北京生物医学工程

评价智能心电检测仪诊断心律失常的准确性

Diagnostic accuracy of intelligent electrocardiogram monitor in the diagnosis of arrhythmia

作者：周和徐亚伟

单位：同济大学医学院全科医学系（上海 200092） 上海市徐汇区凌云街道社区卫生服务中心全科（上海 200237） 上海市第十人民医院心内科（上海 200092） 通信作者：周和。E-mail：442782589@qq.com

关键词：心电监护；心律失常；诊断准确性；人工智能；远程预警

分类号：R318.04

出版年·卷·期（页码）：2022·41·1（73-78）

摘要：

目的评价智能手机APP操作的单导联手持心电检测仪(智能1L-ECG)在心房颤动( atrial fibrillation ,AF) 、心房扑动 ( atrial flutter ,AFL)等心律失常筛查中的准确性，探讨其人工智能算法和远程预警的优势。方法选择2019年11月至2020年9月上海市徐汇区凌云街道65岁以上自愿接受12L-ECG诊断和智能1L-ECG的体检患者375例。采用随机原则由2位不同医生分别完成12L-ECG及智能1L-ECG的操作。智能1L-ECG采集的图谱由智能集成算法和盲法的心脏病专家评估。结果最终纳入了350例老年患者，年龄为（71.68±5.14）岁，女性占57.1%。智能1L-ECG的智能算法对诊断AF/AFL的受试者工作曲线下面积（area under curve，AUC）为0.851（95%CI，0.649—1），灵敏度、特异度、准确度、阳性似然比和阴性似然比分别为71.4%、98.8%、98.3%、59.5、0.29。心脏病专家诊断AF/AFL的AUC为0.927（95%CI，0.774—1），灵敏度、特异度、准确度、阳性似然比和阴性似然比分别为85.7%、99.7%、99.4%、285.7、0.14；对其他心律异常的AUC为0.791（95%CI，0.719—0.863），灵敏度、特异度、准确度、阳性似然比和阴性似然比分别为85.7%、99.7%、99.4%、285.7、0.14；对房室传导阻滞的AUC为0.853（95%CI，0.709—0.996），灵敏度、特异度、准确度、阳性似然比和阴性似然比分别为71.4%、99.1%、98%、79.3、0.29。结论智能1L-ECG的智能算法对AF/AFL和房室传导阻滞具有较高的诊断价值，能用于诊断房颤等心律失常，提高筛检率。

Objective To evaluate the accuracy of a smart phone-operated applications, single-lead ECG monitor (intelligent 1L-ECG) in screening of atrial fibrillation(AF)/ atrial flutter(AFL) and other arrhythmias, and explore the advantages of its intelligent artificial algorithm and remote warning. Methods A total of 375 patients over 65 years old who voluntarily received 12L-ECG and intelligent 1L-ECG from Nov. 2019 to Sep. 2020 were selected from Lingyun Street, Xuhui District, Shanghai. All intelligent 1L-ECG atlas of electrocardiograms which were collected through smart phone-operated apps were estimated by blinded cardiologists as well as by the smart phone-integrated algorithm.Results We identified a total of 350 elderly patients in Shanghai. Mean±SD age was 71.68 ± 5.14 years, and 57.1% of the patients were female. The algorithm for intelligent 1L-ECG to diagnose AF / AFL achieved an area under the receiver operating curve (AUC) of 0.851 (95% CI, 0.649 to 1) with sensitivity, specificity, accuracy,positive likelihood ratio(+LR) and negative likelihood ratio(-LR) of 71.4%,98.8%,98.3%,59.5 and 0.29 respectively,while the cardiologists to diagnose AF / AF had an AUC of 0.927 (95% CI, 0.774 to 1) with sensitivity, specificity, accuracy,+LR and -LR of 85.7%,99.7%,99.4%,285.7 and 0.14 respectively.The cardiologists to diagnose other arrhythmias had an AUC of 0.791（95%CI，0.719 to 0.863）with sensitivity, specificity, accuracy,+LR and -LR of 85.7%,99.7%,99.4%,285.7 and 0.14 respectively.and diagnose atrioventricular block (AV block) had an AUC of 0.853（95%CI，0.709 to 0.996）with sensitivity, specificity, accuracy,+LR and -LR of 71.4%,99.1%,98%,79.3 and 0.29 respectively.Conclusions The algorithm of intelligent 1L-ECG has high diagnostic value for AF /AFL and AV block. It can be used to diagnose arrhythmias such as atrial fibrillation and improve the screening rate.

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