Medizinische Universität Graz - Research portal
Selected Publication:
Mady, S.
Diagnose der Herzinsuffizienz während des Routine-EKGs durch das CombynTM EKG
Humanmedizin; [ Diplomarbeit ] Medizinische Universität Graz; 2023. pp. 74
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- Authors Med Uni Graz:
- Advisor:
- Fruhwald Friedrich
- Skrabal Falko
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- Abstract:
- Objective: The objective of this thesis was to investigate the potential of detecting HF during routine-ECG using impedance plethysmography and impedance spectroscopy integrated into a 12-lead ECG by comparing the results with gold-standards e.g. serum NT-proBNP levels and the NYHA functional classification. Background: Despite our best efforts HF still represents a major cause of morbidity and mortality all around the globe. Its timely diagnosis and accurate grading is crucial for providing adequate medical therapy, improving quality of life and preventing chronification of disease. Material and methods: We obtained measurements of 827 individuals with the CombynTM ECG at the institute of cardiovascular medicine, Mariatrosterstraße 67 and the outpatient department of cardiology at the state hospital Graz. An electrocardiogram (ECG) was obtained and segmental impedance measurements were performed at 5, 40 and 400 kHz. Additionally, the patients were asked to grade their degree of functional impairment by using the NYHA classification and blood samples were drawn to measure serum NT-proBNP levels. All data were exported to Microsoft Excel and statistical analysis was performed using the statistical software program SPSS. Results: Comparison of serum NT-proBNP levels with Heart function (estimated degree of HF determined by the CombynTM ECG) showed a significant association between all the results (p<0.001) with AUCs of 0.85, 0.63, 0.56 and 0.86 for NT-proBNP classes 1-4, respectively. Additionally, comparison of Heart function by CombynTM ECG with the NYHA classification also showed significant associations with a p-value<0.001 and AUCs of 0.74, 0.4, 0.77 and 0.88 for NYHA classes I-IV. Comparison of NT-proBNP classes and NYHA classification revealed significant association (p-value<0.001), except when comparing group III with group IV, with AUCs of 0.81, 0.65, 0.82 and 0.94 for NYHA classes I-IV. Mean NT-proBNP levels in NYHA group I were 286±470.4 pg/mL (n=400), in group II 1036.7±3096.1 (n=222), in group III 2190.1±5424.3 pg/mL (n=109) and in group IV 5318.5±4765.8 pg/mL. Heart function by CombynTM ECG also showed significant association with the ECF/ICF ratio in lower extremities (p-value<0.001) with AUCs of 0.87, 0.6, 0.67 and 0.89 for Heart function classes 1-4. Comparison of blood acceleration over the thorax and over the left leg with Heart function mostly showed signification associations (p-values<0.001). AUCs were 0.64, 0.68, 0.82 and 0.82 for Heart function classes 1-4 when compared with blood acceleration over the thorax and 0.64, 0.55, 0.64 and 0.74 when compared with blood acceleration over the left leg, respectively. Conclusion: The CombynTM ECG represents an accurate and novel diagnostic tool for the detection and classification of HF during a routine 12-channel ECG. Especially in individuals with low or very high NT-proBNP levels the device performs well appropriately estimating the degree of HF. Additionally, it enables cardiovascular phenotyping by measurement of amplitudes of blood accelerations over the thorax and legs, in conjunction to beat-to-beat segmental volume changes in the extremities, which have been shown to correlate with the severity of HF. We observed a broad range of NT-proBNP values among all NYHA functional classes and therefore conclude with a high degree of certainty that most HF patients underestimate their functional impairment.