Summary
The computer analysis of electrocardiograms proceeds in the following steps: Collection and storage of analog signals, analog-to-digital-conversion, wave-recognition, measurement of the identified waves and diagnosis. The problems which arise at each of these stages are discussed and some of the solutions are presented, which have been tried by various groups and which contributed to the developments in this new field. A subsequent paper will deal in more detail with several systems, which have been subject to extensive practical applications.
Zusammenfassung
Da über die Computeranalyse von Elektrokardiogrammen bisher nur in Einzelveröffentlichungen der verschiedenen Arbeitsgruppen berichtet wurde, soll die vorliegende Arbeit eine Übersicht über dieses Gebiet geben. Die automatische EKG-Auswertung erfolgt in folgenden Einzelschritten: Analogsignalerfassung und -speicherung, Analog-Digital-Umwandlung, Datenübertragung, Wellenidentifizierung und -vermessung, Diagnosestellung. In einer eingehenden Darstellung dieser Auswertungsstufen werden die verschiedenen Wege beschrieben, die bisher zur Bearbeitung der einzelnen Teilbereiche beschritten wurden. Probleme, die sich z. T. auch grundsätzlich bei allen Formen der Computer-diagnostik stellen, werden für den speziellen, elektrokardiographischen Anwendungsbereich aufgezeigt und zusammen mit möglichen Beurteilungskriterien für Ergebnisvergleiche dargestellt. Im zweiten Teil der Arbeit sollen einige Systeme eingehender beschrieben werden, die für die Entwicklung der automatischen EKG-Analyse eine besondere Bedeutung erlangt haben und in größerem Umfang angewendet werden.
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Literatur
Abel, H.: Maschinelle Auswertung von Elektrokardiogrammen. IBM-Seminar „Datenverarbeitung und Medizin“ vom 25.–27. Oktober 1967 in Bad Liebenzell.
—— Schönberger, W.: Funktionsdiagnostik mit Hilfe der Elektrokardiographie. Herz Kreisl.1, 43–49 (1969).
Akazome, T., Ohbayashi, K., Kasai, G., Kimura, E.: ECG wave measurement by a hybrid computer for automatic diagnosis of arrhythmias. Digest of the 7th internat. conference on medical and biological engineering, Stockholm, 1967, p. 102.
Alexander, D. C., Wortzman, D.: Computer diagnosis of electrocardiograms. I. Equipment. Comput. biomed. Res.1, 348–365 (1968).
Amlinger, P. R.: Biotelemetry and computer analysis of electrocardiograms. Meth. Inform. Med.8, 120–127 (1969).
Arvedson, O.: Methods for data acquisition and evaluation of electrocardiograms and vectorcardiograms with the digital computer. Umea 1968.
Batchlor, C. D., Berson, A. S., Naval, I. A., Pipberger, H. V.: Computer search for electrocardiographic lead directions to optimize diagnostic differentiation. A novel concept in electrocardiographic lead design. Circulation36, 320–330 (1967).
Berson, A. S.: Analog-to-digital conversion for medicine. In: Caceres, C. A., Dreifus, L. D. (Hrsg.), Clinical electrocardiography and computers, p. 22–36. New York and London: Academic Press 1970.
-- Gamboa, R., Naval, A., Pipberger, H. V.: Differences caused by changes in electrode positions in two corrected orthogonal lead systems. (In Vorbereitung.)
-- Pipberger, A. V.: Electrode to skin impedance problems in ECG recordings. Digest of the 7th internat. conference on medical and biological engineering, Stockholm, 1967, p. 415.
—— —— Electrocardiographic distortions caused by inadequate high-frequency response of direct-writing electrocardiographs. Amer. Heart J.74, 208–218 (1967).
—— —— Skin-electrode impedance problems in electrocardiography. Amer. Heart J.76, 514–525 (1968).
Blackburn, H., Keys, H., Simonson, E., Rautaharju, P., Punsar, S.: The electrocardiogram in population studies. A classification system. Circulation21, 1160–1175 (1960).
—— —— —— The exercise electrocardiogram: Differences in interpretation. Report of a technical group on exercise electrocardiography. Amer. J. Cardiol.21, 871–880 (1968).
Blomquist, G.: The FRANK lead exercise electrocardiogram. A quantitative study based on averaging technique and digital computer analysis. Acta med. scand.178, Suppl. 440 1–98 (1965).
Bonner, R. E., Schwetman, H. D.: Computer diagnosis of electrocardiograms. II. A computer program for EKG measurements. Computers and biomed. Res.1, 366–386 (1968).
—— —— Computer diagnosis of electrocardiograms. III. A computer program for arrhythmia diagnosis. Comput. biomed. Res.1, 387–407 (1968).
