Statistical evaluation of reproducibility of automated ECG measurements: An example from arrhythmogenic right ventricular dysplasia/cardiomyopathy clinic

Timothy Huang, Cynthia Anne James, Crystal Tichnell, Brittney Murray, Joel Xue, Hugh Calkins, Larisa G. Tereshchenko

Research output: Contribution to journalArticle

Abstract

Background Arrhythmogenic right ventricular dysplasia/cardiomyopathy (ARVD/C) is characterized by delay in depolarization of the right ventricle, detected by prolonged terminal activation duration (TAD) in V1-V3. However, manual ECG measurements have shown moderate-to-low intra- and inter-reader agreement. The goal of this study was to assess reproducibility of automated ECG measurements in the right precordial leads. Methods Pairs of ECGs recorded in the same day from Johns Hopkins ARVD/C Registry participants [n = 247, mean age 35.2 ± 15.6 years, 58% men, 92% whites, 11(4.5%) with definite ARVD/C] were retrospectively analyzed. QRS duration, intrinsicoid deflection, TAD, and T-wave amplitude in the right precordial leads, as well as averaged across all leads QRS duration, QRS axis, T axis, QTc interval, and heart rate was measured automatically, using 12SL TM algorithm (GE Healthcare, Wauwatosa, WI, USA). Intrinsicoid deflection was measured as the time from QRS complex onset to the alignment point of the QRS complex. TAD was calculated as the difference between QRS duration and intrinsicoid in V1-V3. Reproducibility was quantified by Bland-Altman analysis (bias with 95% limits of agreement), Lin's concordance coefficient, and Bradley-Blackwood procedure. Results Bland-Altman analysis revealed satisfactory reproducibility of tested parameters. V1 QRS duration bias was -0.10 ms [95% limits of agreement -12.77 to 12.56 ms], V2 QRS duration bias -0.09 ms [-11.13 to 10.96 ms]; V1 TAD bias 0.14 ms [-13.23 to 13.51 ms], V2 TAD bias 0.008 ms [-12.42 to 12.44 ms]. Conclusion Comprehensive statistical evaluation of reproducibility of automated ECG measurements is important for appropriate interpretation of ECG. Automated ECG measurements are reproducible to within 25%.

Original languageEnglish (US)
Pages (from-to)23-30
Number of pages8
JournalBiomedical Signal Processing and Control
Volume13
Issue number1
DOIs
StatePublished - 2014

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Arrhythmogenic Right Ventricular Dysplasia
Electrocardiography
Chemical activation
Depolarization
Heart Ventricles
Registries
Heart Rate
Delivery of Health Care

Keywords

  • ARVD/C
  • Automated measurement
  • Electrocardiogram
  • QRS duration
  • Reproducibility
  • Terminal activation duration

ASJC Scopus subject areas

  • Health Informatics
  • Signal Processing

Cite this

Statistical evaluation of reproducibility of automated ECG measurements : An example from arrhythmogenic right ventricular dysplasia/cardiomyopathy clinic. / Huang, Timothy; James, Cynthia Anne; Tichnell, Crystal; Murray, Brittney; Xue, Joel; Calkins, Hugh; Tereshchenko, Larisa G.

In: Biomedical Signal Processing and Control, Vol. 13, No. 1, 2014, p. 23-30.

Research output: Contribution to journalArticle

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abstract = "Background Arrhythmogenic right ventricular dysplasia/cardiomyopathy (ARVD/C) is characterized by delay in depolarization of the right ventricle, detected by prolonged terminal activation duration (TAD) in V1-V3. However, manual ECG measurements have shown moderate-to-low intra- and inter-reader agreement. The goal of this study was to assess reproducibility of automated ECG measurements in the right precordial leads. Methods Pairs of ECGs recorded in the same day from Johns Hopkins ARVD/C Registry participants [n = 247, mean age 35.2 ± 15.6 years, 58{\%} men, 92{\%} whites, 11(4.5{\%}) with definite ARVD/C] were retrospectively analyzed. QRS duration, intrinsicoid deflection, TAD, and T-wave amplitude in the right precordial leads, as well as averaged across all leads QRS duration, QRS axis, T axis, QTc interval, and heart rate was measured automatically, using 12SL TM algorithm (GE Healthcare, Wauwatosa, WI, USA). Intrinsicoid deflection was measured as the time from QRS complex onset to the alignment point of the QRS complex. TAD was calculated as the difference between QRS duration and intrinsicoid in V1-V3. Reproducibility was quantified by Bland-Altman analysis (bias with 95{\%} limits of agreement), Lin's concordance coefficient, and Bradley-Blackwood procedure. Results Bland-Altman analysis revealed satisfactory reproducibility of tested parameters. V1 QRS duration bias was -0.10 ms [95{\%} limits of agreement -12.77 to 12.56 ms], V2 QRS duration bias -0.09 ms [-11.13 to 10.96 ms]; V1 TAD bias 0.14 ms [-13.23 to 13.51 ms], V2 TAD bias 0.008 ms [-12.42 to 12.44 ms]. Conclusion Comprehensive statistical evaluation of reproducibility of automated ECG measurements is important for appropriate interpretation of ECG. Automated ECG measurements are reproducible to within 25{\%}.",
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AU - Calkins, Hugh

