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Purpose. Morphological electrocardiographic and vectorcardiographic features have been used in the detection of cardiovascular diseases and prediction of the risk of cardiac death for a long time. The objective of the current study was to investigate the morphological electrocardiographic modifications in the presence of cardiovascular diseases and diabetes mellitus in an elderly male population, most of them with multiple comorbidities. Methods. A database of ECG recordings from the Italian Longitudinal Study on Aging (ILSA-CNR), created to evaluate physiological and pathological modifications related to aging, was considered. The study examined a group of 1109 males with full clinical documentation aged 65–84 years. A healthy control group (219 individuals) was compared to the groups of diabetes mellitus (130), angina pectoris (99), hypertension (607), myocardial infarction (160), arrhythmia (386), congestive heart failure (73), and peripheral artery disease (95). Twenty-one electrocardiographic features were explored, and the effects of cardiovascular diseases and diabetes on these parameters were analyzed. The three-years mortality index was derived and analyzed. Results and Conclusions. Myocardial infarction and arrhythmia were the diagnostic groups that showed a significant deviation of 11 electrocardiographic parameters compared to the healthy group, followed by hypertension and congestive heart failure (10), angina pectoris (9), and diabetes mellitus and peripheral artery disease (8). In particular, a set of three parameters (QRS and T roundness and principal component analysis of T wave) increased significantly, whereas four parameters (T amplitude, T maximal vector, T vector ratio, and T wave area dispersion) decreased significantly in all cardiovascular diseases and diabetes mellitus with respect to healthy group. The QRS parameters show a more specific discrimination with a single disease or a group of diseases, whereas the T-wave features seems to be influenced by all the pathological conditions. The present investigation of disease-related electrocardiographic parameters changes can be used in assessing the risk analysis of cardiac death, and gender medicine. Full article

Computerized electrocardiography (ECG) has been widely used and allows linkage to electronic medical records. The present study describes the development and clinical applications of an electronic cohort derived from a digital ECG database obtained by the Telehealth Network of Minas Gerais, Brazil, for the period 2010–2017, linked to the mortality data from the national information system, the Clinical Outcomes in Digital Electrocardiography (CODE) dataset. From 2,470,424 ECGs, 1,773,689 patients were identified. A total of 1,666,778 (94%) underwent a valid ECG recording for the period 2010 to 2017, with 1,558,421 patients over 16 years old; 40.2% were men, with a mean age of 51.7 [SD 17.6] years. During a mean follow-up of 3.7 years, the mortality rate was 3.3%. ECG abnormalities assessed were: atrial fibrillation (AF), right bundle branch block (RBBB), left bundle branch block (LBBB), atrioventricular block (AVB), and ventricular pre-excitation. Most ECG abnormalities (AF: Hazard ratio [HR] 2.10; 95% CI 2.03–2.17; RBBB: HR 1.32; 95%CI 1.27–1.36; LBBB: HR 1.69; 95% CI 1.62–1.76; first degree AVB: Relative survival [RS]: 0.76; 95% CI0.71–0.81; 2:1 AVB: RS 0.21 95% CI0.09–0.52; and RS 0.36; third degree AVB: 95% CI 0.26–0.49) were predictors of overall mortality, except for ventricular pre-excitation (HR 1.41; 95% CI 0.56–3.57) and Mobitz I AVB (RS 0.65; 95% CI 0.34–1.24). In conclusion, a large ECG database established by a telehealth network can be a useful tool for facilitating new advances in the fields of digital electrocardiography, clinical cardiology and cardiovascular epidemiology. Full article

Ever since the first publication of the standard communication protocol for computer-assisted electrocardiography (SCP-ECG), prENV 1064, in 1993, by the European Committee for Standardization (CEN), SCP-ECG has become a leading example in health informatics, enabling open, secure, and well-documented digital data exchange at a low cost, for quick and efficient cardiovascular disease detection and management. Based on the experiences gained, since the 1970s, in computerized electrocardiology, and on the results achieved by the pioneering, international cooperative research on common standards for quantitative electrocardiography (CSE), SCP-ECG was designed, from the beginning, to empower personalized medicine, thanks to serial ECG analysis. The fundamental concept behind SCP-ECG is to convey the necessary information for ECG re-analysis, serial comparison, and interpretation, and to structure the ECG data and metadata in sections that are mostly optional in order to fit all use cases. SCP-ECG is open to the storage of the ECG signal and ECG measurement data, whatever the ECG recording modality or computation method, and can store the over-reading trails and ECG annotations, as well as any computerized or medical interpretation reports. Only the encoding syntax and the semantics of the ECG descriptors and of the diagnosis codes are standardized. We present all of the landmarks in the development and publication of SCP-ECG, from the early 1990s to the 2009 International Organization for Standardization (ISO) SCP-ECG standards, including the latest version published by CEN in 2020, which now encompasses rest and stress ECGs, Holter recordings, and protocol-based trials. Full article