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Development and validation of a smartphone-sized device for cardiac monitoring using four precordial electrodes

Vries, Nynke de (2022) Development and validation of a smartphone-sized device for cardiac monitoring using four precordial electrodes.

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Embargo date:31 December 2023
Abstract:Introduction The electrocardiogram (ECG) is one of the most important diagnostic tools in medicine, with an estimated 300 million ECGs recorded each year worldwide1. In the UMC Utrecht, a mobile device for ECG acquisition (miniECG) was developed that uses four precordial electrodes to obtain a multi-lead ECG. The miniECG was designed to bring 12-lead ECG diagnostic accuracy to the patient home. The goal of this research was firstly to investigate the detection of cardiac ischemia using the miniECG and secondly to gain insight into the differences and similarities of the miniECG and 12-lead ECG. Methods This thesis incorporates three studies. An animal study was performed, in which MiniECG and 12-lead ECG recordings were acquired simultaneously before, during and after coronary artery occlusion and ST-deviation (ST-elevation and ST-depression) was evaluated. A clinical pilot study was performed in the Meander Medical Centre (MMC) and University Medical Center Utrecht (UMC Utrecht) to evaluate presence of ST-deviation in patients with cardiac ischemia. Patients with chest pain presenting at the Emergency Room (ER) received both a miniECG and 12-lead ECG. Prescence of ST-deviation was evaluated by two independent cardiologists. Lastly, a clinical study was set-up to evaluate detection of the full spectrum of ECG abnormalities by the miniECG. Preliminary analysis of this study focused on an investigation of normal sinus rhythm criteria for the miniECG and criteria for the detection of common ECG abnormalities. Results MiniECGs showed early and large ST-deviation compared to 12-lead ECG during 75 minutes of porcine coronary artery occlusion. ST-deviation in the animal model peaked around 10 and 30 minutes, respectively, after which ST-deviation decreased. MiniECG ST-deviation was observed by two cardiologists in 48% of ST-elevation Myocardial Infarction (STEMI) patients. Detection of miniECG ST-deviation was related with TIMI-flow and ST-deviation at hospital arrival was more often confirmed in a 12-lead ECG or 1-lead monitoring ECG in patients with miniECG ST-deviation. Draft criteria for normal SR were established. Conclusion The studies show the potential of the miniECG in the detection cardiac abnormalities. More research into factors influencing miniECG ST-deviation is needed before the added value of the miniECG in the early detection of cardiac ischemia can be established. In future research, time between miniECG and 12-lead reference ECGs should be minimized to mitigate the dynamic nature of ECG changes as a factor in the capture of these abnormalities.
Item Type:Essay (Master)
Faculty:TNW: Science and Technology
Subject:44 medicine
Programme:Technical Medicine MSc (60033)
Link to this item:https://purl.utwente.nl/essays/90474
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