AU - Tereshchenko, Larisa G.

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N2 - Background Arrhythmogenic right ventricular dysplasia/cardiomyopathy (ARVD/C) is characterized by delay in depolarization of the right ventricle, detected by prolonged terminal activation duration (TAD) in V1-V3. However, manual ECG measurements have shown moderate-to-low intra- and inter-reader agreement. The goal of this study was to assess reproducibility of automated ECG measurements in the right precordial leads. Methods Pairs of ECGs recorded in the same day from Johns Hopkins ARVD/C Registry participants [n = 247, mean age 35.2 ± 15.6 years, 58% men, 92% whites, 11(4.5%) with definite ARVD/C] were retrospectively analyzed. QRS duration, intrinsicoid deflection, TAD, and T-wave amplitude in the right precordial leads, as well as averaged across all leads QRS duration, QRS axis, T axis, QTc interval, and heart rate was measured automatically, using 12SL TM algorithm (GE Healthcare, Wauwatosa, WI, USA). Intrinsicoid deflection was measured as the time from QRS complex onset to the alignment point of the QRS complex. TAD was calculated as the difference between QRS duration and intrinsicoid in V1-V3. Reproducibility was quantified by Bland-Altman analysis (bias with 95% limits of agreement), Lin's concordance coefficient, and Bradley-Blackwood procedure. Results Bland-Altman analysis revealed satisfactory reproducibility of tested parameters. V1 QRS duration bias was -0.10 ms [95% limits of agreement -12.77 to 12.56 ms], V2 QRS duration bias -0.09 ms [-11.13 to 10.96 ms]; V1 TAD bias 0.14 ms [-13.23 to 13.51 ms], V2 TAD bias 0.008 ms [-12.42 to 12.44 ms]. Conclusion Comprehensive statistical evaluation of reproducibility of automated ECG measurements is important for appropriate interpretation of ECG. Automated ECG measurements are reproducible to within 25%.

AB - Background Arrhythmogenic right ventricular dysplasia/cardiomyopathy (ARVD/C) is characterized by delay in depolarization of the right ventricle, detected by prolonged terminal activation duration (TAD) in V1-V3. However, manual ECG measurements have shown moderate-to-low intra- and inter-reader agreement. The goal of this study was to assess reproducibility of automated ECG measurements in the right precordial leads. Methods Pairs of ECGs recorded in the same day from Johns Hopkins ARVD/C Registry participants [n = 247, mean age 35.2 ± 15.6 years, 58% men, 92% whites, 11(4.5%) with definite ARVD/C] were retrospectively analyzed. QRS duration, intrinsicoid deflection, TAD, and T-wave amplitude in the right precordial leads, as well as averaged across all leads QRS duration, QRS axis, T axis, QTc interval, and heart rate was measured automatically, using 12SL TM algorithm (GE Healthcare, Wauwatosa, WI, USA). Intrinsicoid deflection was measured as the time from QRS complex onset to the alignment point of the QRS complex. TAD was calculated as the difference between QRS duration and intrinsicoid in V1-V3. Reproducibility was quantified by Bland-Altman analysis (bias with 95% limits of agreement), Lin's concordance coefficient, and Bradley-Blackwood procedure. Results Bland-Altman analysis revealed satisfactory reproducibility of tested parameters. V1 QRS duration bias was -0.10 ms [95% limits of agreement -12.77 to 12.56 ms], V2 QRS duration bias -0.09 ms [-11.13 to 10.96 ms]; V1 TAD bias 0.14 ms [-13.23 to 13.51 ms], V2 TAD bias 0.008 ms [-12.42 to 12.44 ms]. Conclusion Comprehensive statistical evaluation of reproducibility of automated ECG measurements is important for appropriate interpretation of ECG. Automated ECG measurements are reproducible to within 25%.

KW - ARVD/C

KW - Automated measurement

KW - Electrocardiogram

KW - QRS duration

KW - Reproducibility

KW - Terminal activation duration

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