An increased risk of myocardial ischemic changes was demonstrated in patients suffering from panic disorder (PD). Using classical ECG methods, this risk cannot be evaluated in most patients. We measured the vectocardiogram (VCG) using Frank orthogonal leads and body surface maps (BSM) including 12-lead ECG. In our study of 11 PD patients (2 men, 9 women), without any seizures and pharmacological treatment and without cardiovascular symptoms, we found marked sinus tachycardia (heart rate 90.1±12.2 min-1) and a shorter R-R interval (678±93.6 ms) than in 27 controls (heart rate 73.6±7.7min-1, R-R 822.7±86.4 ms) (5 men, 22 women) (p<0.001). The VCG measured spatial QRS-STT angle was more opened (70.3±24.5°) than in the control group (49.5±19.5°) (p<0.05). The maximum (extremum) in depolarization (DIAM max 30, 40) and repolarization (RIAM max 35) of body surface isoarea and isointegral (RIIM max) maps was less positive (p<0.001) and the minimum (DIAM min 40) was less negative than in the controls (p<0.05) even in the period free of a panic attack. Our results showed the changes in the heart electric field parameters occurred in PD patients when compared to the control group., K. Pišvejcová, I. Paclt, J. Slavíček, O. Kittnar, A. Dohnalová, E. Kitzlerová., and Obsahuje bibliografii
Tricyclic antidepressant drugs dosulepine (TCA), serotonin selective reuptake inhibitor (SSRI) and prophylactic agent with antidepressant effect lithium carbonicum (Li) have different cardiovascular side-effects. We compared them in the prophylactic therapy of periodic affective disorder in remission with TCA, SSRI and Li. Our previous papers confirmed the most prominent effects of heart electric field parameters in TCA patients (Slavíček et al. 1998). In the present work we studied for the first time the dose-dependent changes of ECG, body surface potential maps (BSPM - parameter DIAM 30, 40) in 43 TCA dosulepine, 40 SSRI citalopram and 30 Li outpatients (Hamilton scale: HAMD£10; age 40±5 years; treated for depressive disorders or bipolar disorders). The daily doses of dosulepine were 50-250 mg, citalopram 20-80 mg, Li plasma levels 0.66±0.08 meq/l. The electrocardiogram (ECG), vectorcardiogram (VCG), and BSPM were measured and calculated by the Cardiag 112.1 diagnostic system. The results have shown a relation between the dose of dosulepine and extremum (maximum and minimum) of depolarization isoarea map in dosulepine, but not in citalopram patients. The repolarization BSPM changes were most pronounced in SSRI patients. Lithium in long-term prophylaxy (1-22 years) caused only minimal ECG BSPM changes. The present results correspond with our previous observations., I. Paclt, J. Slavíček, A. Dohnalová, E. Kitzlerová, K. Pišvejcová., and Obsahuje bibliografii
The aim of this study was to analyze the ECG time intervals in the course of the development of chronic anthracycline cardiomyopathy in rabbits. Furthermore, this approach was employed to study the effects of a model cardioprotective drug (dexrazoxane) and two novel iron chelating compounds - salicylaldehyde isonicotinoyl hydrazone (SIH) and pyridoxal 2-chlorobenzoyl hydrazone (o-108). Repeated daunorubicin administration induced a significant and progressive prolongation of the QRS complex commencing with the 8th week of administration. At the end of the study, we identified a significant correlation between QRS duration and the contractility index dP/dtmax (r=-0.81; P<0.001) as well as with the plasma concentrations of cardiac troponin T (r=0.78; P<0.001). In contrast, no alterations in ECG time intervals were revealed in the groups co-treated with either dexrazoxane or both novel cardioprotective drugs (SIH, o-108). Hence, in this study, the QRS duration is for the first time shown as a parameter suitable for the non-invasive evaluation of the anthracycline cardiotoxicity and cardioprotective effects of both well established and investigated drugs. Moreover, our results strongly suggest that novel iron chelators (SIH and o-108) merit further study as promising cardioprotective drugs against anthracycline cardiotoxicity., A. Potáčová, M. Adamcová, H. Čajnáková, L. Hrbatová, M. Štěrba, O. Popelová, T. Šimůnek, P. Poňka, V. Geršl., and Obsahuje bibliografii a bibliografické odkazy
Computer-aided ECG analysis is very important for early diagnosis of heart diseases. Automated ECG analysis integrated with experts' opinions may provide more accurate and reliable results for detection of arrhythmia. In this study, a novel genetic algorithm-neural network (GA-NN) approach is proposed as a classifier, and compared with other classification methods. The GA-NN approach was shown to perform better than alternative approaches (e.g. k-nn, SVM, naive Bayes, Bayesian networks) on the UCI Arrythmia and the novel TEPAS ECG datasets, where the GA resulted in a feature reduction of 95%. Based on the selected features, several rule extraction algorithms are applied to allow the interpretation of the classification results by the experts. In this application, the accuracy and interpretability of results are more important than processing speed. The results show that neural network based approaches benefit greatly from dimensionality reduction, and by employing GA, we can train the NN reliably.
