Alex Zwanenburg1,2,3, Ben Jm Hermans1,4, Peter Andriessen5,6, Hendrik J Niemarkt5, Reint K Jellema5, Daan Rmg Ophelders2,5, Rik Vullings7, Tim Gam Wolfs2,5,8, Boris W Kramer2,5,8, Tammo Delhaas1,3. 1. Department of Biomedical Engineering, Maastricht University, Maastricht, The Netherlands. 2. MHeNs School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands. 3. CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, The Netherlands. 4. Department of Technical Medicine, University of Twente, Enschede, The Netherlands. 5. Department of Pediatrics, Maastricht University Medical Centre, Maastricht, The Netherlands. 6. Department of Pediatrics, Máxima Medical Centre, Veldhoven, The Netherlands. 7. Signal Processing Systems Group, Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands. 8. GROW School for Oncology and Developmental Biology, Maastricht University, Maastricht, The Netherlands.
Abstract
BACKGROUND: Current methods for assessing perinatal hypoxic conditions did not improve infant outcomes. Various waveform-based and interval-based ECG markers have been suggested, but not directly compared. We compare performance of ECG markers in a standardized ovine model for fetal hypoxia. METHODS: Sixty-nine fetal sheep of 0.7 gestation had ECG recorded 4 h before, during, and 4 h after a 25-min period of umbilical cord occlusion (UCO), leading to severe hypoxia. Various ECG markers were calculated, among which were heart rate (HR), HR-corrected ventricular depolarization/repolarization interval (QTc), and ST-segment analysis (STAN) episodic and baseline rise markers, analogue to clinical STAN device alarms. Performance of interval- and waveform-based ECG markers was assessed by correlating predicted and actual hypoxic/normoxic state. RESULTS: Of the markers studied, HR and QTc demonstrated high sensitivity (≥86%), specificity (≥96%), and positive predictive value (PPV) (≥86%) and detected hypoxia in ≥90% of fetuses at 4 min after UCO. In contrast, STAN episodic and baseline rise markers displayed low sensitivity (≤20%) and could not detect severe fetal hypoxia in 65 and 28% of the animals, respectively. CONCLUSION: Interval-based HR and QTc markers could assess the presence of severe hypoxia. Waveform-based STAN episodic and baseline rise markers were ineffective as markers for hypoxia.
BACKGROUND: Current methods for assessing perinatal hypoxic conditions did not improve infant outcomes. Various waveform-based and interval-based ECG markers have been suggested, but not directly compared. We compare performance of ECG markers in a standardized ovine model for fetal hypoxia. METHODS: Sixty-nine fetal sheep of 0.7 gestation had ECG recorded 4 h before, during, and 4 h after a 25-min period of umbilical cord occlusion (UCO), leading to severe hypoxia. Various ECG markers were calculated, among which were heart rate (HR), HR-corrected ventricular depolarization/repolarization interval (QTc), and ST-segment analysis (STAN) episodic and baseline rise markers, analogue to clinical STAN device alarms. Performance of interval- and waveform-based ECG markers was assessed by correlating predicted and actual hypoxic/normoxic state. RESULTS: Of the markers studied, HR and QTc demonstrated high sensitivity (≥86%), specificity (≥96%), and positive predictive value (PPV) (≥86%) and detected hypoxia in ≥90% of fetuses at 4 min after UCO. In contrast, STAN episodic and baseline rise markers displayed low sensitivity (≤20%) and could not detect severe fetal hypoxia in 65 and 28% of the animals, respectively. CONCLUSION: Interval-based HR and QTc markers could assess the presence of severe hypoxia. Waveform-based STAN episodic and baseline rise markers were ineffective as markers for hypoxia.
Authors: Reint K Jellema; Valéria Lima Passos; Daan R M G Ophelders; Tim G A M Wolfs; Alex Zwanenburg; Stephanie De Munter; Maria Nikiforou; Jennifer J P Collins; Elke Kuypers; Gerard M J Bos; Harry W Steinbusch; Joris Vanderlocht; Peter Andriessen; Wilfred T V Germeraad; Boris W Kramer Journal: Exp Neurol Date: 2013-10-08 Impact factor: 5.330
Authors: Alex Zwanenburg; Reint K Jellema; Ward Jennekens; Daan Ophelders; Rik Vullings; Arne van Hunnik; Carola van Pul; Laura Bennet; Tammo Delhaas; Boris W Kramer; Peter Andriessen Journal: Pediatr Res Date: 2013-01-22 Impact factor: 3.756
Authors: Reint K Jellema; Valéria Lima Passos; Alex Zwanenburg; Daan R M G Ophelders; Stephanie De Munter; Joris Vanderlocht; Wilfred T V Germeraad; Elke Kuypers; Jennifer J P Collins; Jack P M Cleutjens; Ward Jennekens; Antonio W D Gavilanes; Matthias Seehase; Hans J Vles; Harry Steinbusch; Peter Andriessen; Tim G A M Wolfs; Boris W Kramer Journal: J Neuroinflammation Date: 2013-01-24 Impact factor: 8.322
Authors: Peter Andriessen; Alex Zwanenburg; Judith O E H van Laar; Rik Vullings; Ben J M Hermans; Hendrik J Niemarkt; Reint K Jellema; Daan R M G Ophelders; Tim G A M Wolfs; Boris W Kramer; Tammo Delhaas Journal: PLoS One Date: 2018-04-16 Impact factor: 3.240
Authors: Catherine T Gunther-Harrington; Rick Arthur; Krista Estell; Beatriz Martinez Lopez; Alexandra Sinnott; Eric Ontiveros; Anita Varga; Joshua A Stern Journal: BMC Vet Res Date: 2018-01-18 Impact factor: 2.741