ST‐Segment Analysis in Ambulatory ECG (AECG or Holter) Monitoring in Patients with Coronary Artery Disease: Clinical Significance and Analytic Techniques

Stone, Peter H.

doi:10.1111/j.1542-474x.2005.10203.x

Cited by 12 publications

(8 citation statements)

References 59 publications

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“…Additionally, silent ischemia may be detected with the use of AECG devices such as the Holter monitor. These AECG monitors can detect ischemia with as few as 2 leads and are typically worn for 24 to 48 h with recordings analyzed using various computer algorithms (7). STsegment changes during AECG monitoring can be nonspecific, and false positives do occur; thus, strict criteria are necessary to support a diagnosis of silent ischemia.…”

Section: Definition Diagnosis and Mechanismmentioning

confidence: 99%

Silent Ischemia

Conti

Bavry

Petersen

2012

Journal of the American College of Cardiology

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Myocardial ischemia can occur without overt symptoms. In fact, asymptomatic (or silent) ST-segment depression during ambulatory electrocardiogram monitoring occurs more often than symptomatic ST-segment depression in patients with coronary artery disease. Initial studies documented that silent ischemia provided independent prediction of adverse outcomes in patients with known and unknown coronary artery disease. The ACIP (Asymptomatic Cardiac Ischemia Pilot Study) enrolled patients in the 1990s and found that revascularization was better than medical therapy in reducing silent ischemic episodes and possibly cardiovascular (CV) events. However, the more recent COURAGE (Clinical Outcomes Utilizing Revascularization and Aggressive Drug Evaluation) trial found similar CV event rates between patients treated with optimal medical therapy alone and those treated with optimal medical therapy plus percutaneous revascularization. Therefore, in the current era, medical therapy appears to be as effective as revascularization in suppressing symptomatic ischemia and preventing CV events. COURAGE was not designed to evaluate changes in the frequency of silent ischemia. Therefore, silent ischemia may persist despite current-era treatment and might still identify patients with increased risk of CV events. Also, silent ischemia is likely to occur frequently in heart transplant patients with denervated hearts and coronary allograft vasculopathy, and future study aimed at improving the management of silent ischemia in this population is warranted. Additionally, future research is warranted to study the effect of newer medical therapies such as ranolazine or selected use of revascularization (for example, guided by fractional flow reserve) in those patients with persistent silent ischemia despite optimal current-era medical therapy.

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Section: Definition Diagnosis and Mechanismmentioning

confidence: 99%

Silent Ischemia

Conti

Bavry

Petersen

2012

Journal of the American College of Cardiology

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“…The second stage of the pre-processing is the moving average filter with a window length of 7 samples. The moving average filter is used to decrease the effect of high frequency noise and to smooth the ECG which can be effective for further processing, and in ST-T wave start and endpoint detection [5,23,24]. Figure 3 shows the input and the output of the preprocessing stage; where the first row shows the raw ECG signal before applying pre-processing; the second row shows the ECG signal after applying the pre-processing techniques and finally, the third row shows the filtered ECG signal after applying the smoothing technique.…”

Section: Morphological Analysismentioning

confidence: 99%

Morphological Based Method for Automated Extraction and Classification of ECG ST-T Wave

Alqudah¹,

Alqudah²

2021

I2M

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The wave starting from the beginning of the S wave until the end of the T wave is known as ST-T. ST-T wave extraction and classification is a very important technique in the diagnosis of myocardial ischemia. The myocardial ischemia which is also called cardiac ischemia can cause damage to the heart muscle. A sudden, severe blockage of a coronary artery may lead to a heart attack or other severe complications, and may also cause serious abnormal heart rhythms which will be reflected in the electrocardiogram trace. This paper aims to automate the real-time technique detection of ST-T waves that help in the diagnosis of myocardial ischemia and to classify the patient state. The proposed method uses the ECG wave morphological features that have been extracted using the detrended cumulative area, which is used to detect the ST-T wave. The proposed technique was tested and validated and it revealed promising results. The proposed method scored a sensitivity of 90.13% for K-mean Clustering and 96.3% for the SVM classifier for the ST interval detection. The method was tested on the European ST-T Database.

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“…Ambulatory ECG is generally performed in two clinical settings to assess ischemic risk: as outpatient evaluation of stable CAD patients and as inpatient evaluation of patients with an acute coronary syndrome who need more prolonged recordings [9]. Meanwhile, a strong consideration should be given to the addition of echocardiographic or nuclear imaging studies on patients with baseline ECG abnormalities (Pre-excitation syndrome -Wolf Parkinson White, N1 mm of resting ST depression, complete left bundle branch block), patients taking digoxin, women, and those who have undergone prior coronary revascularization procedures.…”

Section: Diagnostic Considerationsmentioning

confidence: 99%