Heart disease diagnosis is an important non-invasive technique. Therefore, there exists an effort to increase the accuracy of arrhythmia classification based on ECG signals. In this work, we present a novel approach of heart arrhythmia detection. The model consists of two parts. The first part extracts important features from raw ECG signal using Auto-Encoder Neural Network. Extracted features obtained by Auto-Encoder represent an input for the second part of the model, the Gradient Boosting and Feedforward Neural Network classifiers. For comparison purposes, we evaluated our approach by using MIT-BIH ECG database and also following recommendations of the Association for the Advancement of Medical Instrumentation (AAMI) for ECG class labeling. We divided our experiment into two scenarios. The first scenario represents the classification task for the patient-adapted paradigm and the second one was dedicated to the inter-patient paradigm. We compared the measured results to the state-of-the-art methods and it shows that our method outperforms the state-of-the art methods in the Ventricular Ectopic (VEB) class for both paradigms and Supraventricular Ectopic (SVEB) class in the inter-patient paradigm.
Antidepressants, particularly tricyclic (TCA) antidepressants, may have cardiotoxic effects, such as cardiac arrhythmias, especially in patients with cardiovascular diseases. For most of TCA, no exact correlation between dosage, plasma levels and changes of ECG parameters of standard ECG has been found. So far, no relationship between dosulepine plasma levels and heart electric field parameters has been studied. We selected 18 female outpatient subjects diagnosed with recurrent depressive disorders, currently in the remission phase (HAMD < 10), without any cardiovascular disease. Patients were treated with daily dosulepine doses of 25-125 mg for 4-8 weeks. 30 heart electric field parameters were analyzed by Cardiag 128.1 diagnostic system as part of BSPM (Body Surface Potential Mapping). Acquired data were correlated with dosulepine plasma levels by means of Spearmanís rank order correlation test. Four ECG parameters showed a significant correlation with dosulepine plasma levels: QRS axis deviation in frontal plane (p=0.01), DIAM 40 max (p < 0.05), QRS-STT angle in transversal and left sagittal plane (p < 0.05). The demonstrated changes confirmed dosulepine influence on the early myocardium depolarization phase and the correlation of this effect with dosulepine dose (its plasma concentration). The higher the dosulepine level, the more marked are the changes of the QRS-STT angle in transversal and sagittal planes and the changes in the QRS axis deviation in frontal plane. Repeatedly recorded changes in the heart electric field were dosulepine-specific and dependent on its plasma levels., E. Kitzlerová, I. Paclt, J. Slavíček, K. Pišvejcová, M. Anders, A. Dohnalová, M. Balíková., and Obsahuje bibliografii
Metabolic acidosis could occur due to either endogenousm acids accumulation or bicarbonate loss from the gastrointestinal tract or commonly from the kidney. This study aimed to investigatethe possible underlying mechanism(s) of chronic acidosis-inducedcardiac contractile and electrical
changes in rats. Twenty four adult Wistar rats, of both sexes, were randomly divided into control group and chronic metabolic acidosis group, which received orally 0.28 M NH4Cl in the drinking water for 2 weeks. At
the end of experimental period, systolic and diastolic blood pressure values
were measured. On the day of sacrifice, rats were an esthetized by i.p. pentobarbitone (40mg/kg b.w.), transthoracic echocardiography and ECG
were performed. Blood samples were obtained from abdominal aorta for complete blood count and determination of pH, bicarbonate, chloride,
sodium, potassium, troponin I, CK-MB, IL-6, renin and aldosterone levels.
Hearts from both groups were studied for cardiac tissue IL-6 and
aldosterone in addition to histopathological examination.
Compared to control group, chronic metabolic acidosis groupshowed anemia, significant systolic and diastolic hypotension accompanied by significant reduction of ejection fraction and fraction of shortening, significant bradycardia, prolonged QTc interval and higher widened T wave
as well as significantly elevated plasma levels of renin, aldosterone, troponin
I, CK-MB and IL-6, and cardiac tissue aldosterone and IL-6. The left
ventricular wall of the acidosis group showed degenerated myocytes
with fibrosis and apoptosis. Thus, chronic metabolic acidosis induced negative inotropic and chronotropic effects and cardiomyopathy, possibly by elevated aldosterone and IL-6 levels released from the cardiac tissue.