Borun, E. R.: Variability of electrocardiographic data recorded with orthogonal leads. Amer. Heart. J.76, 62–69 (1968).
—— Chapman, J. M., Massey, F. J., Jr.: Computer analysis of FRANK lead electrocardiographic data recorded in an epidemiologic study. Amer. J. Cardiol.18, 664–671 (1966).
Brandon, C. W., Brody, D. A.: A hardware trigger for temporal indexing of the electrocardiographic signal. Comput. biomed. Res.3, 47–57 (1970).
Caceres, C. A.: Electrocardiographic analysis by a computer system. Arch. intern. Med.111, 114 (1963).
—— Dreifus, L. S. (Hrsg.): Clinical electrocardiography and computers. New York and London: Academic Press 1970.
—— Hochberg, H. M.: Performance of the computer and physician in the analysis of the electrocardiogram. Amer. Heart J.79, 439–443 (1970).
—— Steinberg, C. A., Abraham, S., Rikli, A. E.: Computer extraction of electrocardiographic parameters. Circulation25, 356–362 (1962).
Cady, L. D., Simonson, E., Blackburn, H., Taylor, H. L.: Computed cardiographic pattern diagnosis. Meth. Inform. Med.4, 92–95 (1965).
—— Woodbury, M. A., Gertler, M. M., Tick, L. J.: Mass screening of cardiograms. Amer. J. Publ. Hlth52, 1872–1876 (1962).
—— —— Tick, L. J., Gertler, M. M.: A method for electrocardiogram wave-pattern estimation. Example: Left ventricular hypertrophy. Circulat. Res.9, 1078–1082 (1961).
Cosma, J., Levy, B., Pipberger, H.: The spatial ventricular gradient during alterations in the ventricular activation pathway. Amer. Heart J.71, 84–91 (1966).
Dobrow, R. J., Fieldman, A., Page, W., Clason, C., Gorman, P., Reinfrank, R. F., Caceres, C. A.: Transmission of electrocardiograms from a community hospital for remote computer analysis. Amer. J. Cardiol.21, 678–698 (1968).
Fischmann, E., Cosma, J., Pipberger, H. V.: Beat to beat and observer variation of the electrocardiogram. Amer. Heart J.75, 465–473 (1968).
Forsythe, G. E., von der Groeben, J., Toole, J. G.: Vector-cardiographic diagnosis with the aid of ALGOL. Commun. ACM5, 118–122 (1962).
Frank, E.: An accurate lead system for spatial vectorcardiography. Circulation13, 737 (1956).
Gamboa, R., Klingeman, J. D., Pipberger, H. V.: Computer diagnosis of biventricular hypertrophy from the orthogonal electrocardiogram. Circulation34, 72–82 (1969).
Gillmann, H.: Über die Möglichkeit der datenmäßigen EKG-Erfassung und einer automatischen EKG-Analyse. Z. Kreisl.-Forsch.57, 1–17 (1968).
—— Über den heutigen Stand der Elektrokardiographie. Münch. med. Wschr.111, 1281–1287 (1969).
-- Probleme und Möglichkeiten der Erfassung klinisch wichtiger EKG-Daten durch orthogonale Ableitungen. Vortrag auf dem Symposium „Datenverarbeitung in der Elektrokardiodiagnostik“, 18. 4. 1970 in Bad Godesberg.
—— Augsburger, W.: Grundsätzliche Probleme der EKG-Computerdiagnostik und Entwurf für ein Blockdiagramm orthogonal registrierter Ableitungen. Dtsch. med. J.21, 660–669 (1970).
Goldman, M. J., Pipberger, H. V.: Analysis of the orthogonal electrocardiogram and vectorcardiogram in ventricular conduction defects with and without myocardial infarction. Circulation34, 243–250 (1969).
Haywood, L. J., Murthy, V. K., Harvey, G. A., Saltzberg, S.: On-line real time computer algorithm for monitoring the ECG waveform. Comp. Biomed. Res.3, 15–25 (1970).
Hochberg, H. M., Calatayud, J. B., Weihrer, A. L., Whiteman, J. R., Caceres, C. A.: Automatic electrocardiogram analysis in rapid mass creening. Arch. environm. Hlth15, 390–398 (1967).
Horan, L. G., Flowers, N. C., Brody, D. A.: Principal factor waveforms of the thoracic QRS complex. Circulat. Res.15, 131–145 (1964).
Jacobs, J. E., Horikoshi, K., Petrovick, M. A.: Feasibility of automated analysis of phonocardiograms. J. Audio-Engin. Soc.1, 49–54 (1969).
Kerr, A., Jr., Adicoff, A., Klingeman, J. D., Pipberger, H. V.: Computer analysis of the orthogonal electrocardiogram in pulmonary emphysema. Amer. J. Cardiol.25, 34–45 (1970).
