Niccolo' Maurizi1, Alessandro Faragli2, Jacopo Imberti2, Nicolò Briante2, Mattia Targetti3, Katia Baldini3, Amadou Sall4, Abibou Cisse5, Francesca Gigli Berzolari6, Paola Borrelli6, Fulvio Avvantaggiato7, Stefano Perlini8, Niccolo' Marchionni9, Franco Cecchi9, Gianbattista Parigi2, Iacopo Olivotto3. 1. Referral Center for Cardiomyopathies, Careggi University Hospital, Florence, Italy. Electronic address: niccolo.maurizi@gmail.com. 2. Center for International Cooperation, University of Pavia, Italy. 3. Referral Center for Cardiomyopathies, Careggi University Hospital, Florence, Italy. 4. Dept. of Cardiology, Regional Hospital of Ziguinchor, Senegal. 5. Regional Hospital of Ziguinchor, Senegal. 6. Biostastic and Clinical Epidemiology Unit, Dept. of Public Health, Experimental and Forensic Medicine, University of Pavia, Pavia, Italy. 7. Dept. of Radiology, IRCCS San Matteo, Pavia, Italy. 8. Internal Medicine Unit, Cardiovascular and Metabolic Diseases, IRCCS San Matteo, Pavia, Italy. 9. Dept. of Clinical and Experimental Medicine, University of Florence, Italy.
Abstract
BACKGROUND: MHealth technologies are revolutionizing cardiovascular medicine. However, a low-cost, user-friendly smartphone-based electrocardiograph is still lacking. D-Heart® is a portable device that enables the acquisition of the ECG on multiple leads which streams via Bluetooth to any smartphone. Because of the potential impact of this technology in low-income settings, we determined the accuracy of D-Heart® tracings in the stratification of ECG morphological abnormalities, compared with 12-lead ECGs. METHODS: Consecutive African patients referred to the Ziguinchor Regional Hospital (Senegal) were enrolled (n=117; 69 males, age 39±11years). D-Heart® recordings (3 peripheral leads plus V5) were obtained immediately followed by 12 lead ECGs and were assessed blindly by 2 independent observers. Global burden of ECG abnormalities was defined by a semi-quantitative score based on the sum of 9 criteria, identifying four classes of increasing severity. RESULTS: D-Heart® and 12-lead ECG tracings were respectively classified as: normal: 72 (61%) vs 69 (59%); mildly abnormal: 42 (36%) vs 45 (38%); moderately abnormal: 3 (3%) vs 3 (3%). None had markedly abnormal tracings. Cohen's weighted kappa (kw) test demonstrated a concordance of 0,952 (p<0,001, agreement 98,72%). Concordance was high as well for the Romhilt-Estes score (kw=0,893; p<0,001 agreement 97,35%). PR and QRS intervals comparison with Bland-Altman method showed good accuracy for D-Heart® measurements (95% limit of agreement ±20ms for PR and ±10ms for QRS). CONCLUSIONS: D-Heart® proved effective and accurate stratification of ECG abnormalities comparable to the 12-lead electrocardiographs, thereby opening new perspectives for low-cost community cardiovascular screening programs in low-income settings.
BACKGROUND: MHealth technologies are revolutionizing cardiovascular medicine. However, a low-cost, user-friendly smartphone-based electrocardiograph is still lacking. D-Heart® is a portable device that enables the acquisition of the ECG on multiple leads which streams via Bluetooth to any smartphone. Because of the potential impact of this technology in low-income settings, we determined the accuracy of D-Heart® tracings in the stratification of ECG morphological abnormalities, compared with 12-lead ECGs. METHODS: Consecutive African patients referred to the Ziguinchor Regional Hospital (Senegal) were enrolled (n=117; 69 males, age 39±11years). D-Heart® recordings (3 peripheral leads plus V5) were obtained immediately followed by 12 lead ECGs and were assessed blindly by 2 independent observers. Global burden of ECG abnormalities was defined by a semi-quantitative score based on the sum of 9 criteria, identifying four classes of increasing severity. RESULTS: D-Heart® and 12-lead ECG tracings were respectively classified as: normal: 72 (61%) vs 69 (59%); mildly abnormal: 42 (36%) vs 45 (38%); moderately abnormal: 3 (3%) vs 3 (3%). None had markedly abnormal tracings. Cohen's weighted kappa (kw) test demonstrated a concordance of 0,952 (p<0,001, agreement 98,72%). Concordance was high as well for the Romhilt-Estes score (kw=0,893; p<0,001 agreement 97,35%). PR and QRS intervals comparison with Bland-Altman method showed good accuracy for D-Heart® measurements (95% limit of agreement ±20ms for PR and ±10ms for QRS). CONCLUSIONS: D-Heart® proved effective and accurate stratification of ECG abnormalities comparable to the 12-lead electrocardiographs, thereby opening new perspectives for low-cost community cardiovascular screening programs in low-income settings.
Authors: A Faragli; D Abawi; C Quinn; M Cvetkovic; T Schlabs; E Tahirovic; H-D Düngen; B Pieske; S Kelle; F Edelmann; Alessio Alogna Journal: Heart Fail Rev Date: 2021-09 Impact factor: 4.214