scholarly journals A Deep-learning Algorithm With the Real World Validation for Detecting Acute Myocardial Infarction

2020 ◽  
Author(s):  
Wen-Cheng Liu ◽  
Chin-Sheng Lin ◽  
Chien-Sung Tsai ◽  
Tien-Ping Tsao ◽  
Cheng-Chung Cheng ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Sensitivity And Specificity ◽  
Real World ◽  
Troponin I ◽  
Learning Algorithm ◽  
Characteristic Curve ◽  
Support Tool ◽  
The Real ◽  
St Segment ◽  
Better Than

Abstract BackgroundThe initial detection and diagnosis of ST-segment or non-ST-segment elevation myocardial infarction (STEMI or NSTEMI) definitely rely on a 12-lead electrocardiogram (ECG). Delay or misdiagnosis is not unusual by subjective interpretation. Our aim is to develop a DLM as a diagnostic support tool to detect MI based on a 12-lead ECG and to evaluate the performance of this model.MethodsThis study included 1,051 ECGs from 737 coronary angiography (CAG)-validated STEMI patients, 697 ECGs from 287 CAG-validated NSTEMI patients, and 140,336 not-MI ECGs from 76,775 patients at emergency departments. DLM was trained and validated for the performance using 80% and 20% of the ECGs, respectively. A human-machine competition was conducted. The area under the receiver operating characteristic curve (AUC), sensitivity, and specificity were used to evaluate the performance of DLM and experts. STEMI versus not-STEMI, and MI versus not-MI were evaluated by DLM.ResultsThe AUCs of DLM for identifying STEMI and MI were 0.976 and 0.944 in the human-machine competition, respectively, which were significantly better than those of our best clinicians. In the real world setting, DLM presented with AUC of 0.995/0.916 with corresponding sensitivities of 96.9%/77.0%, and specificities of 96.2%/92.9% in the identification of STEMI and MI, respectively. Furthermore, DLM demonstrated sufficient diagnostic capacity for STEMI without the aid of troponin I (TnI) (AUC= 0.996) with corresponding sensitivity and specificity of 98.4% and 96.9%. The AUC of combined DLM and the first recorded TnI for the detection of NSTEMI were increased to 0.978 with corresponding sensitivity and specificity of 91.6% and 96.7%, which was better than that of DLM (0.877) or TnI (0.949) alone. ConclusionsDLM may serve as a diagnostic decision tool to assist intensive or emergency medical system-based networks and frontline physicians in identifying STEMI and NSTEMI in a timely and precise manner to prevent delay or misdiagnosis, and thereby to facilitate subsequent reperfusion therapy.

scholarly journals No additional value of conventional and high-sensitivity cardiac troponin over clinical scoring systems in the differential diagnosis of type 1 vs. type 2 myocardial infarction

2018 ◽  
Vol 56 (5) ◽  
pp. 702-709 ◽  
Author(s):  
Luciano Consuegra-Sánchez ◽  
Juan José Martínez-Díaz ◽  
Luis García de Guadiana-Romualdo ◽  
Samantha Wasniewski ◽  
Patricia Esteban-Torrella ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Cardiac Troponin ◽  
Troponin I ◽  
Troponin T ◽  
Characteristic Curve ◽  
High Sensitivity ◽  
St Segment ◽  
Clinical Scoring

AbstractBackground:The distinction of type 1 and type 2 myocardial infarction (MI) is of major clinical importance. Our aim was to evaluate the diagnostic ability of absolute and relative conventional cardiac troponin I (cTnI) and high-sensitivity cardiac troponin T (hs-cTnT) in the distinction between type 1 and type 2 MI in patients presenting at the emergency department with non-ST-segment elevation acute chest pain within the first 12 h.Methods:We measured cTnI (Dimension Vista) and hs-cTnT (Cobas e601) concentrations at presentation and after 4 h in 200 patients presenting with suspected acute MI. The final diagnosis, based on standard criteria, was adjudicated by two independent cardiologists.Results:One hundred and twenty-five patients (62.5%)were classified as type 1 MI and 75 (37.5%) were type 2 MI. In a multivariable setting, age (relative risk [RR]=1.43, p=0.040), male gender (RR=2.22, p=0.040), T-wave inversion (RR=8.51, p<0.001), ST-segment depression (RR=8.71, p<0.001) and absolute delta hs-cTnT (RR=2.10, p=0.022) were independently associated with type 1 MI. In a receiver operating characteristic curve analysis, the discriminatory power of absolute delta cTnI and hs-cTnT was significantly higher compared to relative c-TnI and hs-cTnT changes. The additive information provided by cTnI and hs-cTnT over and above the information provided by the “clinical” model was only marginal.Conclusions:The diagnostic information provided by serial measurements of conventional or hs-cTnT is not better than that yielded by a simple clinical scoring model. Absolute changes are more informative than relative troponin changes.