Klingeman, J., Pipberger, H. V.: Computer classifications of electrocardiograms. Comput. Biomed. Res.1, 1–17 (1967).
—— —— Time shared computer analysis of orthogonal electrocardiograms. In: Caceres, C. A., Dreifus, L. S. (Hrsg.), Clinical electrocardiography and computers, p. 122–134. New York and London: Academic Press 1970.
Koller, S.: Mathematisch-statistische Grundlagen der Diagnostik. Klin. Wschr.45, 1065–1072 (1967).
Lange, H.-J.: Möglichkeiten und Grenzen der sogenannten Computerdiagnostik. Münch. med. Wschr.111, 2473–2479 (1969).
Lemmerz, A. H.: Aussagefähigkeit des EKG nach Frank. Herz Kreisl.1, 35–41 (1969).
Lindberg, D. A. B., Amlinger, P. R.: Automated analysis of the electrocardiogram. Missouri Med.65, 742–745 (1968).
Lusted, L. B.: Introduction to medical decision making. Springfield, Ill.: Ch. C. Thomas 1968. 271 S.
MacFarlane, P. W.: Computer interpretation of electrocardiograms. Brit. Heart J.31, 793 (1969).
-- Lawrie, T. D. V., Lorimer, A. R.: Computer interpretation of over 1000 orthogonal lead and corresponding conventional ECGs. Vortrag XI Internat. Symposium on Vectorcardiography, New York 1970 (Proceedings noch nicht veröffentlicht).
Macy, J.: Analog-digital conversion system. In: Computers in biomedical research. Hrsg.: Stacy, R. W., Waxman, B. D., vol. 2, p. 3–34. New York-London: Academic Press 1965.
Marriott, H. J. L.: Electrocardiographic diagnosis of arrhythmias. An experiment in testing physicians proficiency. Amer. J. Cardiol.16, 906–911 (1965).
McFee, R., Parungo, A.: An orthogonal lead system for clinical electrocardiography. Amer. Heart J.62, 93 (1961).
Naval, I. A., Cosma, J., Pipberger, H. V.: Reevaluation of the Q wave in the electrocardiographic diagnosis of myocardial infarction. Med. Ann. D. C.36, 349–353 (1967).
Neufeld, H. N., Sive, P. H., Riss, E., Yahini, J. H., Marscalkowicz, A., Baruch, D., Medalie, J. H.: The use of a computerized ECG interpretation system in an epidemiologic study. Vortrag auf der 7. Internat. Biometr. Conference, Hannover, 19. 8. 1970.
Okamoto, N., Simonson, E.: Separation of normal and abnormal vectorcardiograms. Use of spatial orientation of initial, central and terminal segmental planes of the QRS loop. Amer. J. Cardiol.18, 682–689 (1966).
Pipberger, H. V.: Die Bedeutung der orthogonalen Elektrokardiographie und Vektorkardiographie für die klinische Kardiologie. Arch. Kreisl.-Forsch.29, 58–76 (1958).
—— Analysis of electrocardiograms by digital computer. Meth. Inform. Med.1, 69–71 (1962).
—— Advantages of three lead cardiographic recordings. Ann. N.Y. Acad. Sci.126, 873–881 (1965).
—— Bialek, S. M., Perloff, J. K., Schnaper, H. W.: Correlation of clinical information in the standard 12-lead ECG and in a corrected orthogonal 3-lead ECG. Amer. Heart J.61, 34–43 (1961).
—— Freis, E. D.: Automatische Analyse kardiologischer Analog-Daten mittels elektronischer Rechenmaschinen. Med. Docum.4, 58 (1960).
—— Goldman, M. J., Littmann, D., Murphy, G. P., Cosma, J., Snyder, J. R.: Correlations of the orthogonal electrocardiogram and vectorcardiogram with constitutional variables in 518 normal men. Circulation35, 536–550 (1967).
—— Klingeman, J. D., Cosma, J.: Computer evaluation of statistical properties of clinical information in the differential diagnosis of chest pain. Meth. Inform. Med.7, 79–92 (1968).
—— Pipberger, H.A.: Display and analysis of electrocardiographic data. Amer. J. Cardiol.14, 307 (1964).
—— Stallmann, F. W.: Computation of differential diagnosis in electrocardiography. Ann. N.Y. Acad. Sci.115, 1115–1128 (1964).
—— —— Berson, A. S.: Automatic analysis of the P-QRS-T complex of the electrocardiogram by digital computer. Ann. intern. Med.57, 776 (1962).
