Automated serial ECG comparison based on the Minnesota code

doi:10.1016/S0022-0736(96)80016-1

Journal of Electrocardiology

Volume 29, Supplement 1, 1996, Pages 29-34

https://doi.org/10.1016/S0022-0736(96)80016-1 Get rights and content

Abstract

The Minnesota code was introduced in 1960, and since then, a number of computer programs have been written for classifying electrocardiograms according to the rules of the code. However, in 1982, extended rules for serial comparison based on the Minnesota code were published. This article presents the details of implementation of automated serial electrocardiographic comparison using the code. Its application in the West of Scotland Coronary Prevention Study, which was a double-blind trial of lipid lowering in 6,595 men, is also discussed.

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A computer program for classification of ECGs according to the Minnesota code

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Prevalence of major and minor electrocardiographic abnormalities in one million primary care Latinos
2021, Journal of Electrocardiology
Citation Excerpt :
Patients with same “ID” were considered identical and, therefore, only the first ECG was considered for further analysis. We ran the University of Glasgow 12‑lead ECG analysis software to automatically analyse the ECG database [17,18]. This is an established program for ECG analysis that has shown positive results for signal processing (e.g. identifying waves and computing axes, durations, amplitudes and intervals), rhythm analysis and diagnostic interpretation, and thus it is fit for use in epidemiological studies [19,20].
This study aims to assess the prevalence of electrocardiographic abnormalities based on the Minnesota code from a large sample of 1.01 m adult Brazilian primary care patients and to evaluate its association with age, sex, and cardiovascular risk factors. A large electrocardiogram (ECG) database of such patients aged ≥18 years (mean age 52 ± 17 years-old with 60.2% female). was analyzed and the results were stratified by sex and age. The prevalence of abnormalities was more common in men and the elderly population. Major electrocardiographic abnormalities were observed in 20.2% of adults and 43.1% of elderly patients, and minor abnormalities were found in 46.0% 39.4%, respectively. For adult patients, the number and percentage of major abnormalities rise depending on the number of cardiovascular risk factors. For elderly patients, the correlation between these variables is not clear, and the percentage of major abnormalities remains stable independently of the number of risk factors.
Evaluation of mortality in bundle branch block patients from an electronic cohort: Clinical Outcomes in Digital Electrocardiography (CODE) study
2019, Journal of Electrocardiology
Citation Excerpt :
The clinical information, ECGs tracings and reports were stored in a specific database. For the purpose of the present study, the Glasgow 12-lead ECG analysis program (release 28.4.1, issued on June 16th 2009) was used to automatically interpret all ECGs available in the database, exporting the diagnosis, codified by both Glasgow and Minnesota codes [11]. ECGs were analyzed by a team of fourteen trained cardiologists using standardized criteria [12].
Left bundle branch block is recognized as a marker of higher risk of death, but the prognostic value of the right bundle branch block in the general population is still controversial. Our aim is to evaluate the risk of overall and cardiovascular mortality in patients with right (RBBB) and left bundle branch block (LBBB) in a large electronic cohort of Brazilian patients.
This observational retrospective study was developed with the database of digital ECGs from Telehealth Network of Minas Gerais, Brazil (TNMG). All ECGs performed from 2010 to 2017 in primary care patients over 16 years old were assessed. The electronic cohort was obtained by linking data from ECG exams (name, sex, date of birth, city of residence) and those from national mortality information system, using standard probabilistic linkage methods (FRIL: Fine-grained record linkage software, v.2.1.5, Atlanta, GA). Only the first ECG of each patient was considered. Clinical data were self-reported, and ECGs were interpreted manually by cardiologists and automatically by the Glasgow University Interpreter software. Hazard ratio (HR) for mortality was estimated using Cox regression.
