律失常患者的vQRS准确度为97%，aQRS准确度为80%，SR组的vP准确度为95%。AF组基线振幅高于SR组（0.08 mV vs.0.02 mV，P< 0.01），但aQRS的准确性无显著差异（79%vs.81%，P = 1.00）。获得准确aQRS的阈值为QRS振幅> 0.42 mV和基线振幅< 0.20 mV。QRS振幅受电极放置和体位的显著影响（P< 0.01，双向方差分析），与坐姿相比，改变体位估计最大降低30%。当电极间距垂直延长时，QRS波振幅显著增加（垂直延长组1.51mV，对照组0.93mV，P< 0.01）。单导联ECG提供的vQRS准确度至少为97%，aQRS准确度为80%，vP准确度为74%。为了在任何体位下获得稳定的aQRS，考虑到改变体位引起的降低，坐姿下要求QRS振幅> 0.60 mV且基线振幅< 0.20 mV。电极间距的垂直延长使QRS波振幅增加。
Although many wearable single-lead electrocardiogram (ECG) monitoring devices have been developed, information regarding their ECG quality is limited. This study aimed to evaluate the quality of single-lead ECG in healthy subjects under various conditions (body positions and motions) and in patients with arrhythmias, to estimate requirements for automatic analysis, and to identify a way to improve ECG quality by changing the type and placement of electrodes. A single-lead ECG transmitter was placed on the sternum with a pair of electrodes, and ECG was simultaneously recorded with a conventional Holter ECG in 12 healthy subjects under various conditions and 35 patients with arrhythmias. Subjects with arrhythmias were divided into sinus rhythm (SR) and atrial fibrillation (AF) groups. ECG quality was assessed by calculating the sensitivity and positive predictive value (PPV) of the visual detection of QRS complexes (vQRS), automatic detection of QRS complexes (aQRS), and visual detection of P waves (vP). Accuracy was defined as a 100% sensitivity and PPV. We also measured the amplitude of the baseline, P wave, and QRS complex, and calculated the signal-to-noise ratio (SNR). We then focused on aQRS and estimated thresholds to obtain an accurate aQRS in more than 95% of the data. Finally, we sought to improve ECG quality by changing electrode placement using offset-type electrodes in 10 healthy subjects. The single-lead ECG provided 100% accuracy for vQRS, 87% for aQRS, and 74% for vP in healthy subjects under various conditions. Failure for accurate detection occurred in several motions in which the baseline amplitude was increased or in subjects with low QRS or P amplitude, resulting in low SNR. The single-lead ECG provided 97% accuracy for vQRS, 80% for aQRS in patients with arrhythmias, and 95% accuracy for vP in the SR group. The AF group showed higher baseline amplitude than the SR group (0.08 mV vs. 0.02 mV,P< 0.01) but no significant difference in accuracy for aQRS (79% vs. 81%,P= 1.00). The thresholds to obtain an accurate aQRS were a QRS amplitude > 0.42 mV and a baseline amplitude < 0.20 mV. The QRS amplitude was significantly influenced by electrode placement and body position (P< 0.01 for both, two-way analysis of variance), and the maximum reduction by changing body position was estimated as 30% compared to the sitting posture. The QRS amplitude significantly increased when the inter-electrode distance was extended vertically (1.51 mV for vertical extension vs. 0.93 mV for control,P< 0.01). The single-lead ECG provided at least 97% accuracy for vQRS, 80% for aQRS, and 74% for vP. To obtain stable aQRS in any body positions, a QRS amplitude > 0.60 mV and a baseline amplitude < 0.20 mV were required in the sitting posture considering the reduction induced by changing body position. Vertical extension of the inter-electrode distance increased the QRS amplitude.