Mew possibilities of quantitative evaluation of body surface potential mapping were studied in 78 patients with ischaemic heart disease. Integral maps of the Q wave, QRS and ST-T intervals were plotted and isochronous maps of ventricular activation time and maps of asynchronous potential minima of the Q wave were determined. Minimum and maximum potential values and their time relations were evaluated in the maps. Left ventricular contraction abnormality detected by left ventricular angiography was determined by a point score and expressed as an index of asynergy. The number of coronary artery branches with significant narrowing was assessed and the extent of coronary artery damage was evaluated by an arbitrary defined index. Using quantitative parameters from the maps, multiple stepwise linear regression was performed. The relationship between map parameters and index of asynergy corresponded to multiple correlation coefficient r=0.69 (p=0.01) in the whole group of patients. In the group of patients with left ventricular contraction abnormality the relationship between these parameters was found to be r=0.87 (p=0.01). The relationship between map parameters and the number of coronary artery branches with significant stenosis was r=0.60 (p=0.01) in the group of patients with positive coronary angiography. In the same group of patients the relationship between map parameters and the index evaluating coronary artery damage was equal to r=0.63 (p=0.01). The data obtained from body surface integral maps enable to quantify cardiac ischaemic damage.
a1_Diabetes mellitus is not just a simple metabolic disorder, however, it is considered to be a cardiovascular disease of a metabolic origin. This is apparent especially when speaking about type 2 diabetes (DM II). The objective of our study was to determine whether a comprehensive spa treatment (procedures and drinking cure) may affect the level of the sympathetic tone of patients suffering from DM II. As an indicator of the sympathetic tone, selected electrocardiographic parameters derived from the heart rate variability and microwave alternans were chosen. There were 96 patients enrolled in our study: 38 patients with poorly controlled DM II and two control groups: 9 patients with compensated DM II and 49 patients, average age without diabetes or other disorders of the glucose metabolism. All received an identical spa treatment and continued their medical therapy. The electrophysiological examination of patients was performed before and after a three-week spa treatment using the KARDiVAR system. Parameters derived from the analysis of heart rate variability (HRV), microvolt T-wave alternans, and microvolt R-wave alternans were analyzed in order to evaluate the tones of the autonomic nervous system (ANS). The control group showed a slight increase of parameter the index of activity of regulatory systems (IRSA) (4.4±1.3 vs. 3.8±1.4; p=0.006) after the spa treatment, while increased heart rate (80.9±11.0 vs. 74.6±9.6; p=0.028), reduced index of centralization (IC) (1.3±0.6 vs. 2.9±1.4; p=0.027) and reduced index of myocardium (IM) (9.9±7.4 vs. 18.0±6.3; p=0.041) were found in patients with a compensated DM II. Patients with a poorly compensated DM II showed a decreased IM (10.9±8.6 vs. 16.9±5.2; p=0.001) and also a reduced IRSA (4.1±3.5 vs. 6.3±1.9; p=0.001)., a2_The results proved favorable changes in ANS cardiovascular control of patients with DM II after a spa treatment, especially in terms of reducing the sympathoadrenal system activity (decreased IRSA), improving electrical stability of the myocardium and increasing centrally controlled heart rate variability without overloading the cardiovascular system (drop of IM)., E. Fialová, O. Kittnar., and Obsahuje bibliografii
In the present study, we investigated the effects of vagus nerve stimulation (VNS), a proposed treatment for patients with intractable epilepsy, on cardiac rhythm following seizures induced by pentylenetetrazole (PTZ) in Wistar rats. After a baselinerecording of electroencephalogram (EEG), electrocardiogram (ECG) and blood pressure (BP), rats in the first group received a single convulsive dose of PTZ (70 mg/kg) (Group 1). In the other
two groups, the Wistar rats were implanted with a cuff electrode on the left cervical vagus nerve. One day after surgery, rats in the second group were treated with VNS (Group 2), whereas rats in the third group were connected to the stimulator but did not receive VNS (Group 3). Ten minutes after VNS onset, 70 mg/kg dose of PTZ was injected. EEG, ECG and BP were continuously recorded during post-injection period. Seizure severity was scored behaviorally. Then, baseline, ictal and postictal periods were analyzed for cardiac rhythms, seizure severity and blood pressure variability. PTZ treatment induced tonic-clonic seizure activity in all animals of Group 1 and Group 3. In these groups a marked increase of mean arterial blood pressure (MABP) but a significant decrease in heart rate and PP interval fluctuations was observed at postictal period. However, in the VNS-treated group the seizure scores and cardiac parameter returned to the baseline level. Present results emphasize that VNS effectively reduces seizure severity and suppress the seizure-induced cardiac rhythm changes.