The diagnostic and prognostic value of right ventricle systolic and diastolic function in inferior myocardial infarction patients

2018 ◽  
Vol 2 (1) ◽  
pp. 4
Author(s):  
Niniek Purwaningtyas
Keyword(s):  
Myocardial Infarction ◽  
Diastolic Function ◽  
Diagnostic Criteria ◽  
Sensitivity And Specificity ◽  
Systolic Function ◽  
Inferior Myocardial Infarction ◽  
Diagnostic Significance ◽  
St Segment Elevation ◽  
St Segment ◽  
Systolic And Diastolic Function

Background: Inferior myocardial infarction (MI) with right ventricular (RV) involvement will increase mortality and morbidity. Data of systolic and diastolic RV function in inferior ST-segment elevation MI (STEMI) are useful to predict the RV involvement.  Aims: To evaluate the prognostic and diagnostic significance of RV systolic and diastolic function compared to RVMI diagnostic criteria by electrocardiography in inferior MI patients.Methods: Consecutive patients with first, acute, inferior STEMI were prospectively assessed. The RVMI was defined as an ST-segment elevation ≥ 0.1 mV in lead V4R. Echocardiography was performed within 24 hours of the inferior STEMI symptoms. We assessed the RVMI diagnostic criteria in inferior MI patients using echocardiography.Results: Out of 31 patients (mean age 56.39 ± 9.02 years), RVMI by electrocardiography and echocardiography was found in 18 (37%). Moreover, multivariate analysis showed that two variables — RV systolic and diastolic function, were independent predictors of RVMI in inferior MI patients. Sensitivity and specificity of the RV systolic function were 94.4% and 69.2%, respectively, while RV diastolic functions were 44% and 76.9%, respectively.Conclusion: RV systolic function predict RVMI with relatively high sensitivity and specificity. RV diastolic function predicts RVMI with relatively low sensitivity but with high specificity.

Systemic Immune-Inflammation Index May Predict the Development of Contrast-Induced Nephropathy in Patients With ST-Segment Elevation Myocardial Infarction

Angiology ◽  
2021 ◽  
pp. 000331972110300
Author(s):  
Ali Bağcı ◽  
Fatih Aksoy ◽  
Hasan Aydin Baş
Keyword(s):  
Myocardial Infarction ◽  
Characteristic Curve ◽  
Contrast Induced Nephropathy ◽  
Predictive Capacity ◽  
St Segment Elevation ◽  
Neutrophil Lymphocyte Ratio ◽  
Lymphocyte Ratio ◽  
Segment Elevation Myocardial Infarction ◽  
St Segment ◽  
Immune Inflammation

The aim of this study was to investigate the predictive capacity of a systemic immune-inflammation index (SII) in the detection of contrast-induced nephropathy (CIN) following ST-segment elevation myocardial infarction (STEMI). A total of 477 STEMI patients were enrolled in the study. The patients were divided into 2 groups according to CIN development. A cutoff point of 5.91 for logarithm-transformed SII was identified with 73.0% sensitivity and 57.5% specificity to predict CIN following STEMI. According to a pairwise analysis of receiver operating characteristic curve analysis, the predictive power of SII in detecting CIN following STEMI was similar to that of high-sensitivity C-reactive protein and better than the neutrophil/lymphocyte ratio or platelet/lymphocyte ratio. As a result, SII can be used as one of the independent predictors of CIN after STEMI.

scholarly journals P3680Treatment administrated to patients with myocardial infarction with non-obstructive coronary arteries in the real world and its impact on prognosis

2017 ◽  
Vol 38 (suppl_1) ◽  
Author(s):  
J. Lopez Pais ◽  
B. Izquierdo Coronel ◽  
D. Galan Gil ◽  
M.J. Espinosa Pascual ◽  
M. Lopez Pais ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Coronary Arteries ◽  
Real World ◽  
The Real

scholarly journals THE DIAGNOSTIC AND PROGNOSTIC VALUE OF RIGHT VENTRICLE SYSTOLIC AND DIASTOLIC FUNCTION IN INFERIOR MYOCARDIAL INFARCTION

Biomedika ◽  
2018 ◽  
Vol 10 (1) ◽  
Author(s):  
Niniek Purwaningtyas
Keyword(s):  
Myocardial Infarction ◽  
Diastolic Function ◽  
Sensitivity And Specificity ◽  
Systolic Function ◽  
Tissue Doppler ◽  
Doppler Imaging ◽  
Inferior Myocardial Infarction ◽  
St Segment Elevation ◽  
St Segment ◽  
Systolic And Diastolic Function