Pordy, L., Jaffe, H., Chesky, K., Friedberg, C. K., Fallowes, L., Bonner, R. E.: Computer diagnosis of electrocardiograms. IV. A computer program for contour analysis with clinical results of rhythm and contour interpretation. Comput. biomed. Res.1, 408–433 (1968).
Pryor, T. A., Russell, R., Budkin, A., Price, W. G.: Electrocardiographic interpretation by computer. Comput. Biomed. Res.2, 537–548 (1969).
Rautaharju, P.M.: Deterministic type waveform analysis in electrocardiography. Ann. N.Y. Acad. Sci.128, 939–954 (1966).
Rautharju, P. M.: Blackburn, H.: The exercise electrocardiogram. Experience in analysis of “noisy” cardiograms with a small computer. Amer. Heart J.69, 515–520 (1965).
Reichertz, P.: Computer-Diagnostik von Extremitäten-Elektrokardiogrammen mittels formaler und parametrischer Vergleiche. Arch. Kreisl.-Forsch.53, 161–173 (1967).
Riedl, H., Meyer, W., Hoffmann, H., Hott, K.-H., Uzel, S.: Das Siemens-System der automatischen EKG-Auswertung. „Electromedica“ (im Druck).
Schaefer, H.: Zur Gültigkeit der Vektortheorie des EKG und über Inhalt und Wert des elektrischen Herzbildes. Münch. med. Wschr.96, 951 (1954).
Schmitt, O. H., Caceres, C. A.: Electronic and computer assisted studies of biomedical problems. Springfield/Ill.: Ch. C. Thomas 1964.
Shefield, L.T., Holt, J.H., Lester, F.M., Conroy, D.V., Reeves, T.J.: On-line analysis of the exercise electrocardiogram. Circulation40, 935–944 (1969).
Smith, R. E., Hyde, C. M.: A computer system for electrocardiographic analysis. Third Annual Rocky Mountain Bioengineering Symposium, Univ. of Colorado, Boulder, May 2–3, 1966.
—— —— Strand, E. M., Gau, G. T.: Computer analysis of electrocardiograms at the Mayo Clinic. Transactions of the Internat. Symposium for the Electrical Activity of the Heart, London-Ontario: Ch. C. Thomas, May 1967.
Snyder, J. R., Pipberger, H. V.: The orthogonal electrocardiogram as an index of digitalis response in normal adults. Amer. Heart J.73, 640–646 (1967).
Spindelberger, W.: Charakterisierung des Elektrokardiogramms mittels Tschebyscheffscher Polynome. Meth. Inf. Med.7, 104–110 (1968).
Staples, L. F., Gustafson, J. E., Balm, G. J., Tate, W. A.: Computer interpretation of electrocardiograms. Amer. Heart J.72, 351–358 (1966).
Stark, L., Dickson, J. F., Whipple, G. H., Horibe, H.: Remote real-time diagnosis of clinical electrocardiograms by a digital computer system. Ann. N.Y. Acad. Sci.126, 851–872 (1965).
—— Okajima, M., Whipple, G. H.: Computer pattern recognition techniques: Electrocardiographic diagnosis. Commun. ACM5, 527–531 (1962).
Strand, E. M., Hyde, C. M., Smith, R. E.: Computerized technique for the recognition and characterization of ECG atrial activity. Fifth Annual Symposium on Biomathematics and Computer Science in the Life Sciences, Houston, Texas, March 30–April 1, 1967.
Thompson, N. P.: Fourier analysis of the electrocardiographic function. Amer. J. Med. Electron. 299–307 (1962).
Walker, W. J.: Small portable digital-analogue device for electrocardiographic screening. J. Amer. med. Ass.200, 313 (1967).
Waver, C. S., Groeben, J. v. d., Mantey, P. E., Torle, J. G., Cole, C. A., Fitzgerald, J. W., Lawrence, R. W.: Digital filtering with applications to electrocardiogram processing. IEEE Trans. Audio-Electro AU-16, 350–391 (1968).
Whiteman, J. R., Gorman, P. A., Catalayud, J. B., Abraham, S., Weiher, P. L., Carceres, C. A.: Automation of electrocardiographic diagnostic criteria. J. Amer. med. Ass.200, 932–938 (1967).
Yano, K., Pipberger, H. V.: Spatial magnitude, orientation, and velocity of the normal and abnormal QRS complex. Circulation29, 107–117 (1964).
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Dudeck, J., Michaelis, J. Computeranalyse des Elektrokardiogramms. Klin Wochenschr 49, 717–729 (1971). https://doi.org/10.1007/BF01495494
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DOI: https://doi.org/10.1007/BF01495494
Key-words
- Electrocardiogram
- vectorcardiogram
- lead systems
- analog-data-storage
- digital computers
- analog-to-digital-conversion
- data formating
- computer diagnosis
- noise-reduction
- wave recognition