From a dataset of 1,773,689 patients, 1,558,421 primary care patients over 16 years old underwent a valid ECG recording during 2010 to 2017. We excluded 17,359 patients that didn't have a valid QRS measure from the Glasgow program and 11,091 patients from the control group that had QRS equal or above 120 ms and were not RBBB or LBBB. Therefore, 1,529,971 were included (median age 52 [Q1:38; Q3:65] years; 40.2% were male). In a mean follow-up of 3.7 years, the overall mortality rate was 3.34%. RBBB was more frequent (2.42%) than LBBB (1.32%). In multivariate analysis, adjusting for sex, age and comorbidities, both patients with RBBB (HR 1.32; CI 95% 1.27–1.37) and LBBB (HR 1.69; CI 95% 1.62–1.76) had higher risk of overall mortality. Women with RBBB had an increased risk of all-cause death compared to men (p < 0.001). Cardiovascular mortality was higher in patients with LBBB (HR 1.77; CI 95% 1.55–2.01), but not for RBBB.
Patients with RBBB and LBBB had higher risk of overall mortality. Women with RBBB had more risk of all-cause death than men. LBBB was associated with higher risk of cardiovascular mortality.
Tele-electrocardiography and bigdata: The CODE (Clinical Outcomes in Digital Electrocardiography) study
2019, Journal of Electrocardiology
Citation Excerpt :
The classification model was tested on 4557 medical reports evaluated manually, with the following macro F1 scores achieved: [1] 1d AV block = 0.729; [2] RBBB = 0.849; [3] LBBB = 0.838; [4] Sinus Bradycardia = 0.991; [5] AF = 0.993; [6] Sinus Tachycardia = 0.974. All ECG tracings in the database were also analyzed by the Glasgow 12‑lead ECG analysis program (release 28.4.1, issued on June 16th 2009), exporting the automatic diagnosis, codified by both Glasgow Diagnostic Statements [11] and Minnesota codes [12]. Correspondences between CODE classes, Glasgow Diagnostic Statements and Minnesota codes were mapped.
Digital electrocardiographs are now widely available and a large number of digital electrocardiograms (ECGs) have been recorded and stored. The present study describes the development and clinical applications of a large database of such digital ECGs, namely the CODE (Clinical Outcomes in Digital Electrocardiology) study.
ECGs obtained by the Telehealth Network of Minas Gerais, Brazil, from 2010 to 17, were organized in a structured database. A hierarchical free-text machine learning algorithm recognized specific ECG diagnoses from cardiologist reports. The Glasgow ECG Analysis Program provided Minnesota Codes and automatic diagnostic statements. The presence of a specific ECG abnormality was considered when both automatic and medical diagnosis were concordant; cases of discordance were decided using heuristisc rules and manual review. The ECG database was linked to the national mortality information system using probabilistic linkage methods.
From 2,470,424 ECGs, 1,773,689 patients were identified. After excluding the ECGs with technical problems and patients <16 years-old, 1,558,415 patients were studied. High performance measures were obtained using an end-to-end deep neural network trained to detect 6 types of ECG abnormalities, with F1 scores >80% and specificity >99% in an independent test dataset. We also evaluated the risk of mortality associated with the presence of atrial fibrillation (AF), which showed that AF was a strong predictor of cardiovascular mortality and mortality for all causes, with increased risk in women.
In conclusion, a large database that comprises all ECGs performed by a large telehealth network can be useful for further developments in the field of digital electrocardiography, clinical cardiology and cardiovascular epidemiology.
Model for classification of heart failure severity in patients with hypertrophic cardiomyopathy using a deep neural network algorithm with a 12-lead electrocardiogram
2023, Open Heart
Detection of Arterial Hypertension Through Electrocardiograms
2022, Computing in Cardiology
Association between Atrioventricular Block and Mortality in Primary Care Patients: The CODE Study
2022, Arquivos Brasileiros de Cardiologia

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View full text

Automated serial ECG comparison based on the Minnesota code

Abstract

Am Heart

Am J Cardiol

Lancet

Myocardial infarction

Cardiac infarction score: an electrocardiographic coding scheme for ischaemic heart disease

Circulation

The electrocardiogram in population studies: a classification system

Circulation

Use and abuse of electrocardiographic classification systems in epidemiologic studies

Eur J Cardiol

Part I. Reduction in incidence of coronary heart disease to cholesterol lowering

JAMA

Helsinki heart study: primary prevention trial with gemfibrozil in middle-aged men with dyslipidemia: safety of treatment, changes in risk factors and incidence of coronary heart disease

N Engl J Med

The Dalhousie program: a comprehensive analysis program for rest and exercise electrocardiograms

A computer program for classification of ECGs according to the Minnesota code