Right ventricular (RV) involvement increases mortality and morbidity in inferior myocardial infarction (MI). There are sparse data on the usefulness of pulsed tissue Doppler imaging (TDI) in the diagnosis of RV dysfunction in ST segment elevation MI (STEMI). This study evaluate the diagnostic and prognostic significance of RV systolic and diastolic function compared to classical electrocardiographic RVMI diagnostic criteria in this group of patients. Consecutive patients with first, acute, inferior STEMI were prospectively assessed. The RVMI was defined as an ST-segment elevation ≥ 0.1 mV in lead V4R. Echocardiography with TDI was performed within24 h of the onset of symptoms. Out of 31 patients (mean age 56.39 ± 9.02 years), RVMI was found in 18 (37%). Multivariate analysis showed that two variables—RV systolic and diastolic function, were independent predictors of in-hospital prognosis. Sensitivity and specificity the RV systolic function were 94,4% and 69,2%, respectively. While RV diastolic function were 44% and 76,9%, respectively. RV systolic function predict ECG diagnosis of RVMI with relatively high sensitivity and specificity. RV diastolic function predict ECG diagnosis of RVMI with relatively low sensitivity but with high specificity.Keywords: tissue Doppler imaging, RV myocardial infarction, inferior myocardial infarction

scholarly journals Loeffler’s endocarditis and possible coronary spasm secondary to eosinophilic coronary periarteritis with ECG change mimicking acute non-ST-segment elevation myocardial infarction: A case report

2020 ◽  
Author(s):  
Fan-xin Kong ◽  
Meng Li ◽  
Chun-Yan Ma ◽  
Ping-ping Meng ◽  
Yong-huai Wang ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Differential Diagnosis ◽  
Coronary Artery ◽  
Troponin I ◽  
Hypereosinophilic Syndrome ◽  
Coronary Spasm ◽  
St Segment Elevation ◽  
Coronary Syndrome ◽  
Segment Elevation Myocardial Infarction ◽  
St Segment

Abstract Background Loeffler’s endocarditis is an inflammatory cardiac condition of hypereosinophilic syndrome which rarely involves coronary artery. When coronary artery is involved, known as eosinophilic coronary periarteritis, the clinical presentation, electrocardiographic changes and troponin level are extremely nonspecific and may mimic acute coronary syndrome. It is very important to make differential diagnosis for ECPA in order to avoid the unnecessary further invasive coronary angiography. Case presentation We report a case with chest pain, ST-segment depression in electrocardiogram and increased troponin-I mimicking acute non-ST-segment elevation myocardial infarction. However, quick echocardiography showed endomyocardial thickening with normal regional wall motion, which corresponded to the characteristics of Loeffler’s endocarditis. Emergent blood analysis showed marked increase in eosinophils and computed tomography angiography found no significant stenosis of coronary artery. Manifestations of magnetic resonance imaging consisted with findings of echocardiography. Finally, the patient was diagnosed as Loeffler’s endocarditis and possible coronary spasm secondary to eosinophilic coronary periarteritis. Conclusion This case exhibits the crucial use of quick transthoracic echocardiography and the emergent hematological examination for differential diagnosis in such scenarios as often if electrocardiogram change mimicking myocardial infarction.

Continuous 12-lead ST-segment recovery predicts outcome in acute myocardial infarction better than “snapshot” angiograms of TIMI flow

1998 ◽  
Vol 30 ◽  
pp. 167
Author(s):  
Mitchell W. Krucoff ◽  
Cindy L. Green ◽  
Anatoly Langer ◽  
Peter Klootwijk ◽  
Kathleen M. Trollinger ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Timi Flow ◽  
St Segment ◽  
Better Than

Abstract 15549: Esophagopleural Fistula Associated Regional Pericarditis Mimicking Inferior Myocardial Infarction

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Iain J Thompson ◽  
Jorge Fernandez ◽  
Hiroko Beck
Keyword(s):  
Myocardial Infarction ◽  
Troponin I ◽  
Normal Sinus Rhythm ◽  
Fluid Collection ◽  
Definitive Treatment ◽  
Normal Sinus ◽  
St Segment ◽  
Left Pleural Effusion ◽  
Patient Reported ◽  
Ventricular Response

Introduction: Regional pericarditis is a rare clinical entity that may mimic myocardial infarction (MI) and occurs most frequently after myocardial injury. We describe a unique case of regional pericarditis secondary to esophagopleural fistula (EPF) in a patient presenting to the catheterization lab for suspected ST-segment MI. Results: A 75-year-old man with non-small cell lung cancer presented with hypotension, weakness, dyspnea, and chest pain. The initial electrocardiogram (ECG: Figure 1) revealed normal sinus rhythm with inferior lead ST- segment elevations, a chest X-ray showed a left pleural effusion, and troponin I was <0.01 ng/ml. The patient underwent emergent coronary angiography showing no evidence of obstructive coronary disease. Subsequently, the patient reported palpitations and new onset dysphagia. An ECG revealed atrial fibrillation with rapid ventricular response. A barium esophagram (Figure 2) was performed to evaluate the dysphagia and revealed the presence of an EPF with fluid collection adjacent to the inferior heart border. The patient was treated for pericarditis with colchicine and definitive treatment with esophageal stenting was performed. Conclusions: We describe a case of regional pericarditis secondary to EPF masquerading as inferior MI. Given the prevalence and severity of MI, remaining cognizant of its mimickers such as regional pericarditis is important in clinical practice. This case report highlights the utility of maintaining a broad differential and performing a thorough history and physical both at initial presentation and when new information challenges the initial diagnosis.

Sign in / Sign up

Export Citation Format

Share Document