In this report, we dealt with ventricular activation abnormalities in 30 patients with previous non-Q myocardial infarction (Mi) by means of the CARD1AG 128.1 device, which enables analysis of ECGs, VCGs and body surface potential maps. The diagnosis was verified by left ventriculography, echocardiography and perfusion scintigraphy. Twenty-nine healthy subjects served as the control group. Morphological findings confirmed the presence of a significant subgroup with serious left ventricular asynergy. Seven electrocardiological variables, which significantly differed from control values, disclosed that non-Q Ml is responsible for localized activation time prolongation, and that inferoposterior scars tend to delay the entire activation of ventricles, and to cause disturbances of the terminal depolarization phase together with a decrease in voltage production during QRS. Lesions of the anterior wall and the apicomesial part of the inferoposterior wall affect the distribution of the Q wave more often than the posterior basal ones. The probability of such abnormalities increases with the degree of asynergy. Some VCG criteria increase the sensitivity of electrocardiological analysis. These parameters will be used for evaluating the diagnostic value of electrocardiological analysis in the chronic non-Q Ml. Non-Q myocardial infarctions represent a heterogeneous group of infarctions from both electrophysiological and morphological aspects.
The departure index area of departure maps before and after the PTCA procedure was evaluated in 10 randomly chosen patients with clinically significant ischaemic heart disease. The body surface mapping system CARD1AG 128.1, (ZPA Prague-£akovice) was used. The departure index was calculated using Kubota's formula. The departure indexes of the ST-T interval and departure maps of 36 ms and 80 ms intervals from the J point were followed. A decrease of the departure index area was considered as a sign of successful PTCA. A correct classification was made in 6 patients out of 9 (66 %) with successfully performed PTCA. The identification of one patient with unsuccessful PTCA procedure was also correctly determined. The overall correlation between the effect of PTCA and the departure index area change was 7 out of 10 (70 %). The authors consider this method to be a useful non-invasive method for identifying of successful or unsuccessful PTCA in patients with coronary artery disease.
A method using body surface potential maps for assessment of myocardium lesions with changed repolarization is presented and suitable mapping system is introduced. Differences between normal and altered QRST integral maps together with torso volume conductor model were used to determine the equivalent dipole representing the lesion. Performance of the method was studied on simulated data. Changed repolarization was modeled by shortening of myocyte action potentials in regions typical for stenosis of the main coronary arteries. The equivalent dipole estimated the positions of small lesions with a mean error of 9±4 mm (17±14 mm for larger transmural lesions). The subepicardial or subendocardial character of the lesions was reflected in the dipole orientation. Tests of the method on patients after myocardial infarction that underwent coronary intervention on a single coronary vessel showed that in 7 of 8 successfully treated patients the dipole position matched well with the treated vessel. A small dipole moment in another patient indicated unsuccessful treatment. The method was implemented in a new 128-channel mapping system. Its active electrodes, battery powered measuring unit and optical computer interface help to minimize noise in ECG and guarantee patient´s safety. The results suggest that the method and mapping system offer useful tools for noninvasive identification of local repolarization changes in the myocardium., M. Tyšler, P. Kneppo, M. Turzová, J. Švehlíková, S. Karas, E. Hebláková, K. Hána, S. Filipová., and Obsahuje bibliografii
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.
The aim of our work was to study the opposite polarity of the PQ segment to the P wave body surface potential maps in different groups of patients. We constructed isointegral maps (IIM) in 26 healthy controls (C), 16 hypertensives (HT), 26 patients with arterial hypertension and left ventricular hypertrophy (LVH) and 15 patients with myocardial infarction (MI). We analyzed values and positions of map extrema and compared the polarity of maps using the correlation coefficien t. The IIM P maxima appeared mainly over the precordium, the minima mainly in the right subclavicular area. The highest ma xima were in the MI group, being significantly higher than in the HT and LVH groups. No differences concerning any values of other extrema were significant. The IIM PQ maxima were distributed over the upper half of the chest; the minima mainly over the middle sternum. A statistically significant opposite polarity between the IIM P and IIM PQ was found in 80 % of cases. The opposite polarity of the P wave and the PQ segment was proved in isointegral body surface maps. The extrema occurr ed in areas not examined by the standard chest leads. This has to be considered for diagnostic purposes., K. Kozlíková ... [et al.]., and Obsahuje bibliografii a bibliografické odkazy